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New Linked Employee-Employer Data Show Workforce Composition Is Associated With Health Insurance Offers Among Small Employers. 新的雇员-雇主关联数据显示，劳动力构成与小雇主提供的健康保险有关。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2025-02-01 Epub Date: 2024-10-23 DOI: 10.1177/10775587241286920
Alice Zawacki, Thomas A Hegland, Patricia S Keenan, G Edward Miller
{"title":"New Linked Employee-Employer Data Show Workforce Composition Is Associated With Health Insurance Offers Among Small Employers.","authors":"Alice Zawacki, Thomas A Hegland, Patricia S Keenan, G Edward Miller","doi":"10.1177/10775587241286920","DOIUrl":"10.1177/10775587241286920","url":null,"abstract":"<p><p>Decades of research shows that small firms are much less likely to offer health insurance than large firms, but less is known about differences among small employers. We examine this issue using the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR), a unique employer-employee linked data set that is constructed by matching the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to Internal Revenue Service administrative records and the Decennial Census. Multivariate analyses show that among firms with fewer than 50 workers, the probability that workers receive an insurance offer is positively associated with higher median workforce incomes, and conditional offers of dependent coverage increase when the majority of workers are married or from a family with at least three members. This first application of the MEPS-ICAR highlights the significance of workforce characteristics in shaping small employer insurance benefits and the data's usefulness for expanding analyses of policy changes, wage-benefit tradeoffs, and health insurance benefits.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"79-87"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses. 州全面执业授权条例与护士执业自主权：来自 2018 年全国注册护士抽样调查的证据。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2025-02-01 Epub Date: 2024-10-29 DOI: 10.1177/10775587241282163
Eric P Slade, Kelli DePriest, Yvonne Commodore-Mensah, Laura Samuel, Ginger C Hanson, Rita D'Aoust
{"title":"State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses.","authors":"Eric P Slade, Kelli DePriest, Yvonne Commodore-Mensah, Laura Samuel, Ginger C Hanson, Rita D'Aoust","doi":"10.1177/10775587241282163","DOIUrl":"10.1177/10775587241282163","url":null,"abstract":"<p><p>State full practice authority (FPA) laws are designed to permit NPs to practice autonomously from physicians. Little is known regarding how FPA laws affect NPs' practice autonomy in daily practice. This study used nationwide survey data from 20,830 NPs to estimate how NPs' practice autonomy differs between NPs in FPA and non-FPA states. NPs in states with FPA laws were more than twice as likely as NPs in non-FPA states to practice in clinic settings with no onsite physicians and were twice as likely to not have a physician collaborator. Associations between FPA laws and four other indicators of practice autonomy were positive but smaller in magnitude. States with FPA laws more than 10 years experienced larger changes in nurse practitioner (NP) autonomy compared with states with FPA laws in effect less than 10 years. FPA laws may promote the development of autonomous NP practice sites, thereby expanding access in underserved populations.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"68-78"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review. 医院-医生和医院-急诊后医疗垂直整合后的成本、质量和使用情况：系统回顾。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2025-02-01 Epub Date: 2024-05-06 DOI: 10.1177/10775587241247682
Alexandra Harris, Sarah Philbin, Brady Post, Neil Jordan, Molly Beestrum, Richard Epstein, Megan McHugh
{"title":"Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review.","authors":"Alexandra Harris, Sarah Philbin, Brady Post, Neil Jordan, Molly Beestrum, Richard Epstein, Megan McHugh","doi":"10.1177/10775587241247682","DOIUrl":"10.1177/10775587241247682","url":null,"abstract":"<p><p>Vertical integration of health systems-the common ownership of different aspects of the health care system-continues to occur at increasing rates in the United States. This systematic review synthesizes recent evidence examining the association between two types of vertical integration-hospital-physician (<i>n</i> = 43 studies) and hospital-post-acute care (PAC; <i>n</i> = 10 studies)-and cost, quality, and health services utilization. Hospital-physician integration is associated with higher health care costs, but the effect on quality and health services utilization remains unclear. The effect of hospital-PAC integration on these three outcomes is ambiguous, particularly when focusing on hospital-SNF integration. These findings should raise some concern among policymakers about the trajectory of affordable, high-quality health care in the presence of increasing hospital-physician vertical integration but perhaps not hospital-PAC integration.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"3-42"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in Medicaid Take-Up Among Eligible Adults After the Affordable Care Act Medicaid Expansions: 2014-2019. 平价医疗法案》扩大医疗补助范围后，符合条件的成年人接受医疗补助的趋势：2014-2019.
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2025-02-01 Epub Date: 2024-09-05 DOI: 10.1177/10775587241273429
Salam Abdus
{"title":"Trends in Medicaid Take-Up Among Eligible Adults After the Affordable Care Act Medicaid Expansions: 2014-2019.","authors":"Salam Abdus","doi":"10.1177/10775587241273429","DOIUrl":"10.1177/10775587241273429","url":null,"abstract":"<p><p>Little is known about how take-up of Medicaid among eligible adults has changed since 2014. This study used data from the Medical Expenditure Panel Survey to examine changes in Medicaid enrollment among Medicaid-eligible adults between 2014 and 2019. Eligibility for Medicaid was simulated using state- and year-specific eligibility rules. Among all Medicaid-eligible citizen adults aged 19-64 years, the proportion enrolled in Medicaid increased from 55.5% in 2014-2015 to 61.9% in 2016-2017, and then remained approximately at the same level in 2018-2019 (61.5%). Among adults who became eligible because of the Medicaid expansions, the proportion enrolled in Medicaid increased from 44.1% in 2014-2015 to 53.8% in 2016-2017. Among pre-Affordable Care Act (ACA)-eligible adults, there was no statistically significant change in the proportion enrolled in Medicaid between 2014-2015 and 2016-2017 (66.8% and 69.7%, respectively). There were significant differences in changes in take-up rates across population subgroups.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"100-106"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Policy and Payment Decisions on Peritoneal Dialysis in the United States: A Review. 美国腹膜透析的政策和支付决策：回顾。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-12-01 Epub Date: 2024-02-25 DOI: 10.1177/10775587241233614
Anagha Lokhande, David F Painter, Braden Vogt, Ankur Shah
{"title":"Policy and Payment Decisions on Peritoneal Dialysis in the United States: A Review.","authors":"Anagha Lokhande, David F Painter, Braden Vogt, Ankur Shah","doi":"10.1177/10775587241233614","DOIUrl":"10.1177/10775587241233614","url":null,"abstract":"<p><p>End-stage kidney disease (ESKD) accounts for a sizable proportion of Medicare spending. Peritoneal dialysis remains an underutilized treatment modality for ESKD despite its quality of life and cost-saving benefits. Medicare policy on reimbursements and patient eligibility for dialysis coverage has been amended numerous times since its inception in 1972. Over the last two decades, Medicare policy on ESKD reimbursements has evolved from a primarily fee-for-service model to a prospective payment system, and within the past few years, it has begun including more experimental payment structures. While prior work has explored the evolution of Medicare's ESKD policy as a whole, we specifically outline the impact of Medicare policy changes on peritoneal dialysis reimbursement rates, uptake by physicians and dialysis facilities, and accessibility to patients. This narrative review offers historical insights, an overview of modern ESKD policy, actionable strategies, and policy opportunities to increase the accessibility of this treatment modality.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"419-431"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Health Care Use of ACA Marketplace Enrollees During the COVID-19 Pandemic. 在 COVID-19 大流行期间，ACA 市场参保者的医疗保健使用情况。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-12-01 Epub Date: 2024-09-19 DOI: 10.1177/10775587241277954
Xinqi Li, Lex Frazier, Brett Lissenden, John Kautter, Robin McCrea
{"title":"Health Care Use of ACA Marketplace Enrollees During the COVID-19 Pandemic.","authors":"Xinqi Li, Lex Frazier, Brett Lissenden, John Kautter, Robin McCrea","doi":"10.1177/10775587241277954","DOIUrl":"10.1177/10775587241277954","url":null,"abstract":"<p><p>The onset of the COVID-19 pandemic in March 2020 had a sudden and substantial impact on health care utilization for most, if not all, individuals. We study the impact the pandemic had on the population insured in the individual and small group markets under the Patient Protection and Affordable Care Act (ACA) of 2010, using administrative claims data from January 2019 through December 2021. Our results demonstrated how health care utilization differed between the acute phase (i.e., 2020) and the post-acute phase (i.e., 2021) compared with the pre-pandemic phase. We found that in the ACA markets, most spending and utilization categories decreased drastically during the initial months of the pandemic and recovered by the end of 2021. While the role of telehealth among office visits decreased substantially by the end of 2021, it remained the main mode of delivery for mental health services.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"464-473"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals. 病人护理体验和护士工作环境的变化：美国医院纵向研究》。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-12-01 Epub Date: 2024-10-02 DOI: 10.1177/10775587241282403
Kathleen E Fitzpatrick Rosenbaum, Karen B Lasater, Matthew D McHugh, Eileen T Lake
{"title":"Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals.","authors":"Kathleen E Fitzpatrick Rosenbaum, Karen B Lasater, Matthew D McHugh, Eileen T Lake","doi":"10.1177/10775587241282403","DOIUrl":"10.1177/10775587241282403","url":null,"abstract":"<p><p>Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29; <i>p</i> < .001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"444-454"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program. 加利福尼亚州全人护理试点计划中与减少医疗补助受益人急症护理使用相关的计划实施策略》（Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneiciaries in California's Whole Person Care Pilot Program）。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-12-01 Epub Date: 2024-09-03 DOI: 10.1177/10775587241273404
Emmeline Chuang, Dahai Yue, Brenna O'Masta, Leigh Ann Haley, Weihao Zhou, Nadereh Pourat
{"title":"Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.","authors":"Emmeline Chuang, Dahai Yue, Brenna O'Masta, Leigh Ann Haley, Weihao Zhou, Nadereh Pourat","doi":"10.1177/10775587241273404","DOIUrl":"10.1177/10775587241273404","url":null,"abstract":"<p><p>Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"432-443"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between Self-Direction and Personal Care Aide Wages. 自我指导与个人护理助理工资之间的关系。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-12-01 Epub Date: 2024-08-26 DOI: 10.1177/10775587241273413
Denise A Tyler, Miku Fujita, Susan A Chapman
{"title":"Association Between Self-Direction and Personal Care Aide Wages.","authors":"Denise A Tyler, Miku Fujita, Susan A Chapman","doi":"10.1177/10775587241273413","DOIUrl":"10.1177/10775587241273413","url":null,"abstract":"<p><p>The supply of personal care aides (PCAs), who assist people receiving home care, is a growing concern. PCA shortages result, in part, from the low wages earned by these workers. State policies have had some effect on wages. Self-direction (SD) may be associated with wages because SD allows home care recipients to hire and manage workers, including setting wages in most states. We used wage data from the Bureau of Labor Statistics to examine the association between SD and the wages of PCAs. We found implementation of SD did not have a consistent association with PCA wages, with wages improving in some states and worsening in others. We also found little difference in PCA wages between states that allow participants to set worker wages and those that do not. SD does not seem to improve PCA wages in states, so other policy strategies will be needed.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"455-463"},"PeriodicalIF":2.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Varying Estimates of Social Workers in the United States: Which Data Source to Use? 美国社会工作者的估计值各不相同：使用哪种数据来源？
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-10-01 Epub Date: 2024-06-12 DOI: 10.1177/10775587241257983
Brianna M Lombardi, Lisa de Saxe Zerden, Erin Fraher
{"title":"Varying Estimates of Social Workers in the United States: Which Data Source to Use?","authors":"Brianna M Lombardi, Lisa de Saxe Zerden, Erin Fraher","doi":"10.1177/10775587241257983","DOIUrl":"10.1177/10775587241257983","url":null,"abstract":"<p><p>Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"408-416"},"PeriodicalIF":2.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11389054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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