Annual Medical Provider Visits Among People Aged 18 to 64 by Health Status : 2001 to (original) (raw)
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Hospital topics, 2009
The authors used data from nationally representative surveys to estimate health insurance sources for non-elderly patient visits to U.S. physicians. Results show that hospital emergency departments attract a greater share of ambulatory care visits by uninsured patients than by patients with either Medicaid or private insurance. Results also show that hospital outpatient departments attract a greater share of visits by uninsured patients or patients with Medicaid than by patients with private insurance. The annual visit rate of uninsured individuals for nonemergency care is less than half of that for individuals with either private insurance or Medicaid. The proportion of uninsured emergency department visits by individuals between the ages of 0 and 64 years was significantly greater than the proportion of uninsured individuals between the ages of 0 and 64 years. In contrast, the proportion of uninsured physician office visits by individuals between the ages of 0 and 64 years was sig...
The Effect of Health Insurance Coverage on the Use of Medical Services
American Economic Journal: Economic Policy, 2012
Substantial uncertainty exists regarding the causal effect of health insurance on the utilization of care. Most studies cannot determine whether the large differences in healthcare utilization between the insured and the uninsured are due to insurance status or to other unobserved differences between the two groups. In this paper, we exploit a sharp change in insurance coverage rates that results from young adults "aging out" of their parents' insurance plans to estimate the effect of insurance coverage on the utilization of emergency department (ED) and inpatient services. Using the National Health Interview Survey (NHIS) and a census of emergency department records and hospital discharge records from seven states, we find that aging out results in an abrupt 5 to 8 percentage point reduction in the probability of having health insurance. We find that not having insurance leads to a 40 percent reduction in ED visits and a 61 percent reduction in inpatient hospital admissions. The drop in ED visits and inpatient admissions is due entirely to reductions in the care provided by privately owned hospitals, with particularly large reductions at for profit hospitals. The results imply that expanding health insurance coverage would result in a substantial increase in care provided to currently uninsured individuals.
A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults
Annals of Internal Medicine, 2008
T he number of Americans without insurance increased from 31 million in 1987 to 47 million in 2006 (1, 2). Policymakers, including President George W. Bush, have cited the youthfulness and presumed health of those without insurance (3-5), and some have argued that the predicament of uninsured persons is often voluntary and rarely consequential (6). Chronic illnesses, such as diabetes mellitus, coronary artery disease, and hypertension, are highly prevalent in the United States. Modern therapies for these conditions extend life and minimize disabling complications (7-11). Fragmentary data suggest that lack of health insurance may worsen care of chronic illness. A medically indigent population in California had deterioration in blood pressure control and self-reported health status after their Medicaid coverage was discontinued (12). Persons without health insurance may be more likely to skip medications, use the emergency department, and be hospitalized (13, METHODS Data Source To evaluate individuals age 18 to 64 years in the United States, we used 6 years of data (1999-2004) from the continuous NHANES (National Health and Nutrition Examination Survey), which is conducted during 2-year intervals. The National Center for Health Statistics conducts NHANES, which is designed to assess the health and nutrition status of the noninstitutionalized U.S. population. The survey is conducted in English and Spanish and includes interviews, physical examinations, and laboratory testing. Because almost all persons older than age 64 years See also:
Issue brief (Commonwealth Fund), 2016
Issue: Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics. Goal: Examine demographics and health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults differed notably from adults with multiple chronic diseases but no functional limitations. They had average annual health care expenditures that were nearly three times higher—and which were more likely to remain high over two years of observation—and out-of-pocket expenses that were more than a third higher, despite their lower incomes. Rates of hospital use for high-need adults were more than twice those for adults with multiple chronic conditi...
Household out-of-pocket health care expenditure trends: 1980-95
International Journal of Consumer Studies, 2001
restraining costs through use of preventive care, prepayment of most medical services and restricting the use of medical services. 2-4 The elderly and the poor can obtain basic health care through government funded Medicare and Medicaid respectively. 5,6 Tax and transfer payments essentially redistribute a portion of the health care financial burden from these groups to the general population. This redistribution implies that a social contract exists which says that those least able to help themselves as a result of advanced age, limited physical capacity or inadequate economic resources should receive help to meet a basic need. Escalating health care costs have begun to force reconsideration of the form and extent of this social contract, however. Provisions of the 1997 Balanced Budget Act were clearly intended to slow growth in public health care expenditures under Medicare and Medicaid. If accessible and affordable health care for a broad segment of the U.S. population is a public policy goal, assessing household out-of-pocket spending on health care is important for national health policy planning. This study uses 15 years of Consumer Expenditure Survey data to chart trends in constant dollar outof-pocket dollar expenditures and household budget shares for health insurance, medical services, prescription drugs and medical supplies, taking eligibility for government health care programmes into consideration. Findings were used to draw policy implications regarding the effect of health care market changes and the allocation of the health care financial burden. Related literature The health economics literature suggests that the low price that consumers pay out-of-pocket after the insurance company covers the larger share of the costs induces a higher demand for health care. 7 In support of this idea, Rubin and Koelln 8 found a significant and
Medical Spending and the Health of the Elderly
Health Services Research, 2011
Objective. To estimate the relationship between variations in medical spending and health outcomes of the elderly. Data Sources. [1992][1993][1994][1995][1996][1997][1998][1999][2000][2001][2002] Medicare Current Beneficiary Surveys. Study Design. We used instrumental variable (IV) estimation to identify the relationships between alternative measures of elderly Medicare beneficiaries' medical spending over a 3-year observation period and health status, measured by the Health and Activity Limitation Index (HALex) and survival status at the end of the 3 years. We used the Dartmouth Atlas End-of-Life Expenditure Index defined for hospital referral regions in 1996 as the exogenous identifying variable to construct the IVs for medical spending. Data Collection/Extraction Methods. The analysis sample includes 17,438 elderly (age 464) beneficiaries who entered the Medicare Current Beneficiary Survey in the fall of each year from 1991 to 1999, were not institutionalized at baseline, stayed in feefor-service Medicare for the entire observation period, and survived for at least 2 years. Measures of baseline health were constructed from information obtained in the fall of the year the person entered the survey, and changes in health were from subsequent interviews over the entire observation period. Medicare and total medical spending were constructed from Medicare claims and self-reports of other spending over the entire observation period. Principal Findings. IV estimation results in a positive and statistically significant relationship between medical spending and better health: 10 percent greater medical spending over the prior 3 years (mean 5 U.S.$2,709) is associated with a 1.9 percent larger HALex value (p 5 .045; range 1.2-2.2 percent depending on medical spending measure) and a 1.5 percent greater survival probability (p 5 .039; range 1.2-1.7 percent). Conclusions. On average, greater medical spending is associated with better health status of Medicare beneficiaries, implying that across-the-board reductions in Medicare spending may result in poorer health for some beneficiaries.
Self-reported healthcare provider utilization across United States Midwestern households
Preventive Medicine Reports, 2018
Understanding the relationships between health care provider usage and demographics of patients is necessary for the development of educational materials, outreach information, and programs targeting individuals who may benefit from services. This analysis identified relationships between health care provider usage and individual's demographics. A sample of Midwestern U.S. respondents (n = 1265) was obtained through the use of an online survey distributed February 12-26, 2016 and was targeted to be representative of the population of the Midwestern states sampled in terms of sex, age, income, and state of residence. Specific factors identified as significant in contributing to provider usage (in the past five years) differed across the eleven provider types studied. In the most commonly used practitioners (the general or primary physician), relationships between provider usage and age, income, health insurance coverage status, and having children in the household were identified. Furthermore, significant (and positive) correlations were identified between the usage of various practitioners; reporting the use of one type of practitioner studied was correlated positively with reporting the use of another type of health care provider studied in this analysis. This analysis provides insight into the relationships between health care provider usage and demographics of individuals, which can aid in the development of educational materials, outreach programs, and policy development. 2. Methods 2.1. Survey instrument Data was collected using a survey designed in Qualtrics and hosted
Exploring Disparities in Access to Physician Services Among Older Adults: 2000-2007
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013
Objectives. To compare racial/ethnic disparities in access to physician services among older adults in 2000 and 2007 and to identify potential factors driving the changes observed. Method. Using 2000 and 2007 Medical Expenditure Panel Survey data, we examine 2 measures of access for adults aged 65 and older: whether the individual reports of having a usual source of care (USC) and whether he/she made any physician visits during the past year. We model the determinants of access using logistic regressions and then calculate disparities in access between older African Americans and older Whites and between older Hispanics and older Whites applying a disparity definition suggested by the Institute of Medicine. Results. In both 2000 and 2007, significant racial/ethnic disparities were evident in having no USC and in having no physician visits. Over the period, the disparity in having no physician visits diminished by 6.16% (p = .003) for African Americans, but it worsened by 5.28% (p = .021) for Hispanics. These changes were associated with a positive shift in the distribution of education among older African Americans and an erosion in Medicare among Hispanic seniors. Conclusion. Among older adults, disparities in access to physician services have diminished for African Americans but have grown worse for Hispanics.
Unreimbursed expenses for medical care among urban elderly people
Journal of Community Health, 1990
Out-of-pocket medical expenditures were examined among a sample of 400 low-to-moderate income Medicare recipients living in the Bronx for a twelve month period in 1986-87. Using three different measures of magnitude, the most significant expenses were for Medicare and private insurance premiums, medications, and dental care. The mean percent of per capita income spent out-of-pocket for medical care (including health care premiums) was 11.0%. Elderly people who spend over 12% of their own income on medical care include those in the poorest health, those with annual incomes under $15,000, people living with spouses or others, and those using a private physician as a primary source of medical care.
American Journal of Public Health, 2011
We sought to determine how part-year and full-year gaps in health insurance coverage affected working-aged persons with chronic health care needs. We conducted multivariate analyses of the 2002-2004 Medical Expenditure Panel Survey to compare access, utilization, and out-of-pocket spending burden among key groups of persons with chronic conditions and disabilities. The results are generalizable to the US community-dwelling population aged 18 to 64 years. Among 92 million adults with chronic conditions, 21% experienced at least 1 month uninsured during the average year (2002-2004). Among the 25 million persons reporting both chronic conditions and disabilities, 23% were uninsured during the average year. These gaps in coverage were associated with significantly higher levels of access problems, lower rates of ambulatory visits and prescription drug use, and higher levels of out-of-pocket spending. Implementation of health care reform must focus not only on the prevention of chronic conditions and the expansion of insurance coverage but also on the long-term stability of the coverage to be offered.