SUMMARIES OF 7 KAISER REPORTS
Mar 2002 - Apr 2002
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family foundation directly.
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to Mar 2002 from the Kaiser Family Foundation
PHYSICIANS RECOGNIZE RACIAL DISPARITIES IN MEDICAL TREATMENT
Most physicians are aware of racial disparities in medical treatment for specific conditions, but they don’t believe it is a widespread problem. Most physicians agree that racial disparity does exist for treatment of heart disease and HIV/AIDS. Almost two-thirds of physicians agree that "African Americans with heart disease are more likely than whites who have heart disease to get specialized medical procedures and surgery. Similarly, 57% agree that "Whites with HiV/AIDS are more likely than African Americans with HIV AIDSS to get the newsest medicines or treatments". Fully 50% more female than male physicians agree that race or ethnic background at often results in unfair treatment of patients.
African American physicians disagree with their fellow physicians - nearly eight in ten (77%) believe race and ethnicity impact how people are treated at least somewhat often. Physicians see insurance status as a key determinate of treatment within the health care system, with more than seven in ten (72%) saying that the system very or somewhat often treats people unfairly based on their health insurance status.
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EXTERNAL REVIEW PROGRAMS, BUT THEY ARE USED INFREQUENTLY
Forty-two states have external review programs to resolve disputes between health plans and consumers. Although consumers are granted relief about half the time on average, the report finds the programs are used infrequently. Health plan denials are overturned in whole in 45% of appeals filed by consumers, ranging from a low of 21% to a high of 72%, and fully upheld 49% of the time. However, the experience to date shows that these programs are used infrequently, with about 4,000 documented appeals annually. A number of administrative features of state programs may limit the number of appeals filed by consumers, including: requirements that internal appeals to a health plan be exhausted before turning to the state, filing fees, and rules that set a minimum dollar amount that must be in dispute before an appeal can be made.
Both the U.S. House and Senate have passed bills that would establish a federal right to independent external review of health plan decisions for all privately insured individuals (including those in self-insured employer plans, who are now excluded from state programs). However, the bills take different approaches to already enacted state laws. In addition to the pending federal legislation, a case currently under consideration by the U.S. Supreme Court, Rush Prudential HMO, Inc. v. Debra C. Moran, et al., could also affect the future of state-run external review programs if the Court rules that their decisions cannot be binding on health plans that offer coverage purchased by employers.
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HEALTH INSURANCE AND DEMOGRAPHIC INDICATORS
The Kaiser Commission on Medicaid and the Uninsured using Urban Institute analysis has produced national and state-level estimates of health insurance and demographic indicators based on the most current health insurance coverage survey by the federal government. Information on racial disparities, age disparities and gender disparities by state.
Health Insurance Coverage in America: 2000 Data Update (#4007) provides the most recent national data on health insurance coverage, with special attention to the uninsured. It includes trends and major shifts in coverage, key discussion points providing context to the graphical information, and a profile of the uninsured population.
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COVERAGE IN THE CURRENT ECONOMY
The New Challenge of the Uninsured: Coverage in the Current Economy is executive director Diane Rowland’s testimony to the U.S. House Energy and Commerce Subcommittee on Health.
In April 2002 over 38 million Americans are without health insurance and nearly 2/3 of these have incomes below 200% of federal poverty (less than $30,000/year /family of 3). 80% of uninsured are in working families. Only 60% of US workers earning under $7/h have access to job-based coverage, compared to 96% of higher wage workers (more than $15/h).
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IMPORTANT ROLE FOR NURSING HOMES
Americans see an important role for nursing homes in caring for those not able to care for themselves, yet they also voice significant concerns about the actual quality of care nursing homes provide. In general, many Americans have concerns about the staffing at nursing homes, with most agreeing that nursing homes don’t have enough staff (80%) and believing that the staff neglects at least some residents (77%).
People who have substantial experience with a friend or family member in a nursing home, or have been in a nursing home themselves, have generally positive views about the care provided, although a significant minority say that the person they know has had problems. About one in four say the person they know has received poor quality care in the nursing home, including being treated badly or abused by the staff (25%); developing bedsores or skin ulcers (23%); or being overmedicated (23%).
The majority of Americans see an important role for the government in long-term care, both in oversight and in financing. Sixty-six percent agree there is not enough government regulation of nursing home quality, and 70% favor the government doing more to help pay the costs of nursing home care, even if it would require a substantial increase in taxes.
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NATIONAL SURVEY OF SMALL BUSINESSES
Two-thirds (66%) of small employers say that they are dissatisfied with the cost of health care and health insurance, and about one-third (35%) of small businesses that now offer insurance say they are likely to increase the share of costs borne by employees in the next year. If costs continue to escalate, many small employers predict changes that would potentially disrupt coverage for workers.
Seventy-one percent of small businesses that offer health insurance provide employees with just one health plan (no choice). When asked why they offer only one, the company usually states that it gets a better deal by offering only one plan, or that the plan rules require that all employeess be in the same plan. When asked how the nation's uninsured should get coverage, 54% of the small business owners favor expanding medicare to cover the uninsured while 40% support a national health plan.
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PHYSICIANS' VIEWS ABOUT THEIR PROFESSION
Most physicians (87%) say the overall morale of physicians has decreased in the last five years. About six in ten say their own enthusiasm for practicing medicine has lessened over the same time period. Most doctors are satisfied with the continuity of their relationships with their patients (84%), professional challenges (79%) and current incomes (57%), but they are dissatisfied with the amount of work hours spent on administration compared with patient care (74%), the time they have for nonprofessional interests, family and friends (56%), autonomy in clinical decisions (54%) and their future income prospects (53%). The survey also found that more than four in 10 physicians say they would not recommend the practice of medicine to a young person today. Doctors’ willingness to recommend medicine has changed little since 1981, when the Kaiser Family Foundation asked physicians a similar question.
The majority of doctors (76%) say that managed care has at least somewhat negatively affected the way they practice medicine - and doctors are more likely now than they were in 1999 to believe this strongly (41% vs. 25% in 1999). Doctors do believe managed care has had a positive effect on the use of practice guidelines and preventive care.
The National Survey of Physicians is based on a nationally representative
random sample of 2,608 physicians. The complete survey results will
be released later in 2002.
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Additionally, see 39 summaries preceding Mar 2002 from the
Kaiser Family Foundation
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