Examining the effects of the Medicaid expansion on health outcomes

Kim, Andrew; Zhao, Liang

doi:10.1002/wmh3.464

Cited by 4 publications

(24 citation statements)

References 18 publications

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“…These studies examined various policy interventions. Sixteen studies assessed policies for insurance coverage expansion, including 4 on Medicare Part D and 12 on Medicaid expansion . Eight studies evaluated cost-sharing policies in health care, such as Medicaid prior authorization (n = 1), changes in copayment for antihypertensive medications (n = 3), medication coverage gap (n = 1), copayment reductions and/or value-based insurance design (VBID, n = 1), and prescription limit/cap in Medicaid programs (n = 2) .…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 7 studies evaluated financial incentive programs for improving quality such as the pay-for-performance (P4P) model, financial incentives paid to physicians and/or patients, Medicaid Incentives for the Prevention of Chronic Diseases, and innovative payment models including the Accountable Care Organization (ACO), patient-centered medical home, and the Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model programs . The policies were implemented at different levels: nationwide (n = 17), state-specific (n = 10), or within specific health care settings (n = 4) . The study populations primarily consisted of Medicaid (n = 16), and Medicare beneficiaries (n = 8), with 3 studies including privately insured populations, 3 focusing on the US Department of Veterans Affairs (VA), and 1 on uninsured populations .…”

Section: Resultsmentioning

confidence: 99%

“…insurance coverage expansion, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] cost sharing in health care, [28][29][30][31][32][33][34][35] and financial incentives for quality. [36][37][38][39][40][41][42] Results of this analysis revealed that expanding insurance coverage through policies such as…”

Section: Discussionmentioning

confidence: 99%

“…17 Most studies used a difference-in-differences (DiD) approach to assess policy effects (n = 26), [12][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][39][40][41] whereas 2 studies used randomized controlled trial (RCT) designs, 17,38 and 3 studies used a cluster randomized clinical trial design. 36,37,42 Regarding outcome measures, 15 studies used antihypertensive treatment (6 assessed medication adherence using the proportion of days covered [PDC] measure 14,29,31,32,40,41 ), [13][14][15]23,25,[27][28][29][31][32][33]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…17 The other 10 studies consistently showed a positive association with antihypertensive treatment or BP control. 16,[18][19][20][22][23][24][25][26][27] One study found a significant reduction in systolic BP, but no significant association with diastolic BP. 21 Financial incentives for quality (eg, pay-for-performance, financial incentives, or alternative payment models aimed at improving the quality of care).…”

Section: Associations Between Insurance Coverage Expansion and Bp Con...mentioning

confidence: 99%

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Association of Economic Policies With Hypertension Management and Control

Zhang,

Lee,

Pollack

et al. 2024

JAMA Health Forum

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ImportanceEconomic policies have the potential to impact management and control of hypertension.ObjectivesTo review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US.Evidence ReviewA search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than 140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects.FindingsIn total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation.Conclusions and RelevanceThe findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non–health care economic policies on hypertension control.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Associations Between Insurance Coverage Expansion and Bp Con...mentioning

confidence: 99%

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Association of Economic Policies With Hypertension Management and Control

Zhang,

Lee,

Pollack

et al. 2024

JAMA Health Forum

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Access to clinical genetic services: An evaluation of patient referral characteristics and identifying barriers in Michigan

Lemke,

Bupp,

Niemchick

2024

Journal of Genetic Counseling

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The utilization of genetics in medical care has enhanced the utility of precision medicine and hence increased the need for clinical genetic services. These services have reduced the costs and expanded the availability of genetic testing, but their use is limited in certain populations. This study explores the access to clinical genetic services for Michigan patients referred to a genetics clinic on the western side of the state. Factors included the travel distance (miles), wait time for appointment (days from the referral date to the date of first appointment), population demographics, and cultural characteristics. A retrospective record review of all aged patients (n = 568) referred to a genetics clinic in 2018 demonstrated that all patients were insured (100%), of which majority were white‐non‐Hispanic (90.7%), more than half were < 10 years of age at referral (53.3%), and most of them kept their first appointment (93.5%). Our analysis showed that the wait time was associated with referral non‐compliance, p < 0.01. Adjusting for all variables, for each additional day in wait time, patients had 1% increased risk of not seeking clinical genetic services (OR = 1.01, 90% CI [1.01, 1.02]). Policies to encourage genetic service utilization and improve equitable access to precision health are needed. An opportunity exists for strategies that broaden and add diverse populations to those receiving genetic services.

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The Effects of the Medicaid Expansion on Prescription Drug Behavior

Kim¹,

Sadayuki

2022

Population Health Management

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Examining the effects of the Medicaid expansion on health outcomes

Cited by 4 publications

References 18 publications

Association of Economic Policies With Hypertension Management and Control

Association of Economic Policies With Hypertension Management and Control

Access to clinical genetic services: An evaluation of patient referral characteristics and identifying barriers in Michigan

The Effects of the Medicaid Expansion on Prescription Drug Behavior

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