Health Policy

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?

The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?
S. Glied, A. Arora, and C. Solís-Román, The CBO’s Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act? The Commonwealth Fund, December 2015.

Sherry A. Glied, Anupama Arora, Claudia Solis-Roman
12/15/2015

The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act’s impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO’s projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law’s rollout and participation in its reforms, the CBO’s forecast was reasonably accurate.

A comparative analysis of hospital readmissions in France and the US

A comparative analysis of hospital readmissions in France and the US

Gusmano, MK, Rodwin, VG, Weisz, D, Cottenet, J, and Quantin, C.
10/04/2015

Policymakers in the US and France are struggling to improve coordination among
hospitals and other health care providers. A comparison of hospital readmission rates, and the factors that may explain them, can provide important insights about the French and US health care systems. In addition, it illustrates a methodological approach to comparative research: how an empirical inquiry along a single indicator can reveal broader issues about system-wide differences across health care systems and policy. Using data from three French regions, the article extends a
previous national-level comparison indicating that rates of hospital readmission for the population aged 65+ are lower in France than in the US. In addition, we extend the range of variables available in the national comparison by drawing on neighborhood-level income data available from a previous study of access to primary care among three French regions. Within France, the odds of surgical hospital readmission are significantly lower in private for-profit hospitals compared with public hospitals. Patients who live in lower income neighborhoods are also more likely to be readmitted for medical and surgical conditions than are patients living in higher income neighborhoods, but this income effect is weaker than in the US. The article concludes with a discussion of how these findings reflect broader system-wide differences between the US and French health systems and the ways in which policymakers attempt to coordinate hospitals and community based services.

Housing, Neighborhoods, and Children’s Health

Housing, Neighborhoods, and Children’s Health
Future of Children, Volume 25 Number 1 Spring 2015

Ingrid Gould Ellen and Sherry Glied
09/17/2015

In theory, improving low-income families’ housing and neighborhoods could also improve their children’s health, through any number of mechanisms. For example, less exposure to environmental toxins could prevent diseases such as asthma; a safer, less violent neighborhood could improve health by reducing the chances of injury and death, and by easing the burden of stress; and a more walkable neighborhood with better playgrounds could encourage children to exercise, making them less likely to become obese.

Yet although neighborhood improvement policies generally achieve their immediate goals— investments in playgrounds create playgrounds, for example—Ingrid Gould Ellen and Sherry Glied find that many of these policies don’t show a strong effect on poor children’s health. One problem is that neighborhood improvements may price low-income families out of the very neighborhoods that have been improved, as new amenities draw more affluent families, causing rents and home prices to rise. Policy makers, say Ellen and Glied, should carefully consider how neighborhood improvements may affect affordability, a calculus that is likely to favor policies with clear and substantial benefits for low-income children, such as those that reduce neighborhood violence.

Housing subsidies can help families either cope with rising costs or move to more affluent neighborhoods. Unfortunately, demonstration programs that help families move to better neighborhoods have had only limited effects on children’s health, possibly because such transi- tions can be stressful. And because subsidies go to relatively few low-income families, the presence of subsidies may itself drive up housing costs, placing an extra burden on the majority of families that don’t receive them. Ellen and Glied suggest that policy makers consider whether granting smaller subsidies to more families would be a more effective way to use these funds.

 

Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic.

Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic.
Cohen D, Bhatia R, Story MT, Sugarman SD, Economos CD, Whitsel LP, Williams JD, Elbel B, Harris J, Kappagoda M, Champagne CM, Shields K, Lesser LI, Fox T, Becker N. Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic. Santa Monica, CA: RAND Corporation; 2013.

Cohen D, Bhatia R, Story MT, Sugarman SD, Economos CD, Whitsel LP, Williams JD, Elbel B, Harris J, Kappagoda M, Champagne CM, Shields K, Lesser LI, Fox T, Becker N.
09/10/2015

The Introduction of a Supermarket via Tax-Credits in a Low-Income Area: The Influence of Purchasing and Consumption.

The Introduction of a Supermarket via Tax-Credits in a Low-Income Area: The Influence of Purchasing and Consumption.
Elbel B, Mijanovich T, Kiszko K, Abrams C, Dixon LB. The Introduction of a Supermarket via Tax-Credits in a Low-Income Area: The Influence of Purchasing and Consumption. American Journal of Health Promotion. In press.

Elbel B, Mijanovich T, Kiszko K, Abrams C, Dixon LB.
09/10/2015

Calorie Labeling and Consumer Estimation of Calories Purchased.

Calorie Labeling and Consumer Estimation of Calories Purchased.
Taksler GB, Elbel B. Calorie Labeling and Consumer Estimation of Calories Purchased. International Journal of Behavioral Nutrition and Physical Activity. 2014; 11: 91.

Taksler GB, Elbel B.
09/10/2015

BACKGROUND:

Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation.

FINDINGS:

Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216-409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p = 0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p = 0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR = 0.25, p < 0.001) and for individuals ordering small meals (AOR = 0.54, p = 0.001). Accuracy worsened for females (AOR = 1.38, p < 0.001) and for individuals ordering large meals (AOR = 1.27, p = 0.028).

CONCLUSIONS:

We concluded that the odds of underestimating calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.

Corner store purchases in a low-income urban community in NYC.

Corner store purchases in a low-income urban community in NYC.
Kiszko K, Cantor J, Abrams C, Ruddock C, Moltzen K, Devia C, McFarline B, Singh H, Elbel B. Corner store purchases in a low-income urban community in NYC. Journal of Community Health. In press.

Kiszko K, Cantor J, Abrams C, Ruddock C, Moltzen K, Devia C, McFarline B, Singh H, Elbel B.
09/10/2015

We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.

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