Category Archives: Health Care

The Relationship Between Health Spending And Social Spending In High-Income Countries: How Does The US Compare?

Source: Irene Papanicolas, Liana R. Woskie, Duncan Orlander, E. John Orav, and Ashish K. Jha, Health Affairs, Ahead of Print, August 14, 2019
(subscription required)

From the abstract:
There is broad consensus that the US spends too much on health care. One proposed driver of the high US spending is low investment in social services. We examined the relationship between health spending and social spending across high-income countries. We found that US social spending (at 16.1 percent of gross domestic product [GDP] in 2015) is slightly below the average for Organization for Economic Cooperation and Development (OECD) countries (17.0 percent of GDP) and above that average when education spending is included (US: 19.7 percent of GDP; OECD: 17.7 percent of GDP). We found that countries that spent more on social services tended to spend more on health care. Adjusting for poverty and unemployment rates and the proportion of people older than age sixty-five did not meaningfully change these associations. In addition, when we examined changes over time, we found additional evidence for a positive relationship between social and health spending: Countries with the greatest increases in social spending also had larger increases in health care spending.

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Source: Devan Hawkins, Cora Roelofs, James Laing, Letitia Davis, American Journal of Industrial Medicine, Early View, July 26, 2019
(subscription required)

From the abstract:

Background:
Thousands of people in the United States continue to die from opioid overdoses every year. Work‐related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid‐related overdose deaths (OROD). This study sought to determine whether OROD rates differed by industry and occupation and explored work‐related factors that might contribute to these differences.

Methods:
We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work‐related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD.

Results:
Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD.

Conclusions:
These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

In Hospitals With More Nurses Who Have Baccalaureate Degrees, Better Outcomes For Patients After Cardiac Arrest

Source: Jordan M. Harrison, Linda H. Aiken, Douglas M. Sloane, J. Margo Brooks Carthon, Raina M. Merchant, Robert A. Berg, Matthew D. McHugh, Health Affairs, Vol. 38 No. 7, July 2019
(subscription required)

From the abstract:
In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association’s Get With the Guidelines–Resuscitation registry (for 2013–18), RN4CAST-US hospital nurse surveys (2015–16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing.

Growth Of Public Coverage Among Working Families In The Private Sector

Source: Douglas Strane, Genevieve P. Kanter, Meredith Matone, Ahaviah Glaser, and David M. Rubin, Health Affairs, Vol. 38 No. 7, July 2019
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From the abstract:
Working families have increasingly enrolled their children in Medicaid or the Children’s Health Insurance Program in recent years. Parents’ place of employment affects the availability and cost of family health insurance, making it a determinant of pediatric public insurance enrollment. We examined that enrollment in the period 2008–16 in families working full time and earning more than 100 percent of the federal poverty level at three types of employers. Among low-income families (100–199 percent of poverty), children’s public health insurance coverage was highest for those with parents employed at small private firms, increasing from 53 percent to 79 percent, while the public insurance coverage rate also increased among children with parents working for large private firms (from 45 percent to 69 percent). Among moderate-income families (200–299 percent of poverty) working at small private firms, public coverage increased from 21 percent to 64 percent. Increases in the number of working families with pediatric public insurance were driven by employees of large private firms. Maintaining high pediatric insurance coverage rates will require policies that recognize the changing role of public insurance for working families as the cost of employer-based coverage grows.

Blue-Collar Workers Had Greatest Insurance Gains After ACA Implementation

Source: Sumit D. Agarwal, Anna L. Goldman, and Benjamin D. Sommers, Health Affairs, Vol. 38 No. 7, July 2019
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From the abstract:
Analyzing national survey data, we found that workers in traditionally blue-collar industries (service jobs, farming, construction, and transportation) experienced the largest gains in health insurance after implementation of the Affordable Care Act (ACA) in 2014. Compared to other occupations, these had lower employer-based coverage rates before the ACA. Most of the post-ACA coverage gains came from Medicaid and directly purchased nongroup insurance.

The CHIP Dip

Source: Federal Funds Information for States, Issue Brief 19-20, July 1, 2019
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From the summary:
Beginning in fiscal year (FY) 2020, states will face increased costs for the Children’s Health Insurance Program (CHIP). The 23-percentage point increase in the federal CHIP matching rate—included in the Affordable Care Act (ACA)—will be reduced in FY 2020 and fully phased out in FY 2021. FFIS estimates that state costs could increase by approximately $4.3 billion (302%) to maintain total spending, although several factors remain uncertain.

The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor

Source: Wendi C. Thomas, MLK50 & ProPublica, June 27, 2019

Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years. ….. Its own employees are no exception. Since 2014, Methodist has sued dozens of its workers for unpaid medical bills, including a hospital housekeeper sued in 2017 for more than $23,000. That year, she told the court, she made $16,000. She’s in a court-ordered payment plan, but in the case of more than 70 other employees, Methodist has garnished the wages it pays them to recoup its medical charges….

Related:
This Memphis Hospital System Flouts IRS Rules by Not Publicly Posting Financial Assistance Policies
Source: Wendi C. Thomas, MLK50 & ProPublica, June 27, 2019

Nonprofit hospitals must post financial assistance policies for the public to see, including in emergency rooms. But Methodist Le Bonheur Healthcare’s five Shelby County emergency rooms had no signs or displays when a reporter checked.

Prevalence and Characteristics of Virginia Hospitals Suing Patients and Garnishing Wages for Unpaid Medical Bills
Source: William E. Bruhn, Lainie Rutkow, Peiqi Wang, Stephen E. Tinker, BS3; Christine Fahim, Heidi N. Overton, Martin A. Makary, JAMA, Research Letter, June 25, 2019

An estimated 20% of US consumers had medical debt in collections in 2014. Medical debt has been increasing with direct patient billing, rising insurance deductibles, and more out-of-network care being delivered, even at in-network facilities. Bills sent directly to patients may use the undiscounted price of a hospital’s services and can result in financial hardship and avoidance of future medical care. Hospitals need to be paid for care delivered, but some bills are unpaid. Hospitals may negotiate, reduce, or write off payments. Some have begun adopting a range of aggressive strategies for collecting unpaid bills, including suing patients and garnishing their wages or bank savings. We examined garnishment legal actions among Virginia hospitals.

Employers take action to improve access to quality, affordable health care

Source: Willis Towers Watson, Press Release, May 8, 2019

An increasing number of employers intend to provide their workforce with better access to high-quality and cost-effective health care by embracing a myriad of solutions such as high-performance networks, centers of excellence, onsite or near-site health centers, and accountable care organizations. Nearly one-half (45%) of employers say they intend to adopt these types of solutions by 2021, compared to just 32% that have already done so, according to research from leading global advisory, broking and solutions company Willis Towers Watson’s Health Care Access and Delivery Survey.

Notably, the survey also uncovered employers’ top concerns around delivering high-quality, comprehensive health care to their workforce and found they’re most concerned about inadequate access to mental health services (54%) and substance abuse treatment (47%)…..

Rising Mortality Rates Among Working-Age Americans

Source: Emily Fazio, Regional Financial Review, Vol. 29 no. 9, May 2019
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Mortality in the U.S. is rising. As a result, life expectancy at birth has fallen every year since its peak in 2014. This paper discusses the rise in mortality and the influence of increased rates of suicide and fatal drug overdoses. It also looks at geographic differences in mortality. Third, this paper considers the impact of economic conditions on changes in mortality, suicide rates, and fatal drug overdoses.