P J Cunningham

..Virtually all of this decreased spending was because of lower spending on prescription drugs as people shifted from brand-name medications to less expensive generics...

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..Public coverage expansions have reversed the surge in uninsurance rates during 1977-1987...

..Providers are adopting some of the same strategies being used in the private sector to attract higher-paying patients and changing their "image" as a safety-net provider...

..In terms of specific policies, prior authorization and mandatory generic substitutions had the largest effects on access to prescription drugs...

..This study examines how changes in physicians' practice income, ownership, and size affect their decisions to stop or start treating charity care and Medicaid patients...

..The results suggest that cost containment efforts that reduce eligibility and enrollment will achieve cost savings largely by reducing access and shifting costs away from Medicaid/SCHIP...

..To address this problem, many states are undertaking expansions of insurance coverage, but federal support will be critical, particularly in states with large numbers of low-income residents...

..Some states and communities are aggressively addressing these gaps, although funding for new programs remains scarce...

..Outpatient capacity constraints also contribute to high ED use. However, high ED use in some communities also likely reflects generic preferences for EDs as a source of care for nonurgent problems...

..Increasing these rates may be insufficient to increase physicians' participation unless accompanied by reductions in administrative burden...

..Policymakers should consider CHC expansions as complementary to insurance coverage expansions rather than as a substitute...

..The financial burden of medical care expenses is increasing for American families. However, the association between high medical cost burdens and patient trust in physicians is not known...

..The findings indicate that increasing activation levels among Hispanic immigrants may be as important as expanding insurance coverage in reducing disparities in unmet medical need...

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..By requiring or encouraging enrollees to obtain a usual source of care, managed care programs hope to improve access to care without incurring higher costs...

..To examine differences in insurance and racial/ethnic disparities in access to care between a single-item measure of general unmet medical need and a multi-item measure of symptom-specific unmet medical need...

..Moreover, almost 30 percent of the U.S. population either had a high financial burden of health costs or were uninsured. These facts underscore that escalating health care costs affect all socioeconomic strata, not just the poor...

..Participation in SCHIP may increase in high-uninsurance communities as the new programs mature, although low participation rates in public programs prior to SCHIP suggest that enrollment barriers may still be greater in such communities...

..The prevalence of persons with persistently high financial burdens is likely to increase in the future, because of expected increases in prescription drug costs as well as chronic disease prevalence...

..The results suggest that implementing mental health parity nationally will reduce some but not all of the barriers to mental health care...

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..Changes in the health care system, many of which are driven locally, may further exacerbate these differences...

..In general, consumers tended to overreport plan restrictions, especially the need for approval to see specialists...

..Health system changes may be affecting the ability of physicians to provide care with little or no compensation from patients who are uninsured and under-insured and may result in decreased access to physicians for uninsured persons...

..Despite the large number of identifiable factors included in the analysis, there is still a substantial amount of unexplained regional variation in uninsurance rates...

..Access gaps either remained the same or worsened slightly for English-speaking Hispanics and African Americans relative to whites...

..Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions...

..Sustained increases in private insurance premiums will continue to create enrollment pressures on state insurance programs for children...

..However, the limits to this surprising level of support are exemplified by decisions in many states to shelve some planned future expansions indefinitely...

..However, large fee increases were associated with primary care physicians' greater willingness to accept new Medicaid patients...

..Although local strategies can fill some holes, communities often do not have the resources necessary to fully address the problems of the uninsured on their own...

..Although uninsurance rates still can be decreased further, state budget pressures threaten the momentum toward higher participation in public programs...

..These results reflect the early stages of SCHIP implementation, however, and are subject to change as the SCHIP programs mature...

..Implications concerning policies to improve access to care for the uninsured are discussed...

..The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees...

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