Predicting State Investment in Medicaid Home- and Community-Based Services, 2000-2011.

Although state use of Medicaid home- and community-based services (HCBS) to provide long-term services and supports to older adults and individuals with physical disabilities continues to increase, progress is uneven across states. We used generalized linear models to examine state factors associated with increased allocation of Medicaid dollars to HCBS for the period 2000 to 2011. We observed enhanced growth in states that began the period with limited investment in HCBS, as reflected in significant year trends among these states.

Disparities in access to health care among middle-aged and older adults with disabilities.

Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n=13,174).

The relation between health insurance and health care disparities among adults with disabilities.

Objectives: We examined disparities among US adults with disabilities and the degree to which health insurance attenuates disparities by race, ethnicity, and socioeconomic status (SES).

Methods: We pooled data from the 2001-2007 Medical Expenditure Panel Survey on individuals with disabilities aged 18 to 64 years. We modeled measures of access and use as functions of predisposing, enabling, need, and contextual factors.

Effects of gender, disability, and age in the receipt of preventive services.

Purpose Of The Study: We extend research to examine relations between gender, disability, and age in the receipt of preventive services.

Design And Methods: We pool Medical Expenditure Panel Survey data for years 2001-2007. Using logit models, we examine the relations between gender, disability, and age and the receipt of preventive services.

The effect of pharmacy benefit design on patient-physician communication about costs.

Background: Incentive-based formularies have been widely instituted to control the rising costs of prescription drugs. To work properly, such formularies depend on patients to be aware of financial incentives and communicate their cost preferences with prescribing physicians. The impact of financial incentives on patient awareness of and communication about those costs is unknown.

Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery.

Objective: This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver.

Study Design: A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor.

Risk adjustment for people with chronic conditions in private sector health plans.

Background: Although the problem of adverse selection into more generous health insurance plans has been the focus of previous work, risk adjustment systems have only recently begun to be implemented to blunt its effect.

Objectives: This study examines the ability of the leading risk adjustment systems to predict health care expenditures for people with chronic conditions, using claims and enrollment data from 2 large employers.

Research Design: Predictive errors and total financial losses/gains are compared for different risk adjustment approaches (primarily hierarchical condition categories [HCCs] and adjusted clinical groups) for several chronic conditions.