Abstract:
OBJECTIVE:. To examine the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer. DATA SOURCES:Administrative enrollment data from the Office of Personnel Management (OPM) and plan premiums and benefits data taken from the Checkbook Guide to health plans. STUDY DESIGN:We estimate individual plan choice models where the choice of health plan is a function of out-of-pocket premium, actuarial value, plan attributes, and individual characteristics. Plan attributes include plan structure (fee-for-service/preferred provider organization, point-of-service, or health maintenance organization), drug benefit structure, and whether or not the plan covers other types of spending such as dental services and diabetic supplies. The models are estimated by conditional logit. Our study focuses on three populations that currently choose FEHBP as their primary health care coverage and are similar to the Medicare population: current employees and retirees who are approaching the age of Medicare eligibility (ages 60-64) and current federal employees age 65+. Current employees age 65+ are eligible for Medicare, but their FEHBP plan is their primary payer. Retirees and employees 60-64 are not yet eligible for Medicare but are similar in many respects to recently age-eligible Medicare beneficiaries. We also estimate our model for current employees age 55 and younger as a comparison group. DATA COLLECTION METHODS:We select a random sample of retirees and employees age 60-64, as well as all current employees age 65+, from the OPM administrative database for the calendar year 2001. The plan choices available to each person are determined by the plans participating in their metropolitan statistical area. We match plan premium and attribute information from the Checkbook Guide to each plan in the enrollee's list of choices. PRINCIPAL FINDINGS:We find that current workers 65+, 60-64, and non-Medicare eligible retirees are sensitive to variation in plan premiums. The premium elasticities for these groups are similar in magnitude to those of the age 55 and under employee group. Older workers and retirees not yet eligible for Medicare are willing to pay a substantial amount for plans with open provider networks. The willingness to pay for open networks is significantly greater for these groups than for younger employees. Willingness to pay for open network plans varies significantly by income, but varies little by age within group. CONCLUSIONS:Our finding that older workers and non-Medicare eligible retirees are sensitive to plan premiums suggests that choice-based reform of Medicare would lead to cost-conscious choices by Medicare beneficiaries. However, our finding that these groups are willing to pay more for open network plans than younger employees suggest that higher risk individuals may migrate toward higher benefit, higher cost plans. Our findings on the relationship between income and willingness to pay for open network plans suggest that means testing is a viable reform for lowering Medicare program costs.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Florence CS,Atherly A,Thorpe KEdoi
10.1111/j.1475-6773.2006.00580.xsubject
Has Abstractpub_date
2006-10-01 00:00:00pages
1741-61issue
5eissn
0017-9124issn
1475-6773pii
HESR580journal_volume
41pub_type
杂志文章abstract:OBJECTIVE:To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES:Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Ass...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12032
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To measure the association between clinician specialization in nursing home (NH) practice and outcomes of patients who received postacute care in skilled nursing facilities (SNFs). DATA SOURCES:Medicare claims and NH assessments for 2 118 941 hospital discharges to 14 526 SNFs in January 2012-October 2014 an...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13138
更新日期:2019-06-01 00:00:00
abstract::The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income ...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:Patients discharged from a self-managed nursing unit are compared with patients from traditionally managed units on postdischarge outcomes. DATA SOURCES AND STUDY SETTING:Primary data were collected on patients discharged from eight nursing units in three clinical areas in one hospital from August through No...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:To describe the landscape of state antitrust activity and review related research and policy issues. In particular, to examine state laws that attempt to immunize mergers among healthcare providers from state and federal antitrust prosecution and consent decrees issued by state attorneys general permitting he...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To assess optimal activity size/mix of Connecticut local public health jurisdictions, through estimating economies of scale/scope/specialization for environmental inspections/services. DATA SOURCES/STUDY SETTING:Connecticut's 74 local health jurisdictions (LHJs) must provide environmental health services, bu...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12740
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To assess the influence of relational climate on quality of diabetes care. DATA SOURCES/STUDY SETTING:The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA adminis...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12675
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To compare the estimated effects of dialysis center profit status on patient survival using alternative estimation strategies with retrospective data. DATA SOURCES/STUDY SETTING:Patient and provider-level retrospective data from the United States Renal Data System (USRDS), 1996-1999. STUDY DESIGN:Observatio...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00581.x
更新日期:2006-12-01 00:00:00
abstract::Uniform hospital discharge abstract data from Maryland were used to examine the homogeneity of trauma-related DRGs with respect to a well-established measure of injury severity, the Injury Severity Score (ISS). Thirty DRGs were identified as including trauma cases with a wide range of severity; for each of these DRGs,...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:10.1111/j.1475-6773.2005.00450.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To describe the development of an instrument for assessing workforce perceptions of hospital safety culture and to assess its reliability and validity. DATA SOURCES/STUDY SETTING:Primary data collected between March 2004 and May 2005. Personnel from 105 U.S. hospitals completed a 38-item paper and pencil sur...
journal_title:Health services research
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1475-6773.2007.00706.x
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers. DATA:We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12792
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of partisan political control on financial performance, structure, and outcomes of for-profit and not-for-profit US nursing homes. DATA SOURCES/STUDY SETTING:Nineteen-year panel (1996-2014) of state election outcomes, financial performance data from nursing home cost reports, operation...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13061
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics. DATA SOURCES:Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments. STUDY DESIGN:Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12344
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:To compare health care utilization between Canadian and U.S. residents. DATA SOURCES:Nationally representative 2007 surveys from the Medical Expenditure Panel Survey for the United States and the Canadian Community Health Survey for Canada. STUDY DESIGN:We use descriptive and multivariate methods to examine...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01466.x
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:The use of Medicaid data to study cancer-related outcomes would be highly desirable. However, the accuracy of Medicaid claims data in the identification of incident cases of breast cancer is unknown. OBJECTIVES:(1) To estimate the sensitivity of Medicaid claims data for case ascertainment of breast cancer, ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.00155
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:In 2004, the State of Wisconsin introduced a change to their Medicaid Policy allowing medical care providers to be reimbursed for fluoride varnish treatment provided to Medicaid enrolled children. OBJECTIVE:To determine the extent by which a state-level policy change impacted access to fluoride varnish trea...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2009.00975.x
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVES:To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES:2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12215
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:To examine financial and nonfinancial access to care and utilization of primary health care services among children of working low-income families earning below 200 percent of the federal poverty level in California, and to compare them to children in nonworking low-income families and in families earning ove...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:This study explores the impact of multiple-site practices on the distribution of physician services within a medical service region. DATA SOURCES AND STUDY SETTING:A questionnaire was mailed to all urologists (100 percent response rate) practicing in north central Connecticut (the Hartford medical service ar...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To describe the key features of the first three Cash and Counseling demonstration programs and identify those which the programs have in common and those on which they differ. STUDY SETTING:Demonstration Cash and Counseling programs in Arkansas, Florida, and New Jersey. DATA SOURCES:Interviews with program ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00677.x
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To explore state patterns in the racial life expectancy gap. DATA SOURCES:The 1997-2004 Multiple Cause of Death PUF, 2000 U.S. Census. STUDY DESIGN:We calculated life expectancy at birth for black and white men and women. DATA EXTRACTION METHODS:Data were obtained by the NCHS and U.S. Census Bureau. PRINC...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01345.x
更新日期:2012-02-01 00:00:00
abstract::The concept of propensity to use ambulatory care is defined as the probability that a utilization occurs in a very small interval of time, given that no utilization has been observed before. With this definition of utilization, survival analysis can be used to assess the effect of a set of predictors on utilization. T...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:We estimate long-term health care costs of former smokers compared with continuing and never smokers using a retrospective cohort study of HMO enrollees. Previous research on health care costs associated with former smokers has suggested that quitters may incur greater health care costs than continuing smoker...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.00142
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING:Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13175
更新日期:2019-12-01 00:00:00
abstract::The concepts of class, race, and ethnicity figure prominently in health services research in Britain. Occupational class has been employed for nearly a century to investigate social inequalities in health and access to care. More recently, researchers have identified differences in health status and utilization betwee...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1995-04-01 00:00:00
abstract:OBJECTIVE:To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN:The 1991-93 administrative data from the...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children. DATA SOURCES:Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data. STUDY DESIGN:Cross-sect...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2003.00195.x
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To analyze the relationship between mental health and savings and compare it to the relationship between common chronic physical conditions and savings. DATA SOURCE:Healthcare for Communities, a national survey conducted in 1997/1998 with approximately 10,000 respondents. STUDY DESIGN:We used logistic regre...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994). DATA SOURCES/STUDY SETTING:State of Mar...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2001-04-01 00:00:00