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  1. Article ; Online: Does Supporting Children Help Their Parents Thrive?

    Shafer, Paul R

    JAMA network open

    2024  Volume 7, Issue 2, Page(s) e2356376

    Language English
    Publishing date 2024-02-05
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.56376
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  2. Article ; Online: Expanded unemployment benefits and their implications for health during the COVID-19 pandemic.

    Shafer, Paul R

    Health services research

    2021  Volume 57, Issue 1, Page(s) 12–14

    MeSH term(s) COVID-19/economics ; COVID-19/epidemiology ; Health Expenditures/statistics & numerical data ; Humans ; Insurance Benefits/economics ; Insurance Benefits/statistics & numerical data ; Unemployment/statistics & numerical data ; United States/epidemiology
    Language English
    Publishing date 2021-10-14
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.13881
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    Zs.A 582: Show issues Location:
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  3. Article ; Online: Impact of US Smoke-free Air Laws on Restaurant and Bar Employment, 1990-2015.

    Shafer, Paul

    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

    2018  Volume 21, Issue 4, Page(s) 547–550

    Abstract: Introduction: Secondhand smoke exposure is responsible for an estimated 50000 deaths per year among nonsmokers in the United States. Smoke-free air laws reduce secondhand smoke exposure but often encounter opposition over concerns about their economic ... ...

    Abstract Introduction: Secondhand smoke exposure is responsible for an estimated 50000 deaths per year among nonsmokers in the United States. Smoke-free air laws reduce secondhand smoke exposure but often encounter opposition over concerns about their economic impact. Expansion of these laws has stagnated and efforts to weaken existing laws may exacerbate existing disparities in exposure. Studies at the state and local levels have found that smoke-free air laws do not generally have an adverse effect, but there are no recent estimates of the impact of these laws nationally.
    Methods: Employment and sales are two measures commonly used to estimate the economic impact of smoke-free air laws. Sales data are gathered by state and local taxing authorities but not uniformly across jurisdictions. Dynamic panel models are used to estimate a population-weighted national average treatment effect of smoke-free air laws on restaurant and bar employment using data from the Quarterly Census of Employment and Wages for 1990 to 2015.
    Results: A one-percentage point increase in population covered by a restaurant smoke-free air law is associated with a small increase (approximately 0.01%) in restaurant employment (b = .0001, p < .001). The percentage of state population covered by a bar smoke-free air law was not associated with bar employment.
    Discussion: Smoke-free air laws are a powerful tool for protecting hospitality workers and patrons from the dangers of secondhand smoke. Using data from over more than two decades, these results suggest that smoke-free air laws in the United States do not generally have any meaningful effect on restaurant and bar employment.
    Implications: Smoke-free air laws are associated with reductions in negative health outcomes and decreased smoking prevalence. Despite this clear public health argument and strong public support, passage of new laws has stagnated and exemptions are being used to weaken existing laws. The ability to make both a health and business case in support of existing laws may also bolster the case for expansion. This study provides an updated look at the economic impact of smoke-free air laws nationally through 2015. The lack of adverse findings provides additional support for these laws as public health win-win.
    MeSH term(s) Employment/legislation & jurisprudence ; Employment/trends ; Humans ; Public Health/methods ; Public Health/trends ; Restaurants/legislation & jurisprudence ; Restaurants/trends ; Tobacco Smoke Pollution/legislation & jurisprudence ; Tobacco Smoke Pollution/prevention & control ; United States/epidemiology
    Chemical Substances Tobacco Smoke Pollution
    Language English
    Publishing date 2018-01-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1452315-2
    ISSN 1469-994X ; 1462-2203
    ISSN (online) 1469-994X
    ISSN 1462-2203
    DOI 10.1093/ntr/ntx280
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  4. Article ; Online: Medicaid Applications Spike during Marketplace Open Enrollment: Lessons from Covered California.

    Shafer, Paul R / Hinde, Jesse M

    Journal of health care for the poor and underserved

    2022  Volume 33, Issue 3, Page(s) 1155–1162

    Abstract: The expansion of Medicaid coverage as part of the Affordable Care Act has insured millions of Americans and reduced costly churn in the program. A large increase in Medicaid applications during Marketplace open enrollment would indicate two potential ... ...

    Abstract The expansion of Medicaid coverage as part of the Affordable Care Act has insured millions of Americans and reduced costly churn in the program. A large increase in Medicaid applications during Marketplace open enrollment would indicate two potential information gaps: 1) individuals do not know that they are eligible, and/or 2) individuals do not know that they can enroll in Medicaid year-round. We used statewide monthly Medicaid applications data for California over a three-year period (July 2016 to June 2019) to assess whether Marketplace open enrollment influences Medicaid applications. Over one-third of all Medicaid applications (35.0%) were received during months with Marketplace open enrollment, and daily average Medicaid application volume was 32.5% higher in those months than in months outside of open enrollment. These findings generate concerns about whether there is enough consumer education and outreach to potential enrollees to limit coverage gaps and associated barriers in access to care.
    MeSH term(s) California ; Health Insurance Exchanges ; Humans ; Insurance Coverage ; Medicaid ; Patient Protection and Affordable Care Act ; United States
    Language English
    Publishing date 2022-10-16
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1142637-8
    ISSN 1548-6869 ; 1049-2089
    ISSN (online) 1548-6869
    ISSN 1049-2089
    DOI 10.1353/hpu.2022.0102
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  5. Article: Comparison of Full-Time Equivalent and Clinic Time Labor Input Measures in Productivity Metrics.

    Saeed, Iman / Barr, Kyle / Palani, Sivagaminathan / Shafer, Paul / Pizer, Steven

    Journal of healthcare management / American College of Healthcare Executives

    2024  Volume 69, Issue 3, Page(s) 178–189

    Abstract: Goal: A lack of improvement in productivity in recent years may be the result of suboptimal measurement of productivity. Hospitals and clinics benefit from external benchmarks that allow assessment of clinical productivity. Work relative value units ... ...

    Abstract Goal: A lack of improvement in productivity in recent years may be the result of suboptimal measurement of productivity. Hospitals and clinics benefit from external benchmarks that allow assessment of clinical productivity. Work relative value units have long served as a common currency for this purpose. Productivity is determined by comparing work relative value units to full-time equivalents (FTEs), but FTEs do not have a universal or standardized definition, which could cause problems. We propose a new clinical labor input measure-"clinic time"-as a substitute for using the reported measure of FTEs.
    Methods: In this observational validation study, we used data from a cluster randomized trial to compare FTE with clinic time. We compared these two productivity measures graphically. For validation, we estimated two separate ordinary least squares (OLS) regression models. To validate and simultaneously adjust for endogeneity, we used instrumental variables (IV) regression with the proportion of days in a pay period that were federal holidays as an instrument. We used productivity data collected between 2018 and 2020 from Veterans Health Administration (VA) cardiology and orthopedics providers as part of a 2-year cluster randomized trial of medical scribes mandated by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.
    Principal findings: Our cohort included 654 unique providers. For both productivity variables, the values for patients per clinic day were consistently higher than those for patients per day per FTE. To validate these measures, we estimated separate OLS and IV regression models, predicting wait times from the two productivity measures. The slopes from the two productivity measures were positive and small in magnitude with OLS, but negative and large in magnitude with IV regression. The magnitude of the slope for patients per clinic day was much larger than the slope for patients per day per FTE. Current metrics that rely on FTE data may suffer from self-report bias and low reporting frequency. Using clinic time as an alternative is an effective way to mitigate these biases.
    Practical applications: Measuring productivity accurately is essential because provider productivity plays an important role in facilitating clinic operations outcomes. Most importantly, tracking a more valid productivity metric is a concrete, cost-effective management tactic to improve the provision of care in the long term.
    MeSH term(s) Humans ; United States ; Efficiency, Organizational ; Efficiency ; United States Department of Veterans Affairs ; Benchmarking ; Female ; Relative Value Scales ; Male
    Language English
    Publishing date 2024-05-10
    Publishing country United States
    Document type Journal Article ; Comparative Study ; Observational Study
    ZDB-ID 1418083-2
    ISSN 1944-7396 ; 1096-9012
    ISSN (online) 1944-7396
    ISSN 1096-9012
    DOI 10.1097/JHM-D-23-00106
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    Zs.A 977: Show issues Location:
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  6. Article ; Online: Impact of US smoke-free air laws on restaurants and bars by employer size: a panel study.

    Shafer, Paul

    BMJ open

    2017  Volume 7, Issue 11, Page(s) e018137

    Abstract: Objectives: Thirty states have smoke-free air laws that ban smoking in restaurants and bars, covering nearly two-thirds of the US population. It is well established that these laws generally have a null or positive economic impact on restaurants and ... ...

    Abstract Objectives: Thirty states have smoke-free air laws that ban smoking in restaurants and bars, covering nearly two-thirds of the US population. It is well established that these laws generally have a null or positive economic impact on restaurants and bars. However, all establishments in a geographic area are usually treated as a homogeneous group without considering the potential for differential effects by establishment characteristics. This study uses variation in smoke-free air laws over time to estimate their impact on employment in restaurants and bars with a focus on potential differences by employer size (number of employees). A two-pronged approach with a national-level and state-level analysis is used to take advantage of more granular data availability for a single state (North Carolina).
    Design: Observational study using panel data.
    Setting: 1) US, 2) North Carolina INTERVENTIONS: Smoke-free air laws.
    Outcome measures: State-level accommodation and food services employment for all 50 states and District of Columbia from 1990 through 2014 (Quarterly Census of Employment and Wages); county-level restaurant and bar employment in North Carolina from 2001 through 2014 (North Carolina Department of Commerce).
    Results: There is no evidence of a redistributive effect of smoke-free air laws on restaurant and bar employment by employer size.
    Conclusion: The lack of a redistributive effect is an important finding for policy-makers considering implementation or expansion of a smoke-free air law to protect employees and patrons from the dangers of exposure to secondhand smoke.
    MeSH term(s) Cigarette Smoking/legislation & jurisprudence ; Employment/legislation & jurisprudence ; Employment/statistics & numerical data ; Humans ; North Carolina ; Occupational Diseases/prevention & control ; Occupational Exposure/legislation & jurisprudence ; Occupational Exposure/prevention & control ; Restaurants/legislation & jurisprudence ; Restaurants/statistics & numerical data ; Smoke-Free Policy/legislation & jurisprudence ; Smoking Prevention/legislation & jurisprudence ; Tobacco Smoke Pollution/legislation & jurisprudence ; Tobacco Smoke Pollution/prevention & control ; Workplace/legislation & jurisprudence ; Workplace/statistics & numerical data
    Chemical Substances Tobacco Smoke Pollution
    Language English
    Publishing date 2017-11-25
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2017-018137
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  7. Article ; Online: Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers.

    Shafer, Paul R / Davis, Amanda / Clark, Jack A

    BMC health services research

    2023  Volume 23, Issue 1, Page(s) 1400

    Abstract: Background: Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in ...

    Abstract Background: Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk-Medicare enrollees with multiple chronic illnesses enrolled in care management services-and measure their prevalence prior to any systematic screening.
    Methods: We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters.
    Results: Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%).
    Conclusions: There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.
    MeSH term(s) Humans ; Aged ; United States/epidemiology ; Medicare ; Multiple Chronic Conditions ; Housing ; Patient Care Management ; Risk Factors
    Language English
    Publishing date 2023-12-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-023-10446-2
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  8. Article ; Online: State-level data on TANF policy changes during the COVID-19 pandemic.

    Dore, Emily C / Shafer, Paul R / Livingston, Melvin D

    BMC research notes

    2023  Volume 16, Issue 1, Page(s) 97

    Abstract: Objective: COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as ... ...

    Abstract Objective: COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as increased financial need. This dataset captures the changes made to Temporary Assistance for Needy Families (TANF) programs during the COVID-19 pandemic, from March 2020 through December 2020. The authors created this dataset as part of a larger study that examined the health effects of TANF policy changes during the COVID-19 pandemic.
    Data description: TANF is the main cash assistance program for low-income families in the U.S., but benefits are often conditional on work requirements and can be revoked if an individual is deemed noncompliant. Structural factors during the COVID-19 pandemic made meeting these criteria more difficult, so some states relaxed their rules and increased their benefits. This dataset captures 24 types of policies that state TANF programs enacted, which of the states enacted each of them, when the policies went into effect, and when applicable, when the policies ended. These data can be used to study the effects of TANF policy changes on various health and programmatic outcomes.
    MeSH term(s) Humans ; United States/epidemiology ; Social Welfare ; Pandemics/prevention & control ; COVID-19/epidemiology ; COVID-19/prevention & control ; Poverty ; Policy
    Language English
    Publishing date 2023-06-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2413336-X
    ISSN 1756-0500 ; 1756-0500
    ISSN (online) 1756-0500
    ISSN 1756-0500
    DOI 10.1186/s13104-023-06351-w
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  9. Article ; Online: Out-of-pocket costs for preventive care persist almost a decade after the Affordable Care Act.

    Hoagland, Alex / Shafer, Paul

    Preventive medicine

    2021  Volume 150, Page(s) 106690

    Abstract: Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients ... ...

    Abstract Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients often still get unexpected bills after receiving preventive services. We examined out-of-pocket costs for preventive care in 2018, almost ten years after the implementation of the ACA. We quantify the excess cost burden on a national scale using a partial identification approach and explore how this burden varies geographically and across preventive services. We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.
    MeSH term(s) Contraception ; Cost Sharing ; Female ; Health Expenditures ; Humans ; Insurance Coverage ; Patient Protection and Affordable Care Act ; Preventive Health Services ; United States
    Language English
    Publishing date 2021-06-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 184600-0
    ISSN 1096-0260 ; 0091-7435
    ISSN (online) 1096-0260
    ISSN 0091-7435
    DOI 10.1016/j.ypmed.2021.106690
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  10. Article ; Online: Potential inequities in access to in-person SHIP counseling services.

    Garrido, Melissa M / Dorneo, Allison / Adelberg, Michael / Biko, David / Shafer, Paul R / Frakt, Austin B

    The American journal of managed care

    2024  Volume 30, Issue 2, Page(s) e46–e51

    Abstract: Objectives: Counseling and education on Medicare coverage options are available through the federal State Health Insurance Assistance Program (SHIP), but little is known about the population that SHIP reaches.: Study design: Cross-sectional study.: ...

    Abstract Objectives: Counseling and education on Medicare coverage options are available through the federal State Health Insurance Assistance Program (SHIP), but little is known about the population that SHIP reaches.
    Study design: Cross-sectional study.
    Methods: Using a novel data source on SHIP counseling site locations, we characterized the availability of in-person SHIP counseling by zip code tabulation area (ZCTA) and used linear regression and t tests to evaluate whether SHIP counseling sites are disproportionately located in higher-income communities.
    Results: Our sample included 1511 SHIP counseling sites. More than half (63%) of the localities in our sample have a SHIP site within the ZCTA or county. Twenty-four percent do not have a SHIP site within the county but have one in an adjacent county. The remaining 13% do not have a nearby SHIP site. There is a disproportionate number of individuals eligible for Medicare in localities without a SHIP site. Moreover, the population living in areas without in-person SHIP sites is more likely to have low income and fewer years of education than the population living in areas with a SHIP site.
    Conclusions: These results suggest that there are areas where in-person SHIP service expansion or other additional navigation support may be warranted.
    MeSH term(s) Aged ; Humans ; United States ; Medicare ; Cross-Sectional Studies ; Insurance, Health ; Counseling ; Income ; Health Services Accessibility
    Language English
    Publishing date 2024-02-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2035781-3
    ISSN 1936-2692 ; 1088-0224 ; 1096-1860
    ISSN (online) 1936-2692
    ISSN 1088-0224 ; 1096-1860
    DOI 10.37765/ajmc.2024.89500
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