Suchergebnisse

Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.

Abstract
We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women's Health Initiative Study (WHIS) – the largest randomized controlled trial of women's health – which demonstrated in 2002 the health risks associated with the long-term use of hormone replacement therapy (HRT). We first show that, after the release of the WHIS findings, HRT use dropped sharply among post-menopausal women. We then estimate the spillover effects of the WHIS findings on preventive care by means of a difference-in-differences methodology comparing changes in preventive care use among 60 to 69 year-old women (who have high rates of HRT use) with the change among women aged 75 and above (who have much lower rates of HRT use). Using data from the Behavioral Risk Factor Surveillance System for the period 1998–2007, we find that women aged 60–69 had statistically and economically significant declines in their annual mammography checks, checkups, cholesterol checks and blood stool tests, when compared to older women.

Background National Health Service emergency departments have been under considerable pressure. Many patients presenting to emergency departments could be managed in primary care, suggesting that aspects of general practice might be associated with unplanned hospital admission. Recently a government scheme introduced the concept of a named GP (general practitioner) responsible for the care of patients aged 75 and older to reduce unplanned hospital admission. We aimed to investigate whether better continuity of care is associated with lower risk of emergency hospital admission.

In 2006 Massachusetts enacted a major health care reform aimed at achieving near-universal coverage in the state. While other studies have found that this reform substantially affected the use of health services in general, the impact of the reform on children is largely unexplored. Children are of special interest to policymakers because it is widely believed that better health in early childhood results in large payoffs to adult health and achievement. I analyze how the reform affected the insurance coverage, health care utilization patterns, and health outcomes of children under 18 years old.

Objectives To examine the relation between physical and psychological health indicators at adolescence (age 18) and household, personal, and nursing home care use later in life at ages 57- 69 years. Methods Using medical examinations on men born in 1944-1947 who were evaluated for military service at age 18 in the Netherlands, we link physical and psychological health assessments to national administrative microdata on the use of home care services at ages 57-69 years. We postulate a panel probit model for home care use over these years. In the analyses, we account for selective survival through correlated panel probit models. Results Poor mental health and being overweight at age 18 are important predictors of later life home care use. Home care use at ages 57-69 years is also highly related to and interacts with father's socioeconomic status and recruits' education at age 18. Discussion Specific health characteristics identified at age 18 are highly related to the later utilization of home-care at age 57-69 years. Some characteristics may be amenable to early life health interventions to decrease the future costs of long-term home care.

OBJECTIVES. We sought to describe prenatal care use in the United States and in three European countries where accessibility to prenatal care has been reported to be better than it is in the United States. METHODS. We analyzed the 1980 US National Natality Survey, the 1981 French National Natality Survey, a 1979 sample of Danish births, and a survey performed from 1979 to 1980 in one Belgian province. RESULTS. The proportion of women who began prenatal care late (after 15 weeks) is highest in the United States (21.2%) and lowest in France (4.0%). This contrasts with the median number of visits, which is greater in the United States (11) than in Denmark (10) or in France (7). Across all maternal ages, parities, and educational levels, late initiation of prenatal care is more frequent in the United States, and median number of visits in the United States is equal to or higher than that in the other countries. CONCLUSIONS. In countries that offer nearly universal access to prenatal care, women begin care earlier during pregnancy and have fewer visits than women in the United States.