The Association between Medicare Advantage Market Penetration and Diabetes in the United States.

The objective of this study is to explore the extent to which managed care market penetration in the United States is associated with the presence of chronic disease. Diabetes was selected as the chronic disease of interest due to its increasing prevalence as well as the disease management protocols that can lessen disease complications. We hypothesized that greater managed care market penetration would be associated with (1) lower prevalence of diabetes and (2) lower prevalence of diabetes-related comorbidities (DRCs) among diabetics. Data for this analysis came from two sources. We merged Medicare Advantage (MA) market penetration data from the Centers for Medicare and Medicaid Services (CMS) with data from the Medical Expenditure Panel Survey (MEPS) (2004-2008). Results suggest that county-level MA market penetration is not significantly associated with prevalence of diabetes or DRCs. That finding is quite interesting in that managed care market penetration has been shown to have an effect on utilization of inpatient services. It may be that managed care protocols do not offer the same benefits beyond the inpatient setting.

Chronic Disease Prevalence and Medicare Advantage Market Penetration: Findings From the Medical Expenditure Panel Survey.

By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary's portfolio of cardiometabolic diagnoses. This study uses 2004 to 2008 Medical Expenditure Panel Survey (MEPS) Household Component data to construct an aggregate index that captures multiple diagnoses in one outcome measure (Chronic Disease Severity Index [CDSI]). The MEPS data for 8089 Medicare beneficiaries are merged with MA market penetration data from Centers for Medicare and Medicaid Services (CMS). Ordinary least squares regressions are run with SAS 9.3 to model the effects of MA market penetration on CDSI. The results suggest that each percentage increase in MA market penetration is associated with a greater than 2-point decline in CDSI (lower burden of cardiometabolic chronic disease). Spill-over effects may be driving improvements in the cardiometabolic health of beneficiary populations in counties with elevated levels of MA market penetration.

The relationship between HAART use and employment for HIV-positive individuals: an empirical analysis and policy outlook.

OBJECTIVE: This study jointly analyzes the determinants of the use of highly active antiretroviral therapy (HAART) along with the determinants of employment status for human immunodeficiency virus (HIV)-positive individuals. METHODS: Data from the HIV Cost and Services Utilization Study (HCSUS) were analyzed using a bivariate probit model. HSCUS collected data on 2864 individuals in 180 clinics, hospitals and private practices in 28 urban areas and 24 clusters of rural counties in the United States. We used data from the baseline interview to categorize individuals as employed or unemployed and for the determination of HAART use. RESULTS: The empirical results suggest that individuals taking HAART have an increased likelihood of working and that individuals with private health insurance are more likely to use HAART compared to individuals with public health insurance coverage or no coverage. CONCLUSIONS: Due to the fact that employment of HIV-positive is directly related to HAART use, policymakers need to look to the private health insurance industry and public program to increase access to HAART. Suggested models for consideration are mandating insurance benefits and ADAP expansion.