Delayed enrollment and College Plans: is There a Postponement Penalty?
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ABSTRACT:
SUBMITTER: Niu S
PROVIDER: S-EPMC3627725 | biostudies-other | 2013 Jan
REPOSITORIES: biostudies-other
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Project description:OBJECTIVE:To investigate whether enrollment in high-deductible health plans (HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests. STUDY SETTING:Claims data from more than 40 large employers. STUDY DESIGN:We compared the change in price for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices. DATA COLLECTION:Claims data from 2004 to 2010 on 1.8 million enrollees. PRINCIPAL FINDINGS:After enrollment in HDHPs, 28 percent of enrollees changed physicians for office visits (compared to 19 percent in the Traditional Plan group, p < .01); however, this did not result in a statistically significant reduction in price for office visits. About 25 percent of enrollees changed providers for laboratory tests (compared to 23 percent in the Traditional Plan group, p < .01), resulting in savings of about $2.09 or a 12.8 percent reduction in price per laboratory test. We found that HDHPs had lower negotiated prices for office visits but not for laboratory tests. CONCLUSIONS:High-deductible health plan enrollment may shift enrollees to lower cost providers, resulting in modest savings.
| S-EPMC6056587 | biostudies-literature
Project description: Not available
| S-EPMC10867677 | biostudies-literature
Project description:ObjectivesWe assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans.DesignLongitudinal study linked with Medicare claims data.SettingThe Hispanic Established Populations for the Epidemiologic Study of the Elderly.ParticipantsCommunity-dwelling Mexican American older adults (N = 1455).MeasurementsWe examined insurance status using the Medicare Beneficiary Summary File and estimated the association of sociodemographic and clinical factors with insurance plan switching.ResultsAmong Mexican American older adults, FFS enrollees were more likely to be born in Mexico, speak Spanish, have lower levels of education, and have more disability than MA enrollees. Older adults with a larger number of limitations of instrumental activities of daily living (odds ratio [OR] = .50; 95% confidence interval [CI] = .26-.98) and more social support (OR = .70; 95% CI = .45-.98) were less likely to switch from FFS to MA compared with older adults with no limitations and less social support. Additionally, older adults living in counties with a greater number of MA plans were more likely to switch from FFS to MA (OR = 2.1; 95% CI = 1.45-3.16), compared with counties with a lower number of MA plans. In counties with a higher number of MA plans, older adults with more social support had lower odds of switching from FFS to MA (OR = .48; 95% CI = .28-.82) compared with older adults with less social support.ConclusionCompared with those enrolled in MA, older Mexican American adults enrolled in Medicare FFS are more socioeconomically disadvantaged and more likely to demonstrate poor health status. Stronger social support and increased physical limitations were strongly associated with less frequent switching from FFS to MA plans. Additionally, increased availability of MA plans at the county level is a significant driver of enrollment in MA plans. J Am Geriatr Soc 68:313-320, 2020.
| S-EPMC7015142 | biostudies-literature
Project description:BACKGROUND:There is concern that medical marijuana laws (MMLs) could negatively affect adolescents. To better understand these policies, we assess how adolescent exposure to MMLs is related to educational attainment. METHODS:Data from the 2000 Census and 2001-2014 American Community Surveys were restricted to individuals who were of high school age (14-18) between 1990 and 2012 (n=5,483,715). MML exposure was coded as: (i) a dichotomous "any MML" indicator, and (ii) number of years of high school age exposure. We used logistic regression to model whether MMLs affected: (a) completing high school by age 19; (b) beginning college, irrespective of completion; and (c) obtaining any degree after beginning college. A similar dataset based on the Youth Risk Behavior Survey (YRBS) was also constructed for confirmatory analyses assessing marijuana use. RESULTS:MMLs were associated with a 0.40 percentage point increase in the probability of not earning a high school diploma or GED after completing the 12th grade (from 3.99% to 4.39%). High school MML exposure was also associated with a 1.84 and 0.85 percentage point increase in the probability of college non-enrollment and degree non-completion, respectively (from 31.12% to 32.96% and 45.30% to 46.15%, respectively). Years of MML exposure exhibited a consistent dose response relationship for all outcomes. MMLs were also associated with 0.85 percentage point increase in daily marijuana use among 12th graders (up from 1.26%). CONCLUSIONS:Medical marijuana law exposure between age 14 to 18 likely has a delayed effect on use and education that persists over time.
| S-EPMC5123757 | biostudies-literature
Project description:Anxiety is the top mental health concern for undergraduates. While researchers have identified ways that in-person science courses can affect anxiety, little is known about how online science courses affect anxiety. In this study, 2111 undergraduates at a large research-intensive institution completed survey questions about their anxiety in large-enrollment online science courses. Specifically, we assessed students' anxiety in the context of online science courses and asked what aspects of online science courses increase and decrease their anxiety. Students also identified what instructors can do to lessen anxiety in online classrooms. We used open coding and logistic regression to analyze student responses. More than 50% of students reported at least moderate anxiety in the context of online college science courses. Students commonly reported that the potential for personal technology issues (69.8%) and proctored exams (68.0%) increased their anxiety, while being able to access content at a later time (79.0%) and attending class from where they want (74.2%) decreased their anxiety. The most common ways that students suggested that instructors could decrease student anxiety is to increase test-taking flexibility (25.0%) and be understanding (23.1%). This study provides insight into how instructors can create more inclusive online learning environments for students with anxiety.
| S-EPMC8715781 | biostudies-literature
Project description:Healthcare.gov was created to facilitate the market for non-group insurance in states that did not establish their own marketplaces. In Healthcare.gov, families are asked to report their tobacco use status, and tobacco use surcharges of up to 50% may result. We tabulate enrollment information for 35 states offering insurance plans through Healthcare.gov in both 2014 and 2016. The Centers for Medicare and Medicaid Services provided counts of enrollees indicating tobacco use, by state, year, and risk level. The number of enrollees increased from 5.0 million in 2014 to 9.4 million in 2016. From 2014 to 2016, the number of enrollees rose 39% for tobacco users and 90% for non-tobacco users. Reported non-tobacco user enrollment rose faster than reported tobacco user enrollment in 30 out of 35 states. Reported tobacco users are enrolling in marketplace plans at a lower rate and are more likely to enroll in less generous plans. The decline in smoking as reported when purchasing insurance on Healthcare.gov surpasses declines in smoking observed in other data sources, which suggests that tobacco users may be decreasingly likely to report their tobacco use status accurately to avoid surcharges. Finally, we find no evidence of the surcharges being associated with lower enrollment among self-reported tobacco users, or in rates of smoking.
| S-EPMC5447394 | biostudies-literature
Project description:BACKGROUND:The difference in cocaine use between student and non-student emerging adults is not well understood, despite the longstanding assumption that college is protective against use. OBJECTIVE:To describe trends in cocaine use among emerging adults by college enrollment. METHODS:Using cross-sectional, nationally-representative data from the National Survey on Drug Use and Health (2002-2016), we estimated the prevalence of four cocaine use indicators by year among emerging adults (ages 18-22) and stratified by college enrollment. We tested for linear and quadratic trends over time. RESULTS:From 2002 to 2016, 11.7% reported lifetime cocaine use, 5.8% reported past 12-month use, 1.7% reported past 30-day use, and 1% had a use disorder in the past 12-months. We observed significant linear decreases in all four use indicators over time (Lifetime: ??=?-0.20, Past 12-months: ??=?-0.17, Past 30-days: ??=?-0.22, Past 12-months disorder: ??=?-0.37). Students had lower rates of cocaine use than non-students, although prevalence estimates were more similar between groups for past 12-month (Students:5.3%, 95% CI:5.0-5.5; Non-students:6.3%, 95% CI:6.1-6.5) and past 30-day use (Students:1.6%, 95% CI:1.4-1.7; Non-students:1.8%, 95% CI:1.7-1.9) than for lifetime use (Students:9.4%, 95% CI:9.1-9.7; Non-students:13.8%, 95% CI:13.5-14.1). CONCLUSIONS:Cocaine use has declined among emerging adults since the early 2000s. The college environment appears compensate for early life differences in cocaine use risk between students and non-students, closing the gap between groups for recent indicators of cocaine use. Given the severe health consequences associated with cocaine use, more public health attention to this issue is needed.
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Project description:Objective: This study examines the prospective relationship between substance use during college and two outcomes: having definite plans to attend graduate school; and, among individuals with plans, enrolling in graduate school upon college graduation. Participants: n?=?980 were originally enrolled as first-time, first-year college students in an ongoing longitudinal study (August 2004 to present). Methods: Measures from personal interviews included demographics, GPA, alcohol use, alcohol abuse/dependence, and other drug use during college. Results: Fifty-four percent had definite plans to attend graduate school, and 47% of students with definite plans enrolled in graduate school. Alcohol dependence was significantly associated with reduced likelihood of having graduate school plans. Among students with plans to attend graduate school, alcohol abuse and alcohol dependence during college were associated with decreased likelihood of enrolling in graduate school. Conclusions: Substance use during college might impact graduate school enrollment, and early intervention efforts could help students achieve their educational goals.
| S-EPMC6694003 | biostudies-literature
Project description:The purpose of this study was to explore whether the institutional presence of public health expertise within colleges and universities was associated with operational plans for the fall semester of 2020. Using cross-sectional data collected by the College Crisis Initiative of Davidson College, six levels of instructional modalities (ranked from least to most restrictive) were compared between Council on Education of Public Health (CEPH)-accredited and non-CEPH-accredited 4-year institutions. Institutions with CEPH-accredited schools and programs were more likely to select some restrictive teaching modalities: 63.8% more likely to use hybrid/hyflex or more restrictive and 66.9% more likely to be primarily online (with some in person) or more restrictive. However, having CEPH-accredited programs did not push institutions to the most restrictive modalities. COVID-19 cases in county, enrollment, and political affiliation of the state governor were also found to be associated with instructional modality selection. While any ecological study has certain limitations, this study suggests that college and university fall plans may have been influenced by the presence of CEPH-accredited schools and programs of public health, and/or the input of their faculty. The influence of relevant faculty expertise on institutional decision-making can help inform college and university responses to future crises.
| S-EPMC8795676 | biostudies-literature
Project description:The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among a group of women whose employers switched their insurance coverage from health plans with low deductibles ($500 or less) to plans with high deductibles ($1,000 or more) between 2004 and 2014. Primary subgroups of interest comprised 54,403 low-income and 76,776 high-income women continuously enrolled in low-deductible plans for a year and then up to four years in HDHPs. Matched controls had contemporaneous low-deductible enrollment. Low-income women in HDHPs experienced relative delays of 1.6 months to first breast imaging, 2.7 months to first biopsy, 6.6 months to incident early-stage breast cancer diagnosis, and 8.7 months to first chemotherapy. High-income HDHP members had shorter delays that did not differ significantly from those of their low-income counterparts. HDHP members living in metropolitan, nonmetropolitan, predominantly white, and predominantly nonwhite areas also experienced delayed breast cancer care. Policies may be needed to reduce out-of-pocket spending obligations for breast cancer care.
| S-EPMC7268048 | biostudies-literature