Ruth Robertson

Affordable Care Act Reforms Could Reduce The Number Of Underinsured US Adults By 70 Percent

To provide a baseline and assess the potential of changes brought about under the Affordable Care Act, this study estimates the number of US adults who were underinsured or uninsured in 2010. Using indicators of medical cost exposure relative to income, we find that 44 percent (81 million) of adults ages 19-64 were either uninsured or underinsured in 2010-up from 75 million in 2007 and 61 million in 2003. Adults with incomes below 250 percent of the federal poverty level account for sizable majorities of those at risk of becoming uninsured or underinsured. If reforms succeed in increasing the affordability of care for people in this income range, we could expect a 70 percent drop in the number of underinsured people and a steep drop in the number of uninsured people.

Choice policies in Northern European health systems

This paper compares the introduction of policies to promote or strengthen patient choice in four Northern European countries - Denmark, England, the Netherlands and Sweden. The paper examines whether there has been convergence in choice policies across Northern Europe. Following Christopher Pollitts suggestion, the paper distinguishes between rhetorical (discursive) convergence, decision (design) convergence and implementation (operational) convergence (Pollitt, 2002). This leads to the following research question for the article: Is the introduction of policies to strengthen choice in the four countries characterised by discursive, decision and operational convergence? The paper concludes that there seems to be convergence among these four countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). It appears that the institutional context and policy concerns such as waiting times have been important in affecting the timing of the introduction of choice policies and implementation, but less so in the design of choice policies. An analysis of the impact of choice policies is beyond the scope of this paper, but it is concluded that further research should investigate how the institutional context and timing of implementation affect differences in how the choice policy works out in practice.

The impact of patient choice of provider on equity: Analysis of a patient survey:

Objectives To understand the impact on equity of giving patients a choice of provider. Methods A postal survey of 5997 patients in four areas of England about choice at their recent referral and, using a discrete choice experiment, how they would choose in hypothetical situations. Binary logistic regression and a series of multinomial and nested logit models were used to analyse the data to discover whether patients with particular characteristics were more likely to: think choice is important; be offered a choice; and, choose a non-local provider. Results The response rate was 36%. Choice was more important to older patients aged 51-80 years, patients from non-white backgrounds, women, those with no qualifications and those with a bad past experience of their local hospital. There were no significant differences in who was offered a choice in terms of education, age group or ethnicity. In both real and hypothetical situations patients with no formal qualifications and those living in urban centres were more likely to choose their local hospital, and patients with a bad or mixed past experience at the local hospital were more likely to choose an alternative. In hypothetical choices those who do not normally travel by car and without Internet access were more likely to choose their local hospital irrespective of that hospitals characteristics. Conclusions More educated, affluent patients were no more likely to be offered a choice than other population groups, but there does appear to be a social gradient in who chose to travel beyond the local area for treatment. If these results were replicated across England, there is at least the potential risk that when local hospitals are failing, patient choice could result in inequitable access to high quality care, rather than enhancing equity as the policys architects had hoped.