Insurance Commons^™

A Mixed-Methods Study: Self-Efficacy And Barriers To Participation In Workplace Wellness Programs, Massiel Perez-Calhoon

Dissertations

America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation’s health. Lack of awareness and sensitivity to what motivates individual participants versus group participants built formidable barriers to accessing all workplace employees equitably. The purpose of this study was twofold. First, the intent of this study was to explore the relationship between self-efficacy and the impact on participation and engagement when …

Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering

Independent Study Project (ISP) Collection

The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the sample …

Expanding Dental Practices Into Long-Term Care, American Dental Association

Action for Dental Health

No abstract provided.

Consumer Financial Protection In Health Care, Erin C. Fuse Brown

Faculty Publications By Year

There are inadequate consumer protections from harmful medical billing practices that result in unavoidable, unexpected, and often financially devastating medical bills. The problem stems from the increasing costs shifting to patients in American health care and the inordinate complexity that makes health care transactions nearly impossible for consumers to navigate. A particularly outrageous example is the phenomenon of surprise medical bills, which refers to unanticipated and involuntary out-of-network bills in emergencies or from out-of-network providers at in-network facilities. Other damaging medical billing practices include the opaque and à la carte nature of medical bills, epitomized by added “facility fees,” as …

Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling

Community & Environmental Health Faculty Publications

INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.

METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban …

Medicare And The Aca: Shifting The Paradigm Of Fraud Detection, David P. Paul Iii, Sarah Clemente, Ronald Mcgrady, Rob Repass, Alberto Coustasse

Management Faculty Research

Medicare fraud and abuse costs are estimated at 3%-10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

From Offline To Online: How Health Insurance Policies Drive The Demand For Online Healthcare Service?, Yue Yu, Qiu-Yan Mei, Qiu-Hong Wang

Research Collection School Of Computing and Information Systems

Online healthcare service has gradually become a significant part of healthcare services, especially in emerging economy with shortage in medical resources and wide coverage in the Internet usage. This paper studies how health insurance policies affect the demand for online healthcare consultation by using longitudinal online healthcare and offline medical services datasets of a major city in China. The two policies we study are the integration of health insurance systems in urban and rural regions and the integration of health insurance systems between pairwise-cities. The empirical results show that both policies significantly affected the demand for online consultation. Our study …

Why Not Fix It?, William H. Lane

English Faculty Publications

Have you felt the pinch of rising health care costs this year? If not, maybe you haven't actually needed to see a doctor or pay for a prescription. Even those of us who are lucky enough to be "covered" at work have noticed rapidly rising deductibles and copays - and shrinking networks of providers. Employers, facing a big, one-year increase in insurance costs, naturally enough go shopping for a new plan. But the big savings with a new plan often mean a big effective pay cut for everyone who's covered under it when employee contributions, deductibles and copays all rise …

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey …

Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando

Community & Environmental Health Faculty Publications

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in …

Critical Analysis Of The Confounding Of Clinical Trials, Eleanor L. Jordan

Senior Honors Projects, 2010-2019

To provide a comprehensive overview of issues confounding clinical trials, Chapter 2 will discuss the parties involved in the research and development of medications and detail the individual responsibilities of each. However, the ambition of these individual entities often produces a conflict of interest especially when profits are involved [9]. Organizations and individuals such as insurance corporations, pharmaceutical companies (sponsors), pharmacy benefit managers, investigators (doctors/medical professionals) and most importantly patients, are all involved in carrying out clinical research and have definitive responsibilities they are required to follow for unbiased results. However, many rules are overlooked and biases go unrecorded causing …

10 Steps To Increase Provider Participation In Medicaid And Reduce Associated Administration Burdens, American Dental Association

Action for Dental Health

No abstract provided.

Coalitions 101 Questions And Answers, American Dental Association

Action for Dental Health

No abstract provided.

4 Steps To Building An Elder Care Coalition: Best Practice Guide For State Dental Societies, American Dental Association

Action for Dental Health

No abstract provided.

5 Steps To Promote Incurred Medical Expense (Ime) Reimbursement In Your State, American Dental Association

Action for Dental Health

No abstract provided.

6 Steps To Joining An Elder Care Coalition: Best Practice Guide For State Dental Societies, American Dental Association

Action for Dental Health

No abstract provided.

Balancing Act: Successfully Combining Creativity And Accountability In The Practice Of Marriage And Family Therapy, Nathalie Duque Bello

Department of Family Therapy Dissertations and Applied Clinical Projects

The conditions that allowed early MFTs the freedom to creatively explore different interventions and theories of change are no longer available in today’s mental health care system. Although there are many benefits to the structure of managed behavioral healthcare organizations, a thorough review of the literature demonstrates that many therapists working in managed care agencies struggle with maintaining their theoretical creativity, claiming third-party payers’ service requirements and paperwork a barrier to their creativity. A phenomenological transcendental research method was utilized to understand the phenomenon of successfully combining creativity and accountability in the practice of marriage and family therapy from the …

10 Steps To Increase Provider Participation In Medicaid/Streamline Administration, American Dental Association

Action for Dental Health

No abstract provided.

Priority-Setting, Cost-Effectiveness, And The Affordable Care Act, Govind Persad

Georgetown Law Faculty Publications and Other Works

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations,this Article attempts to defend three substantive propositions.

First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality.

Second, I argue …

Navigating The Health Care Labyrinth: Portraits Of The Socioeconomically Disadvantaged, Thomas C. Crawford Phd

Antioch University Dissertations & Theses

In 2010, an estimated population of the 311,212,863 Americans generated approximately 1,014,688,290 physician office encounters (Moore, 2010). The frequency and number of professional interactions between caregivers and patients/family members in medical office settings equated to a staggering 1,931 visits per minute. Based on the massive volume of interactions that occurred between patients of different races, ethnicities, genders, sexual orientations, and socioeconomic standings that generated an average household income of $49,445 in 2010 (United States Census Bureau, 2010a) with a physician workforce that the Association of American Medical Colleges (2010) captured as being 75% White that earned (primary care specialties) in …

Emotional Intelligence And Community Healthcare Productivity, Christopher Jacob Fox

Dissertations

Economic crisis is threatening state budgets. The strain on state budgets effects pensions and the healthcare benefits to communities. Rising healthcare costs and lagging insurance reimbursement rates are forcing healthcare organizations to sustain programs with fewer financial resources. Research studies indicate that payment increases from Medicare and Medicaid will not keep pace with the historical trend in hospital cost inflation (Kaufman, 2011). Of the healthcare facilities affected by federal budget constraints are community mental healthcare centers. The strain on state budgets has taken its toll on community mental healthcare facilities in particular struggling under the healthcare reform initiatives (Simpson, 1995). …

Improving Health Outcomes For Children (Ihoc): Summary Of Pediatric Quality Measures For Children Enrolled In Mainecare Ffy 2009 - Ffy 2012, Nathaniel J. Anderson Ms, Mph, Tracey Meagher

Population Health & Health Policy

his report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of this document …

Global Budgets, Payment Reform And Single Payer: Understanding Vemont's Health Reform, Trish Riley

Population Health & Health Policy

The Muskie School of Public Service hosted two health policy colloquia this April to promote informed discussion throughout the state regarding MaineCare coverage options under the ACA and the implications of Vermont’s move toward a single-payer system.The series, sponsored by the Muskie School Board of Visitors, offers community conversations in which experts from various disciplines and perspectives inform and engage the broader public to explore and debate critical policy issues. On April 22, community and sector leaders joined for Global Budgets, Payment Reform, and Single Payer: Understanding Vermont's Health Reform. Participants discussed Vermont's recent movie toward single payer health …

Malpractice Claims For Endoscopy, Lyndon V. Hernandez, Dominic Klyve, Scott E. Regenbogen

Mathematics Faculty Scholarship

AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure.

METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time.

RESULTS: There were 1901 endoscopy-related closed claims against …

Examining Mainecare’S Coverage Options Under The Affordable Care Act, Erika C. Ziller Phd, Trish Riley

Population Health & Health Policy

The Affordable Care Act (ACA) was designed to achieve nearly universal access to health coverage in the United States—in part by standardizing Medicaid eligibility across the country so that each state’s program would cover individuals with incomes below 138% of the federal poverty level (FPL), or $15,856 for an individual and $32,499 for a family of four in 2013 (see Figure 1).i However, in June 2012, the U.S. Supreme Court determined that states could not be required to broaden Medicaid and retained the decision as a state option. States that choose to participate may do so by amending their state …

Impact Of Health Reform On Latinos And Immigrants In The Omaha-Council Bluffs Metropolitan Area, Jim P. Stimpson, Kelly Shaw-Sutherland, Yang Wang

Reports: Center for Health Policy

No abstract provided.

The Affordable Care Act Of 2010: A Brief Summary, Jim P. Stimpson

Reports: Center for Health Policy

In March 2010, the Patient Protection and Affordable Care Act (ACA, P.L. 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA, P.L. 111-152) (referred to hereafter as the ACA) was signed into law as the most comprehensive piece of legislation since the passage of Medicare and Medicaid legislation in 1965 aimed at creating sweeping health care reform. This brief provides a summary of the titles contained in the law, the implementation of the provisions, and the estimated financial impact.

Health Care Reform's Effect On Private Medical Practices, Spencer R. Clark

CMC Senior Theses

In March of 2010, the 44^th President of the United States, Barack Obama, signed into law a health care reform bill that will change the medical and business approach to healthcare that has been witnessed for quite some time. The Patient Protection and Affordable Care Act, aims to eliminate several inefficiencies encountered in our current health care system, as well as extend coverage by providing affordable care for the roughly forty six million Americans currently uninsured. Many of the changes will be implemented over the next several years, but hospitals, businesses, physicians, and insurance companies are no doubt planning …

Collaborating With A Financial Therapist: The Why, Who, What And How, Cicily Maton, Michelle Maton, William Martin

College of Business Faculty and Staff Works

Financial planning clients are seeking holistic solutions to their financial opportunities and challenges. Yet, few financial planners and mental health professionals work together to benefit clients. This article showcases a partnership between a financial therapist, trained as a psychologist, and two financial planners who have implemented an evidence-based model of financial planning drawing upon the behavioral finance, neureconomics, evolutionary psychology, and coaching literature.