View Research by Author - Karen Stockley

Publications

This study analyzes data from a 2009 Commonwealth Fund survey of American physicians in internal medicine, family or general practice, or pediatrics to identify predictors of their having plans to retire or leave their practice for other reasons in the next 5 years. Just over half (53%) of physicians age 50 or older and 30% of physicians between age 35 and 49 have such plans. The strongest of the multiple predictors involved was time they spent coordinating care for patients. Factors that predict plans to retire differ from those associated with plans to leave practices for other reasons.

Five years after the enactment of Massachusetts health reform initiative, gains in insurance coverage and access to care have been sustained. This report provides an update on trends in the Bay State since fall 2006, just prior to the implementation of the state's health reform initiative, along with a more in-depth overview of the circumstances of working-age adults in 2010, as the state begins implementation of the Affordable Care Act.

Massachusetts is in its sixth year of a reform initiative that provided the template for the federal Affordable Care Act of 2010. This Health Affairs article reports on the status of health reform in Massachusetts as of 2010, providing an early indication of potential gains and challenges under national reform.

The growth in U.S. health care spending has become a focal point in debates over federal and state health care reform. While the problem is easy to quantify, strategies for slowing rising expenditures are controversial, and evidence of their effectiveness is often elusive. Our full report provides background that describes the problem and reviews the cost containment provisions of the Affordable Care Act (ACA). It also presents estimates of cost savings from several policies that go beyond those included in the ACA. In this appendix, we provide more detail on the methods used to generate these cost savings estimates.

In this paper we review data on health care spending growth and the reasons for the persistent high rates of growth. We discuss the cost containment provisions that are incorporated into the Affordable Care Act. A number of options that are not included in the ACA are then analyzed. We use a consistent analytic framework for making estimates relying on an extensive body of research evidence. We make estimates of the savings from eliminating tax exclusion, malpractice reform, chronic care management, prevention and various approaches to setting rates for providers. We conclude that no one option could provide substantial savings by themselves and that a combination of several policies is necessary to reduce the rate of growth.

This report provides a comprehensive update on the status of health reform in Massachusetts as of fall 2009. The report examines the overall impact of reform on non-elderly adults; the impacts on vulnerable population subgroups of adults; impacts on racial/ethnic disparities; the status of the remaining uninsured adults in the state; an assessment of the adequacy of coverage under health reform; and support for reform over time. The authors find that Massachusetts has made significant progress in accomplishing the goals of the legislation, although some challenges with respect to the cost of health care remain. A chartbook of key findings was also released as a supplement to the full report.

This policy brief examines the progress women have made in under health reform in Massachusetts. The authors find that women achieved significant gains in coverage, access, use, and affordability under health reform, although gains in affordability were more limited. Gains were particularly strong for vulnerable subgroups of women, including lower-income women and racial/ethnic minority women.

This Health Affairs article provides an update on the progress of health reform in Massachusetts as of fall 2009 using data from surveys of working-aged adults. Massachusetts continues to sustain record high levels of insurance coverage in the midst of the economic recession, with uninsurance at 4.8 percent for non-elderly adults in fall 2009. In addition, the authors find that the gains in access and affordability reported in Massachusetts under the initial years of health reform persisted into fall 2009. However, some barriers to accessing care persist and problems affording care continue to be an issue for some residents.

The Massachusetts Health Insurance Survey (MHIS) collects information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. It is funded by the Massachusetts Division of Health Care Finance and Policy (DHCFP) and is conducted by the Urban Institute, along with its subcontractor, Social Science Research Solutions (SSRS). This report examines health care access and use in 2008 in Massachusetts.

This joint study by the Urban Institute and the Medical Group Management Association demonstrates that it is possible to simulate physician compensation as if all physician services were paid under the Medicare Fee Schedule and to compare the results with the actual compensation. This analysis confirms substantial differences in actual hourly and annual compensation across specialties, and that, under simulated Medicare compensation, the compensation ratios across specialties are narrowed very little. The non-surgical, procedural specialties, particularly cardiology, continue to do relatively better under the Medicare Fee Schedule than under current reimbursements that includes Medicare as well as other payers.

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