Urban Institute

About: Urban Institute is a nonprofit organization based out in Washington D.C., District of Columbia, United States. It is known for research contribution in the topics: Medicaid & Population. The organization has 927 authors who have published 2330 publications receiving 86426 citations.

Why is there state variation in employer-sponsored insurance?

Abstract: Using the National Survey of America's Families (NSAF) in 1997 and 1999, this paper investigates the sources behind variation in employer-sponsored health insurance (ESI) across states. We find that demographics and family characteristics (such as race/ethnicity and citizenship status), individual employment characteristics (such as firm size, labor force attachment), and local labor market characteristics (such as unionization) consistently explain the relative position of all of the states with either high or low rates of ESI coverage. Income plays a lesser role in explaining the state variation, but is still an important determinant, especially among states whose average income deviates substantially from the national average. (Health Affairs 22(1): 241?51, January/February 2003.)

Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use: Patient and Provider Perspectives.

Abstract: Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use.

The impact of Medicaid managed care on pregnant women in Ohio: a cohort analysis.

Abstract: This paper examines the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, c-section use, and birth weight, using linked birth certificate and Medicaid enrollment for 10 Ohio counties. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. Authors found that the effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared with women in voluntary counties. Changes over time in outcomes, both positive and negative, were more pronounced for African-American women. Authors conclude that, with careful implementation and attention to women's individual differences, outcomes for pregnant women may improve with Medicaid managed care implementation. (Health Services Research 39(4), 2004.)

Spillover Effects of Medicare Fee Reductions: Evidence from Ophthalmology

Abstract: Relatively little research has examined physicians' supply responses to Medicare fee cuts especially whether fee reductions for specific procedures have "spillover" effects that cause physicians to increase the supply of other services they provide. In this study we investigate whether ophthalmologist changed their provision of non-cataract services to Medicare patients over the time period 1992-1994, when the Medicare Fee Schedule (MFS) resulted in a 17.4% reduction in the average fee paid for a cataract extraction. Following the McGuire-Pauly model of physician behavior (McGuire and Pauly, 1991), we estimated a supply function for non-cataract procedures that included three price variables (own-price, a Medicare cross-price and a private cross-price) and an income effect. The Medicare cross-price and income variables capture spillover effects. Consistent with the model's predictions, we found that the Medicare cross-price is significant and negative, implying that a 10% reduction in the fee for a cataract extraction will cause ophthalmologists to supply about 5% more non-cataract services. Second, the income variable is highly significant, but its impact on the supply of non-cataract services is trivial. The suggests that physicians behave more like profit maximizing firms than target income seekers. We also found that the own-price and the private cross-price variables are highly significant and have the expected positive and negative effects on the volume of non-cataract services respectively. Our results demonstrate the importance of evaluating volume responses to fee changes for the array of services the physician performs, not just the procedure whose fee has been reduced. Focusing only on the procedure whose fee has been cut will yield an incomplete picture of how fee reductions for specific procedures affect physician supply decisions.

Customer Experience with Rent-to-Own Transactions

Abstract: The authors examine the characteristics and experiences of rent-to-own customers using a nationwide survey of 532 customers and 11,575 noncustomers. The authors find that most customers have low incomes and education levels, but most have a motor vehicle and some type of credit card or bank account; most customers use rent-to-own transactions to purchase merchandise, not merely as short-term rentals; and most customers are satisfied with the transactions and are treated well if they are late making a payment, though some experience abusive collection practices. The authors discuss the implications of the findings for public policy.