Access To Care Flashcards
What are some barriers for nonelderly adults to healthcare?
No usual source of care, postponed seeking care due to cost, and went without needed care due to cost
How can insurers restrict access to care?
Cost sharing, coverage limits, prior authorization, and use of referrals
Also via restricting kinds of care and reimbursement rates
What are some ways legislation can aid access to care?
- insurance mandates: state mandates certain coverages in plans
- Medicaid waivers: funds programs in home and community
- mental health parity: mental health care required
What are some central tenets of the ACA?
- 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
What does the ACA Marketplace offer?
Choices of different health plans that allow the consumer to understand their options before applying
What are the requirements for a tax credit?
- 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
What was the individual mandate?
Geared to combat adverse selection by incentivizing healthy people to be in the pool with a tax, but the tax was dropped to $0
What are block grants?
Set amount of money from federal government given to smaller state governments
What did the federal government propose to states to incentivize Medicaid expansion?
Temporary federal funding to expand Medicaid to nonelderly working adults under 133% FPL
What is the medical loss ratio?
Limit to the amount of premiums that insurers keep for admin, marketing, and profits to 15-20%
What’s the impact of Medicaid?
- 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)
What study was the Polsky et al. Study?
The secret shopper calling PCP experiment
What were the two caller scripts in the Polsky et al. Study?
Script 1: just making a check up
Script 2: getting set up w/ a regular doctor to get a health concern checked
With Medicaid coverage, was the appointment availability better than before Medicaid? How about against private insurance?
- 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)
What are some limitation of the secret caller experiment in the Polsky study?
- 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
What was the Agarwal study?
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
What was a finding Polsky had regarding wait times?
They increased for both Medicaid and private health insurance
What are some public and private policy implications of the Polsky study?
Better coordination of care and better use of urgent care
What was the data source of the Agarwal study?
Systematic review of quasi-experimental studies
What were the key findings of the Agarwal study?
- HDHP lower HC cost and decrease in healthcare use
- preventative care and medication adherence increased
What are the limitation of the Agarwal study?
- 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
What was the Wray study?
Survey on different types of health insurance and their experience with/ access to care, costs of care, and satisfaction w/ care
What was the data source of the Wray experiment?
Survey data of those w/ private and public insurances
What were the key findings of the Wray study?
- 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
What are some public and private policy implications of the Wray paper?
- protect private health insurance individuals from increasing costs
- increase number of individuals covered by public Health Insurance
What were the limitations of the Wray study?
- missed out the uninsured
- telephone survey - selection bias - internal validity
- sociodemographic - uncontrolled confounder
- self-report bias
- heterogeneity of insurance plans
- no distinguished payment models
