Grantee Publication

Consumer-driven health plans (CDHPs) are built on the assumption that with increased cost sharing consumers will select cost-effective evidence-based care. In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents. The analysis uses a schema for categorizing claims data into high-priority (evidence-based care) and low-priority (limited or no evidence-based care) utilization.

Objective: We sought to explore how mantatory Medicaid managed care programs affect access to care and use among full-year Medicaid beneficiaries not receiving SSI or Medicare.

This study assesses the determinants of conversions in hospital ownership from 1986 through 1996. To place such changes in context, we also analyze causes of hospital mergers and closures, which are often alternatives to hospital ownership conversion. A consistent result from our analysis is that an important antecedent of ownership conversions is a low profit margin. Conversions from private nonprofit or government ownership to for-profit status are preceded by chronically low margins and high debt-to-asset ratios.

Objectives: Healthy People 2010 identifies the elimination of health disparities as a critical national goal. The article analyzes the availability of state and local data to support this work.

Methods: We assessed data availability for the 10 leading health indicators (LHIs), comprising a set of 26 measures. Our analysis is based on a mid-2007 review of federal and state Web sites.

Many small businesses finance health coverage through multiple employer arrangements, also called association health plans (AHPs) and MEWAs.  However, in the past 30 years, many such groups have become insolvent.  Since 2000, four AHPs left 66,000 people without health insurance and with an estimated $48 million in medical claims. 

This study looks into the "black box" of hospital ownership conversion in a "natural experiment." The researchers posed two competing theories about how conversion might influence management practices. Results support complexity theory and not threat-rigidity theory. As predicted from complexity theory, MDs and RNs had greater levels of participation and influence over final decision choices in converted hospitals than in nonconverted hospitals.

This paper is the first to compare health care purchasing in the retail versus other sectors of the Fortune 500. Employing millions of low-wage workers, the retail sector is the largest employer of uninsured workers in the economy. We found that retail companies are using the same competitive bidding process that other companies use to obtain a given level of coverage for the lowest possible cost. However, they are more price oriented than other Fortune 500 companies are. The most striking disparity lies in the nearly fivefold difference in offer rates for health care coverage.

It is well known that caring for a sick child creates an economic burden for families.  Less is known about how this burden differs by condition.  We found that caring for a child with mental health care needs affects financial well-being more than caring for a child with other special health care needs.  Parents of children with mental health disorders are also more likely than other parents to cut work hours, to quit work, and to spend more time arranging their child's care.  Equalizing private insurance coverage and providing case support could play a vital role in ea

Using data from the 1999 National Survey of America's Families, this brief provides details of uninsurance among low-income workers in 13 states. States with relatively high rates of uninsurance among low-income workers tend to have greater than average proportions of Hispanics (both citizens and noncitizens); workers in fair or poor health; and workers in agriculture and construction. The research did not find differences across states in uninsurance among low-income workers by employer size.

Risk contracting by states for coverage of previously uninsured populations has been hampered by uncertainty regarding likely claims experience. This study reports on the utilization experience of two state programs offering subsidized coverage in commercial managed care organizations to low-income and previously uninsured people. Program participants used services similarly to people enrolled through large employer benefit plans. There was no evidence of pent-up demand or an unusual level of chronic illness.