Certificate of need laws: a systematic review and cost-effectiveness analysis.

Background: Certificate of Need (CON) laws, currently in place in 35 US states, require certain health care providers to obtain a certification of their economic necessity from a state board before opening or undertaking a major expansion. We conduct the first systematic review and cost-effectiveness analysis of these laws.

Methods: We review 90 articles to summarize the evidence on how certificate of need laws affect regulatory costs, health expenditures, health outcomes, and access to care.

The Case Against Medicaid Expansion in North Carolina.

This commentary argues against Medicaid expansion in North Carolina for 5 reasons: Expansion will reduce access to care for highly vulnerable individuals who are already enrolled in Medicaid; it is unlikely to save lives; it is unaffordable in the long run; its current financing structure encourages fiscal irresponsibility; and it will eliminate more jobs than it creates.

Insurance coverage among people living with combined HIV/AIDS, chronic mental illness, and substance abuse disorders.

HIV triply-diagnosed adults (those with chronic mental illness and substance abuse disorders) must rely heavily on public insurance to cover high annual medical costs (approximately $50,000). This study examines the nature and determinants of insurance coverage (including managed care) for this population, along with annual transitions in coverage. Relative to people living with HIV/AIDS in general, fewer triply-diagnosed adults rely on private coverage (3% vs.

Costs of care for people living with combined HIV/AIDS, chronic mental illness, and substance abuse disorders.

To determine healthcare access and costs for triply diagnosed adults, we examined baseline data from the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site cohort study of HIV+ adults with co-occurring mental and substance abuse disorders conducted between 2000 and 2004. Baseline interviews were conducted with 1138 triply diagnosed adults in eight predominantly urban sites nationwide. A modified version of Structured Interview for DSM-IV Axis I Disorders (SCID) was used to assign Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses for the preceding year.

Cost-effectiveness analysis of integrated care for people with HIV, chronic mental illness and substance abuse disorders.

Background: Triply diagnosed patients, who live with HIV and diagnosed mental health and substance abuse disorders, account for at least 13% of all HIV patients. This vulnerable population has substantial gaps in their care, attributable in part to the need for treatment for three illnesses from three types of providers.

Aims Of The Study: The HIV/AIDS Treatment Adherence, Health Outcomes and Cost study (HIV Cost Study) sought to evaluate the cost-effectiveness of integrated HIV primary care, mental health, and substance abuse services among triply diagnosed patients.

Triply-diagnosed patients in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study: patterns of home care use.

Although AIDS is a chronic illness, little is known about the patterns and correlates of long-term care use among triply diagnosed HIV patients. We examined nursing and home care use among 1,045 participants in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site study of HIV-positive patients with at least one mental health and one substance disorder. Patient interviews and medical record review data were used to examine the average monthly cost of nursing home, formal home and informal home care.

Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders.

Objective: To examine the effects of race/ethnicity, insurance, and type of substance abuse (SA) diagnosis on utilization of mental health (MH) and SA services among triply diagnosed adults with HIV/AIDS and co-occurring mental illness (MI) and SA disorders.

Data Source: Baseline (2000 to 2002) data from the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study.

Study Design: A multiyear cooperative agreement with 8 study sites in the United States.

Income and employment of people living with combined HIV/AIDS, chronic mental illness, and substance abuse disorders.

Background: This paper examines the labor market outcomes of HIV triply-diagnosed adults having a combination of HIV, mental illness and substance abuse problems.

Aims Of The Study: We sought to determine the sources of money income for HIV triply diagnosed adults (public or private), receipt of transfer income (e.g.

For-profit conversion of Blue Cross plans: public benefit or public harm?

Conversions of Blue Cross plans to for-profit status have the potential to remake the corporate landscape of health care finance. Absent regulatory intervention, current trends could easily result in more than half of Blue Cross subscribers being in for-profit plans, a phenomenon far more significant than the conversion of nonprofit hospitals. Therefore, regulators' deliberations over conversion proposals are beginning to focus on the health policy impacts.

The impact of Blue Cross conversions on health spending and the uninsured.

Using statewide data on health spending and uninsurance rates, we investigate the impact of Blue Cross conversions on health care costs and coverage. We find mixed results, with some conversion states improving their performance on either or both measures relative to the national average and others experiencing a decline. A multivariate analysis suggests that overall, the impact of Blue Cross conversion may be to reduce hospital and total spending, but whether this effect endures depends in part on how "conversion" is defined.

Antecedents of hospital ownership conversions, mergers, and closures.

This study assesses the determinants of conversions in hospital ownership from 1986 through 1996. To place such changes in context, we also analyze causes of hospital mergers and closures, which are often alternatives to hospital ownership conversion. A consistent result from our analysis is that an important antecedent of ownership conversions is a low profit margin.

Rates of return from hospital conversions.

This article presents information on the rates of return obtained by purchasers of U.S. hospitals since the mid 1980s.

Impact of medicaid managed care on utilization of obstetric care: evidence from TennCare's early years.

Background: TennCare expanded Medicaid coverage, substituting managed care for fee-for-service reimbursement in Tennessee.

Methods: To study effects of TennCare on utilization of obstetric care (office visits, prenatal tests, care at labor/delivery), we used a before (1993) and after (1995) design with North Carolina as a control state. Data came from interviews with women with various forms of insurance, delivering in 1993 or 1995 in both states.