Suchergebnisse

OBJECTIVE: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. MATERIALS AND METHODS: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 20006 and 2012). RESULTS: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. CONCLUSIONS: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Objective. Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods. Fixed-effects instrumental-variable (FE-IV) pseudo-panel es­timation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results. Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hy­pertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions. Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

RESEARCH OBJECTIVE: The trajectory of COVID‐19 pandemic has been different across different countries and regions, with varying number of per‐population cases and deaths. Such variation may be a function of a number of country‐specific factors such as population distribution, disease profile, non‐pharmaceutical interventions (e.g., lockdowns) undertaken at the wake of the pandemic, political leadership, and others. Our objective is to examine the extent to which a country's progress towards universal health coverage (UHC) explains COVID outcomes. We also measure how the effect of UHC varies across different levels of social capital. We proxy the UHC progress using service coverage index (SCI). The SCI is a broad‐based measure of UHC, and is tracked at the country level by the World Health Organization (WHO) and its collaborating partners. Our overall hypothesis is that the UHC‐SCI has a protective effect on health, and therefore, is negatively associated with the COVID outcomes (COVID cases and deaths per 100 k population). STUDY DESIGN: We use longitudinal data‐based generalized linear models (GLMs) to investigate the relationship between the outcome variable (COVID cases and deaths) and the key explanatory variables. We run cross‐country linear regressions, with month fixed effects and country‐level clustering. We run two sets of linear regressions. First, we regress each COVID outcome on the SCI. Second, we regress each COVID outcome on the SCI and the interaction term between SCI and social capital. Both sets of regressions include controls for GDP per capita, share of population above 65, stringency measures, and COVID testing rates. Our data for the SCI comes from the WHO while the longitudinal (monthly) data on COVID outcomes and other key variables come from "ourworldindata.org" (University of Oxford). The data on government trust is obtained from the social capital component of the Legatum Prosperity Index (LPI), 2019. POPULATION STUDIED: 173 countries. PRINCIPAL FINDINGS: Our findings show that there ...

Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes.

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans' incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.

Medicare and Medicaid dual-eligible beneficiaries use more medical care and experience worse health outcomes than Medicare-only beneficiaries. This article points to a possible inefficiency in the skilled nursing facility (SNF) admission process, specifically that patients and SNFs are partially matched based on dual-eligibility status, and investigates its influence on patients' SNF length of stay. Using a set of fee-for-service beneficiaries newly admitted for Medicare-paid SNF care, we document two findings: (1) compared with Medicare-only patients, dual-eligibles are more likely to be discharged to SNFs with low nurse-to-patient ratios and (2) dual-eligibles are more likely to become long-stay nursing home residents than Medicare-only beneficiaries if treated in SNFs with low nurse-to-patient ratios. We conclude that changes in the current SNF care referral process have the potential to reduce excess SNF utilization by dual-eligible beneficiaries and could help reduce spending by both Medicare and Medicaid.

The Patient Driven Payment Model (PDPM) was implemented in U.S. skilled nursing facilities (SNFs) in October 2019, shortly before COVID-19. This new payment model aimed to reimburse SNFs for patients' nursing needs rather than the previous model which reimbursed based on the volume of therapy received. Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021, this qualitative study clarifies the impact of COVID-19 on the administration of PDPM at SNFs. Interview data were analyzed using modified grounded theory and thematic analysis. Our findings show that SNF administrators shifted focus from management of the PDPM to COVID-19-related delivery of care adaptations, staff shortfalls, and decreased admissions. As the pandemic abated, administrators re-focused their attention to PDPM. Policy makers should consider the continued impacts of the pandemic at SNFs, particularly on delivery of care, admissions, and staffing, on the ability of SNF administrators to administer a new payment model.