SUMMARIES OF 16
COMMONWEALTH REPORTS
Oct - Dec 2002
Browse some of the 103 earlier reports from Commonwealth Fund
Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches,
by Joseph R. Betancourt, M.D., of Massachusetts
General Hospital-Harvard Medical School, and Alexander R. Green, M.D., and J.
Emilio Carrillo
A new report spotlights a diverse group of health care organizations striving to improve access and quality of care for a growing minority and immigrant population. These organizations are working to dismantle the cultural and communication barriers to good health care through innovative programs that develop minority leadership, promote community involvement, and increase awareness of the social and cultural factors that affect health beliefs and behaviors. An effort to overcome racial disparities in health care.
Click here to read or download the Press Release.
Medicare versus Private Insurance: Rhetoric and
Reality, by Karen Davis and colleagues
Medicare outperforms private sector plans in terms of patients' satisfaction with insurance, access to care, and overall insurance ratings. The survey found that elderly Medicare beneficiaries are 2.7 times more likely than enrollees in employer-sponsored plans to rate their health insurance as excellent and one-third as likely to say they could not get health care because of cost. They were also more likely to report being very satisfied with their care, more likely to rate their doctor as excellent, and more likely to be very confident in their ability to get care in the future.
The survey also found that Medicare provides better coverage against financial hardship than employer coverage. Elderly Medicare beneficiaries were one-fourth as likely as those with employer coverage to report problems with medical bills. They were less likely to say they were not able to pay medical bills and less likely to say they had been contacted by a collection agency for unpaid medical bills. However, the absence of prescription drug coverage contributed to Medicare beneficiaries' higher out-of-pocket costs as a percentage of income--a finding that underscores the importance of a prescription drug benefit.
Click here to read or download the report, State Pharmacy Assistance Programs
MEDICARE+CHOICE ENROLLEES FACED RISING PREMIUMS, BENEFIT CUTS, AND INCREASED COSTS IN 2002
Two new reports from The Commonwealth Fund find that Medicare+Choice plans cut back on benefits such as prescription drug coverage in 2002 while enrollees faced a 40 percent rise in monthly premiums and substantial cost-sharing increases for their health care. The first report, finds that average out-of-pocket costs for Medicare+Choice enrollees in 2002 are $1,786, up 24 percent from 2001 and 83 percent from from 1999, with enrollees in poor health facing the steepest cost increases.
The second report, finds that the percentage of enrollees in a plan requiring hospital cost-sharing more than doubled, from 33 percent in 2001 to 78 percent in 2002, and copayments for physician office visits increased as well. Moreover, pharmacy benefits were cut, as many plans reduced or eliminated coverage for brand-name or off-formulary drugs.
Both reports, which document the continued erosion of Medicare+Choice plans' ability to address the benefit limitations of Medicare,
are available.
REDUCING MEDICARE ENROLLEES' COST-SHARING BURDENS
Recognizing that prospects for a major overhaul of the Medicare program are limited in the near future, Marilyn Moon and fellow analysts identify possible ways to modernize the Medicare benefit package's cost-sharing structure without incurring significant new federal spending. The authors propose a range of modest policy options that would enable Medicare to reduce financial burdens on the sickest beneficiaries while offering a more sound insurance package.
Click here to read, download, or order the report Modernizing Medicare Cost-Sharing: Policy Options and Impacts on Beneficiary and Program
Expenditures.
COVERING THE UNINSURED: INNOVATIVE STATE PROGRAMS
In the last decade a number of states have carried out innovative programs to increase the number of residents with health insurance coverage. A report from The Commonwealth Fund profiles such programs in Oregon, Rhode Island, New Jersey, and Georgia, and analyzes elements common to each state's success, including strong leadership and commitment, seamless coverage for disparate groups, and involving providers and consumer advocates in program design. While most states are now facing budget shortfalls and the challenge of sustaining gains in health insurance coverage, the experiences of these four states can still be a blueprint for other states in the future. [EINO: Several different approaches in the 90's with incremental reform, program expansion. No discussion of comprehensive UHC, or comparison of programs to satisfying all health care needs of the respective states.]
The report, Assessing State Strategies for Health Coverage Expansion, by Silow-Carroll, Waldman, Meyer, Williams, Fox and Cantor is based on site visits and interviews with program administrators, policymakers, and representatives from the consumer, business, and health plan/provider communities. The full report
, summary report, and four case studies are available
CONSUMER-DRIVEN HEALTH PLANS: ARE THEY MORE THAN TALK?
With an estimated enrollment of 1.5 million, health plans that allow consumers to customize their benefits and provider networks have become central to major insurers' business plans. In fact, they could comprise 15 to 50 percent of the market in five years, according to a new analysis.
In "'Consumer-Driven' Health Plans: Are They More Than Talk Now?," Gabel, Lo Sasso, and Rice warn that these plans need to be watched closely to see if the added choices and greater emphasis on consumer spending disincentives appeal broadly to employees and enrollment grows, or if, as some predict, consumer-driven health plans split up risk pools and shift costs to sicker enrollees. If this happens, enrollment would level off. [EINO: There is little discussion of how these new consumer-driven plans serve up cheaper plans for relatively young and healthy Americans, thereby shrinking the risk-pool and shifting the remaining risk pool towards older and less healthy Americans (its main flaw from the public's viewpoint). By placing an ever larger burden on public programs and facilities these plans act to the detriment of every taxpayer. This is mentioned as the second factor under the subtitle "Access to Care" and then and then briefly discussed under "Selection Bias". The discussion is poor, though - it suggests that it is not the responsibility of health plans, or the insurance industry, but should be adjusted for by the employers' contributions (sliding scale towards older and sicker). But this absurd suggestion is itself not given much attention.]
"Consumer-driven" plans are those in which enrollees designate their benefit package and providers and pay any cost beyond their employer's fixed contribution, or those that establish "health spending accounts" into which employers contribute pretax dollars.
The article can be viewed
CHOICES FOR STATE HEALTH INSURANCE EXPANSIONS
A Commonwealth Fund publication offers insight into ways that states can provide health insurance coverage to more people. Toward Comprehensive Health Coverage for All: Summaries of 20 State Planning Grants from the U.S. Health Resources and Services Administration details the efforts of the first 20 states that received planning grants from the federal government to collect data on their uninsured populations and devise plans to provide them with affordable coverage. [Federal program is specifically directed towards states adding to current private insurance programs and products, expanding certain programs so as to approach improved rate of insurance.]
Key aspects of current and proposed coverage policies are presented in an easy-to-use format that helps users quickly identify the highlights of states' efforts. The summaries, which were prepared by Heather Sacks and colleagues at the Economic and Social Research Institute,
are available
COMMUNITY HEALTH CENTERS FACE GROWING CHALLENGES
Community health centers (CHCs) are a vital source of preventive and primary health care for the nation's uninsured. Because of limits on the services they are able to provide on-site, however, CHCs typically must refer patients for diagnostic tests, such as mammograms and colonoscopies, or for more specialized physician services, such as cardiology. But according to a new Health Affairs study, "Exploring the Limits of the Safety Net: Community Health Centers and Care for the Uninsured," CHCs often find it difficult or impossible to arrange and refer for such services or for nonemergency hospital care--despite the considerable efforts of staff to obtain referrals and negotiate reduced fees. Uninsured patients, consequently, often go without needed care. [EINO: CHCs have been promoted by the Bush Administration as a solution to the crisis of under and uninsurance. The administration has made funds available for facilities, but expects all services to be provided by unpaid volunteer staff.
see also EINO FAQ ]
In interviews with CHC directors, researchers Gusmano, Fairbrother, and Park found that while centers are able to provide the same level of care on-site for both uninsured and insured patients, many patients often need services beyond those available. For insured patients, CHCs usually can refer and arrange for all needed care, but they encounter barriers when attempting to get their uninsured patients the services they need. The study highlights the increasing strain placed on resources and staff as CHCs try to stretch limited primary care budgets to serve uninsured patients and others in their communities. It also points to the limits to what CHCs can do for their patients in the absence of expanded health insurance coverage.
Click here to access the Health Affairs website
NEW YORK SENIORS AND PRESCRIPTION DRUG COVERAGE
Although New York has one of the nation's largest and most effective prescription drug assistance programs for the elderly, nearly one of five seniors in the state had no coverage for medications in 2001, according to a new report from The Commonwealth Fund. As a result of lack of coverage or inadequate benefits, one-fifth of all New York seniors, including one-third of those without drug coverage, reported they skipped doses of medication or did not fill a prescription because of cost concerns.
Sandman, Schoen, DDowney, How and Safran present analysis of results from a 2001 survey of the elderly in eight states. The researchers found that New York's two key public programs to supplement Medicare for seniors--Medicaid and EPIC--in combination reached one-third of seniors with incomes below 200 percent of the federal poverty level.
Click here to read or download New York Seniors and Prescription Drugs: Seniors Remain at Risk Despite State
Efforts
STAYING COVERED: THE IMPORTANCE OF HEALTH INSURANCE RETENTION
Helping insured people retain their health coverage may be as important and cost-effective a method for reducing the uninsured rate as efforts to expand eligibility for public and private coverage. Moreover, increasing insurance retention has the added benefit of improving the continuity and quality of people's health care.
In Staying Covered: The Importance of Retaining Health Insurance for Low-Income Families, analysts Ku and Ross say that the number of uninsured, low-income children would decline by nearly 40 percent, and uninsured adults by more than one-quarter, if every person with public or private health coverage at the beginning of a given year retained it throughout the next 12 months.
Click here to read or download Staying Covered: The Importance of Retaining Health Insurance for Low-Income
Families
ESCAPE FIRE: LESSONS FOR THE FUTURE OF HEALTH CARE
A widely discussed and influential address on the state of health care quality in America is available in book form from The Commonwealth Fund. In Escape Fire: Lessons for the Future of Health Care, Donald M. Berwick, M.D. provides a compelling account of his and his wife's personal experiences in the health care system, describing "the enormous, costly, and painful gaps between what we got in our days of need, and what we needed." He identifies quality problems endemic to the health system and then sketches an ambitious program for reform.
Berwick calls this program an "escape fire," the term firefighters use for a deliberately burnt patch of land that, in an emergency, can provide refuge from an oncoming blaze. He argues that the health care system can avoid potential catastrophe only through a similarly inspired leap of faith. His program for reform consists of unencumbered access to care, reliance on the best available science, and a focus on healing relationships.
["Our challenges are not marginal and their solutions are not incremental. Our current tools cannot do the job." Mostly considerations on the principles in quality health care. Some discussion of access which the author indicates is access to health care treatments all the time 24/7 and 365. Most of the access discussion, though, is promoting a new concept of access - "access to healing relationships".]
Limited copies of Escape Fire can be ordered from The Commonwealth Fund, and an electronic version
is available
EXPANDING HEALTH COVERAGE: KAREN DAVIS OUTLINES APPROACHES ON NPR
In an extensive interview aired yesterday on NPR, Commonwealth Fund president Karen Davis outlined promising options for reforming the U.S. health care system to make health insurance accessible and affordable for all Americans. Davis noted her support for reforms in current federal programs, such as Medicare, as well as improvements in employer-based health insurance. Davis was a guest on the NPR syndicated program "Fresh Air"; the full program
is available
PRESCRIPTION DRUG DEBATE NEGLECTING MEDICARE'S DISABLED
Although they represent the fastest-growing segment of the Medicare population, disabled Medicare beneficiaries are often forgotten in the debate over a Medicare prescription drug benefit. Five million disabled Medicare beneficiaries under age 65 face a daunting combination of low income, poor health status, heavy prescription drug use, and high medication bills. Yet with the exception of Medicaid, these enrollees have few options for obtaining stable and comprehensive prescription drug coverage.
Click here to read press release or
Click here to download the chartbook.
ASSET TESTS SQUEEZING MANY LOW-INCOME MEDICARE BENEFICIARIES
Many Medicare beneficiaries across the country have discovered that "assets trump income" is the rule when applying for government programs that provide help with premiums and out-of-pocket medical costs. When the so-called Medicare Savings Programs were created by Congress beginning in 1988, income and asset limits were set to ensure that financial assistance would be given to those beneficiaries with the greatest need. But less than half (48%) of those who meet the income requirements also meet the asset limits-meaning a substantial proportion of low-income individuals are unable to get help from the programs.
Click here to read briefing note or
Click here to read the chartbook, Quality of Health Care in the United
States
MOST WORKERS COULD NOT AFFORD COBRA IF THEY LOST THEIR JOB
A survey of U.S. workers finds that only one of four would be very likely to continue his or her health insurance coverage through COBRA if he or she lost a job, and cost appears to be the main reason. The percentage of workers who would choose to retain their health coverage would more than double if a subsidy were available to help pay part of the COBRA premium-an option that has been enacted by Congress for some groups of displaced workers. For those who lacked health insurance in 2001, job loss was the primary reason.
Click here to read press release or Click here to read or download the chartbook.
HEALTH INSURANCE TAX CREDITS COULD SHORTCHANGE WOMEN
Proposed federal policies to help low-income adults buy health insurance have focused on tax credits for purchasing coverage in the individual insurance market. But tax credits within the range of those contemplated in recent proposals would not be large enough to make health insurance affordable to women with low incomes. The authors conclude that unless tax credits are combined with options to buy into group insurance, individual insurance market reforms, or other protections, relatively few low-income women are likely to use them.
Click here to read the press release.
Continue with 103 additional reports from May
2002 and earlier
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