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Biomedical subjects

S H Long

Publications and source records attributed to S H Long.

At least 37 records · Page 2Linked to original sources
PubMed1996

Some pitfalls in making cost estimates of state health insurance coverage expansions.

This paper cautions state policy analysts who estimate expected costs of state health reforms using state-specific data from general purpose, national surveys. It compares cost estimates of subsidized insurance programs for low-income uninsured persons in 10 states using the Current Population Survey (CPS) and the Robert Wood Johnson Foundation state surveys. Depending on the measure of insurance and concept of the family that are used, costs of state programs could exceed the estimates by more than 50%. State policy analysts need to be aware of such pitfalls and make appropriate adjustments when using CPS data to estimate program costs.

Bias↗
PubMed1995

Worker demand for health insurance in the non-group market.

This paper examines decisions to purchase individual insurance by workers who do not have employment-based insurance. Using data from the Current Population Survey and the Survey of Income and Program Participation, coupled with prices for a standard insurance product in different market areas, we estimate a price elasticity of -0.3 to -0.4 and an income elasticity of 0.15. Our estimate of the price response raises doubts that even substantial subsidies to the working uninsured would induce many of them to purchase coverage voluntarily.

Data Collection↗
PubMed1995

Private employment-based health insurance in ten states.

This Data Watch reports key findings from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey, through which more than 20,000 employers in ten states were interviewed. Our report contrasts the behavior of four size classes of small businesses (fewer than fifty workers) with that of all other businesses. We examine offer rates by business size; characteristics of employers and workers in business offering and not offering insurance; premiums, benefits, and medical underwriting; the extent of choice among plans; and self-insurance. We discuss the implications of our findings for health policy.

Data Collection↗
PubMed1995

Do shifts toward service industries, part-time work, and self-employment explain the rising uninsured rate?

It is conventional wisdom that the increase in the number of uninsured people during the 1980s was due, in part, to systematic trends in employment, specifically: 1) shifts from full-time to part-time jobs and to self-employment; and 2) changes in the industrial mix of employment, especially toward the service industries. This paper uses the March Current Population Survey data from 1980 through 1987 to measure the contribution of these factors to the rise in the uninsured. In the first case, we find the premise of rising part-time work and self-employment to be untrue. In the second case, less than 15% of the decline in health insurance over this period was due to employment shifting from higher-coverage to lower-coverage industries. Instead, the decline resulted from falling coverage rates across all industries. This is not to dismiss the possible importance of such employment trends over decades, but to emphasize the need to investigate other causes of the change during recent years.

Data Collection↗
PubMed1994

Effects of grammar facilitation on the phonological performance of children with speech and language impairments.

Although there is a great deal of evidence for a significant developmental relationship between grammar and phonology, the nature of this relationship and its implications for the intervention of children with impairments in both grammar and phonology are unclear. The purpose of this investigation was to determine whether two approaches to grammar facilitation that placed no emphasis on phonology would have indirect effects on the phonological output of preschoolers with speech and language impairments. All 26 subjects, ages 44-70 months, had impairments both in grammar and in phonology. Ten subjects took part in a clinician-administered intervention program, eight subjects received a similar intervention program implemented by their parents, and eight children served as delayed intervention controls (Fey, Cleave, Long, & Hughes, 1993). The results indicated that despite a strong effect for the intervention on the children's grammatical output, there were no indirect effects on the subjects' phonological production. It is concluded that despite a close relationship between the development of grammar and phonology, language intervention approaches for children approximately 4 to 6 years of age should address phonological problems directly if significant effects on phonology are to be expected.

Child↗
PubMed1994

The costs and financing of perinatal care in the United States.

OBJECTIVES: The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS: Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS: The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS: National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid.

Adult↗
PubMed1993

Two approaches to the facilitation of grammar in children with language impairment: an experimental evaluation.

Two approaches to grammar facilitation in preschool-age children with language impairment were evaluated. One approach was administered by a speech-language pathologist and the other was presented by the subjects' parents, who were trained by the speech-language pathologist. Both treatment packages ran for 4 1/2 months and made use of focused stimulation procedures and a cyclical goal-attack strategy. Subjects were 30 children between the ages of 3:8 and 5:10 (years:months) who had marked delays in grammatical development. Children who served in a delayed-treatment control group averaged no gains over their no-treatment period. In contrast, large treatment effects were observed for both treatment groups on three of four measures of grammatical expression. However, closer inspection of the data revealed that the effects for the clinician treatment were more consistent across treatment administrations than were those for the parent treatment. Although the specific contributions of the focused stimulation procedures and the cyclical goal attack strategy were not evaluated, the results support the viability of these components as parts of larger treatment packages. The results also support the participation of parents as primary intervention agents in grammar facilitation programs. When parents take such a large role in the intervention process, however, it is imperative that the children's progress be monitored carefully and that program adjustments be made whenever gains are smaller than expected.

Child↗
PubMed1993

Gaps in employer coverage: lack of supply or lack of demand?

According to data from the May 1988 Current Population Survey, 18 percent of workers are in firms that do not offer health insurance. The question explored here is whether the absence of insurance in these firms is related to lack of supply (that is, a failure of the firm to offer the benefit because the price it faces is too high or the benefit too low) or lack of demand (that is, employees in these firms would not purchase the insurance even if it were offered). Characteristics hypothesized to affect the supply of insurance by firms (size, rate of turnover, and union status) are found to distinguish whether or not firms offer insurance. The data show near-universal acceptance of group insurance among employees offered the opportunity to participate. Both of these factors suggest a failure of supply. However, employees in firms that do not offer insurance are young, low-wage earners who work part time. These are also characteristics of workers who do not purchase group insurance even when it is offered, suggesting that many of the workers who are not offered group insurance would not participate in a plan even if the supply failure were corrected. These findings have implications for the effectiveness of voluntary strategies to improve access, but they also raise concern over the fairness to workers of mandates requiring that they purchase coverage.

Adolescent↗
PubMed1988

Patterns of language comprehension deficit in abused and neglected children.

The similarity between factors associated with child abuse/neglect and those associated with language disability suggests that maltreated children are a population at risk for language problems. This study investigated the performance of three groups of abused/neglected children and a matched group of nonmaltreated subjects on three tests of language comprehension. Results revealed significant differences among groups for all measures. Severely neglected children obtained the lowest scores on all tests; the abused children consistently obtained lower scores than the controls; and generally neglected children showed the smallest difference in performance from the control group. These findings suggest a model for understanding relationships between abuse/neglect and language disability.

Child↗
PubMed1988

Employee premiums, availability of alternative plans, and HMO disenrollment.

The notion that greater competition among health plans helps contain health-care costs presumes that consumers respond to economic incentives. This article tests that proposition through an examination of the factors that cause individuals to disenroll from health maintenance organizations (HMOs). The study relies upon a multivariate probit model of disenrollment behavior, estimated with data on 1,553 subscribers in three Minneapolis-St. Paul HMOs in 1984. The results indicate that disenrollments are a function largely of economic factors; disenrollments rise significantly with increases both in relative premiums and in the number of plan choices available to consumers. To illustrate, a +5.00 increase in the employee's monthly premium for one HMO, relative to the average change in the employees' premiums for all other available plans, would lead to a two thirds increase in that HMO's disenrollment rate.

Economic Competition↗
PubMed1988

An evaluation of Utah's primary care case management program for Medicaid recipients.

One of the first case management (CM) programs for limiting Medicaid enrollees' freedom of choice of provider was established by Utah. By assigning enrollees to specific providers responsible for arranging all nonemergency care, Utah intended both to improve access and to reduce program costs. State officials expected the program to increase recipients' use of primary-care providers, while reducing their use of specialists, prescription drugs, and hospital outpatient services. Savings from reductions in unnecessary use were expected to more than offset increases in outlays arising from access enhancements, resulting in lower program expenditures. This study investigated the extent to which the state Medicaid program achieved these goals. The analysis was based on a two-part multivariate model of usage, estimated from data created from claims-level information provided by Utah. The findings revealed that the use of primary-care physician services increased significantly. However, the program also raised the use of specialists' services and prescription drugs. In contrast, the use of hospital outpatient services was lowered. Overall, CM apparently achieved the objective of increased access, but failed to attain the cost-containment goal. The findings indicated that expected costs for ambulatory care rose by 25% in the early years as a result of case management.

Cost Control↗
PubMed1987

Acute health care costs for the aged Medicare population: overview and policy options.

Despite its seeming largesse, Medicare has always been a cost-sharing program. The potential costs borne by beneficiaries can be substantial, leading to more than 70 percent seeking protection through supplementary private insurance. Others risk payment out of pocket, and fewer rely on Medicaid. Actual costs incurred by each group of Medicare beneficiaries are examined and seen to have significant and inequitable impacts. Current Medicare policies are often poorly designed or irrelevant. Future responses will have to address both taxation and copayment while weighing concerns for individual financial hardship against possible overuse of services.

Acute Disease↗
PubMed1987

Public versus employment-related health insurance: experience and implications for black and nonblack Americans.

Despite a complex web of private and public health insurance programs, over 6 million black and almost 31 million nonblack Americans were uninsured in 1985. Although the situation since 1980 had deteriorated relatively less for them, nonelderly blacks remained 1.5 times more likely to be uninsured. Because of differences in family structure and economic circumstances, blacks less frequently have employment-related insurance and are more often covered by a public program. Mandated employment-related insurance is less likely to benefit blacks than would expansion of Medicaid. A combined approach may be needed to reduce the total number of uninsured Americans.

Adolescent↗
PubMed1986

Reimbursement and access to physicians' services under Medicaid.

Several recent studies have shown that physician participation in state Medicaid programs is directly related to the generosity of their reimbursement levels. The implication is that when states reduce fees, Medicaid eligibles suffer because their access to physicians' services is thereby limited. The results presented in this paper do not support this implication. Multivariate analyses of utilization and site-of-visit patterns among non-elderly Medicaid eligibles indicate that stringent physician reimbursement practices do not impede access to ambulatory care when all sites at which a doctor may be seen are considered.

Adult↗