SUMMARIES OF 28
COMMONWEALTH REPORTS
May - Sept 2002
Browse some of the 74 earlier reports from Commonwealth Fund
TRAINING TOMORROW'S
DOCTORS: THE MEDICAL EDUCATION MISSION OF ACADEMIC HEALTH CENTERS
Training at our nation's teaching hospitals may not be keeping pace with the changing nature and demands of modern medical practice. The Task Force finds that education is no longer a primary activity for the nation's medical schools and affiliated teaching hospitals. The report details curriculum inadequacies, changing medical practices, and the uneven nature of medical education across the country. It also reveals that there is not enough data to measure adequately the performance of academic health centers in conducting their educational missions or assessing the associated costs.
Click here to read or download the Press Release.
STATE PHARMACY ASSISTANCE PROGRAMS: ALTERNATIVE APPROACHES TO PROGRAM DESIGN
State pharmacy assistance programs for Medicare beneficiaries help only a small proportion of the Medicare population just 3 percent, or 1.2 million beneficiaries out of 39 million nationwide. Authors Kimberley Fox, Thomas Trail, and Stephen Crystal say that a federal program is needed to fill this gap in coverage, and that it should coordinate with the 28 state programs currently in place. The report concludes that while there are important lessons to be learned from state programs, "best practices" are still evolving.
Click here to read or download the Press Release.
Click here to read or download the report, State Pharmacy Assistance Programs
QUALITY OF HEALTH CARE IN THE UNITED STATES: A CHARTBOOK
Based on more than 150 published studies and reports about quality of care, this chartbook contains 54 charts and accompanying analysis that document serious gaps in quality on many crucial dimensions of care. Lack of preventive care, medical mistakes, substandard care for chronic conditions, and health care disparities are among the issues examined in this comprehensive study. This chartbook, by Sheila Leatherman and Douglas McCarthy includes a unique section on successful examples of collaborative projects that have led to improvement.
Click here to read or download the press release about the chartbook:
Click here to read or download the chartbook, Quality of Health Care in the United
States
THE UNRAVELING OF HEALTH INSURANCE
As employers are shifting more responsibility for health care decisions to employees, millions of Americans may be hit by high copayments when they can least afford them. Medical savings accounts, and other strategies designed to drive down costs for insurers and save money for employers are resulting in higher copayments and deductibles for consumers. The report, by Trudy Lieberman is based on new research by Consumer Reports health care experts and findings from The Commonwealth Fund 2001 Health Insurance Survey.
Lieberman warns that the effect of increasing copayments and deductibles often doesn't become apparent to consumers until they become sick or disabled. Employees with a chronic condition or disability paid an average of $625 a year in out-of-pocket medical expenses, compared with $267 for those without such conditions, according to the 2001 survey.
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FAMILY OUT-OF-POCKET SPENDING FOR HEALTH SERVICES: A CONTINUING SOURCE OF FINANCIAL INSECURITY
Despite the shift to managed care in the 1990s, health care costs remain a major source of financial insecurity for many families, especially working families with low incomes, Medicare beneficiaries, those with chronic or serious health problems, and families with private health insurance through the individual insurance market. This report by Mark Merlis examines trends over time and family health care expenditures compared to family income. Key findings include:
One of six families (16%)--about 18 million nationally--spent more than 5 percent of their incomes on health care services in 1996. Seven percent of all families--8 million families--spent more than 10 percent.
Medicare families were in general at highest risk with more than one third (35%) spending more than 5 percent of their income on health care services. Still, over a two-year period--1996 to 1997--17 percent of non-Medicare families spent more than 5 percent of their incomes on health care services, not counting premiums.
One-quarter of non-Medicare families with incomes below the federal poverty level spent more than 5 percent of their income in out-of-pocket health care costs in 1996; 14 percent spent more than 10 percent.
Among insured non-Medicare families, those insured in the individual market were at higher risk than those with employer plans. One in five families with nongroup coverage spent more than 5 percent of income compared to one of twelve families with employer coverage.
In comparing 1996 to 1987, the report finds that prescription drugs emerged as the leading source of out of pocket spending, surpassing physician and hospital costs.
The report concludes with a discussion of ways public policy could promote adequate protection against high costs relative to income, including ways the current personal income tax code could be better targeted to reach those at greatest risk.
Click here to read or download the report Family Out-of-Pocket Spending for Health Services
DEVELOPING A HEALTH PLAN REPORT CARD ON QUALITY OF CARE FOR MINORITY POPULATIONS. LONG TERM CARE
Despite legal and practical concerns, health plans can and should collect data on disparities in quality of care for racial and ethnic minority groups. This study stresses the importance of racial and ethnic data collection as the key to improving quality and eliminating disparities in care. The authors recommend that health plans collect racial and ethnic data preferably from plan members directly, or from existing sources, and that plans be required to collect and report these data. Plans are currently not required to do so. The authors also recommend that standards be developed to indicate what magnitude of disparity should be cause for concern. Analysis of the health plan data revealed that disparities in care often existed between racial and ethnic groups, although minority patients sometimes received higher quality of care than whites, including in some Medicaid plans.
Click here to read, order, or download the report Developing a Health Plan Report Card on Quality of Care for Minority
Populations.
Five-Nation Survey: U.S. Adults Least Satisfied with Health System
A new survey of health care systems in five industrialized nations finds that U.S. adults, particularly those with below-average incomes, have the most difficulty obtaining affordable health care and are the least satisfied with their health care system. Among surveyed adults in Australia, Canada, New Zealand, the United Kingdom, and the United States, Americans were generally more likely to report problems accessing medical services because of cost and were the most likely to be in favor of "completely rebuilding" the health system.
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for survey
Click here
for Health Affairs article (ACROBAT)
Click here
for Issue brief and individual data briefs (Australia, Canada, New Zealand, U.K., U.S.)
International Spotlight: Alan Milburn, U.K. Secretary of State for Health
Beginning in October of last year, U.K. Secretary of State for Health Alan Milburn has set out a new vision for Britain's National Health Service (NHS) that, at least on paper, heralds a radically different conception. It is one in which the service will remain tax-funded and largely free at the point of use, but will offer services from a much more diverse group of providers. In an interview in the May/June Health Affairs, Nicholas Timmins, public policy editor of the Financial Times, spoke to Milburn about his vision.
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for International Spotlight
Eight Million U.S. Families Experienced a Serious Medical or Drug Error
Eight Million U.S.
An estimated 8 million households have experienced a medical or medication error that turned out to be very serious, according to a new survey of U.S. health care quality. Analysts also found that many Americans fail to get preventive services at recommended intervals or receive substandard care for chronic conditions.
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here for 8 million families
U.S. Health Care Quality Falls Short on Crucial Measures
U.S. Health Care Quality Falls Short on Crucial Measures
A first-of-its-kind portrait of U.S. health care quality documents serious gaps--from low immunization rates for toddlers to the prescribing of unsafe or inappropriate medications for the elderly. The new reference is based on more than 150 published studies and reports.
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here for US health care quality falls short
Chartbook
Medical Education Must Pass Some Tough Tests
Medical Education Must Pass Some Tough Tests, Task Force Says
Academic health centers in the United States need to make the continuous improvement of medical education a top priority, according to the latest report from The Commonwealth Fund Task Force on Academic Health Centers. While academic health centers--medical schools and their affiliated hospitals and physician groups--have been largely successful in training the nation's doctors, competing demands on these institutions pose a threat to the quality of physician education down the road.
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here for medical education must pass
Report and briefing note
Bare-Bones Health Plans Raise Risks
Bare-Bones Health Plans Promise Lower Costs but Raise Risks
Faced with health insurance premiums rising at double-digit rates, policymakers are scrambling to find new ways to offer viable, less costly approaches to health coverage. One approach that has recently captured attention is the so-called bare-bones benefit package--a plan that offers basic, stripped-down benefits at substantially lower premiums.
(http://www.cmwf.org/publist/quarterly/spr02qrt.asp?link=6#bare)
Issue brief (ACROBAT)
Individual Insurance Costs More, Offers Less
Individual Insurance Costs More, Offers Less Than Group Plans
A study of the individual health insurance market in 17 U.S. cities has found that the coverage it offers is much more expensive than comparable coverage provided by group plans. Premium costs for individual plans were also found to vary widely by age and gender.
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here for individual insurance costs more
Report (ACROBAT)
Medicare+Choice Enrollees Face Higher Cost-Sharing
Medicare+Choice beneficiaries can continue to expect increased cost-sharing and reduced benefits in 2002, new estimates reveal. According to an analysis of data from the federal Centers for Medicare and Medicaid Services, many enrollees in Medicare's embattled managed care program are now, or soon will be, experiencing a substantial rise in monthly premiums at the same time that prescription drug coverage and other benefits are becoming less generous.
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here for enrollees face higher cost-sharing
Report
Minorities Lag on Many Health Care Measures
On a wide range of health care quality measures, minority Americans do not fare as well as whites, according to newly published research. One study found that African Americans, Asian Americans, and Hispanics are more likely than whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care, to encounter barriers to health care, and to feel they would receive better care if they were of a different race or ethnicity. In another study, African American enrollees in Medicare managed care plans were less likely than white enrollees to receive recommended clinical treatments for four major health conditions.
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here for minorities lag
Survey report and fact sheets (African Americans, Asian Americans, Hispanics)
Array of Programs Provides Patients with Interpreting Services
With recent data showing that more than 44 million Americans now speak a language other than English at home, ensuring effective communication in health care settings is more important than ever. Many studies have documented that lack of adequate language interpretation services can reduce access to health care for people with no or limited knowledge of English, which can in turn lead to serious health consequences.
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here for array of programs provide
Report (ACROBAT)
New Minority Health Policy Fellows Chosen
In July, the seventh class of Commonwealth Fund/Harvard University Fellows in Minority Health Policy will begin their work at Harvard's School of Public Health toward master's degrees in public health. The one-year fellowships, established in 1995, prepare minority physicians for leadership positions in the fields of minority health and public policy.
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here for new minority health policy fellows
Out-of-Pocket Medical Costs Pose Financial Threat to Millions
A new study finds that the current health care system poses a "major" financial threat to millions of American families, with the most vulnerable being low-income households and families with a member suffering serious health problems. Even though real out-of-pocket health care spending was flat for most families during the 10-year period that ended in 1996, some 18 million families (16%) spent more than 5 percent of their incomes annually on out-of-pocket medical expenses, not including health insurance premiums.
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for out of pocket medical costs
Report
Commonwealth Fund Publications (ACROBAT)
Colleen L. Barry and Janet Kline, Medicare Managed Care: Medicare+Choice at Five Years
Juliette Cubanski and Janet Kline, Improving Health Care
Quality: Can Federal Efforts Lead the Way?
Juliette Cubanski and Janet Kline, A Medicare Prescription Drug
Benefit: Focusing on Coverage and Cost
Juliette Cubanski and Janet Kline, In Pursuit of Long-Term
Care: Ensuring Access, Coverage, Quality
The Henry J. Kaiser Family Foundation, Health Research and Educational Trust, and The Commonwealth Fund,
Erosion of Private Health Insurance Coverage for Retirees: Findings from the 2000 and 2001 Retiree Health and Prescription Drug Coverage Survey
Sara Rosenbaum and Colleen Sonosky, Options for Assisting Uninsured Parents in Securing Basic Health Services
New Minority Health Policy Fellows Chosen
In July, the seventh class of Commonwealth Fund/Harvard University Fellows in Minority Health Policy will begin their work at Harvard's School of Public Health toward master's degrees in public health. The one-year fellowships, established in 1995, prepare minority physicians for leadership positions in the fields of minority health and public policy.
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here for new minority health policy fellows
LEGAL IMMIGRANTS AND HEALTH INSURANCE COVERAGE
Legal immigrants should find it easier to get public health insurance coverage in New York. A study, by Bachrach and Lipson examines the way in which federal welfare reform restricted legal immigrants' access to Medicaid and how a NY decision provides coverage for those previously denied. States' need for federal financial assistance to help provide legal immigrants with health coverage on the same basis as citizens is also included. Implications of the federal government's retreat from supporting Medicaid coverage for immigrants are discussed.
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to read report
Elderly Skipping Needed
Medications
Nearly one-quarter of the elderly say they skip medication doses or fail to get prescriptions filled because of cost concerns, according to a survey in eight states by KFF, The Commonwealth Fund, and Tufts. One of four seniors spent $100 or more per month on their prescription medicines in 2001. Access to drug coverage and scope of benefits depended on where one lived and on income. The survey of nearly 11,000 Medicare beneficiaries was conducted in 8 states where 42% of seniors and 41% of low-income elderly live.
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to read the press release
Click here to read the Health Affairs article:
Stretching Federal
Dollars: Policy Tradeoffs in Designing a Medicare Drug Benefit with Limited Resources
A new analysis suggests that a Medicare prescription drug benefit could be crafted that protects low-income beneficiaries and places a cap on all beneficiaries' yearly out-of-pocket expenses. M. Moon and M. Storeygard analyzed the impact on beneficiaries of three policy options. The authors conclude that with a $450 billion federal contribution, a drug benefit providing at least some coverage to all beneficiaries could offer low-income protections and catastrophic limits, laying the groundwork for a more comprehensive benefit down the road.
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to read "Stretching Federal Dollars"
Early Childhood
Development in North Carolina
Promising efforts are being made in North Carolina to coordinate and strengthen the early childhood development services the state provides to low-income children and their families. NC's comprehensive, community-based child development services system integrates developmental screening and surveillance into well-child visits and follows up with case management for parents.
Click here for additional information about the program
EVALUATION OF THE WELLSPRING MODEL FOR IMPROVING NURSING HOME QUALITY
Despite the passage of major reforms in 1987, serious quality-of-life problems are endemic throughout many of the nation's 17,000 nursing homes. However, the Wellspring model of nursing home care, which relies on a team approach to care, demonstrates that high quality can in fact be achieved.
Wellspring, an Alliance of 11 nonprofit nursing homes in Wisconsin, has so far managed to stabliize staff turnover in its member facilities--a major problem for all nursing homes--and eliminate serious quality deficiencies on state inspections, according to an evaluation of the program conducted by Robyn I. Stone and colleagues.
The Commonwealth Fund report Evaluation of the Wellspring Model for Improving Nursing Home Quality further notes that Wellspring homes achieved these results without incurring additional costs. Wellspring's success is largely based on staff empowerment, particularly among nursing assistants and others who work on the "front lines" of resident care.
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for Evaluation of the Wellspring Model for Improving Nursing Home Quality:
EMPLOYER HEALTH COVERAGE IN THE EMPIRE STATE
According to a new survey in New York State, employer-sponsored health insurance faces an uncertain future. The combination of a weak economy, higher unemployment, and rising health care costs is placing pressure on employers to eliminate or scale back health benefits for workers, their dependents, and retirees. Many employers also plan to shift more health care costs to employees: in the next few years. Low-wage firms in New York are far less likely to offer health coverage than comparable firms across the nation.
The full survey results, including information about premium costs, rates of coverage and eligibility, and enrollment patterns across the state, as well as employers' views on the role of government in maintaining coverage, are available.
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for Employer Health Coverage in the Empire State: An Uncertain Future
THE EROSION OF EMPLOYER-BASED HEALTH COVERAGE
The Commonwealth Fund's Workplace Health Insurance Survey finds that only one of four workers would be very likely to continue their health insurance coverage through COBRA if they became unemployed, and cost appears to be the main reason. The percentage of employees opting for COBRA coverage would more than double, however, if a subsidy were available to help pay part of the cost.
According to The Erosion of Employer-Based Health Coverage and the Threat to Workers' Health Care, a report by Commonwealth Fund researchers Jennifer Edwards, Michelle M. Doty, and Cathy Schoen, two of five workers experienced increases in their premiums or cost-sharing, or both, during the year. Although public support for job-based health insurance remains strong, many workers are not confident that employers will continue to offer coverage to them down the road. Workers are even more uncertain about their ability to get good health care in the future.
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for The Erosion of Employer-Based Health Coverage and the Threat to Workers' Health Care
FINANCIAL PERFORMANCE OF ACADEMIC HEALTH CENTER HOSPITALS
The Commonwealth Fund warns that the traditional missions of academic health centers (AHCs)--teaching and research, providing sophisticated new treatments, and caring for the poor--are increasingly at risk because of the troubled state of their finances. In 2000, AHC and major teaching hospitals ran at an operating loss, with margins of -1.4 percent and -2.6 percent, respectively. Moreover, the financial performance of AHC hospitals and major teaching hospitals has declined more sharply since 1996 than other hospitals. According to the report, AHCs' troubles are leaving them with fewer resources to subsidize their socially beneficial activities.
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for Financial Performance of Academic Health Center Hospitals, 1994-2002
LESSONS FOR MEDICARE'S FUTURE-FINDINGS FROM SEVEN MAJOR CITIES
Medicare+Choice After Five Years: Lessons for Medicare's Future-Findings from Seven Major Cities, by Brian Biles, Geraldine Dallek, and Andrew Dennington examines the reasons behind the widespread dissatisfaction of private health plans, health care providers, and beneficiaries with the Medicare+Choice program. The authors attempt not only to understand how the program could be stabilized but to help inform policy discussions concerning broader Medicare reform.BR>
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for Medicare+Choice After Five Years
GEOGRAPHIC INEQUITY IN MEDICARE+CHOICE BENEFITs
Geographic Inequity in Medicare+Choice Benefits-Findings from Seven Communities, by Dallek, Dennington, and Biles, compares the 2002 benefit packages of Medicare+Choice plans to assess the degree of regional disparities in benefit packages. The authors find wide variations in out-of-pocket costs for Medicare+Choice enrollees depending on where beneficiaries live.
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for Geographic Inequity in Medicare+Choice Benefits
MEDICARE+CHOICE IN NEW YORK CITY: SO FAR, SO GOOD?
Medicare+Choice in New York City: So Far, So Good?, by Jennifer Stuber, Andrew Dennington, and Brian Biles, looks at why the Medicare+Choice program-faltering in many regions-has thus far enjoyed relative stability in New York City. However, according to the report there are signs that these conditions may soon change.
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for Medicare+Choice in New York City: So Far, So Good
Continue with 74 additional reports from April
2001and earlier
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