Category Archives: Health Care

2017’s Cities Most Affected by Trumpcare

Source: Richie Bernardo, WalletHub, March 20, 2017

…According to estimates by the nonpartisan Congressional Budget Office, the recently proposed American Health Care Act — unofficially going by the names “Trumpcare” and “Ryancare” — would raise the average health-insurance premium for an individual policyholder by 15 to 20 percent just one or two years from now and lower federal subsidies. In contrast, the CBO projected, average Obamacare premiums would decrease 10 percent by 2026.

In order to gauge the AHCA’s impact on people who buy their own insurance, WalletHub’s analysts compared the differences in premium subsidies that the average households in 457 U.S. cities would receive under Obamacare and Trumpcare. Read on for our findings, commentary from a panel of experts and a full description of our methodology….

Source: WalletHub

The Impact of the Affordable Care Act on Health Coverage for Direct Care Worker

Source: Stephen Campbell, PHI, Issue Brief, March 2017

From the summary:
Direct care workers—nursing assistants, home health aides, and personal care aides who support older Americans and people with disabilities—are among America’s lowest paid workers, often struggling to access health coverage. However, new coverage numbers show that this workforce benefited substantially from the Affordable Care Act (ACA). Between 2010 and 2014, half a million direct care workers gained coverage. At the same time, the uninsured rate across this workforce decreased by 26 percent. As the Trump administration and the new Congress consider the future of the Affordable Care Act (ACA) and Medicaid, it is important to consider the impact of these changes on this critical U.S. workforce.

Medicaid for State Policymakers

Source: National Conference of State Legislatures (NCSL), March 1, 2017

Overview:
Over its 50-year history, Medicaid has represented a critical and evolving issue for state policymakers, who care about Medicaid for many reasons.

– Medicaid provides health insurance for low-income people who have complex needs and require expensive care. Approximately 70 million—or one in five Americans— received health and long-term care coverage through Medicaid in 2015, making it the largest source of coverage for low-income individuals, including pregnant women, children, adults and people with disabilities and low-income seniors who are also covered by Medicare.

– The program is a federal-state partnership, and both the federal government and the states play important roles in ensuring that Medicaid is fiscally sustainable over time and effective in meeting the needs of the populations it serves.

– In 2016, Medicaid accounted for 21.5 percent of total expenditures from state general funds. Across the nation, state spending on Medicaid totaled $509 billion in 2015, of which 62 percent was financed by the federal government and 38 percent by states. ….

No Difference in Patient Mortality in Medical ICUs Staffed by NPs vs Residents

Source: Karen Rosenberg, Joan Zolot, AJN, American Journal of Nursing, Volume 117 – Issue 3, March 2017
(subscription required)

From the abstract:
According to this study:
* No differences were found in mortality rates or costs between a medical ICU staffed by NPs and one staffed by residents, although patients on the NP-staffed unit had longer lengths of stay.
* NPs provide safe, competent care to patients in the medical ICU, offering an alternative to care provided by residents and interns.

Effects of an employee exercise programme on mental health

Source: N. D. Emerson, D. A. Merrill, K. Shedd, R. M. Bilder, P. Siddarth, Occupation Medicine, Volume 67 Issue 2, March 2017
(subscription required)

From the abstract:
Background:
Prior research indicates that workplace wellness programmes (WWPs) are generally associated with lowered healthcare costs and improved employee health. Despite the importance of mental well-being in workplace productivity and attendance, few WWP studies have focused on improvements in psychological well-being.

Aims:
To examine the effects of the Bruin Health Improvement Program (BHIP), a 3-month exercise and nutrition WWP, on seven domains of health: physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life.

Methods:
Using data from BHIP completers, we conducted multiple one-way multivariate analyses of variance and follow-up univariate t-tests to examine changes in physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. Effect sizes were also calculated post hoc to determine the magnitude of each effect.

Results:
Results for the 281 participants reveal significant improvements across all seven domains (P < 0.001). Effect sizes ranged from 0.19 to 0.67. Conclusions: This study is unique in revealing the effects of a WWP on multiple domains of psychological well-being. Given rising healthcare costs associated with mental health, targeting mental health through WWP may be an effective strategy for reducing indirect healthcare costs associated with absenteeism and presenteeism.

Competition and Gaming Behavior by Medicare Home Health Agencies in the United States

Source: Hyunjee Kim, Bingxiao Wu, Jeah Jung, OnlineFirst, Home Health Care Management & Practice, First Published December 5, 2016
(subscription required)

From the abstract:
Under the Medicare home health prospective payment system, agencies could make large profits by targeting the 10th therapy visit. The objective of this study is to examine the influence of market competition on home health agencies’ targeting the 10th therapy visit. This article uses changes in competition rates within each market over time to examine whether home health agencies were more likely to target the 10th visit under greater competition. No significant associations were found between competition and agencies’ targeting behavior on average, but competition effects on targeting behavior were significantly greater for freestanding agencies that were likely to be in relatively financially disadvantageous positions. These findings suggest that competition might increase financially unstable agencies’ 10th-visit targeting behavior, potentially leading to unnecessary Medicare spending.

Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

Source: Vasilis Kontis, James E Bennett, Colin D Mathers, Guangquan Li, Kyle Foreman, Prof Majid Ezzati, The Lancet, Published: 21 February 2017

From the summary:
Background:
Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using an approach that takes into account the uncertainty related to the choice of forecasting model.

Methods:
We developed an ensemble of 21 forecasting models, all of which probabilistically contributed towards the final projections. We applied this approach to project age-specific mortality to 2030 in 35 industrialised countries with high-quality vital statistics data. We used age-specific death rates to calculate life expectancy at birth and at age 65 years, and probability of dying before age 70 years, with life table methods.

Findings:
Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men. There is a 90% probability that life expectancy at birth among South Korean women in 2030 will be higher than 86·7 years, the same as the highest worldwide life expectancy in 2012, and a 57% probability that it will be higher than 90 years. Projected female life expectancy in South Korea is followed by those in France, Spain, and Japan. There is a greater than 95% probability that life expectancy at birth among men in South Korea, Australia, and Switzerland will surpass 80 years in 2030, and a greater than 27% probability that it will surpass 85 years. Of the countries studied, the USA, Japan, Sweden, Greece, Macedonia, and Serbia have some of the lowest projected life expectancy gains for both men and women. The female life expectancy advantage over men is likely to shrink by 2030 in every country except Mexico, where female life expectancy is predicted to increase more than male life expectancy, and in Chile, France, and Greece where the two sexes will see similar gains. More than half of the projected gains in life expectancy at birth in women will be due to enhanced longevity above age 65 years.

Interpretation:
There is more than a 50% probability that by 2030, national female life expectancy will break the 90 year barrier, a level that was deemed unattainable by some at the turn of the 21st century. Our projections show continued increases in longevity, and the need for careful planning for health and social services and pensions.

Related:
What income inequality is doing to Americans’ life spans
Source: Don Sapatkin, Philadelphia Inquirer, February 23, 2017