Factors Associated With Health Insurance Literacy: Proficiency in Finding, Selecting, and Making Appropriate Decisions.

EXECUTIVE SUMMARY: This study set out to determine individuals' proficiency in finding, selecting, and making appropriate health insurance decisions for a positive healthcare experience. Primary data were collected by means of a cross-sectional online survey of 1,469 adults in the United States. Using separate multivariate regression models, we examined the relationships between patient characteristics and an individual's ability to choose, compare, manage, and use health insurance plan benefits. Across all four constructs, younger individuals exhibited significantly lower health insurance literacy. Compared to males, females reported lower levels of health insurance literacy. However, females were better able to compare health insurance benefits and efficiently use health plan benefits. Respondents who reported private insurance coverage or being uninsured had significantly lower health insurance literacy levels. We concluded that health insurance literacy is a salient issue that affects optimal healthcare use. Identifying characteristics associated with limited health insurance literacy is useful in guiding efforts to address health insurance literacy among healthcare consumers.

Relationship Between Accountable Care Organization Status and 30-Day Hospital-wide Readmissions: Are All Accountable Care Organizations Created Equal?

OBJECTIVE: We compare hospital readmission rates by accountable care organization (ACO) status with national readmission averages, to determine whether ACO affiliation influences 30-day hospital-wide readmission rates. METHODS: Data from the 2015 American Hospital Association Survey of Care Systems and Payment database were merged with Centers for Medicare and Medicaid's 2015 Hospital Compare Deaths and Readmissions data set. A multinomial logistic regression model is used to examine readmission rates, categorized as better, no different, or worse, in comparison to national averages, by ACO status. RESULTS: Compared with Non-ACO hospitals and holding the covariates constant, the relative risk of having better than national average readmissions was 1.85 in Medicare ACO hospitals (p = .36). Compared with facilities in the Northeast region, the relative risk of having better than national average readmissions was 2.21 for facilities in the West (p = .10). Facilities in the Midwest and Southern regions had a lower risk of having better than national average rates (Relative Risk: 0.90 and 0.23, respectively; p = .83 and .06, respectively). As hospital beds increase, facilities have significantly lower risks of having worse than national average readmissions. CONCLUSIONS: Overall, the ACO status did not significantly improve readmissions. However, Medicare ACOs performed better than non-Medicare ACOs and those hospitals without any reported ACO arrangements.

Mental health status and healthcare utilization among community dwelling older adults.

BACKGROUND: Shifts in mental health utilization patterns are necessary to allow for meaningful access to care for vulnerable populations. There have been long standing issues in how mental health is provided, which has caused problems in that care being efficacious for those seeking it. AIMS: To assess the relationship between mental health status and healthcare utilization among adults ≥65 years. METHODS: A negative binomial regression model was used to assess the relationship between mental health status and healthcare utilization related to office-based physician visits, while a two-part model, consisting of logistic regression and negative binomial regression, was used to separately model emergency visits and inpatient services. RESULTS: The receipt of care in office-based settings were marginally higher for subjects with mental health difficulties. Both probabilities and counts of inpatient hospitalizations were similar across mental health categories. The count of ER visits was similar across mental health categories; however, the probability of having an emergency department visit was marginally higher for older adults who reported mental health difficulties in 2012. CONCLUSION: These findings are encouraging and lend promise to the recent initiatives on addressing gaps in mental healthcare services.