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This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills—defined as the percent with problems paying medical bills—increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

Using data from the 1996/1997 Community Tracking Study household survey, this study examines the effects of public programs on the decision to take up employer coverage when offered versus enrolling in public coverage or being uninsured. The results show that among those with access to employer-sponsored coverage, low-income persons living in states with more expansive eligibility for Medicaid were more likely to decline employer coverage in favor of public coverage, while low-income persons in areas with public hospitals were more likely to decline coverage in favor of being uninsured. While persons who decline employer coverage in favor of public coverage maintain the same level of access to medical care, those who decline coverage in favor of being uninsured give up a considerable degree of access. Implications concerning policies to improve access to care for the uninsured are discussed.

Antennas presently being used for vehicular military VHF communications are narrowband. New generation frequency hopping radios, however, require broadband antennas. The antenna must be base isolated in order to reduce undesirable pattern nulls and impedance variations caused by currents induced on the support structure. Physical constraints limit the antenna length to three meters while operating from a frequency of 30 MHz to 88 MHz. To satisfy the above requirements a model of a broadband, base isolated, cylindrical antenna less than three meters long was analyzed and built. Equations for the current distribution as a function of the physical parameters were formulated and solved. The antenna selected as most optimum, i.e., maximum gain on the horizon, was 2.5 meters in length and fed 1.0 meters above the mounting surface. The most optimum base isolation network consisted of a coaxial cable choke wound on a ferrite toroid. The cable choke was made resonant at 25 MHz with minimum distributed capacity. The equalizer network for this antenna was located at the feed-point. Several network configuration were examined before selecting a two-pole T-network and autotransformer. The equalizer network reduced the antenna VSWR to 7:1. A 2 dB attenuator is required to reduce this VSWR to an acceptable 3.5:1.

Previous research has not found a strong association between Medicaid reimbursement levels and enrollees' access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees' access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician Medicaid acceptance in an area. Numerous other physician practice, health system, and community characteristics also affect Medicaid acceptance. The effects of Medicaid fees on Medicaid acceptance are substantially lower in areas with high Medicaid managed care penetration and for physicians who practice in institutional settings. The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees.

This article analyzes the degree to which interactions between race/ethnicity and other characteristics of a person and their local area are important in determining the probability of any mental health care use. Separate equations are estimated for "Blacks and Hispanics" and "Whites and other groups." Simulations are then performed where the probabilities of use are estimated for individuals in one racial/ethnic group, using coefficients estimated for another racial/ethnic group. These simulations show that the probability of use for Blacks and Hispanics would be similar to Whites if they were subject to the same behavioral patterns (regression coefficients) as Whites, and vice versa. The results indicate the limitations of simply using dummy variables to represent race/ethnicity and the value of learning more about how the health care system interacts with persons of different racial/ethnic backgrounds. Policies that directly affect the location, characteristics, and behavior of health care providers, as well as the behavior of consumers, may be as relevant to achieving equality of use or access as incremental changes in health coverage.

The State Children's Health Insurance Program (SCHIP) was designed to increase the number of children with health insurance coverage without resulting in large numbers of children substituting public coverage for private insurance. This study uses data from the Community Tracking Study collected before and after SCHIP implementation to examine the effects of increases in eligibility for public coverage on children's health insurance coverage. Using a regression-based difference-in-differences approach, the authors find that increases in eligibility for public coverage did increase the likelihood of having Medicaid or other state coverage versus being uninsured for the primary SCHIP target population—children in families with incomes between 100 and 200 percent of the federal poverty level. However, eligibility increases also increased the likelihood of having public coverage versus private insurance for this income group, indicating that SCHIP expansions resulted in substitution of public for private insurance. In fact, simulation results indicate that the initial impact of SCHIP on private insurance coverage has been far greater than on uninsurance rates. These results reflect the early stages of SCHIP implementation, however, and are subject to change as the SCHIP programs mature.

The Affordable Care Act is expected to profoundly affect inpatient hospital utilization, both as a result of expansions in insurance coverage as well as payment and delivery system reforms. The objective of this study is to examine changes in inpatient utilization between 2010 and 2013 in California, following a Medicaid expansion and implementation of the Delivery System Reform Incentive Payment program. Findings show that between 2010 and 2013: (a) the overall number of inpatient admissions increased, mainly because an increase in Medicaid admissions exceeded the decrease in uninsured admissions; (b) the number of preventable admissions did not change; (c) preventable admissions decreased at safety net hospitals that received Delivery System Reform Incentive Payment funds relative to other safety net hospitals. The results suggest that delivery system reforms may help offset the upward pressures on utilization and costs due to coverage expansions.

The use of the hospital emergency department (ED) for nonurgent health problems has been a subject of considerable controversy, in part because there is no widely accepted definition of "nonurgent." Elimination or substantial reduction in nonurgent ED use is frequently offered as a strategyfor reducing health expenditures. Previous studies, often limited to individual hospitals or communities, have limited generalizability and do not permit examination of multiple factors likely to influence nonurgent ED utilization or examination of ED use for nonurgent problems in the context of overall outpatient utilization. This analysis of the 1987 National Medical Expenditure Survey (NMES) provides a nationally representative examination of nonurgent ED utilization that describes the frequency of ED use for nonurgent problems, characteristics of individuals that are associated with an increased likelihood of nonurgent ED use, the use of other outpatient physician services, and expenditures associated with nonurgent ED visits.