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Reports from 2004 and through Summer 2005 (not Kaiser or Commonwealth)
MANAGED CARE MANDATES FALL SHORT OF CURBING CALIFORNIA MEDICAID COSTS
From AcademyHealth, March 2005 by BJ Austin
Over the past several years, growth in Medicaid spending has far outpaced the growth in state tax revenues and now accounts for nearly 22 % of total state government spending. Rapid health care cost increases during the 1990s led many state governments to shift Medicaid recipients into managed care plans in an effort to control costs. The conventional wisdom at the time suggested that states would save money as a result. Like many other states, California sought relief through managed care; it passed legislation to foster enrollment and county by county, Medicaid recipients moved from a fee-for-service (FFS) system to managed care plans.
The findings suggest that managed care contracting reduced the efficiency of the Medicaid program in California. In fact, Medicaid spending appeared to increase by almost 20% following the shift to managed care and persisted long after the mandates first took effect, suggesting that they are not simply driven by startup costs of a new plan. The researchers also found that the switch from FFS to managed care did not lead to significant improvements in health outcomes.
Anecdotal evidence suggests that the shift from FFS to Medicaid managed care contracts resulted in increased administrative costs for the state. Therefore, the increase in Medicaid spending resulting from the shift to Medicaid managed care in this project may be understated. Clearly, California's goal of reducing Medicaid expenditures by shifting beneficiaries from FFS to managed care plans was not successful.
The full report may still be available at CLICK HERE
UNINSURED AMERICANS WITH CHRONIC HEALTH CONDITIONS: KEY FINDINGS
Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey shows that millions of uninsured adults in the USA suffer with chronic illness and have medical needs that are unmet.In eight states, at least one in five working adults is uninsured. In 39 other states, at least one working adult in every 10 does not have health care coverage.
The full report may still be available at CLICK HERE
ONE IN THREE UNINSURED CHILDREN HAD NO MEDICAL CARE FOR AN ENTIRE YEAR
A third of uninsured children in America went without medical care for an entire year, according to a new report"Going Without: America's Uninsured Children". Nearly 88 % of insured children received care during the same period.
The full report may still be available at CLICK HERE
RISE IN THE NUMBER OF UNINSURED AMERICANS TO 45.8 MILLION
These figures mask the true extent of the collapse of private, employer-sponsored health insurance. The number of uninsured would exceed 60 million were it not for a huge expansion of Medicaid - up 9.6 million since 2000 - and other public programs that are busting state budgets, while they attempt to fill in from the deteriorating options and higher premiums of employer-based health care coverage. The overall figures also fail to capture how the health care crisis is increasingly affecting families with incomes $50,000 - $75,000. Almost 8 million of the uninsured are in this income group, up 616,000 since 2003. These are small business owners, the self-employed, free-lance workers, solo professionals, and others who've been turned down for and/or priced out of health insurance.
The full report may still be available at CLICK HERE
61% OF MEDICARE DOLLARS THAT WILL BE SPENT TO BUY MORE PRESCRIPTIONS TO REMAIN WITH DRUG MAKERS AS ADDED PROFITS
Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.
An estimated 61.1 % of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits. This windfall means an estimated $139 billion dollars in increased profits over eight years for the world's most profitable industry. At $17 billion annually, this means about a 38 percent rise in drug maker profit. This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.
CLICK HERE for the Report (Acrobat)
US COULD SAVE AT LEAST $286 BILLION ANNUALLY WITH NHI
A study by researchers at Harvard Medical School and Public Citizen published in the International Journal of Health Services finds that health care bureaucracy last year cost the United States $399.4 billion. The study estimates that national health insurance (NHI) could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.
The study was based on the most comprehensive analysis to date of health administration spending, including data on the administrative costs of health insurers, employers health benefit programs, hospitals, nursing homes, home care agencies, physicians and other practitioners in the United States and Canada. The authors found that bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada. They also found that administration has grown far faster in the United States than in Canada.
Published in Jan 2004 in the International Journal of Health Services
Best link at PNHP CLICK HERE
COVERAGE AND COST IMPACTS OF THE PRESIDENT'S HEALTH INSURANCE TAX CREDIT AND
TAX DEDUCTION PROPOSALS
The President's tax credit and tax deduction proposals for non-group health insurance, when fully implemented, would increase the number of people with health insurance by almost 1.3 million, at a cost of more than $4,700 per newly insured person ($2.1 BIL in total cost). While the net change in the number of people with insurance is relatively small, these policies would result in a substantial movement of individuals away from employer-based coverage and into the non-group market, or in some cases, into being uninsured. Also of significance, the tax credit and tax deduction policies together result in a lower number of newly insured people, and a higher cost for each person newly insured, than the tax credit policy would achieve standing alone.
By offering tax subsidies for non-group health insurance, the policies would reduce the preference under current tax law for employer-based coverage over non-group insurance, with the likely result that fewer employers would offer health benefits to their employees. In some cases, these employees would not find other insurance, either because they would not want to pay the premiums for non-group insurance or because health problems could make it difficult for them to find affordable coverage in some states. People with health problems who lose employer-based coverage would likely face higher premiums and more coverage restrictions in the non-group health insurance market than they currently face when receiving health benefits through work. These same problems-relatively high premiums and coverage restrictions-already exist for people with health problems purchasing non-group health insurance in most states today.
Who benefits from the proposed policies? The newly insured under the tax credit policy (and the results for the combined policies are almost identical) tend to be younger and healthier than the uninsured overall, and tend to be younger than the under 65 population as a whole. This raises the question of whether these policies could be modified to provide more assistance to older or less healthy uninsured people, or whether an additional policy response, such as a public coverage expansion, would be needed to increase insurance access for these more costly groups of uninsured people.
Published in Jan 2004 in the International Journal of Health Services
Best link at PNHP CLICK HERE
INFLUENCE OF DIRECT TO CONSUMER PHARMACEUTICAL ADVERTISING AND PATIENTS' REQUESTS ON PRESCRIBING DECISIONS: TWO SITE CROSS SECTIONAL SURVEY
Barbara Mintzes, Morris L Barer, Richard L Kravitz, Arminée Kazanjian, Ken Bassett, Joel Lexchin, Robert G Evans, Richard Pan and Stephen A Marion
Only the United States and New Zealand allow advertising of prescription drugs directed at patients. US spending on such advertising grew rapidly during the 1990s, reaching $2.47bn in 2000. The dramatic increase in investment by the US pharmaceutical industry is evidence of an expected effect on sales. On the rationale that such advertising provides important information to consumers and patients who may benefit from advertised products, pharmaceutical manufacturers have campaigned in the European Union and Canada for the relaxing of current regulatory restrictions. We examined the relation between direct to consumer advertising and patients' requests for prescriptions and the relation between patients' requests and prescribing decisions.
CLICK HERE for this Report
BUSH, CONGRESS SHOULD DEVELOP UNIVERSAL HEALTH SYSTEM, IOM PANEL SAYS
The Institute of Medicine issued a report in which the agency for the first time formally recommended that by 2010 the United States implement a universal health insurance system to "prevent more unnecessary suffering, death and economic costs to society," the Washington Post reports (Stein, Washington Post, 1/15). The IOM based the report, titled "Insuring America's Health: Principles and Recommendations," on three years of research and five previous reports on the cost of health insurance (Kemper, Los Angeles Times, 1/15). A committee of academics, business leaders, health insurers and health care providers drafted the 205-page report (Appleby, USA Today, 1/15). The report concluded that the large number of uninsured U.S. residents -- about 43.6 million, or 15.2% of the population -- "results in unnecessary sickness and death, weakens the nation's economy and undermines the entire health care system," the Times reports (Los Angeles Times, 1/15).
According to the 16-member committee, "The lack of health insurance for tens of millions of Americans has serious negative consequences and economic costs not only for the uninsured themselves but also for their families, the communities they live in and the whole country," adding, "The situation is dire and expected to worsen." The five previous IOM reports found that uninsured residents receive about 50% less medical care as those with health insurance, a trend that "tends to leave them sicker and likely to die younger," the Post reports.
About 18,000 residents die each year because they lack health insurance. [In terms of loss of life that's a World Trad Center attack every two months, even if its "business as usual for the Bush Administration"]
CHANGES IN ECONOMIC CONDITIONS AND HEALTH INSURANCE COVERAGE, 2000-2004
Between 2000 and 2004, the number of "officially uninsured" Americans increased by six million, primarily because of a decline in employer-sponsored insurance. All of the increase occurred among adults, for whom the drop in employer coverage was not offset by an increase in public coverage. About two-thirds of the growth in the uninsured was among Americans below 200 % of the federal poverty level. About half of the growth in the uninsured was among young adults ages 19-34, about 55 % among whites, and 73 % among native-born citizens. The decline in employer coverage is likely to continue. Increases in health care costs, and thus health insurance premiums, are likely to continue to grow faster than workers' earnings. The decline in employer coverage will be further exacerbated if the shift from working in large and midsize firms to small firms and self-employment and from high- to low-coverage industries continues.
This article from the journal Health Affairs of November 1, 2005 may still be available CLICK HERE
RACIAL/ETHNIC DISPARITIES IN POTENTIALLY PREVENTABLE READMISSIONS: THE CASE
OF DIABETES
Considerable differences in prevalence of diabetes and management of the disease exist among racial/ethnic groups. Racial/ethnic differences in risk-adjusted likelihood of readmission for diabetes-related conditions were more evident when observed over a longer follow-up period (i.e., 180 vs 30 days). This suggests that disparities in diabetes-related outcomes are more likely due to differences in outpatient management of the disease than to the quality of inpatient care. Blacks and Hispanics have higher hospital readmission rates, even with control for demographic, clinical, and socioeconomic characteristics and hospital attributes. Among the 3 largest racial/ethnic groups, Hispanics have the highest likelihood of readmission across the entire adult population. The differences across racial/ethic groups are greater among Medicare patients than among patients with private insurance or Medicaid coverage. Readmission diagnoses also vary by race/ethnicity, with Blacks and Hispanics at higher risk for those complications that are more likely preventable with effective postdischarge care. The findings presented here suggest that interventions should be designed for racial/ethnic minorities, particularly among the elderly, to improve the quality of outpatient care and reduce potentially preventable readmissions for diabetes complications.
Look for this article in the Am J Public Health. 2005;95(9):1561-1567.
PNHP member Jim Kahn showed that billing and insurance-related bureaucracy consumed a whopping 1/5 of private insurance premiums in California. The study confirms our assertion that savings on administrative waste could cover all the uninsured. The San Francisco Chronicle, CBS radio, and other media ran stories about the study.
You might be able to find this article in the early November issue of Health Affairs or try the PNHP website CLICK HERE
NY COUNCIL BACKS BENEFITS BILL
The New York City Council on August 16, 2005 passed a measure requiring most stores that sell groceries to provide a set level of health care coverage for their workers in a move aimed at forcing companies such as Whole Foods and Wal-Mart to change their labor practices. In New York, 46 of the council's 51 members voted in favor of the bill, with one member against it. It would require any grocery store with 35 or more employees or other retail stores with 10,000 square feet or more of floor space for food items to contribute $2.50 to $3 for health care for each hour an employee works. That is the average amount that employers in the New York grocery industry that provide health care currently contribute. Mayor Bloomberg (a Republican) is expected to veto the measure, however it only takes 34 votes to override a mayoral veto.
This article from The Washington Post of August 18, 2005 might still be available CLICK HERE
TAKING THE PULSE OF HEALTH CARE SYSTEMS: EXPERIENCES OF PATIENTS WITH HEALTH PROBLEMS IN SIX COUNTRIES
This paper reports on a 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand, the UK and the USA. Sizable shares of patients in all six countries report safety risks, poor care coordination, and deficiencies in care for chronic conditions, however the USA stands out for inefficient care and errors and is an outlier on access/cost barriers. As found in past surveys, the USA is an outlier for financial burdens on patients and patients forgoing care because of costs [that is our country would be 'beyond the pale' in this regards even if we were not the most vociferous in our supposed commitment to 'family values' which perhaps has nothing at all to do with valuing families?]. Half of sicker adults in the United States said that they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost. On each access/cost question, the US rate was 1.5 to double the forgone care rates reported in the next-worst country. Moreover, the percentage of US sicker adults forgoing care because of costs was much higher on all three indicators compared with the 2002 survey of sicker adults. Despite these high rates of care forgone, one-third of US patients spent more than $1,000 out of pocket in the past year, a level rare in the other countries. Insured and uninsured US patients were about equally likely to report expenditures this high (34 % insured and 32 % uninsured).
You might be able to find this article still at the journal Health Affairs of November 3, 2005 CLICK HERE
Or try this version from The Commonwealth Fund: CLICK HERE
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