Kosali Simon's research while affiliated with Indiana University Bloomington and other places
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Publications (111)
Background:
Intensive care unit (ICU) utilization has increased among patients with Alzheimer disease and related dementia (ADRD), although outcomes are poor.
Objectives:
To compare ICU discharge location and subsequent mortality between patients with and patients without ADRD enrolled in Medicare Advantage.
Methods:
This observational study u...
A significant concern in the policy landscape of the U.S. opioid crisis is whether supply-side controls can reduce opioid prescribing without harmful substitution. We consider an unstudied policy: the federal Controlled Substance Act (CSA) restrictions placed in August 2014 on tramadol, the second most popular opioid medication. This was followed s...
Importance:
A significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020.
Objective:
To examine trends in methadone and buprenorphine dispensing among Medicare Advanta...
Buprenorphine is a treatment medication that decreases mortality risks among people with opioid use disorder (OUD). Despite its efficacy, buprenorphine is underused in the US. Insurance restrictions are commonly cited as barriers to buprenorphine prescribing. Using Medicaid, Medicare Advantage, and commercial insurance formulary files, we examined...
Importance:
The US Supreme Court ruling in Dobbs v Jackson Women's Health Organization on June 24, 2022, revealed immediate and distinct differences between states regarding abortion legality. Whether the ruling was associated with population-level changes in seeking information on reproductive health care-related information is unknown.
Objectiv...
We review quasi-experimental studies that examine the relationship of opioids to health, healthcare, and crime in the U.S. Our findings align with the general perception that the opioid crisis has negatively impacted health and increased healthcare costs; we find limited evidence that appropriate opioid use enhances work capacity or carries other b...
We study the impact of a temporary U.S. paid sick leave mandate that became effective April 1st, 2020 on self‐quarantining, proxied by physical mobility behaviors gleaned from cellular devices. We study this policy using generalized difference‐in‐differences methods, leveraging pre‐policy county‐level heterogeneity in the share of workers likely el...
Objectives:
To study the predictive validity of the CMS Practice Assessment Tool (PAT) among 632 primary care practices.
Study design:
Retrospective observational study.
Methods:
The study included primary care physician practices recruited by the Great Lakes Practice Transformation Network (GLPTN), 1 of 29 CMS-awarded networks, and used data...
Purpose:
The number of patients tapered from long-term opioid therapy (LTOT) has increased in recent years in the United States. Some patients tapered from LTOT report improved quality of life, while others face increased risks of opioid-related hospital use. Research has not yet established how the risk of opioid-related hospital use changes acro...
This cross-sectional study investigates the growth in the number of clinicians in the US who obtained waivers for prescribing buprenorphine after the elimination of federal educational requirements.
US workers receive unemployment benefits if they lose their job, but not for reduced working hours. In alignment with the benefits incentives, we find that the labor market responded to COVID‐19 and related closure‐policies mostly on the extensive (12 pp outright job loss) margin. Exploiting timing variation in state closure‐policies, difference‐in...
School and college reopening-closure policies are considered one of the most promising non-pharmaceutical interventions for mitigating infectious diseases. Nonetheless, the effectiveness of these policies is still debated, largely due to the lack of empirical evidence on behavior during implementation. We examined U.S. college reopenings’ associati...
This cross-sectional study assesses buprenorphine coverage and prior authorization requirements in US commercial formulary data from 2017 to 2021.
Objective:
Because individuals with a history of depression who are receiving opioids are at higher risk for adverse events, the authors examined whether antidepressant treatment reduces risk for overdose and self-harm among individuals with a history of depression who receive opioids.
Methods:
Commercial insurance claims of individuals with a h...
Importance:
COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied ac...
On December 1, 2021, FSSA and DMHA commissioned a cost-analysis of untreated
mental illness, in alignment with a 2020 state statute for the Indiana Behavioral
Health Commission (Indiana Code 12-21-7). The completed summary report is in the
Appendices (Appendix F), with the following excerpts from the report noted below:
The burden of mental illness...
This study examines the sociodemographic divide in early labor market responses to the U.S. COVID-19 epidemic and associated policies, benchmarked against two previous recessions. Monthly Current Population Survey (CPS) data show greater declines in employment in April and May 2020 (relative to February) for Hispanic individuals, younger workers, a...
Objectives
We estimate the effect of the Affordable Care Act’s (ACA) Medicaid expansions on Medicaid coverage of reproductive-aged women at varying childbearing stages.
Methods
Using data from the American Community Survey (ACS) (n = 1,977,098) and a difference-in-differences approach, we compare Medicaid coverage among low-income adult women with...
This article quantifies changes in employment and average wages of employees of 6 key health care organizations during the COVID-19 pandemic.
Introduction
Due to the ongoing opioid use disorder crisis, improved access to opioid treatment programs (OTPs) is needed. However, OTPs operate in a complex regulatory environment which may limit their ability to positively affect health outcomes. The objective of this study was to examine how the number and type of state OTP regulations are assoc...
With the passage of the Affordable Care Act, states were given the option to expand their Medicaid programs. Since then, thirty-eight states and Washington, D.C., have done so. Previous work has identified the widespread effects of expansion on enrollment and the financial implications for individuals, hospitals, and the federal government, yet adm...
Objectives:
Although increased access to buprenorphine treatment for opioid use disorder is a central policy objective in addressing the US opioid overdose crisis, insufficient capacity for buprenorphine treatment exists relative to treatment need. Little is known about the characteristics of practitioners who opt into the public listing, an onlin...
We studied the effect of marijuana liberalization policies on perinatal health with a multiperiod difference-in-differences estimator that exploited variation in effective dates of medical marijuana laws (MML) and recreational marijuana laws (RML). We found that the proportion of maternal hospitalizations with marijuana use disorder increased by 23...
Background
The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain (Guideline hereafter) emphasized tapering patients from long-term opioid therapy (LTOT) when the harms outweigh the benefits.
Methods
To examine tapering from LTOT before and after the Guideline release, we conducted a retrospective co...
This study quantifies the effect of the 2020 state COVID economic activity reopening policies on daily mobility and mixing behavior, adding to the economic literature on individual responses to public health policy that addresses public contagion risks. We harness cellular device signal data and the timing of reopening plans to provide an assessmen...
COVID-19 vaccination campaigns continue in the United States, with the expectation that vaccines will slow transmission of the virus, save lives, and enable a return to normal life in due course. However, the extent to which faster vaccine administration has affected COVID-19-related deaths is unknown. We assessed the association between US state-l...
Importance
After abrupt closures of businesses and public gatherings in the US in late spring 2020 due to the COVID-19 pandemic, by mid-May 2020, most states reopened their economies. Owing in part to a lack of earlier data, there was little evidence on whether state reopening policies influenced important pandemic outcomes—COVID-19–related hospita...
Importance.
Given that mental health and substance use conditions are ongoing major public health problems in the United States, it is important for researchers to understand the behavioral health treatment workforce landscape and to assess whether increases in treatment capacity exist in areas with public health needs.
Objectives
This study quant...
This article examines the relationship between federal regulations, state scope-of-practice regulations on nurse practitioners (NPs), and buprenorphine prescribing patterns using pharmacy claims data from Optum’s deidentified Clinformatics Data Mart between January 2015 and September 2018. The county-level proportion of patients filling prescriptio...
Background
Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the...
Responding to the U.S. opioid crisis requires a holistic approach supported by evidence from linking and analyzing multiple data sources. This paper discusses how 20 available resources can be combined to answer pressing public health questions related to the crisis. It presents a network view based on U.S. geographical units and other standard con...
The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance...
New government health insurance programs may affect participation in existing safety-net benefits that provide health insurance as a secondary aim. We examine whether the outside options for health insurance made available by the Affordable Care Act affected Social Security Disability Insurance (DI) application decisions. Using the universe of U.S....
This cohort study examines changes in the number of buprenorphine prescriptions fill by individuals with opioid use disorder before and during the coronavirus disease 2019 pandemic.
This article aimed to determine the association between the Affordable Care Act young adult mandate and suicidal behavior. From 2007 to 2013, we used the Nationwide/National Inpatient Sample and National Poison Data System to examine suicide attempt, and Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research...
School and college reopening-closure policies are considered one of the most promising non-pharmaceutical interventions for mitigating infectious diseases. Nonetheless, the effectiveness of these policies is still debated, largely due to the lack of empirical evidence on behavior during implementation. We examined U.S. college reopenings' associati...
One of the Affordable Care Act’s (ACA) signature reforms was creating centralized Health Insurance Marketplaces to offer comprehensive coverage in the form of comprehensive insurance complying with the ACA’s coverage standards. Yet, even after the ACA’s implementation, millions of people were covered through noncompliant plans, primarily in the for...
In the early phases of the COVID-19 epidemic labor markets exhibited considerable churn, which we relate to three primary findings. First, reopening policies generated asymmetrically large increases in reemployment of those out of work, compared to modest decreases in job loss among those employed. Second, most people who were reemployed appear to...
The COVID-19 outbreak is a global pandemic with community circulation in many countries, including the United States, with confirmed cases in all states. The course of this pandemic will be shaped by how governments enact timely policies and disseminate information and by how the public reacts to policies and information. Here, we examine informati...
We make several contributions to understanding how the COVID-19 epidemic and policy responses have affected U.S. labor markets, benchmarked against two previous recessions. First, monthly Current Population Survey (CPS) data show greater declines in employment in April 2020 (relative to February) for Hispanics, workers aged 20 to 24, and those with...
The relationship between population health and measures of economic well-being and economic activity is a long standing topic in health economics (Preston, 1975; Cutler, Deaton, and LlerasMuney, 2006; Ruhm, 2000). The conceptual issues in analyzing the complicated link between health and economic well-being are central to understanding the implicat...
The novel coronavirus (COVID-19) outbreak is a global pandemic with community circulation in many countries, including the U.S. where every state is reporting confirmed cases. The course of this pandemic will be largely shaped by how governments enact timely policies, disseminate the information, and most importantly, how the public reacts to them....
Introduction
The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly comp...
Background:
Opioid use disorder (OUD) has become an increasingly consequential public health concern, especially in the United States where 47,600 opioid overdose deaths occurred in 2017 (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2019). Medications for OUD (MOUD) are effective for decreasing opioid-related morbidity and mortality, including within...
A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chroni...
Background
Effective treatment strategies exist for substance use disorder (SUD), however severe hurdles remain in ensuring adequacy of the SUD treatment (SUDT) workforce as well as improving SUDT affordability, access and stigma. Although evidence shows recent increases in SUD medication access from expanding Medicaid availability under the Afford...
Importance
In the United States, access to medications prescribed for opioid use disorder (OUD) is lower in rural counties than in urban counties. Considering the positive associations between direct-to-physician promotion of opiates and OUD medications and their prescribing rates, a study examining the association between pharmaceutical promotion...
The Patient Protection and Affordable Care Act (ACA) increased demand for healthcare across the U.S., but it is unclear if or how the supply side has responded to meet this demand. In this paper, we take advantage of plausibly exogenous geographical heterogeneity in the ACA to examine the healthcare education sector's response to increased demand f...
Antipsychotics (APMs) are commonly used off-label to control behavioral symptoms of dementia in nursing home (NH) residents despite FDA warnings. As part of the Centers for Medicare and Medicaid Services’ (CMS) partnership to reduce the use of APMs in long-stay NH residents with dementia, CMS began publicly reporting an APM quality measure on the N...
Effective treatment strategies exist for substance use disorder (SUD), however severe hurdles remain in ensuring adequacy of the SUD treatment (SUDT) workforce as well as improving SUDT affordability, access and stigma. Although evidence shows recent increases in SUD medication access from expanding Medicaid availability under the Affordable Care A...
Background:
Opioid use disorder (OUD) has become an increasingly grave public health concern, especially in the United States where approximately 80% of the global opioid supply is consumed. Despite greater awareness of the present overdose crisis, potentially life-saving OUD pharmacotherapy (medications for opioid use disorder or MOUD) utilizatio...
Objectives We examine trends in prescription contraceptive sales following the Affordable Care Act’s (ACA) zero-copayment contraceptive coverage mandate in areas more likely to be affected by the provision relative to areas less likely to be affected. Methods Before the ACA, several states had their own contraceptive insurance coverage mandates. Us...
Background and Aims
Given the recent complete suspension of opioid‐related promotional activities aimed at physicians, interest has renewed in understanding the role of promotion in the US opioid crisis. The present analysis aimed to measure associations between such interactions and opioid prescribing.
Design
Data on all promotions by pharmaceuti...
This study examines how subsidized coverage affects prescription drug utilization among low-income non-elderly adults. Using the Affordable Care Act's Medicaid expansions as a source of variation and a national, all-payer pharmacy transactions database, we find that within the first 15 months of new health insurance availability, aggregate Medicaid...
The design of Medicare Part D causes most beneficiaries to receive fragmented health insurance, with drug and medical coverage separated. Fragmentation is potentially inefficient since separate insurers optimize over only one component of healthcare spending, despite complementarities and substitutabilities between healthcare types. Fragmentation o...
We use panel U.S. tax data spanning 2008-2013 to study the impact of the Affordable Care Act (ACA) young adult provision on an important demographic outcome: childbearing. The impact is theoretically ambiguous: gaining insurance may increase access to contraceptive services while also reducing the out-of-pocket costs of childbirth. Because employer...
Background:
The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health.
Objective:
To estimate the longer-term (three-ye...
In 2015, Indiana expanded eligibility for Medicaid under the Affordable Care Act (ACA) through a unique waiver, Healthy Indiana Plan 2.0, which requires enrollees to make monthly contributions to an account that is similar to a health savings account to receive full benefits. Enrollees who fail to make these contributions receive less generous bene...
The difference in difference (DID) design is a quasi-experimental research design that researchers often use to study causal relationships in public health settings where randomized controlled trials (RCTs) are infeasible or unethical. However, causal inference poses many challenges in DID designs. In this article, we review key features of DID des...
Objectives:
To determine whether the 2014 Medicaid expansions facilitated by the Affordable Care Act affected overall and early-stage cancer diagnosis for nonelderly adults.
Methods:
We used Surveillance, Epidemiology, and End Results Cancer Registry data from 2010 through 2014 to estimate a difference-in-differences model of cancer diagnosis ra...
We investigate determinants of market entry and premiums within the context of the Affordable Care Act’s Marketplaces for individual insurance. Using Bresnahan and Reiss (1991) as the conceptual framework, we study how competition and firm heterogeneity relate to premiums in 36 states using Federally Facilitated or Supported Marketplaces in 2016. O...
Using a data set of US tax records spanning 2008 to 2013, the authors study the impact of the Affordable Care Act (ACA) young adult dependent coverage requirement on labor market–related outcomes, including measures of employment status, job characteristics, and postsecondary education. They find that the ACA provision did not result in substantial...
The Affordable Care Act (ACA) has reduced the number of uninsured persons in the United States to a historic low. Debate continues about potential changes to the law that could affect coverage for millions, particularly those with preexisting conditions. Meanwhile, cancer is the leading cause of death among Americans aged 19 to 64 years.¹ Treatment...
Difference-in-differences payer share results through Q3 of 2015.
(PDF)
FastStats discharge subcategories.
(PDF)
Difference-in-difference estimates of effect of Medicaid expansion on payer mix with controls.
(PDF)
Payer mix pre-trends, no controls.
(PDF)
Additional synthetic control time series.
(PDF)
Context
The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges.
Object...
Difference-in-difference estimates of effect of Medicaid expansion on private share.
(PDF)
Synthetic control visits per 1,000 population results through Q3 2015.
(PDF)
Payer mix pre-trends, with controls.
(PDF)