Health Policy Research

New Developments in Medicare. The resources needed to sustain the Medicare program are growing as baby boomers begin to retire and the elderly and disabled population expands. We are at the forefront of studying how Medicare is changing and meeting the needs of elders. We are assessing health plan and provider participation and implications for beneficiary access in the Medicare Advantage program. To inform debates leading up to passage of the Medicare prescription drug benefit, we estimated the costs and structure of such a benefit, using information from Medicare beneficiaries who also have Medicaid coverage. Since much of Medicare's costs go toward people with chronic diseases, we evaluate the effectiveness of chronic disease management programs as well as ways of paying for them. We are also helping assess the quality of care provided in different settings.

Covering Low-Income Families through Medicaid and SCHIP. We are addressing how the complementary Medicaid and SCHIP programs cover low-income families and promote access to care. Moreover, we are assessing how states decide to modify these programs when budgets are tight. In addition, we are studying state health care buy-in programs for disabled people who return to work and are no longer eligible for Medicaid.

Covering Uninsured Families. The number of Americans who lack health insurance is a pressing policy concern. We have estimated the number of uninsured families, assessed how their safety net functions, and looked at the contributions to charity care of private-sector physicians.

Private Health Insurance Markets. States have been testing new options for expanding insurance access, with some considering universal coverage. We simulated a single-payer plan in Maine and examined its impacts on different groups as well as the state economy. We are evaluating how parity laws for mental health and substance abuse problems affect the availability of employer coverage, as well as access, utilization, and spending. We also estimate the number of people with public and private mental health coverage, including the number with employer-based behavioral health coverage subject to parity laws.

Across the life span, the health care needs of the population vary. We evaluate maternal and child health care programs as well as community initiatives for families and older Americans, including supportive housing, behavioral health programs, and disease management options for older and disabled adults with chronic diseases. Moreover, we help advance measures of care quality and consumer satisfaction.

We have been a leader in studying pay for performance, public reporting of quality data, disease management, and use of technology to monitor and improve care—four of the most promising strategies available to policymakers and private health care leaders to encourage quality improvement. Sound quality measurement is central to these strategies, and we have worked on the development, analysis, and evaluation of quality measures, including claims-based, medical-chart-based, and patient-reported measures.

We have a long history of exploring health care needs and quality of care for vulnerable populations—including people who are low-income, disabled, frail and elderly, poorly served, or residents of rural areas. Focusing on how the health professional work force meets their needs, we examine the safety net, behavioral and mental health service delivery, rural health service delivery, shortages of health professionals, and the need for trained medical interpreters.

The nation's public health agencies face challenges as new infectious diseases, such as SARS, spread. In addition, bioterrorism has assumed a higher profile, and chronic diseases, such as diabetes, have become major health burdens. We are working with the CDC to assess disease surveillance systems, programs to prevent domestic violence, and disease prevention and health promotion initiatives. Our nutrition studies are looking at the problems of obesity and chronic diseases linked to dietary practices and examining nutritional support for pregnant women and their children. Because adolescent health and risk taking are major concerns, we are conducting the first rigorous study of abstinence programs and their effectiveness.

Building on our extensive policy expertise, we provide optimal analysis using the most effective methods. We collect data through surveys, using web, telephone, in-person, and mail approaches. Qualitative techniques, such as case studies, site visits, and focus groups, are an important part of our work. We evaluate best practices and assess program performances using rigorous approaches. We create large-scale insurance databases for Medicaid, SCHIP, and Medicare and design systems so they can be used easily for research. We have extensive experience merging administrative data sets built from WIC records, Medicaid and birth certificates, and Medicaid and Social Security data. Our services range from providing technical assistance to states needing immediate help with pressing issues, to estimating longer-term impacts of new programs and policies on the people they are intended to serve. We also develop surveillance systems for tracking health indicators and provide formative feedback to programs to use in improving quality.

Disability or chronic illness can affect all aspects of someone's life: employment, education, health, housing, income, and the need for medical and support services. Mathematica draws on its extensive background in these areas to develop insights into how public policies influence the lives of people with disabilities and chronic illnesses. We also have substantial knowledge of programs, legislation, and judicial decisions affecting children, adults, and elderly persons with these conditions.