Papers by Alshadye Yemane
PsycEXTRA Dataset, 2006
The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of ... more The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
Health care financing review
SUMMARY Lack of health insurance coverage is a pressing and persistent challenge for low-income a... more SUMMARY Lack of health insurance coverage is a pressing and persistent challenge for low-income adults. In 2003, four in ten low-income adults (below 200% of poverty or $18,620 for an individual in 2004) were uninsured and low-income adults accounted for about half of the uninsured population (Figure 1). Because low-income adults often work at jobs that do not offer employer-
Inquiry : a journal of medical care organization, provision and financing, 2013
The expansion of Medicaid coverage under the Affordable Care Act offers the potential for signifi... more The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.
Health care financing review, 2004
We estimated the proportion of children with special health care needs (CSHCN) eligible for Medic... more We estimated the proportion of children with special health care needs (CSHCN) eligible for Medicaid and the State Children's Health Insurance Program (SCHIP) using data from the 2000 and 2001 National Health Interview Survey (NHIS) and an algorithm to determine likely eligibility. We find that CSHCN were more likely to be eligible compared with other children (50 versus 43 percent), and that they were eligible through different program mechanisms. Relatively few faced waiting periods and premiums to participate in public programs. Participation rates were higher for CSHCN eligible through Medicaid Program rules prior to the SCHIP expansions, compared with those newly eligible after 1997. CSHCN had higher rates of participation than children without special needs (CWOSN), across all eligibility categories.
Medicare & Medicaid Research Review, 2014
Descriptive analysis comparing changes in hospital inpatient readmissions to emergency department... more Descriptive analysis comparing changes in hospital inpatient readmissions to emergency department visits and observation stays that occurred within 30 days of an inpatient stay. Medicare fee-for-service (FFS) beneficiaries that had at least one acute hospital inpatient stay. Using 100 percent of claims in the Chronic Condition Data Warehouse, we compare growth in annual readmission stays to post-hospitalization emergency department visits and observation stays that were not accompanied by an inpatient stay. Comparisons are performed at the national level and within the Dartmouth Hospital Referral Regions (HRRs). In calendar year 2012, the national, all-cause, 30-day hospital readmission rate among Medicare FFS beneficiaries was 18.5 percent, a significant decline from 19 percent in 2011, which was also the average rate over the previous five years. The number of index admission stays per-1,000 Medicare beneficiaries declined by 4.3 percent, from 283.4 in 2011 to 271.3 in 2012. On a per-1,000 beneficiary basis, the number of readmission stays declined by 6.8 percent, from 53.8 in 2011 to 50.1 in 2012. On the same per-beneficiary basis, the rate of outpatient visits to an emergency department occurring within 30 days of an index hospitalization remained similar at 23.5 in 2011 and 23.4 in 2012. Per-1,000 beneficiaries, the number of observation stays within 30 days of an index hospitalization increased by 0.3 percent, from 3.4 in 2011 to 3.7 in 2012. The reasons behind the decline in the Medicare readmission rate in 2012 are not yet clear. When looking at utilization changes in absolute terms, our findings suggest that the reduction in the nation-wide readmission rate observed in 2012 was not primarily the result of increases in either post-index ED visits or post-index observation stays.
Medicare & Medicaid Research Review, 2013
Descriptive analysis of 30-day, all-cause hospital readmission rate patterns from 2007-2012. Medi... more Descriptive analysis of 30-day, all-cause hospital readmission rate patterns from 2007-2012. Medicare FFS beneficiaries experiencing at least one acute inpatient hospital stay. Using Chronic Condition Data Warehouse claims, we estimate unadjusted, monthly, readmission rates for the nation, within the Dartmouth Hospital Referral Regions (HRR), and compare participating and non-participating hospitals in the Partnership for Patients (P4P) program (overall and by number of inpatient beds at each facility). From 2007 through 2011, the national 30-day, all-cause, hospital readmission rate averaged 19 percent. During calendar year 2012, the readmission rate averaged 18.4 percent. Of the 306 HRRs, rates in 166 HRRs fell by between 1 and 5 percent, while rates dropped by more than 5 percent in 73 HRRs, with the largest reduction in Longview, Texas. Rates increased by more than 1 percent in only 30 HRRs, with the largest increase in Bloomington, Illinois. Readmission rates at hospitals participating in the P4P program have been, on average, consistently lower than the rates at non-participating hospitals within all size categories except for the very smallest and largest hospitals, but rates at both participant and non-participant hospitals fell in 2012. Although claims data are not yet final for 2012, our analysis indicates that hospital readmission rates for all Medicare FFS beneficiaries dropped noticeably during the year. The reasons behind the apparent reduction are not yet clear and merit further investigation.
American Economic Review, 2009
... Discussants: Thomas Buchmueller, University of Michigan; Norma Coe ... Long: The Urban Instit... more ... Discussants: Thomas Buchmueller, University of Michigan; Norma Coe ... Long: The Urban Institute, 2100 M Street, NW, Washington, DC 20037 (e-mail: [email protected]); Stockley: The Urban Institute, 2100 M Street, NW, Washington, DC 20037 (e-mail: KStockley@urban. ...
American Economic Review, 2010
Inquiry, 2002
Families to examine the effects of the various forms of mandatory Medicaid managed care on access... more Families to examine the effects of the various forms of mandatory Medicaid managed care on access and use among beneficiaries not receiving Supplemental Security Income or Medicare benefits. The results show that mandatory health maintenance organization (HMO) programs have had a positive impact on both children and adults, particularly when compared to Medicaid fee-for-service plans. We observed less dependence on emergency rooms as a usual source of care, a greater probability of visiting a doctor and, for children, greater use of preventive care. In contrast, mandatory primary care case management plans (PCCM) provided some benefits to children, but appeared to have very little impact on adult Medicaid beneficiaries. Mandatory programs that use both HMOs and PCCM produced mixed results. With the exception of mandatory HMO programs, discrepancies in access and use continue to exist between Medicaid managed care enrollees and low-income privately insured people.
Inquiry, 2003
This study examines the effects of having an uninsured parent on access to health care for low-in... more This study examines the effects of having an uninsured parent on access to health care for low-income children. Using data from the 1999 National Survey of America's Families, we find that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Estimates for low-income children who have insurance but have an uninsured parent indicate a 4.1 percentage-point reduction in the probability of having any medical provider visit, and a similar 4.2 percentage-point reduction in the probability of having a well-child visit relative to those with insured parents. The effects of having an uninsured parent are smaller in magnitude than the effects of a child being uninsured. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. Although the magnitude of these effects is small relative to the direct effect of providing insurance to either the child or parent, they should be considered in analyses of costs and benefits of proposed policies.
Health Services Research, 2003
Objective. To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees'... more Objective. To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level. Data Sources/Study Setting. 1991 and a 1998 Urban Institute survey on state Medicaid managed care programs. Study Design. Using multivariate regression models, we estimated the effect of living in a county with an MMC program on several access and use measures for nonelderly women who receive Medicaid through AFDC and child Medicaid recipients. We focus on mandatory programs and estimate separate effects for primary care case management (PCCM) programs, health maintenance organization (HMO) programs, and mixed PCCM/HMO programs, relative to fee-for-service (FFS) Medicaid. We control for individual and county characteristics, and state and year effects. linked to information on Medicaid managed care characteristics at the county level from the 1998 MMC survey. Principal Findings. We find virtually no effects of mandatory PCCM programs. For women, mandatory HMO programs reduce some types of non-emergency room (ER) use, and increase reported unmet need for medical care. The PCCM/HMO programs increase access, but had no effects on use. For children, mandatory HMO programs reduce ER visits, and increase the use of specialists. The PCCM/HMO programs reduce ER visits, while increasing other types of use and access. Conclusions. Mandatory PCCM/HMO programs improved access and utilization relative to traditional FFS Medicaid, primarily for children. Mandatory HMO programs caused some access problems for women.
Health Affairs, 2006
States' principal motivation for pursuing HIFA demonstrations was to expand coverage, not, as som... more States' principal motivation for pursuing HIFA demonstrations was to expand coverage, not, as some had feared, to control costs.
Health Affairs, 2009
This paper examines various reasons for the growth in Medicaid spending in the current decade. Al... more This paper examines various reasons for the growth in Medicaid spending in the current decade. Although Medicaid spending has grown faster than the rate of increase in national health spending, much of this is explained by increased enrollment. Per enrollee, Medicaid spending actually compares favorably to increases in medical care prices and gross domestic product. The relative success in Medicaid cost containment seems to be attributable to limits on provider payment rates, expansion of managed care, limits on the use and pricing of prescription drugs, and expansion of community-based long-term care programs. We suggest two strategies for further cost containment. [Health Aff I n t h e f i r s t y e a r o f p r e s i d e n t b a r ac k o b a m a's t e r m , Americans' attention has turned again to health reform. One major topic in the reform debates of 2009 is the cost of public health insurance coverage. To inform these discussions, we analyze recent spending growth in the federal-state Medicaid program, which covers low-income and disabled Americans. Medicaid spending increased from $205.7 billion in 2000 to $330.8 billion in 2007-an average annual growth rate of 7.0 percent (Exhibit 1). In 2006, Medicaid prescription drug spending for dual eligibles (those eligible for both Medicare and Medicaid) was shifted to Medicare, which meant a one-time reduction in Medicaid spending and a lower rate of growth. After adjusting for this shift, Medicaid spending increased about 7.8 percent over this period. As we contend in this paper, Medicaid spending growth has largely been driven by enrollment and underlying health care inflation. Per enrollee, this growth, over and above increases in medical care prices or growth in gross domestic product (GDP), has been quite small. Nonetheless, there are still areas in which Medicaid spending growth could be better controlled. 1 4 5 6 S e p t e m b e r / O c t o b e r 2 0 0 9 L o o k i n g A h e a d on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from 1 4 5 8 S e p t e m b e r / O c t o b e r 2 0 0 9 L o o k i n g A h e a d on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from M e d i c a i d H E A LT H A F F A I R S~Vo l u m e 2 8 , N u m b e r 5 1 4 5 9 on July 19, 2016 by HW Team Health Affairs by http://content.healthaffairs.org/ Downloaded from 1 4 6 0 S e p t e m b e r / O c t o b e r 2 0 0 9
Health Affairs, 2005
Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial ... more Although the rapid increase in Medicaid managed care during the early 1990s attracted commercial plans to the program, by the late 1990s commercial plan participation in Medicaid had begun to decline. This study examines the role of Medicaid policies, plan characteristics, and local health care market conditions in a commercial plan's decision to exit. We find that many of the factors that influence commercial plans' decisions to exit Medicaid are within the control of state policymakers and program administrators, including capitation rates, service carve-outs, mandatory enrollment policies, and the number of Medicaid enrollees and areas served by the plan. M anage d c a r e h a s b e c o m e t h e d o m i nan t m o d e of care delivery within the Medicaid program, covering nearly 60 percent of all enrollees in 2003. 1 That dominance is expected to grow as states expand Medicaid managed care (MMC) to additional geographic areas and populations, including rural areas and disabled people.
American Journal of Evaluation, 2006
This article provides a critical review of the quality of 12 recent large federal program evaluat... more This article provides a critical review of the quality of 12 recent large federal program evaluations. The review focused on elements of the evaluation design, inclusion of evaluation expertise among those who have oversight of the evaluation, and evaluation dissemination. Overall, the process analyses from these evaluations provide good models for how to assess implementation and provide feedback to grantees. However, other features of these evaluations require improvement. For example, program monitoring often did not include adequate outcome data and few evaluations had solid impact analyses. Efforts to disseminate findings to grantees, government stakeholders, and academic audiences were also weak. The authors provide recommendations to improve the evaluations of large federal programs.
American Journal of Public Health, 2010
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Papers by Alshadye Yemane