|
| |
SUMMARIES OF 2007 REPORTS(most recent at bottom)
STATES PROMOTED BROADER COVERAGE FOR CHILDREN IN 2007, BUT REPORT THAT A DECLINING ECONOMY COUPLED WITH LACK OF SCHIP REAUTHORIZATION AND NEW FEDERAL RULES NOW COMPROMISE EFFORTS TO REDUCE THE NUMBER OF UNINSURED
A downturn in the economy, the federal failure to reauthorize the State Children’s Health Insurance Program (SCHIP) and new federal rules affecting Medicaid and SCHIP eligibility all suggest that the recent period of aggressive expansion of coverage by states may now be over beyond 2007. This is the conclusion based on a series of new studies by the KCMU, including a 50-state survey of eligibility and enrollment rules in Medicaid and SCHIP for children and families, interviews with Medicaid directors in ten states representing all regions of the country, and recent studies of enrollment in Medicaid and SCHIP. "Without additional federal assistance for Medicaid and SCHIP in this economic downturn, we are likely to see added growth in the uninsured," Diane Rowland, executive director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured added.
Nearly two-thirds (32) of states expanded access to their Medicaid and SCHIP programs between July 2006 and January 2008. However, without the reauthorization of the SCHIP program and with a new federal directive restricting states from using SCHIP to cover children in families earning more than 250% of the federal poverty level, these state efforts could be compromised. Twenty-three states could be affected by the directive, including 14 which have already implemented their plans and another ten which have authorized the plans into law, but not yet implemented them. (Washington state is counted in both categories.) Three states have already cut back on their coverage. States also continue to report that the Medicaid citizenship documentation rule is hampering efforts to simplify enrollment and resulting in delays and denials of coverage.
Given earlier efforts to minimize Medicaid spending, the officials noted that achieving significant Medicaid cost savings could be more difficult than in prior years. Virtually every state has already taken cost control actions on prescription drugs and provider payments. Additional action in these areas would yield minimal additional savings and could impact access to care, according to the Medicaid directors. The directors also expressed concern over growing strain in their relationship with the federal government and federal rules on health coverage and services issued over the past year that will restrict federal Medicaid financing, which they believe will adversely affect beneficiaries and safety net providers as they struggle to cope with the economic downturn, and create impediments to effective program design. The directors criticized the timeliness of annual changes in the federal matching rate for Medicaid funds as not responsive to changing economic conditions.
The individual reports include:
* Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles,
* Current Issues in Medicaid: A Mid -FY 2008 Update Based on a Discussion with Medicaid Directors,
* SCHIP Enrollment in June 2007: An Update on Current Enrollment and SCHIP Policy Directions,
* Medicaid Enrollment in 50 States: December 2006 Data Update, and
* State Children’s Health Insurance Program (SCHIP): Reauthorization History
The full article may still be available CLICK HERE
ENVISIONING THE FUTURE: THE 2008 PRESIDENTIAL CANDIDATES' HEALTH REFORM PROPOSALS
The Commonwealth Fund, January 15, 2008 " By Sara R. Collins, Ph.D., and Jennifer L. Kriss
This report analyzes the health care proposals of eight Democratic and Republican 2008 presidential candidates - Hillary Clinton, John Edwards, Rudolph Giuliani, Mike Huckabee, Dennis Kucinich, John McCain, Barack Obama, and Mitt Romney. Their approaches to health insurance reform fall into three categories: 1) proposals that emphasize tax incentives for obtaining insurance through the individual market (Giuliani, Huckabee, McCain, Romney); 2) proposals that build on existing private and public group insurance with shared responsibility for financing coverage (Clinton, Edwards, Obama); and 3) proposals that aim to cover everyone through publicly sponsored insurance systems like Medicare (Kucinich). The report examines differences among the proposals, and evaluates them against key principles like affordability, provision of essential services, financial protection, streamlined administration, and fair financing.
To evaluate these new policies, The Commonwealth Fund Commission on a High Performance Health System identified several key principles to moving the health system toward high performance. They include:
* Provision of equitable and comprehensive insurance for all
* Provision of benefits that cover essential services with appropriate financial protection
* Premiums, deductibles, and out-of-pocket costs are affordable relative to family income
* Health risks should be broadly pooled
* The proposals should be simple to administer with coverage that is automatic and continuous
* Dislocation should be kept to a minimum - people could stay in the coverage they have if desired
* Financing would need to be adequate, fair, shared across stakeholders.
Measured against these principles, the mixed private-public group insurance with a shared responsibility for financing proposed by the leading Democratic candidates and the public insurance reform proposals put forward by Kucinich have the greatest potential to move the health care system toward high performance.
The Republican candidates' proposals for reform that rely on tax incentives and voluntary purchase of coverage in an unregulated individual insurance market are, on their own, unlikely to achieve universal coverage.
The full article CLICK HERE or the summary may still be available CLICK HERE
INSURANCE PLUS ACCESS DOES NOT EQUAL HEALTH CARE: TYPOLOGY OF BARRIERS TO HEALTH CARE ACCESS FOR LOW-INCOME FAMILIES
Jennifer E. DeVoe, MD, DPhil; Alia Baez, BA; Heather Angier, BA; Lisa Krois, MPH; Christine Edlund, MSc; Patricia A. Carney, PhD, Ann Fam Med. 2007;5(6):511-518. ©2007 Annals of Family Medicine, Inc.
Public health insurance programs have expanded coverage for the poor, and family physicians provide essential services to these vulnerable populations. Despite these efforts, many Americans do not have access to basic medical care. This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.
Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families. Conclusions: Barriers to health care can be insurmountable for low-income families, even those with insurance coverage. Patients who do not seek care in a family medicine clinic are not necessarily getting their care elsewhere.
The full article may still be available CLICK HERE
UNINSURED AND DYING BECAUSE OF IT: UPDATING THE INSTITUTE OF MEDICINE ANALYSIS ON THE IMPACT OF UNINSURANCE ON MORTALITY
Urban Institute, January 2008, By Stan Dorn
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm - namely, greater risk of death - and seeks to illustrate its general order of magnitude.
In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.
More broadly, these estimates should be viewed as reasonable indicators of the general magnitude of excess mortality that results from lack of insurance, not as precise "body counts." The true number of deaths resulting from uninsurance may be somewhat higher or lower than the estimates in this paper, but that number is surely significant.
The full article may still be available CLICK HERE
DRUG SAMPLES SEEN AS UNLIKELY TO REACH POOR OR UNINSURED
By Charles Bankhead, January 04, 2008 based on "Characteristics of recipients of free prescription drug samples: a nationally representative analysis" Am J Pub Health 2008; DOI:10.2105/AJPH.2007.114249.
Fewer than 30% of prescription drug samples go to low-income patients, and fewer than 20% reach the hands of the medically uninsured.
Citing an assertion by an executive from the Pharmaceutical Research and Manufacturers of America, in a letter to the New York Times, that "many uninsured and low-income patients benefit from these free samples, which often serve as a safety net," the investigators claimed foul.
Dr. Cutrona, maintained "the patterns we found indicate that pharmaceutical firms may be directing their samples to physicians and clinics least likely to care for the uninsured."
In their paper, Dr. Cutrona and colleagues also noted that studies have shown that many physicians believe that samples allow them to give free medication to needy patients. Yet few studies have generated data about the recipients of samples.
Of all persons who received free samples, 17.9% were uninsured for all or part of the year. Additionally, 71.9% of all samples went to recipients with an income of 200% or more of the federal poverty level ($18,400 for a family of four in 2003), and 28.1% of the samples went to patients with lower incomes.
"The poor were the least likely to receive free samples, whereas individuals in the highest income category were the most likely to receive free samples [P 0.001]," the authors reported.
Dr. Cutrona responded: "We appreciate PhRMA's emphasis on the larger issue of providing affordable medications to millions of Americans for whom medication costs are a significant issue. We do not believe that free sample distribution, as currently practiced by the drug industry, is an effective response to this problem."
TOO GREAT A BURDEN: AMERICA’S FAMILIES AT RISK
Families USA, December 2007
Health care costs have become a growing burden for America’s families, as premiums and out-of-pocket expenses continue to rise at alarming rates. Families USA commissioned The Lewin Group to analyze data from the U.S. Department of Health and Human Services and the Census Bureau.
Millions of Insured Americans Are Affected
* More than four out of five people (82.4 %) in families spending more than 10% of their pre-tax income on health care costs are insured.
* 50.7 million non-elderly Americans with insurance are in families that will spend more than 10% of their pre-tax income on health care costs in 2008.
* More than three out of four people (75.8%) in families spending more than 25% of their pre-tax income on health care costs are insured.
* 13.5 million Americans with insurance are in families that will spend more than 25% of their pre-tax income on health care costs in 2008.
The full article may still be available CLICK HERE
REPORT LINKS HEALTH INSURANCE STATUS WITH CANCER CARE
American Cancer Society, December 20, 2007
Uninsured Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts. For all cancers combined the uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.
People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.
Individuals with health insurance were about twice as likely as those without to have had a recent mammogram or colorectal cancer screening. People with insurance were also more likely to be diagnosed with early stage disease and less likely to be diagnosed with advanced stage disease than the uninsured.
The researchers saw a survival difference in breast and colorectal cancer, too. About 89% of privately insured white women with breast cancer survived at least 5 years, compared to 76% of white women with Medicaid or no insurance. Among African-American women, 81% of breast cancer patients with private insurance survived 5 years, compared to 65% of those on Medicaid and 63% of those without insurance. A similar pattern emerged in colorectal cancer. Among white patients with private insurance, 66% survived 5 years, compared to 50% of those with no insurance and 46% of those on Medicaid. Among African Americans, 60% with private insurance survived 5 years compared to 41% of the uninsured and Medicaid patients.
Among people with cancer, 29% had out-of-pocket expenses that exceeded 10% of their family's income and about 11% exceeded it by 20% (10% or more is commonly taken as the definitive measure for being underinsured).
The full article may still be available CLICK HERE
SUMMARY OF HEALTH DISPARITIES-FOCUSED LEGISLATION INTRODUCED IN 110TH CONGRESS
December 17, 2007
As the first session of the 110th Congress draws to a close, the Kaiser Family Foundation has prepared a summary of the legislative proposals that focus specifically on addressing racial and ethnic disparities in health and health care that have been introduced.
Including:
* A new chartpack with findings from a public opinion poll, Views about the Quality of Long-Term Care Services in the United States, which finds: more than two-thirds (68%) of the public have an immediate family member or someone they know well receiving care as a nursing home resident, at home, or in another type of facility; 86% say they are very/somewhat concerned about the quality of nursing home care available in this country today; and nearly two thirds (64%) say there is not enough government regulation of nursing home quality. The nationally representative survey, with 1,032 adults including 326 adults ages 65 and older, was conducted via telephone interviews in October 2007.
* A short film, "Nursing Home Reform: Then and Now," that examines the history surrounding the landmark law, including the state of nursing home care before the law, an overview of the legislative process that brought about the law, and recent developments in nursing home quality. The video, available online and for ordering in DVD format, features historical clips and new interviews of key individuals from government, the nursing home industry, and consumer advocates who were instrumental in the historical developments related to nursing home reform.
* A new report, Nursing Home Care Quality: Twenty Years After the Omnibus Budget Reconciliation Act of 1987, authored by Joshua Weiner and colleagues at RTI International. The brief explains the key provisions of OBRA ’87 related to nursing home care and examines the progress and problems in quality assurance in nursing homes over the past twenty years. Also released was the updated fact sheet, Medicaid and Long-Term Care Services, by the Foundation’s Kaiser Commission on Medicaid and the Uninsured.
The briefing was a moderated panel discussion led by Ed Howard of the Alliance for Health Reform and Diane Rowland of the Foundation. Panelists included Ruth Katz, George Washington University, and former counsel to the House Subcommittee on Health and the Environment chaired by Rep. Henry Waxman; John Rother, AARP; Susan Weiss, American Association of Homes and Services for the Aging; Janet Wells, National Citizens’ Coalition for Nursing Home Reform; Paul Willging, Johns Hopkins University and former head of the American Health Care Association (AHCA); Christine Williams, former health aide to then-Senate Majority Leader George Mitchell; Jack MacDonald, Golden Horizons; and Mary Jane Koren, The Commonwealth Fund, and former director of New York’s Survey and Certification agency. A webcast of the briefing will be available by the afternoon of Monday, December 10.
The full article may still be available CLICK HERE
ACHIEVING A HEALTH CARE SYSTEM WITH UNIVERSAL ACCESS: WHAT THE UNITED STATES CAN LEARN FROM OTHER COUNTRIES
Annals of Internal Medicine January 1, 2008 Position Paper American College of Physicians
Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it to health care in other countries. The concluding section proposes lessons that the U.S. can learn from these countries and recommendations for achieving a high-performance health care system in the USA.
Lessons from Other Countries and ACP Recommendations for Redesigning the U.S. Health Care System
Recommendation 1a: Provide universal health insurance coverage to assure that all people within the USA have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:
1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals' freedom to make their own health care choices.
2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (australia and new zealand). pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector.
The full article may still be available CLICK HERE
CALIFORNIA FINES PLAN FOR FAILING TO REVEAL POLICY CANCELLATION INCENTIVE
American Medical News, December 10, 2007, By Emily Berry
Health Net has agreed to pay the state of California $1 million for failing to tell the whole truth to regulators about how it rewarded its employees who cancelled individuals' health insurance. The company -- and others -- could face more fines in the future as the California Dept. of Managed Health Care continues to investigate insurance rescission practices.
The Dept. of Managed Health Care on two occasions asked Health Net officials whether they offered incentives to employees to cancel policies and was told incorrectly that there were no such programs, department spokeswoman Lynne Randolph said. California law does not allow insurance companies to compensate claims reviewers for decisions they make on claims.
...the department fined Blue Cross of California, a WellPoint plan, $1 million in March and $200,000 in September 2006 for illegally canceling individual insurance policies. The department said Blue Cross failed to prove the applicants were intentionally deceptive -- the only legal means by which a health plan may rescind coverage.
The full article may still be available CLICK HERE
HOW MUCH ‘SKIN IN THE GAME’ DO MEDICARE BENEFICIARIES HAVE? THE INCREASING FINANCIAL BURDEN OF HEALTH CARE SPENDING, 1997-2003
Health Affairs November/December 2007 By Patricia Neuman, Juliette Cubanski, Katherine A. Desmond and Thomas H. Rice
Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. Over this period, median out-of-pocket spending as a share of income increased from 11.9% to 15.5%. In 2003, the 25% of beneficiaries with the largest burden spent at least 29.9% of their income on health care, while 39.9% spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries.
The full article may still be available CLICK HERE
EXPLORING MEDICAID'S CURRENT AND FUTURE CHALLENGES IN PROVIDING LONG-TERM CARE
Nov. 28, 2007, Kaiser Family Foundation
Medicaid has evolved to become the primary payer for long-term care (LTC) services and supports to low-income elderly and disabled individuals, financing nearly half (42%) of the nation’s spending on long-term care services. The structure and cost associated with the program’s role are key considerations as states begin to implement some of the changes passed as part of the Deficit Reduction Act of 2005.
* Integration of services for people who use long-term care, many who require substantial acute care, and needs beyond traditional health care;
* Varying disability criteria for Medicaid LTC coverage which can create potential inequalities across beneficiary groups and states;
* The relationship of means-testing benefits with other program goals such as community integration;
* Achieving a balance between institutional and community-based care, especially with the recent shift towards more community-based alternatives;
* Flexibility in benefit design which could accommodate more consumer preferences, but may create equity issues;
* Continued and improved focus on quality of care, especially with LTC provided in the community; and
* Future financing of the program’s LTC services as the number of users is projected to grow in coming years and the nation has yet to develop major, viable alternatives to Medicaid as a payer of these services.
The full article may still be available CLICK HERE
OVERBURDENED AND OVERWHELMED: THE STRUGGLES OF COMMUNITIES WITH HIGH MEDICAL COST BURDENS
An estimated 38% of people in the USA are saddled with high medical cost burdens relative to their income, ranging from 55% of residents of West Palm Beach, Fla., to 16% of residents of Bridgeport, Conn. A level of 10% of after tax income is commonly considered evidence of being underinsured.
High medical cost burdens appear to be endemic in U.S. communities with a high concentration of low-wage jobs, which tend to have no health benefits or less-generous benefits compared with higher-wage jobs. The problem is made worse, Cunningham says, by tighter eligibility standards for public health insurance programs, especially for adults, in these areas.
The full article may still be available CLICK HERE
TOWARD HIGHER-PERFORMANCE HEALTH SYSTEMS: ADULTS’ HEALTH CARE EXPERIENCES IN SEVEN COUNTRIES
Health Affairs November 1, 2007 By Cathy Schoen, Robin Osborn, Michelle M. Doty, Meghan Bishop, Jordon Peugh and Nandita Murukutla
This 2007 survey compares adults’ health care experiences in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the USA. In all countries, the study finds that having a "medical home" that is accessible and helps coordinate care is associated with significantly more positive experiences. There were wide country differences in access, after-hours care, and coordination but also areas of shared concern. Patient-reported errors were high for those seeing multiple doctors or having multiple chronic illnesses. The USA stands out for cost-related access barriers and less-efficient care.
The survey asked adults about their overall health system views, confidence, access, cost burdens, and perceptions of waste and complexity. Repeating the pattern observed since 1998, U.S. adults held the most negative views and were the most likely to report affordability concerns. In contrast to the USA, public views in Canada and New Zealand have grown steadily more positive in the past decade and are now comparable to views in Australia and the United Kingdom.
The full article may still be available CLICK HERE
HEALTHY STEPS FOR YOUNG CHILDREN: SUSTAINED RESULTS AT 5.5 YEARS
Minkovitz CS, Strobino D, Mistry KB, Scharfstein DO, Grason H, Hou W, Ialongo N and Guyer B for Robert Woods Johnson Foundation
The Healthy Steps for Young Children (HS) program is an intervention that aimed to enhance relationships among parents, children and pediatric practices by placing trained developmental specialists in pediatric practices to provide enhanced behavior and development services during the first three years of a child's life. Results from a follow-up study suggest that benefits from that program were sustained two years after participation ended. The study sample included 3,165 families.
Compared to families in the control group, intervention families were more satisfied with the care they received and more likely to receive anticipatory guidance. Also, intervention families had decreased odds of reporting ever using severe discipline, such as spanking and greater odds of reporting that they often or almost always negotiated with their child. They also reported more favorable practices with respect to encouraging reading. These results suggest that HS has potential to enhance parenting outcomes that are critical to positive child development and that the benefits of HS participation can be sustained beyond the intervention period.
The full article may still be available CLICK HERE
RACIAL AND ETHNIC DISPARITIES IN ACCESS TO AND QUALITY OF HEALTH CARE
RWJF Issue 12: September 2007
Eliminating racial and ethnic disparities in health is a major national objective, one of two overall goals for Healthy People 2010. Efforts to eliminate health disparities must incorporate strategies to reduce racial and ethnic disparities in health care as well. These strategies are also a critical component of overall efforts to improve health care quality.
There is a pressing need for policy-makers to understand the degree to which race and ethnicity or other factors (e.g., insurance coverage, income, etc.) contribute to health care disparities. This knowledge will help shape interventions to eliminate disparities. This synthesis presents findings on the size and causes of racial and ethnic disparities in access to care followed by findings on disparities in quality of care.
Key Findings:
* Racial and ethnic disparities in access to and quality of care are pervasive although not universal. The largest access disparities are for Spanish-speaking Hispanics.
* Insurance coverage, income and other factors explain a portion of the disparities, but racial and ethnic gaps in access and quality remain after accounting for these factors
* After adjusting for other factors, disparities in recommended processes of care - the appropriate use of screening tests, medications, and laboratory tests - tend to be small or nonexistent. Disparities are larger for intermediate outcomes, newer therapies and invasive outcomes even after adjusting for other factors.
The full article may still be available CLICK HERE
HIGHER COSTS, WORSE OUTCOMES FOR PREVIOUSLY UNINSURED MEDICARE BENEFICIARIES
Research published recently in the New England Journal of Medicine underscores the importance of having health insurance coverage - not only for ensuring access to needed care, but also for controlling overall health care costs and promoting good health outcomes.
Among U.S. adults ages 59 to 64 who had been diagnosed with hypertension, diabetes, heart disease, or stroke, those lacking insurance coverage had much higher medical costs - 51% higher - after becoming eligible for Medicare at age 65, compared to those with insurance coverage.
Uninsured adults in this age group also reported 13% more doctor visits and 20% more hospitalizations than their insured counterparts. Higher use of services and higher costs persisted through age 72, the researchers found. "These findings support the hypothesis that previously uninsured adults used health services more intensively and required costlier care as Medicare beneficiaries than they would have if previously insured," wrote the authors.
The costs of providing health insurance to people earlier in life, they note, may be partly offset by reduced spending on health care after age 65.
The full article may still be available CLICK HERE
DIFFERENCES IN DISEASE PREVALENCE AS A SOURCE OF THE U.S.-EUROPEAN HEALTH CARE SPENDING GAP
Health Affairs October 2, 2007, By Kenneth E. Thorpe, David H. Howard, Katya Galactionova
The USA spends more on health care than any European country. Previous studies have sought to explain these differences in terms of system capacity, access to technologies, gross domestic product, and prices. We examine differences in disease prevalence and treatment rates for ten of the most costly conditions between the USA and ten European countries using surveys of the noninstitutionalized population age fifty and older. Disease prevalence and rates of medication treatment are much higher in the USA than in these European countries. Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.
The full article may still be available CLICK HERE
AMERICAN HEALTH POLICY: CRACKS IN THE FOUNDATION
Journal of Health Policy, Politics and Law October 2007 By John A. Nyman
Much American health policy over the past thirty-five years has focused on reducing the additional health care that is consumed when a person becomes insured, that is, reducing moral hazard. According to conventional theory, all of moral hazard represents a welfare loss to society because its cost exceeds its value. Empirical support for this theory has been provided by the RAND Health Insurance Experiment, which found that moral hazard - even moral hazard in the form of effective and appropriate hospital procedures - could be reduced substantially using cost-sharing policies with little or no measurable effect on health.
This article critically analyzes these two cornerstones of American health policy. It holds that a large portion of moral hazard actually represents health care that ill consumers would not otherwise have access to without the income that is transferred to them through insurance. This portion of moral hazard is efficient and generates a welfare gain. Further, it holds that the RAND experiment’s finding (that health care could be reduced substantially with little or no effect on health) may actually be caused by the large number of participants who voluntarily dropped out of the cost-sharing arms of the experiment. Indeed, almost all of the reduction in hospital use in the cost-sharing plans could be attributed to this voluntary attrition.
The article concludes by observing that the preoccupation with moral hazard is misplaced and has worked to obscure policies that would better reduce health care expenditures. It has also led us away from policies that would extend insurance coverage to the uninsured.
The full article CLICK HERE or the summary may still be available CLICK HERE
GAPS IN VACCINE FINANCING FOR UNDERINSURED CHILDREN IN THE UNITED STATES
JAMA August 8, 2007 By Grace M. Lee, MD, MPH; Jeanne M. Santoli, MD; Claire Hannan, MPH;
Children who are uninsured or who have public health insurance, such as Medicaid, can receive vaccines free of charge through the Vaccines for Children (VFC) program.
Only 34% of states had a health insurance mandate that required insurers to follow current ACIP or American Academy of Pediatrics recommendations for children and adolescents. And 17% of states had a health insurance mandate that did not require insurers to cover all recommended vaccines and 49% of states did not have any health insurance mandate.
Limitations in both federal (section 317) and state vaccine financing were reported as the dominant barriers to states' providing vaccines to underinsured children. Lack of section 317 funding was cited as a barrier for 81% (Tdap) to 100% (pneumococcal conjugate) of state immunization programs that were not able to provide vaccines to underinsured children.
The public sector safety net for offering vaccine to underinsured children seems to be under considerable strain. Past studies have suggested that many private clinicians refer underinsured children to public health clinics for vaccination. Unfortunately, a growing number of states are no longer able to provide expensive vaccines, such as the meningococcal conjugate vaccine, to underinsured children in the public sector. Furthermore, the proportion of vulnerable US children whose insurance plans either do not cover vaccines or require families to pay out-of-pocket for preventive care is likely to grow. A recent article by the American Academy of Pediatrics found that 20% of employers are offering catastrophic health insurance plans (high-deductible health plans), up from only 5% in 2003, and only 30% of these plans covered preventive care before the deductible was met.
Despite the ability of vaccines to prevent illness and death, our current system of vaccine financing has resulted in a gap for underinsured children.
The full article may still be available CLICK HERE
RELATIVE BURDEN OF OUT-OF-POCKET COSTS ON SENIORS AND YOUNGER ADULTS
Recent policy debate has focused on the issue of rising health care costs and whether it might be possible to control costs by requiring consumers to pay a larger share of their health care costs out of pocket. While most of the policy discussion has focused on people of working age, rising health care costs and the burden of out-of-pocket spending also affects seniors, who generally have higher medical expenses and lower incomes than younger adults.
A new analysis issued by the Kaiser Family Foundation examines the relative burdens of out-of-pocket spending on seniors and younger adults. It finds that seniors consistently spent a larger share of their income out of pocket on health care than younger people. In 2003, the median senior living alone spent 12.5% of their income on out-of-pocket health care, more than five times the 2.2% share spent by the median younger adult living alone. Given the persistent differences between young and old, the analysis suggests that even with Medicare’s prescription drug benefit, significantly narrowing the wide gap between seniors and younger adults in their out-of-pocket spending burdens is unlikely.
The full article may still be available CLICK HERE
MIDDLE-CLASS AMERICANS JOIN RANKS OF UNINSURED IN 2006 AS PRIVATE COVERAGE SHRINKS
Physicians for a National Health Program August 28, 2007
The U.S. Census Bureau released data showing that the number of uninsured Americans jumped by 2.2 million in 2006 to 47.0 million people, with nearly all the increase (2.03 million) concentrated among middle-class Americans earning over $50,000 per year.
"Middle-income Americans are now experiencing the human suffering that comes with being uninsured. It makes any illness a potential economic and social catastrophe," said Dr. Steffie Woolhandler and she noted the following:
* The 2.18 million rise in the number of uninsured is the biggest jump reported by the Census Bureau since 1992.
* There are now more uninsured in the U.S. - 47.0 million - than at any time since passage of Medicare/Medicaid in the mid-1960’s.
* 93% of the increase is among middle and high income families:
Of the 2.18 million increase:
1.398 million (64% of the increase) was in >$75k family income An additional 633,000 (29% of the increase) was among $50-$75k group Among full time workers, the number of uninsured increased by 1.230 million (56.4% of the increase). [EINO: Note also that official census numbers for the uninsured only count those uninsured continually from Jan 1 through Dec 31. If you are uninsured from Feb 2005 continually through November of 2006 (22 months) you are not counted as uninsured in either year, officially.]
The full article may still be available CLICK HERE
INCOME, POVERTY, AND HEALTH INSURANCE COVERAGE IN THE UNITED STATES: 2006
Current Population Reports, August 2007
Health Insurance Coverage in the USA:
* Both the percentage and the number of people without health insurance increased in 2006. The percentage without health insurance increased from 15.3% in 2005 to 15.8% in 2006, and the number of uninsured increased from 44.8 million to 47.0 million.
* The percentage and the number of children under 18 years old without health insurance increased to 11.7% and 8.7 million in 2006 (a 7.3% increase from 2005).
* The percentage and the number of uninsured Blacks increased (from 19.0% and 7.0 million in 2005) to 20.5% and 7.6 million in 2006.
* The percentage and the number of uninsured Hispanics increased to 34.1% and 15.3 million in 2006.
The full article may still be available CLICK HERE
TECHNICAL ASSESSMENT OF HEALTH CARE REFORM PROPOSALS
The Lewin Group August 20, 2007 The Colorado Blue Ribbon Commission for Health Care Reform
The Lewin Group was engaged by the Colorado Blue Ribbon Commission for Health Reform to assist in developing and analyzing alternative proposals to expand health insurance coverage and reform the Colorado health care system.
BETTER HEALTH CARE FOR COLORADO
Better Health Care for Colorado provides a path to universal health care through a public program expansion and access to private insurance coverage with low-income subsidies through a Health Insurance Exchange. Individuals eligible for public programs would receive benefits under those programs, and individuals who purchase private coverage would have access to a limited core set of benefits, with premiums copays.
467,200 - number remaining uninsured
$595 million - increase in health spending
SOLUTIONS FOR A HEALTHY COLORADO
Solutions for a Healthy Colorado provides coverage to all Colorado residents under a Core Limited Benefit Plan in the private sector and expands coverage under Medicaid and Child Health Plus (CHP+). People who are low income but who would not be eligible for the government programs would receive a premium subsidy.
133,400 - number remaining uninsured
$271 million - increase in health spending
A PLAN FOR COVERING COLORADO
A Plan for Covering Coloradans provides coverage to Coloradans through a public program expansion and a mandatory private pool for all residents not eligible for the public program. It provides a minimum benefits package in a private pool and premium assistance based on income for those who cannot afford insurance. All plans would provide a comprehensive minimum benefits package, and differ mainly on cost-sharing amounts.
106,500 - number remaining uninsured
$1.3 billion - increase in health spending
COLORADO HEALTH SERVICES SINGLE PAYER PROGRAM
The Colorado Health Services (CHS) Program is a single payer plan that would provide coverage to all residents of the state, including state and local workers, and residents currently covered under Medicare, Tricare, Veteran’s Health, Indian Health Services and Federal Health Benefits programs. The program would provide all people with comprehensive health care benefits that cover the same list of services now covered by the Colorado Medicaid benefits package. Consumers would have their choice of providers and hospitals within the state.
0 - number remaining uninsured
$1.4 billion - decline in health spending
:
The full Lewin's Technical Assessment of Health Care Reform Proposals (230
page report) may still be available CLICK HERE
PRIMER ON TRENDS IN HEALTH CARE COSTS
Kaiser Family Foundation 2007
This primer examines the rapid growth in the nation’s health care costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. The share of the economy devoted to health care grew from 7.2% in 1970 to 16% in 2005, and is projected to increase to 19.6% by 2016. Between 2000 and 2006, insurance premiums for family coverage rose 87%, more than four times the growth in wages.
The primer describes the types and sources of health care spending, the demographic factors associated with higher or lower levels of spending, and the impact of higher premiums and out-of-pocket costs on families. It also discusses other factors that influence health care spending growth, including the use of new medical technology, population changes, and changes in disease prevalence.
The full article may still be available CLICK HERE
RITE OF PASSAGE? WHY YOUNG ADULTS BECOME UNINSURED AND HOW NEW POLICIES CAN HELP
In 2005, 13.3 million adults ages 19 to 29 were uninsured, up from 12.9 million in 2004. Despite comprising only 17% of the under-65 population, they account for 30% of the nonelderly uninsured.
Sixteen states have enacted legislation in the last four years requiring that insurance policies covering parents also cover their children beyond age 18 or 19. Extending eligibility for Medicaid and the State Children's Health Insurance Program (SCHIP) beyond age 18, the authors say, would further expand coverage, since a majority of uninsured young adults have low incomes.
"There are misconceptions that young adults don't have health insurance by choice," said Sara Collins, "However, affordability and access to coverage are real barriers for many young people who lack access to employer coverage."
The full article may still be available CLICK HERE
PROTECTING AMERICA'S FUTURE: A STATE-BY-STATE LOOK AT SCHIP & UNINSURED KIDS
State Health Access Data Assistance Center, Published: Aug 9, 2007
The analysis shows:
* Since Congress first authorized SCHIP in 1997, the percentage of uninsured children in America has fallen by 24%.
* A total of 6.6 million children nationwide were enrolled in SCHIP at some point during 2006.
* Nationally, uninsured children are more than three times less likely than insured children to visit a doctor in the course of a year (10% for insured children versus 33% for uninsured children).
* More than half (54%) of all uninsured children did not have a "well-child" checkup in the past year - more than double the rate of children with insurance (25%).
The full article may still be available CLICK HERE
DOC GROUP SAYS NEW ASC RATE WOULD BE 'DEATH BLOW'
Modern Physician August 20, 2007 By Jennifer Lubell
Ambulatory surgery centers (ASCs) are trying to figure out how they'll cope with a new Medicare payment system that threatens to drastically reduce their reimbursement rates. The CMS in July 2007 issued a series of regulations to revise the payment system for ASCs, setting a new compensation rate of 65% of what hospital outpatient departments get paid under Medicare. While some centers may seek to benefit under the rule, others - particularly single-specialty ASCs, whose payments are expected to drop dramatically - will be left with some tough decisions on whether to keep their Medicare patient base or to close their doors altogether.
"The system we are announcing today will promote the goals of quality and efficiency in care furnished to people with Medicare in ambulatory surgery centers," said Leslie Norwalk, who resigned last month as the CMS' acting administrator.
The full article may still be available CLICK HERE
CONCENTRATION AND QUALITY OF HOSPITALS THAT CARE FOR ELDERLY BLACK PATIENTS
A new study detailing hospital care for African-American patients was published in Archives of Internal Medicine and funded by RWJF.
Just 5% of American hospitals cared for nearly half of all elderly African-American patients, and just 25% of hospitals cared for nearly 90% of elderly African-American patients. The study also clearly shows that hospitals with high concentrations of minority patients provide modestly inferior care in pneumonia for all its patients.
"Ensuring that people of color receive the same level of care as whites is one of the Foundation's top priorities," said John Lumpkin. "By working with hospitals that serve African Americans, we can have the biggest impact. These hospitals which are on the front line of care for people of color are frequently the least likely to have the resources to change on their own."
The study used 2004 Medicare data to calculate the volume and proportion of African-American patients discharged. The study examined the hospitals' structural characteristics and performances according to quality measures for patients with acute myocardial infarction, congestive heart failure and pneumonia.
USE OF HEALTH SERVICES BY PREVIOUSLY UNINSURED MEDICARE BENEFICIARIES
Among U.S. adults ages 59 to 64 who had been diagnosed with hypertension, diabetes, heart disease, or stroke, those lacking insurance coverage had much higher medical costs--51% higher--after becoming eligible for Medicare at age 65 than did those with insurance coverage.
Those who were uninsured also reported 13% more doctor visits and 20% more hospitalizations than those who were insured before Medicare. Higher use of services and higher costs persisted through age 72.
"These findings support the hypothesis that previously uninsured adults used health services more intensively and required costlier care as Medicare beneficiaries than they would have if previously insured," say lead author J. Michael McWilliams, M.D., and his colleagues at Harvard Medical School. The costs of providing health insurance to people earlier in life may be partly offset by reduced spending on health care after age 65.
Among adults with hypertension, diabetes, heart disease, or stroke diagnosed before age 65, previously uninsured adults reported significantly greater increases in the numbers of doctor visits and hospitalizations under Medicare than did previously insured adults. They also reported higher total medical expenditures. In analyses adjusted for supplemental and prescription drug coverage, previously uninsured adults with these conditions reported more doctor visits, more hospitalizations, and higher total medical expenditures from ages 65 to 72, compared with previously insured adults.
The full article may still be available CLICK HERE
|
|
|
