Explore the vast range of titles available.

We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid-reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event-study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post-expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.

\"A visionary and completely original investigation that will change the way we think about health care: how and why it is failing, why expanding insurance coverage will only make things worse, and how it can be transformed into a transparent, affordable, successful system. In 2007, David Goldhill's father died from a series of infections acquired in a well-regarded New York hospital. The bill was for several hundred thousand dollars--and Medicare paid it. These circumstances left Goldhill angry and determined to understand how it was possible that world-class technology and well-trained personnel could result in such simple, inexcusable carelessness--and how a business that failed so miserably could be rewarded with full payment. Catastrophic Care is the eye-opening result. Goldhill explicates a health-care system that now costs nearly $2.5 trillion annually, bars many from treatment, provides inconsistent quality of care, offers negligible customer service, and in which an estimated 200,000 Americans die each year from errors. Above all, he exposes the fundamental fallacy of our entire system--that Medicare and insurance coverage make care cheaper and improve our health--and suggests a comprehensive new approach that could produce better results at more acceptable costs immediately by giving us, the patients, a real role in the process. \"-- Provided by publisher.

Foreigners from third countries are not entitled to participate in the Czech public health insurance system unless they have either permanent residence in the Czech Republic or a Czech employer. This article aims to analyse the economic impact of the possible inclusion of such foreigners into the public health insurance system in the Czech Republic. First, we estimate the size of the group of foreigners concerned and follow with the estimation of contributions paid and the cost involved. The analysis is based on publicly available data that entail simplifications. The conducted research shows that the inclusion of foreigners from third countries into the public health system of the Czech Republic would positively impact the economic balance of the system in that the estimated contributions would surpass the estimated costs.

Disparities in access to care and transplantation outcomes, including prolonged waitlist times and reduced living donor transplantation rates, are well-documented in Hispanic kidney transplant patients. While post-transplant graft and patient survival rates are generally comparable to those of non-Hispanic white patients, variability within the Hispanic population is driven by socioeconomic and clinical factors. Insurance type may be a crucial determinant of both access to transplantation and post-transplantation outcomes, warranting a focused study of its impact within this population. We used the OPTN/UNOS database to identify Hispanic kidney-only transplant recipients in the United States between 2015 and 2019. We categorized patients by insurance type to public versus non-public insurance. We compared risk of graft failure and death after kidney transplant between the public and non-public insurance groups. Of 14,639 Hispanic kidney transplant recipients, 10,761 (74%) had public insurance. Public insurance group were older, had more kidney retransplant, more deceased donor but less preemptive kidney transplant, longer dialysis duration, more diabetes, peripheral vascular disease, reduced functional status, and were less likely to be employed or have high education level compared to non-public insurance group. Public insurance was significantly associated with an increased risk of death-censored graft failure (HR 1.36; 95% CI 1.16–1.60) and patient death (HR 1.15; 95% CI 1.01–1.30). Similarly, public insurance was significantly associated with an increased risk of graft failure when accounting for death as the competing risk. Disparities in post-transplant outcomes were observed between Hispanic kidney recipients with public versus non-public insurance. Public insurance was a significant predictor for reduced graft and patient survival after kidney transplant.

In the United States, the \"right to choose\" an abortion is the law of the land. But what if a woman continues her pregnancy because she didn't really have a choice? What if state laws, federal policies, stigma, and a host of other obstacles push that choice out of her reach?     Based on candid, in-depth interviews with women who considered but did not obtain an abortion, No Real Choice punctures the myth that American women have full autonomy over their reproductive choices. Focusing on the experiences of a predominantly Black and low-income group of women, sociologist Katrina Kimport finds that structural, cultural, and experiential factors can make choosing abortion impossible-especially for those who experience racism and class discrimination. From these conversations, we see the obstacles to \"choice\" these women face, such as bans on public insurance coverage of abortion and rampant antiabortion claims that abortion is harmful. Kimport's interviews reveal that even as activists fight to preserve Roe v. Wade, class and racial disparities have already curtailed many women's freedom of choice.   No Real Choice analyzes both the structural obstacles to abortion and the cultural ideologies that try to persuade women not to choose abortion. Told with care and sensitivity, No Real Choice gives voice to women whose experiences are often overlooked in debates on abortion, illustrating how real reproductive choice is denied, for whom, and at what cost. 

This paper studies the effect of losing public health insurance eligibility on preventative care, self-reported health, and emergency department use. I exploit the 2005 TennCare disenrollment in which 190,000 residents–mainly non-elderly childless adults–lost public health insurance eligibility due to budget cuts. I use two surveys, the Behavioral Factor Surveillance System and the National Health Interview Survey, in a difference-in-difference methodology to study the effects of the reform. I find that the reform lead to a 4%–5% reduction in reporting having mammograms and breast exams. An increase of 20% in number of days with health incapacitation and no strong evidence of changes of emergency department visits (nor number of visits). I document margins of heterogeneity of the effects across demographic characteristics. Finally, I explore the margins of symmetry between gaining and losing public insurance by comparing estimates to those from the Affordable Care Act Medicaid Expansions.

Co-payments for prescription drugs are a common feature of many healthcare systems, although often with exemptions for vulnerable population groups. International evidence demonstrates that cost-sharing for medicines may delay necessary care, increase use of other forms of healthcare and result in poorer health outcomes. Existing studies concentrate on adults and older people, particularly in the US, with relatively less attention afforded to paediatric and European populations. In Ireland, prescription drug co-payments were introduced for the first time for medical cardholders (i.e. those with public health insurance) in October 2010, initially at a cost of ϵ0.50 per item, rising to ϵ1.50 in January 2013, and further increasing to ϵ2.50 in December 2013. Using data from the Growing Up in Ireland longitudinal study of children, and a diiference-in-difference research design, we estimate the impact of the introduction (and increase) of these co-payments on health, healthcare utilisation and household financial wellbeing. The introduction of modest co-payments on prescription items was not estimated to impinge on the health of children and parents from low-income families. For the younger Infant Cohort, difference-in-difference estimates indicated that the introduction (and increase) in co-payments was associated with a decrease in GP visits and hospital nights, and a decrease in the proportion of households reporting 'difficulties with making ends meet'. In contrast, for the older cohort of children (the Child Cohort), co-payments were associated with an increase in GP visiting, and an increase in household deprivation. While the parallel trends assumption for difference-in-difference analysis appeared to be satisfied, further investigation revealed that there were other time-varying observable factors (such as exposure to the economic recession over the period) that affected the treatment and control groups, as well as the two cohorts of children differentially, that may partly explain these divergent results. For example, while the analysis suggests that the introduction of the ϵ0.50 co-payment in 2010 was associated with an increase in the probability of treated families in the Child Cohort being deprived by 9.4 percentage points, the proportion of treated families experiencing unemployment and reductions in household income also increased significantly around the time of the co-payment introduction. This highlights the difficulty in identifying the effect of the co-payment policy in an environment in which assignment to the treatment (i.e. medical cardholder status) was not randomly assigned.

This article examines the impacts of public health insurance on the health of adults through use of data from the China Health and Nutrition Survey. We use the endogenous treatment effects model to infer the causal effects of public health insurance on health. We find that public health insurance significantly improves the physical and mental health status of health insurance beneficiaries after controlling for other covariates. Among the 2 types of voluntary public health insurance, the Urban Resident Basic Medical Insurance has the greater impact in improving health than the New Cooperative Medical Scheme. Moreover, the health effect appears to be stronger for middle-aged individuals, the elderly, and those with lower incomes than for their counterparts. The positive health effects may result from few channels, including the increase of health care utilization, the improvement of health-related behaviors, and the fact that individuals with public health insurance are more likely to use higher level care providers. This study provides implications on reforming China’s health care system.

We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across geographic areas and has a very low correlation with Medicare spending. For the privately insured, half of the spending variation is driven by price variation across regions, and half is driven by quantity variation. Prices vary substantially across regions, across hospitals within regions, and even within hospitals. For example, even for a nearly homogeneous service such as lower-limb magnetic resonance imaging, about a fifth of the total case-level price variation occurs within a hospital in the cross section. Hospital market structure is strongly associated with price levels and contract structure. Prices at monopoly hospitals are 12% higher than those in markets with four or more rivals. Monopoly hospitals also have contracts that load more risk on insurers (e.g., they have more cases with prices set as a share of their charges). In concentrated insurer markets the opposite occurs—hospitals have lower prices and bear more financial risk. Examining the 366 mergers and acquisitions that occurred between 2007 and 2011, we find that prices increased by over 6% when the merging hospitals were geographically close (e.g., 5 miles or less apart), but not when the hospitals were geographically distant (e.g., over 25 miles apart).