From the Affordable Care Act to Affordable Care

Cutler, David M.

doi:10.1001/jama.2015.7683

Cited by 20 publications

(14 citation statements)

References 6 publications

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“…This aligns with recommendation of remote monitoring as a standard follow-up mechanism and the shift in incentives from the quantity of services to include a quality metric ("valuebased reimbursement") by the Department of Health and Human Services. [23][24][25]…”

Section: All Patientsmentioning

confidence: 99%

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

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Background-Inappropriate implantable cardioverter-defibrillator programming can be detrimental. Whether trials/recommendations informing best implantable cardioverter-defibrillator programming (high-rate cutoff and/or extended duration of detection) influence practice is unknown. Methods and Results-We measured reaction to publication of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy; 2012) and the Consensus Statement (2015) providing generic programming parameters, in a national cohort of implantable cardioverter-defibrillator recipients, using the ALTITUDE database (Boston Scientific). Yearly changes in programmed parameters to either trial-specified or class 1 recommended parameters (≥185 beats per minute or delay ≥6 seconds) were assessed in parallel. From 2008 to 2017, 232 982 patients (aged 67AE13 years; 28% women) were analyzed. Prevalence of MADIT-RIT-specific settings before publication was <1%, increasing to 13.6% in the year following. Thereafter, this increased by <6% over 5 years. Among preexisting implants (91 171), most patients (58 739 [64.4%]) underwent at least 1 inperson device reprogramming after trial publication, but <2% were reprogrammed to MADIT-RIT settings. Notably, prevalence of programming to ≥185 beats per minute or delay ≥6 seconds was increased by MADIT-RIT (57.4% in 2013 versus 40.2% at baseline), but the following publication of recommendations had minor incremental effect (73.2% in 2016 versus 70.8% in 2015). High-rate cutoff programming was favored almost 2-fold compared with extended duration throughout the test period. Practice changes demonstrated large interhospital and interstate variations. Conclusions-Trial publication had an immediate effect during 1 year postpublication, but absolute penetration was low, and amplified little with time. Consensus recommendations had a negligible effect. However, generic programming was exercised more widely, and increased after trial publication, but not following recommendations.

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Section: All Patientsmentioning

confidence: 99%

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

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“…2 , 3 Recent studies demonstrate that the implementation of the ACA is associated with significant improvement in self-reported insurance coverage, access to primary care and medications, and health outcomes. 4 , 5 …”

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confidence: 99%

Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

et al. 2016

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Objective:To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014.Research Design:Using the 2011–2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors.Results:The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=−0.03, P<0.001), delaying any necessary care (coef=−0.03, P<0.001), forgoing any necessary care (coef=−0.02, P<0.001), and a significant increase in the probability of having any physician visits (coef=0.02, P<0.001), compared with the reference year 2011. Interaction terms between the 2014 year indicator and race/ethnicity demonstrate that uninsured rates decreased more substantially among non-Latino African Americans (African Americans) (coef=−0.04, P<0.001) and Latinos (coef=−0.03, P<0.001) compared with non-Latino whites (whites). Latinos were less likely than whites to delay (coef=−0.02, P<0.001) or forgo (coef=−0.02, P<0.001) any necessary care and were more likely to have physician visits (coef=0.03, P<0.005) in 2014. The association between year indicator of 2014 and the probability of having any emergency department visits is not significant.Conclusions:Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation. Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.

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“…In the United Kingdom, for example, alleged negative productivity growth of the UK medical care sector became such a major concern that a special parliamentary commission was formed to explore the issue (Atkinson 2005). In the United States, Medicare payments have been linked to expected improvements in hospital performance on a number of cost and quality dimensions under the Affordable Care Act (Blumenthal, Abrams and Nuzum 2015; Cutler 2015; Nyweide et al 2015). In Australia, the efficiency of hospitals has also been in the spotlight following the introduction of a national activity‐based funding scheme for all public hospitals from 2012 onward (IHPA 2013).…”

Section: Introductionmentioning

confidence: 99%

An Examination of Public Hospital Productivity and its Persistence: An Index Number Approach

Cheng¹,

Scott²,

Sundararajan³

et al. 2020

Australian Economic Review

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This paper measures the level and growth of total factor productivity (TFP) of public hospitals in Victoria, Australia, using an index number approach. We further examine the persistence of productivity over time, and the extent to which productivity varies with hospital characteristics such as hospital size. Hospital administrative data from Victoria from 2007–08 to 2011–12 are used. We find substantial variation in TFP across hospitals: large hospitals perform significantly better than small hospitals, both in TFP level and growth. Productivity level is highly persistent over time, but not productivity growth.

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From the Affordable Care Act to Affordable Care

Cited by 20 publications

References 6 publications

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act

An Examination of Public Hospital Productivity and its Persistence: An Index Number Approach

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