scholarly journals Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

BMJ ◽  
2020 ◽  
pp. m40 ◽  
Author(s):  
Hiroshi Gotanda ◽  
Ashish K Jha ◽  
Gerald F Kominski ◽  
Yusuke Tsugawa
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
Low Income ◽  
Financial Burden ◽  
Healthcare Spending ◽  
Difference In Difference ◽  
Quasi Experimental ◽  
Premium Contributions ◽  
Medicaid Expansions ◽  
Experimental Difference

Abstract Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. Setting United States. Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. Results 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0% (95% confidence interval −38.4% to −15.8%); adjusted absolute change −$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (−29.0% (−40.5% to −15.3%); −$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change −4.7 (−7.9 to −1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

scholarly journals Community Health Centers and Access to Care Among Underserved Populations: A Synthesis Review

2019 ◽  
Vol 77 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Brendan Saloner ◽  
Adam S. Wilk ◽  
Jonathan Levin
Keyword(s):  
Access To Care ◽  
Community Health ◽  
Low Income ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Health Centers ◽  
Access Cost ◽  
Medicaid Eligibility ◽  
Quasi Experimental ◽  
Medicaid Expansions

Community health centers (CHCs) deliver affordable health services to underserved populations, especially uninsured and Medicaid enrollees. Since the early 2000s, CHCs have grown because of federal investments in CHC capacity and expansions of Medicaid eligibility. We review 24 relevant studies from 2000 to 2017 to evaluate the relationship between CHCs, policies that invest in services for low-income individuals, and access to care. Most included studies use quasi-experimental designs. Greater spending on CHCs improves access to care, especially for low-income and minority individuals. Medicaid expansions also increase CHC use. Some studies indicate that CHC investments complement Medicaid expansions to increase access cost-effectively. Further research should explore patient preferences and patterns of CHC utilization versus other sites of care and population subgroups for which expanding CHC capacity improves access to care most. Researchers should endeavor to use measures and sample definitions that facilitate comparisons with other estimates in the literature.

Effectiveness of Penalties for Lockdown Violations During the COVID-19 Pandemic in Germany

2020 ◽  
Vol 110 (12) ◽  
pp. 1844-1849 ◽  
Author(s):  
Seung Hoon Chae ◽  
Hyung Jun Park
Keyword(s):  
Time Dependent ◽  
Control Group ◽  
Difference In Difference ◽  
Robert Koch Institute ◽  
Federal States ◽  
Percentage Points ◽  
Reproduction Numbers ◽  
Quasi Experimental ◽  
Using Data ◽  
Experimental Difference

Objectives. To investigate whether the imposition of fines can mitigate the spread of COVID-19. Methods. We used quasi-experimental difference-in-difference models. On March 20, 2020, Bavaria introduced fines as high as €25 000 (US $28 186) against citizens in violation of the Bundesland’s (federal state’s) lockdown policy. Its neighboring Bundesländer (federal states), on the other hand, were slow to impose such clear restrictions. By comparing 38 Landkreise (counties) alongside Bavaria’s border from March 15 to May 11 using data from the Robert Koch Institute, we produced for each Landkreis its (1) time-dependent reproduction numbers (Rt) and (2) growth rates in confirmed cases. Results. The demographics of the Landkreise were similar enough to allow for difference-in-difference analyses. Landkreise that introduced fines on March 20 reduced the Rt by a further 0.32 (95% confidence interval [CI] = −0.46, −0.18; P < .001) and decreased the growth rate in confirmed cases by an additional 6 percentage points (95% CI = −0.11, −0.02; P = .005) compared with the control group. Conclusions. Imposing fines may slow down the spread of COVID-19. Public Health Implications. Lockdowns may work better when governments introduce penalties against those who ignore them.

scholarly journals Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States

2019 ◽  
Vol 109 ◽  
pp. 327-333 ◽  
Author(s):  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Medicaid Expansion ◽  
Access To Health ◽  
Interview Survey ◽  
Using Data ◽  
The Impact ◽  
Medicaid Expansions

This paper evaluates the impact of the Affordable Care Act Medicaid expansions four years after implementation using data from the 2010-2017 National Health Interview Survey. We find that low-income adults in states that implemented the Medicaid expansions experienced increases in insurance and Medicaid coverage and improvements in access to health care across several measures.

scholarly journals Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States

2021 ◽  
Author(s):  
Stephen Y Wang ◽  
Javier Valero‐Elizondo ◽  
Hyeon‐Ju Ali ◽  
Ambarish Pandey ◽  
Miguel Cainzos‐Achirica ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Low Income ◽  
Healthcare Costs ◽  
Financial Burden ◽  
The United States ◽  
Financial Toxicity ◽  
Insurance Premiums ◽  
Low Income Families ◽  
Healthcare Expenses

Abstract Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey (MEPS), we identified all families with ≥1 adult member with HF during 2014 – 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated two outcomes of financial toxicity: (1) high financial burden – total out‐of‐pocket healthcare expense to post‐subsistence income of >20%, and (2) catastrophic financial burden with the rate of >40% ‐ a bankrupting expense defined by the WHO. There were 788 families in MEPS with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%‐18%) of families experienced a high burden and 5% (95% CI, 3%‐6%) experienced a catastrophic burden. Among the two‐fifths of families considered low‐income, 24% (95% CI, 18%‐30%) experienced a high financial burden, while 10% (95% CI, 6%‐14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high (OR=3.9, 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR=14.2, 95% CI, 5.1–39.5) compared with middle/high income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.

scholarly journals Recent trends in the probability of high out-of-pocket medical expenses in the United States

2016 ◽  
Vol 4 ◽  
pp. 205031211666032 ◽  
Author(s):  
Katherine E Baird
Keyword(s):  
United States ◽  
Low Income ◽  
Financial Risk ◽  
Health Care Policy ◽  
Financial Burden ◽  
Household Survey ◽  
The United States ◽  
Health Condition ◽  
Nationally Representative ◽  
Out Of Pocket Expenses

Objective: This article measures the probability that out-of-pocket expenses in the United States exceed a threshold share of income. It calculates this probability separately by individuals’ health condition, income, and elderly status and estimates changes occurring in these probabilities between 2010 and 2013. Data and Method: This article uses nationally representative household survey data on 344,000 individuals. Logistic regressions estimate the probabilities that out-of-pocket expenses exceed 5% and alternatively 10% of income in the two study years. These probabilities are calculated for individuals based on their income, health status, and elderly status. Results: Despite favorable changes in both health policy and the economy, large numbers of Americans continue to be exposed to high out-of-pocket expenditures. For instance, the results indicate that in 2013 over a quarter of nonelderly low-income citizens in poor health spent 10% or more of their income on out-of-pocket expenses, and over 40% of this group spent more than 5%. Moreover, for Americans as a whole, the probability of spending in excess of 5% of income on out-of-pocket costs increased by 1.4 percentage points between 2010 and 2013, with the largest increases occurring among low-income Americans; the probability of Americans spending more than 10% of income grew from 9.3% to 9.6%, with the largest increases also occurring among the poor. Conclusion: The magnitude of out-of-pocket’s financial burden and the most recent upward trends in it underscore a need to develop good measures of the degree to which health care policy exposes individuals to financial risk, and to closely monitor the Affordable Care Act’s success in reducing Americans’ exposure to large medical bills.

scholarly journals All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

2019 ◽  
Vol 2019 (2) ◽  
pp. 1-92
Author(s):  
Craig Garthwaite ◽  
John Graves ◽  
Tal Gross ◽  
Zeynal Karaca ◽  
Victoria Marone ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Medicaid Expansions

scholarly journals Impact of non-communicable disease multimorbidity on health service use, catastrophic health expenditure and productivity loss in Indonesia: a population-based panel data analysis study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041870
Author(s):  
Tiara Marthias ◽  
Kanya Anindya ◽  
Nawi Ng ◽  
Barbara McPake ◽  
Rifat Atun ◽  
...  
Keyword(s):  
Panel Data ◽  
Health Service ◽  
Low Income ◽  
Health Expenditure ◽  
Service Use ◽  
Financial Burden ◽  
Panel Data Analysis ◽  
Productivity Loss ◽  
Catastrophic Health Expenditure ◽  
Health Service Use

ObjectivesTo examine non-communicable diseases (NCDs) multimorbidity level and its relation to households’ socioeconomic characteristics, health service use, catastrophic health expenditures and productivity loss.DesignThis study used panel data of the Indonesian Family Life Survey conducted in 2007 (Wave 4) and 2014 (Wave 5).SettingThe original sampling frame was based on 13 out of 27 provinces in 1993, representing 83% of the Indonesian population.ParticipantsWe included respondents aged 50 years and above in 2007, excluding those who did not participate in both Waves 4 and 5. The total number of participants in this study are 3678 respondents.Primary outcome measuresWe examined three main outcomes; health service use (outpatient and inpatient care), financial burden (catastrophic health expenditure) and productivity loss (labour participation, days primary activity missed, days confined in bed). We applied multilevel mixed-effects regression models to assess the associations between NCD multimorbidity and outcome variables,ResultsWomen were more likely to have NCD multimorbidity than men and the prevalence of NCD multimorbidity increased with higher socioeconomic status. NCD multimorbidity was associated with a higher number of outpatient visits (compared with those without NCD, incidence rate ratio (IRR) 4.25, 95% CI 3.33 to 5.42 for individuals with >3 NCDs) and inpatient visits (IRR 3.68, 95% CI 2.21 to 6.12 for individuals with >3 NCDs). NCD multimorbidity was also associated with a greater likelihood of experiencing catastrophic health expenditure (for >3 NCDs, adjusted OR (aOR) 1.69, 95% CI 1.02 to 2.81) and lower participation in the labour force (aOR 0.23, 95% CI 0.16 to 0.33) compared with no NCD.ConclusionsNCD multimorbidity is associated with substantial direct and indirect costs to individuals, households and the wider society. Our study highlights the importance of preparing health systems for addressing the burden of multimorbidity in low-income and middle-income countries.

Sign in / Sign up

Export Citation Format

Share Document