The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage.
As health systems seek to incentivize physicians to deliver high-value care, the
relationship between physician compensation and health care delivery is an
important knowledge gap. To examine physician compensation nationally and its
relationship with care delivery, we examined 2012-2015 cross-sectional data on
ambulatory primary care physician visits from the National Ambulatory Medical
Care Survey. Among 175 762 office visits with 3826 primary care physicians,
15.4% of primary care physicians reported salary-based, 4.5% productivity-based,
and 12.9% “mixed” compensation, while 61.4% were practice owners. After
adjustment, delivery of out-of-visit/office care was more common for practice
owners and “mixed” compensation primary care physicians, while there was little
association between compensation type and rates of high- or low-value care
delivery. Despite early health reform efforts, the overall landscape of
physician compensation has remained strongly tethered to fee-for-service. The
lack of consistent association between compensation and care delivery raises
questions about the potential impact of payment reform on individual physicians’
behavior.
In 'Power to the People: Evidence from a Randomised Field Experiment on Community-Based Monitoring in Uganda' (2009), Björkman and Svensson show that a relatively simple interventionproviding community-level health service delivery information and guidance on community-based monitoringimproved provider behaviour, health care utilisation, and health outcomes. In this paper we conduct a pure replication of the original study and extend the original analysis. Overall, we find that the intervention modified healthcare provider behaviours and utilisation, but that the results surrounding the programme's impact on health outcomes appear less robust.
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