Inquiry: The Journal of Health Care Organization, Provision, and Financing This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida
This study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care patients had 7% shorter LOSs and a 1.9% lower inpatient cost than did Medicaid fee-for-service (FFS) patients. Medicaid managed care patie...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - October 14, 2015 Category: Health Management Authors: Park, J. Tags: Original Research Source Type: research

The Relationship Between the Use of a Worksite Medical Home and ED Visits or Hospitalizations
Worksite medical homes may be a good model for improving employee health. The aim of this study was to compare the likelihood of being seen in the emergency department (ED) or being hospitalized by level of use (no use, occasional use, or primary care) of a worksite medical home, overall and by type of user (employee, adult dependent, or pediatric dependent). This was a retrospective analysis of claims data, using covariate-adjusted logistic regression models for ED visits and inpatient hospitalizations. Secondary data for the years 2006 to 2008 from a company that offers an on-site health care center (HCC) were used. Anal...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - October 11, 2015 Category: Health Management Authors: Stroo, M., Conover, C., Adcock, G., Myneni, R., Olaleye, D., Ostbye, T. Tags: Original Research Source Type: research

Racial Differences in Awareness of the Affordable Care Act and Application Assistance Among Low-Income Adults in Three Southern States
The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a surve...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - October 8, 2015 Category: Health Management Authors: Garcia Mosqueira, A., Hua, L. M., Sommers, B. D. Tags: Original Research Source Type: research

Adverse Selection in the Childrens Health Insurance Program
This study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utilization in the first month of enrollment for new enrollees (who had not been in the program for at least 12 months) with utilization among continuing enrollees. A second analysis compared first-month utilization of those who renew immediately with those who waited at least 2 months to renew. A 2-part model estimated the probability of usage and then the exten...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - October 1, 2015 Category: Health Management Authors: Morrisey, M. A., Blackburn, J., Becker, D. J., Sen, B., Kilgore, M. L., Caldwell, C., Menachemi, N. Tags: Original Research Source Type: research

Adverse Selection in the Children's Health Insurance Program
This study investigates whether new enrollees in the Alabama Children’s Health Insurance Program have different claims experience from renewing enrollees who do not have a lapse in coverage and from continuing enrollees. The analysis compared health services utilization in the first month of enrollment for new enrollees (who had not been in the program for at least 12 months) with utilization among continuing enrollees. A second analysis compared first-month utilization of those who renew immediately with those who waited at least 2 months to renew. A 2-part model estimated the probability of usage and then the exten...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - October 1, 2015 Category: Health Management Authors: Morrisey, M. A., Blackburn, J., Becker, D. J., Sen, B., Kilgore, M. L., Caldwell, C., Menachemi, N. Tags: Article Source Type: research

Measuring and Benchmarking Technical Efficiency of Public Hospitals in Tianjin, China: A Bootstrap-Data Envelopment Analysis Approach
China has long been stuck in applying traditional data envelopment analysis (DEA) models to measure technical efficiency of public hospitals without bias correction of efficiency scores. In this article, we have introduced the Bootstrap-DEA approach from the international literature to analyze the technical efficiency of public hospitals in Tianjin (China) and tried to improve the application of this method for benchmarking and inter-organizational learning. It is found that the bias corrected efficiency scores of Bootstrap-DEA differ significantly from those of the traditional Banker, Charnes, and Cooper (BCC) model, whic...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - September 21, 2015 Category: Health Management Authors: Li, H., Dong, S. Tags: Article Source Type: research

Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act
The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. We grouped states by political party control and compared their reactions across these policy goals. To identify changes in states’ rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA’s enactment, we conducted legal research and contacted each state’s insurance regulator. We linked rate r...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - September 21, 2015 Category: Health Management Authors: Fulton, B. D., Hollingshead, A., Karaca-Mandic, P., Scheffler, R. M. Tags: Article Source Type: research

Multistate Health Plans: Agents for Competition or Consolidation?
We discuss and evaluate the Multi-State Plan (MSP) Program, a provision of the Affordable Care Act that has not been the subject of much debate as yet. The MSP Program provides the Office of Personnel Management with new authority to negotiate and implement multistate insurance plans on all health insurance exchanges within the United States. We raise the concern that the MSP Program may lead to further consolidation of the health insurance industry despite the program’s stated goal of increasing competition by means of health insurance exchanges. The MSP Program arguably gives a competitive advantage to large insure...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - September 8, 2015 Category: Health Management Authors: Moffit, R. E., Meredith, N. R. Tags: Article Source Type: research

Provider Behavior Under Global Budgeting and Policy Responses: An Observational Study on Eye Care Services in Taiwan
This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multileve...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - August 30, 2015 Category: Health Management Authors: Chang, C.-K., Xirasagar, S., Chen, B., Hussey, J. R., Wang, I.-J., Chen, J.-C., Lian, I.-B. Tags: Article Source Type: research

More Health Expenditure, Better Economic Performance? Empirical Evidence From OECD Countries
This study aims to estimate the optimal health care expenditure in a growing economy. Applying the experiences of countries from the Organization for Economic Co-Operation and Development (OECD) over the period 1990 to 2009, this research introduces the method of system generalized method of moments (GMM) to derive the design of the estimators of the focal variables. Empirical evidence indicates that when the ratio of health spending to gross domestic product (GDP) is less than the optimal level of 7.55%, increases in health spending effectively lead to better economic performance. Above this, more spending does not equate...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - August 25, 2015 Category: Health Management Authors: Wang, F. Tags: Article Source Type: research

Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion
Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sens...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - August 25, 2015 Category: Health Management Authors: Jones, C. D., Scott, S. J., Anoff, D. L., Pierce, R. G., Glasheen, J. J. Tags: Article Source Type: research

Operating Profitability of For-Profit and Not-for-Profit Florida Community Hospitals During Medicare Policy Changes, 2000 to 2010
This study analyzed Florida community hospitals from 2000 through 2010, assessing changes in pre-tax operating margin (PTOM). Florida Agency for Health Care Administration data were analyzed for 104 community hospitals (62 FPs and 42 NFPs). Academic, public, and small hospitals were excluded. A mixed-effects model was used to assess the association of RAC implementation, organizational and payer type variables, and ownership interaction effects on PTOM. FP hospitals began the period with a higher average PTOM, but converged with NFPs during the study period. The average Medicare Advantage effect was not significant for eit...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - August 19, 2015 Category: Health Management Authors: Langland-Orban, B., Large, J. T., Sear, A. M., Zhang, H., Zhang, N. Tags: Article Source Type: research

Authorship Inflation in Medical Publications
The number of authors per manuscript in peer-reviewed medical journals has increased substantially in the last several decades. Several reasons have been offered to explain this authorship growth, including increased researcher collaboration, honorary authorship driven by increased pressures for funding and promotion, the belief that including senior authors will facilitate publication, and the growing complexity of medical research. It is unknown, however, whether authorship has grown over time due to growing complexity of published academic articles, in which case growth could be warranted, or whether it has grown due to...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - July 29, 2015 Category: Health Management Authors: Tilak, G., Prasad, V., Jena, A. B. Tags: Research Letter Source Type: research

The Impact of Medicaid Expansion on Medicaid Focused Insurers in California
To gain insights into the impact of Medicaid Expansion under the Affordable Care Act, this study assesses the enrollment, utilization, and financial performance measures of California Medicaid focused health insurers. The study compares these quarterly measures, during the expansion period of 2014 to the same quarterly measures in 2013 and 2012. During 2014, Medicaid focused insurers expanded enrollment, decreased inpatient days, and generated higher profit margins. (Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing)
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - July 29, 2015 Category: Health Management Authors: McCue, M. J. Tags: Article Source Type: research

Capital Investment by Independent and System-Affiliated Hospitals
Capital expenditures are a critical part of hospitals’ efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals’ ability to make capital expenditures. Using data from the American Ho...
Source: Inquiry: The Journal of Health Care Organization, Provision, and Financing - June 22, 2015 Category: Health Management Authors: Carroll, N. W., Smith, D. G., Wheeler, J. R. C. Tags: Article Source Type: research