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- 12th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 14th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 15th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 16th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 5th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 6th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 7th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 8th annual Herbert Lourie Memorial Lecture on Health Policy (1)
- 9th Annual Herbert Lourie Memorial Lecture on Health Policy (1)
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- Child Medicaid Expansions (1)
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- Childbirth (1)
Articles 1 - 30 of 30
Full-Text Articles in Health Policy
Waiving Snap Interviews During The Covid-19 Pandemic Increased Snap Caseloads, Colleen Heflin, William Clay Fannin, Leonard M. Lopoo, Siobhan O'Keefe
Waiving Snap Interviews During The Covid-19 Pandemic Increased Snap Caseloads, Colleen Heflin, William Clay Fannin, Leonard M. Lopoo, Siobhan O'Keefe
Center for Policy Research
Food insecurity in the United States reached historically high rates during the COVID-19 pandemic, thus substantially increasing demand for the Supplemental Nutrition Assistance Program (SNAP). To facilitate access to SNAP during the pandemic, the federal government granted state SNAP offices the option to waive the interview requirement – an administrative burden associated with the SNAP certification process. This brief summarizes findings from a recent study that used data from SNAP offices across 10 states to examine the impact of SNAP interview waivers on SNAP caseloads from January 5th to April 30th of 2021. Findings reveal that counties that implemented the …
Medicaid-Insured Older Adults On Snap May Have Stronger Medication Adherence, Colleen Heflin, Chinedum O. Ojinnaka, Irma A. Arteaga, Leslie Hodges, Gabriella Alphonso
Medicaid-Insured Older Adults On Snap May Have Stronger Medication Adherence, Colleen Heflin, Chinedum O. Ojinnaka, Irma A. Arteaga, Leslie Hodges, Gabriella Alphonso
Center for Policy Research
For older adults with hypertension, medication adherence is critical to decreasing hospitalization, poor health outcomes, and healthcare costs. The Supplemental Nutrition Assistance Program (SNAP)—the largest food and nutrition assistance program in the United States—could protect against medication non-adherence. This brief summarizes the findings from a recent study, which linked Missouri Medicaid administrative claims data to SNAP data from 2006 to 2014. The findings suggest that longer and consistent receipt of SNAP benefits was associated with higher levels of antihypertensive medication adherence among Medicaid-insured individuals aged 60 years and older.
Let Them Eat Lunch: The Impact Of Universal Free Meals On Student Performance, Amy Ellen Schwartz, Michah W. Rothbart
Let Them Eat Lunch: The Impact Of Universal Free Meals On Student Performance, Amy Ellen Schwartz, Michah W. Rothbart
Center for Policy Research
This paper investigates the impact of extending free school lunch to all students, regardless of income, on academic performance in New York City middle schools. Using a difference-in-difference design and unique longitudinal, student level data, we derive credibly causal estimates of the impacts of “Universal Free Meals” (UFM) on test scores in English Language Arts (ELA) and mathematics, and participation in school lunch. We find UFM increases academic performance by as much as 0.059 standard deviations in math and 0.083 in ELA for non-poor students, with smaller, statistically significant effects of 0.032 and 0.027 standard deviations in math and ELA …
Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo
Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo
Center for Policy Research
The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …
What Are The Financial Implications Of Public Quality Disclosure? Evidence From New York City’S Restaurant Food Safety Grading Policy, Rachel Meltzer, Michah W. Rothbart, Amy Ellen Schwartz, Thad Calabrese, Diana Silver, Tod Mijanovich, Meryle Weinstein
What Are The Financial Implications Of Public Quality Disclosure? Evidence From New York City’S Restaurant Food Safety Grading Policy, Rachel Meltzer, Michah W. Rothbart, Amy Ellen Schwartz, Thad Calabrese, Diana Silver, Tod Mijanovich, Meryle Weinstein
Center for Policy Research
Grading schemes are an increasingly common method of quality disclosure for public services. Restaurant grading makes information about food safety practices more readily available and may reduce the prevalence of foodborne illnesses. However, it may also have meaningful financial repercussions. Using fine-grained administrative data that tracks food safety compliance and sales activity for the universe of graded restaurants in New York City and its bordering counties, we assess the aggregate financial effects from restaurant grading. Results indicate that the grading policy, after an initial period of adjustment, improves restaurants’ food safety compliance and reduces fines. While the average effect on …
Incentivizing Healthy Eating In Children: An Investigation Of The “Ripple” And “Temporal” Effects Of Reward-Based Interventions, Saied Toossi
Center for Policy Research
Although previous studies have established the effectiveness of using small reward-based incentives in inducing the choice and consumption of healthier foods among children, little is known about their impact outside of experimental settings or their effectiveness over time when administered daily. This paper presents the results of a field experiment conducted to provide insight on these matters. The study employs a pretest-posttest within-subject design and was conducted at a summer program catering to low-income children between the ages of 5 and 12. Corroborating existing studies, the introduction of small reward-based incentives was found to induce large increases in the number …
The Health Care Expenditure And Income: A Global Perspective, Badi H. Baltagi, Raffaele Lagravinese, Francesco Moscone, Elisa Tosetti
The Health Care Expenditure And Income: A Global Perspective, Badi H. Baltagi, Raffaele Lagravinese, Francesco Moscone, Elisa Tosetti
Center for Policy Research
This paper investigates the long-run economic relationship between health care expenditure and income in the world using data on 167 countries over the period 1995-2012, collected from the World Bank data set. The analysis is carried using panel data methods that allow one to account for unobserved heterogeneity, temporal persistence, and cross-section dependence in the form of either a common factor model or a spatial process. We estimate a global measure of income elasticity using all countries in the sample, and for sub-groups of countries, depending on their geo-political area and income. Our findings suggest that at the global level, …
A Framework For Measurement Error In Self-Reported Health Conditions, Ling Li, Perry Singleton
A Framework For Measurement Error In Self-Reported Health Conditions, Ling Li, Perry Singleton
Center for Policy Research
This study develops and estimates a model of measurement error in self-reported health conditions. The model allows self-reports of a health condition to differ from a contemporaneous medical examination, prior medical records, or both. The model is estimated using a two-sample strategy, which combines survey data linked medical examination results and survey data linked to prior medical records. The study finds substantial inconsistencies between self-reported health, the medical record, and prior medical records. The study proposes alternative estimators for the prevalence of diagnosed and undiagnosed conditions and estimates the bias that arises when using self-reported health conditions as explanatory variables.
So Many Hospitals, So Little Information: How Hospital Value Based Purchasing Is A Game Of Chance, Andrew I. Friedson, William C. Horrace, Allison F. Marier
So Many Hospitals, So Little Information: How Hospital Value Based Purchasing Is A Game Of Chance, Andrew I. Friedson, William C. Horrace, Allison F. Marier
Center for Policy Research
As part of the Patient Protection and Affordable Care Act, participating Medicare hospitals have part of their Medicare reimbursements withheld and then redistributed based on quality performance. The Hospital Value Based Purchasing reimbursement plan relies partly on ordinal rankings of hospitals to determine how money is distributed. We analyze the quality metric distributions used for payment and show that there is not enough information to reliably differentiate hospitals from one another near the payment cutoffs; and conclude that a large part of the payment formula is driven by sampling variability rather than true quality information. Alternative reimbursement plans are developed.
Health, Medical Innovation And Disability Insurance: A Case Study Of Hiv Antiretroviral Therapy, Perry Singleton
Health, Medical Innovation And Disability Insurance: A Case Study Of Hiv Antiretroviral Therapy, Perry Singleton
Center for Policy Research
This study examines the effect of health on SSDI outcomes. The effect is identified by a new antiretroviral therapy to treat the human immunodeficiency virus. Administrative data on SSDI applications come from the Disability Research File. According to the analysis, the new therapy had an immediate and persistent effect on program entry. By 1997, the therapy decreased applications by 35.2 percent and new awards by 36.7 percent. Among existing beneficiaries, the therapy decreased program exits through death, but did not substantially increase program exits for work. By 1999, the therapy increased HIV-related expenditures by $43.6 million.
Still “Saving Babies”? The Impact Of Child Medicaid Expansions On High School Completion Rates, Lincoln H. Groves
Still “Saving Babies”? The Impact Of Child Medicaid Expansions On High School Completion Rates, Lincoln H. Groves
Center for Policy Research
Precipitated by the legislative decision to decouple child Medicaid benefits from welfare receipt, the number of young children qualifying for public health insurance grew markedly throughout the 1980s and early 1990s. From a baseline of roughly 15% in the average state at the beginning of the decade, the rate increased to more than 40% of all young children in the United States by the time all federal mandates were fully enacted in 1992. This paper extends the academic literature examining early childhood investments and longer-term human capital measures by exploring whether public health insurance expansions to low-income children led to …
Welfare Reform And Children’S Health, Badi H. Baltagi, Yin -Fang Yen
Welfare Reform And Children’S Health, Badi H. Baltagi, Yin -Fang Yen
Center for Policy Research
This study investigates the effect of the Temporary Aid to Needy Families (TANF) program on children’s health outcomes using data from the Survey of Income and Program Participation (SIPP) over the period 1994 to 2005. The TANF policies have been credited with increased employment for single mothers and a dramatic drop in welfare caseload. Our results show that these policies also had a significant effect on various measures of children’s medical utilization among low-income families. These health measures include a rating of the child’s health status reported by the parents; the number of times that parents consulted a doctor; and …
Treatment Effects With Unobserved Heterogeneity: A Set Identification Approach, Sung Jae Jun, Yoonseok Lee, Youngki Shin
Treatment Effects With Unobserved Heterogeneity: A Set Identification Approach, Sung Jae Jun, Yoonseok Lee, Youngki Shin
Center for Policy Research
We propose the sharp identifiable bounds of the distribution functions of potential outcomes using a panel with fixed T. We allow for the possibility that the statistical randomization of treatment assignments is not achieved until unobserved heterogeneity is properly controlled for. We use certain stationarity assumptions to obtain the bounds. Dynamics in the treatment decisions is allowed as long as the stationarity assumptions are satisfied. In particular, we present an example where our assumptions are satisfied and the treatment decision of the present time may depend on the treatments and the observed outcomes of the past. As an empirical illustration …
Health Care Expenditure And Income In The Oecd Reconsidered: Evidence From Panel Data, Badi H. Baltagi, Francesco Moscone
Health Care Expenditure And Income In The Oecd Reconsidered: Evidence From Panel Data, Badi H. Baltagi, Francesco Moscone
Center for Policy Research
This paper reconsiders the long-run economic relationship between health care expenditure and income using a panel of 20 OECD countries observed over the period 1971-2004. In particular, the paper studies the non-stationarity and cointegration properties between health care spending and income. This is done in a panel data context controlling for both cross-section dependence and unobserved heterogeneity. Cross-section dependence is modeled through a common factor model and through spatial dependence. Heterogeneity is handled through fixed effects in a panel homogeneous model and through a panel heterogeneous model. Our findings suggest that health care is a necessity rather than a luxury, …
Universal Health Insurance Coverage: Progress And Issues., Jonathan Gruber
Universal Health Insurance Coverage: Progress And Issues., Jonathan Gruber
Center for Policy Research
Jonathan Gruber was a key architect of Massachusetts’ ambitious health reform effort, and in 2006 became an inaugural member of the Health Connector Board, the main implementing body for that effort. He delivered this lecture on October 2, 2009, and his references are to Congressional bills that were under consideration on that date. He laid out the universal coverage debate that’s gone on for a long time in the United States; described a new solution that he think they found for Massachusetts; described how the Massachusetts reform works; and how it can be extended nationally. Finally he spent time on …
Our Troubled Health Care System: Why Is It So Hard To Fix?, Judy Feder
Our Troubled Health Care System: Why Is It So Hard To Fix?, Judy Feder
Center for Policy Research
This brief draws heavily on Judith Feder, 2004, "Crowd-Out and the Politics of Health Reform," The Journal of Law, Medicine, and Ethics 32(3): 461-464. We all know that affordable health care is now back on the political agenda, and it's about time! Because all of us--families, businesses, and governments--are struggling with the ever-increasing costs of care. Every year about a million people are added to the rolls of the uninsured. In 2006, it was even more, over 2 million. The number of people without health insurance coverage has reached more than 47 million. People *with* insurance are seeing their benefits …
Do We Want To Measure The Quality Of Care For Vulnerable Older People? The Acove Approach., Neil S. Wenger
Do We Want To Measure The Quality Of Care For Vulnerable Older People? The Acove Approach., Neil S. Wenger
Center for Policy Research
There's limited information available about measuring the quality of medical care that is targeted to the needs of older patients. And there's very limited pressure on the system to provide high quality geriatric care. Why is that? Because the quality measures haven't been adequately developed and implemented, and it's more difficult to measure care for an older sample. Measuring care for ill older adults is complex, because they tend to have multiple medical conditions, and they demonstrate substantial variation in goals for care (Wenger and colleagues 2007). The Assessing Care of Vulnerable Elders (ACOVE) project began in 1998 as a …
The Truth About Moral Hazard And Adverse Selection., Mark V. Pauly
The Truth About Moral Hazard And Adverse Selection., Mark V. Pauly
Center for Policy Research
This brief is actually going to have two levels. One level will go with the advertised title, and I’ll tell you my current views on the truth about moral hazard and adverse selection. Adverse selection will serve as somewhat of a handmaid of moral hazard, as you will see. That’s one level. The other level, though, which continues to surprise me, is that these two topics—they’re two buzzwords from insurance theory—have generated an enormous amount of policy interest and, yes, passion. Some people passionately believe some things about moral hazard that others passionately disbelieve. And so as part of this …
Changing Economic Incentives In Long-Term Care, R. Tamara Konetzka
Changing Economic Incentives In Long-Term Care, R. Tamara Konetzka
Center for Policy Research
Just as managed care has changed utilization and incentives in other parts of health care, there is a whole set of incentives built around long-term care that really matter. For example, if nursing homes have a financial incentive to hospitalize people with certain health conditions, then in the long run they are not going to develop the programs and invest in the resources to treat those people in the facility. Instead they're going to use those resources to stay in business or to provide other types of care. And while we can assume that policymakers do not create regulations that …
Variations Among Regions And Hospitals In Managing Chronic Illness: How Much Care Is Enough?, John E. Wennberg
Variations Among Regions And Hospitals In Managing Chronic Illness: How Much Care Is Enough?, John E. Wennberg
Center for Policy Research
Classic epidemiology looks at what happens to people who live in a defined region over time. For example, birth rate, the number of births that occur among populations over a year, is a common statistics that we're all familiar with. Since the early 1990s we have conducted research at Dartmouth Medical School to convert that classic epidemiologic perspective into looking at what is happening in terms of the health care system itself. We ask how much care people are getting in different regions of the country. We want to know the patterns of that care. And we want to get …
Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help?, Milton C. Weinstein
Spending Health Care Dollars Wisely: Can Cost-Effectiveness Analysis Help?, Milton C. Weinstein
Center for Policy Research
Are we getting the most health improvement possible for our money. In other words, are all the things that we do in medicine really worth it? That is where cost-effectiveness comes in. As a nation, we have been unwilling, at least publicly, to look explicitly at the value, in terms of improved health outcome, that we get for our health care dollars. With advances in medical technology putting unsustainable pressure on health care costs, our historical reluctance to measure value for health care may have to change. I start this brief by describing cost-effectiveness analysis as a method of determining …
Are The Benefits Of Medicine Worth What We Pay For It?, David M. Cutler
Are The Benefits Of Medicine Worth What We Pay For It?, David M. Cutler
Center for Policy Research
Is medical care worth it? Conventional wisdom says no, but my answer is emphatically yes. The benefits that we have received from medical advance are enormously greater than the costs. I suggest that public policy far outweighs the importance of cost containment relative to coverage expansion; we could in fact spend more and get a lot more for our health care dollars. In what follows, I talk about the costs and benefits of medical advance, focusing on two areas where I have done the most work: improvements in cardiovascular disease care and care for low birth weight infants. In each …
The Changing American Hospital In The Twenty-First Century, Ralph W. Muller
The Changing American Hospital In The Twenty-First Century, Ralph W. Muller
Center for Policy Research
One is always hesitant to speak about the future. A famous philosopher from New York, Yogi Berra, said "Making predictions is difficult, especially about the future," and I have some trepidation about doing so now. There is also the difficulty of understanding what really has happened in the past. I recall the Bolshevik general in 1917 who said "The future is clear, but the past is very murky." We anticipate the future with more clarity than is justified, even as we disagree on what is happening right now or what happened before. In that vein, I will describe the role …
Medicaid, Managed Care, And Kids. 12th Annual Herbert Lourie Memorial Lecture On Health Policy, Deborah A. Freund
Medicaid, Managed Care, And Kids. 12th Annual Herbert Lourie Memorial Lecture On Health Policy, Deborah A. Freund
Center for Policy Research
This policy brief talks about what managed care for Medicaid is, how it influences kids, and how it relates to the State Child Health Insurance Program (CHIP). It focuses on what we have learned over the last 20 years through research about cost, use, and quality. It also discusses some of the expectations we had for children covered by Medicaid managed care. Finally, it talks about the future of Medicaid managed care and the implications for CHIP.
Does Chronic Illness Affect The Adequacy Of Health Insurance Coverage?, Kevin T. Stroupe, Eleanor D. Kinney, Thomas J. Kniesner
Does Chronic Illness Affect The Adequacy Of Health Insurance Coverage?, Kevin T. Stroupe, Eleanor D. Kinney, Thomas J. Kniesner
Center for Policy Research
Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that illness decreased the probability of having adequate insurance, particularly among single individuals. Chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Pre-existing condition exclusions were a major source of inadequate insurance. …
Patients As Consumers: Making The Health Care System Our Own., David J. Lansky
Patients As Consumers: Making The Health Care System Our Own., David J. Lansky
Center for Policy Research
I ask you to think about our health care system. Think beyond the issues that are in front of us today: the anxiety we have about managed care, obtaining our own health care and paying for it, the survival of Medicare, and the unpredictable impact of government regulations. Think about our *health*, what we want from our health care system, what we're spending all this money for, and what we care about for ourselves and for our families. The challenge we face in the next five, ten, or fifteen years is to place the American health care system under the …
New Conundrums: Public Policy And The Emerging Health Care Marketplace, James R. Tallon
New Conundrums: Public Policy And The Emerging Health Care Marketplace, James R. Tallon
Center for Policy Research
There is a fundamentally new dynamic in American health care, one that has yet to be fully experienced but that threatens to leave a large portion of the American population without access to the quality health care they have received in the past. While the federal government has not completely abandoned the goal of assuring universal health care, a goal that dates back to the creation of Medicare and Medicaid in the 1960s and even earlier, the mechanisms to pursue that goal have changed. The implicit contract between government and health care providers--mostly doctors and not-for-profit hospitals--under which subsidized care …
Health Care: Public Good Or Private Enterprise?, David M. Lawrence
Health Care: Public Good Or Private Enterprise?, David M. Lawrence
Center for Policy Research
I start with the premise that the success of our efforts in health care is best measured by our ability to impact the health status of our citizens in the most affordable way possible. This brief provides an overview of the history of organized health care systems, then discusses several of the conundrums that are posted by knowledge of that history.
The Rhetoric And The Reality Of Health Care Reform Legislation, Marilyn Moon
The Rhetoric And The Reality Of Health Care Reform Legislation, Marilyn Moon
Center for Policy Research
A plethora of political autopsies have been performed on the Clinton Administration's failed health care reform of 1994--it was too much; it was too late; there was too much pandering; there was too little pandering. Such critiques of this complex undertaking are at least partially correct. It was probably hubris to believe that such a comprehensive health care reform package could be proposed and passed in a single year. But much of the instant analysis of its failure has repeated the rhetoric of the debate rather than stepping back and placing the events of 1994 in perspective. Here I focus …
Pursuing Health-Care Reform: The Promise And The Pitfalls, John K. Iglehart
Pursuing Health-Care Reform: The Promise And The Pitfalls, John K. Iglehart
Center for Policy Research
In developing health care reform proposals, it is important to recognize that our health care system has evolved over a long period of time and reflects values in which Americans believe deeply--values like pluralism and entrepreneurialism, consumer choice, limited government, and low taxation. Any major reforms will assault, or at least do some violence to, these values. Nevertheless there's a gathering consensus that reform of the fractured health care system to which Americans have grown accustomed is necessary, based on two overriding concerns: an uninsured population of approximately 35 million people, more than half of whom are adults holding full-time …