The Impact Of Medicaid Expansion On People Living With HIV And Seeking Behavioral Health Services

Arnold, Emily; Fuller, Shannon; Kirby, Valerie B.; Steward, Wayne T.

doi:10.1377/hlthaff.2018.0414

Cited by 15 publications

(20 citation statements)

References 16 publications

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“…Most previouss studies were analyzed the relationships between characteristics of patients and healthcare-seeking behaviors for speci c diseases and some characteristics [22,23,24]. However, the current study focused on general characteristics of outpatients' behaviors which were closely related to the current healthcare-seeking problems in China.…”

Section: Discussionmentioning

confidence: 94%

The Relationship between Chinese Outpatients’ Characteristics and Healthcare-Seeking Behavioral Decision-Making: Decision Tree and Linear Regression Analyses Based on Survey Data in Jiaxing

Yang

2021

Preprint

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Background Chinese patients generally experience difficulties and high costs when obtaining medical services. One consensus reason for these difficulties is imbalances in hospitals’ medical standards and resources, which cannot be changed in the short term. This article explores the most perplexing healthcare-seeking problems in China by considering the laws pertaining to how different patients may see a doctor. Methods Data mining and analysis can characterize a person and explore the heuristics underlying his or her decisions using a combination of comprehensive feature data. Accordingly, a questionnaire was designed that probed numerous variables of relevance to decision-making and we analyzed the survey data using a decision tree and linear regression. The decision tree facilitated observation of the healthcare-seeking decision-making routes of different patients. In addition, linear regression analysis revealed that patients tended to choose different hospitals with different features.Results This article primarily argues that in China, having medical insurance and a profession that represents economic strength and social class are the most important factors that guide the outpatient's patterns of seeing a doctor. Further, outpatients who live far from hospitals and recognize they have a serious disease would choose different hospitals than those on the contrary. Conclusion Using a decision tree and line regression, we drew the portraits and decision-making routes behind various outpatients’ characteristics when he or she saw a doctor. It provides direction about the type and location about future hospital construction in this area, and it addresses how to avoid overcrowding at large hospitals and how to provide enhanced possibilities for diversion to smaller hospitals.

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Section: Discussionmentioning

confidence: 94%

The Relationship between Chinese Outpatients’ Characteristics and Healthcare-Seeking Behavioral Decision-Making: Decision Tree and Linear Regression Analyses Based on Survey Data in Jiaxing

Yang

2021

Preprint

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“…We found no difference in odds of achieving all process QMs by insurance type, but patients covered by Medicaid or Medicare were significantly less likely to achieve all outcome or all QMs combined. 41 The implication of this finding is that, while patients are given all needed medical services regardless of insurance coverage, other factors contribute to successful outcomes, including social determinants of health such as socioeconomic status, are not fully reflected in our metrics. 20 Between our two study periods, there were significant increases in patients meeting process QMs, reflecting the ongoing emphasis on preventative care through vaccinations and screenings by KPMAS leadership, and corresponding improved patient care due to a ''Hawthorne effect'' on providers.…”

Section: Discussionmentioning

confidence: 94%

Beyond the HIV Care Continuum and Viral Suppression: Broadening the Scope of Quality Metrics for Total HIV Patient Care

Horberg

Certa

Rubenstein

et al. 2020

AIDS Patient Care and STDs

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Assessing quality care for people with HIV (PWH) should not be limited to reporting on HIV Care Continuum benchmarks, particularly viral suppression rates. At Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated health system providing HIV care in the District of Columbia, Maryland, and Virginia, we created a comprehensive measure of HIV quality care, including both preventative measures and clinical outcomes. We included PWH ‡18 years old with ‡6 months KPMAS membership between 2015 and 2018. Process quality metrics (QMs) include: pneumococcal vaccination and influenza vaccination; primary care physician (PCP) and/or HIV/infectious disease (HIV/ID) visits with additional HIV/ID visit; antiretroviral treatment medication fills; and syphilis and gonorrhea/chlamydia screenings. Outcome QMs include HIV RNA <200/mL and other measurements within normal range [blood pressure, body mass index (BMI), hemoglobin, blood sugar, alanine transaminase, low-density lipoproteins, estimated glomerular filtration rate]; no hospitalization/emergency department visit; no new depression diagnosis; remaining or becoming a nonsmoker. Logistic models estimated odds of achieving QMs associated with sex, age, race/ethnicity, insurance type, and HIV risk. A total of 4996 observations were analyzed. 45.6% met all process QMs, while 19.6% met all outcome QMs. Least frequently met process QM was PCP or HIV/ID visit (74.5%); least met outcome QM was BMI (60.2%). Significantly lower odds of achieving all QMs among women {odds ratio (OR) = 0.63 [95% confidence interval (CI): 0.49-0.81]} and those with Medicaid and Medicare [vs. commercial; OR = 0.48 (95% CI: 0.30-0.76) and 0.47 (95% CI: 0.31-0.71)]. Broadening the scope of HIV patient care QMs beyond viral suppression helps identify opportunities for improvement. Successful process metrics do not necessarily coincide with greater outcome metrics.

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“…Although Medicaid expansion has benefitted PWH [ 47 , 48 ], too few Medicaid beneficiaries were identified to examine separately. Yet repeating our analyses with Medicaid beneficiaries excluded, as a sensitivity analysis, resulted in few changes to the results.…”

Section: Discussionmentioning

confidence: 99%

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

Satre

Parthasarathy

Silverberg

et al. 2020

BMC Health Serv Res

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Background The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care utilization and HIV clinical outcomes among individuals newly enrolled in insurance coverage following implementation of the ACA. Methods Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N = 880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1–$999 and > = $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts; viral suppression at HIV RNA < 75 copies/mL). Results Health care use was greatest immediately after enrollment and decreased over 3 years. Those with high deductibles were less likely to use primary care (OR = 0.64, 95% CI = 0.49–0.84, p < 0.01) or psychiatry OR = 0.59, 95% CI = 0.37, 0.94, p = 0.03) than those with no deductible. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR] = 0.40, 95% CI = 0.18–0.86; p = 0.02), but ADAP was associated with more psychiatry visits (RR = 2.22, 95% CI = 1.24–4.71; p = 0.01). Those with high deductibles were less likely to have viral suppression (OR = 0.65, 95% CI = 0.42–1.00; p = 0.05), but ADAP enrollment was associated with viral suppression (OR = 2.20, 95% CI = 1.32–3.66, p < 0.01). Black (OR = 0.35, 95% CI = 0.21–0.58, p < 0.01) and Hispanic (OR = 0.50, 95% CI = 0.29–0.85, p = 0.01) PWH were less likely to be virally suppressed. Conclusions In this sample of PWH newly enrolled in an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization, high deductibles were associated with worse HIV outcomes, but support from ADAP appeared to help patients achieve viral suppression. Race/ethnic disparities remain important to address even among those with access to insurance coverage.

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The Impact Of Medicaid Expansion On People Living With HIV And Seeking Behavioral Health Services

Cited by 15 publications

References 16 publications

The Relationship between Chinese Outpatients’ Characteristics and Healthcare-Seeking Behavioral Decision-Making: Decision Tree and Linear Regression Analyses Based on Survey Data in Jiaxing

The Relationship between Chinese Outpatients’ Characteristics and Healthcare-Seeking Behavioral Decision-Making: Decision Tree and Linear Regression Analyses Based on Survey Data in Jiaxing

Beyond the HIV Care Continuum and Viral Suppression: Broadening the Scope of Quality Metrics for Total HIV Patient Care

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

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