Posts tagged with "Medicaid"

Steps Linked to Reduced Medical Costs

Proactive Steps Linked To Reduced Medical Costs, Hospital Visits for Children With Asthma

A new study looking at data from tens of thousands of children with asthma finds that several widely available interventions are associated with both reduced medical costs and a reduced likelihood that the children will need to visit an emergency room or stay in the hospital.

“This work shows that you can improve the quality of life for children with asthma and you can reduce government spending by implementing these proactive interventions,” says Julie Swann, lead author of the study. Swann is the department head and A. Doug Allison Distinguished Professor of the Fitts Department of Industrial and Systems Engineering at North Carolina State University.

The researchers looked at data from 2010 and 2011 on more than 70,000 children with asthma enrolled in the Medicaid programs in New York and Michigan. The researchers focused on four interventions: asthma self-management education (ASME); flu vaccine; the use of spacers, which are low-cost plastic tubes that improve the performance of inhalers; and the use of nebulizers, which are devices that convert liquid medicine into an aerosol that patients can inhale.

Specifically, the researchers analyzed the data to understand the extent to which each of these interventions was associated with three outcomes: asthma-related visits to the emergency room; asthma-related visits to a primary-care physician; and asthma-related stays in the hospital. The researchers also assessed the extent to which each intervention influenced costs associated with each child’s asthma medication and so-called “utilization costs” – which are the costs associated with other aspects of a child’s asthma treatment, such as the cost of visiting a primary-care provider or hospital.

To address these questions, the researchers plugged the healthcare data into models that allowed them to assess the impact of each intervention separately, compared to no intervention.

“One of the key findings, which should be of interest to policymakers, is that all four interventions were associated with lower medication costs and utilization costs,” Swann says.

And while the numbers varied between states, the decreases in cost could be substantial. For example, being vaccinated against the flu was associated with a 16.4% reduction in utilization expenses and a 15.6% reduction in medication expenses for children in New York. 

“There can be significant cost reductions associated with a fairly inexpensive intervention,” Swann says.

“Our results suggest that ASME training, and the use of spacers and nebulizers, are also associated with significant decreases in both emergency room visits and hospitalizations,” says study co-author Pinar Keskinocak. “And the flu vaccine helps reduce the number of visits to a child’s primary care provider.” Keskinocak is the William W. George Chair and Professor in Georgia Tech’s H. Milton Stewart School of Industrial and Systems Engineering and the director of the Center for Health and Humanitarian Systems at Georgia Tech.

“It’s important to note that we looked at the impact of these outcomes separately while accounting for other interventions,” Swann says. “You would expect that the more of these proactive interventions a child has, the greater the positive impact we would expect to see on both their health and on what Medicaid would be asked to spend on their care.”

The study, “Estimating the Impact of Self-Management Education, Influenza Vaccines, Nebulizers, and Spacers on Healthcare Utilization and Expenditures for Medicaid-Enrolled Children with Asthma,” is published in the Journal of Asthma.

The paper was co-authored by Fatma Melike Yildirim, a Ph.D. student at Georgia Tech; Paul Griffin, the St. Vincent Health Chair of Healthcare Engineering at Purdue University; and Jean O’Connor of Emory University.

The work was done with support from the Center for Health and Humanitarian Systems and the William W. George Endowment at Georgia Tech, and the Edward P. Fitts and the A. Doug Allison Distinguished Professorship at NC State.

Teen Pregnancy

By Cassandra Yany

Teen Pregnancy in the United States

In 2018, the birth rate among women aged 15 to 19 years in the United States was less than half of what it was in 2008, which was 41.5 births per 1,000 girls, as stated by the Pew Research Center.

In 2017, 194,377 babies were born to women in the U.S. between the ages of 15 and 19 years old, according to the Centers for Disease Control and Prevention. The birth rate dropped seven percent from 2016, with 18.8 babies born per 1,000 women in this age group. This was a record low for the nation.

The teen birth rate has been declining since the early 1990s, and this decline accelerated after the Great Recession. A 2011 Pew Research Center study connected the decrease in teen births to the economic downturn of the recession. The rate has continued to fall even after the economy’s recovery.

Evidence suggests that the declining birth rate is also partly due to more teens abstaining from sexual activity, and more who are sexually active using birth control than in previous years. Still, the CDC reports that U.S. teen pregnancy rate is substantially higher than other “western industrialized” nations.

DoSomething.org states that three out of 10 American girls will become pregnant at least once before the age of 20. About 25 percent of teen moms will have a second child within two years of their first baby.

Data shows that there are racial, ethnic and geographic disparities among teen pregnancies in the U.S. From 2016 to 2017, birth rates among 15 to 19-year-olds decreased 15 percent for non-Hispanic Asian teens, nine percent for Hispanic teens, eight percent for non-Hispanic white teens, six percent for non-Hispanic Black teens, and six percent for Native American teens. In 2017, the birth rate of Hispanic teens was 28.9 percent and of non-Hispanic black teens was 27.5 percent for non-Hispanic Black teens. These were both two times higher than the rate for non-Hispanic white teens, which was 13.2 percent. Among the different racial and ehtnic groups, Native American teens had the highest rate of 32.9 percent.

From 2007 to 2015, the teen birth rate was lowest in urban communities with 18.9 percent, and highest in rural communities with 30.9 percent— as reported by the CDC. During the same years, the rate among teens in rural communities had only declined 37 percent in rural counties, while large urban counties saw a 50 percent decrease and medium and small counties saw a 44 percent decrease. State-specific birth rates from 2017 were lowest in Massachusetts (8.1 percent) and highest in Arkansas (32.8 percent).

Socioeconomic disparities also exist among teen pregnancy rates. Teens in child welfare systems are at higher risk of teen pregnancy and birth than other groups of teens. Those living in foster care are more than twice as likely to become pregnant than those not in foster care. This then leads to financial difficulties for these young families. More than half of all mothers on welfare had their first child as a teenager, and two-thirds of families started by a young mother are considered poor.  

Teen pregnancy and motherhood can have significant effects on a young woman’s education. According to DoSomething.org, parenthood is the leading reason for teen girls dropping out of school. Only about 50% of teen mothers receive a high school diploma by the age of 22, while 90% of women who do not give birth during their teen years graduate from high school. Less than 2% of teen moms earn a college degree by age 30. 

Being a child of a teen mother can also have lasting effects on an individual. The children are more likely to have lower school achievement and drop out of high school. They are more likely to be incarcerated at some point in their lives and face unemployment as a young adult. They could also have more health problems and are more likely to become a parent as a teenager themselves. 

According to the CDC, teen fatherhood occurred at a rate of 10.4 births per 1,000 ranging from 15 to 19-years-old in 2015. Data indicates that these young men attend fewer years of school and are less likely to earn their high school diploma. 

A decline in teen pregnancy means an increase in U.S. public savings. According to the CDC, between 1991 and 2015, the teen birth rate dropped 64%, which led to $4.4 billion dollars in public savings for 2015 alone.

Global Teen Pregnancy

According to the World Health Organization, approximately 12 million girls 15 to 19-years-old and 777,000 girls under 15 give birth in “developing” regions each year. About 21 million girls aged 15 to 19 in these areas become pregnant.

Complications during pregnancy and childbirth are the leading cause of death for girls age 15 to 19 years globally. An estimated 5.6 million abortions occur each year among 15 to 19-year-old girls, with 3.9 million of them being unsafe. This can lead to death or lasting health problems.

Additionally, teen moms face higher risk of eclampsia, puerperal endometriosis and systemic infections than 20 to 24-year-old women. Babies of these mothers face higher risk of lower birth weight, preterm delivery and severe neonatal conditions.

Across the globe, adolescent pregnancies are more likely to take place in marginalized communities that are driven by poverty, and lack of education and employment opportunities. In many societies and cultures, girls get married and have children while they are teenagers. In some locations, girls choose to become pregnant due to limited educational and employment prospects. These societies either value motherhood and marriage, or union and childbearing may be the best option available to these young women. 

Teenage girls in some areas may not be able to avoid pregnancy because they do not have the knowledge of how to obtain contraceptive methods or how to use them. There are restrictive laws and policies regarding provision of contraception based on age or marital status that prevent these women from access to forms of pregnancy prevention. 

Health worker bias also exists in these areas, as well as an unwillingness to acknowledge adolescents’ sexual health needs. These individuals also may not be able to access contraception due to transportation and financial constraints. 

Another cause for unintended pregnancy around the work is sexual violence, with more than one-third of girls in some countries reporting that their first sexual experience was forced. After pregnancy, young women who became mothers before the age of 18 are more likely to experience violence in their marriage or partnership.

The University of Queensland in Australia conducted a study that found children who experience some type of neglect are seven times more likely than other victims of abuse to experience teen pregnancy. They drew these conclusions by looking at data from 8,000 women and children beginning in pregnancy and moving into early adulthood.

According to News Medical, researchers found that neglect was one of the most severe types of maltreatment when compared to emotional, sexual and physical abuse. The study defined child neglect as “not providing the child with necessary physical requirements (food, clothing or a safe place to sleep) and emotional requirements (comfort and emotional support) a child should receive, as determined by the Queensland Govt. Department of Child Safety.”

CBS reported that an increase in calls to Japan’s pregnancy hotline since March indicates that COVID-19 has caused an uptick in teenage pregnancies there. Jikei Hospital in Kumamoto, Japan said that calls from junior and senior high school students hit a 10-year high back in April. Pilcon, a Tokyo-based non-profit that runs school sex-ed programs, said that it was flooded with calls from concerned teens after they used home pregnancy tests or they missed periods.

Global Citizen stated that 152,000 Kenyan teen girls became pregnant during the country’s three-month lockdown, which was a 40 percent increase in their monthly average. Data from the International Rescue Committee shows that girls living in refugee camps were particularly affected, with 62 pregnancies reported at Kakuma Refugee Camp this past June compared to only eight in June 2019.

In an online press conference, Dr. Manisha Kumar, head of the Médecins Sans Frontières task force on safe abortion care, said, “During the pandemic, a lot of resurces got pulled away from a lot of routine services and care, and those services were redirected to coronavirus response.” The growing economic, hunger and health crises worldwide due to the pandemic makes this an especially challenging time for pregnant teens. 

Both Marie Stopes International and the United Nations Fund warned that the new focus on the coronavirus in the medical field would negatively affect reproductive health. This included disruptions to family planning services and restricted access to contraception, leading to more unintended pregnancies.

Preventing Teen Pregnancy

The U.S. Department of Health and Human Services Evidence Review has identified a variety of evidence-based teen pregnancy prevention programs. These include sexuality education programs, youth development programs, abstinence education programs, clinic-based programs and programs specifically designed for diverse populations and locations. 

Resources that focus on social health determinants in teen pregnancy prevention, specifically at the community level, play a crucial role in addressing the racial, ethnic and geographical disparities that exist in teen births. The CDC also supports several projects that educate, engage and involve young men in reproductive health. 

According to the CDC, research shows that teens who have conversations with their parents about sex, relationships, birth control and pregnancy tend to begin to have sex at a later age. When or if they do have sex, these teenagers are more likely to do so less often, use contraception, and have better communication with romantic partners.

A 2014 report by the Brooking Insitution’s Senior Fellow Melissa S. Kearney and Phillip B. Levine of Wellesley College found that the MTV reality programs like “16 and Pregnant” and “Teen Mom” led to a 5.7 percent in teen births in the 18 months after the shows first aired. This number accounts for approximately one-third of the overall decline in teen births during that time period.

In locations where more teenagers watched MTV, they saw a larger decline in teen pregnancy after the introduction of the show. The show also led young adults to educate themselves more on birth control. Research showed that when an episode aired, there were large spikes the following day in the rate that people were conducting online searches for how to obtain contraceptives.

Contraception and Reproductive Rights

According to Power to Decide, contraception is a key factor in recent declines in teen pregnancy. Yet, over 19 million women eligible for publicly funded contraception don’t have access to the full range of birth control methods where they live.

Between 2011 and 2015, 81 percent of females and 84 percent of males between the ages of 15 and 19 who had sex reported using a contraceptive the first time. This number increased for females since 2002, when 74.5 percent used contraception. 

A sexually active teen who doesn’t use contraceptives has a 90 percent chance of becoming pregnant within a year. 

NPR reported that a challenge to the Affordable Care Act could reach the Supreme Court in the near future, which would significantly affect reproductive healthcare. This could make contraceptives unaffordable and unobtainable for some Americans, which would in turn affect the number of teenagers having unprotected sex.

Some also fear that the recent death of Ruth Bader Ginsburg will jeopardize women’s reproductive rights. If her replacement is opposed to abortion, it will most likely turn the court in favor of increasing restrictions on abortion, and could even go as far as to overturn Roe v. Wade. This would have the potential to increase the number of unsafe abortions among pregnant teens, or increase the number of teen births.

According to Kaiser Health News, there is a case waiting in the lower court that involves federal funding of Planned Parenthood in both the Medicaid and federal family programs. Ginsburg always sided with women on issues such as these, so her absence could mean a lack of access to education, family planning and contraceptives for teens.

360 Magazine, Wheelchair

COVID-19’s Impact on Nursing Homes

The American Health Care Association National Center for Assisted Living has published a report detailing the impact that both the COVID-19 crisis and historic underfunding are having on nursing homes.

Between declines in occupancy, supply costs increasing by up to 103 percent, and labor costs rising, nursing homes across the U.S. are on the verge of collapse. The estimated revenue loss is up to 23 percent, or $57 billion. “Because of COVID-19, communities cannot continue move-ins or use revenue from new residents to counteract these expenses… this means that many homes will fail” (Dr. Ira Bedzow, NY Medical College, FoxNews.com, 4/29/20).

When it comes to nursing home care, as the old saying goes, we get what we pay for. Due in part to the exclusion of long-stay nursing home services from the Medicare benefit, Medicaid is the dominant payer of nursing home services. “Medicaid payment rates are typically 70-80% of private pay prices” said David Grabowski, PhD, Harvard Medical School (Testimony To U.S. Senate Finance Committee, 3/16/19).

Pre-COVID, the average nursing home was operating at a net loss or shoestring budget due to Medicaid’s funding shortfall. “In 2018, the average total margin – reflecting all payers (including  managed care, Medicaid, Medicare, and private insurers) and all lines of business (such as skilled and long-term care, hospice, ancillary services, home health care, and investment income) – was –0.3 percent, down from 2017 (0.6 percent).” (MedPAC Report To Congress: Medicare Payment Policy, 3/1/20).

“Medicaid must begin to pay a higher rate commensurate with the costs of delivering high-quality long-term care to frail older adults. In many states, this will require greater federal contributions” (David Grabowski, PhD,Harvard Medical Schoo, and Vincent Mor, PhD, Brown University).

VICE News + Donald Trump

As the GOP is recruiting candidates ahead of the 2018 midterms, most of the potential candidates for Senate look more like the 16 other Republicans in last year’s presidential primary than the populist anomaly who took the White House. On ViceNews.com, Alex Thompson examines how the GOP is looking for more conventional Republicans and is not recruiting candidates who share full political views with Trump.

Publicly, the GOP from the national to the local level is loyal and supportive of the president, but their actions suggest that they see Trump’s surprise victory as a one-off rather than a sign of a fundamental shift in the American electorate. Some Republicans are actively fighting Trump’s recent injection of populism, while loyalists see him as the beginning of a new era of politics.

Read “The GOP is not looking for the next Donald Trump” by VICE News’ Alex Thompson here: http://news.vice.com/story/the-republican-party-is-not-looking-for-the-next-donald-trump.

Follow @vicenews and @AlxThomp for more updates.