Access To Care

Question 1

What are some barriers for nonelderly adults to healthcare?

Answer 1

No usual source of care, postponed seeking care due to cost, and went without needed care due to cost

Question 2

How can insurers restrict access to care?

Answer 2

Cost sharing, coverage limits, prior authorization, and use of referrals

Also via restricting kinds of care and reimbursement rates

Question 3

What are some ways legislation can aid access to care?

Answer 3

• insurance mandates: state mandates certain coverages in plans
• Medicaid waivers: funds programs in home and community
• mental health parity: mental health care required

Question 4

What are some central tenets of the ACA?

Answer 4

• preventing insurers from denying individuals coverage including exclusions to coverage due to health conditions
• prohibiting annual and lifetime limits on coverage
• capping out of pocket max for individuals and families and $9.45k and $18.9k

Question 5

What does the ACA Marketplace offer?

Answer 5

Choices of different health plans that allow the consumer to understand their options before applying

Question 6

What are the requirements for a tax credit?

Answer 6

• below federal poverty level
• no affordable access to care through employer
• not eligible for Medicare, Medicaid, or CHIP
• U.S. citizen
• if married, file taxes jointly

Question 7

What was the individual mandate?

Answer 7

Geared to combat adverse selection by incentivizing healthy people to be in the pool with a tax, but the tax was dropped to $0

Question 8

What are block grants?

Answer 8

Set amount of money from federal government given to smaller state governments

Question 9

What did the federal government propose to states to incentivize Medicaid expansion?

Answer 9

Temporary federal funding to expand Medicaid to nonelderly working adults under 133% FPL

Question 10

What is the medical loss ratio?

Answer 10

Limit to the amount of premiums that insurers keep for admin, marketing, and profits to 15-20%

Question 11

What’s the impact of Medicaid?

Answer 11

• lowered uninsured rate from 16%-8%
• emergency department use is suspect whether it went up or down
• scarily small networks (fewer than 25% of local physicians participate)

Question 12

What study was the Polsky et al. Study?

Answer 12

The secret shopper calling PCP experiment

Question 13

What were the two caller scripts in the Polsky et al. Study?

Answer 13

Script 1: just making a check up
Script 2: getting set up w/ a regular doctor to get a health concern checked

Question 14

With Medicaid coverage, was the appointment availability better than before Medicaid? How about against private insurance?

Answer 14

• appointment availability increased pre and post Medicaid for Medicaid covered
• however, private insurance still had far superior appointment availability (with slight decreases in their availability)

Question 15

What are some limitation of the secret caller experiment in the Polsky study?

Answer 15

• only conducted in 10 states, not generalizable
• only focused on PCP
• role of race, age, and gender was only based on voice of caller
• only in network providers included

Question 16

What was the Agarwal study?

Answer 16

The systematic review that claimed high-deductible health plans reduce health care cost and utilization, including use of needed preventive services

Agatta read all these papers

Question 17

What was a finding Polsky had regarding wait times?

Answer 17

They increased for both Medicaid and private health insurance

Question 18

What are some public and private policy implications of the Polsky study?

Answer 18

Better coordination of care and better use of urgent care

Question 19

What was the data source of the Agarwal study?

Answer 19

Systematic review of quasi-experimental studies

Question 20

What were the key findings of the Agarwal study?

Answer 20

• HDHP lower HC cost and decrease in healthcare use
• preventative care and medication adherence increased

Question 21

What are the limitation of the Agarwal study?

Answer 21

• categorization of studies were vague
• studies were quasi-experimental which had questionable internal and external validity
• not much research on health outcomes
• many of the papers were from MA or single employer - report bias

Question 22

What was the Wray study?

Answer 22

Survey on different types of health insurance and their experience with/ access to care, costs of care, and satisfaction w/ care

Question 23

What was the data source of the Wray experiment?

Answer 23

Survey data of those w/ private and public insurances

Question 24

What were the key findings of the Wray study?

Answer 24

• employer sponsored health insurance and individual private plans were more likely to report poor access to health care, higher costs of care, less satisfaction to care than public health insurance
• public health insurance provided more cost effective care

Question 25

What are some public and private policy implications of the Wray paper?

Answer 25

• protect private health insurance individuals from increasing costs
• increase number of individuals covered by public Health Insurance

Question 26

What were the limitations of the Wray study?

Answer 26

• missed out the uninsured
• telephone survey - selection bias - internal validity
• sociodemographic - uncontrolled confounder
• self-report bias
• heterogeneity of insurance plans
• no distinguished payment models