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Health Policy Research
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 At a time when health care costs are consuming more than 15 percent
of our gross domestic product and straining state and federal budgets,
policymakers need timely and reliable information on the effectiveness
of health care investments and an accurate analysis of what needs remain
unmet. Our policy analysis for federal and state agencies and the health
care industry helps them respond to these challenges. Using the most current
and effective methods, we collect and analyze data, evaluate programs,
summarize policy implications, identify solutions, and translate results
into practice. Read more about our health research. |
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A Decade of Lessons from the State Children's Health Insurance Program
 The State Children's Health Insurance Program (SCHIP) is at the center of current policy debates. A report and issue brief present findings from Mathematica's comprehensive evaluation. The study found that SCHIP reduced both the number and rate of uninsured children and improved children's access to health care. Read more. |
Reversing the Upward Trend of Diabetes: How Can Government Help?
 The federal government spent $80 billion more in 2005 to treat those with diabetes and care for its complications than it spent for those without diabetes—12 percent of total federal health care spending nationwide. A recent report identifies ways for the federal government to take a leadership role in reversing the upward trend of diabetes. Read more.
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Reports: |
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"Report to Congress on the Evaluation of Medicare Disease Management Programs." Arnold Chen, Randall Brown, Dominick Esposito, Jennifer Schore, and Rachel Shapiro, February 2008. Before Medicare Part D, Congress authorized the Medicare disease management demonstration to evaluate whether disease management programs—in conjunction with a comprehensive prescription drug benefit—could improve health outcomes and reduce Medicare expenditures. The demonstration targeted fee-for-service Medicare beneficiaries with advanced congestive heart failure, diabetes, or coronary artery disease. This congressionally mandated study found that, based on the population-based random assignment design, none of the three demonstration programs had impacts on key outcomes of Medicare Part A and B expenditures and service use.
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"Health Insurance Exchange Study." Deborah Chollet, Su Liu, Kate Stewart, Alison Wellington, Allison Barrett, Mila Kofman, and Amy M. Lischko, March 2008. In 2007, the state of Minnesota considered establishing a Health Insurance Exchange to serve small groups and individuals, facilitating access to coverage, choice among insurance products, portability of coverage, and affordability. Mathematica studied the coverage, cost, and fiscal impacts of a series of health reforms that might occur coincident with the implementation of the exchange—guaranteed issue and community rating of both small group and individual products, a mandate requiring all residents to obtain coverage, and a requirement that all employers with 11 or more employees offer a Section 125 or “cafeteria” plan. This report estimates the impacts of the reforms alone and in combination. In addition, it explores the range of implementation and legal issues that policymakers in Minnesota would need to address in order to develop an exchange.
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“Health Care Access and Use Among Low-Income Children on Subsidized Insurance Programs in California.” Christopher Trenholm, Anna Saltzman, Shanna Shulman, Michael Cousineau, and Dana Hughes, May 2008. This paper summarizes the CaliforniaKids and Healthy Kids programs—county-based insurance programs in California for low-income children. The study examined features of both programs, use of basic health care services by the children enrolled, and typical experiences accessing inpatient and other high-cost care. Children enrolled in the two programs made substantial use of outpatient health care, despite important variation in program features. The study concludes with recommendations on how future research can more rigorously and precisely examine children's access and use of the programs.
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"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002." Audra T. Wenzlow, Robert Schmitz, and Kathy Shepperson, January 2008. This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. The authors compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services. They also examine long-term care expenditures and utilization for two key groups of enrollees—young disabled enrollees and enrollees ages 65 and older. The article decomposes community-based long-term care expenditures by type of service and summarizes other Medicaid services used and costs incurred in 2002. Executive Summary
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"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." Audra T. Wenzlow, Robert Schmitz, and Jill Gurvey, January 2008. This report describes patterns of Medicaid nursing home utilization for each state and nationally. The authors address the following questions: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do these people become eligible for Medicaid? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? They also examine how state policies are associated with nursing home utilization. Executive Summary
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"Federal Medical and Disability Program Costs Associated with Diabetes, 2005. Summary of Methods and Key Findings." Marsha Gold, Craig Thornton, Allison Hedley, Cheryl Fahlman, Suzanne Felt-Lisk, Bob Weathers, and Thomas Croghan, September 2007. Diabetes is a growing threat to the nation's health that has serious and costly complications. This paper looks behind the $79.7 billion estimates for 2005 of medical and disability costs to the federal government cited in Mathematica's main study. The estimates include $2.5 billion in disability payments associated with diabetes and $77.2 billion in increased medical costs. Nearly 80 percent of the medical costs to the federal government were incurred in the Medicare program. Without enhanced efforts to control blood glucose, reduce the risk of complications, and prevent the onset of diabetes, federal costs related to diabetes will grow in the future.
More Reports
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Journal Articles: |
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"A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care." Larry Wissow, Bruno Anthony, Jonathan Brown, Susan DosReis, Anne Gadomski, Golda Ginsburg, and Mark Riddle, Administration and Policy in Mental Health, July 2008. Strategies used to treat children's mental health problems in primary care have several limitations. This article proposes a new clinical model for delivering mental health services in pediatric primary care and suggests that physicians can efficiently learn a core set of treatment skills and apply them to a broad range of mental health problems. The authors review how implementation of this model would impact the delivery, organization, and funding of pediatric primary care and propose a research agenda to test the model.
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“Neo-Materialist Theory and the Temporal Relationship Between Income Inequality and Longevity Change.” Andrew Clarkwest, Social Science & Medicine, May 2008. The author challenges prior fixed effects analyses of the relationship between income inequality and population health. He argues that the temporal relationships are likely to be complex and that fixed effects approaches, though important for addressing confounding, are poorly equipped to capture potential real impacts. Longevity improved less in states with higher levels of inequality, and there is a strong negative association between change in inequality and change in longevity after adjusting for initial levels of state characteristics.
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“Dynamics in Medicaid and SCHIP Eligibility Among Children in SCHIP's Early Years: Implications for Reauthorization.” Anna S. Sommers, Lisa Dubay, Linda J. Blumberg, Fredric E. Blavin, and John L. Czajka, Health Affairs, September/October 2007. Two-thirds of children in the United States were income eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) at some point from 1996 to 2000. One in five were income eligible for both programs, and 73 percent of children ever eligible for SCHIP were eligible at other times for Medicaid. The authors note that as SCHIP is reauthorized, Congress will need to give states the tools and financial commitment to ensure that uninsured children are enrolled in and retain coverage for which they are eligible.
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"Convergence and Dissonance: Evolution in Private-Sector Approaches to Disease Management and Care Coordination." Glen P. Mays, Melanie Au, and Gary Claxton, Health Affairs, November/December 2007. Disease management approaches survived the 1990s backlash against managed care because of their potential for consumer-friendly cost containment, but purchasers have been cautious about investing heavily in them because of uncertainty about return on investment. This article examines how private-sector approaches to disease management have evolved over the past two years in the midst of the movement toward consumer-driven health care. Findings indicate that these programs have become standard features of health plan design, despite a thin evidence base concerning their effectiveness.
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"Receiving Advice About Child Mental Health from a Primary Care Provider: African American and Hispanic Parent Attitudes." Jonathan D. Brown, Lawrence S. Wissow, Ciara Zachary, and Benjamin L. Cook, Medical Care, November 2007. African American and Hispanic youth with mental health problems are less likely than their Caucasian counterparts to receive mental health services. Primary care providers are often the source of mental health care for children and may play a role in reducing disparities. This research investigated parent attitudes associated with receiving advice about child mental health in primary care and whether attitudes differed according to race and ethnicity during 773 visits to 54 providers in 13 clinics. Hispanics were more likely than non-Hispanics to agree that primary care providers should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the provider. African American parents were significantly less willing than Caucasians and Hispanics to allow their child to receive medications for mental health but did not differ in their willingness to visit a therapist. These findings suggest that African American parents are generally as willing as Caucasian parents to have their child's mental health needs addressed in primary care and that primary care may be a particularly good point of intervention for Hispanic youth with mental health problems.
More Journal Articles
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Issue Briefs: |
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"Medicare Advantage in 2008." Marsha Gold, June 2008. Medicare Advantage (MA), a voluntary program that provides beneficiaries with an alternative way to access traditional Medicare benefits, replaced the Medicare+Choice program in 2004 and became fully operational in 2006. This issue brief reviews recent trends in the program and includes information trends in firm participation and market share, changes in beneficiary choice, and growth in MA plans available to employer groups. The brief notes that the number of Medicare beneficiaries in MA plans continues to grow, to 8.2 million at the end of 2007, up from 5.4 million in March 2005. In the first four months of 2008, enrollment increased by more than 800,000. Private fee-for-service plans account for more than half of this new growth. About one in five Medicare beneficiaries (19 percent) is enrolled in an MA plan. In addition, four main players—UnitedHealthcare, Humana, Kaiser, and Blue Cross Blue Shield—accounted for more than half of enrollment at the end of 2007.
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"Improving Processes and Increasing Efficiency: The Case for States Participating in a Process Improvement Collaborative." Sheila Hoag and Judith Wooldridge, September 2007. State Medicaid and SCHIP agencies provide vital health coverage to low-income populations and other groups, but they have limited administrative resources to support enrollment and renewal. This brief looks at experiences of some state Medicaid and SCHIP agencies in using a process change model to strengthen the way they approach enrollment and retention, concluding that committed leadership and resources are an effective model for changing Medicaid and SCHIP enrollment and retention processes rapidly and for sustaining improved processes. The brief also explores whether a process improvement collaborative is a worthwhile investment for states, finding that they have much to gain in terms of increased efficiency and savings using the model, which can be applied to any area of state administration.
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"Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families." In Brief #1. Christopher Trenholm, Embry Howell, Ian Hill, and Dana Hughes, November 2007. Since 2001, initiatives have emerged in 25 of California's 58 counties to expand health insurance coverage for children. These initiatives make use of a new insurance product, Healthy Kids, that covers children who are ineligible for Medi-Cal and Healthy Families, California's public programs for children in families with incomes up to 250 percent of the federal poverty level. This brief presents highlights from evaluations of Healthy Kids programs in Los Angeles, San Mateo, and Santa Clara counties. The brief notes that children's access to and use of medical care improved, unmet health care needs declined, and parents of children enrolled in Healthy Kids reported far more confidence that they could obtain care for their children.
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Other: |
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"New Hospital Information Technology: Is It Helping to Improve Quality?" Suzanne Felt-Lisk, in Hospital Management New Initiatives/Dimensions, 2008. Although health information technology (IT) is at the center of efforts to improve the nation’s health care system by enhancing patient safety and reducing inefficiencies, little evidence exists to link IT to quality improvements and efficiency gains. This book chapter reprints a May 2006 issue brief reporting on how six types of information technology have affected hospital quality, based on interviews with senior hospital executives. The findings suggest that IT has been an important factor in enhancing quality, particularly in terms of more timely clinical information, diagnosis, and treatment.
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On March 5, senior fellow Deborah Chollet testified before a House Appropriations Subcommittee at a hearing on Expanding Health Care Access. Read her statement on "State Comprehensive Access Initiatives."
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"The Medicaid Analytic eXtract (MAX) Chartbook." Audra T. Wenzlow, Dan Finkelstein, Ben Le Cook, Kathy Shepperson, Christine Yip, and David Baugh, 2007. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experience in 2002. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollee demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2002. Appendix Tables
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