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Biomedical subjects

Anthony T Lo Sasso

Publications and source records attributed to Anthony T Lo Sasso.

At least 19 recordsLinked to original sources
PubMed2006

The effect of distance to provider on employee response to changes in mental health benefits.

We assess whether distance to provider moderates the effect of a change in mental health benefits on treatment initiation of employees of a large US-based company for psychiatric disorders. Mental health treatment administrative claims data plus eligibility information provided by a Fortune 50 company for the years 1995-1998 are used for the analysis. The effect of distance is measured using the relative effect of the initiative on residents living far from providers compared to those living close to providers. We model the probability of treatment initiation using a random effects logit specification. We find that the effect of distance to provider has the potential to over-shadow other incentives to initiate treatment, especially at distances greater than 4 miles. These results lend further support to the notion that geographic dispersion of providers should be an important consideration when forming a selective contracting network.

Adolescent↗
PubMed2006

The evolving gender gap in general obstetrics and gynecology.

OBJECTIVE: The purpose of this study was to analyze the trend in subspecialization among men graduating from obstetrics and gynecology residency programs. STUDY DESIGN: Results of the Survey of Residents Completing Training in New York State were analyzed for 1998 to 2003. The proportions of men and women graduating from residency programs and pursuing subspecialty training were compared. Multivariate regression analysis was conducted to analyze trends over time while controlling for confounding variables. RESULTS: Seven hundred thirty-seven Ob/Gyn, 1820 pediatrics, and 5007 internal medicine residents responded. The proportion of male graduating Ob/Gyn residents decreased from 46% to 23% (P < .001). Of those men, the proportion that proceeded with subspecialty training increased from 5.3% to 25.0% (P = .01). Women graduating from an Ob/Gyn residency program displayed a similar but smaller trend towards subspecialization, as did men graduating from pediatrics residencies. Men graduating from internal medicine residency programs demonstrated no change. CONCLUSION: As the proportion of men entering Ob/Gyn residency programs declines, the number of men entering general Ob/Gyn is declining at an even more dramatic rate.

Career Choice↗
PubMed2006

Modeling the impact of enhanced depression treatment on workplace functioning and costs: a cost-benefit approach.

BACKGROUND: The impact of depression on the workplace has been widely observed in studies examining absenteeism and reduced productivity during days at work. However, there is little scientific evidence about whether depression interventions are cost-beneficial to employers. OBJECTIVE: We construct a cost-benefit analysis of depression treatment under different workplace assumptions better reflecting the nature of employment. RESEARCH DESIGN: Data from a randomized controlled trial in which employed primary care patients with depression were treated in practices randomly assigned to an enhanced treatment intervention or usual care were used to construct a cost-benefit model from an employer perspective under different assumptions regarding employment. SUBJECTS: A national sample of 198 workers employed in a range of positions by companies was studied. MEASURES: Benefits included self-reported productivity and absenteeism; costs included intervention and treatment costs. Net benefit was calculated under different scenarios and return on investment (ROI) is derived. RESULTS: Enhanced depression treatment resulted in an average net benefit to the employer of Dollars 30 per participating worker in Year 1 of the intervention and Dollars 257 per participating worker in Year 2, for an estimated ROI during the 2-year period of 302%. ROI increased in firms that rely on team production, hire more costly substitute labor, or realize penalties for output shortfalls. ROI decreased in firms that have a large fraction of employees with dependent coverage and experience high turnover rates. Results also are sensitive to how subjectively reported productivity is valued. CONCLUSION: Many employers will receive a potentially significant ROI from depression treatment models that improve absenteeism and productivity at work.

Absenteeism↗
PubMed2006

Expanded mental health benefits and outpatient depression treatment intensity.

BACKGROUND: The justification for higher cost-sharing for behavioral health treatment is its greater price sensitivity relative to general healthcare treatment. Despite this, recent policy efforts have focused on improving access to behavioral health treatment. OBJECTIVES: We measured the effects on outpatient treatment of depression of a change in mental health benefits for employees of a large U.S.-based corporation. RESEARCH DESIGN: The benefit change involved 3 major elements: reduced copayments for mental health treatment, the implementation of a selective contracting network, and an effort to destigmatize mental illness. Claims data and a difference-in-differences methodology were used to examine how the benefit change affected outpatient treatment of depression. SUBJECTS: Subjects consisted of 214,517 employee-years of data for individuals who were continuously enrolled for at least 1 full year at the intervention company and 96,365 employee-years in the control group. MEASURES: We measured initiation into treatment of depression and the number of outpatient therapy visits. RESULTS: The benefit change was associated with a 26% increase in the probability of initiating depression treatment. Conditional on initiating treatment, patients in the intervention company received 1.2 additional (P < 0.001) outpatient mental health treatment visits relative to the control group. CONCLUSIONS: Our results suggest that the overall effect of the company's benefit change was to significantly increase the number of outpatient visits per episode of treatment conditional on treatment initiation.

Adult↗
PubMed2006

Communal housing settings enhance substance abuse recovery.

Oxford Houses are democratic, mutual help-oriented recovery homes for individuals with substance abuse histories. There are more than 1200 of these houses in the United States, and each home is operated independently by its residents, without help from professional staff. In a recent experiment, 150 individuals in Illinois were randomly assigned to either an Oxford House or usual-care condition (i.e., outpatient treatment or self-help groups) after substance abuse treatment discharge. At the 24-month follow-up, those in the Oxford House condition compared with the usual-care condition had significantly lower substance use, significantly higher monthly income, and significantly lower incarceration rates.

Aftercare↗
PubMed2006

The impact of elder care on women's labor supply.

Adult daughters traditionally have served as primary caregivers for frail unmarried adults, but the levels of care they have provided in the past may interfere with their growing work responsibilities. This paper examines the impact of time transfers to elderly parents on labor supply at midlife. Using a sample of women ages 55 to 67 in the Health and Retirement Study, we estimate panel data models of annual hours of paid work controlling for the endogeneity of time assistance to parents. The results indicate that time help to parents strongly reduces female labor supply at midlife.

Aged↗
PubMed2006

The effects of expanded mental health benefits on treatment costs.

BACKGROUND: Mental health disorders represent one of the most common problems facing adults in the labor force. It is estimated that within a 12-month period nearly 30% of the US population experiences some diagnosable mental health or addictive disorder. This study examines the impact that corporate benefit policies can have on mental health treatment costs. AIMS: To measure the effects of a change in mental health benefit design on treatment expenditures for employees of a large US-based company. METHODS: Data came from mental health treatment administrative claims and eligibility information provided by the company and a comparable set of claims for a randomly selected control group for the years 1995-1998. We measure the effect of a change in mental health benefits consisting of three major elements: a company-wide effort to destigmatize mental illness; reduced cost-sharing for mental health treatment; and the implementation of a provider network that emphasized access to non-physician mental health specialists. We use a two-part regression model within a difference in differences framework to examine outpatient, pharmaceutical, and combined outpatient and pharmaceutical expenditures between the treatment company and the control group. RESULTS: We find that the program led to a statistically significant dollar 17 increase in outpatient costs (excluding pharmaceutical costs) per employee. Similar to outpatient care we find that the benefit change was associated with a statistically significant increase in pharmaceutical costs of about dollar 15. DISCUSSION: The results reveal that the mental health benefit expansion at the company led to a significant increase in aggregate mental health expenditures among employees. However, the aggregate increase in cost masks a number of interesting underlying trends in mental health utilization. First, conditional upon any mental health treatment, mental health costs were virtually unchanged before and after the benefit change. Conditional on any use, outpatient and pharmaceutical expenditures went in opposite directions, with outpatient expenditures falling and pharmaceutical expenditures increasing. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Private sector initiatives can increase use of mental health care treatment through decreased cost-sharing, improved access to specialty providers, and destigmatization of mental disorders. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: Given that the vast majority of people in the US get their health insurance through employer-sponsored health insurance, efforts on the part of the private sector to recognize and treat serious chronic illnesses such as mental disorder in a proactive manner should be encouraged. IMPLICATIONS FOR FUTURE RESEARCH: While the aggregate cost of corporate initiatives to improve access to quality mental health care is frequently examined, it is also important to decompose the aggregate cost changes into effects from a change in the rate of initiation and changes in utilization conditional upon initiation.

Adolescent↗
PubMed2005

The price of palliative care: toward a complete accounting of costs and benefits.

In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the "tip of the iceberg" of the potential costs and benefits. Using this framework, the authors offer guidelines for performing comprehensive cost-benefit analyses of palliative care and conclude that many of the issues beneath the surface may be substantial and deserving of closer scrutiny. Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders.

Cost-Benefit Analysis↗
PubMed2005

The effect of expanded mental health benefits on treatment initiation and specialist utilization.

OBJECTIVE: To measure the effects of a mental health benefit design change on treatment initiation for psychiatric disorders of employees of a large U.S.-based company. DATA SOURCES: Mental health treatment administrative claims data plus eligibility information provided by the company for the years 1995-1998. STUDY DESIGN: We measure the effect of a change in mental health benefits consisting of three major elements: a company-wide effort to destigmatize mental illness; reduced copayments for mental health treatment; and an effort to increase access to specialty mental health providers. DATA EXTRACTION METHODS: We identified the subsample of employees that were continuously enrolled in the company's health plan over the period 1995-1998, were between the ages of 18 and 65, and were actively employed. PRINCIPAL FINDINGS: Our results suggest that the combined effect of destigmatization and reduced copayments led to an 18 percent increase (p<.01) in the probability of initiating mental health treatment. The results suggest that the effort to increase access to specialty providers was effective, but only for nonphysician providers: initiation at nonphysician mental health providers increased nearly 90 percent (p<.01) relative to nonspecialty providers, while use of psychiatrists declined by nearly 40 percent (p<.01). CONCLUSIONS: Our results suggest that the benefit change increased initiation for mental health treatment overall and encouraged the use of nonphysician specialty mental health providers.

Adult↗
PubMed2004

The effect of prospective payment on rehabilitative care.

OBJECTIVES: To estimate the difference between cost and prospective payment system (PPS) reimbursements for rehabilitation care and to simulate potential consequences of cost-reducing strategies. DESIGN: A retrospective study to estimate costs and functional status at discharge from care. SETTING: An academic, urban, rehabilitation hospital. PARTICIPANTS: Stroke patients on their first admission to a rehabilitation hospital between 1994 and 1998. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cost was estimated from billing databases. Function was measured using the motor and cognitive components of the FIM instrument. RESULTS: PPS reimbursements were 10,825 dollars (37%) lower than costs. No matter how much therapy was reduced, the costs were still greater than the mean PPS reimbursement. A reduction in length of stay by 9.6 days was required to bring costs in line with the PPS reimbursement, reducing discharge cognitive function by 1.1 points (P <.01). Use of group therapy brought costs close to PPS reimbursement amount and improved discharge cognitive function by 0.5 points (P <.10). CONCLUSIONS: Our study shows the large difference between costs and expected PPS reimbursements that would have been observed before the PPS. Institutions have many options that reduce costs, with little effect on function at discharge. Future studies should determine the impact of evolving reimbursement rules on facilities financial status, and on patient outcomes.

Adult↗
PubMed2004

The effect of the State Children's Health Insurance Program on health insurance coverage.

This paper presents the first national estimates of the effects of the SCHIP expansions on insurance coverage. Using CPS data on insurance coverage during the years 1996-2000, we estimate instrumental variables regressions of insurance coverage. Our regression results imply that 9% of children meeting income eligibility standards for SCHIP gained public insurance. While low, our estimates indicate that states were more successful in enrolling children in SCHIP than they were with prior Medicaid expansions that were focused on children just above the poverty line. Crowd-out of private health insurance was estimated to be nearly 50%, which is in line with estimates for the Medicaid expansions of the early 1990s. In addition, state anti-crowd-out provisions in the form of waiting periods were found to significantly affect both take-up and crowd-out.

Adolescent↗
PubMed2004

Tales from the new frontier: pioneers' experiences with consumer-driven health care.

OBJECTIVE: To conduct site visits to study the early experiences of firms offering consumer-driven health care (CDHC) plans to their employees and firms that provide CDHC products. DATA SOURCES/STUDY SETTING: A convenience sample of three firms offering CDHC products to their employees, one of which is also a large insurer, and one firm offering an early CDHC product to employers. STUDY DESIGN: We conducted onsite interviews of four companies during the spring and summer of 2003. These four cases were not selected randomly. We contacted organizations that already had a consumer-driven plan in place by January 2002 so as to provide a complete year's worth of experience with CDHC. PRINCIPAL FINDINGS: The experience of the companies we visited indicated that favorable selection tends to result when a CDHC plan is introduced alongside traditional preferred provider organization (PPO) and health maintenance organization (HMO) plan offerings. Two sites demonstrated substantial cost-savings. Our case studies also indicate that the more mundane aspects of health care benefits are still crucial under CDHC. The size of the provider network accessible through the CDHC plan was critical, as was the role of premium contributions in the benefit design. Also, companies highlighted the importance of educating employees about new CDHC products: employees who understood the product were more likely to enroll. CONCLUSIONS: Our site visits suggest the peril (risk selection) and the promise (cost savings) of CDHC. At this point there is still far more that we do not know about CDHC than we do know. Little is known about the extent to which CDHC changes people's behavior, the extent to which quality of care is affected by CDHC, and whether web-based information and tools actually make patients become better consumers.

Consumer Behavior↗
PubMed2003

The effect of urban hospital closure on markets.

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2-4% for all patients and about 6-8% for patients who would have been treated at the closed hospital.

Catchment Area, Health↗
PubMed2002

Selective serotonin reuptake inhibitor usage patterns as risk factors for hospitalization.

The authors examined how differences in SSRI utilization affect the risk of hospitalization among persons with depression. In particular, they decompose how different types of drug therapy affect hospitalization and how that effect varies with the usage pattern of the drug. Using retrospective medical and pharmacy claims from a Midwestern health maintenance organization, they employed multiple logistic regression analyses of patients newly treated for depression. Their findings were that (a) paroxetine may be a significant risk factor for early discontinuation compared with fluoxetine; and (b) sertraline initiation among stable-use patients may lower the risk of hospitalization. However, initiation on paroxetine or sertraline rather than fluoxetine may increase the risk of hospitalization among patients not exhibiting a stable usage pattern.

Antidepressive Agents, Second-Generation↗
PubMed2002

The effects of copayments on substance abuse treatment expenditures and treatment reoccurrence.

OBJECTIVE: Employers can influence treatment decisions by adjusting characteristics of the structure of the benefits they offer, such as copayments. The authors estimated the relationship between copayment levels for substance abuse treatment and both the insurers' expenditures for treatment and the reoccurrence of treatment. METHODS: Retrospective data from a Midwestern behavioral health insurer were used to identify persons with a diagnosis of a substance use disorder. The claims data were used to construct episodes of treatment. Using the variation in copayment levels across 211 different employer groups, the authors used multiple regression models to estimate the effect of copayment levels on treatment expenditures and the likelihood of a treatment reoccurrence. RESULTS: Copayment levels had a significant effect on the reoccurrence of substance abuse treatment. Each 10 percent increase in copayment was associated with a 1 percent increase in the probability of reoccurrence. Copayment levels had a significant effect on current-episode treatment expenditures. Each 10 percent increase in copayment was associated with an 8.7 percent decrease in total per-episode expenditures. From the plan's perspective, a $1 increase in copayment for outpatient substance abuse treatment reduced per-episode spending by $110; however, roughly $13 is lost from that saving because of the increased likelihood of treatment reoccurrence. CONCLUSIONS: The longer a person is retained in substance abuse treatment, the greater the likelihood of recovery. Copayments may represent a barrier to retention in treatment. Higher copayments for substance abuse treatment make treatment reoccurrence more likely.

Adult↗
PubMed2002

Does informal care from adult children reduce nursing home admissions for the elderly?

Despite the policy importance, particularly as society ages, little is known about the impact of informal care on nursing home admissions. This paper jointly models the receipt of regular help from adult children and subsequent nursing home care, using data from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). Results indicate that frequent help from children with basic personal care reduces the likelihood of nursing home use over a subsequent two-year period by about 60% for disabled Americans age 70 and older. However, we found no significant reduction in nursing home admissions when help was measured more broadly to include assistance with chores and errands.

Activities of Daily Living↗
PubMedDate not supplied

The sensitivity of substance abuse treatment intensity to co-payment levels.

This study exploits variation in co-payment levels among different contractual arrangements within a regional managed behavioral health care organization to estimate the relationship between co-payment levels for substance use treatment services and the intensity of substance use treatment. The substance use treatment benefits involved a range of co-payment levels across nearly 400 employers during the years 1993 through 1998. Multiple regression techniques were used to estimate the effect of co-payment levels on treatment intensity. The results indicate that co-payment levels had a significant negative effect on outpatient and inpatient substance use treatment. For outpatient treatment the effect on intensity implied a co-payment elasticity of -0.18, implying that moving from a $10 co-payment to a $20 co-payment would result in, for example, a reduction from 5 to 4 outpatient visits per episode. However, the effect was larger for persons with combined alcohol and drug use disorders, as they exhibited a co-payment elasticity of -0.27. For inpatient days, the co-payment elasticity was considerably smaller at -0.017. Given the benefits of maintaining persons with substance use disorders in treatment, employers may have an incentive to take steps to minimize the barriers to treatment.

Adult↗