The Magnitude and Nature of Risk Selection in Employer-Sponsored Health Plans

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data set of enrollees in employer-sponsored health plans. We find that people who switched from a non-HMO to an HMO plan used 11 percent fewer medical services in the period prior to switching than people who remained in the non-HMO plan, and that this relatively low use persists once they enroll in an HMO. Furthermore, people who switch from an HMO to a non-HMO plan used 18 percent more medical services in the period prior to switching than those who remained in an HMO plan. HMOs would most likely continue to experience favorable risk selection if employers adjusted health plan payments based on enrollees' gender and age because the selection appears to occur based on enrollee characteristics that are difficult to observe such as preferences for medical care and health status.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans

Physicians and Advanced Practitioners Specializing in Nursing Home Care, 2012-2015

The number of clinicians specializing in nursing home care increased by 33.7% from 2012 to 2015, although nursing home specialists made up only 21% of nursing home clinicians in 2015. Most of these specialists were advanced practitioners (physician assistants and nurse practitioners) delivering post-acute care. The change in number of nursing home specialists varied significantly by geographic region

The Pay-Off on Nursing Home Report Cards

For the past decade, policymakers have used public reporting of quality measures as a strategy to improve quality in nursing homes. In theory, public reporting might improve overall quality in two ways: first, if consumers choose nursing homes with better performance, and second, if public reporting encourages nursing homes to improve their performance. Has public reporting had its intended effects? Does improving quality give nursing homes a competitive advantage in the marketplace, thereby improving their bottom line? This Issue Brief summarizes a series of studies that assess the impact of public reporting on nursing home quality and on the financial performance of these facilities

The Health Effects of Medicare for the Near-Elderly Uninsured

We study how the trajectory of health for the near-elderly uninsured changes upon enrolling into Medicare at the age of 65. We find that Medicare increases the probability of the previously uninsured having excellent or very good health, decreases their probability of being in good health, and has no discernable effects at lower health levels. Surprisingly, we found Medicare had a similar effect on health for the previously insured. This suggests that Medicare helps the relatively healthy 65 year olds, but does little for those who are already in declining health once they reach the age of 65. The improvement in health between the uninsured and insured were not statistically different from each other. The stability of insurance coverage afforded by Medicare may be the source of the health benefit suggesting that universal coverage at other ages may have similar health effects.

Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes

A nursing home report card that converted 12 measures of quality into a simple 5-star system significantly affected consumer demand for low- and high-scoring facilities. One-star facilities typically lost 8 percent of their market share and 5-star facilities gained more than 6 percent of their market share. These results support the use of summary measures in report cards

Physician Consolidation and the Spread of Accountable Care Organizations

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger

Infección por Rhodococcus equi luego de cirugía de reducción mamaria en huésped inmunocompetente

The majority of infections caused by R. equi occur in hosts with some degree of cell-mediated immunodeficiency. Immunocompetent individuals are infrequently affected and usually present with localized disease. Infections of the skin or related structures are uncommon and are usually related to environmental contamination. The microbiology laboratory plays a key role in the identification of the organism since it may be mistaken for common skin flora. We describe a 31 year-old woman without medical problems who presented nine weeks after breast reduction with right breast cellulitis and purulent drainage from the surgical wound. She underwent incision and drainage, and cultures of the wound yielded Rhodococcus equi. The patient completed six weeks of antimicrobial therapy with moxifloxacin and rifampin with complete resolution.La mayoría de las infecciones causadas por Rhodococcus equi ocurren en huéspedes con algún grado de inmunodeficiencia celular. Los individuos inmunocompetentes son afectados con baja frecuencia y suelen presentarse con enfermedad localizada. Las infecciones de la piel o partes blandas son poco frecuentes y están usualmente relacionadas con contaminación ambiental. El laboratorio de microbiología juega un papel clave en la identificación del organismo, ya que este puede confundirse con flora normal de la piel. Se describe una mujer de 31 años sin problemas médicos que consultó nueve semanas después de haber sido sometida a cirugía de reducción mamaria, con celulitis del seno derecho y drenaje purulento de la herida quirúrgica. Se practicó incisión y drenaje quirúrgico y los cultivos de la herida demostraron R. equi. La paciente recibió seis semanas de tratamiento antimicrobiano con moxifloxacina y rifampicina demostrando resolución completa

Shrinking Suburbs in a Time of Crisis

The Routledge Companion to the Suburbs provides one of the most comprehensive examinations available to date of the suburbs around the world. International in scope and interdisciplinary in nature, this volume will serve as the definitive reference for scholars and students of the suburbs. This volume brings together the leading scholars of the suburbs researching in different parts of the world to better understand how and why suburbs and their communities grow, decline, and regenerate. The volume sets out four goals: 1) to provide a synthesis and critical appraisal of the historical and current state of understanding about the development of suburbs in the world; 2) to provide a forum for a comprehensive examination into the conceptual, theoretical, spatial, and empirical discontents of suburbanization; 3) to engage in a scholarly conversation about the transformation of suburbs that is interdisciplinary in nature and bridges the divide between the Global North and the Global South; and 4) to reflect on the implications of the socioeconomic, cultural, and political transformations of the suburbs for policymakers and planners. The Routledge Companion to the Suburbs is composed of original, scholarly contributions from the leading scholars of the study of how and why suburbs grow, decline, and transform. Special attention is paid to the global nature of suburbanization and its regional variations, with a focus on comparative analysis of suburbs through regions across the world in the Global North and the Global South. Articulated in a common voice, the volume is integrated by the very nature of the concept of a suburb as the unit of analysis, offering multidisciplinary perspectives from the fields of economics, geography, planning, political science, sociology, and urban studies.https://scholarworks.wm.edu/asbookchapters/1069/thumbnail.jp

Physicians’ Participation in ACOs is Lower in Places With Vulnerable Populations Than in More Affluent Communities

In 2013, physician participation in accountable care organizations (ACOs) was inversely related to the percentage of the local population that was black, living in poverty, uninsured, or disabled or that had less than a high school education. This risks exacerbating disparities in the quality of care received by these vulnerable populations