Registries as a Knowledge-Development Tool: The Experience of Sweden and England (Research Report)
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Registries of patients with particular conditions or who have received a particular treatment have a long history and are widely used in many countries. This paper focuses on two kinds of registries – for patients with diabetes and for those who have received a joint hip replacement – in Sweden and England. These examples illustrate how registries can serve multiple purposes, including providing quality and safety feedback to providers and purchasers, generating planning data for health systems, evaluating guidelines, and performing outcomes research. While registries are not foreign to the United States, the completeness and accomplishments of Sweden and England’s registry system go well beyond the American experience, and show how more can be done to make use of these valuable tools.
How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? (Research Report)
|Posted to Web: July 12, 2013||Publication Date: July 01, 2013|
Many Medicaid and CHIP programs and private health plans are pursuing medical home initiatives aimed at improving the quality of health care, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight, funded by the U.S. Department of Health and Human Services, examines the measurement of "medical homeness" in selected CHIPRA Quality Demonstration projects, describes the development of the Medical Home Index-Revised Short Form (an adaptation of the Medical Home Index survey), and presents preliminary statistics on medical homeness for demonstration practices in six States.
Achieving the Potential of Health Care Performance Measures (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: June 14, 2013||Publication Date: June 14, 2013|
There is a consensus that evaluating and reporting on the performance of health care providers can be instrumental in improving value in U.S. health care. But the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide incentives to improve performance. This Robert Wood Johnson Foundation-funded paper describes the current state of performance measurement and reporting, details what’s wrong, and outlines seven policy recommendations that offer a path to achieving the promise of performance measurement while avoiding its adverse consequences.
Enrollment-Driven Expenditure Growth: Medicaid Spending during the Economic Downturn, FY 2007-2011 (Research Report)
|Posted to Web: May 23, 2013||Publication Date: May 23, 2013|
This report presents data on changes in Medicaid's enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.
Developing Subannual Estimates of Health Insurance Coverage from the American Community Survey: Challenges and Promising Next Steps (Research Report)
|Posted to Web: April 24, 2013||Publication Date: April 24, 2013|
Following the introduction of a question on health insurance coverage in 2008, the American Community Survey (ACS) has increasingly been used as a source for state-level health insurance estimates. This reflects a number of key advantages of the ACS, including a survey design that supports state representative estimates for all states and the large size of its sample. As a result, the ACS yields relatively precise state-level estimates of annual health insurance coverage. This paper explores the feasibility of expanding the value of the ACS for tracking health insurance coverage by generating subannual estimates.
Financial Burden of Medical Spending by State and the Implications of the 2014 Medicaid Expansions (Research Report)
|Posted to Web: April 17, 2013||Publication Date: April 17, 2013|
This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.
Uninsured New Yorkers After Full Implementation of the Affordable Care Act: Source of Health Insurance Coverage by Individual Characteristics and Sub-State Geographic Area (Research Report)
|Posted to Web: April 03, 2013||Publication Date: March 28, 2013|
The Urban Institute developed a New York state-specific version of its Health Insurance Reform Simulation Model (HIPSM) to support to the state in its effort to assess the implications of the implementation of the Affordable Care Act (ACA). Initial findings from this work were made available in March of 2012.The tables presented here provide sub-state analyses, focusing on those without insurance coverage of any kind prior to reform. We show the share of uninsured expected to gain coverage under the ACA, and include the distribution of characteristics for those anticipated to gain insurance of each type whenever sample sizes allow.
The Financial Burden of Medical Spending Among the Non-Elderly, 2010 (Research Report)
|Posted to Web: February 15, 2013||Publication Date: February 15, 2013|
We estimate the financial burden of medical spending among the non-elderly using an alternative data source than previous studies. We investigate whether higher burden levels are largely due to higher medical spending, lower income, or some combination. Furthermore, we study individual characteristics correlated with burdens exceeding a given threshold. Although medical spending is higher for individuals facing higher burden levels, the effect of low income on high burden status dominates. Multivariate analysis shows that individuals covered by non-group insurance and the unhealthy have significantly higher risk of facing higher burden levels, while those with public insurance have much lower risk.
|Posted to Web: November 19, 2012||Publication Date: November 19, 2012|