Health Policy Center AuthorsPublications by Yu-Chu Shen for Health Policy Center Back to Browse by Author
What's Driving the Downward Trend in Employer Sponsored Health Insurance? (Research Report) Author(s): Sharon K. Long, Yu-Chu Shen This study examines the factors driving the downward trend in employer sponsored insurance coverage between 1999 and 2002 for low- and moderate-income workers. We find that while low-income workers are more likely to be uninsured and are most vulnerable to the loss of ESI coverage, many middle income workers are also in a precarious position when faced with the loss of ESI coverage. The study also finds that the drop in ESI offers over the period was driven largely by changes in the nature of workers' jobs, while the drop in ESI take-up was driven largely by rising premiums. Health Services Research, Vol. 41, No. 6, 2006, pp. 2074-2096.
Options for Improving Medicare Payment for Skilled Nursing Facilities (Research Report) Author(s): Korbin Liu, Bowen Garrett, Douglas A. Wissoker, Stephanie Maxwell, Andrew Kramer, Theresa Eilertsen, Anne Epstein, Yu-Chu Shen, Sung-Joon Min, Sharon K. Long, Robert Schlenker, Brant Fries, Joan Buchanan Medicare has paid skilled nursing facilities (SNFs) using a prospective payment system (PPS) since 1998. This report offers policy options to refine Medicare’s payment of SNF services by developing alternative patient classification models. Three models classify patients according to expected non-therapy ancillary (NTA) costs: two models use data from the SNF to model NTA costs; a third adds data from prior hospital stays. A fourth model predicts rehabilitation therapy costs using patient characteristics. The fifth uses Diagnostic Related Groups to predict total SNF care costs. The report also simulates options for outlier payments for exceptionally high-cost cases.
Assessing Access to Care Under Medicaid: Evidence for the Nation and Thirteen States (Article) Author(s): Teresa A. Coughlin, Sharon K. Long, Yu-Chu Shen This study examined how the Medicaid program is providing access to beneficiaries, using the level of access available to low-income privately insured people in the local health care market as the benchmark. The analysis, which focused on ambulatory care measures, was done for the nation as a whole and for thirteen individual states. The researchers concluded that, on balance, Medicaid beneficiaries fared no worse than their low-income privately insured peers in most of the states examined. (Coughlin, Teresa A., Long, Sharon K., Shen, Yu-Chu. July/August 2005. "Assessing Access to Care Under Medicaid: Evidence for the Nation and Thirteen States." Health Affairs 24(4): 1073-1083.)
The Effect of Medicaid Payment Levels on Access and Use Among Beneficiaries (Article) Author(s): Yu-Chu Shen, Stephen Zuckerman This study examines the effects of Medicaid payment generosity on access and care for Medicaid adults and children. We used data from the National Surveys of America's Families for 1997, 1999, and 2002 and the Urban Institute Medicaid capitation rate surveys. Higher payment rates improve some aspects of care for Medicaid beneficiaries, but the effects are not dramatic. Higher payments increase the probability of having a usual source of care and having at least one visit to a doctor or other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. (Shen, Yu-Chu and Zuckerman, Stephen. June 2005. "The Effect of Medicaid Payment Levels on Access and Use Among Beneficiaries." Health Services Research 40(3): 723-744.)
Low-Income Workers with Employer-Sponsored Insurance (Article) Author(s): Sharon K. Long, Yu-Chu Shen This study examines the effects of a firm's decision to drop the offer of employer-sponsored insurance (ESI), reduce eligibility for ESI, or significantly increase employee costs on the health insurance status of currently covered low-income workers. We find that at least a third of such workers do not have affordable insurance options outside of the group market. Furthermore, a simulation analysis shows that 54 percent of those workers would become uninsured if their employers were to drop ESI. Expanding public programs to cover low-income workers would reduce the high uninsurance rate, but substantial minorities would remain uninsured. (Medical Care Research and Review 61:474–94.)
Changing Options for Insurance Coverage (Policy Briefs/Health Policy Online) Author(s): Sharon K. Long, Yu-Chu Shen This paper analyzes what is likely to happen to low- and middle-income workers that lose access to ESI. Low- and middle-income workers have fewer other options for coverage. The study examined the share of workers with access to ESI through a spouse, the cost of purchasing nongroup insurance relative to income, and eligibility for public programs. It found 50 percent of low-income workers and 20 percent of middle-income workers have no affordable insurance options outside the ESI market. According to the authors, 43 percent of low-income workers and 31 percent of middle-income workers would become uninsured if ESI were no longer available to them.
Characteristics of Occasional and Frequent Emergency Department Users (Article) Author(s): Stephen Zuckerman, Yu-Chu Shen This paper uses the 1997 and 1999 National Survey of America’s Families to explore how insurance coverage and access to care, along with other individual characteristics, are related to the large differences in Emergency Department (ED) use among the general population. People are classified into three ED use levels based on the number of visits over the 12 months prior to the survey: non-ED users (zero visits), occasional users (one or two visits), or frequent users (three or more visits). People in fair/poor health are 3.74 times more likely than others to be frequent ED users as compared to non-users. The uninsured and the privately insured adults have the same risk of being frequent users, but publicly insured adults are 2.08 times more likely to be frequent users. Adults who made three or more visits to doctors are 5.05 times more likely to be frequent ED users than those who made no such visits. It seems hard to blame the overcrowding of EDs on the uninsured. Instead, the publicly insured are over-represented of among ED users. Frequent ED users do not appear to use the ED as a substitute for their primary care and, in fact, are a less healthy population who need and use more care overall. (Medical Care 42(2): 176–82, February 2004.)
The Health Insurance Reform Simulation Model (HIRSM) (Research Report) Author(s): Linda J. Blumberg, Yu-Chu Shen, Len Nichols, Matthew Buettgens, Lisa Dubay, Stacey McMorrow The Health Insurance Reform Simulation Model (HIRSM) is designed to simulate the coverage, cost, and tax implications of health insurance coverage expansion proposals and other reforms to the health insurance system. The model uses nationally representative data on employers, workers, and those outside of the labor market. HIRSM simulates the behavioral choices of insurers, employers, and individuals under the current system and under reform, allowing us to predict the coverage consequences of various policies. It can simulate the effects of reforms affecting private insurance markets and public programs. This report details the model in its entirety and presents prototypical results.
A New Approach to Risk Spreading via Coverage Expansion Subsidies (Article) Author(s): John Holahan, Len Nichols, Linda J. Blumberg, Yu-Chu Shen This article reports results from using the Health Insurance Reform Simulation Model (HIRSM) to simulate the effects of a proposal for expanding health insurance developed by Holahan, Nichols, and Blumberg. This expansion proposal would subsidize health insurance purchases for low-income individuals and families and simultaneously addresses the issue of inefficient and inequitable risk pooling in current private health insurance markets. The results suggest that roughly half of the uninsured population would obtain coverage under this plan, while preserving the role of employers as a major payer for coverage. Unlike other proposals that would subsidize coverage for the low-income, this plan would also significantly reduce the inefficient risk-pooling in individual and small group markets. (American Economic Association Papers and Proceedings 93(2): 277–82, May 2003.)
Why Is There State Variation in Employer-Sponsored Insurance? (Article) Author(s): Yu-Chu Shen, Stephen Zuckerman Using the National Survey of America's Families (NSAF) in 1997 and 1999, this paper investigates the sources behind variation in employer-sponsored health insurance (ESI) across states. We find that demographics and family characteristics (such as race/ethnicity and citizenship status), individual employment characteristics (such as firm size, labor force attachment), and local labor market characteristics (such as unionization) consistently explain the relative position of all of the states with either high or low rates of ESI coverage. Income plays a lesser role in explaining the state variation, but is still an important determinant, especially among states whose average income deviates substantially from the national average. (Health Affairs 22(1): 241–51, January/February 2003.)
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