SUMMARIES OF 15
COMMONWEALTH REPORTS
Dec 2001 - Feb 2002
View these from commonwealth fund
directly.
Additionally, see summaries of 9 reports from December 2000 - June 2001
hosted by the Commonwealth Fund
Additionally, see summaries of 34 reports from the December 2000 conference
hosted by the Commonwealth Fund
MEDICARE+CHOICE DOESN'T ADD UP FOR SENIORS
New research finds that tremendous turmoil within
Medicare+ Choice Medicare’s managed care program is causing severe disruption, dislocation, and confusion for elderly Medicare beneficiaries and the hospitals and health care providers that care for them. Scores of managed care plan withdrawals from the Medicare market have sent hundreds of thousands of enrollees scrambling for new health coverage. High physician turnover within Medicare+Choice plans which averages 30 percent or more in some states has limited patients’ access to their regular doctor or hospital.
Evidence suggests that the program’s ills are not likely to be solved simply by raising Medicare payments to plans. A host of local and national factors, it appears, play key roles as well. These findings, contained in three new Commonwealth Fund reports by analysts at George Washington University, highlight the need for both immediate and long-term program reforms to increase plan choice, stabilize enrollment, and regain beneficiaries’ trust.
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MEDICARE DRUG BENEFIT NEEDED TO AVERT CRISIS, ANALYSIS FINDS
Ominous trends in prescription drug coverage for Medicare beneficiaries all point to a looming crisis unless Congress takes concerted action soon. According to a new analysis of prescription benefits in the 1990s, the growth in availability of drug benefits seen in the middle part of the decade should not be taken as a sign that either the private market or current public programs will be enough to provide the elderly with the coverage they need. The study, which was supported by The Commonwealth Fund, finds that rising out-of-pocket prescription costs, shrinking Medigap and Medicare HMO drug benefits, and the erosion in retiree health insurance coverage portend a deteriorating outlook for beneficiaries.
The report cites studies finding that since 1999, HMOs participating in Medicare+Choice Medicare’s managed care option have been pulling back on their prescription coverage. Benefit caps have grown more stringent, copays are rising, and increasing numbers of plans offer no drug coverage at all in their basic contracts. While virtually all Medicare+Choice plans offered a drug benefit in 1997, only 70 percent did by 2001. At the same time, these plans’ cost to beneficiaries has risen sharply. Eighty percent of plans in 1999 offered zero-premium policies; by March 2001, just 46 percent did so.
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WOMEN FACE PROSPECT OF LESS HEALTH COVERAGE
A study of recent national trends by a leading health policy analyst shows that women often face greater difficulty obtaining health insurance and accessing medical services than men do. Moreover, these disparities appear to be worsening: the number of uninsured women has grown three times faster than the rate for men over the past five years. If this pace continues, the ranks of the uninsured in 2005 could include more women than men for the first time.
Women need and use more health care services than men. More women than men have chronic illnesses, and women are more likely to use mental health services and, as they age, prescription drugs. More than 80 percent of women between ages 50 and 70 rely on prescription drugs, compared with 71 percent of men that age.
Uninsured women are nearly 20 percent more likely to have difficulty obtaining health care services than uninsured men. Among Americans in the 50-to-64 age group, women are nearly twice as likely as men to have trouble accessing care.
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NEW RESEARCH FINDS TREMENDOUS TURMOIL WITHIN MEDICARE+CHOICE
New research finds that tremendous turmoil within Medicare+Choice Medicare’s managed care program is causing severe disruption, dislocation, and confusion for elderly Medicare beneficiaries and the hospitals and health care providers that care for them. Scores of managed care plan withdrawals from the Medicare market have sent hundreds of thousands of enrollees scrambling for new health coverage. High physician turnover within Medicare+Choice plans which averages 30 percent or more in some states has limited patients’ access to their regular doctor or hospital.
Evidence suggests that the program’s ills are not likely to be solved simply by raising Medicare payments to plans. A host of local and national factors, it appears, play key roles as well. These findings, contained in three new Commonwealth Fund reports by analysts at George Washington University, highlight the need for both immediate and long-term program reforms to increase plan choice, stabilize enrollment, and regain beneficiaries’ trust.
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SMALL FIRMS NEED PUBLIC SECTOR HELP TO PROVIDE COVERAGE
Private sector efforts alone are not enough to help small companies provide health insurance for their workers. In a new study, policy analysts find that purchasing cooperatives and other programs initiated by business coalitions over the last decade have had only limited success in making insurance more affordable to small-business employees. To be successful, they say, these programs will require federal and state support in the form of seed money, expertise, regulatory reform, and help in defraying high-cost insurance claims.
Overall, however, large-employer initiatives have been mostly unable to lower the number of uninsured workers. With the exception of HealthPass, only 10 to 20 percent of small companies that have enrolled in these programs since the mid-1990s are offering insurance for the first time.
If the goal is to expand health insurance coverage within the small-business sector, then the public sector will have to step in to make private insurance more accessible and affordable to workers, says Meyer, the study’s lead author. That will require government to stimulate the business community’s interest in lending its expertise to smaller firms, provide seed money and other resources to support programs until they are self-sufficient, and develop regulations to attract small firms.
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COLLECTING RACIAL AND ETHNIC
HEALTH DATA: IT'S LEGAL AND NECESSARY
A gap exists between the goals of federal initiatives to eliminate racial and ethnic disparities in health care and the manner in which government agencies collect the data needed to achieve these goals, a new report finds. The problem stems in part from concerns and confusion over the legality of collecting data on patients’ race, ethnicity, and language. The report’s authors call for the federal government to assume a leadership role in addressing legitimate concerns over the misuse or misinterpretation of this sensitive information, as well as in clarifying and enforcing data collection standards throughout federal agencies.
Most health officials agree that administrative, health services, and research data should include information on individuals’ race, ethnicity, and primary language spoken. Such information, collected and reported systematically at the federal and state levels, is critical for the success of efforts to achieve more equitable access to health care, improve quality of care, counter racial discrimination, and promote delivery of culturally appropriate services to diverse populations. Currently, there are several federal initiatives to reduce health disparities, including Healthy People 2010 and the Culturally and Linguistically Appropriate Care Standards developed by the U.S. Office of Minority Health.
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ONE OF 10 MEDICAL RESIDENTS FEELS UNPREPARED FOR "NON-TRADITIONAL" PATIENTS
More than one of 10 medical residents say they feel unprepared to handle certain treatments and procedures relative to their specialties despite years of solid training, according to a study in the Journal of the American Medical Association (Sept. 5).
While residents surveyed for the study feel prepared to handle most of the common conditions they would likely encounter in their clinical careers, surprising percentages reported they are not confident in treating less-traditional categories of patients. For example, more than 20 percent of primary care residents feel unprepared to handle nursing home patients, HIV/ AIDS cases, substance abusers, and critically ill patients.
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Diag (ACROBAT).
NCQA DEVELOPING PHYSICIAN QUALITY MEASURES FOR CONSUMERS
The National Committee for Quality Assurance (NCQA), the nonprofit accrediting organization for managed care plans, is now developing measures of physician care quality for public use. Under a grant from The Commonwealth Fund, NCQA recently conducted a series of consumer focus groups to learn what people perceive to be the most important aspects of physician care.
Consumers said they want to work together with their physicians and be included in the decision-making process but do not want to assume sole or primary responsibility for their own care. Medicare beneficiaries, in particular, tended to equate good care more with aspects of the doctor patient relationship and less with the physician’s level of experience. Medicare beneficiaries, like other consumers, were aware of and concerned with medical safety problems, but they appeared to be more accepting and forgiving of physician errors than other patients.
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PHYSICIAN WEBSITES FOUND TO LACK KEY INFORMATION
While a growing number of consumers are turning to the Internet for information on health and health care, much of what they are finding on websites especially about physicians is unreliable.
In a review of 40 physician directory websites, researchers found that many suffered from incomplete physician listings, few search options, and empty, inaccurate, or outdated data fields. Only 25 of the 40 sites (63%) posted the doctor’s medical school, for example, while just 10 (25%) listed the number of years in practice. Other physician characteristics that patients typically want to know were also absent: for example, less than half the sites provided doctors’ gender and languages spoken, and none listed their race. Moreover, very few websites provided information on disciplinary actions, malpractice claims, mortality rates, or other clinical outcomes.
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SECURITY MATTERS: HOW INSTABILITY IN HEALTH INSURANCE PUTS U.S. WORKERS AT RISK
A new survey from The Commonwealth Fund reveals that being without health insurance coverage even for a short time could have long-term health and economic consequences. Insured people who had experienced a time uninsured during the past year were equally likely to have problems paying medical bills and accessing health care as those who were uninsured when surveyed. Together they account for one of four working-age adults, or 38 million Americans between the ages of 19 and 64. This includes the two following reports:
MAINTAINING HEALTH INSURANCE DURING A RECESSION: LIKELY COBRA ELIGIBILITY
EXPERIENCES OF WORKING-AGE ADULTS IN THE INDIVIDUAL INSURANCE MARKET
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TRENDS IN THE MEDICARE+CHOICE
Three new reports on Medicare are now available from The Commonwealth Fund. Two of the papers focus on trends in the Medicare+Choice program from 1999 to 2001, while the third examines prescription drug coverage for Medicare beneficiaries. Medicare+Choice 1999-2001: An Analysis of Managed Care Plan Withdrawals and Trends in Benefits and Premiums, Lori Achman and Marsha Gold, Mathematica Policy Research, Inc. In this analysis, the authors report that mean premium and cost-sharing levels in Medicare+Choice plans continued to increase in 2001 at the same time that coverage of prescription drugs was reduced.
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Racial (ACROBAT). http://www.cmwf.org/publist/publist2.asp?CategoryID=9
OUT-OF-POCKET HEALTH CARE EXPENSES FOR MEDICARE HMO BENEFICIARIES
Out-of-Pocket Health Care Expenses for Medicare HMO Beneficiaries: Estimates by Health Status, 1999-2001, Lori Achman and Marsha Gold, Mathematica Policy Research, Inc. This companion report explores the financial impact that changes in benefits provided by Medicare managed care plans have had on Medicare+Choice enrollees. In 2001, enrollees paid nearly 50 percent more in out-of-pocket costs for their health care than they did in 1999.
CLICK HERE to download, or order Diag (ACROBAT).
DRUG COVERAGE FOR MEDICARE BENEFICIARIES
Drug Coverage for Medicare Beneficiaries: Why Protection May Be in Jeopardy, Becky Briesacher and Bruce Stuart, University of Maryland; Dennis Shea, Pennsylvania State University. This issue brief examines prescription coverage trends for Medicare beneficiaries' during the 1990s to project future coverage and costs. According to the authors' analysis, beneficiary drug coverage peaked around 1998 and has been in decline ever since.
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EXPERIENCE OF TWO NEW YORK HEALTH INSURANCE PROGRAMS DESIGNED TO HELP SMALL BUSINESSES
Two new reports available from The Commonwealth Fund examine the experience of two New York health insurance programs designed to help small businesses employees and low-income workers obtain affordable coverage. The first report, Lessons from a Small Business Health Insurance Demonstration Project, looks at a recently concluded demonstration program in New York City that offered a comprehensive, low-cost insurance option for firms with from two to 50 workers. Author Stephen Rosenberg, M.D., of Columbia University found that while the program reduced premiums to about half of market rates, it failed to attract enough participants to make it worthwhile to employers.
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A PROMISING STATE INSURANCE PROGRAM FOR WORKERS IN SMALL FIRMS
Healthy New York, a promising state insurance program for workers in small firms and low-income adults who lack access to group coverage, is the subject of Healthy New York: Making Insurance More Affordable for Low-Income Workers. Author Katherine Swartz of the Harvard School of Public Health shows that premiums charged by the program, which began enrolling people in January 2001, are much lower than what are offered in the individual market.
Continue with 43 additional reports from December 2000
and earlier
Continue with 43 additional reports from December 2000
and earlier
Continue with 43 additional reports from December 2000
and earlier
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