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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Mueller, Keith J. ; Alfero, Charlie ; Coburn, Andrew F. ; Lundblad, Jennifer P. ; MacKinney, A. Clinton ; McBride, Timothy D. ; Barker, Abigail
    Reference Type: Report
    Year: 2018

    This paper discusses the realities and challenges of designing a market structure that will result in affordable health insurance being offered in rural markets, and reviews the rural implications of policies affecting rural health insurance markets and health systems. (Edited author introduction)

     

    This paper discusses the realities and challenges of designing a market structure that will result in affordable health insurance being offered in rural markets, and reviews the rural implications of policies affecting rural health insurance markets and health systems. (Edited author introduction)

     

  • Individual Author: Mueller, Keith J. ; Alfero, Charles ; Coburn, Andrew F. ; Lundblad, Jennifer P. ; MacKinney, A. Clinton; McBride, Timothy D. ; Weigel, Paula
    Reference Type: Report
    Year: 2018

    The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations, such as accountable care and other risk-based models, drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages. It is clear that more changes are required if real progress is to be made toward lowering total health care system costs, improving access and health care...

    The U.S. health care system is undergoing significant transformation as a result of Federal, State, and private payer policies designed to improve access to medical care as well as the value and outcomes of health care while attempting to slow cost growth. Some payment innovations, such as accountable care and other risk-based models, drive organizational and delivery changes that have shown evidence of improved quality, reduced care fragmentation, and lowered costs for certain populations. Yet overall, the entire system has not realized substantial cost savings nor has quality improved for everyone. There continue to be gaps between people who live in areas where progress is being made and those who do not, perhaps reflecting symptoms such as rising health insurance premiums, unstable insurance markets with limited plan choice, large variation in uninsured rates and access to care, and continued health professional shortages. It is clear that more changes are required if real progress is to be made toward lowering total health care system costs, improving access and health care experiences for all individuals, and achieving better population health.

    This paper examines the progress of health system transformation and the gaps that remain as they affect rural people, places, and providers. The health system transformation activities examined here are not limited to the Patient Protection and Affordable Care Act of 2010 (PPACA), but also touch upon activities undertaken by states, insurance plans, and private and public payers.

    The paper is organized into seven chapters covering topic areas that have key implications for rural people and the rural health care delivery system: Medicare, Medicaid and CHIP, Insurance Coverage and Affordability, Quality, Health Care Finance and System Transformation, Workforce, and Population Health. Each chapter begins with a summary of Policy Opportunities, followed by a background section on Rural Trends and Challenges that summarizes rural-related policy advances and continued gaps. We conclude each chapter with a Looking Ahead section that highlights the most pressing issues in today’s rural health care system environment, and we suggest future policy directions related to each issue. (Author abstract)

  • Individual Author: Okoro, Catherine A.; Zhao, Guixiang; Fox, Jared B.; Eke, Paul I.; Greenlund, Kurt J.; Town, Machell
    Reference Type: Report
    Year: 2017

    The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18–64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e.,...

    The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Data are collected from states, the District of Columbia, and participating U.S. territories on health risk behaviors, chronic health conditions, health care access, and use of clinical preventive services (CPS). An optional Health Care Access module was included in the 2014 BRFSS. This report summarizes 2014 BRFSS data from all 50 states and the District of Columbia on health care access and use of selected CPS recommended by the U.S. Preventive Services Task Force or the Advisory Committee on Immunization Practices among working-aged adults (aged 18–64 years), by state, state Medicaid expansion status, expanded geographic region, and federal poverty level (FPL). This report also provides analysis of primary type of health insurance coverage at the time of interview, continuity of health insurance coverage during the preceding 12 months, and other health care access measures (i.e., unmet health care need because of cost, unmet prescription need because of cost, medical debt [medical bills being paid off over time], number of health care visits during the preceding year, and satisfaction with received health care) from 43 states that included questions from the optional BRFSS Health Care Access module. (Author abstract) 

  • Individual Author: Kemper, Leah; Barker, Abigail R.; Wilbers, Lyndsey; McBride, Timothy D.; Mueller, Keith
    Reference Type: Report
    Year: 2016

    In this policy brief, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available to rural beneficiaries. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, we also discuss how market dynamics may impact the smaller and less wealthy populations that are characteristic of rural places. (Author abstract)

    In this policy brief, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available to rural beneficiaries. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, we also discuss how market dynamics may impact the smaller and less wealthy populations that are characteristic of rural places. (Author abstract)

  • Individual Author: Ciol, Marcia A.; Kasch, Elizabeth K.; Hoffman, Jeanne M.; Huynh, Minh; Chan, Leighton
    Reference Type: Journal Article
    Year: 2014

    Background

    Disability is a dynamic process where functional status may change over time. Examination of the Medicare population suggests that, for those over age 65, disability status will fluctuate in 30% of beneficiaries each year. Less is known about those under age 65. The dynamic nature of disability is of relevance since it has important implications for social policies related to disability.

    Objectives

    To: 1) describe the characteristics of Medicare beneficiaries eligible due to disability; and 2) estimate the proportion of individuals with transitions in functional status over a one-year period stratified by baseline characteristics and diagnostic subgroups.

    Methods

    We used the Medicare Current Beneficiary Survey from 1995 to 2005 to examine transitions in mobility and daily activities among individuals who were eligible for Medicare coverage due to disability.

    Results

    From the standpoint of function in mobility and daily activities, the working-age Medicare population with disability is fairly stable. While 75%–90% of our...

    Background

    Disability is a dynamic process where functional status may change over time. Examination of the Medicare population suggests that, for those over age 65, disability status will fluctuate in 30% of beneficiaries each year. Less is known about those under age 65. The dynamic nature of disability is of relevance since it has important implications for social policies related to disability.

    Objectives

    To: 1) describe the characteristics of Medicare beneficiaries eligible due to disability; and 2) estimate the proportion of individuals with transitions in functional status over a one-year period stratified by baseline characteristics and diagnostic subgroups.

    Methods

    We used the Medicare Current Beneficiary Survey from 1995 to 2005 to examine transitions in mobility and daily activities among individuals who were eligible for Medicare coverage due to disability.

    Results

    From the standpoint of function in mobility and daily activities, the working-age Medicare population with disability is fairly stable. While 75%–90% of our sample reported no disability or stable disability from one year to the next, depending on the condition and disability metric, as many as 13–14% of individuals showed improvement or decline in their functional status.

    Conclusions

    In the working-age population with disability, a small percentage of individuals will improve or worsen from one year to the next. Since these transitions are associated with a variety of individual characteristics including health conditions, further research applied to larger samples is required to refine policy relevant models that might inform decisions related to ongoing eligibility for disability programs. (author abstract)

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