scholarly journals The Effects of State Medicaid Expansions for Working-Age Adults on Senior Medicare Beneficiaries

2017 ◽  
Vol 9 (3) ◽  
pp. 408-438 ◽  
Author(s):  
Melissa McInerney ◽  
Jennifer M. Mellor ◽  
Lindsay M. Sabik
Keyword(s):  
Healthcare Spending ◽  
Spillover Effects ◽  
Medicare Beneficiaries ◽  
Medicare Current Beneficiary Survey ◽  
Adverse Health Effects ◽  
Dual Eligibles ◽  
Working Age ◽  
Using Data ◽  
Medicaid Expansions ◽  
Medicare Spending

Do Medicaid expansions to working-age adults affect healthcare spending and utilization among older Medicare beneficiaries? Although economic theory provides conflicting predictions about the presence and direction of such spillover effects, it does identify circumstances when spillovers can reduce Medicare spending. Using data on Medicaid expansions during the 2000s and microdata from the Medicare Current Beneficiary Survey, we find that a 1 percentage point rise in the share of working-age adults eligible for Medicaid has modest effects on the average Medicare beneficiary's spending, but reduces average spending by $477 among dual eligibles. Importantly, we find no evidence of adverse health effects. (JEL G22, H75, I12, I13, I18, I38, J14)

scholarly journals High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017

2021 ◽  
Author(s):  
Joohyun Park ◽  
Ping Zhang ◽  
Yu Wang ◽  
Xilin Zhou ◽  
Kevin A. Look ◽  
...  
Keyword(s):  
Health Care Cost ◽  
Medicare Beneficiaries ◽  
Joinpoint Regression ◽  
Medicare Current Beneficiary Survey ◽  
The Past ◽  
Race Ethnicity ◽  
Using Data ◽  
Design And Methods ◽  
Increasing Trends ◽  
Income Quartile

<b>Objective</b> <p>We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries ages 65 years or older with diabetes overall, and by income level, by race/ethnicity, and compared to beneficiaries without diabetes. </p> <p><b>Research Design and Methods </b></p> <p>Using data from the 1999−2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.</p> <p><b>Results </b></p> <p>Total OOP costs were $3,609 to $5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57% to 72% at the 10% income threshold and 29% to 41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25−50% income quartiles. Non-Hispanic whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, <i>P</i> <0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, <i>P </i><0.01). </p> <p><b>Conclusions</b></p> Over the past 2 decades, Medicare beneficiaries ages 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.

scholarly journals High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017

2021 ◽  
Author(s):  
Joohyun Park ◽  
Ping Zhang ◽  
Yu Wang ◽  
Xilin Zhou ◽  
Kevin A. Look ◽  
...  
Keyword(s):  
Health Care Cost ◽  
Medicare Beneficiaries ◽  
Joinpoint Regression ◽  
Medicare Current Beneficiary Survey ◽  
The Past ◽  
Race Ethnicity ◽  
Using Data ◽  
Design And Methods ◽  
Increasing Trends ◽  
Income Quartile

<b>Objective</b> <p>We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries ages 65 years or older with diabetes overall, and by income level, by race/ethnicity, and compared to beneficiaries without diabetes. </p> <p><b>Research Design and Methods </b></p> <p>Using data from the 1999−2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.</p> <p><b>Results </b></p> <p>Total OOP costs were $3,609 to $5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57% to 72% at the 10% income threshold and 29% to 41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25−50% income quartiles. Non-Hispanic whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, <i>P</i> <0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, <i>P </i><0.01). </p> <p><b>Conclusions</b></p> Over the past 2 decades, Medicare beneficiaries ages 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.

scholarly journals The effects of physical restructuring on the socioeconomic status of neighbourhoods: Selective migration and upgrading

Urban Studies ◽  
2018 ◽  
Vol 56 (8) ◽  
pp. 1647-1663
Author(s):  
Merle Zwiers ◽  
Maarten van Ham ◽  
Reinout Kleinhans
Keyword(s):  
Large Scale ◽  
Spillover Effects ◽  
High Income ◽  
Direct Effects ◽  
Urban Restructuring ◽  
Deprived Neighbourhoods ◽  
New Construction ◽  
Using Data ◽  
Main Instrument ◽  
Dutch Cities

In the last few decades, many governments have implemented urban restructuring programmes with the main goal of combating a variety of socioeconomic problems in deprived neighbourhoods. The main instrument of restructuring has been housing diversification and tenure mixing. The demolition of low-quality (social) housing and the construction of owner-occupied or private rented dwellings was expected to change the population composition of deprived neighbourhoods through the in-migration of middle- and high-income households. Many studies have been critical with regard to the success of such policies in actually upgrading neighbourhoods. Using data from the 31 largest Dutch cities for the 1999 to 2013 period, this study contributes to the literature by investigating the effects of large-scale demolition and new construction on neighbourhood income developments on a low spatial scale. We use propensity score matching to isolate the direct effects of policy by comparing restructured neighbourhoods with a set of control neighbourhoods with low demolition rates, but with similar socioeconomic characteristics. The results indicate that large-scale demolition leads to socioeconomic upgrading of deprived neighbourhoods as a result of attracting and maintaining middle- and high-income households. We find no evidence of spillover effects to nearby neighbourhoods, suggesting that physical restructuring only has very local effects.

scholarly journals Carbon Productivity and Mitigation: Evidence from Industrial Development and Urbanization in the Central and Western Regions of China

2021 ◽  
Vol 13 (16) ◽  
pp. 9014
Author(s):  
Yongjiao Wu ◽  
Huazhu Zheng ◽  
Yu Li ◽  
Claudio O. Delang ◽  
Jiao Qian
Keyword(s):  
Carbon Emissions ◽  
Industrial Development ◽  
Industrial Structure ◽  
Spillover Effects ◽  
Spatial Lag Model ◽  
Workforce Allocation ◽  
Lag Model ◽  
Using Data ◽  
Shape Curve ◽  
Carbon Productivity

This paper investigates carbon productivity (CP) from the perspectives of industrial development and urbanization to mitigate carbon emissions. We propose a hybrid model that includes a spatial lag model (SLM) and a fixed regional panel model using data from the 17 provinces in the central and western regions of China from 2000 to 2018. The results show that the slowly increasing CP has significant spatial spillover effects, with High–High (H–H) and Low–Low (L–L) spatial distributions in the central and western regions of China. In addition, industrial development and urbanization in the study area play different roles in CP, while economic urbanization and industrial fixed investment negatively affect CP, and population urbanization affects CP along a U-shape curve. Importantly, the results show that the patterns of industrial development and urbanization that influence CP are homogenous and mutually imitated in the 17 studied provinces. Furthermore, disparities in CP between regions are due to industrial workforce allocation (TL), but TL has been inefficient; industrial structure upgrades are slowly improving conditions. Therefore, the findings suggest that, in the short term, policymakers in China should implement industrial development policies that reduce carbon emissions in the western and central regions by focusing on improving industrial workforce allocation.

Abstract 2707: The Magnitude of Health Care Resource Utilization by Medicare Beneficiaries with Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert L Page ◽  
Kara B Strongin ◽  
Roger M Mills ◽  
Christopher Hogan ◽  
JoAnn Lindenfeld
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
The United States ◽  
Hospital Inpatient ◽  
Medicare Beneficiaries ◽  
Data Set ◽  
Physician Visits ◽  
Hospital Outpatient ◽  
Co Morbidity ◽  
Medicare Spending

Introduction: By 2010, the number of individuals ≥ 65 years with a heart failure (HF) diagnosis should increase by an additional 700,000. As the financial burden of HF is expected to substantially increase, we examined health care expenditures of Medicare beneficiaries with HF to estimate the current healthcare costs and resource allocation. Methods: An analysis of 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. The cohort was defined by the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model which requires one HF diagnosis from a physician or hospital outpatient department/inpatient bill. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. Results: Based on inclusion criteria, 260,076 beneficiaries were identified. Beneficiaries with HF accounted for 13% of the total beneficiary population and 37% of all Medicare spending. Reimbursement for hospital inpatient admissions, physician visits, and hospital outpatient visits accounted for $12,556; $5,875; and $2,753 per-capita, respectively. In one year, 22% of all beneficiaries required hospitalization compared to 59% of beneficiaries with HF. Thirty-one percent of beneficiaries with HF had ≥ 2 inpatient admissions. Twenty-four percent of all hospital discharges were for HF, either as a principal diagnosis or co-morbidity, accounting for $30.4 billion. On average, 8.3 different outpatient and inpatient providers ordered services for a single beneficiary. Beneficiaries with at least two prior HF hospitalizations within the index period had on average 3.04 physician visits every three months. Only 26% of these visits were conducted by a cardiologist. Conclusion : Medicare beneficiaries with HF impose a tremendous burden on Medicare, consisting of over one-third of Medicare spending. It will be important to determine how much of this burden is due to HF and how much to comorbid conditions. Development of specialized Medicare HF Management Programs, also providing comprehensive care for co-morbidities, could curtail these admissions and potentially reduce costs.

scholarly journals Perceived Consumer Effectiveness as A Trigger of Behavioral Spillover Effects: A path towards Recycling

2020 ◽  
Vol 12 (11) ◽  
pp. 4348 ◽  
Author(s):  
Claudia Arias ◽  
Carlos A. Trujillo
Keyword(s):  
Environmental Behavior ◽  
Sustainable Consumption ◽  
Spillover Effects ◽  
Situational Factors ◽  
Mediation Model ◽  
Starting Point ◽  
Perceived Consumer Effectiveness ◽  
Using Data ◽  
The Relationship ◽  
Level Of Effort

Increasing and promoting recycling is crucial to achieving sustainable consumption. However, this is a complex task that involves the interplay of beliefs, knowledge and situational factors in ways not yet understood. This study examines a spill-over model in which perceived consumer effectiveness influences the adoption of an easy task (carrying reusable shopping bags) and that, in turn, influences recycling. Using data from a national survey with a representative sample of 1286 respondents in Colombia, we test a hypothesized path using a mediation model. Our results suggest that the relationship between perceived consumer effectiveness and recycling is mediated by the use of reusable shopping bags. Thus, once the adoption of simple pro-environmental behavior is triggered by pro-environmental beliefs, spillover effects may ensue to favor the adoption of recycling behavior. This suggests that individuals may adopt pro-environmental behavior in stages or levels. Therefore, focusing on behaviors that require less effort (e.g., reducing/reusing) could be a starting point when it comes to encouraging the adoption of other behaviors that demand a greater level of effort such as recycling. This study suggests that attitudinal variables can be the starting point of spill-over effects.

scholarly journals Opioid-Related Diagnoses and Concurrent Claims for HIV, HBV, or HCV among Medicare Beneficiaries, United States, 2015

2019 ◽  
Vol 8 (11) ◽  
pp. 1768 ◽  
Author(s):  
Man-Huei Chang ◽  
Ramal Moonesinghe ◽  
Lyna Z. Schieber ◽  
Benedict I. Truman
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Opioid Overdose ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Cross Sectional ◽  
Using Data ◽  
Chronic Hcv ◽  
Demographic Attributes

Unsterile opioid injection increases risk for infection transmission, including HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV). We assess prevalence of and risk factors associated with opioid overdose and infections with HIV, HBV, or HCV among Medicare beneficiaries with opioid-related fee-for-service claims during 2015. We conducted a cross-sectional analysis to estimate claims for opioid use and overdose and HIV, HBV, or HCV infections, using data from US Medicare fee-for-service claims. Beneficiaries with opioid-related claims had increased odds for HIV (2.3; 95% confidence interval (CI), 2.3–2.4), acute HBV (6.7; 95% CI, 6.3–7.1), chronic HBV (5.0; 95% CI, 4.7–5.4), acute HCV (9.6; 95% CI, 9.2–10.0), and chronic HCV (8.9; 95% CI, 8.7–9.1). Beneficiaries with opioid-related claims and for HIV, HBV, or HCV infection, respectively, had a 1.1–1.9-fold odds for having a claim for opioid overdose. Independent risk factors for opioid overdose and each selected infection outcome included age, sex, race/ethnicity, region, and residence in a high-vulnerability county. Having opioid-related claims and selected demographic attributes were independent, significant risk factors for having HIV, HBV, or HCV claims among US Medicare beneficiaries. These results might help guide interventions intended to reduce incidences of HIV, HCV, and HBV infections among beneficiaries with opioid-related claims.

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.

scholarly journals Impact of Travel Time on Health Care Costs and Resource Use by Phase of Care for Older Patients With Cancer

2019 ◽  
Vol 37 (22) ◽  
pp. 1935-1945 ◽  
Author(s):  
Gabrielle B. Rocque ◽  
Courtney P. Williams ◽  
Harold D. Miller ◽  
Andres Azuero ◽  
Stephanie B. Wheeler ◽  
...  
Keyword(s):  
Health Care ◽  
Travel Time ◽  
Health Care Costs ◽  
Resource Use ◽  
Cancer Care ◽  
Medicare Beneficiaries ◽  
Patient Cost ◽  
Hospitalization Rates ◽  
Care Costs ◽  
Medicare Spending

PURPOSEMany community cancer clinics closed between 2008 and 2016, with additional closings potentially expected. Limited data exist on the impact of travel time on health care costs and resource use.METHODSThis retrospective cohort study (2012 to 2015) evaluated travel time to cancer care site for Medicare beneficiaries age 65 years or older in the southeastern United States. The primary outcome was Medicare spending by phase of care (ie, initial, survivorship, end of life). Secondary outcomes included patient cost responsibility and resource use measured by hospitalization rates, intensive care unit admissions, and chemotherapy-related hospitalization rates. Hierarchical linear models with patients clustered within cancer care site (CCS) were used to determine the effects of travel time on average monthly phase-specific Medicare spending and patient cost responsibility.RESULTSMedian travel time was 32 (interquartile range, 18-59) minutes for the 23,382 included Medicare beneficiaries, with 24% of patients traveling longer than 1 hour to their CCS. During the initial phase of care, Medicare spending was 14% higher and patient cost responsibility was 10% higher for patients traveling longer than 1 hour than those traveling 30 minutes or less. Hospitalization rates were 4% to 13% higher for patients traveling longer than 1 hour versus 30 minutes or less in the initial (61 v 54), survivorship (27 v 26), and end-of-life (310 v 286) phases of care (all P < .05). Most patients traveling longer than 1 hour were hospitalized at a local hospital rather than at their CCS, whereas the converse was true for patients traveling 30 minutes or less.CONCLUSIONAs health care locations close, patients living farther from treatment sites may experience more limited access to care, and health care spending could increase for patients and Medicare.

scholarly journals The Educational System and the Ethnic Skills Gap among the Working-Age Population: An Analysis of 16 Western Immigration Countries

2020 ◽  
Vol 6 ◽  
pp. 237802312092571
Author(s):  
Jan Paul Heisig ◽  
Merlin Schaeffer
Keyword(s):  
Formal Education ◽  
Second Generation ◽  
Educational Aspirations ◽  
Children Of Immigrants ◽  
Education Systems ◽  
Structural Integration ◽  
Working Age ◽  
Using Data ◽  
Immigrant Optimism ◽  
Labor Market Attainment

Research shows that children of immigrants, the “second generation,” have comparatively high educational aspirations. This “immigrant optimism” translates into ambitious educational choices, given the second generation’s level of academic performance. Choice-driven (comprehensive) education systems, which allow the children of immigrants to follow their ambitions, are therefore regarded as facilitating their structural integration. The authors focus on an underappreciated consequence of these findings. If the second generation strives for higher qualifications than children of native-born parents with similar performance, working-age children of immigrants should have lower skills than children of native-born parents with comparable formal education. This could result in (statistical) employer discrimination and ultimately hamper integration. This pattern should be particularly pronounced in choice-driven education systems and in systems that emphasize vocational education. Two-step regression models using data on 16 countries support these expectations. The authors explore implications of these findings for comparative research on ethnic gaps in labor market attainment.

Sign in / Sign up

Export Citation Format

Share Document