Elizabeth Wikler

Elizabeth Wikler

Policy Director, Wisconsin Department of Health Services

Dissertation Title: "Transformations in Health Policy: An Analysis of Alzheimer’s Disease Testing, Medicaid Enrollment, and Insurance Market Concentration"This dissertation consists of three quantitative papers addressing contemporary issues in health policy.

The first paper draws on a survey of 2,678 adults from the United States and four European countries to assess demand for a hypothetical early medical test for Alzheimer’s disease (AD). Overall, 67% of respondents reported that they would be “very” or “somewhat” likely to get the test if it were available. Through logistic regression analysis, we find that interest was higher among those worried about developing AD, with an immediate blood relative with AD, and who have provided care for AD patients. Knowing that AD is fatal did not influence demand, except among those with an affected blood relative. Age and country of residence also predicted interest in testing. We expect that a test becoming available could precipitate the creation of a large constituency of asymptomatic, diagnosed adults, affecting a range of health policy decisions.

The second paper utilizes Current Population Survey data to explore rates of Medicaid enrollment among eligible parents between 2003 and 2010. Previous research demonstrates that Medicaid enrollment varies across racial and ethnic groups nationally. We set out to explore such disparities in take-up at the state level. We found that among low-income parents eligible for Medicaid, disparities were most dramatic in conservative states: average take-up for Hispanics was 23%, whereas take-up was 38% for both whites and blacks in those same states, adjusting for state and individual demographics. Enrollment also varied within racial/ethnic groups—38% of eligible whites in conservative states enrolled in Medicaid compared to 59% in liberal states, and among eligible Hispanics, enrollment rates were less than half as high in conservative states than liberal states (23% versus 61%). Take-up was significantly lower among Mexican-Americans than Hispanics of other backgrounds. Adjusting for differences in state Medicaid policies narrowed these disparities significantly, highlighting the importance of new provisions aimed at streamlining enrollment procedures across all states.

The last paper draws on Census data and data from the American Medical Association and American Hospital Association from 2007 to 2010 to analyze how administrative spending by health insurers and providers varied across states with different levels of insurance and hospital market concentration. Using regression analysis, we find that in provider offices, high levels of insurance concentration were associated with lower administrative costs. If all states were as concentrated as the most concentrated state in our sample, we would expect nationwide savings of $3.6 billion in administrative expenses. However, levels of insurance or hospital market concentration were not associated with levels administrative spending by insurers or hospitals, suggesting that consolidation is not associated with increased administrative efficiency in the health care system.

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