SUMMARIES OF 21
COMMONWEALTH REPORTS
Jan - June 2003
Browse some of the 119 earlier reports from Commonwealth Fund
FRONT LINES OF HEALTH CARE DELIVERY
Pres. Karen Davis' message The states have traditionally been the prime generators of innovation in health care policy, in part because of their role as guardians of public health and in part because of their proximity to the front lines of health care delivery. In her essay, "From Place to Place: Learning from Innovations in Health Policy," Commonwealth Fund president Karen Davis discusses the variety of ways that the Fund is supporting state-led incremental health reforms.
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ENVISIONING THE FUTURE OF ACADEMIC HEALTH CENTERS MeIn "Envisioning the Future of Academic Health Centers" the Fund cautions that future funding of these institutions is at risk. In addition to the pressures caused by spiraling health care costs and rising numbers of uninsured, recently proposed Medicare reforms could seriously affect future funding for academic health centers, which rely heavily on Medicare for financial support.
"Our health care system seems to be spiraling toward crisis. Any respite for AHCs from societal scrutiny and pressure is thus likely to be short-lived. If the future is a reflection of the past, reactions to rising costs and ongoing concerns over access to care and quality of health services will present these institutions with new and unprecedented challenges as well as opportunities in the pursuit of their special missions."
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for the report
HISPANIC PATIENTS’ DOUBLE
BURDEN: LACK OF HEALTH INSURANCE AND LIMITED ENGLISH
TIn "Hispanic Patients’ Double Burden: Lack of Health Insurance and Limited English," the Fund reports that Hispanics who speak primarily Spanish are in poorer health, are less likely to have a regular doctor, and are more likely to lack insurance and rely on public or community clinics for their health care, compared with Hispanics who speak primarily English, non-Hispanic whites, and African Americans. The report discusses the high uninsured rates found among Hispanics and the resulting difficulties encountered in gaining access to care. It also finds that lack of health insurance severely diminishes the quality of medical visits for Hispanic patients as well as non-Hispanic whites and African Americans. These difficulties are compounded for uninsured Hispanics whose primary language is Spanish: for example, two-thirds (66%) of these individuals do not have a regular Doctor, compared with 37 percent of uninsured non-Hispanic whites.
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here for the report
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here for the Press Release
FAILURE OF THE U.S. HEALTH CARE SYSTEM TO MEET THE OBJECTIVES OF ENSURING ACCESS
RIn invited testimony before the Senate Special Committee on Aging, Fund president Karen Davis detailed the failure of the U.S. health care system to meet the objectives of ensuring access to needed medical care and protecting Americans from the financial burden of costly medical bills. Calling the system "costly, complex, and confusing," Davis said the solution requires automatic and affordable health insurance coverage for all Americans and shared responsibility for financing coverage.
"Fundamentally we need to commit to high-quality health care for all as a national policy priority. If we continue to put cutting taxes over ensuring a strong and healthy nation, we will pay a heavy price. Our health care system will not be there when we need it. Investment in better health care can have a significant return in terms of healthier, more productive workers who are able to continue longer in the workforce, children who grow up to be healthy, productive adults, and healthy immigrants, who can help fuel our economic growth and bring vitality and diversity to our cultural life. The returns also include prevention of serious illness, better management of chronic conditions, and better functioning and quality of life in old age. We have a shared stake in working together to find common ground. It is a challenge worthy of the 21st century."
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here for the full testimony
NO INCENTIVE FOR QUALITY CARE IN U.S. SYSTEM Hospitals and health systems seeking to make quality improvement a priority may lose financially by doing so. While programs such as smoking cessation and diabetes disease management unquestionably improve patients’ lives, have a value to society, and may save health care dollars over the long run, the "business case" for these efforts is weak or nonexistent. Suggests incentivizing policies which improve quality of care, so that there will be profit motive in providing high quality care.
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here for Press Release
MEDICARE OUTPERFORMS PRIVATE
INSURANCE IN CONTROLLING SPENDING Over the past 30 years, Medicare health care spending per enrollee rose at a slower rate than private health insurance spending. Per-enrollee Medicare spending grew at an average of 9.6 percent per year from 1970 to 2000--slower than the 11.1 percent average annual growth rate found for private health insurers. This is equivalent to increasing just over 12-fold in 30 years for Medicare or 22-fold for private insurance. The study also compared spending for comparable health care services, revealing that private insurance still experienced a higher cumulative rate of spending growth than Medicare over the three decades. Medicare’s long-term success in holding down spending is due partly to its structured payment systems and regulatory controls.
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HOSPITAL DISCLOSURE PRACTICES The study, "Hospital Disclosure Practices: Results of a National Survey" found that hospitals with major concerns about malpractice claims are twice as likely to be reluctant to disclose preventable harm. Results from a national survey of hospital risk managers reveal that the vast majority of hospitals at least some of the time tell patients or their families when a patient has been harmed by care. However, when presented with different clinical scenarios, respondents reported that their hospital was much less likely to disclose preventable harms than nonpreventable ones of comparable severity. was conducted by Rae M. Lamb, David M. Studdert, Richard M.J. Bohmer, Donald M. Berwick, and Troyen A. Brennan, with support from The Commonwealth Fund.
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here for Abstract
LOW-WAGE WORKERS ARE AT A SERIOUS DISADVANTAGE
Low-wage workers are at a serious disadvantage when it comes to health insurance coverage and access to care, even when they work for large businesses. Low-wage workers are less likely than higher-wage workers to be employed by firms that offer health coverage, or to be eligible for the company health plan when one is offered. Eighty-five percent of low-wage employees in large companies work for firms that offer them health insurance, but only 69 percent are eligible for that insurance. Among higherwage workers at large companies, 97 percent work for firms that offer insurance and 96 percent are eligible.
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here for Press Release
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here for Issue Brief
MINNESOTA ESTIMATES 95% OF NON-ELDERLY POPULATION
IS INSURED Minnesota estimates that in 2001, 95 percent of its nonelderly population had health insurance--among the highest coverage rates in the nation. The state's secret, a new study reveals, is an effective combination of public programs and publicly sponsored private insurance that complements existing private coverage.
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here for Briefing Note
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here for Report
QUALITY-OF-CARE INFORMATION IS UNDERMINED BY VOLUNTARY REPORTING In "Health Plan Quality-of-Care Information Is Undermined by Voluntary Reporting" evidence is presented that health plan performance is highly associated with whether a plan publicly releases its performance information. The finding makes a compelling argument for the support of policies that mandate reporting of quality-of-care measures. Currently, there are no universal reporting requirements imposed on managed care plans.
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SAVINGS FROM MEDICARE DRUG BENEFIT
Enactment of a Medicare drug benefit could save states up to $6.8 billion annually, helping states avoid cuts in Medicaid services and helping low income seniors with a more uniform basic benefit. Medicaid prescription drug coverage for approximately 6 million "dual eligibles"--low-income seniors and persons with disabilities who are covered by both Medicaid and Medicare--accounts for nearly half of all Medicaid spending on prescription drugs, including both federal and state shares of Medicaid prescription costs. Medicaid spent $16 billion on prescription drug coverage in 2002 for the 6 million dual eligibles. This comes to an average of more than $2,800 per year per beneficiary. Current proposals in Congress to cover prescription drugs under Medicare could provide major fiscal relief to state Medicaid programs.
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HEALTH INSURANCE SPENDING AMONG CANCER PATIENTS
The amount that uninsured cancer patients spent on their care over a typical 6 month period is just over half that spent by cancer patients with private insurance. The lower spending among uninsured patients is partly, if not completely, due to lower use of needed health services--including hospital admissions, physician visits, and emergency room visits. Fully 200,000 of the 4 million cancer patients undergoing treatment each year have no health insurance coverage although their out-of-pocket spending is nearly two-and-one-half times that of privately insured patients. The uninsured rate for Hispanic cancer patients is twice that of whites (under 65). Provision of health coverage to uninsured patients would improve cancer treatment and survival rates for many Americans.
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The approximately 4.5 million enrollees in Medicare+Choice managed care plans continue to face limits on their benefits--including prescription drug coverage--as well as rising average monthly premiums and increased cost-sharing. The 2003 monthly plan premiums for beneficiaries averaged $37, up from $23 in 2001. The percentage of enrollees with drug coverage is slightly down and more enrollees now have copayments for hospital stays and physician visits.
NEAR UHC PLAN FROM COMMONWEALTH PRESIDENT
Near UHC: presents a framework to provide automatic, affordable health insurance to approximately 90% of the currently uninsured Americans. The article, "Creating Consensus on Coverage Choices," builds on existing sources of public and private health coverage by combining tax credits for private insurance, public program expansions, and a new mechanism to make enrollment more automatic. [Essentially further public subsidies are directed towards the purchase of insurance from private for-profit insurance corporations, along with further government pick-up of the folks that are too unprofitable for the for-profits to cover. The article shows that even this incremental approach to cover 90% of the uninsured would cost no more than additional $27 BIL/ year without considering indirect savings from treating additional mental illness, drug abuse prevention and early disease interventions.]
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CLICK HERE for Health Affairs Article
FIVE NATION COMPARISON OF MEDICAL ERRORS
An interactive survey of adults with health problems in the United States and four other industrialized countries (Australia, Canada, New Zealand, and the United Kingdom) revealed Among the sicker individuals surveyed, US patients reported significantly more medical errors, nearly twice the rate as that of the lowest rate nation (New Zealand). The next highest error rate to US was less than 50% greater than that of New Zealand. Leading complaint to government in all the other nations (which all had UHC of course) was that the government needed to invest more funding in health care. In the US (where we spend twice per capita what the other four do, and 64% of this expenditure is already out of tax dollars) this complaint was only made 11 to 13% as frequently as in any of the UHC countries. Data briefs for each country offer additional analyses and cross-national comparisons.
CLICK HERE for Health Affairs Article
CLICK HERE for Country Data Briefs
Three articles in the May/June issue of Health Affairs analyzed pharmaceutical markets and pricing policies internationally for lessons about controlling costs and improving efficiency while still ensuring patients' access to needed medications.
"Dilemmas in Regulation of the Market for Pharmaceuticals," points to an emerging consensus that reimbursement should be informed by evidence of the cost-effectiveness of different drugs. In addition to price controls, there is a need for effective volume controls, prescribing guidelines, and incentives.
CLICK HERE for Health Affairs Article
"Reference Pricing for Drugs
This report by Panos Kanavos and Uwe Reinhardt reports that "Reference pricing" --an approach in which the insurer covers only the prices of low-cost, benchmark drugs and patients pay the difference in price for higher-cost alternatives--has been used in Canada, Germany, and elsewhere to control costs. The authors explore arguments for and against reference pricing, and discuss how this approach might work in the United States.
CLICK HERE for Health Affairs Article Abstract
WHITHER SENIORS' PHARMACARE: LESSONS FROM (AND FOR) CANADA
This report explains how Canadian provincial governments use a variety of tactics to contain costs of prescription drug coverage, even though spending continues to increase. The tension between seniors’ health needs and drug industry policies has hampered effective prescription drug regulation. The authors argue that political leadership and more comprehensive utilization management and competitive pricing policies are needed to create a sustainable pharmaceutical benefit program.
CLICK HERE for Health Affairs Article Abstract
AUTOMATIC ENROLLMENT TO PUBLIC HEALTH INSURANCE PROGRAMS
Programs that enroll people with little effort on the part of the individual have the highest rates of participation. The authors recommend introducing automatic enrollment to public health insurance programs to improve participation among eligible individuals. Millions of Americans are eligible for public programs such as Medicaid, but never sign up for them.
CLICK HERE for American Journal of Public Health Article
HOLDING PHYSICIANS AND INSURERS ACCOUNTABLE FOR THE QUALITY AND SAFETY
By wielding their market power, public and private purchasers may be able to hold physicians and insurers accountable for the quality and safety of the health care they provide. Yet, there is little evidence that current value-based purchasing activities ("consumer choice and consumer driven health care" which are major trends in health insurance in 2003) --are having an impact. These 2 studies evaluate the value-based purchasing movement and identify obstacles to achieving broader engagement and results.
CLICK HERE for How Does Quality Enter Into Health Care Purchasing Decisions?
CLICK HERE for Value-Based Purchasing: A Review of the Literature
YOUNG ADULTS ARE FAR MORE LIKELY TO BE UNINSURED THAN OLDER ADULTS
Nearly two of five college graduates and one-half of high school graduates who do not go on to college will undergo a time without health insurance in the first year after graduation. Young adults are often dropped from their parents' policies or public insurance programs at age 19, or when they graduate from college, and then struggle to find jobs with health benefits. They are far more likely to be uninsured than older adults. The problem has worsened over the last decade, with young adults from low-income households the hardest hit. Jobs available to young adults are often low-wage or temporary and typically do not provide health insurance.
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