Digital Commons Network^™

Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System, J. Mac Mccullough, Umesh Ghimire, Jason M. Orr, Sezan O. Onal, Ashley Edmiston, Krishna Patel, Timothy C. Mccall, Jonathon P. Leider

Public Health and Population Science Faculty Publications and Presentations

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials’ National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents’ revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources …

A New Framework For Condominium Structural Safety Reforms, Stewart E. Sterk, Reid K. Weisbord

Faculty Articles

Forty years after the widespread popularization of residential condominium ownership in the United States, millions of Americans now live in aging, densely occupied structures that are subject to little (if any) ongoing regulation of structural safety. Most structural safety requirements are imposed and enforced at the time of initial construction, thus relegating questions of how to maintain a building’s structural integrity to individual owners and the mechanisms of condominium governance. However, reliance on voluntary action by unit owners too often falters because the divided ownership characteristic of the condominium form deters associations from investing in preventive maintenance. Postponement of critical …

Covering The Care: Health Insurance Coverage In New Hampshire | 2023 Update, Kelly Dixon, Deborah Fournier, Rebecca Simon

Faculty Publications

The rate of individuals without health insurance in New Hampshire has continued to decrease in recent years, with a rate of 5.1% in 2021 and 4.9% in 2022. This pattern aligns with the national rate of uninsured individuals; in 2021, 8.6% of the US population did not have health insurance, and 8.0% in 2022. Compared to other states in New England, New Hampshire remains in the middle with respect to its rate of uninsured residents. Maine’s uninsured rate was 5.7% in 2021 and 6.6% in 2022, while Massachusetts’ rate was 2.5% in 2021 and 2.4% in 2022.

Quantifying The Role Of Insurance In Tornado-Impacted Community Recovery: A Survey And Simulation-Based Approach, Jie Zhao, Ji Yun Lee, Guirong Grace Yan, Fangjiao Ma

Civil, Architectural and Environmental Engineering Faculty Research & Creative Works

Insurance against disasters plays a critical role in community recovery by providing policyholders with reliable and timely payments for repairing or reconstructing damaged houses. By allowing homeowners to transfer risk, insurance enables homeowners to address house without experiencing significant financial burdens. Although historical events have highlighted the importance of insurance, its quantitative impact on community recovery, particularly in tornado-impacted communities, is understudied. This study focuses on advancing our understanding of whether sufficiently insured houses can have a positive impact on the recovery of tornado-impacted communities (i.e., the main research question). This paper proposes a two-stage simulation framework to quantitatively evaluate …

Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries And What The Law Can Do About It, Christopher Robertson, Annabel Kupke, Louise P. King

Faculty Scholarship

The nearly four million Americans who undergo gynecological surgeries each year suffer avoidable lifelong, painful, and disabling injuries. This Article diagnoses the root cause in our legal framework for healthcare finance and identifies legal solutions.

America’s public-private system for reimbursing healthcare pays for procedures rather than outcomes, and it pays substantially more for work on male rather than female anatomies. This disparity is due to the federal government’s reliance on a secretive industry committee to set those rates, and the committee’s reliance on junk science surveys, allowing self-interested and gender-biased responses, contrary to objective measures.

As payors disvalue the bodies …

Modelling Climate Litigation Risk For (Re)Insurers, Martin Lockman

Sabin Center for Climate Change Law

In response to the growing threat of climate change, the insurance industry has made significant investments in modelling and quantifying physical climate risks. However, the emerging risk of climate litigation has proven particularly difficult to model. In 2015 Mark Carney, then-Governor of the Bank of England and Chairman of the Financial Stability Board, warned that climate litigation poses “long-tail risks” for insurers that may be “significant, uncertain and non-linear.” Since that warning, the number of climate-related cases has more than doubled, and the scope and financial significance of climate litigation has become increasingly clear. However, insurers and regulators still struggle …

Law School News: Joyce And Bill Cummings Of Cummings Foundation To Deliver Keynote Address At Rwu Commencement 4-20-2023, Jill Rodrigues

Life of the Law School (1993- )

No abstract provided.

Impact Of The Covid-19 Pandemic On Chronic Disease Management And Patient Reported Outcomes In Patients With Pulmonary Hypertension: The Pulmonary Hypertension Association Registry, Megan Mayer, David B. Badesch, Kelly H. Nielsen, Steven Kawut, Todd Bull, John J. Ryan, Jeffrey Sager, Sula Mazimba, Anna Hemnes, Adolfo Kaplan

School of Medicine Publications and Presentations

To better understand the impact of the COVID-19 pandemic on the care of patients with pulmonary hypertension, we conducted a retrospective cohort study evaluating health insurance status, healthcare access, disease severity, and patient reported outcomes in this population. Using the Pulmonary Hypertension Association Registry (PHAR), we defined and extracted a longitudinal cohort of pulmonary arterial hypertension (PAH) patients from the PHAR's inception in 2015 until March 2022. We used generalized estimating equations to model the impact of the COVID-19 pandemic on patient outcomes, adjusting for demographic confounders. We assessed whether insurance status modified these effects via covariate interactions. PAH patients …

Journeying Through The Hurdles Of Gender-Affirming Care Insurance: A Literature Analysis., Heli Patel, Justin M. Camacho, Neeku Salehi, Romina Garakani, Leigh Friedman, Chris M. Reid

HPD Articles

Gender-affirming surgery (GAS) has been proven to be successful in the treatment of gender dysphoria. The benefits of providing insurance coverage for transition-related surgeries far surpass the costs of suffering from persistent gender dysphoria, including many positive health outcomes such as decreased rates of substance use, psychiatric illness, and suicide. Despite being deemed a medical necessity, discrepancies in access to treatment and insurance coverage for GAS persist. The purpose of this review is to understand the impact of limited insurance coverage on the well-being of transgender patients. A comprehensive search was conducted utilizing the Preferred Reporting Items for Systematic Reviews …

Geographic Variations And The Associated Factors In Adherence To And Persistence With Adjuvant Hormonal Therapy For The Privately Insured Women Aged 18-64 With Breast Cancer In Texas, Junghyun Kim, Man S Kim, Suja S Rajan, Xianglin L Du, Luisa Franzini, Tae Gi Kim, Sharon H Giordano, Robert O Morgan

Journal Articles

The purpose of this study is to examine the geographical patterns of adjuvant hormonal therapy adherence and persistence and the associated factors in insured Texan women aged 18-64 with early breast cancer. A retrospective cohort study was conducted using 5-year claims data for the population insured by the Blue Cross Blue Shield of Texas (BCBSTX). Women diagnosed with early breast cancer who were taking tamoxifen or aromatase inhibitors (AIs) for adjuvant hormonal therapy with at least one prescription claim were identified. Adherence to adjuvant hormonal therapy and persistence with adjuvant hormonal therapy were calculated as outcome measures. Women without a …

Geographic Variations And The Associated Factors In Adherence To And Persistence With Adjuvant Hormonal Therapy For The Privately Insured Women Aged 18-64 With Breast Cancer In Texas, Junghyun Kim, Man S Kim, Suja S Rajan, Xianglin L Du, Luisa Franzini, Tae Gi Kim, Sharon H Giordano, Robert O Morgan

Journal Articles

The purpose of this study is to examine the geographical patterns of adjuvant hormonal therapy adherence and persistence and the associated factors in insured Texan women aged 18-64 with early breast cancer. A retrospective cohort study was conducted using 5-year claims data for the population insured by the Blue Cross Blue Shield of Texas (BCBSTX). Women diagnosed with early breast cancer who were taking tamoxifen or aromatase inhibitors (AIs) for adjuvant hormonal therapy with at least one prescription claim were identified. Adherence to adjuvant hormonal therapy and persistence with adjuvant hormonal therapy were calculated as outcome measures. Women without a …

Association Of State Insurance Mandates For Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing For Aneuploidy, Bronwyn S Bedrick, Katelin B Nickel, Joan K Riley, Tarun Jain, Emily S Jungheim

2020-Current year OA Pubs

IMPORTANCE: Multiple gestation is one of the biggest risks after in vitro fertilization (IVF), largely due to multiple embryo transfer (MET). Single embryo transfer (SET) uptake has increased over time and has been attributed to various factors, such as mandated insurance coverage for IVF and preimplantation genetic testing for aneuploidy (PGT-A).

OBJECTIVE: To investigate whether mandates for IVF insurance coverage are associated with decreased use of MET after PGT-A.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted using data on embryo transfers reported to the Society for Assisted Reproductive Technology between 2014 and 2016. Data were analyzed from January …

Factors Associated With Delaying Medical Care: Cross-Sectional Study Of Nebraska Adults, Kendra Ratnapradipa, Snehal Jadhav, Josiane Kabayundo, Hongmei Wang, Lisa C. Smith

Journal Articles: Epidemiology

BACKGROUND: Delayed medical care may result in adverse health outcomes and increased cost. Our purpose was to identify factors associated with delayed medical care in a primarily rural state.

METHODS: Using a stratified random sample of 5,300 Nebraska households, we conducted a cross-sectional mailed survey with online response option (27 October 2020 to 8 March 2021) in English and Spanish. Multiple logistic regression models calculated adjusted odds ratios (aOR) and 95% confidence intervals.

RESULTS: The overall response rate was 20.8% (n = 1,101). Approximately 37.8% of Nebraskans ever delayed healthcare (cost-related 29.7%, transportation-related 3.7%), with 22.7% delaying care in the …

Caremark'S Butterfly Effect, Angela N. Aneiros, Karen E. Woody

Scholarly Articles

In 1996, the Delaware Court of Chancery detailed the minimum standard for corporate boards of directors (“board”) with regard to corporate compliance programs and monitoring protocols. The landmark Caremark decision held that directors would not face liability for a breach of fiduciary duties unless they failed to implement a system of controls and compliance, or knowingly failed to monitor that system. In order to bring a successful Caremark claim, plaintiffs must prove that the board operated in bad faith by failing to exercise oversight in a sustained or systemic way. The Delaware Court of Chancery opinion noted that the theory …

Changemakers: Master Of Studies In Law: 'Something New And Different...': Monique Kuester, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Uninsurance Rates And Associated Impacts Within Urban And Rural Counties In Ohio In 2022, Anneliese M. Fisher, Megan Sharifi

Scholarship in Medicine - All Papers

Background: Rural populations comprise of 20% of the American population and 19% of those individuals are over the age of 65 (compared to 15% in urban areas).1,2 There has been an increase in discussion surrounding the social determinants of health (SDOH), and the literature shows that the SDOH often disproportionately impact individuals based on where they live, including rural areas. The rural-urban mortality rate disparity within the United States has been growing and has been attributed to levels of poverty.3 The SDOH also include access to healthcare and insurance, and insurance coverage is associated with higher healthcare access and quality.4 …

The Case For Pausing Any Immediate Embrace Of The Social Inflation Argument For Legal System Reforms, Kenneth S. Klein

Faculty Scholarship

This paper brings a critical eye to the current conversation about "social inflation," reaching the conclusion that the current calls for legal system reform--whether that be controls on attorney advertising, clamping down on litigation financing, revisiting of fee recovery rules, or other similar reform proposals--currently lack the empirical support and analytical comprehensiveness for. regulators and legislators to act with confidence that the requested reforms will do more good than harm. In a variety of States, insurance premiums are rising faster than general inflation, some insurers are becoming insolvent, and some insurers are leaving markets entirely. Insurers are pointing to social …

Baseline Representativeness Of Patients In Clinics Enrolled In The Primary Care Opioid Use Disorders Treatment (Proud) Trial: Comparison Of Trial And Non-Trial Clinics In The Same Health Systems, Paige D. Wartko, Hongxiang Qiu, Abisola E. Idu, Onchee Yu, Jennifer Mccormack, Abigail G. Matthews, Jennifer F. Bobb, Andrew J. Saxon, Cynthia I. Campbell, David Liu, Jordan M. Braciszewski, Sean M. Murphy, Rachael P. Burganowski, Mark T. Murphy, Viviana E. Horigian, Leah K. Hamilton, Amy K. Lee, Denise M. Boudreau, Katharine A. Bradley

Center for Health Policy and Health Services Research Articles

BACKGROUND: Pragmatic primary care trials aim to test interventions in "real world" health care settings, but clinics willing and able to participate in trials may not be representative of typical clinics. This analysis compared patients in participating and non-participating clinics from the same health systems at baseline in the PRimary care Opioid Use Disorders treatment (PROUD) trial.

METHODS: This observational analysis relied on secondary electronic health record and administrative claims data in 5 of 6 health systems in the PROUD trial. The sample included patients 16-90 years at an eligible primary care visit in the 3 years before randomization. Each …

Bryant, Farnsworth Dudley, B. 1939 - Collector (Mss 741), Manuscripts & Folklife Archives

MSS Finding Aids

Finding aid for Manuscripts Collection 741. Business papers of the Thomson family of Fayette County, Kentucky, most notably Patrick Henry Thomson, his son William Z. Thomson, and son-in-law Squire C. Gaines. Includes scans of selected materials (Click on "Additional Files" below).

Insurance Coverage And Respiratory Morbidities In Bronchopulmonary Dysplasia., Joseph M. Collaco, Michael C. Tracy, Catherine A. Sheils, Jessica L. Rice, Lawrence M. Rhein, Leif D. Nelin, Paul E. Moore, Winston M. Manimtim, Jonathan C. Levin, Khanh Lai, Lystra P. Hayden, Julie L. Fierro, Eric D. Austin, Stamatia Alexiou, Amit Agarwal, Natalie Villafranco, Roopa Siddaiah, Antonia P. Popova, Ioana A. Cristea, Christopher D. Baker, Manvi Bansal, Sharon A. Mcgrath-Morrow

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge.

METHODS: Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart …

Health Informatics Interventions To Minimize Out-Of-Pocket Medication Costs For Patients: What Providers Want., Karalyn A Kiessling, Bradley E Iott, Jessica Pater, Tammy Toscos, Shauna Wagner, Laura M Gottlieb, Tiffany C Veinot

Health Services and Informatics Research

OBJECTIVE: To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development.

MATERIALS AND METHODS: We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes.

RESULTS: Providers lacked access to information about: patients' ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related …

Exploring Mechanisms Insurers Employ To Set Premiums And Maximize Profitability, Brent Ferenczy

Senior Honors Theses

The insurance industry is a very complex segment of the macroeconomy. An explain will be given as to how these companies are able to maintain and maximize their profits, allowing them to remain in business. A key area in this process is the setting of premiums. This activity draws from many areas of the business model. This paper will start with a birds-eye view and telescope in, starting with standard business practices and ending with specific undertakings of insurance companies. Companies must keep adequate liquid funds. This is done mainly through forecasting cash outflows and investing their assets under management. …

What History Can Tell Us About The Future Of Insurance And Litigation After Covid-19, Kenneth S. Abraham, Tom Baker

All Faculty Scholarship

This Article, written for the annual Clifford Symposium on Tort Law and Social Policy, chronicles a series of developments in American history that profoundly influenced the course of insurance and insurance law, in order to predict the post-COVID-19 future of these fields. In each instance, there was a direct and decided cause-and-effect relationship between these developments and subsequent change in the world of insurance and insurance law. As important as the influence of COVID-19 is at present and probably will be in the future, in our view the COVID-19 pandemic will not be as significant an influence on insurance and …

Consumer Bankruptcy, Mortgage Default And Labor Supply, Wenli Li, Costas Meghir, Florian Oswald

Cowles Foundation Discussion Papers

We specify and estimate a lifecycle model of consumption, housing demand and labor supply in an environment where individuals may file for bankruptcy or default on their mortgage. Uncertainty in the model is driven by house price shocks, education specific productivity shocks, and catastrophic consumption events, while bankruptcy is governed by the basic institutional framework in the US as implied by Chapter 7 and Chapter 13. The model is estimated using micro data on credit reports and mortgages combined with data from the American Community Survey. We use the model to understand the relative importance of the two chapters (7 …

Law School News: National Housing Advocate Named To Lead Rwu's New Real Estate Initiatives 02/08/2022, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Colonoscopy Standardization: Insurance Verification And Direct Access, Connor Crutchfield, Jacqueline Chen, Kiernan Mcnelis, Luke Kelly

Physician Executive Leadership-Plus (PEL-Plus)

Outline

• Background
• Problem Scope
• Approach
• Progress
• Recommendations

Impact Pathways From Climate Services To Sdg2 (“Zero Hunger”): A Synthesis Of Evidence, James Hansen, Geneva List, Shauna Downs, Edward Carr, Rahel Diro, Walter Baethgen, Andrew Kruczkiewicz, Melody Braun, John Furlow, Kayla Walsh, Nitin Magima

Sustainability and Social Justice

Climate services can help address a range of climate-sensitive development challenges, including agricultural production and food security. However, generating empirical evidence of impact is challenging. In this paper, we synthesize published evidence of pathways by which climate services contribute to improved food security. A summary of key mechanisms by which climate risk drives food insecurity provides a context for understanding potential climate risk management interventions. Our review of available evaluation literature finds moderately strong evidence that climate services contribute to improvements in food security or its precursors through farmers’ risk management decisions and index-based agricultural insurance; and a weaker body …

Third Party Moral Hazard And The Problem Of Insurance Externalities, Gideon Parchomovsky, Peter Siegelman

All Faculty Scholarship

Insurance can lead to loss or claim-creation not just by insureds themselves, but also by uninsured third parties. These externalities—which we term “third party moral hazard”—arise because insurance creates opportunities both to extract rents and to recover for otherwise unrecoverable losses. Using examples from health, automobile, kidnap, and liability insurance, we demonstrate that the phenomenon is widespread and important, and that the downsides of insurance are greater than previously believed. We explain the economic, social and psychological reasons for this phenomenon, and propose policy responses. Contract-based methods that are traditionally used to control first-party moral hazard can be welfare-reducing in …

Federal Courts’ Recalcitrance In Refusing To Certify State Law Covid-19 Business Interruption Insurance Issues, Christopher French

Journal Articles

Over 2,000 COVID-19 business interruption insurance cases have been filed in state and federal courts the past two years with most of the cases filed in or removed to federal courts. The cases are governed by state law. Rather than certify the novel state law issues presented in the cases to the respective state supreme courts that ultimately will determine the law applicable in the cases, each of the eight federal circuit courts to issue decisions on the merits in such cases to date has done so by making an Erie guess regarding how the controlling state supreme courts would …

Changemakers Master Of Studies In Law: 'Such A Different Outlook...': Derek Tevyaw, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.