Category Archives: Health Care

New Chartbook Provides the Essentials of Medi-Cal

Source: California Health Care Foundation, May 2007

Summary
The main source of health insurance for one in six Californians, Medi-Cal is the nation’s largest Medicaid program covering 6.6 million people. Medi-Cal pays for nearly half of all births in the state, two-thirds of nursing home residents, and brings in more than $20 billion in federal funds to California’s health care providers.

The third edition of Medi-Cal Facts and Figures provides the essential elements of this massive program, including new information on enrollment, benefits and cost sharing, program spending and cost drivers. It also features key trends and comparisons with other states, describes the important role that Medi-Cal serves in California’s health care system, and examines several challenges facing the program.

Evolving Beyond Traditional Employer-Sponsored Health Insurance

Source: Stuart M. Butler, The Brookings Institution, Hamilton Project Discussion Paper 2007-06, May 2007

For most working-age families, health insurance coverage is directly connected to the workplace. But because of structural weaknesses in this traditional form of coverage, it is steadily eroding, especially for workers in the small business sector. The health insurance system needs to evolve along a different path if it is to adapt to the goals and needs of today’s workforce. Unfortunately, existing laws and insurance arrangements obstruct that evolution. Three key steps are needed to achieve a gradual transformation without disrupting the successful parts of the system.

First, states should establish “insurance exchanges.” Exchanges would offer an array of coverage options, and families could retain their chosen plan from workplace to workplace with the same tax benefits as those available for traditional employer-sponsored plans. Second, most employers should become facilitators, rather than sponsors, of coverage. While many large employers would continue to sponsor coverage, most employers would hand over sponsorship to an insurance exchange and focus on providing administrative support for their employees’ insurance choices. Third, the federal government should reform the tax treatment of health to focus help on lower-income families.
+ Full policy brief

Working Sick, Getting Stiffed: How Some of America’s Biggest Companies Fail Their Workers and Jeopardize Public Health

Source: Association of Community Organizations for Reform Now, Inc. (ACORN), March 1, 2007

ACORN’s Healthy Workers, Healthy Families Campaign calls on businesses to provide workers with a fair number of paid sick days a year. We also call on Congress and state legislatures to pass laws guaranteeing that all workers have paid sick days.

Nearly half of American private-sector workers have no guaranteed paid sick days – yet everyone gets sick and everyone needs time to get well. Workers also have families and responsibilities to care for sick children and other relatives who need them.

ACORN called 50 of the largest food service and retail companies operating in America and asked if they provided their hourly workers with paid sick days. Despite the close contact with the public that characterizes jobs in these industries, a near-majority of the companies for which we gathered information were clear that they did not offer paid sick days to hourly employees.

When I’m 64: How Boomers Will Change Health Care

Source: American Hospital Association, May 2007

From press release:

The over-65 population will nearly triple between 1980 and 2030 as a result of the aging Baby Boomers, adding new demands and challenges on an already stressed-out health system, according to a new report released today by First Consulting Group of Long Beach, Calif. With new projections on Boomer health into 2030, the report details how this powerful population will impact health care for decades to come.

The first Boomers will turn 65 in 2011 and, according to today’s report, more than 37 million of them – six out of 10 – will be managing more than one chronic condition by 2030. Also by 2030:
• 14 million Boomers will be living with diabetes – that’s one out of every four Boomers.
• Almost half of the Boomers will live with arthritis and that number peaks to just over 26 million in 2020.
• More than one out of three Boomers – over 21 million – will be considered obese.

Maternity Care and Consumer-Driven Health Plans

Source: Women’s Health Policy Program, Kaiser Family Foundation, June 12, 2007

With maternity care representing one of the most common and costly medical interventions that women experience, Kaiser and the March of Dimes co-hosted a forum to release new studies that analyze the costs of maternity care and assess coverage under consumer-driven health plans (CDHPs). Kaiser released a new study that compares the out-of-pocket costs of maternity care under CDHPs and traditional health insurance plans. The March of Dimes released a new study prepared by Thomson Healthcare that examines the overall costs of having a baby.

+ Executive Summary
+ Full Report
+ Thomson Report: The Healthcare Costs of Having a Baby
+ March of Dimes: Maternity Care Fact Sheet

Health Insurance: Can Californians Afford it?

Source: California Health Care Foundation, June 2007

Summary

The report offers a number of key findings including:
– Monthly premiums in the small group market are, on average, 50% higher than in the individual market.
– Insurance covered 83% of a person’s medical bills in the small group market, and 55% of those costs in the individual market.
– A person buying coverage in the individual market earning the median household income ($30,623) would have spent 16% of income for health care and coverage, compared to less than 4% of income in the small group market, where employers are likely to contribute a share of the premium and benefits are more generous.

Further Evidence of Affordability Problems
A companion piece, available as a Health Affairs Web exclusive, provides additional evidence of growing affordability problems in these two markets, albeit in different ways. Jon Gabel and co-authors find that small group premiums in California increased 53% between 2003 and 2006, while premiums for individual coverage rose only 23% between 2002 and 2006.
However, the average actuarial value of individual coverage declined dramatically. In 2003 individual market policies paid 75% of medical costs on average; that figure had dropped to 55% just three years later. In contrast, small group market policies retained their actuarial value, paying for roughly 83% of medical expenses across a similar period.

Principles for SCHIP Reform

Source: Council for Affordable Health Insurance’s Issues and Answers no. 143, June 2007

From press release:

The State Children’s Health Insurance Program (SCHIP) is up for reauthorization, and there appears to be bipartisan support for not just reauthorizing the program but greatly expanding it. Indeed, the legislation may become a vehicle for much of what Congress wants to accomplish in health care this year.
However, SCHIP was intended to be a limited program to help uninsured children from modest- income families — not a huge entitlement covering middle- and upper-middle-income children and hundreds of thousands of adults.

Today, the Council for Affordable Health Insurance (CAHI) released its newest Issues & Answers, “Principles for SCHIP Reform.” The paper identifies key principles that should guide lawmakers in their reauthorization efforts, if they want a financially sustainable program that provides access to quality health care for low- income children.

ANA 2007 Study of Injectable Medication Errors

Source: American Nurses Association and Inviro Medical Devices, 2007

The 2007 Study of Injectable Medication Errors gathered opinions of 1,039 U.S. nurses about errors related to injectable medications and syringe labeling. The independent research, sponsored by the American Nurses Association (ANA) and Inviro Medical Devices, reveals 97% of nurses worry about medication errors, and two-thirds (68%) believe medication errors could be reduced with more consistent syringe labeling.

Hospitals, Language, and Culture: A Snapshot of the Nation – Exploring Cultural and Linguistic Services in the Nation’s Hospitals: A Report of Findings

Source: Amy Wilson-Stronks and Erica Galvez, The Joint Commission, 2007

As our nation becomes more diverse, so do the patient populations served by our nation’s hospitals. Few studies have explored the provision of culturally and linguistically appropriate health care in a systematic fashion across a large number of hospitals. With funding from The California Endowment, the Hospitals, Language, and Culture: A Snapshot of the Nation project is working to strengthen this understanding. Hospitals, Language, and Culture is a qualitative cross-sectional study designed to provide a snapshot of how sixty hospitals across the country are providing health care to culturally and linguistically diverse patient populations. This project sought to answer the following questions:

• What challenges do hospitals face when providing care and services to culturally and linguistically diverse populations?

• How are hospitals addressing these challenges?

• Are there promising practices that may be helpful to and can be replicated in other hospitals?

The project findings will be presented in multiple reports. This report highlights findings regarding the first two research questions.

Consumer-Driven Health Care in Its Adolescence

Source: Kevin O’Hara, Employee Benefit Plan Review, March 2007

As the groundswell continues for the implementation of the American health care model’s latest panacea, consumer-driven health care (CDHC), it becomes important to take a moment or two to review the progress to date. The popularity of CDHC plans has grown steadily in recent years with projections for their adoption rate to accelerate as early missteps are corrected. Difficulties encountered in the communication and administration of CDHC benefits short-circuited extremely optimistic early forecasts of their penetration rate as a percentage of all sponsored plan offerings. Recent surveys, such as the Kaiser Family Foundation Employer Health Benefits 2006 Annual Survey, indicate a continued increase in CDHC enrollment but at a much reduced rate than first anticipated.