Health Policy Research


	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.

Highlights

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.

Latest Work

	Reports:
	"Research Design Report for the Evaluation of the Money Follows the Person (MFP) Grant Program." Randall Brown, Carol Irvin, Debra Lipson, Sam Simon, and Audra Wenzlow, October 2008. This report presents the research design for the evaluation of the Money Follows the Person program implementation and effects on participants and the long-term care system. Under the program, 31 participating states are providing enhanced services to help interested Medicaid beneficiaries in long-term care institutions move back to the community. States receive funds from the program’s augmented federal matching rate for support services provided to those who make the transition. States are expected to use these funds to improve long-term care systems and options for beneficiaries wishing to remain in the community. Back to Top
	"State Efforts to Address the Healthy People 2010 Goal to Eliminate Health Disparities: Two Case Studies." Leslie Conwell, Melissa Neuman, and Marsha Gold, September 2008. Healthy People 2010 identified eliminating health disparities as one of two overarching goals for the U.S., along with increasing quality and years of healthy life. This report examines North Carolina and Washington, two states that are making notable use of data to address disparities. Washington’s initiative is in the early stages, while North Carolina’s has existed since the early 1990s. Case studies in this report illustrate how data are being used to identify health disparities and develop initiatives to eliminate them. Back to Top
	“Evidence of Trends, Risk Factors, and Intervention Strategies. A Report from the Healthy Start National Evaluation 2006: Racial and Ethnic Disparities in Infant Mortality.” So Sasigent O’Neil, Melanie Besculides, and Margo Rosenbach, June 2008. Experts believe that eliminating racial and ethnic disparities in birth outcomes is key to continued reduction in infant mortality in the United States. Healthy Start, a national initiative begun in 1991, is the largest program addressing disparities in birth outcomes. This paper provides an evidence base to support Healthy Start’s targeted interventions. It reviews risk factors that include prenatal care, folic acid use, periodontal care, infant sleeping position, breastfeeding, well-child care, interconceptional care, maternal smoking, alcohol and other drug use, adolescent pregnancy, perinatal depression, stress, domestic violence, and maternal birthweight. Back to Top
	"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. Back to Top
	"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. More Reports Back to Top

	Journal Articles:
	“Impacts of a Disease Management Program for Dually Eligible Beneficiaries.” Dominick Esposito, Randall Brown, Arnold Chen, Jennifer Schore, and Rachel Shapiro, Health Care Financing Review, fall 2008. This articles examines interim impacts of a disease management demonstration for Medicare fee-for-service beneficiaries also enrolled in Medicaid (dual eligibles). The study randomly assigned dual eligibles with congestive heart failure, coronary artery disease, and/or diabetes to treatment or control groups for a population-based program that provides telephone patient education and monitoring services. Findings during the first 18 months show virtually no overall impacts on hospital or emergency room use, Medicare expenditures, quality of care, or prescription drug use for the 33,000 enrollees. However, for beneficiaries with congestive heart failure who resided in high-cost counties, the program reduced Medicare expenditures by 9.6 percent. Back to Top
	“Availability of Data to Measure Disparities in Leading Health Indicators at the State and Local Levels.” Marsha Gold, Allison Hedley Dodd, and Melissa Neuman, Journal of Public Health Management and Practice, November 2008. Healthy People 2010 identifies the elimination of health disparities as a critical national goal. This article analyzes the availability of state and local data to support this goal. Researchers assessed data availability for the 10 leading health indicators, comprising a set of 26 measures, and based their analysis on a mid-2007 review of federal and state websites. They conclude that some relevant state-level disparities data exist, major gaps remain, local estimates are limited, and some states make better use of data than others. Federal leadership and support are critical to states’ abilities to address the Healthy People 2010’s disparities goal. Back to Top
	"How Medicaid Agencies Administer Mental Health Services: Results from a 50-State Survey." James Verdier and Allison Barrett, Psychiatric Services (subscription required), October 2008. This report describes notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. It is based on telephone interviews with all state and District of Columbia Medicaid directors or their designees. Medicaid and mental health agencies are located in the same umbrella agency in 28 states, potentially facilitating collaboration. Mental health agencies provide funding for some Medicaid mental health services in 32 states, and counties provide funding in 22 states. The increasing role of Medicaid in funding state mental health services underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities. Back to Top
	"Antidepressant Use in Black and White Populations in the United States." Hector M. González, Thomas Croghan, Brady West, David Williams, Randolph Nesse, Wassim Tarraf, Robert Taylor, Ladson Hintion, and Harold Neig, Psychiatric Services (subscription required), October 2008. This article estimates the prevalence and correlates of antidepressant use by black and white Americans, using data from the Collaborative Psychiatric Epidemiology Surveys. Among individuals with depressive and anxiety disorders in the past year, black respondents (14.6 percent) had significantly lower antidepressant use than white respondents (32.4 percent). Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and use of antidepressants in these medical conditions was independent of coexisting psychiatric conditions. The results also indicate patients without a diagnosable psychiatric disorder use antidepressants frequently. Back to Top
	"15-Site Randomized Trial of Coordinated Care in Medicare Fee-for-Service." Randall Brown, Deborah Peikes, Arnold Chen, and Jennifer Schore, Health Care Financing Review, fall 2008. This study randomly assigned Medicare fee-for-service beneficiaries who had chronic illnesses and volunteered to participate in 15 care coordination programs to treatment or control status. Nurses provided patient education (mostly by telephone) to improve adherence and ability to communicate with physicians. The findings after two years show that few programs improved patient behaviors, health, or quality of care. The treatment group had significantly fewer hospitalizations in only one program; no program reduced gross or net expenditures. However, effects may be observed after four years of followup are available and sample sizes increase. Back to Top
	"Understanding the Variation in Costs Among HIV Primary Care Providers." Boyd Gilman and Jeremy Green, AIDS Care (subscription required), October 2008. This paper uses a hybrid cost model to identify determinants of cost variation among programs that offer early intervention services to people living with HIV/AIDS. The model combines the effects of input price and output volume from traditional economic cost functions with institutional factors based on program and patient characteristics on the cost of providing primary medical care. The impact of economic factors conforms to conventional theory and reveals the potential for cost savings through greater economies of scale and substitutability of low-cost for high-cost labor inputs. Similarly, programs that use staff more efficiently and share an affiliation with other organizations exhibit lower costs than more labor intensive and non-affiliated providers. In addition, patient characteristics are equally important cost determinants. Back to Top
	"Impact of Critical Access Hospital Conversion on Beneficiary Liability." Boyd Gilman, Journal of Rural Health (subscription required), fall 2008. The Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, but it puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare Part B benefit. This paper examines the impact of hospital conversion to CAH status on beneficiary out-of-pocket coinsurance payments for hospital outpatient services. Conversion is associated with an increase in beneficiary coinsurance payments per outpatient visit of $17.19, equivalent to 34 percent of mean out-of-pocket Part B payments for the study sample as a whole. However, CAH designation had no significant effect on the share of outpatient costs paid by the beneficiary. More Journal Articles Back to Top

	Issue Briefs:
	"Improving Public Coverage for Children: Lessons from CKF in New Jersey." Chioma Uzoigwe, Sheila Hoag, and Judith Wooldridge, August 2008. Health insurance coverage in New Jersey is threatened on all sides: private insurance coverage is eroding; the number of uninsured individuals is growing; and state budget pressure, combined with federal policy pressure, could lead to public insurance coverage cutbacks. This issue brief presents a historical review of the Robert Wood Johnson Foundation's Covering Kids & Families program in the state. The review shows that advocates for insurance coverage, working in concert with state officials, can positively impact public insurance policy and procedures, and can sustain this work even after funding ends. Back to Top
	“Three Independent Evaluations of Healthy Kids Programs Find Substantial Gains in Children’s Dental Health Care.” In Brief #2. Dana Hughes, Embry Howell, Christopher Trenholm, Ian Hill, and Lisa Dubay, September 2008. This brief highlights rigorous, independent evaluations of the Healthy Kids programs in three California counties: Los Angeles, San Mateo, and Santa Clara. It describes some of the many positive impacts that Healthy Kids programs have had on children’s access and use of dental services. For children enrolled in the program, access to dental care improved and unmet need for dental care declined. More Issue Briefs Back to Top

	Other:
	"Monitoring and Assessing the Use of External Quality Review Organizations to Improve Services for Young Children: A Toolkit for State Medicaid Agencies." Tara Krissik, Henry T. Ireys, Anne Rossier Markus, and Sara Rosenbaum, July 2008. Federal regulations encourage state Medicaid agencies to use external quality review organizations (EQROs) to help implement strategies for assessing and improving the quality of medical services provided to beneficiaries enrolled in managed care plans. However, many states have not availed themselves of this opportunity and may lack guidance on how to do so. This report provides agencies with specifications for developing a scope of work that will lead to conceptually and methodologically sound studies of the quality of preventive and developmental services for young children enrolled in Medicaid. Among other recommendations, the authors outline strategies for states to contract with EQROs to conduct performance measurement and quality improvement projects that focus directly on improving the quality of preventive and developmental services. Back to Top
	"Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2003." Jim Verdier, Ann Bagchi, and Dominick Esposito, April 2008. This chartbook, prepared for the Centers for Medicare & Medicaid Services, provides a snapshot of Medicaid pharmacy benefit use and reimbursement in 2003 and shows key trends from 1999 to 2003. Back to Top
	"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. Back to Top
	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." More Back to Top