This paper explores the effects of public health insurance expansions on hospitals’ decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals’ decisions to adopt neonatal intensive care units NICUs. While the Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. This leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital’s incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. This finding is consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by providing suggestive evidence on the health impacts of this deceleration of NICU diffusion, and by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act.
The Effect of Health Insurance on Near-Elderly Health and Mortality by Bernard S. Black, José-Antonio Espín-Sánchez, Eric French, Kate Litvak :: SSRNMay 13, 2014
We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly initial age 50-61 over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies.
The Annals of Internal Medicine study, using a rigorous methodology, tells us something that actually isn’t very surprising: that expanding coverage using private-sector health insurance improves health outcomes. The very same medical literature that overwhelmingly highlights Medicaid’s poor outcomes also highlights the substantial benefits of private health insurance.
This is cause for serious concern. Not only does the change lend credence to a discredited approach to fighting obesity, but it in effect allows companies to punish their employees for pre-existing conditions, something that Obamacare was designed to avoid.
Worse that being simply ineffective, financial penalties for obesity have significant negative effects. They erode trust between employers and employees, prompting some workers to quit or suffer the genuine fear that the release of private health data will endanger their future employability.
These penalties also discriminate against the poor — many of whom live in neighborhoods with limited access to nutritional foods but plenty of cheap junk food available – and against people with mobility problems who are more likely to be obese. Large controlled studies show that increasing health care charges actually steers people away from essential medical care, exacerbating high blood pressure, worsening vision, and increasing mortality by 10% among low income people with chronic diseases.
45,000 People Die From Lack Of Insurance Because Michael Hiltzik Of The L.A. Times Says So – Amy Ridenour’s National Center Blog – A Conservative BlogMarch 21, 2014
Michael Hiltzik is a business columnist for the Los Angeles Times who has spent a good deal of the last few months blogging about ObamaCare. I noticed that he recently used the discredited statistic that “45,000 Americans die annually because they lack insurance.”
That statistic came from this study entitled “Health Insurance and Mortality in US Adults”—henceforth the “Wilper-2009 study” after the lead author. The Wilper-2009 study examined the insurance status of a group of people in 1993 and then checked their mortality in 2001. The researchers found a higher death rate among those who where uninsured in 1993 and from that computed that 45,000 statistic.
The big flaw, as I pointed out, is “the authors had no idea how many people uninsured in 1993 subsequently acquired health insurance. Someone who was uninsured in 1993, got insurance in, say, 1996, and then died in 2000—well, it would be pretty hard to attribute his death to being uninsured, wouldn’t it? “
The growing bureaucratization of medicine presents a serious threat to physicians’ ability to provide quality patient care. Whether through big government or mega hospital systems, innovation and detailed attention to the needs of individual patients will suffer.
The pain will be especially acute for independent practices specializing in primary care. They operate with the narrowest margins and have the fewest resources to adjust to the mountain of new regulatory demands being imposed on them.
Health-policy experts often talk up the notion of a “patient-center medical home”—in which a medical practice actively manages patients’ chronic conditions to improve their health and avoid hospitalizations—as the ideal model for transforming the U.S. health-care system.
But a study of one of the earliest and largest medical-home pilots found that after three years, patients’ health improved in only 1 of 11 measures. There was no change in hospital or emergency-room use, and no significant cost savings.
“There are folks who believe the medical home is a proven intervention that doesn’t even need to be tested or refined. Our findings will hopefully change those views,” said Mark W. Friedberg, a researcher at RAND Corp. and lead author of the study, published Tuesday in the Journal of the American Medical Association.
Context: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.
Methods: We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.
Findings: The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.
Conclusions: Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.
According to a recent study, severely injured patients are less likely to be transferred to a trauma center if they have health insurance.
Researchers from the Stanford University of Medicine found that patients with insurance are less likely to get the best care than those who do not have insurance. They found that insured patients taken to non-trauma hospitals were 13 to 15 percent less likely to be transferred to trauma centers than uninsured ones.
Dr. Held talks to Neil Cavuto about why she sent a termination letter to Aetna to protect her patients from ObamaCare