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President's Perspective
Deborah S. Larsen. Neurology Report, 2013-12-18
Topic: Risk, prevention and care in population studies
Some individuals who are DE receive full Medicaid coverage, whereas others only receive partial coverage, which does not cover hearing, vision, dental, or long-term care.1 Individuals who are DE tend to be medically complicated, often with 4 or more diagnoses, and many with chronic neurologic disorders (eg, poststroke, spinal cord injury, and multiple sclerosis) with or without mental (eg, retardation and dementia) or psychological disorders; in fact, recent estimates suggest that 40% to 50% of DE enrollees are disabled. This fragmentation of the 2 systems often results in poor coordination of care, characterized by providers and provider systems that do not communicate with each other; further, dual eligibility may mean different coverage by individual and by state. It has been noted that enrollees could have “three ID cards (Medicare, prescription drugs, Medicaid), three different sets of benefits, and multiple providers.”3(p.222) Interestingly, although Medicaid pays for long-term care, Medicare pays for hospitalizations; it has been suggested that this is a disincentive to avoid hospitalizations for those in long-term care, often for avoidable infections or conditions. This process, known as cost-shifting, likely results in overall poorer quality of care for the enrollees who are DE.3 This is just one example of the challenges of dual coverage and limited coordination of services; however, it is critical that we develop an integrated care system that streamlines the coverage for DEs, who are our most needy consumers of medical care, and to include within that system coverage for health promotion and maintenance.
Key findings
- Some individuals who are DE receive full Medicaid coverage, whereas others only receive partial coverage, which does not cover hearing, vision, dental, or long-term care.1 Individuals who are DE tend to be medically complicated, often with 4 or more diagnoses, and many with chronic neurologic disorders (eg, poststroke, spinal cord injury, and multiple sclerosis) with or without mental (eg, retardation and dementia) or psychological disorders; in fact, recent estimates suggest that 40% to 50% of DE enrollees are disabled.
- This fragmentation of the 2 systems often results in poor coordination of care, characterized by providers and provider systems that do not communicate with each other; further, dual eligibility may mean different coverage by individual and by state.
- It has been noted that enrollees could have “three ID cards (Medicare, prescription drugs, Medicaid), three different sets of benefits, and multiple providers.”3(p.222) Interestingly, although Medicaid pays for long-term care, Medicare pays for hospitalizations; it has been suggested that this is a disincentive to avoid hospitalizations for those in long-term care, often for avoidable infections or conditions.
- This process, known as cost-shifting, likely results in overall poorer quality of care for the enrollees who are DE.3 This is just one example of the challenges of dual coverage and limited coordination of services; however, it is critical that we develop an integrated care system that streamlines the coverage for DEs, who are our most needy consumers of medical care, and to include within that system coverage for health promotion and maintenance.
Why it matters
This column describes challenges faced by people dually eligible for Medicare and Medicaid, noting many have chronic neurologic disorders with or without dementia. It is about coverage coordination and care quality, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 9/100
Report — not peer-reviewed. It scored 9 on the same rubric, which is below the 16 cap we apply to non-peer-reviewed sources. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on institution's track record, so that was left out: it earned 9 of the 97 points we could judge it on, which is 9 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Neurology Report) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 3 / 10 | Report — not peer-reviewed. Named source is an organisational report, not a journal article. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 15 year(s) since 2013 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 0 / 4 | Last-listed author Deborah S. Larsen: h-index 3 (OpenAlex, whole career) |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 24351860) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 9 / 97 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 9 of the 97 points we could judge it on is 9 out of 100. |
| Total | 9 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Larsen, D. S. (2013). President's Perspective. Neurology Report. https://doi.org/10.1097/npt.0000000000000028
Vancouver
Larsen DS. President's Perspective. Neurology Report. 2013. doi:10.1097/npt.0000000000000028. PMID: 24351860.
BibTeX
@article{larsen2013-24351860,
author = {Larsen, Deborah S.},
title = {{President's Perspective}},
journal = {Neurology Report},
year = {2013},
doi = {10.1097/npt.0000000000000028},
pmid = {24351860},
url = {https://doi.org/10.1097/npt.0000000000000028}
}
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