Grantee Publication

CONTEXT: Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. OBJECTIVE: We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism.

BACKGROUND: Many internal medicine physicians report both primary and secondary specialties in the American Medical Association (AMA) Physician Masterfile. Usually, those represent combinations of general internal medicine and medical subspecialty practice. Whether reported specialty combinations can be used to assess the contribution of specialists to primary care is unknown.

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State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on government spending and health care quality is difficult if, as is often the case, recipients have the option to enroll in a plan. To estimate the average effect of HMO enrollment, this paper exploits county-level mandates introduced during the last several years in the state of California that required most Medicaid recipients to enroll in a managed care plan.

OBJECTIVE--To examine the status of trauma system development and key structural and operational characteristics of these systems. DESIGN AND SETTING--National survey of trauma systems with enabling state statute, regulation, or executive orders and for which designated trauma centers were present. PARTICIPANTS--Trauma system administrators and directors of 37 state and regional organizations that had legal authority to administer trauma systems, which represented a response rate of 90.2%. MAIN OUTCOME MEASURES--Trauma system components that had been implemented or were under development.

Most current strategies to improve quality and efficiency in health-care delivery focus on measuring and improving physician practice. A new “second generation” of physician profiling—episode-based profiling—is moving beyond legacy “first-generation” physician profiles based on population health and preventive services measures.

State risk pools exist primarily for persons who want to buy health insurance, but are either medically uninsurable or are only able to find a policy at considerably higher cost than the rate for a standard insured person. While some people enroll in state risk pools for extended periods, many enroll only for a limited time. This study analyzes duration of enrollment in eight state risk pools using data from 1988 through 1991. A discrete time hazard model provides estimates of the relationship between voluntary disenrollment and enrollee and plan characteristics.

OBJECTIVE: To measure the level of satisfaction with care by Medicaid-eligible patients before and after implementation of a mandatory managed care plan known as TennCare. STUDY DESIGN: We used multivariate logit analysis of survey data to calculate the effects of TennCare on patient satisfaction for TennCare patients compared to those on traditional Medicaid, using North Carolina as a control state.

Our analysis sought to characterize the capacity of states to identify and track disparities in health across subgroups of the population (like race/ethnicity), using the leading health indicators (LHIs) from Healthy People 2010 (HP2010) as the basis for our work. Assessing health status is one of the three core functions of public health (along with formulating public policies and assuring that all populations have access to appropriate and cost-effective care).

This paper estimated the effects of tort law and insurer investment returns on physician malpractice insurance premiums. Data were collected on tort law from 1991 through 2004, and multivariate regression models, including fixed effects for state and year, were used to estimate the effect of changes in tort law on medical malpractice premiums. The premium consequences of national policy changes were simulated.