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SUMMARIES OF RECENT REPORTS
First six months of 2006 (most recent at bottom)
LIMITATIONS OF THE NEW HEALTH CARE TAX CREDIT (HCTC) PROGRAM
Approximately 22% of eligible individuals received the health care tax credit in September 2004, the most recent month for which complete data are publicly available. The HCTC program was created by the Trade Act of 2002, primarily to help workers displaced by globalization and early retirees whose former employers defaulted on promised pension payments.
High premium payments required from beneficiaries, a complex application process, the frequent exclusion of coverage for preexisting conditions, and limited outreach are largely behind the low take-up, the report's authors say. In designing future tax credits aimed at specific populations, they suggest that policymakers ensure that: 1) premium costs are affordable for the low-income uninsured 2) enrollees have access to health plans that cover preexisting conditions 3) the outreach strategy uses easily understandable, multilingual materials and proactive enrollment efforts; and 4) the application process is kept simple, requiring no more than a single form to be filed with one agency.
The full Commonwealth report may still be available at CLICK HERE
NO 31 FLAVORS ONLY ROCKY ROAD IN US HEALTH CARE
When Welsh health care economist RT Edwards spent a year in Seattle, she was overwhelmed by the choices available to her: for coffee, TV channels, ice cream flavors--just about everything. But her brush with illness caused Edwards to question the value of choice in health care. Edwards describes her experience navigating the US health system after she developed a serious sinus infection. Not only does she report having trouble tracking down a provider who would agree to accept her "comprehensive" health insurance, she says she even found it difficult to schedule a timely appointment. Choice--among health plans, providers, and treatments--can only work well in a competitive market in which consumers are fully informed, goods or services are homogeneous, and there is free entry into and out of the market. None of these conditions, she argues, exist in the U.S. health care system today. "[Choice] certainly is not a rational alternative to universal coverage or even wider basic health care coverage for all," Edwards concludes. "The market mechanism has not led to high-quality health care in the U.S., even for those with health insurance."
Proponents of the individual health insurance market and health savings accounts promise they can provide consumers choice among health plans, providers, and even treatments. Such policies are grounded in economic theory positing that the "invisible hand" of the competitive market can efficiently balance supply and demand. This can work when consumers are fully informed, goods or services are homogenous, and there is free entry into and out of the market. But, Edwards argues, none of these conditions exists in the U.S. health care system. Rather than freely choosing among providers, patients typically depend on their doctors to act in their best interest. Edwards cites a 2002 Harris Interactive survey of U.S. adults that found only 1% respondents had made a decision to change health plans, doctors, or hospitals on the basis of performance evidence.
The full Commonwealth report may still be available at CLICK HERE
ON THE FRINGE: THE SUBSTANDARD BENEFITS OF WORKERS IN PART-TIME, TEMPORARY AND CONTRACT JOBS
"Nonstandard" workers those employed on a part-time, temporary, or contractual basis are far more likely than regular, full-time employees to lack health care coverage, experience gaps in their coverage, or depend on their spouse's employer coverage or public insurance programs. Just one of five of the estimated 34 million nonstandard workers in the US has health insurance through his or her employer. Some 24% of nonstandard workers are uninsured. In an era of increasingly unstable employment-based health care coverage, with fewer and fewer individuals covered under such policies and the quality of coverage diminished by higher premiums, copayments, and deductibles, nonstandard workers are particularly vulnerable. These workers are often left without the option of employer-based health care coverage, resulting in potentially high out-of-pocket costs. They are more likely than regular, full-time workers to be uninsured or to rely on insurance through a spouse's employer or through the government.
Nonstandard workers currently make up about 25% of the US workforce. Part-time workers compose the largest category within this group, followed by self-employed independent contractors and direct-hire temporaries. Nonstandard workers also relied on government insurance at five times the rate of regular workers and were insured through a spouse's health insurance plan at three and one-half times the rate of regular workers. Some 18% of nonstandard workers had discount cards, but no insurance coverage. However, almost all these workers erroneously reported that their discount card was a health insurance policy, leading the authors to suggest that rates of uninsurance may be underestimated because some individuals who report having insurance may, in fact, have discount cards only.
The full Commonwealth report may still be available at CLICK HERE
HEALTH COVERAGE FOR AGING BABY BOOMERS
US baby boomers are facing a host of problems related to health and health coverage as they age. Over 60% of adults ages 50 to 64 who are working or have a working spouse have been diagnosed with at least one chronic health condition, such as arthritis, cancer, diabetes, heart disease, high cholesterol, or hypertension. At the same time, baby boomers are also coping with barriers to needed care resulting from unstable health insurance coverage and problems with medical bills and medical debt. One-fifth of older workers and their spouses are uninsured or had a time when they were uninsured since turning 50. Two-thirds of older adults in working families reported they are very or somewhat worried that they might not be able to afford needed medical care in the future. Some 72 % expressed interest in enrolling in Medicare before age 65.
The full Commonwealth report may still be available at CLICK HERE
HEALTH CARE COSTS SURVEY
Some 44% of adult Americans report having a chronic condition such as heart disease, cancer, asthma or diabetes, or a handicap or disability that limits their daily lives. This group has a significantly harder time accessing health care specifically because of the costs. Moderate and lower-income, working adults report significantly more problems paying for medical care. Uninsured adults (18% of the public) [as officially counted, but closer to one in three or twice the "official census percentage of uninsured" CLICK HERE ] report considerably greater problems accessing health care because of the costs than those with insurance and say it's costs that keep them out of the health insurance market. It appears that people see few alternatives to lower their health care bills beyond skipping care. Prescription drugs play an important role in many people's lives, and many report problems paying for these drugs.
USA Today/Kaiser Family Foundation/Harvard School of Public Health
Health Care Costs Survey, September 1, 2005
The full Kaiser report may still be available at CLICK HERE
FOUR IN FIVE LARGE FIRMS TO MAINTAIN RETIREE DRUG COVERAGE AND ACCEPT MEDICARE SUBSIDIES IN 2006, BUT ARE LESS CERTAIN ABOUT FUTURE STRATEGY
Four in five businesses that now provide retiree health benefits will accept government subsidies for continuing to provide retiree drug coverage at least as good as Medicare’s coverage when the new drug benefit starts in 2006. Another 10% say that they will provide some drug coverage to supplement the new Medicare benefit, and 9% say that they plan to stop offering drug coverage to Medicare-eligible retirees. Firms accepting the retiree drug subsidy in 2006 are less certain about whether they will continue to take this approach in future years. About four in five say that they are likely to accept the subsidy again in 2007.
Looking ahead to 2010, only half say they are likely to maintain coverage and accept the subsidy. The study analyzed responses from 300 large private-sector firms (1,000 or more employees) that offer retiree health benefits. These firms collectively provide health benefits for 5.7 million retirees and dependents and for 15.8 million workers and dependents [They promised to do so when they negotiated for these workers to expend their productive years toiling away in their plants and offices, by the way -but now do not have to come through on those promises no matter how profitable they continue to be, or to what extent they have moved their operations off shore, or otherwise avoided obligations to the nation]. About one in eight surveyed firms say that they had stopped offering subsidized retiree health benefits in 2005 for future retirees, mainly newly hired workers.
The full Kaiser report may still be available at CLICK HERE
WHAT HAPPENS WHEN PUBLIC COVERAGE IS NO LONGER AVAILABLE?
A new Health Affairs article and Kaiser policy brief conclude that cuts to public coverage programs like Medicaid and SCHIP would increase hospital emergency department use by the uninsured and leave most adult low-income enrollees without an alternative insurance option.
Medicaid and SCHIP eligibility cuts would increase emergency department visits by the uninsured, suggesting that cost containment actions on public coverage programs would shift costs to hospital uncompensated care. No more than 9% of currently enrolled low-income adults would have access to an alternative source of insurance in the absence of public coverage. [EINO: It is likely that such cuts would cost the public much more than any 'savings' from the cutbacks. Uncompensated care at hospitals is reimbursed through overcharges and through public bailouts to keep hospitals open.]
The full Kaiser report may still be available at CLICK HERE
BUSH CONTINUES CAMPAIGN FOR HEALTH SAVINGS ACCOUNTS
Prez Bush has continued his campaign for health savings accounts (HSAs), which he argues will expand insurance coverage and contain health care spending by enabling people to put money into tax-free accounts to cover medical expenses. JJ Mongan, M.D., president and CEO of Partners HealthCare, points out that taxpayers would only be eligible for HSAs if they and their employers traded in comprehensive health care policies for cheaper policies with high deductibles. "This would leave currently insured people fully exposed to health care costs up to this deductible amount, potentially eating up their savings and then some".
Commonwealth Pres Karen Davis says "The patient is not at fault for high health care costs, and the solution isn't making the patient pay more of their own bills out of pocket." Why would the administration prescribe such a health plan? The basic belief is that high-deductible health plans, often called "consumer-directed" health plans, would bring down health care costs by forcing patients to use their own money for basic health needs. This, the rationale goes, would cut back on the frivolous use of health services. There are two flaws to this logic. First, a golfer's desire for an MRI to diagnose the cause of an achy knee may or may not be frivolous, but a basic medical intervention for a sick child is rarely frivolous, nor a reason for rising health care costs.
Second, it is important to remember that only 10% of people account for 70% of our nation's health care costs. These 10% of our fellow citizens are already very sick already have plenty of "skin in the game." Someone who is told that he or she has lung cancer is not likely to be a cost-conscious shopper. These so-called "consumer-directed" plans would have only the most marginal impact on the 70 % of costs incurred by very sick people. [Oh and by the way, any of us or our family members might suddenly find ourselves in this 10% most unfortunate. Hey, that's why we need insurance!]
This Commonwealth report is probably still available CLICK HERE
AN OMINOUS BEGINNING
In January 2005, HHS projected that 39.1 million beneficiaries would have prescription drug coverage either from the new Medicare drug benefit or another source with benefits at least as generous as Medicare’s. The latest HHS enrollment numbers show that by the end of Jan 2006 25.9 million (60%) of the estimated 43.4 million Medicare beneficiaries have coverage. Of the 25.9 million beneficiaries with creditable drug coverage and 10 million of those are in employer plans and had drug coverage prior to the start of the new benefit.
HHS reports that by the end of Jan 2006 15.9 million beneficiaries are enrolled in Medicare prescription drug plans. This total includes 6.2 million Medicare beneficiaries with Medicaid, 4.8 million Medicare Advantage enrollees, and another 4.9 million beneficiaries who signed up for one of the new stand-alone drug plans. Together, they make up 37% of the total Medicare population. The 15.9 million beneficiaries currently enrolled amount to just half (54%) of that initial enrollment target. The enrollment numbers for the end of Jan 2006 suggest that 5.4 million (24%) of the 22.9 million remaining beneficiaries have voluntarily enrolled in a Medicare drug plan or newly enrolled in a Medicare Advantage plan.
This Kaiser report is probably still available CLICK HERE
COLLECTING INFORMATION ON PATIENTS' RACE AND ETHNICITY
Collecting information on patients' race, ethnicity, and language, and linking those with measures of the quality of care, is a crucial first step in eliminating health disparities. However, many providers do not have a collection system in place. A study by DW Baker, and colleagues and published in the March issue of the American Journal of Public Health showed that allowing patients to describe their racial or ethnic background in their own words may improve the accuracy of such data.
This Commonwealth report is probably still available CLICK HERE
WOMEN FACE PARTICULARLY DIFFICULT CHALLENGES
As the cost of health insurance continues to increase, women in particular face difficult challenges because they are more likely to be low-income and use more health care services throughout their lives. Nationally, over 17 million -nearly one in five- non-elderly women were uninsured in 2004; rates vary across the country, from a low of 9% in Minnesota to a high of 29% in Texas.b Women who are low-income have more limited access to employer- sponsored insurance (40%), and are more likely to rely on Medicaid (23%) or be uninsured (36%).
This Kaiser report is probably still available CLICK HERE
MIRROR, MIRROR, ON THE WALL: AN UPDATE ON THE QUALITY OF AMERICAN HEALTH CARE from Commonwealth Fund President Karen Davis and colleagues.
Analysis of 2004 and 2005 patient survey data for Australia, Canada, Germany, New Zealand, the UK, and the US using a framework developed by the Institute of Medicine to evaluate the quality of a health care system. Out of 51 indicators of health care quality, the US ranked first on six indicators and ranked last or tied for last on 27, including measures of patient safety, patient-centeredness, efficiency, and equity.
This Commonwealth report is probably still available CLICK HERE
US HEALTH CARE DIVIDE : DISPARITIES IN PRIMARY CARE EXPERIENCES BY INCOME by P Huynh, C Schoen, and colleagues
In the US, disparities by income were evident for 21 of 30 measures of primary care access, coordination, and doctor-patient relationships included in the study. Differences by income were relatively rare in the other countries. The study also found that US patients with below-average incomes were more likely to have negative care experiences than their counterparts in the other countries. "Contrasting the experiences of patients in the US with those in other countries provides evidence that it is possible to provide care that is more efficient, effective, safe, patient-centered, and equitable," commented Karen Davis.
This Commonwealth report is probably still available CLICK HERE
ALTERNATIVE HEALTH THERAPIES
Studies have consistently shown that Asian Americans are less satisfied with their health care than white Americans are, partly because of difficulties with language and access to care. According to a new study by Commonwealth Fund-supported researchers, there may be another factor at play: physicians often are not aware of the alternative medical therapies--like acupuncture and herbal medicines--that their Asian American patients may be using.
For the study, which appears in the new issue of the American Journal of Public Health, the researchers surveyed Chinese and Vietnamese Americans in eight urban areas. Their findings show that while roughly two-thirds of respondents reported using some form of complementary or alternative therapy, fewer than one of 10 discussed this treatment with their doctor. However, when patients did discuss it, they rated their health care higher.
This Commonwealth report is probably still available CLICK HERE
INJECTING TRANSPARENCY ABOUT COSTS AND QUALITY OF HEALTH SERVICES
Injecting transparency about costs and quality of health services into the health care system could help providers, insurers, government agencies, and patients, say Karen Davis. Yet, it is unreasonable to expect health markets to perform like markets for other goods and services. Greater cost-sharing, through health savings accounts (HSAs) coupled with high-deductible health plans, has been proposed as a way to make patients behave more like consumers. But people enrolled in these plans are far more likely than those with more comprehensive plans to delay, avoid, or skip needed care because of cost. The greatest promise for change lies in information and incentives for health care providers, not for patients.
This Commonwealth report is probably still available CLICK HERE
LAWMAKERS NEVER FACED WITH LOSING BENEFITS By JIM ABRAMS, Associated Press Writer from Apr 19, 2006
Members of Congress occasionally lose elections, but they never lose retirement and health benefits that most Americans can only envy. A federal lawmaker who retires at 60 after just 12 years in office can count on receiving an immediate pension of $25,000 a year and lifetime benefits that could total more than $800,000. That doesn't include 401(k) benefits and any member who lasts five years in office also can get taxpayer-subsidized health care until he or she reaches Medicare age. Any member of Congress with five years of service is eligible for full benefits at 62. Those with 20 years in office can get full benefits at 50, younger than most workers.
It doesn't matter what a lawmaker does before or after leaving office. Former Rep. Randy "Duke" Cunningham, R-Calif., who was sentenced to eight years and four months in jail after pleading guilty to bribery charges this year, is still entitled to an annual pension of about $36,000 for his 15 years in the House. That doesn't include his military pension or 401(k) benefits. Tom DeLay, who is resigning after 22 years, will qualify for an initial pension of $56,000. DeLay could get pension payments of nearly $2 million over his expected lifetime. Unlike workers with agreements for corporate retirement benefits, lawmakers also have the peace of mind of knowing their federally backed plan will be there when they retire.
GAPS IN HEALTH INSURANCE: AN ALL-AMERICAN PROBLEM SR Collins and colleagues
Two of five working-age Americans with annual incomes between $20,000 and $40,000 were uninsured for at least part of the past year. This represents a dramatic and rapid rise from 2001, when just over one-quarter of this group was uninsured. Fully 21 % of adults surveyed, insured as well as uninsured, are struggling to pay off medical debt, while nearly 60 % of chronically ill adults with a recent time uninsured skipped their medications because they could not afford them. The survey also found that the uninsured are more likely to go without recommended cancer, cholesterol, and blood pressure screenings.
This Commonwealth report is probably still available CLICK HERE
MORE GAPS IN HEALTH INSURANCE: AN ALL-AMERICAN PROBLEM By SR Collins, K Davis, MM. Doty, JL Kriss, and AL Holmgren
Gaps in health insurance coverage - a problem that has long afflicted lower-income US families - is increasingly becoming an all-American problem. Of working-age adults in 2005 who were uninsured at some time in the past year, including those currently uninsured, by income level:
53% of low income (<$20,000); 41% of moderate income ($20,000-$39,999); 18% of middle income ($40,000-$59,999) and just 7% of high income ($60,000 or more). Nearly three of five (59%) uninsured adults with incomes of $40,000 or more reported difficulties with medical bills or accrued debt, 46% of adults with higher incomes were paying off unpaid medical bills over time. More than one-third (34%) of adults ages 19 to 64 (both insured and uninsured) either had medical bill problems in the past year or were paying off accrued medical debt.
This Commonwealth report is probably still available CLICK HERE
REFRAMING THE RACIAL DISPARITIES ISSUE FOR STATE GOVERNMENTS. By D Stone.
The most compelling way for policymakers to frame the issue of disparities in health care is in terms of "distributive justice".. Although health care is often discussed and provided as a market good, many Americans believe that medical treatment is essential to well-being, rather than an optional consumer good.
STATE LEGISLATIVE ACTIVITIES RELATED TO ELIMINATION OF HEALTH DISPARITIES. By K Ladenheim and R Groman.
The range of state strategies to reduce disparities reflects the differing ways states understand gaps in minority health.
REDUCING RACIAL AND ETHNIC HEALTH DISPARITIES: By BK Gibbs, L Nsiah-Jefferson, MD McHugh, A Trivedi, and D Prothrow-Stith.
Standard variables are needed to measure the efficacy of disparities reduction initiatives, according to this article. Creation of a "disparity reduction profile" and a "disparity index" are discussed.
This Commonwealth report is probably still available CLICK HERE
COMPARING PROJECTED GROWTH IN HEALTH CARE EXPENDITURES AND THE ECONOMY
A growing share of the nation’s economy is consumed by health care spending. Health care expenditures have consistently risen faster than the US economy, growing from 7.2% of Gross Domestic Product (GDP) in 1965 to 16% today, with total spending this year expected to reach $2.16 TRIL. Health spending is projected to rise to 20% of GDP in 10 years and total $4 trillion by 2015. Slowing the growth in national health expenditures enough to cut the excess over GDP in half over the next decade would require reducing spending by an average of $175 BIL per year over the next decade.
Current proposals to restrain health-care costs, such as incorporating better information technology into health care, paying providers based on quality, and increasing out-of-pocket costs for health-care consumers, are unlikely to produce anything close to this level of savings. And, these cost-control measures would generally provide only one-time savings. Policies that would sharply lower the rate of growth, beyond providing one-time financial relief, would require major, systematic reforms that stretch well beyond what is being considered in the current [GW Bush orchestrated] policy debate.
This Kaiser report is probably still available CLICK HERE
DISTRIBUTION OF OUT-OF-POCKET SPENDING FOR HEALTH CARE SERVICES
Pres Bush has proposed an expansion of Health Savings Accounts (HSAs) and high-deductible health insurance as a way to expand health coverage and control the rising costs of health coverage. These consumer-driven plans are promoted as a way to encourage patients to make more efficient health care decisions by increasing the amount that they pay directly out of pocket.
The data, however, show that people who have any health care spending in a year now pay on average 35% of the costs out of pocket. People with the highest total health care spending due to acute or chronic conditions generally pay a lower share of the cost themselves, with private insurance and public programs like Medicare and Medicaid often picking up most of the expense. But in dollar terms, their out-of-pocket costs are sizeable - $4,331 on average for the 1% of the population with the highest healthcare spending. [Increasing the burden on the disabled and sickest Americans, can't really be his solution, can it?]
This Kaiser report is probably still available CLICK HERE
NEW NATIONAL SURVEY ON HIV/AIDS FINDS INCREASED SUPPORT FOR US LEADERSHIP TO FIGHT THE EPIDEMIC ABROAD AND AT HOME
At a time when there is a growing budget deficit, the American people, despite their characteristic distaste for foreign aid, increasingly believe that the US should be a global leader on HIV/AIDS, including spending more money to help fight the epidemic abroad and at home. Six in ten Americans agree that the US is a global leader and has a responsibility to help fight HIV/AIDS in developing countries - up from 44% in 2002. In addition, more than half (56%) think the US is spending too little on HIV/AIDS in developing countries - up from 31% in 2002.
Nearly two thirds of all Americans (63%) saying that the US government is spending too little at home to fight HIV/AIDS - up from 52% in 2004. This willingness to spend more may stem from a belief that increased spending on prevention (62%) and testing (59%) will lead to meaningful progress in slowing the epidemic. "Perhaps surprisingly, it appears that the American public does not suffer from AIDS fatigue - they want more done and believe it will pay off" said DE Altman, CEO of the Kaiser Family Foundation.
This Kaiser report is probably still available CLICK HERE
EMPLOYEES IN THE SMALLEST US FIRMS PAY MORE from the May/June issue of the journal Health Affairs led by J Gabel
Employees in the smallest US firms pay, on average, 18 % more in health insurance premiums than those in firms with 1,000 or more workers, when actuarial value--the percentage of total medical expenses paid by a health plan--is taken into account. Employees in states with large urban populations, such as California, Massachusetts, New York, and Pennsylvania, tend to get more value for their premium dollar than those in rural states. The type of health insurance plan is even more significant than type or size of employer in determining the generosity of coverage and adjusted premium prices.
This Commonwealth report is probably still available CLICK HERE
WHY EMPLOYER-SPONSORED INSURANCE COVERAGE CHANGED, 1997-2003 from Health Affairs May/June 2006 By JD Reschovsky, BC Strunk and P Ginsburg
Four and a half million Americans gained employer-sponsored health insurance coverage during 1997-2001, while nearly nine million lost coverage in the ensuing economic downturn (2001-2003), after population growth was accounted for. Coverage among low-income people was most affected by economic conditions and premium costs.
This report may be available CLICK HERE
MEDICARE BENEFICIARY OUT-OF-POCKET COSTS: ARE MEDICARE ADVANTAGE PLANS A BETTER DEAL? from The Commonwealth Fund May 2006 By B Biles, LH Nicholas and S Guterman
The benefit packages offered by MA (Medicare Advantage) plans often result in substantial out-of-pocket costs for beneficiaries in poor health. In more than 20% of the MA plans we examined, located all across the nation in 15 cities in 10 states, enrollees in poor health would have had greater out-of-pocket costs in 2005 than if they had been in traditional fee-for-service Medicare with Medigap Plan F.
Even with the completion of planned improvements in the risk adjustment, the incentives for plans to avoid enrollees in poor health are unlikely to disappear. Moreover, as increased pressure to control Medicare spending makes continuation of the current level of extra payments to MA plans more difficult to justify, the incentive to shift costs from healthy to sick enrollees will become stronger.
This Commonwealth report is probably still available CLICK HERE
RITE OF PASSAGE? WHY YOUNG ADULTS BECOME UNINSURED AND HOW NEW POLICIES CAN HELP,
Fully 13.7 million young adults in the US lack health insurance, an increase of 2.5 million from 2000. Americans between ages 19 and 29 represent the largest and fastest-growing segment of the population without health coverage. The consequences of being uninsured are serious: more than half (57%) of young adults in the study without coverage reported having gone without needed health care because of the cost.
This Commonwealth report is probably still available CLICK HERE
RETIRED STEELWORKERS AND THEIR HEALTH BENEFITS
Bankruptcies of two steel companies, the LTV Corporation and Bethlehem Steel have left about 200,000 retirees and spouses without retiree health coverage in 2002 and 2003. The report provides insight into the impact of a tax credit enacted by Congress in 2002 to provide temporary assistance to workers and retirees in "distressed" industries, including the steel industry [by turning more public money over to private insurers].
More than a quarter (26%) of 55 to 64 year old steelworker retirees reported using the generous health insurance tax credit, which pays up to 65% of the cost of health insurance for those eligible. The tax credit is refundable, meaning that if a person owes less in taxes than the amount of the credit, he or she could receive the difference from the IRS. Among retirees under age 65, almost half reported that they or a spouse returned to work or delayed retirement as a result of the loss of their steelworker retiree health benefits. About one in four reported that they cashed in "a lot" of their savings or assets so that they could afford health care costs or premiums.
This Kaiser report is probably still available CLICK HERE
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TAKING PATIENT RACE AND ETHNIC BACKGROUNG INTO ACCOUNT FOR DIAGNOSIS
Medical professionals often take into account patients' race or ethnic background when diagnosing conditions or determining treatment options. For the condition known as hyperbilirubinemia--an acute and potentially devastating form of neonatal jaundice--hospitals use the race of the newborn's mother to predict risk, with blacks being at lowest risk for developing the condition.
A new study published in the journal Pediatrics, however, finds significant disparities between the race assigned to mothers of newborns by hospital staff and mothers' self-described race, potentially undermining efforts to identify and treat the condition.
The research team, led by the Commonwealth Fund's Anne C. Beal, M.D., reports that of the mothers documented as black in the medical record, 23 % described themselves as being of two or more races, while only 70 % described themselves as black. Of those mothers documented as white, only 64 % actually identified themselves as white.
This Commonwealth report is probably still available CLICK HERE
INDUSTRY-SUPPORTED CLINICAL TRIALS MORE LIKELY TO FAVOR NEWER TREATMENTS from the Journal of the American Medical Association for May 17.
Compared with trials funded by nonprofit organizations, industry-supported studies tend to result in favorable outcomes for new treatments. Research funding affected reported outcomes. Proposals to ensure more reliable reporting included improved academic oversight and required registration and publication of all clinical trials. To see if these recommendations have altered trial reporting324 human clinical trials were reviewed published between 2000 and 2005 in JAMA, The Lancet or The New England Journal of Medicine. They found that 49% of not-for-profit trials, 56.5% of jointly funded trials, and 67.2% of industry-funded trials significantly favored newer treatments. Similar patterns were observed for trials of drugs, devices and hard clinical end points. [37% more favorable outcomes in for-profit funded studies]
This report may be available CLICK HERE
THE LATEST TRENDS IN MEDICAID SPENDING AND ENROLLMENT
Annual growth in Medicaid spending on medical services fell from 12.9% during the economic recession of 2000-2002, to 7.4% between 2003 and 2004. Enrollment growth in Medicaid slowed from an average of 9% in the 2000-2002 period to 4.1 % in 2003-2004, mainly due to slower growth in the number children and families enrolled. The reduction in spending growth not only reflects the slowdown in enrollment as the economy improved, but also the aggressive Medicaid cost containment policies that have been adopted by states in recent years [disallowing enrollments, or disallowing specific treatments].
Recent Medicaid growth trends do not point to any easy answers for controlling costs. Nearly three-quarters of Medicaid spending growth between 2000 and 2004 is attributable to increased enrollment and higher prices for care, neither of which can be easily influenced by Medicaid programs without increasing the number of uninsured or decreasing access to care. Medicaid’s enrollment pressures remain due to rising health care costs, demographic trends, and continued declines in employer sponsored insurance. As federal and state policy makers explore options to better manage Medicaid spending, it will be important to assess the impact future reforms may have on the health of Medicaid enrollees, their access to providers, and the number of uninsured Americans.
This Kaiser report is probably still available CLICK HERE
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HMO RATE INCREASES CONTINUE TO DECLINE FOR FOURTH CONSECUTIVE YEAR
In 2007 HMO rates will increase approximately 11.7% -- representing the fourth consecutive year of declining rate
increases. "Although there has been a steady decline in the level of HMO rate increases
over the past several years, double-digit increases are still very difficult
for employers to absorb" said Paul Harris, of Hewitt Associates.
This report may be available CLICK HERE
INSTABILITY OF PUBLIC HEALTH INSURANCE COVERAGE FOR CHILDREN AND THEIR FAMILIES: CAUSES, CONSEQUENCES, AND REMEDIES, L Summer, and C Mann
Four states were studied that have implemented policies to improve coverage for children. They found that coverage instability can largely be averted by adopting key policies and procedures, like limiting the frequency of required renewals; developing easy, seamless transitions among public coverage programs; and setting affordable limits on premium costs.
This Commonwealth report is probably still available CLICK HERE
ENROLLING ELIGIBLE CHILDREN AND FAMILIES INTO MEDICAID AND SCHIP by S Dorn and GM Kenney
Allowing states the flexibility to automatically enroll people into Medicaid and SCHIP using information state officials already have could significantly extend health insurance coverage to uninsured but eligible children and their families. However, legal and technical barriers now prevent auto-enrollment in public health insurance programs. Federal policymakers need to provide states with additional flexibility in determining eligibility and new resources for investing in information technology.
This Commonwealth report is probably still available CLICK HERE
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RETAIL CLINICS: THE COMPETITION HEATS UP from Medical Economics of June 16, 2006 By K Terry
"Retail" walk-in clinics, located in supermarkets and stores like CVS and Target, are already competing with physicians in many communities. Now Blue Cross and Blue Shield of Minnesota has added a new twist: It's waiving copayments for patients who go to these in-store clinics. Copayments for office visits are on the rise everywhere. So if there were no copays in retail clinics, an increasing number of patients would have an incentive to go there.
The insurer's approach to this issue works against efforts to encourage primary care doctors to manage patients' overall health. "It's important for physicians to see patients in their offices, where they have their medical records".
This report may be available CLICK HERE
HEALTH CARE IN CONNECTICUT: SOUNDING THE ALARM by J Gruber
Three health care strategies for Connecticut to consider as alternatives over its current helter-skelter system of health care and coverage were recently studied. Only one of the three strategies fully meets the criteria of universal health care established by the Institute of Medicine (IOM).
Policy I One Health Plan Serving All State Residents. With all state residents under 65 in a single health plan sponsored by the state government, Connecticut would achieve 100% coverage while reducing total health care costs. A new state commission would administer the plan either directly or through a private insurer. The commission would control costs by defining covered benefits and out-of-pocket sharing rules, setting a statewide budget for health spending, negotiating reimbursement levels with providers and setting standards for quality of care. Individuals and employers could purchase additional health care services or coverage.
While all residents would be insured, total health care spending on the nonelderly would fall by 5 percent. Average health costs per insured would decline by 16%, from $4,121 to $3,447, in part because of reduced administrative costs incurred by insurers, health care providers and employers. Universal coverage can be achieved - 100 % of residents would be covered. Health care coverage would be more continuous, with all nonelderly residents enrolled in the state plan. Coverage would be affordable to state residents. The health insurance strategy would be affordable and sustainable for society, although some firms not offering coverage today would experience new costs. The one state plan would have the capacity to implement measures that dramatically improve quality and efficiency, and eliminate disparities in access to and the quality of care among ethnic and racial minorities.
Policy II A State Pool with Competing Private Plans for Residents Lacking Employer-Sponsored Coverage. This second policy alternative would satisfy some, but not all, of the Institute of Medicine's principles.
Policy III Expanding the Health Coverage Safety Net for Low- and Moderate- Income Adults and Insuring All Children. While this approach would cover a significant number of the uninsured at modest cost, it would satisfy at most a few of the criteria of the Institute of Medicine.
This report may be available CLICK HERE
A MISGUIDED AND VERY POPULAR SOLUTION
"Increasing patient cost-sharing is a misguided solution for reining in US health care costs," Commonwealth's Sara Collins, told a House Ways and Means Committee hearing on health savings accounts (HSAs). Dr. Collins said there is no evidence backing the claim that Americans spend too much on health care because they are protected from its real cost--one of the principal justifications put forth by those promoting HSAs coupled with high-deductible health plans.
Americans already pay far more out-of-pocket for their health care than citizens do in any other industrialized country, she noted. Moreover, studies show that high out-of-pocket costs lead patients to decide against getting the health care they need. The major beneficiaries of the tax savings available through HSAs are likely to be healthier and more affluent taxpayers who already have health coverage--and can afford the financial risk posed by higher-deductible plans. Health care needs to be made more affordable, not less, Collins says. Coverage for the nation's 46 million uninsured should build on group forms of health insurance that pool risk and provide people with affordable, meaningful protection. [The other non-official 30+ million uninsured in any given month, likewise need the single risk pool approach. Being uncounted by the Census office doesn't make them more insured.]
This Commonwealth report is probably still available CLICK HERE
ALL KIDS THE ILLINOIS PROGRAM TO PROVIDE HEALTH CARE FOR ALL KIDS by IL Gov RR Blagojevich
More than a quarter of a million children right here in Illinois do not have health insurance. That means they can't see a doctor or get medicine when they need to. When they do get medical care, it's often in the emergency room, after a small problem has grown into a big problem. That's wrong. I believe every child should be able to get medical care when they need it, before it becomes an emergency.
That's why I created the All Kids program: to make health care a reality for hundreds of thousands of families across the state. Illinois will be the first state in the nation to provide affordable, comprehensive health insurance for every child. The All Kids program will offer Illinois' uninsured children comprehensive health care that includes doctor's visits, hospital stays, prescription drugs, vision care, dental care and medical devices. Parents will pay monthly premiums for the coverage, but rates for middle-income families will be significantly lower than they are on the private market.
Comments from Don McCanne: Some advocates of universal health insurance insist that adopting a single program of national health insurance is not politically feasible, so we should abandon that effort and direct our attention to incremental steps that will eventually result in universal coverage. One of the most radical steps that currently has some political traction is to provide universal coverage for all children. Supporting health care for innocent little children is a political winner, not to mention that it is not much of a budget buster since most children are quite healthy and have only very modest health care needs.
In the IL All Kids plan: 1) very low income families may qualify for a rebate if they follow a complex process and can conquer an excessive administrative burden. 2) Iindividuals who wish to switch their children from private coverage to IL All Kids will have to wait one year without any coverage whatsoever before they can be enrolled (except for very low income families). 3) Not only are premiums adjusted by income level, but also co-payments are tiered based on income, and even the total out-of-pocket maximum for cumulative co-payments is adjusted. This results in administrative complexities that are compounded by the fact that income levels change, creating instability in the benefit level for which the children qualify. Also, means tested programs are somewhat intrusive and demeaning and NEVER result in 100% participation. 4) Failure to pay premiums results in cancellation of coverage. Reinstatement requires retroactive payment of all premiums plus a three month penalty of having no coverage. The majority of uninsured children are in families on tight budgets. Periodic problems paying bills are inevitable. 5) physicians and pharmacies may refuse to provide services if co-payments are not paid. 6) Failure to establish a permanent, reliable source of funding is flawed policy. 7) The application is eight pages and requires submission of various supporting documents.
EINO Comments: Why should Americans not get the same value for their health care dollar as citizens of every other industrialized country (instead of just half the value as presently)? Why pretend that children can have a level playing field as long as only the privileged among them have parents, guardians and extended family covered for their health care needs? Who believes that a "child caretaker for a disabled or sick adult" has an equal opportunity to excel at school, for example?
This report may be available CLICK HERE
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