The Health Care Safety Net and Crowd-Out of Private Health Insurance

There is an extensive literature on the extent to which public health insurance coverage through Medicaid induces less private health insurance coverage. However, little is known about the effect of other components of the health care safety net in crowding out private coverage. We examine the effect of Medicaid and uncompensated care provided by clinics and hospitals on insurance coverage. We construct a long panel of metropolitan area and state-level data on hospital uncompensated care and free and reduced price care offered by Federally Qualified Health Centers. We match this information to individual level data on coverage from the Current Population Survey for two distinct groups: children aged 14 and under and single, childless adults aged 18 to 64. Our results provide mixed evidence on the extent of crowd-out. Hospital uncompensated care does not appear to crowd-out health insurance coverage and health center uncompensated care appears to crowd-out private coverage for adults and, in some specifications, children.

How Managed Care Affects Medicaid Utilization: A Synthetic Difference-in-Differences Zero-Inflated Count Model

We develop a synthetic difference-in-differences statistical design to apply to experimental data for adult women living in Hennepin County, Minnesota, to estimate the impact of Medicaid managed care on various modes of medical care use. Because the outcomes of interest are utilization counts with many persons using none of a particular mode of care we use count regression models that are adjusted for excessive zeros. We find no reductions in physician visits or hospital inpatient and emergency department care use, but reductions in hospital outpatient care. Simulations designed to judge the economic significance of our results suggest a program effect that is a savings of about ten percent

The Effects of Consumer-Directed Health Plans on Health Care Spending

We use unique data from an insurer that exclusively offers high-deductible, "consumer-directed" health plans to identify the effect of plan features, notably the spending account, on health care spending. Our results show that the marginal dollar in the spending account is entirely spent on outpatient and pharmacy services. In contrast, inpatient and out-of-pocket spending were not responsive to the amount in the spending account. Our results represent the first plausibly causal estimates of the components of consumer-driven health plans on health spending. The magnitudes of the effects suggest important moral hazard consequences to higher spending account levels.

Identifying the optimal spatial distribution of tracers for optical sensing of stream surface flow

River monitoring is of particular interest as a society that faces increasingly complex water management issues. Emerging technologies have contributed to opening new avenues for improving our monitoring capabilities but have also generated new challenges for the harmonised use of devices and algorithms. In this context, optical-sensing techniques for stream surface flow velocities are strongly influenced by tracer characteristics such as seeding density and their spatial distribution. Therefore, a principal research goal is the identification of how these properties affect the accuracy of such methods. To this aim, numerical simulations were performed to consider different levels of tracer clustering, particle colour (in terms of greyscale intensity), seeding density, and background noise. Two widely used image-velocimetry algorithms were adopted: (i) particle-tracking velocimetry (PTV) and (ii) particle image velocimetry (PIV). A descriptor of the seeding characteristics (based on seeding density and tracer clustering) was introduced based on a newly developed metric called the Seeding Distribution Index (SDI). This index can be approximated and used in practice as SDI = nu(0.1)/(rho/rho(c nu 1)), where nu, rho, and rho(c nu 1 )are the spatial-clustering level, the seeding density, and the reference seeding density at nu = 1, respectively. A reduction in image-velocimetry errors was systematically observed for lower values of the SDI; therefore, the optimal frame window (i.e. a subset of the video image sequence) was defined as the one that minimises the SDI. In addition to numerical analyses, a field case study on the Basento river (located in southern Italy) was considered as a proof of concept of the proposed framework. Field results corroborated numerical findings, and error reductions of about 15.9 % and 16.1 % were calculated - using PTV and PIV, respectively - by employing the optimal frame window

Structure–function relationship during the early and long-term hydration of one-part alkali-activated slag

Understanding the mechanisms controlling the early (fresh) and long-term (hardened) hydration of one-part alkali-activated slags (AAS) is key to extend their use as low CO2 substitutes for ordinary Portland cement (OPC). Their “just add water” use makes them easier and less hazardous to manipulate than the more studied two-part ones. This is due to the absence of liquid alkaline activators, which are environmentally and energy demanding. In this work, numerous experimental techniques have been linked to obtain a comprehensive physico-chemical characterization of a one-part AAS activated with Na2CO3 and Ca(OH)2 powders at several water to solid ratios (w/s). Calorimetry and pH/conductivity measurements describe the functioning of the activators immediately after contact with water. Early reactivity is characterized through in situ X-ray powder diffraction (XRPD) and small amplitude oscillatory shear (SAOS) rheology, which reveal a rapid precipitation of nanometric hydration products (nano-C-A-S-H), which results in a continuous increase in the paste cohesivity until setting. Moreover, SAOS shows that rejuvenating the paste by means of shearing (performed externally to the rheometer in this study) is enough to restore the initial cohesion (i.e., workability) for long time spans until setting occurs. The long-term hydration is characterized by ex situ XRPD on aged AAS pastes, in parallel with mechanical testing on AAS mortar. A correlation can be observed between the amount of nano-C-A-S-H and the increase in compressive strength. Overall, this formulation shows satisfactory fresh and solid properties, demonstrating suitability for low- and normal-strength applications

The Price of Palliative Care: Towards a Complete Accounting of Costs and Benefits

The costs and benefits of hospice and palliative care have recently received attention for many compelling reasons. First, the cost of medical care over a lifetime is largely expended near the end-of-life. The impending demographic bulge of aging baby boomers will only heighten concerns about costs. Second, hospice and palliative care have been offered as potential vehicles for reducing late-in-life spending. Third, palliative care has gained legitimacy as a distinct medical specialty, having as it does a characteristic philosophy, specialized skill sets, and specific service delivery needs. This philosophy of care is consistent with and, to some degree, builds on the philosophy of care that geriatrics also promotes. In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the ‘‘tip of the iceberg’’ of the potential costs and benefits. Using this framework, the authors offer guidelines for performing comprehensive cost-benefit analyses of palliative care and conclude that many of the issues beneath the surface may be substantial and deserving of closer scrutiny. Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders

The Price of Palliative Care: Towards a Complete Accounting of Costs and Benefits

The costs and benefits of hospice and palliative care have recently received attention for many compelling reasons. First, the cost of medical care over a lifetime is largely expended near the end-of-life. The impending demographic bulge of aging baby boomers will only heighten concerns about costs. Second, hospice and palliative care have been offered as potential vehicles for reducing late-in-life spending. Third, palliative care has gained legitimacy as a distinct medical specialty, having as it does a characteristic philosophy, specialized skill sets, and specific service delivery needs. This philosophy of care is consistent with and, to some degree, builds on the philosophy of care that geriatrics also promotes. In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the ‘‘tip of the iceberg’’ of the potential costs and benefits. Using this framework, the authors offer guidelines for performing comprehensive cost-benefit analyses of palliative care and conclude that many of the issues beneath the surface may be substantial and deserving of closer scrutiny. Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders

Liver biopsy in type 2 diabetes mellitus: steatohepatitis represents the sole feature of liver damage

Recent studies report a prevalence of non-alcoholic fatty liver disease (NAFLD) of between 70% and 80% in patients with metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). Nevertheless, it is not possible to differentiate between simple steatosis and nonalcoholic steatohepatitis (NASH) with non-invasive tests. The aim of this study was to differentiate between simple steatosis and NASH by liver biopsy in patients with hypertransaminasemia and MS or T2DM. Two hundred and fifteen patients with increased ALT levels and MS, and 136 patients at their first diagnosis of T2DM regardless of ALT values were consecutively admitted to a tertiary hepatology center between January 2004 and November 2014. Exclusion criteria were other causes of liver disease/ALT increase. Each patient underwent a clinical, laboratory and ultrasound evaluation, and a liver biopsy. Gender distribution, age, and body mass index were similar in the two groups of patients, whereas cholesterol levels, glycemia and blood pressure were significantly different between the two groups. The prevalence of NAFLD was 94.82% in MS patients and 100% in T2DM patients. NASH was present in 58.52% of MS patients and 96.82% of T2DM. Consequently, this study reveals that, by using liver biopsy, almost all patients with T2DM or MS have NAFLD, which in patients with T2DM means NASH. Importantly, it suggests that NASH may be one of the early complications of T2DM due to its pathophysiological correlation with insulin resistance

Air pollution and related respiratory diseases: the experience of a Local Health Authority in Liguria (North Italy)

Background. Numerous epidemiological studies have shown that air pollution due to both industry and heavy traffic has short- and long-term effects on health. The study was carried out in an industrial area with heavy urban and motorway traffic in the Province of Genoa (Italy). Methods. The study was carried out from June 2005 to July 2008. An epidemiologic study was conducted by monitoring an elementary/ middle school situated in an area of recent industrial development and an elementary/middle school located in an area free from sources of industrial pollution. Furthermore, we conducted an investigation of workers in commercial premises situated in one area of heavy vehicular traffic. In the study areas, environmental monitoring campaigns were carried out in order to determine the association between indoor and outdoor pollution and respiratory disorders. Results and discussion. The study did not bring to light any specific health problems attributable with certainty to industrial emissions. The impact of pollution caused by motor traffic proved to be greater than that due to industrial emissions. More exhaustive sampling campaigns should be implemented in order to quantify the effects of specific sources of emissions and to correlate these sources with pollutants (industry, urban traffic, motorway traffic)

Nematic liquid crystal reorientation around multi-walled carbon nanotubes mapped via Raman microscopy

We have studied the formation of topological defects in liquid crystal (LC) matrices induced by multiwalled carbon nanotubes (MWCNTs) and external electric fields. The defects are ascribable to a distortion of the LC molecular director in proximity of the MWCNT surface. The system is analyzed macroscopically using spectroscopic variable angle ellipsometry. Concurrently, confocal micro-Raman spectroscopy is used to study the system state at the microscale. This allows to acquire a three-dimensional, spatially-resolved map of the topological defect, determining scale length variations and orientation topography of the LC molecules around the MWCNT