Original Research

@article{gaffney_effect_2020-1,

title = {The Effect Of Veterans Health Administration Coverage On Cost-Related Medication Nonadherence.},

author = {Adam Gaffney and David H. Bor and David U. Himmelstein and Steffie Woolhandler and Danny McCormick},

doi = {10.1377/hlthaff.2019.00481},

issn = {2694-233X 0278-2715},

year  = {2020},

date = {2020-01-01},

journal = {Health affairs (Project Hope)},

volume = {39},

number = {1},

pages = {33–40},

abstract = {High out-of-pocket drug spending worsens adherence and outcomes, especially for patients who are poor, chronically ill, or members of minority groups. The Veterans Health Administration (VHA) system provides drugs at minimal cost, which could reduce cost-related medication nonadherence. Using data for 2013-17 from the National Health Interview Survey, we evaluated the association of VHA coverage with such nonadherence. Although people with VHA coverage were older and in worse health and had lower incomes than those with other coverage, VHA patients had lower rates of cost-related medication nonadherence: 6.1 percent versus 10.9 percent for non-VHA patients, an adjusted 5.9-percentage-point difference. VHA coverage was associated with especially large reductions in nonadherence among people with chronic illnesses and with reduced racial/ethnic and socioeconomic disparities in nonadherence. The VHA pharmacy benefit is a model for reform to address the crisis in prescription drug affordability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_high-deductible_2020,

title = {High-Deductible Health Plans and Healthcare Access, Use, and Financial Strain in Those with Chronic Obstructive Pulmonary Disease.},

author = {Adam Gaffney and Alexander White and Laura Hawks and David Himmelstein and Steffie Woolhandler and David C. Christiani and Danny McCormick},

doi = {10.1513/AnnalsATS.201905-400OC},

issn = {2325-6621},

year  = {2020},

date = {2020-01-01},

journal = {Annals of the American Thoracic Society},

volume = {17},

number = {1},

pages = {49–56},

abstract = {Rationale: Medical treatment can improve quality of life and avert exacerbations for those with chronic obstructive pulmonary disease (COPD). High-deductible health plans (HDHPs) can increase exposure to medical costs, and might compromise healthcare access and financial well-being for patients with COPD.Objectives: To examine the association of HDHPs with healthcare access, utilization, and financial strain among individuals with COPD.Methods: We analyzed privately insured adults aged 40-64 years with COPD in the 2011-2017 National Health Interview Survey, which uses Internal Revenue Service-specified thresholds to classify health plans as "high" or "traditional" deductible coverage. We assessed the association between enrollment in an HDHP and indicators of cost-related impediments to care, financial strain, and healthcare utilization, adjusting for potential confounders.Results: Our sample included 803 individuals with an HDHP and 1,334 with a traditional plan. The two groups' demographic and health characteristics were similar. Individuals enrolled in an HDHP more frequently reported delayed or foregone care, cost-related medication nonadherence, medical bill problems, and financial strain. They also more frequently reported out-of-pocket healthcare spending in excess of $5,000 a year. Although the two groups' office visit rates were similar, those enrolled in an HDHP were more likely to report a hospitalization or emergency room visit in the past year.Conclusions: For patients with COPD, enrollment in an HDHP was associated with cost-related barriers to care, financial strain, and more frequent emergency room visits and hospitalizations.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_coverage_2019,

title = {Coverage Expansions and Utilization of Physician Care: Evidence From the 2014 Affordable Care Act and 1966 Medicare/Medicaid Expansions.},

author = {Adam Gaffney and Danny McCormick and David Bor and Steffie Woolhandler and David Himmelstein},

doi = {10.2105/AJPH.2019.305330},

issn = {1541-0048 0090-0036},

year  = {2019},

date = {2019-12-01},

journal = {American journal of public health},

volume = {109},

number = {12},

pages = {1694–1701},

abstract = {Objectives. To evaluate the effects of the 2 major coverage expansions in US history-Medicare/Medicaid in 1966 and the Affordable Care Act (ACA) in 2014-on the utilization of physician care.Methods. Using the National Health Interview Survey (1963-1969; 2011-2016), we analyzed trends in utilization of physician services society-wide and by targeted subgroups.Results. Following Medicare/Medicaid's implementation, society-wide utilization remained unchanged. While visits by low-income persons increased 6.2% (P < .01) and surgical procedures among the elderly increased 14.7% (P < .01), decreases among nontargeted groups offset these increases. After the ACA, society-wide utilization again remained unchanged. Increased utilization among targeted low-income groups (e.g., a 3.5-percentage-point increase in the proportion of persons earning less than or equal to 138% of the federal poverty level with at least 1 office visit [P < .001]) was offset by small, nonsignificant reductions among the nontargeted population.Conclusions. Past coverage expansions in the United States have redistributed physician care, but have not increased society-wide utilization in the short term, possibly because of the limited supply of physicians.Public Health Implications. These findings suggest that future expansions may not cause unaffordable surges in utilization.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{banerjee_association_2019,

title = {Association between degree of exposure to the Hospital Value Based Purchasing Program and 30-day mortality: experience from the first four years of Medicare's pay-for-performance program.},

author = {Souvik Banerjee and Danny McCormick and Michael K. Paasche-Orlow and Meng-Yun Lin and Amresh D. Hanchate},

doi = {10.1186/s12913-019-4562-7},

issn = {1472-6963},

year  = {2019},

date = {2019-12-01},

journal = {BMC health services research},

volume = {19},

number = {1},

pages = {921},

abstract = {BACKGROUND: The Hospital Value Based Purchasing Program (HVBP) in the United States, announced in 2010 and implemented since 2013 by the Centers for Medicare and Medicaid Services (CMS), introduced payment penalties and bonuses based on hospital performance on patient 30-day mortality and other indicators. Evidence on the impact of this program is limited and reliant on the choice of program-exempt hospitals as controls. As program-exempt hospitals may have systematic differences with program-participating hospitals, in this study we used an alternative approach wherein program-participating hospitals are stratified by their financial exposure to penalty, and examined changes in hospital performance on 30-day mortality between hospitals with high vs. low financial exposure to penalty. METHODS: Our study examined all hospitals reimbursed through the Medicare Inpatient Prospective Payment System (IPPS) - which include most community and tertiary acute care hospitals - from 2009 to 2016. A hospital's financial exposure to HVBP penalties was measured by the share of its annual aggregate inpatient days provided to Medicare patients ("Medicare bed share"). The main outcome measures were annual hospital-level 30-day risk-adjusted mortality rates for acute myocardial infarction (AMI), heart failure (HF) and pneumonia patients. Using difference-in-differences models we estimated the change in the outcomes in high vs. low Medicare bed share hospitals following HVBP. RESULTS: In the study cohort of 1902 US hospitals, average Medicare bed share was 61 and 41% in high (n = 540) and low (n = 1362) Medicare bed share hospitals, respectively. High Medicare bed share hospitals were more likely to have smaller bed size and less likely to be teaching hospitals, but ownership type was similar among both Medicare bed share groups.. Among low Medicare bed share (control) hospitals, baseline (pre-HVBP) 30-day mortality was 16.0% (AMI), 10.9% (HF) and 11.4% (pneumonia). In both high and low Medicare bed share hospitals 30-day mortality experienced a secular decrease for AMI, increase for HF and pneumonia; differences in the pre-post change between the two hospital groups were small (< 0.12%) and not significant across all three conditions. CONCLUSIONS: HVBP was not associated with a meaningful change in 30-day mortality across hospitals with differential exposure to the program penalty.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_canadas_2019,

title = {Canada's Single-Payer Health Care System-Reply.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1001/jama.2019.14406},

issn = {1538-3598 0098-7484},

year  = {2019},

date = {2019-11-01},

journal = {JAMA},

volume = {322},

number = {19},

pages = {1922–1923},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{urato_national_2019,

title = {National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.},

author = {Adam C. Urato and Elia Abi-Jaoude and John Abramson and Harrison Alter and Louise B. Andrew and David Antonuccio and Lisa Bero and Pierre Biron and Laura S. Boylan and Alain Braillon and James M. Brophy and Shannon Brownlee and Alan Cassels and Robert Cook-Deegan and Lisa Cosgrove and Luca De Fiore and Richard A. Deyo and Adam Elshaug and Cindy Farquhar and Daniel M. Fatovich and Eileen Fingerman and Juan Gérvas and Peter C. Gøtzsche and Rafael Gracia and Iona Heath and David U. Himmelstein and Jerome R. Hoffman and Teppo Järvinen and Jon Jureidini and Andrew Kotaska and Thomas Kuehlein and Jeanne Lenzer and Susan Levenstein and Joel Lexchin and Barbara Mintzes and Florian Naudet and Manon Niquette and Lusy Paulyna Orellana Navarrete and Cynthia A. Pearson and Geneviève Rail and Richard Roberts and Naman Shah and Vera Sharav and Jay Siwek and Stefan Topolski and Alexander C. Tsai},

doi = {10.1097/AOG.0000000000003540},

issn = {1873-233X 0029-7844},

year  = {2019},

date = {2019-11-01},

journal = {Obstetrics and gynecology},

volume = {134},

number = {5},

pages = {1115–1117},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hawks_association_2019,

title = {Association Between Forced Sexual Initiation and Health Outcomes Among US Women.},

author = {Laura Hawks and Steffie Woolhandler and David U. Himmelstein and David H. Bor and Adam Gaffney and Danny McCormick},

doi = {10.1001/jamainternmed.2019.3500},

issn = {2168-6114 2168-6106},

year  = {2019},

date = {2019-11-01},

journal = {JAMA internal medicine},

volume = {179},

number = {11},

pages = {1551–1558},

abstract = {IMPORTANCE: The #MeToo movement has highlighted how frequently women experience sexual violence. However, to date, no recent studies have assessed the prevalence of forced sex during girls' and women's first sexual encounter or its health consequences. OBJECTIVE: To estimate the prevalence of forced sexual initiation among US women and its association with subsequent reproductive, gynecologic, and general health outcomes. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of the 2011-2017 National Survey of Family Growth was conducted, including a population-based sample of 13 310 US women. The study was conducted from September 2011 to September 2017. EXPOSURES: Self-reported forced vs voluntary first sexual intercourse. MAIN OUTCOMES AND MEASURES: Prevalence of forced sexual initiation, age of woman and partner/assailant at first sexual encounter, and odds ratios (ORs) (adjusted for sociodemographic characteristics) for having an unwanted first pregnancy or abortion, development of painful pelvic conditions, and other reproductive and general health measures. RESULTS: A total of 13 310 women between the ages of 18 and 44 years were included in the study. After survey weights were applied, 6.5% (95% CI, 5.9%-7.1%) of respondents reported experiencing forced sexual initiation, equivalent to 3 351 733 women in this age group nationwide. Age at forced sexual initiation averaged 15.6 (95% CI, 15.3-16.0) years vs 17.4 (95% CI, 17.3-17.5) years for voluntary sexual initiation (P < .001). The mean age of the partner/assailant at first sexual encounter was 6 years older for women with forced vs voluntary sexual initiation (27.0; 95% CI, 24.8-29.2 years vs 21.0; 95% CI, 20.6-21.3 years). Compared with women with voluntary sexual initiation, women with forced sexual initiation were more likely to experience an unwanted first pregnancy (30.1% vs 18.9%; adjusted OR [aOR], 1.9; 95% CI, 1.5-2.4) or an abortion (24.1% vs 17.3%; aOR, 1.5; 95% CI, 1.2-2.0), endometriosis (10.4% vs 6.5%; aOR, 1.6; 95% CI, 1.1-2.3), pelvic inflammatory disease (8.1% vs 3.4%; aOR, 2.2; 95% CI, 1.5-3.4), and problems with ovulation or menstruation (27.0% vs 17.1%; aOR, 1.8; 95% CI, 1.4-2.3). Survivors of forced sexual initiation more frequently reported illicit drug use (2.6% vs 0.7%; aOR, 3.6; 95% CI, 1.8-7.0), fair or poor health (15.5% vs 7.5%; aOR, 2.0; 95% CI, 1.5-2.7), and difficulty completing tasks owing to a physical or mental health condition (9.0% vs 3.2%; aOR, 2.8; 95% CI, 2.0-3.9). CONCLUSIONS AND RELEVANCE: Forced sexual initiation in women appears to be common and associated with multiple adverse reproductive and general health outcomes. These findings highlight the possible need for public health measures and sociocultural changes to prevent sexual violence, particularly forced sexual initiation.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_implications_2019,

title = {Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care.},

author = {Leah Zallman and Karen E. Finnegan and David U. Himmelstein and Sharon Touw and Steffie Woolhandler},

doi = {10.1001/jamapediatrics.2019.1744},

issn = {2168-6211 2168-6203},

year  = {2019},

date = {2019-09-01},

journal = {JAMA pediatrics},

volume = {173},

number = {9},

pages = {e191744},

abstract = {IMPORTANCE: In October 2018, the Trump administration published a proposed rule change that would increase the chance of an immigrant being deemed a "public charge" and thereby denied legal permanent residency or entry to the United States. The proposed changes are expected to cause many immigrant parents to disenroll their families from safety-net programs, in large part because of fear and confusion about the rule, even among families to whom the rule does not technically apply. OBJECTIVE: To simulate the potential harms of the rule change by estimating the number, medical conditions, and care needs of children who are at risk of losing their current benefits, including Medicaid and Children's Health Insurance Program (CHIP) and Supplemental Nutrition Assistance Program (SNAP). DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study used nationally representative data from 4007 children 17 years of age or younger who participated in the 2015 Medical Expenditure Panel Survey to assess their potential risk of losing benefits because they live with a noncitizen adult. Statistical analysis was conducted from January 3 to April 8, 2019. MAIN OUTCOMES AND MEASURES: The number of children at risk of losing benefits; the number of children with medical need, defined as having a potentially serious medical diagnosis; being disabled (or functionally limited); or having received any specific treatment in the past year. The numbers of children who would be disenrolled under likely disenrollment scenarios drawn from research on immigrants before and after the 1996 welfare reform were estimated. RESULTS: A total of 8.3 million children who are currently enrolled in Medicaid and CHIP or receiving SNAP benefits are potentially at risk of disenrollment, of whom 5.5 million have specific medical needs, including 615 842 children with asthma, 53 728 children with epilepsy, 3658 children with cancer, and 583 700 children with disabilities or functional limitations. Nonetheless, among the population potentially at risk of disenrollment, medical need was less common than among other children receiving Medicaid and CHIP or SNAP (64.5%; 95% CI, 61.5%-67.4%; vs 76.0%; 95% CI, 73.9%-78.4%; P < .001). The proposed rule is likely to cause parents to disenroll between 0.8 million and 1.9 million children with specific medical needs from health and nutrition benefits. CONCLUSIONS AND RELEVANCE: The proposed public charge rule would likely cause millions of children to lose health and nutrition benefits, including many with specific medical needs that, if left untreated, may contribute to child deaths and future disability.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_effects_2019,

title = {The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States.},

author = {Adam Gaffney and Danny McCormick and David H. Bor and Anna Goldman and Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/M18-2806},

issn = {1539-3704 0003-4819},

year  = {2019},

date = {2019-08-01},

journal = {Annals of internal medicine},

volume = {171},

number = {3},

pages = {172–180},

abstract = {BACKGROUND: Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth. OBJECTIVE: To determine how the implementations of Medicare and Medicaid (1966) and the Patient Protection and Affordable Care Act (ACA) (2014) affected hospital use. DESIGN: Repeated cross-sectional study. SETTING: Nationally representative surveys. PARTICIPANTS: Respondents to the National Health Interview Survey (1962 to 1970) and Medical Expenditure Panel Survey (2008 to 2015). MEASUREMENTS: Mean hospital discharges and days were measured, both society-wide and among subgroups defined by income, age, and health status. Changes between preexpansion and postexpansion periods were analyzed using multivariable negative binomial regression. RESULTS: Overall hospital discharges averaged 12.8 per 100 persons in the 3 years before implementation of Medicare and Medicaid and 12.7 per 100 persons in the 4 years after (adjusted difference, 0.2 discharges [95% CI, -0.1 to 0.4 discharges] per 100 persons; P = 0.26). Hospital days did not change in the first 2 years after implementation but increased later. Effects differed by subpopulation: Adjusted discharges increased by 2.4 (CI, 1.7 to 3.1) per 100 persons among elderly compared with nonelderly persons (P < 0.001) and also increased among those with low incomes compared with high-income populations. For younger and higher-income persons, use decreased. Similarly, after the ACA's implementation, overall hospital use did not change: Society-wide rates of discharge were 9.4 per 100 persons before the ACA and 9.0 per 100 persons after the ACA (adjusted difference, -0.6 discharges [CI, -1.3 to 0.2 discharges] per 100 persons; P = 0.133), and hospital days were also stable. Trends differed for some subgroups, and rates decreased significantly in unadjusted (but not adjusted) analyses among persons reporting good or better health status and increased nonsignificantly among those in worse health. LIMITATION: Data sources relied on participant recall, surveys excluded institutionalized persons, and follow-up after the ACA was limited. CONCLUSION: Past coverage expansions were associated with little or no change in society-wide hospital use; increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use. Reducing coverage may merely shift care toward wealthier and healthier persons. Conversely, universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained. PRIMARY FUNDING SOURCE: None.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_us_2019,

title = {UṠ. Health Care in the Trump Era: A Data Update.},

author = {David U. Himmelstein and Steffie Woolhandler and Clare Fauke},

doi = {10.1177/0020731419840178},

issn = {1541-4469 0020-7314},

year  = {2019},

date = {2019-07-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {49},

number = {3},

pages = {402–411},

abstract = {We present a summary of recent studies and data regarding the state of health and health care in the United States. Health care remains unaffordable to many Americans, including many with insurance. Health outcomes are stagnating or deteriorating. Police killings disproportionately target minority men. The search for profits from prescription drug companies, medical device firms, and for-profit medical providers places patients at risk. The public Medicare and Medicaid insurance programs, which increasingly subcontract with private managed care insurers, now account for the majority of private insurers' total business. Insurance firms continue to avoid unprofitable enrollees and impose a mounting bureaucratic burden on medical providers. Meanwhile, recent polls show mounting public support for single-payer national health insurance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_incidence_2019,

title = {The Incidence of Diabetic Ketoacidosis During "Emerging Adulthood" in the USA and Canada: a Population-Based Study.},

author = {Adam Gaffney and Andrea Christopher and Alan Katz and Dan Chateau and Chelsey McDougall and David Bor and David Himmelstein and Steffie Woolhandler and Danny McCormick},

doi = {10.1007/s11606-019-05006-6},

issn = {1525-1497 0884-8734},

year  = {2019},

date = {2019-07-01},

journal = {Journal of general internal medicine},

volume = {34},

number = {7},

pages = {1244–1250},

abstract = {BACKGROUND: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication. OBJECTIVE: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood." DESIGN: Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013). PARTICIPANTS: Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba). MAIN MEASURES: DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization. KEY RESULTS: The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba. CONCLUSIONS: In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_single-payer_2019,

title = {Single-Payer Reform-"Medicare for All".},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1001/jama.2019.7031},

issn = {1538-3598 0098-7484},

year  = {2019},

date = {2019-06-01},

journal = {JAMA},

volume = {321},

number = {24},

pages = {2399–2400},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_medicare_2019,

title = {Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/M19-0780},

issn = {1539-3704 0003-4819},

year  = {2019},

date = {2019-06-01},

journal = {Annals of internal medicine},

volume = {170},

number = {11},

pages = {793–795},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_care_2019,

title = {Care For America's Elderly And Disabled People Relies On Immigrant Labor.},

author = {Leah Zallman and Karen E. Finnegan and David U. Himmelstein and Sharon Touw and Steffie Woolhandler},

doi = {10.1377/hlthaff.2018.05514},

issn = {2694-233X 0278-2715},

year  = {2019},

date = {2019-06-01},

journal = {Health affairs (Project Hope)},

volume = {38},

number = {6},

pages = {919–926},

abstract = {As the US wrestles with immigration policy and caring for an aging population, data on immigrants' role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants' role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants' role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2 percent of the US population, they made up 9.0 percent of direct care workers. Naturalized citizens, 6.8 percent of the US population, accounted for 13.9 percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_medical_2019,

title = {Medical Bankruptcy: Still Common Despite the Affordable Care Act.},

author = {David U. Himmelstein and Robert M. Lawless and Deborah Thorne and Pamela Foohey and Steffie Woolhandler},

doi = {10.2105/AJPH.2018.304901},

issn = {1541-0048 0090-0036},

year  = {2019},

date = {2019-03-01},

journal = {American journal of public health},

volume = {109},

number = {3},

pages = {431–433},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{saluja_barriers_2019,

title = {Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients' Experiences.},

author = {Sonali Saluja and Danny McCormick and Michael R. Cousineau and Janina Morrison and Lisa Shue and Kyle Joyner and Michael Hochman},

doi = {10.1089/heq.2019.0056},

issn = {2473-1242},

year  = {2019},

date = {2019-01-01},

journal = {Health equity},

volume = {3},

number = {1},

pages = {423–430},

abstract = {Purpose: Millions of people gained health care coverage in Los Angeles after the Affordable Care Act (ACA); however, challenges with obtaining and utilizing primary care still persist, particularly in the safety net. In this study, we explore barriers to accessing primary care services among safety-net patients in Los Angeles after Medicaid expansion and implementation of other programs for safety-net patients after the ACA. Methods: We conducted qualitative interviews, in Spanish and English, with 34 nonelderly adult patients in 1 of 3 insurance groups: Medicaid, MyHealthLA (a health care program for low-income undocumented individuals), or uninsured. We recruited participants from three sites in Los Angeles in 2017. We analyzed our interviews using a framework approach and included emerging concepts from participant responses. Results: We identified seven themes regarding barriers to accessing primary care: understanding the concept of primary care, finding a primary care provider (PCP), switching PCPs, getting timely appointments, geography and transportation, perceived cost or coverage barriers, and preferring emergency or urgent care over primary care. Patients with Medicaid were more likely to report barriers compared with other groups. Uninsured patients were less likely to understand the concept of primary care. Patients with MyHealthLA noted getting timely appointments and cost of care to be significant barriers. Conclusion: Despite Medicaid and other coverage expansions for safety-net patients after the ACA, substantial barriers to accessing primary care persist. Addressing such barriers through the development of targeted interventions or broader policy solutions could improve access to primary care for safety-net patients in Los Angeles.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_impact_2019,

title = {Impact of Social Factors on Hospital Readmissions at Massachusetts' Two Largest Safety Net Hospitals After State Health Reform.},

author = {Danny McCormick and Srini Rao and Nancy Kressin and Rich Balaban and Leah Zallman},

doi = {10.1353/hpu.2019.0092},

issn = {1548-6869 1049-2089},

year  = {2019},

date = {2019-01-01},

journal = {Journal of health care for the poor and underserved},

volume = {30},

number = {4},

pages = {1467–1485},

abstract = {Little is known about whether social factors are related to readmissions among non-elderly adults admitted to safety-net hospitals (SNHs), particularly after health reform that lowered barriers to obtaining post-discharge medical care through insurance expansion. We conducted a prospective cohort study of 713 non-elderly adults at two of Massachusetts' largest SNHs eight years after Massachusetts' health reforms. Social factors were assessed through in-person interviews and electronic health record data. After adjustment for clinical variables, public insurance, White race/ethnicity, being unemployed, being unstably housed, having an alcohol-related index admission, and having a substance use-related index admission remained associated with readmissions at 90 days. At 30 days, public insurance, worry about safety or condition of housing, and having an alcohol-related index admission remained associated with readmissions. Unadjusted models were consistent with these findings. Accounting for social factors in readmission adjustment schemes used by payers may be important for ensuring payment equity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{goldman_analysis_2018,

title = {Analysis of Work Requirement Exemptions and Medicaid Spending.},

author = {Anna L. Goldman and Steffie Woolhandler and David U. Himmelstein and David H. Bor and Danny McCormick},

doi = {10.1001/jamainternmed.2018.4194},

issn = {2168-6114 2168-6106},

year  = {2018},

date = {2018-11-01},

journal = {JAMA internal medicine},

volume = {178},

number = {11},

pages = {1549–1552},

abstract = {This study estimates the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented and calculates current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_immigrants_2018,

title = {Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits.},

author = {Leah Zallman and Steffie Woolhandler and Sharon Touw and David U. Himmelstein and Karen E. Finnegan},

doi = {10.1377/hlthaff.2018.0309},

issn = {2694-233X 0278-2715},

year  = {2018},

date = {2018-10-01},

journal = {Health affairs (Project Hope)},

volume = {37},

number = {10},

pages = {1663–1668},

abstract = {As US policy makers tackle immigration reform, knowing whether immigrants are a burden on the nation's health care system can inform the debate. Previous studies have indicated that immigrants contribute more to Medicare than they receive in benefits but have not examined whether the roughly 50 percent of immigrants with private coverage provide a similar subsidy or even drain health care resources. Using nationally representative data, we found that immigrants accounted for 12.6 percent of premiums paid to private insurers in 2014, but only 9.1 percent of insurer expenditures. Immigrants' annual premiums exceeded their care expenditures by $1,123 per enrollee (for a total of $24.7 billion), which offsets a deficit of $163 per US-born enrollee. Their net subsidy persisted even after ten years of US residence. In 2008-14, the surplus premiums of immigrants totaled $174.4 billion. These findings suggest that policies curtailing immigration could reduce the numbers of "actuarially desirable" people with private insurance, thereby weakening the risk pool.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{flavin_medical_2018,

title = {Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review.},

author = {Lila Flavin and Leah Zallman and Danny McCormick and J. Wesley Boyd},

doi = {10.1177/0020731418791963},

issn = {1541-4469 0020-7314},

year  = {2018},

date = {2018-10-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {48},

number = {4},

pages = {601–621},

abstract = {In health care policy debates, discussion centers around the often-misperceived costs of providing medical care to immigrants. This review seeks to compare health care expenditures of U.S. immigrants to those of U.S.-born individuals and evaluate the role which immigrants play in the rising cost of health care. We systematically examined all post-2000, peer-reviewed studies in PubMed related to health care expenditures by immigrants written in English in the United States. The reviewers extracted data independently using a standardized approach. Immigrants' overall expenditures were one-half to two-thirds those of U.S.-born individuals, across all assessed age groups, regardless of immigration status. Per capita expenditures from private and public insurance sources were lower for immigrants, particularly expenditures for undocumented immigrants. Immigrant individuals made larger out-of-pocket health care payments compared to U.S.-born individuals. Overall, immigrants almost certainly paid more toward medical expenses than they withdrew, providing a low-risk pool that subsidized the public and private health insurance markets. We conclude that insurance and medical care should be made more available to immigrants rather than less so.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_lancet_2018,

title = {The Lancet Commission on public policy and health in the Trump era.},

author = {David U. Himmelstein and Steffie Woolhandler and Rebecca Cooney and Martin McKee and Richard Horton},

doi = {10.1016/S0140-6736(18)32171-8},

issn = {1474-547X 0140-6736},

year  = {2018},

date = {2018-09-01},

journal = {Lancet (London, England)},

volume = {392},

number = {10152},

pages = {993–995},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_disparities_2018,

title = {Disparities in pulmonary fibrosis care in the United States: an analysis from the Nationwide Inpatient Sample.},

author = {Adam W. Gaffney and Steffie Woolhander and David Himmelstein and Danny McCormick},

doi = {10.1186/s12913-018-3407-0},

issn = {1472-6963},

year  = {2018},

date = {2018-08-01},

journal = {BMC health services research},

volume = {18},

number = {1},

pages = {618},

abstract = {BACKGROUND: Idiopathic pulmonary fibrosis is a disease with high morbidity and mortality. Care for these patients, including lung transplantation, may provide significant benefits, but is resource-intensive and expensive. Disadvantaged patients with IPF may hence be at risk for receiving inferior care. METHODS: We analyzed data from the Nationwide Inpatient Sample, a database consisting of all hospitalizations from a 20% sample of US hospitals. We identified adults hospitalized with IPF between 1998 and 2011 using ICD-9 codes. We assessed the effect of insurance coverage and socioeconomic status (SES) on lung transplantation, a treatment that may improve survival. We also examined the effect of coverage and SES on mortality, as well as discharge to inpatient rehabilitation and receipt of a lung biopsy, two markers of the intensity of care delivered. We used multiple logistic regression to adjust for patient and hospital characteristics. RESULTS: We identified 148,877 hospitalizations that met our definition of pulmonary fibrosis. In the main adjusted analyses, hospitalizations of patients with Medicaid (OR 0.30, 95% CI 0.16-0.57) or no insurance (OR 0.22, 95% CI 0.07-0.72) were less likely to result in a lung transplantation compared to hospitalizations of those with non-Medicaid insurance. Those of lower SES were also less likely to undergo transplantation, while hospitalized patients with Medicaid and the uninsured were less likely to be discharged to inpatient rehabilitation or to receive a lung biopsy. CONCLUSIONS: Among hospitalized patients with IPF, those with lower SES, Medicaid coverage and without insurance were less likely to receive several clinical interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_myth_2018,

title = {Myth and Measurement - The Case of Medical Bankruptcies.},

author = {David U. Himmelstein and Steffie Woolhandler and Elizabeth Warren},

doi = {10.1056/NEJMc1805444},

issn = {1533-4406 0028-4793},

year  = {2018},

date = {2018-06-01},

journal = {The New England journal of medicine},

volume = {378},

number = {23},

pages = {2245–2246},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_massachusetts_2018,

title = {Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder-Related Diagnoses.},

author = {Karen E. Lasser and Amresh D. Hanchate and Danny McCormick and Alexander Y. Walley and Richard Saitz and Meng-Yun Lin and Nancy R. Kressin},

doi = {10.1111/1475-6773.12710},

issn = {1475-6773 0017-9124},

year  = {2018},

date = {2018-06-01},

journal = {Health services research},

volume = {53},

number = {3},

pages = {1727–1744},

abstract = {OBJECTIVE: To examine whether Massachusetts (MA) health reform affected substance (alcohol or drug) use disorder (SUD)-related hospitalizations in acute care hospitals. DATA/STUDY SETTING: 2004-2010 MA inpatient discharge data. DESIGN: Difference-in-differences analysis to identify pre- to postreform changes in age- and sex-standardized population-based rates of SUD-related medical and surgical hospitalizations, adjusting for secular trends. DATA EXTRACTION METHODS: We identified 373,751 discharges where a SUD-related diagnosis was a primary or secondary discharge diagnosis. FINDINGS: Adjusted for age and sex, the rates of drug use-related and alcohol use-related hospitalizations prereform were 7.21 and 8.87 (per 1,000 population), respectively, in high-uninsurance counties, and 8.58 and 9.63, respectively, in low-uninsurance counties. Both SUD-related rates increased after health reform in high- and low-uninsurance counties. Adjusting for secular trends in the high- and low-uninsurance counties, health reform was associated with no change in drug- or alcohol-related hospitalizations. CONCLUSIONS: Massachusetts health reform was not associated with any changes in substance use disorder-related hospitalizations. Further research is needed to determine how to reduce substance use disorder-related hospitalizations, beyond expanding insurance coverage.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_healing_2018,

title = {Healing an ailing pharmaceutical system: prescription for reform for United States and Canada.},

author = {Adam Gaffney and Joel Lexchin},

doi = {10.1136/bmj.k1039},

issn = {1756-1833 0959-8138},

year  = {2018},

date = {2018-05-01},

journal = {BMJ (Clinical research ed.)},

volume = {361},

pages = {k1039},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_relationship_2018,

title = {The Relationship of Health Insurance and Mortality.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/L17-0704},

issn = {1539-3704 0003-4819},

year  = {2018},

date = {2018-04-01},

journal = {Annals of internal medicine},

volume = {168},

number = {8},

pages = {605},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{goldman_effects_2018,

title = {Effects Of The ACA's Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis.},

author = {Anna L. Goldman and Danny McCormick and Jennifer S. Haas and Benjamin D. Sommers},

doi = {10.1377/hlthaff.2017.1390},

issn = {2694-233X 0278-2715},

year  = {2018},

date = {2018-04-01},

journal = {Health affairs (Project Hope)},

volume = {37},

number = {4},

pages = {591–599},

abstract = {Descriptive studies have suggested that the Affordable Care Act's (ACA's) health insurance Marketplaces improved access to care. However, no evidence from quasi-experimental studies is available to support these findings. We used longitudinal survey data to compare previously uninsured adults with incomes that made them eligible for subsidized Marketplace coverage (138-400 percent of the federal poverty level) to those who had employer-sponsored insurance before the ACA with incomes in the same range. Among the previously uninsured group, the ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnoses of hypertension, compared to a control group with stable employer-sponsored insurance. Changes were largest among previously uninsured people with incomes of 138-250 percent of poverty, who were eligible for the ACA's cost-sharing reductions. Our quasi-experimental approach provides rigorous new evidence that the ACA's Marketplaces led to improvements in several important health care outcomes, particularly among low-income adults.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_ongoing_2018,

title = {The Ongoing UṠ. Health Care Crisis: A Data Update.},

author = {David U. Himmelstein and Steffie Woolhandler and Mark Almberg and Clare Fauke},

doi = {10.1177/0020731418764073},

issn = {1541-4469 0020-7314},

year  = {2018},

date = {2018-04-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {48},

number = {2},

pages = {209–222},

abstract = {While efforts to repeal the Affordable Care Act were narrowly defeated, grave problems in health care persist. Twenty-eight million remain uninsured, a number that is likely to increase. Millions more who have coverage cannot afford care because of high cost-sharing requirements. Meanwhile, the corporate takeover of medical care in the United States is at a gallop. This article provides a brief précis of recent data on U.S. health policy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_woolhandler_2018,

title = {Woolhandler and Himmelstein Respond.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.2105/AJPH.2018.304318},

issn = {1541-0048 0090-0036},

year  = {2018},

date = {2018-04-01},

journal = {American journal of public health},

volume = {108},

number = {4},

pages = {451},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{goldman_out–pocket_2018,

title = {Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act.},

author = {Anna L. Goldman and Steffie Woolhandler and David U. Himmelstein and David H. Bor and Danny McCormick},

doi = {10.1001/jamainternmed.2017.8060},

issn = {2168-6114 2168-6106},

year  = {2018},

date = {2018-03-01},

journal = {JAMA internal medicine},

volume = {178},

number = {3},

pages = {347–355},

abstract = {IMPORTANCE: The Affordable Care Act (ACA) was associated with a reduced number of Americans who reported being unable to afford medical care, but changes in actual health spending by households are not known. OBJECTIVES: To estimate changes in household spending on health care nationwide after implementation of the ACA. DESIGN, SETTING, AND PARTICIPANTS: Population-based data from the Medical Expenditure Panel Survey from January 1, 2012, through December 31, 2015, and multivariable regression were used to examine changes in out-of-pocket spending, premium contributions, and total health spending (out-of-pocket plus premiums) after the ACA's coverage expansions on January 1, 2014. The study population included a nationally representative sample of US adults aged 18 to 64 years (n = 83 431). In addition, changes were assessed in the likelihood of exceeding affordability thresholds for each outcome and spending changes for income subgroups defined under the ACA to determine program eligibility at 138% or less, 139% to 250%, 251% to 400%, and greater than 400% of the federal poverty level (FPL). EXPOSURE: Implementation of the ACA's major insurance programs on January 1, 2014. MAIN OUTCOMES AND MEASURES: Mean individual-level out-of-pocket spending and premium payments and the percentage of persons experiencing high-burden spending, defined as more than 10% of family income for out-of-pocket expenses, more than 9.5% for premium payments, and more than 19.5% for out-of-pocket plus premium payments. RESULTS: In this nationally representative survey of 83 431 adults (weighted frequency, 49.1% men and 50.9% women; median age, 40.3 years; interquartile range, 28.6-52.4 years), ACA implementation was associated with an 11.9% decrease (95% CI, -17.1% to -6.4%; P < .001) in mean out-of-pocket spending in the full sample, a 21.4% decrease (95% CI, -30.1% to -11.5%; P < .001) in the lowest-income group (≤138% of the FPL), an 18.5% decrease (95% CI, -27.0% to -9.0%; P < .001) in the low-income group (139%-250% of the FPL), and a 12.8% decrease (95% CI, -22.1% to -2.4%; P = .02) in the middle-income group (251%-400% of the FPL). Mean premium spending increased in the full sample (12.1%; 95% CI, 1.9%-23.3%) and the higher-income group (22.9%; 95% CI, 5.5%-43.1%). Combined out-of-pocket plus premium spending decreased in the lowest-income group only (-16.0%; 95% CI, -27.6% to -2.6%). The odds of household out-of-pocket spending exceeding 10% of family income decreased in the full sample (odds ratio [OR], 0.80; 95% CI, 0.70-0.90) and in the lowest-income group (OR, 0.80; 95% CI, 0.67-0.97). The odds of high-burden premium spending increased in the middle-income group (OR, 1.28; 95% CI, 1.03-1.59). CONCLUSIONS AND RELEVANCE: Implementation of the ACA was associated with reduced out-of-pocket spending, particularly for low-income persons. However, many of these individuals continue to experience high-burden out-of-pocket and premium spending. Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{christopher_effects_2018,

title = {The Effects of Household Medical Expenditures on Income Inequality in the United States.},

author = {Andrea S. Christopher and David U. Himmelstein and Steffie Woolhandler and Danny McCormick},

doi = {10.2105/AJPH.2017.304213},

issn = {1541-0048 0090-0036},

year  = {2018},

date = {2018-03-01},

journal = {American journal of public health},

volume = {108},

number = {3},

pages = {351–354},

abstract = {OBJECTIVES: To assess the effect of households' outlays for medical expenditures on income inequality and changes since the implementation of the Affordable Care Act (ACA). METHODS: We analyzed data from the US Current Population Surveys for calendar years 2010 through 2014. We calculated the Gini index of income inequality before and after subtracting households' medical outlays (including insurance premiums and out-of-pocket costs) from income, the financial burden of medical outlays for each income decile, and the number of individuals pushed below poverty by medical outlays. RESULTS: In 2014, the Gini index was 47.84, which rose to 49.21 after medical outlays were subtracted, indicating that medical outlays effectively redistributed about 1.37% of total income from poorer to richer individuals, a slightly smaller redistribution compared with the years before the ACA. Medical outlays reduced the median income of the poorest decile by 47.6% versus 2.7% for the wealthiest decile and pushed 7.013 million individuals into poverty. CONCLUSIONS: The way we finance medical care exacerbates income inequality and impoverishes millions of Americans. This regressive financing pattern improved minimally in the wake of the ACA.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{tesema_training_2018,

title = {Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors.},

author = {Lello Tesema and Jeffrey Marshall and Rachel Hathaway and Christina Pham and Camille Clarke and Genevieve Bergeron and James Yeh and Michael Soliman and Danny McCormick},

doi = {10.1080/08897077.2018.1449047},

issn = {1547-0164 0889-7077},

year  = {2018},

date = {2018-01-01},

journal = {Substance abuse},

volume = {39},

number = {4},

pages = {434–440},

abstract = {BACKGROUND: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. METHODS: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. RESULTS: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). CONCLUSIONS: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_us_2018,

title = {The UṠ. Health Care Crisis Continues: A Data Snapshot.},

author = {David U. Himmelstein and Steffie Woolhandler and Mark Almberg and Clare Fauke},

doi = {10.1177/0020731417741779},

issn = {1541-4469 0020-7314},

year  = {2018},

date = {2018-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {48},

number = {1},

pages = {28–41},

abstract = {Despite implementation of the Affordable Care Act in 2014, the U.S. health care crisis continues. While coverage has been expanded, 28 million people remain uninsured, and tens of millions who have coverage are unable to afford care because of high cost-sharing requirements. Moreover, many with coverage have a sharply restricted choice of physicians and hospitals, and the corporate takeover of medical care in the United States is proceeding rapidly. This article provides a brief précis of recent data on U.S. health policy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_affordable_2017,

title = {The Affordable Care Act: How Nixon's Health Reform Proposal Became Democrats' Albatross.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1177/0020731417729661},

issn = {1541-4469 0020-7314},

year  = {2017},

date = {2017-10-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {47},

number = {4},

pages = {612–620},

abstract = {President Obama's signature health care reform, the Affordable Care Act (ACA), was passed in 2010 and fully implemented in 2014. Two years later, Republicans' attacks on the ACA as a failed reform helped fuel their recent electoral victory. The legislation significantly expanded insurance coverage. But it was built on, and fortified, private health insurance firms, and it accelerated the corporate takeover of hospitals and physicians' practices. This obeisance to corporate interests precluded making coverage universal or care affordable. As a result, the reform failed to address the grave health care problems faced by most working- and middle-class Americans and left many of them feeling betrayed by Democrats who oversold the ACA's benefits.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_single-payer_2017b,

title = {Single-Payer Reform.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/L17-0326},

issn = {1539-3704 0003-4819},

year  = {2017},

date = {2017-10-01},

journal = {Annals of internal medicine},

volume = {167},

number = {7},

pages = {527},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hanchate_impact_2017,

title = {Impact of Massachusetts Health Reform on Inpatient Care Use: Was the Safety-Net Experience Different Than in the Non-Safety-Net?},

author = {Amresh D. Hanchate and Danny McCormick and Karen E. Lasser and Chen Feng and Meredith G. Manze and Nancy R. Kressin},

doi = {10.1111/1475-6773.12542},

issn = {1475-6773 0017-9124},

year  = {2017},

date = {2017-10-01},

journal = {Health services research},

volume = {52},

number = {5},

pages = {1647–1666},

abstract = {OBJECTIVE: Most inpatient care for the uninsured and other vulnerable subpopulations occurs in safety-net hospitals. As insurance expansion increases the choice of hospitals for the previously uninsured, we examined if Massachusetts health reform was associated with shifts in the volume of inpatient care from safety-net to non-safety-net hospitals overall, or among other vulnerable sociodemographic (racial/ethnic minority, low socioeconomic status, high uninsured rate area) and clinical subpopulations (emergent status, diagnosis). DATA SOURCES/STUDY SETTING: Discharge records for adults discharged from all nonfederal acute care hospitals in Massachusetts, New Jersey, New York, and Pennsylvania 2004-2010. STUDY DESIGN: Using a difference-in-differences design, we compared pre-/post-reform changes in safety-net and non-safety-net hospital discharge outcomes in Massachusetts among adults 18-64 with corresponding changes in comparisons states with no reform, overall, and by subpopulations. PRINCIPAL FINDINGS: Reform was not associated with changes in inpatient care use at safety-net and non-safety-net hospitals across all discharges or in most subpopulations examined. CONCLUSIONS: Demand for inpatient care at safety-net hospitals may not decrease following insurance expansion. Whether this is due to other access barriers or patient preference needs to be explored.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_relationship_2017,

title = {The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/M17-1403},

issn = {1539-3704 0003-4819},

year  = {2017},

date = {2017-09-01},

journal = {Annals of internal medicine},

volume = {167},

number = {6},

pages = {424–431},

abstract = {About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Patient Protection and Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{kang_affordability_2017,

title = {Affordability of and Access to Information About Health Insurance Among Immigrant and Non-immigrant Residents After Massachusetts Health Reform.},

author = {Ye Jin Kang and Danny McCormick and Leah Zallman},

doi = {10.1007/s10903-016-0479-y},

issn = {1557-1920 1557-1912},

year  = {2017},

date = {2017-08-01},

journal = {Journal of immigrant and minority health},

volume = {19},

number = {4},

pages = {929–938},

abstract = {Immigrants' perceptions of affordability of insurance and knowledge of insurance after health reform are unknown. We conducted face-to-face surveys with a convenience sample of 1124 patients in three Massachusetts safety net Emergency Departments after the Massachusetts health reform (August 2013-January 2014), comparing immigrants and non-immigrants. Immigrants, as compared to non-immigrants, reported more concern about paying premiums (30 vs. 11 %},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mansour_accountable_2017,

title = {Accountable Care Organizations' Payments to Physicians: Patients Should Have the Right to Know.},

author = {Mayce Mansour and Nathan Favini and Michael A. Carome and Sidney Wolfe and Steffie Woolhandler and David U. Himmelstein},

doi = {10.2105/AJPH.2017.303918},

issn = {1541-0048 0090-0036},

year  = {2017},

date = {2017-08-01},

journal = {American journal of public health},

volume = {107},

number = {8},

pages = {1251–1252},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{tikkanen_hospital_2017,

title = {Hospital Payer and Racial/Ethnic Mix at Private Academic Medical Centers in Boston and New York City.},

author = {Roosa Sofia Tikkanen and Steffie Woolhandler and David U. Himmelstein and Nancy R. Kressin and Amresh Hanchate and Meng-Yun Lin and Danny McCormick and Karen E. Lasser},

doi = {10.1177/0020731416689549},

issn = {1541-4469 0020-7314},

year  = {2017},

date = {2017-07-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {47},

number = {3},

pages = {460–476},

abstract = {Academic medical centers (AMCs) are widely perceived as providing the highest-quality medical care. To investigate disparities in access to such care, we studied the racial/ethnic and payer mixes at private AMCs of New York City (NYC) and Boston, two cities where these prestigious institutions play a dominant role in the health care system. We used individual-level inpatient discharge data for acute care hospitals to examine the degree of hospital racial/ethnic and insurance segregation in both cities using the Index of Dissimilarity, together with recent changes in patterns of care in NYC. In multivariable logistic regression analyses, black patients in NYC were two to three times less likely than whites, and uninsured patients approximately five times less likely than privately insured patients, to be discharged from AMCs. In Boston, minorities were overrepresented at AMCs relative to other hospitals. NYC hospitals were more segregated overall according to race/ethnicity and insurance than Boston hospitals, and insurance segregation became more pronounced in NYC after the Affordable Care Act. Although health reform improved access to insurance, access to AMCs remains limited for disadvantaged populations, which may undermine the quality of care available to these groups.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{saadi_racial_2017,

title = {Racial disparities in neurologic health care access and utilization in the United States.},

author = {Altaf Saadi and David U. Himmelstein and Steffie Woolhandler and Nicte I. Mejia},

doi = {10.1212/WNL.0000000000004025},

issn = {1526-632X 0028-3878},

year  = {2017},

date = {2017-06-01},

journal = {Neurology},

volume = {88},

number = {24},

pages = {2268–2275},

abstract = {OBJECTIVE: To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States. METHODS: We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy). To assess disparities in neurologic care utilization, we performed logistic regression analyses of outpatient department neurologic care visit rates and expenditures for each racial ethnic group controlling for age, sex, health status, socioeconomic characteristics, and geographic region of care. RESULTS: Of the 279,103 MEPS respondents, 16,936 (6%) self-reported a neurologic condition; 5,890 (2%) received a total of 13,685 outpatient neurology visits. Black participants were nearly 30% less likely to see an outpatient neurologist (odds ratio [OR] 0.72, confidence interval [CI] 0.64-0.81) relative to their white counterparts, even after adjustment for demographic, insurance, and health status differences. Hispanic participants were 40% less likely to see an outpatient neurologist (OR 0.61, CI 0.54-0.69). Among participants with known neurologic conditions, blacks were more likely to be cared for in the emergency department, to have more hospital stays, and to have higher per capita inpatient expenditures than their white counterparts. CONCLUSIONS: Our findings highlight racial and ethnic inequalities in the utilization of neurologic care in the United States.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{basu_training_2017,

title = {Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum.},

author = {Gaurab Basu and Richard J. Pels and Rachel L. Stark and Priyank Jain and David H. Bor and Danny McCormick},

doi = {10.1097/ACM.0000000000001580},

issn = {1938-808X 1040-2446},

year  = {2017},

date = {2017-04-01},

journal = {Academic medicine : journal of the Association of American Medical Colleges},

volume = {92},

number = {4},

pages = {515–520},

abstract = {PROBLEM: Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education. APPROACH: In academic year (AY) 2012, the Cambridge Health Alliance internal medicine residency program transformed an elective into a required social medicine and research-based health advocacy curriculum. The course has three major innovations: it has a yearlong longitudinal curriculum, it is required for all residents, and all residents complete a group research-based health advocacy project within the curricular year. The authors describe the structure, content, and goals of this curriculum. OUTCOMES: Over the last four years (AYs 2012-2015), residents (17/32; 53%) have rated the overall quality of the course highly (mean = 5.2, where 6 = outstanding; standard deviation = 0.64). In each year since the new course has been implemented, all scholarly work from the course has been presented at conferences by 31 resident presenters and/or coauthors. The course seems to enhance the residency program's capacity to recruit high-caliber residents and faculty members. NEXT STEPS: The authors are collecting qualitative and quantitative data on the impact of the course. They will use their findings to advocate for a national health advocacy competency framework. Recommendations about how to initiate or further develop social medicine and health advocacy curricula are offered.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_single-payer_2017,

title = {Single-Payer Reform: The Only Way to Fulfill the President's Pledge of More Coverage, Better Benefits, and Lower Costs.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/M17-0302},

issn = {1539-3704 0003-4819},

year  = {2017},

date = {2017-04-01},

journal = {Annals of internal medicine},

volume = {166},

number = {8},

pages = {587–588},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_affordable_2017,

title = {The Affordable Care Act: implications for health-care equity.},

author = {Adam Gaffney and Danny McCormick},

doi = {10.1016/S0140-6736(17)30786-9},

issn = {1474-547X 0140-6736},

year  = {2017},

date = {2017-04-01},

journal = {Lancet (London, England)},

volume = {389},

number = {10077},

pages = {1442–1452},

abstract = {Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access-particularly for poorer Americans, women, and minorities-its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform-especially following the 2016 presidential election-is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{torres_coverage_2017,

title = {Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A Quasi-Experimental Study.},

author = {Hugo Torres and Elisabeth Poorman and Uma Tadepalli and Cynthia Schoettler and Chin Ho Fung and Nicole Mushero and Lauren Campbell and Gaurab Basu and Danny McCormick},

doi = {10.7326/M16-1256},

issn = {1539-3704 0003-4819},

year  = {2017},

date = {2017-04-01},

journal = {Annals of internal medicine},

volume = {166},

number = {7},

pages = {472–479},

abstract = {BACKGROUND: Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted. OBJECTIVE: To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease. DESIGN: Quasi-experimental policy intervention. SETTING: Nationally representative, noninstitutionalized sample in the United States. PATIENTS: 606 277 adults aged 18 to 64 years with a chronic disease. INTERVENTION: Implementation of ACA provisions on 1 January 2014. MEASUREMENTS: Self-reported insurance coverage, having a checkup, having a personal physician, and not having to forgo a needed physician visit because of cost. RESULTS: After the ACA was implemented, insurance coverage increased by 4.9 percentage points (95% CI, 4.4 to 5.4), not having to forgo a physician visit increased by 2.4 percentage points (CI, 1.9 to 2.9), and having a checkup increased by 2.7 percentage points (CI, 2.2 to 3.4). Having a personal physician did not change (0.3 percentage points [CI, -0.2 to 0.8]). All outcomes varied considerably by state, and coverage increased more in states that expanded Medicaid. Although racial/ethnic minorities had greater improvements in some outcomes, approximately 1 in 5 black and 1 in 3 Hispanic persons with a chronic disease continued to lack coverage and access to care after ACA implementation. LIMITATION: The study examined data from only the first year of the ACA's major coverage expansion provisions. CONCLUSION: Although the ACA increased coverage and access for persons with chronic disease, substantial gaps remain, particularly for minorities and those in Medicaid nonexpansion states. PRIMARY FUNDING SOURCE: None.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{dickman_inequality_2017,

title = {Inequality and the health-care system in the USA.},

author = {Samuel L. Dickman and David U. Himmelstein and Steffie Woolhandler},

doi = {10.1016/S0140-6736(17)30398-7},

issn = {1474-547X 0140-6736},

year  = {2017},

date = {2017-04-01},

journal = {Lancet (London, England)},

volume = {389},

number = {10077},

pages = {1431–1441},

abstract = {Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_patient_2017,

title = {Patient preferences and access to text messaging for health care reminders in a safety-net setting.},

author = {Leah Zallman and Adriana Bearse and Catherine West and David Bor and Danny McCormick},

doi = {10.3109/17538157.2015.1113177},

issn = {1753-8165 1753-8157},

year  = {2017},

date = {2017-01-01},

journal = {Informatics for health & social care},

volume = {42},

number = {1},

pages = {32–42},

abstract = {INTRODUCTION: Text messaging may be an effective method for providing health care reminders to patients. We aimed to understand patient access to and preferences for receiving health-related reminders via text message among patients receiving care in safety-net hospitals. MATERIALS AND METHODS: We conducted face-to-face surveys with 793 patients seeking care in three hospital emergency departments at a large safety-net institution and determined clinical and demographic predictors of preferences for text messaging for health care reminders. RESULTS: 95% of respondents reported having daily access to text messaging. Text messaging was preferred over e-mail, phone, and letters for communication. 78% of respondents wanted to receive appointment reminders, 56% wanted expiring insurance reminders, and 36% wanted reminders to take their medications. We found no clinical predictors but did find some demographic predictors-including age, ethnicity, insurance status, and income-of wanting text message reminders. DISCUSSION: In our convenience sample of safety-net patients, text messaging is an accessible, acceptable, and patient-preferred modality for receiving health care reminders. Text messaging may be a promising patient-centered approach for providing health care and insurance reminders to patients seeking care at safety-net institutions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{marrast_racial_2016,

title = {Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study.},

author = {Lyndonna Marrast and David U. Himmelstein and Steffie Woolhandler},

doi = {10.1177/0020731416662736},

issn = {1541-4469 0020-7314},

year  = {2016},

date = {2016-10-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {46},

number = {4},

pages = {810–824},

abstract = {Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_massachusetts_2016,

title = {Massachusetts Health Reform's Effect on Hospitals' Racial Mix of Patients and on Patients' Use of Safety-net Hospitals.},

author = {Karen E. Lasser and Amresh D. Hanchate and Danny McCormick and Chieh Chu and Ziming Xuan and Nancy R. Kressin},

doi = {10.1097/MLR.0000000000000575},

issn = {1537-1948 0025-7079},

year  = {2016},

date = {2016-09-01},

journal = {Medical care},

volume = {54},

number = {9},

pages = {827–836},

abstract = {BACKGROUND: Because of residential segregation and a lack of health insurance, minorities often receive care in different facilities than whites. Massachusetts (MA) health reform provided insurance to previously uninsured patients, which enabled them to potentially shift inpatient care to nonminority-serving or nonsafety-net hospitals. OBJECTIVES: Examine whether MA health reform affected hospitals' racial mix of patients, and individual patients' use of safety-net hospitals. RESEARCH DESIGN: Difference-in-differences analysis of 2004-2009 inpatient discharge data from MA, compared with New York (NY), and New Jersey (NJ), to identify postreform changes, adjusting for secular changes. SUBJECTS: (1) Hospital-level analysis (discharges): 345 MA, NY, and NJ hospitals; (2) patient-level analysis (patients): 39,921 patients with ≥2 hospitalizations at a safety-net hospital in the prereform period. MEASURES: Prereform to postreform changes in percentage of discharges that are minority (black and Hispanic) at minority-serving hospitals; adjusted odds of patient movement from safety-net hospitals (prereform) to nonsafety-net hospitals (postreform) by age group and state. RESULTS: Treating NJ as the comparison state, MA reform was associated with an increase of 5.8% (95% CI, 1.4%-10.3%) in the percentage of minority discharges at MA minority-serving hospitals; with NY as the comparison state, the change was 2.1% (95% CI, -0.04% to 4.3%). Patient movement from safety-net to nonsafety-net hospitals was greater in MA than comparison states (difference-in-differences adjusted OR=1.3; 95% CI, 1.0-1.7; P=0.04). CONCLUSIONS: Following MA health reform, the safety-net remains an important component of the health care system.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_hospital_2016,

title = {The Hospital Readmissions Reduction Program.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1056/NEJMc1606658},

issn = {1533-4406 0028-4793},

year  = {2016},

date = {2016-08-01},

journal = {The New England journal of medicine},

volume = {375},

number = {5},

pages = {493},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{nardin_experiences_2016,

title = {Experiences applying for and understanding health insurance under Massachusetts health care reform.},

author = {Rachel Nardin and Leah Zallman and Assaad Sayah and Danny McCormick},

doi = {10.1186/s12939-016-0397-6},

issn = {1475-9276},

year  = {2016},

date = {2016-07-01},

journal = {International journal for equity in health},

volume = {15},

number = {1},

pages = {110},

abstract = {BACKGROUND: The Affordable Care Act was modeled on the Massachusetts Health Reform of 2006, which reduced the number of uninsured largely through a Medicaid expansion and the provision of publicly subsidized insurance obtained through a Health Benefits Exchange. METHODS: We surveyed a convenience sample of 780 patients seeking care in a safety-net system who obtained Medicaid or publicly subsidized insurance after the Massachusetts reform, as well as a group of employed patients with private insurance. RESULTS: We found that although most patients with Medicaid or publicly subsidized exchange-based plans were able to obtain assistance with applying for and choosing an insurance plan, substantial proportions of respondents experienced difficulties with the application process and with understanding coverage and cost features of plans. CONCLUSIONS: Under the Affordable Care Act, efforts to simplify the application process and reduce the complexity of plans may be warranted, particularly for vulnerable patient populations cared for by the medical safety net.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_rebuttal_2016,

title = {Rebuttal From Drs Gaffney, Verhoef, and Hall.},

author = {Adam W. Gaffney and Philip A. Verhoef and Jesse B. Hall},

doi = {10.1016/j.chest.2016.02.661},

issn = {1931-3543 0012-3692},

year  = {2016},

date = {2016-07-01},

journal = {Chest},

volume = {150},

number = {1},

pages = {14–15},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_point_2016,

title = {POINT: Should Pulmonary/ICU Physicians Support Single-payer Health-care Reform? Yes.},

author = {Adam W. Gaffney and Philip A. Verhoef and Jesse B. Hall},

doi = {10.1016/j.chest.2016.02.660},

issn = {1931-3543 0012-3692},

year  = {2016},

date = {2016-07-01},

journal = {Chest},

volume = {150},

number = {1},

pages = {9–11},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_woolhandler_2016,

title = {Woolhandler and Himmelstein Respond.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.2105/AJPH.2016.303218},

issn = {1541-0048 0090-0036},

year  = {2016},

date = {2016-07-01},

journal = {American journal of public health},

volume = {106},

number = {7},

pages = {e12},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{dickman_health_2016,

title = {Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012.},

author = {Samuel L. Dickman and Steffie Woolhandler and Jacob Bor and Danny McCormick and David H. Bor and David U. Himmelstein},

doi = {10.1377/hlthaff.2015.1024},

issn = {2694-233X 0278-2715},

year  = {2016},

date = {2016-07-01},

journal = {Health affairs (Project Hope)},

volume = {35},

number = {7},

pages = {1189–1196},

abstract = {US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{saluja_unsafe_2016,

title = {Unsafe Drugs Were Prescribed More Than One Hundred Million Times in the United States Before Being Recalled.},

author = {Sonali Saluja and Steffie Woolhandler and David U. Himmelstein and David Bor and Danny McCormick},

doi = {10.1177/0020731416654662},

issn = {1541-4469 0020-7314},

year  = {2016},

date = {2016-07-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {46},

number = {3},

pages = {523–530},

abstract = {For some drugs, safety concerns are only discovered after they have been on the market, sometimes for several years. The U.S. Food and Drug Administration (FDA) has adopted several policies that could increase the likelihood of approving a potentially unsafe medication. We attempted to quantify the number of exposures in the United States to drugs that were newly approved but later withdrawn from the market. We obtained a list of all drugs approved and subsequently withdrawn from the U.S. market due to safety concerns between 1993 and 2010. Using a representative sample of outpatient physician office visits in the National Ambulatory Medical Care Survey, we estimated the number of visits in the United States at which these unsafe drugs were prescribed. Seventeen drugs were approved and later withdrawn during this 18-year period and were prescribed at 112 million physician office visits in the United States. Nine of these drugs were prescribed more than 1 million times before their market withdrawal. New drugs that are later withdrawn due to being unsafe are frequently prescribed in the United States. To minimize the negative health consequences of prescribing potentially unsafe medications, we should reconsider some of the FDA policies that encourage the rapid approval and dissemination of new drugs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_moving_2016,

title = {Moving Forward From the Affordable Care Act to a Single-Payer System.},

author = {Adam Gaffney and Steffie Woolhandler and Marcia Angell and David U. Himmelstein},

doi = {10.2105/AJPH.2015.303157},

issn = {1541-0048 0090-0036},

year  = {2016},

date = {2016-06-01},

journal = {American journal of public health},

volume = {106},

number = {6},

pages = {987–988},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_collateral_2016,

title = {Collateral Damage: Pay-for-Performance Initiatives. In response.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/L15-0572},

issn = {1539-3704 0003-4819},

year  = {2016},

date = {2016-04-01},

journal = {Annals of internal medicine},

volume = {164},

number = {8},

pages = {573},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_current_2016,

title = {The Current and Projected Taxpayer Shares of US Health Costs.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.2105/AJPH.2015.302997},

issn = {1541-0048 0090-0036},

year  = {2016},

date = {2016-03-01},

journal = {American journal of public health},

volume = {106},

number = {3},

pages = {449–452},

abstract = {OBJECTIVES: We estimated taxpayers' current and projected share of US health expenditures, including government payments for public employees' health benefits as well as tax subsidies to private health spending. METHODS: We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees' health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. RESULTS: Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government's share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. CONCLUSIONS: Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government's predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_commuting_2016,

title = {Commuting mode and pulmonary function in Shanghai, China.},

author = {Adam W. Gaffney and Jing-Qing Hang and Mi-Sun Lee and Li Su and Feng-Ying Zhang and David C. Christiani},

doi = {10.1183/13993003.00637-2015},

issn = {1399-3003 0903-1936},

year  = {2016},

date = {2016-03-01},

journal = {The European respiratory journal},

volume = {47},

number = {3},

pages = {733–741},

abstract = {Exposure to air pollution can be particularly high during commuting and may depend on the mode of transportation. We investigated the impact of commuting mode on pulmonary function in Shanghai, China.The Shanghai Putuo Study is a cross-sectional, population-based study. Our primary outcomes were forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) % predicted, and the secondary outcome was spirometric airflow obstruction. We tested the association between mode of transportation and these outcomes after adjusting for confounders.The study population consisted of 20 102 subjects. After adjusting for confounders, the change (95% CI) in FEV1 was -2.15% pred (-2.88- -1.42% pred) among pedestrians, -1.32% pred (-2.05- -0.59% pred) among those taking buses without air conditioning, -1.33% pred (-2.05- -0.61% pred) among those taking buses with air conditioning and -2.83% pred (-5.56- -0.10% pred) among those using underground railways, as compared to cyclists (the reference group). The effects of mode on FVC % predicted were in the same direction. Private car use had a significant protective effect on FVC % predicted and the risk of airflow obstruction (defined by Global Initiative for Chronic Obstructive Lung Disease but not by lower limit of normal criteria).Mode of transportation is associated with differences in lung function, which may reflect pollution levels in different transportation microenvironments.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_socioeconomic_2016,

title = {Socioeconomic status is associated with reduced lung function in China: an analysis from a large cross-sectional study in Shanghai.},

author = {Adam W. Gaffney and Jing-qing Hang and Mi-Sun Lee and Li Su and Feng-ying Zhang and David C. Christiani},

doi = {10.1186/s12889-016-2752-3},

issn = {1471-2458},

year  = {2016},

date = {2016-02-01},

journal = {BMC public health},

volume = {16},

pages = {96},

abstract = {BACKGROUND: An inverse association between socioeconomic status and pulmonary function has emerged in many studies. However, the mediating factors in this relationship are poorly understood, and might be expected to differ between countries. We sought to investigate the relationship between socioeconomic status and lung function in China, a rapidly industrializing nation with unique environmental challenges, and to identify potentially-modifiable environmental mediators. METHODS: We used data from the Shanghai Putuo Study, a cross-sectional study performed in Shanghai, China. Participants completed a questionnaire and spirometry. The primary exposure was socioeconomic status, determined by education level. The primary outcomes were FEV1 and FVC percent predicted. Multiple linear regressions were used to test this association, and the percent explained by behavioral, environmental, occupational, and dietary variables was determined by adding these variables to a base model. RESULTS: The study population consisted of a total of 22,878 study subjects that were 53.3 % female and had a mean age of 48. In the final multivariate analysis, the effect estimates for FEV1 and FVC percent predicted for low socioeconomic status (compared to high) were statistically significant at a p-value of <0.01. Smoking, biomass exposure, mode of transportation to work, a diet low in fruits or vegetables, and occupational category partially attenuated the relationship between SES and lung function. In a fully-adjusted age-stratified analysis, the socioeconomic disparity in lung function widened with increasing age. CONCLUSIONS: We found cross-sectional evidence of socioeconomic disparities in pulmonary function in Shanghai. These differences increased with age and were partially explained by potentially modifiable exposures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_cadillac_2016,

title = {The “Cadillac Tax” on Health Benefits in the United States Will Hit the Middle Class Hardest: Refuting the Myth That Health Benefit Tax Subsidies Are Regressive.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1177/0020731416637163},

issn = {0020-7314},

year  = {2016},

date = {2016-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {46},

number = {2},

pages = {325–330},

abstract = {U.S. employment-based health benefits are exempt from income and payroll taxes, an exemption that provided tax subsidies of $326.2 billion in 2015. Both liberal and conservative economists have denounced these subsidies as “regressive” and lauded a provision of the Affordable Care Act—the Cadillac Tax—that would curtail them. The claim that the subsidies are regressive rests on estimates showing that the affluent receive the largest subsidies in absolute dollars. But this claim ignores the standard definition of regressivity, which is based on the share of income paid by the wealthy versus the poor, rather than on dollar amounts. In this study, we calculate the value of tax subsidies in 2009 as a share of income for each income quintile and for the wealthiest Americans. In absolute dollars, tax subsidies were highest for families between the 80th and 95th percentiles of family income and lowest for the poorest 20%. However, as shares of income, subsidies were largest for the middle and fourth income quintiles and smallest for the wealthiest 0.5% of Americans. We conclude that the tax subsidy to employment-based insurance is neither markedly regressive, nor progressive. The Cadillac Tax will disproportionately harm families with (2009) incomes between $38,550 and $100,000, while sparing the wealthy.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_unauthorized_2016,

title = {Unauthorized Immigrants Prolong the Life of Medicare's Trust Fund.},

author = {Leah Zallman and Fernando A. Wilson and James P. Stimpson and Adriana Bearse and Lisa Arsenault and Blessing Dube and David Himmelstein and Steffie Woolhandler},

doi = {10.1007/s11606-015-3418-z},

issn = {1525-1497 0884-8734},

year  = {2016},

date = {2016-01-01},

journal = {Journal of general internal medicine},

volume = {31},

number = {1},

pages = {122–127},

abstract = {BACKGROUND AND OBJECTIVE: Unauthorized immigrants seldom have access to public health insurance programs such as Medicare Part A, which pays hospitals and other health facilities and is funded through the Medicare Trust Fund. DESIGN AND MAIN MEASURES: We tabulated annual and total Trust Fund contributions and withdrawals by unauthorized immigrants (i.e., outlays on their behalf) from 2000 to 2011 using the Current Population Survey and Medical Expenditure Panel Surveys. We estimated when the Trust Fund would be depleted if unauthorized immigrants had neither contributed to it nor withdrawn from it. We estimated Trust Fund surpluses by unauthorized immigrants if 10 % were to become authorized annually over the subsequent 7 years. KEY RESULTS: From 2000 to 2011, unauthorized immigrants contributed $2.2 to $3.8 billion more than they withdrew annually (a total surplus of $35.1 billion). Had unauthorized immigrants neither contributed to nor withdrawn from the Trust Fund during those 11 years, it would become insolvent in 2029-1 year earlier than currently predicted. If 10 % of unauthorized immigrants became authorized annually for the subsequent 7 years, Trust Fund surpluses contributed by unauthorized immigrants would total $45.7 billion. CONCLUSIONS: Unauthorized immigrants have prolonged the life of the Medicare Trust Fund. Policies that curtail the influx of unauthorized immigrants may accelerate the Trust Fund's depletion.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{christopher_access_2016,

title = {Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.},

author = {Andrea S. Christopher and Danny McCormick and Steffie Woolhandler and David U. Himmelstein and David H. Bor and Andrew P. Wilper},

doi = {10.2105/AJPH.2015.302925},

issn = {1541-0048 0090-0036},

year  = {2016},

date = {2016-01-01},

journal = {American journal of public health},

volume = {106},

number = {1},

pages = {63–69},

abstract = {OBJECTIVES: We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care. METHODS: Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485). RESULTS: Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 3.8, 6.6). Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness (OR = 1.83; 95% CI = 1.26, 2.66) and control (OR = 1.69; 95% CI = 1.32, 2.27) of their condition. Medicaid coverage was also associated with awareness of being overweight (OR = 1.30; 95% CI = 1.02, 1.67), but not with awareness or control of diabetes or hypercholesterolemia. CONCLUSIONS: Among poor adults nationally, Medicaid coverage appears to facilitate outpatient physician care and to improve blood pressure control.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_public_2016,

title = {Public Health's Falling Share of US Health Spending.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.2105/AJPH.2015.302908},

issn = {1541-0048 0090-0036},

year  = {2016},

date = {2016-01-01},

journal = {American journal of public health},

volume = {106},

number = {1},

pages = {56–57},

abstract = {We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health's share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cutshaw_medical_2016,

title = {Medical Causes and Consequences of Home Foreclosures.},

author = {Christina A. Cutshaw and Steffie Woolhandler and David U. Himmelstein and Christopher Robertson},

doi = {10.1177/0020731415614249},

issn = {0020-7314},

year  = {2016},

date = {2016-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {46},

number = {1},

pages = {36–47},

abstract = {The objective of this study was to elucidate the medical causes and consequences of foreclosure. We surveyed 90 households undergoing foreclosure in 2013-2014 in Maricopa County, Arizona on two occasions approximately five months apart. At baseline, median monthly household income was $3,000, and median mortgage payment $1,350. Only 10% of respondents lacked health insurance when surveyed, although 28% had experienced a gap in coverage within the past two years. Fifty-seven percent identified a medical debt or another medical cause of their foreclosure, and 54% had taken on new debt to pay medical bills; 10% had mortgaged their home for this reason. Although 57% of respondents had a chronic condition requiring ongoing care, more than half reported delaying or skipping a needed medical visit. At follow-up, one-third of respondents had been unable to afford food, and 3 respondents reported becoming homeless; 46% said foreclosure had worsened their health; and 63% had already incurred new medical debts. Medical debt and medical problems frequently contribute to foreclosure, even among insured families. Foreclosure compromises access to care and basic necessities like food and shelter, and worsens self-reported health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{saluja_support_2016,

title = {Support for National Health Insurance Seven Years Into Massachusetts Healthcare Reform: Views of Populations Targeted by the Reform.},

author = {Sonali Saluja and Leah Zallman and Rachel Nardin and David Bor and Steffie Woolhandler and David U. Himmelstein and Danny McCormick},

doi = {10.1177/0020731415615314},

issn = {0020-7314},

year  = {2016},

date = {2016-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {46},

number = {1},

pages = {185–200},

abstract = {Before the Affordable Care Act (ACA), many surveys showed majority support for national health insurance (NHI), also known as single payer; however, little is currently known about views of the ACA's targeted population. Massachusetts residents have had seven years of experience with state health care reform that became the model for the ACA. We surveyed 1,151 adults visiting safety-net emergency departments in Massachusetts in late 2013 on their preference for NHI or the Massachusetts reform and on their experiences with insurance. Most of the patients surveyed were low-income and non-white. The majority of patients (72.0%) preferred NHI to the Massachusetts reform. Support for NHI among those with public insurance, commercial insurance, and no insurance was 68.9%, 70.3%, and 86.3%, respectively (p < .001). Support for NHI was higher among patients dissatisfied with their insurance plan (83.3% vs. 68.9%},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_perceived_2015,

title = {Perceived affordability of health insurance and medical financial burdens five years in to Massachusetts health reform.},

author = {Leah Zallman and Rachel Nardin and Assaad Sayah and Danny McCormick},

doi = {10.1186/s12939-015-0235-2},

issn = {1475-9276},

year  = {2015},

date = {2015-10-01},

journal = {International journal for equity in health},

volume = {14},

pages = {113},

abstract = {INTRODUCTION: Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. METHODS: We conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured. RESULTS: We found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured. CONCLUSIONS: Policy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_affordability_2015,

title = {Affordability of health care under publicly subsidized insurance after Massachusetts health care reform: a qualitative study of safety net patients.},

author = {Leah Zallman and Rachel Nardin and Monica Malowney and Assaad Sayah and Danny McCormick},

doi = {10.1186/s12939-015-0240-5},

issn = {1475-9276},

year  = {2015},

date = {2015-10-01},

journal = {International journal for equity in health},

volume = {14},

pages = {112},

abstract = {INTRODUCTION: The Affordable Care Act (ACA) and the 2006 Massachusetts (MA) health reform law, on which the ACA was based, aimed to improve the affordability of care largely by expanding publicly sponsored insurances. Both laws also aimed to promote consumer understanding of how to acquire, maintain and use these public plans. A prior study found an association between the level of cost-sharing required in these plans and the affordability of care. Preparatory to a quantitative study we conducted this qualitative study that aimed to examine (1) whether cost sharing levels built into the public insurance types that formed the backbone of the MA health reform led to unaffordability of care and if so, (2) how insurances with higher cost sharing levels led to unaffordability of care in this context. METHODS: We interviewed 12 consumers obtaining the most commonly obtained insurances under MA health reform (Medicaid and Commonwealth Care) at a safety net hospital emergency department. We purposefully interviewed a stratified sample of higher and low cost sharing recipients. We used a combination of inductive and deductive codes to analyze the data according to degree of cost-sharing required by different insurance types. RESULTS: We found that higher cost sharing plans led to unaffordability of care, as evidenced by unmet medical needs, difficulty affording basic non-medical needs due to expenditures on medical care, and reliance on non-insurance resources to pay for care. Participants described two principal mechanisms by which higher cost sharing led to unaffordability of care: (1) cost sharing above what their incomes allowed and (2) poor understanding of how to effectively acquire, maintain and utilize insurance new public plans. CONCLUSIONS: Further efforts to investigate the relationship between perceived affordability of care and understanding of insurance for the insurance types obtained under MA health reform may be warranted. A potential focus for further work may be quantitative investigation of how the level of calibration of cost-sharing to income and understanding of insurances under the MA reform was associated with perceived affordability of care.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_collateral_2015,

title = {Collateral Damage: Pay-for-Performance Initiatives and Safety-Net Hospitals.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.7326/M15-1393},

issn = {1539-3704 0003-4819},

year  = {2015},

date = {2015-09-01},

journal = {Annals of internal medicine},

volume = {163},

number = {6},

pages = {473–474},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_gene-environment_2015,

title = {Gene-environment interaction from international cohorts: impact on development and evolution of occupational and environmental lung and airway disease.},

author = {Adam Gaffney and David C. Christiani},

doi = {10.1055/s-0035-1549450},

issn = {1098-9048 1069-3424},

year  = {2015},

date = {2015-06-01},

journal = {Seminars in respiratory and critical care medicine},

volume = {36},

number = {3},

pages = {347–357},

abstract = {Environmental and occupational pulmonary diseases impose a substantial burden of morbidity and mortality on the global population. However, it has been long observed that only some of those who are exposed to pulmonary toxicants go on to develop disease; increasingly, it is being recognized that genetic differences may underlie some of this person-to-person variability. Studies performed throughout the globe are demonstrating important gene-environment interactions for diseases as diverse as chronic beryllium disease, coal workers' pneumoconiosis, silicosis, asbestosis, byssinosis, occupational asthma, and pollution-associated asthma. These findings have, in many instances, elucidated the pathogenesis of these highly complex diseases. At the same time, however, translation of this research into clinical practice has, for good reasons, proceeded slowly. No genetic test has yet emerged with sufficiently robust operating characteristics to be clearly useful or practicable in an occupational or environmental setting. In addition, occupational genetic testing raises serious ethical and policy concerns. Therefore, the primary objective must remain ensuring that the workplace and the environment are safe for all.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mccormick_effect_2015,

title = {Effect of Massachusetts healthcare reform on racial and ethnic disparities in admissions to hospital for ambulatory care sensitive conditions: retrospective analysis of hospital episode statistics.},

author = {Danny McCormick and Amresh D. Hanchate and Karen E. Lasser and Meredith G. Manze and Mengyun Lin and Chieh Chu and Nancy R. Kressin},

doi = {10.1136/bmj.h1480},

issn = {1756-1833 0959-8138},

year  = {2015},

date = {2015-04-01},

journal = {BMJ (Clinical research ed.)},

volume = {350},

pages = {h1480},

abstract = {OBJECTIVES: To examine the impact of Massachusetts healthcare reform on changes in rates of admission to hospital for ambulatory care sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and racial and ethnic disparities in such rates, using complete inpatient discharge data (hospital episode statistics) from Massachusetts and three control states. DESIGN: Difference in differences analysis to identify the change, overall and according to race/ethnicity, adjusted for secular changes unrelated to reform. SETTING: Hospitals in Massachusetts, New York, New Jersey, and Pennsylvania, United States. PARTICIPANTS: Adults aged 18-64 (those most likely to have been affected by the reform) admitted for any of 12 ACSCs in the 21 months before and after the period during which reform was implemented (July 2006 to December 2007). MAIN OUTCOME MEASURES: Admission rates for a composite of all 12 ACSCs, and subgroup composites of acute and chronic ACSCs. RESULTS: After adjustment for potential confounders, including age, race and ethnicity, sex, and county income, unemployment rate and physician supply, we found no evidence of a change in the admission rate for overall composite ACSC (1.2%, 95% confidence interval -1.6% to 4.1%) or for subgroup composites of acute and chronic ACSCs. Nor did we find a change in disparities in admission rates between black and white people (-1.9%, -8.5% to 5.1%) or white and Hispanic people (2.0%, -7.5% to 12.4%) for overall composite ACSC that existed in Massachusetts before reform. In analyses limited to Massachusetts only, we found no evidence of a change in admission rate for overall composite ACSC between counties with higher and lower rates of uninsurance at baseline (1.4%, -2.3% to 5.3%). CONCLUSIONS: Massachusetts reform was not associated with significantly lower overall or racial and ethnic disparities in rates of admission to hospital for ACSCs. In the US, and Massachusetts in particular, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hanchate_massachusetts_2015,

title = {Massachusetts health reform and disparities in joint replacement use: difference in differences study.},

author = {Amresh D. Hanchate and Alok Kapoor and Jeffrey N. Katz and Danny McCormick and Karen E. Lasser and Chen Feng and Meredith G. Manze and Nancy R. Kressin},

doi = {10.1136/bmj.h440},

issn = {1756-1833 0959-8138},

year  = {2015},

date = {2015-02-01},

journal = {BMJ (Clinical research ed.)},

volume = {350},

pages = {h440},

abstract = {OBJECTIVE: To estimate the impact of the insurance expansion in 2006 on use of knee and hip replacement procedures by race/ethnicity, area income, and the use of hospitals that predominantly serve poor people ("safety net hospitals"). DESIGN: Quasi-experimental difference in differences study examining change after reform in the share of procedures performed in safety net hospitals by race/ethnicity and area income, with adjustment for patients' residence, demographics, and comorbidity. SETTING: State of Massachusetts, United States. PARTICIPANTS: Massachusetts residents aged 40-64 as the target beneficiaries of reform and similarly aged residents of New Jersey, New York, and Pennsylvania as the comparison (control) population. MAIN OUTCOMES MEASURES: Number of knee and hip replacement procedures per 10 000 population and use of safety net hospitals. Procedure counts from state discharge data for 2.5 years before and after reform, and multivariate difference in differences. Poisson regression was used to adjust for demographics, economic conditions, secular time, and geographic factors to estimate the change in procedure rate associated with health reform by race/ethnicity and area income. RESULTS: Before reform, the number of procedures (/10 000) in Massachusetts was lower among Hispanic people (12.9, P<0.001) than black people (28.1) and white people (30.1). Overall, procedure use increased 22.4% during the 2.5 years after insurance expansion; reform in Massachusetts was associated with a 4.7% increase. The increase associated with reform was significantly higher among Hispanic people (37.9%, P<0.001) and black people (11.4%, P<0.05) than among white people (2.8%). Lower income was not associated with larger increases in procedure use. The share of knee and hip replacement procedures performed in safety net hospitals in Massachusetts decreased by 1.0% from a level of 12.7% before reform. The reduction was larger among Hispanic people (-6.4%, P<0.001) than white people (-1.0%), and among low income residents (-3.9%, p<0.001) than high income residents (0%). CONCLUSIONS: Insurance expansion can help reduce disparities by race/ethnicity but not by income in access to elective surgical care and could shift some elective surgical care away from safety net hospitals.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{schmeltz_identifying_2015,

title = {Identifying individual risk factors and documenting the pattern of heat-related illness through analyses of hospitalization and patterns of household cooling.},

author = {Michael T. Schmeltz and Grace Sembajwe and Peter J. Marcotullio and Jean A. Grassman and David U. Himmelstein and Stephanie Woolhandler},

doi = {10.1371/journal.pone.0118958},

issn = {1932-6203},

year  = {2015},

date = {2015-01-01},

journal = {PloS one},

volume = {10},

number = {3},

pages = {e0118958},

abstract = {BACKGROUND: As climate change increases the frequency and intensity of extreme heat events researchers and public health officials must work towards understanding the causes and outcomes of heat-related morbidity and mortality. While there have been many studies on both heat-related illness (HRI), there are fewer on heat-related morbidity than on heat-related mortality. OBJECTIVE: To identify individual and environmental risk factors for hospitalizations and document patterns of household cooling. METHODS: We performed a pooled cross-sectional analysis of secondary U.S. data, the Nationwide Inpatient Sample. Risk ratios were calculated from multivariable models to identify risk factors for hospitalizations. Hierarchical modeling was also employed to identify relationships between individual and hospital level predictors of hospitalizations. Patterns of air conditioning use were analyzed among the vulnerable populations identified. RESULTS: Hospitalizations due to HRI increased over the study period compared to all other hospitalizations. Populations at elevated risk for HRI hospitalization were blacks, males and all age groups above the age of 40. Those living in zip-codes in the lowest income quartile and the uninsured were also at an increased risk. Hospitalizations for HRI in rural and small urban clusters were elevated, compared to urban areas. CONCLUSIONS: Risk factors for HRI include age greater than 40, male gender and hospitalization in rural areas or small urban clusters. Our analysis also revealed an increasing pattern of HRI hospitalizations over time and decreased association between common comorbidities and heat illnesses which may be indicative of underreporting.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{rapoport_screening_2015,

title = {Screening for Schistosoma mansoni and Strongyloides stercoralis Infection Among Brazilian Immigrants in the United States.},

author = {Alison B. Rapoport and Danny McCormick and Pieter A. Cohen},

doi = {10.1093/ofid/ofv003},

issn = {2328-8957},

year  = {2015},

date = {2015-01-01},

journal = {Open forum infectious diseases},

volume = {2},

number = {1},

pages = {ofv003},

abstract = {The prevalence of schistosomiasis and strongyloidiasis among Brazilian immigrants in the United States is unknown. We performed a retrospective chart review of serologic screening of asymptomatic Brazilian immigrants during routine physicals. Of 208 eligible patients, 189 were screened: 27.7% (n = 52) had elevated Schistosoma antibodies and 5.8% (n = 11) had elevated Strongyloides stercoralis antibodies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{dickman_health_2015,

title = {Health and Financial Consequences of 24 States' Decision to Opt Out of Medicaid Expansion.},

author = {Samuel L. Dickman and David U. Himmelstein and Danny McCormick and Steffie Woolhandler},

doi = {10.2190/HS.45.1.j},

issn = {0020-7314},

year  = {2015},

date = {2015-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {45},

number = {1},

pages = {133–142},

abstract = {Twenty-four states have opted out of expanding Medicaid coverage under the Affordable Care Act. We projected the number of persons who will remain uninsured because of the Medicaid opt-outs and used data from three prior studies to predict the health and financial impacts of the opt-outs. We estimate that as a result of the opt-outs, 7.74 million people who would have gained coverage will remain uninsured. This will result in between 7,076 and 16,945 more deaths than had all states opted-in, as well as 708,195 more persons screening positive for depression, 239,557 more persons suffering catastrophic medical expenditures, 420,273 fewer diabetics receiving medication, 193,735 fewer mammograms, and 441,260 fewer Pap smears. Many low-income adults will suffer health and financial harms because of their state's refusal to expand Medicaid coverage.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{gaffney_neoliberal_2015,

title = {THE NEOLIBERAL TURN IN AMERICAN HEALTH CARE.},

author = {Adam Gaffney},

doi = {10.2190/HS.45.1.d},

issn = {0020-7314},

year  = {2015},

date = {2015-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {45},

number = {1},

pages = {33–52},

abstract = {Leaving millions both uninsured and underinsured, the Affordable Care Act does not create a system of universal health care in the United States. To understand its shortcomings, we have to understand it as part of a historic shift in the political economy of American health care. This "neoliberal turn" began as a reaction against the welfare state as it expanded during the New Deal and post-World War II period. What began as a movement associated with philosophers like Friedrich Hayek ultimately had a powerful impact via the attraction of powerful corporate sponsors and political supporters, and it was to historically transform American health care thought and organization. In health policy circles, for example, it can be seen in a rising emphasis on "moral hazard," overuse, and cost sharing above a concern with universalism and equity. It was likewise manifested by the corporatization of the health maintenance organization and the rise of the "consumer-driven" health care movement. By the time of the health care reform debate, the influence of corporate "stakeholders" was to prove predominant. These developments, however, must be construed as connected parts of a much larger political transformation, reflected in rising inequality and privatization, occurring both domestically and internationally.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{day_affordable_2015,

title = {THE AFFORDABLE CARE ACT AND MEDICAL LOSS RATIOS: NO IMPACT IN FIRST THREE YEARS.},

author = {Benjamin Day and David U. Himmelstein and Michael Broder and Steffie Woolhandler},

doi = {10.2190/HS.45.1.i},

issn = {0020-7314},

year  = {2015},

date = {2015-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {45},

number = {1},

pages = {127–131},

abstract = {The Patient Protection and Affordable Care Act (ACA) set limits on insurers' overhead, mandating a medical loss ratio (MLR) of at least 80 percent in the individual and small-group markets and 85 percent in the large-group market starting in 2011. In implementing the law, the Obama administration introduced new rules that changed (and inflated) how insurers calculate MLRs, distorting time trends. We used insurers' filings with the U.S. Securities and Exchange Commission to calculate the largest insurers' MLRs before and after the ACA regulations took effect, using a constant definition of MLR. MLRs averaged 83.04 percent in the three years before reform and 83.05 percent in the three years after reform. We conclude that the ACA had no impact on insurance industry overhead spending.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{donato_case_2014,

title = {A case of hypercalcemia secondary to hot tub lung.},

author = {Jessica Donato and Colin T. Phillips and Adam W. Gaffney and Paul A. VanderLaan and Majd Mouded},

doi = {10.1378/chest.14-0350},

issn = {1931-3543 0012-3692},

year  = {2014},

date = {2014-12-01},

journal = {Chest},

volume = {146},

number = {6},

pages = {e186–e189},

abstract = {Hypersensitivity pneumonitis (HP) is a diffuse granulomatous lung disease resulting from inhalation of an antigen to which an individual has been previously sensitized. Hot tub lung is an increasingly common form of HP associated with inhalation of water aerosols containing Mycobacterium avium complex organisms that contaminate hot tub water. Granulomatous lung disorders, most classically sarcoidosis, have been associated with unregulated 1-α-hydroxylase expression by macrophages present in the granulomas, causing conversion of 25-OH-vitamin D to the active form of vitamin D, 1,25(OH)2 vitamin D, and, thus, hypercalcemia. To our knowledge, this is the first confirmed case of hypercalcemia secondary to elevated 1,25(OH)2 vitamin D levels associated with HP.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cabin_for-profit_2014,

title = {For-profit dialysis: the authors reply.},

author = {William Cabin and David U. Himmelstein and Steffie Woolhandler},

doi = {10.1377/hlthaff.2014.1101},

issn = {2694-233X 0278-2715},

year  = {2014},

date = {2014-11-01},

journal = {Health affairs (Project Hope)},

volume = {33},

number = {11},

pages = {2083},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_high_2014,

title = {High administrative costs: the authors reply.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.1377/hlthaff.2014.1097},

issn = {2694-233X 0278-2715},

year  = {2014},

date = {2014-11-01},

journal = {Health affairs (Project Hope)},

volume = {33},

number = {11},

pages = {2081},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{jiwani_billing_2014,

title = {Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.},

author = {Aliya Jiwani and David Himmelstein and Steffie Woolhandler and James G. Kahn},

doi = {10.1186/s12913-014-0556-7},

issn = {1472-6963},

year  = {2014},

date = {2014-11-01},

journal = {BMC health services research},

volume = {14},

pages = {556},

abstract = {BACKGROUND: The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. METHODS: We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. RESULTS: BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375 ($254 - $507) billion, or 80%, represents the added BIR costs of the current multi-payer system. CONCLUSIONS: A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_hospitals_2014,

title = {Hospitals excel–in administrative costs.},

author = {Steffie Woolhandler},

issn = {0160-7480},

year  = {2014},

date = {2014-09-01},

journal = {Modern healthcare},

volume = {44},

number = {37},

pages = {25},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_comparison_2014,

title = {A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.},

author = {David U. Himmelstein and Miraya Jun and Reinhard Busse and Karine Chevreul and Alexander Geissler and Patrick Jeurissen and Sarah Thomson and Marie-Amelie Vinet and Steffie Woolhandler},

doi = {10.1377/hlthaff.2013.1327},

issn = {2694-233X 0278-2715},

year  = {2014},

date = {2014-09-01},

journal = {Health affairs (Project Hope)},

volume = {33},

number = {9},

pages = {1586–1594},

abstract = {A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures–a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{frank_era_2014,

title = {Era of faster FDA drug approval has also seen increased black-box warnings and market withdrawals.},

author = {Cassie Frank and David U. Himmelstein and Steffie Woolhandler and David H. Bor and Sidney M. Wolfe and Orlaith Heymann and Leah Zallman and Karen E. Lasser},

doi = {10.1377/hlthaff.2014.0122},

issn = {2694-233X 0278-2715},

year  = {2014},

date = {2014-08-01},

journal = {Health affairs (Project Hope)},

volume = {33},

number = {8},

pages = {1453–1459},

abstract = {After approval, many prescription medications that patients rely on subsequently receive new black-box warnings or are withdrawn from the market because of safety concerns. We examined whether the frequency of these safety problems has increased since 1992, when the Prescription Drug User Fee Act, legislation designed to accelerate the drug approval process at the Food and Drug Administration, was passed. We found that drugs approved after the act's passage were more likely to receive a new black-box warning or be withdrawn than drugs approved before its passage (26.7 per 100.0 drugs versus 21.2 per 100.0 drugs at up to sixteen years of follow-up). We could not establish causality, however. Our findings suggest the need for reforms to reduce patients' exposure to unsafe drugs, such as a statement or symbol in the labeling, medication guides for patients, and marketing materials indicating that a drug was approved only recently.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{cabin_for-profit_2014-1,

title = {For-profit medicare home health agencies' costs appear higher and quality appears lower compared to nonprofit agencies.},

author = {William Cabin and David U. Himmelstein and Michael L. Siman and Steffie Woolhandler},

doi = {10.1377/hlthaff.2014.0307},

issn = {2694-233X 0278-2715},

year  = {2014},

date = {2014-08-01},

journal = {Health affairs (Project Hope)},

volume = {33},

number = {8},

pages = {1460–1465},

abstract = {For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome "avoidance of hospitalization" (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare's market-oriented, risk-based home care payment system.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{brehm_cathepsin_2014,

title = {Cathepsin G degradation of phospholipid transfer protein (PLTP) augments pulmonary inflammation.},

author = {Anthony Brehm and Patrick Geraghty and Michael Campos and Itsaso Garcia-Arcos and Abdoulaye Jules Dabo and Adam Gaffney and Edward Eden and Xian-Cheng Jiang and Jeanine D'Armiento and Robert Foronjy},

doi = {10.1096/fj.13-246843},

issn = {1530-6860 0892-6638},

year  = {2014},

date = {2014-05-01},

journal = {FASEB journal : official publication of the Federation of American Societies for Experimental Biology},

volume = {28},

number = {5},

pages = {2318–2331},

abstract = {Phospholipid transfer protein (PLTP) regulates phospholipid transport in the circulation and is highly expressed within the lung epithelium, where it is secreted into the alveolar space. Since PLTP expression is increased in chronic obstructive pulmonary disease (COPD), this study aimed to determine how PLTP affects lung signaling and inflammation. Despite its increased expression, PLTP activity decreased by 80% in COPD bronchoalveolar lavage fluid (BALF) due to serine protease cleavage, primarily by cathepsin G. Likewise, PLTP BALF activity levels decreased by 20 and 40% in smoke-exposed mice and in the media of smoke-treated small airway epithelial (SAE) cells, respectively. To assess how PLTP affected inflammatory responses in a lung injury model, PLTP siRNA or recombinant protein was administered to the lungs of mice prior to LPS challenge. Silencing PLTP at baseline caused a 68% increase in inflammatory cell infiltration, a 120 and 340% increase in ERK and NF-κB activation, and increased MMP-9, IL1β, and IFN-γ levels after LPS treatment by 39, 140, and 190%, respectively. Conversely, PLTP protein administration countered these effects in this model. Thus, these findings establish a novel anti-inflammatory function of PLTP in the lung and suggest that proteolytic cleavage of PLTP by cathepsin G may enhance the injurious inflammatory responses that occur in COPD.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{lasser_effect_2014,

title = {The effect of Massachusetts health reform on 30 day hospital readmissions: retrospective analysis of hospital episode statistics.},

author = {Karen E. Lasser and Amresh D. Hanchate and Danny McCormick and Meredith G. Manze and Chieh Chu and Nancy R. Kressin},

doi = {10.1136/bmj.g2329},

issn = {1756-1833 0959-8138},

year  = {2014},

date = {2014-03-01},

journal = {BMJ (Clinical research ed.)},

volume = {348},

pages = {g2329},

abstract = {OBJECTIVES: To analyse changes in overall readmission rates and disparities in such rates, among patients aged 18-64 (those most likely to have been affected by reform), using all payer inpatient discharge databases (hospital episode statistics) from Massachusetts and two control states (New York and New Jersey). DESIGN: Difference in differences analysis to identify the post-reform change, adjusted for secular changes unrelated to reform. SETTING: US hospitals in Massachusetts, New York, and New Jersey. PARTICIPANTS: Adults aged 18-64 admitted for any cause, excluding obstetrical. MAIN OUTCOME MEASURE: Readmissions at 30 days after an index admission. RESULTS: After adjustment for known confounders, including age, sex, comorbidity, hospital ownership, teaching hospital status, and nurse to census ratio, the odds of all cause readmission in Massachusetts was slightly increased compared with control states post-reform (odds ratio 1.02, 95% confidence interval 1.01 to 1.04, P<0.05). Racial and ethnic disparities in all cause readmission rates did not change in Massachusetts compared with control states. In analyses limited to Massachusetts only, there were minimal overall differences in changes in readmission rates between counties with differing baseline uninsurance rates, but black people in counties with the highest uninsurance rates had decreased odds of readmission (0.91, 0.84 to 1.00) compared with black people in counties with lower uninsurance rates. Similarly, white people in counties with the highest uninsurance rates had decreased odds of readmission (0.96, 0.94 to 0.99) compared with white people in counties with lower uninsurance rates. CONCLUSIONS: In the United States, and in Massachusetts in particular, extending health insurance coverage alone seems insufficient to improve readmission rates. Additional efforts are needed to reduce hospital readmissions and disparities in this outcome.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{marrast_minority_2014,

title = {Minority physicians' role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities.},

author = {Lyndonna M. Marrast and Leah Zallman and Steffie Woolhandler and David H. Bor and Danny McCormick},

doi = {10.1001/jamainternmed.2013.12756},

issn = {2168-6114 2168-6106},

year  = {2014},

date = {2014-02-01},

journal = {JAMA internal medicine},

volume = {174},

number = {2},

pages = {289–291},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_physician_2014,

title = {Physician payment incentives to improve care quality.},

author = {David U. Himmelstein and Steffie Woolhandler},

doi = {10.1001/jama.2013.284475},

issn = {1538-3598 0098-7484},

year  = {2014},

date = {2014-01-01},

journal = {JAMA},

volume = {311},

number = {3},

pages = {304},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_administrative_2014,

title = {Administrative work consumes one-sixth of UṠ. physicians' working hours and lowers their career satisfaction.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.2190/HS.44.4.a},

issn = {0020-7314},

year  = {2014},

date = {2014-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {44},

number = {4},

pages = {635–642},

abstract = {Doctors often complain about the burden of administrative work, but few studies have quantified how much time clinicians devote to administrative tasks. We quantified the time U.S. physicians spent on administrative tasks, and its relationship to their career satisfaction, based on a nationally representative survey of 4,720 U.S. physicians working 20 or more hours per week in direct patient care. The average doctor spent 8.7 hours per week (16.6% of working hours) on administration. Psychiatrists spent the highest proportion of their time on administration (20.3%), followed by internists (17.3%) and family/general practitioners (17.3%). Pediatricians spent the least amount of time, 6.7 hours per week or 14.1 percent of professional time. Doctors in large practices, those in practices owned by a hospital, and those with financial incentives to reduce services spent more time on administration. More extensive use of electronic medical records was associated with a greater administrative burden. Doctors spending more time on administration had lower career satisfaction, even after controlling for income and other factors. Current trends in U.S. health policy–a shift to employment in large practices, the implementation of electronic medical records, and the increasing prevalence of financial risk sharing–are likely to increase doctors' paperwork burdens and may decrease their career satisfaction.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{himmelstein_health_2014,

title = {Health issues and health care expenses in Canadian bankruptcies and insolvencies.},

author = {David U. Himmelstein and Steffie Woolhandler and Janis Sarra and Gordon Guyatt},

doi = {10.2190/HS.44.1.b},

issn = {0020-7314},

year  = {2014},

date = {2014-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {44},

number = {1},

pages = {7–23},

abstract = {Illness can contribute to financial problems directly, through high medical bills, and indirectly, through lost income. No previous in-depth studies have documented the role of medical problems among Canadian bankruptcy filers. We obtained the bankruptcy filings from a random sample of 5,000 debtors across Canada and mailed surveys to them seeking information about the medical antecedents of their bankruptcy. A total of 521 debtors responded (response rate of 10.4%), of whom 40.1 percent reported losing at least two weeks of work-related income because of illness or injury in the two years before their filing; 8.3 percent reported a similar income loss because of caregiving responsibilities for someone else who was ill. Although 60.1 percent of respondents reported being responsible for a medical bill within the previous two years, only 6.9 percent had bills over $5,000 (all amounts in Canadian Dollars). Prescription drugs were cited as the costliest medical expense by two-thirds of debtors reporting bills > $5,000, with dental bills cited by 22.2 percent. Universal health insurance affords Canadians protection against ruinous doctor and hospital bills. Inadequate coverage for prescription drugs and dental care, however, leaves some with unaffordable out-of-pocket costs. In addition, illness is a frequent indirect cause of bankruptcy through loss of work-related income.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{schooling_gonadal_2013,

title = {Gonadal steroids and body composition, strength, and sexual function in men.},

author = {C. Mary Schooling and David U. Himmelstein and Steffie Woolhandler},

doi = {10.1056/NEJMc1313169},

issn = {1533-4406 0028-4793},

year  = {2013},

date = {2013-12-01},

journal = {The New England journal of medicine},

volume = {369},

number = {25},

pages = {2455–2456},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_undiagnosed_2013,

title = {Undiagnosed and uncontrolled hypertension and hyperlipidemia among immigrants in the US.},

author = {Leah Zallman and David H. Himmelstein and Steffie Woolhandler and David H. Bor and John Z. Ayanian and Andrew P. Wilper and Danny McCormick},

doi = {10.1007/s10903-012-9695-2},

issn = {1557-1920 1557-1912},

year  = {2013},

date = {2013-10-01},

journal = {Journal of immigrant and minority health},

volume = {15},

number = {5},

pages = {858–865},

abstract = {Cardiovascular disease is a major cause of mortality and disability. We analyzed the National Health and Nutrition Examination Survey (1998-2008). We used logistic regression analysis to compare the odds of having undiagnosed and uncontrolled hypertension and hyperlipidemia among FB and US born adults sequentially adjusting for (1) age and gender, (2) income and education, and (3) insurance status. Among FB individuals, we identified factors independently associated with having each outcome using logistic regression analyses. Of 27,596 US adults, 22.6 % were foreign-born. In age- and -gender adjusted analyses, FB were more likely to have undiagnosed hypertension (OR 1.35, 95 % CI 1.13-1.63, p < 0.001), uncontrolled hypertension (OR 1.37, 95 % CI 1.15-1.64, p < 0.001), and uncontrolled hyperlipidemia (OR 1.35, 95 % CI 1.11-1.63},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{azaroff_barriers_2013,

title = {Barriers to use of workers' compensation for patient care at Massachusetts community health centers.},

author = {Lenore S. Azaroff and Letitia K. Davis and Robert Naparstek and Dean Hashimoto and James R. Laing and David H. Wegman},

doi = {10.1111/1475-6773.12045},

issn = {1475-6773 0017-9124},

year  = {2013},

date = {2013-08-01},

journal = {Health services research},

volume = {48},

number = {4},

pages = {1375–1392},

abstract = {OBJECTIVES: To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC). DATA SOURCES/STUDY SETTING: Leadership of CHCs in Massachusetts. STUDY DESIGN: We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts. DATA COLLECTION/EXTRACTION METHODS: Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated. PRINCIPAL FINDINGS: Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services. CONCLUSION: Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{matusow_medication_2013,

title = {Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes.},

author = {Harlan Matusow and Samuel L. Dickman and Josiah D. Rich and Chunki Fong and Dora M. Dumont and Carolyn Hardin and Douglas Marlowe and Andrew Rosenblum},

doi = {10.1016/j.jsat.2012.10.004},

issn = {1873-6483 0740-5472},

year  = {2013},

date = {2013-06-01},

journal = {Journal of substance abuse treatment},

volume = {44},

number = {5},

pages = {473–480},

abstract = {Drug treatment courts are an increasingly important tool in reducing the census of those incarcerated for non-violent drug offenses; medication assisted treatment (MAT) is proven to be an effective treatment for opioid addiction. However, little is known about the availability of and barriers to MAT provision for opioid-addicted people under drug court jurisdiction. Using an online survey, we assessed availability, barriers, and need for MAT (especially agonist medication) for opioid addiction in drug courts. Ninety-eight percent reported opioid-addicted participants, and 47% offered agonist medication (56% for all MAT including naltrexone). Barriers included cost and court policy. Responses revealed significant uncertainty, especially among non-MAT providing courts. Political, judicial and administrative opposition appear to affect MAT's inconsistent use and availability in drug court settings. These data suggest that a substantial, targeted educational initiative is needed to increase awareness of the treatment and criminal justice benefits of MAT in the drug courts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{zallman_immigrants_2013,

title = {Immigrants contributed an estimated $115.2 billion more to the Medicare Trust Fund than they took out in 2002-09.},

author = {Leah Zallman and Steffie Woolhandler and David Himmelstein and David Bor and Danny McCormick},

doi = {10.1377/hlthaff.2012.1223},

issn = {2694-233X 0278-2715},

year  = {2013},

date = {2013-06-01},

journal = {Health affairs (Project Hope)},

volume = {32},

number = {6},

pages = {1153–1160},

abstract = {Many immigrants in the United States are working-age taxpayers; few are elderly beneficiaries of Medicare. This demographic profile suggests that immigrants may be disproportionately subsidizing the Medicare Trust Fund, which supports payments to hospitals and institutions under Medicare Part A. For immigrants and others, we tabulated Trust Fund contributions and withdrawals (that is, Trust Fund expenditures on their behalf) using multiple years of data from the Current Population Survey and the Medical Expenditure Panel Survey. In 2009 immigrants made 14.7 percent of Trust Fund contributions but accounted for only 7.9 percent of its expenditures-a net surplus of $13.8 billion. In contrast, US-born people generated a $30.9 billion deficit. Immigrants generated surpluses of $11.1-$17.2 billion per year between 2002 and 2009, resulting in a cumulative surplus of $115.2 billion. Most of the surplus from immigrants was contributed by noncitizens and was a result of the high proportion of working-age taxpayers in this group. Policies that restrict immigration may deplete Medicare's financial resources.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{woolhandler_savings_2013,

title = {Savings from the Medicare Physician Group Practice Demonstration.},

author = {Steffie Woolhandler and David U. Himmelstein},

doi = {10.1001/jama.2012.88176},

issn = {1538-3598 0098-7484},

year  = {2013},

date = {2013-01-01},

journal = {JAMA},

volume = {309},

number = {1},

pages = {30–31},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{mohan_health_2013,

title = {The health of safety net hospitals following Massachusetts health care reform: changes in volume, revenue, costs, and operating margins from 2006 to 2009.},

author = {Arun Mohan and Jennifer Grant and Maren Batalden and Danny McCormick},

doi = {10.2190/HS.43.2.h},

issn = {0020-7314},

year  = {2013},

date = {2013-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {43},

number = {2},

pages = {321–335},

abstract = {Massachusetts health care reform, designed to expand coverage and access to care for vulnerable populations, serves as the model for national health reform in the United States that will be implemented in 2014. Yet, little is known about how the reform may have affected the demand for and the financial performance of safety net hospitals (SNH), the primary source of care for such populations before the reform. Using a quasi-experimental design that included all acute care hospitals in the state, we calculated changes in mean inpatient and outpatient volumes, revenue, and operating margins at SNH from the pre-reform (Fiscal Year 2006) to the post-reform (Fiscal Year 2009) period. We contrasted these changes with contemporaneous changes occurring among non-safety net hospitals (NSNH) using a difference-in-differences approach. We found that SNH in Massachusetts continue to play a disproportionately large role in caring for disadvantaged patients after reform, but that their financial performance has declined considerably compared with NSNH. Ongoing reform efforts in the United States should account for continued SNH demand among the most vulnerable patients and should be designed so as not to undermine the financial stability of SNH that meet this demand.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{hellander_medicare_2013,

title = {Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion.},

author = {Ida Hellander and David U. Himmelstein and Steffie Woolhandler},

doi = {10.2190/HS.43.2.g},

issn = {0020-7314},

year  = {2013},

date = {2013-01-01},

journal = {International journal of health services : planning, administration, evaluation},

volume = {43},

number = {2},

pages = {305–319},

abstract = {Previous research has documented Medicare overpayments to the private Medicare Advantage (MA) plans that compete with traditional fee-for-service Medicare. This research has assessed individual categories of overpayment for, at most, a few years. However, no study has calculated the total overpayments to private plans since the program's inception. Prior to 2004, selective enrollment of healthier seniors was the major source of excess payments. We estimate this has added US$41 billion to Medicare's costs since 1985. Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added US$122.5 billion to Medicare's costs since 2004. Congress mandated increased payment to private plans in the 2003 Medicare Modernization Act, which was mitigated, to a degree, by the subsequent Affordable Care Act. In total, we find that Medicare has overpaid private insurers by US$282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises. It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}