Category Archives: Health Care

Financing Healthcare

Source: Esteban Ortiz-Ospina and Max Roser, Our World in Data, 2016

Health is a fundamental driver of our overall quality of life. In this entry we focus on healthcare – one of the most important inputs to produce health. There are many other factors affecting health, and you can read more about some of them in our entries about health.

Publicly funded healthcare is a legacy of the Age of Enlightenment. The first examples of legislation on health insurance date back to the late 19th century. Data from these early systems shows that healthcare expenditure only began rising several years after the expansion of insurance coverage, with the discovery of powerful new treatments.

The impact that scientific developments had on healthcare expenditure is epitomized in the U.S. experience: in recent decades, as treatment possibilities expanded rapidly, expenditure on healthcare increased (private and public, both per capita and as a share of gross domestic product); and this occurred without major changes in insurance coverage. This had two important consequences: (i) the U.S. currently spends more government money per person on healthcare than many countries that fund universal programs, and (ii) spending is so concentrated that the top 1% of spenders account for more than 20% of total healthcare expenditure.

Should Medicare Regulate The Price Of Prescription Drugs?

Source: Journal of Policy Analysis and Management, Early View, August 11, 2016
(subscription required)

Articles include:
The Advantages Of Awarding The Federal Government Negotiating Power Over The Prices Of Prescription Drugs
Rena M. Conti

Awarding federal government negotiating power over the prices of prescription drugs for Medicare and Medicaid beneficiaries offers some substantial advantages. Yet, in practice, strongly opposed rhetoric stemming from many actors who profit off the current system may trump its strengths. “Second best” policies with great hope to rein in prescription drug prices are already gaining a foothold in the national debate and should be considered by policymakers looking to rein in prices for Medicare and Medicaid beneficiaries, One entails the use of performance contracting on price for selected drugs between pharmaceutical manufacturers and insurers. The other entails carving out the financing of selected drugs or drug classes with substantial public health import to the federal government.

Why Medicare Price Negotiation Is The Wrong Prescription For Rising Drug Spending
Geoffrey F. Joyce And Neeraj Sood

Why Medicare Price Negotiation Is The Wrong Prescription For Rising Drug Spending: Response To Rena Conti
Geoffrey F. Joyce And Neeraj Sood

Response to Joyce and Soon
Rena M. Conti

Should Medicare Regulate The Price Of Prescription Drugs?

Individuals With Serious Mental Illnesses in County Jails: A Survey of Jail Staff’s Perspectives

Source: Azza AbuDagga, Sidney Wolfe, Michael Carome, Amanda Phatdouang, E. Fuller Torrey, Public Citizen’s Health Research Group and The Treatment Advocacy Center, Research Report, July 14, 2016

From the abstract:
Public Citizen and the Treatment Advocacy Center are releasing a comprehensive national survey that captures the perspectives of county jail staff about inmates with serious mental illnesses. According to the report, 21 percent of the surveyed county jails reported that 16 percent or more of their inmates were seriously mentally ill. The report presents the challenges faced by county jail staff, including the limited training they are given to address the needs of these inmates, who do not belong in jails to begin with.
Related:
Press Release
Recording of the press conference

National Survey of Prison Health Care: Selected Findings

Source: Karishma A. Chari, Alan E. Simon, Carol J. DeFrances, Laura Maruschak National Health Statistics Reports (NHSR), No. 96, July 28, 2016

Objectives—This report presents selected findings on the provision of health care services in U.S. state prisons. Findings on admissions testing for infectious disease, cardiovascular risk factors, and mental health conditions, as well as the location of the provision of care and utilization of telemedicine are all included.
Methods—Data are from the National Survey of Prison Health Care (NSPHC). The survey aimed to conduct semi-structured telephone interviews with respondents from all 50 state Departments of Corrections and the Federal Bureau of Prisons. Interviews were conducted in 2012 for calendar year 2011. The level of participation varied by state and questionnaire item.
Results—Overall, 45 states participated in NSPHC. In 2011, the percentages of prison admissions occurring in states that tested at least some prisoners for the following conditions during the admissions process were: 76.9% for hepatitis A, 82.0% for hepatitis B, 87.3% for hepatitis C, 100.0% for tuberculosis, 100.0% for mental health conditions and suicide risk, 40.3% for traumatic brain injury, 82.5% for cardiovascular conditions and risk factors using electrocardiogram, 70.0% for elevated lipids, and 99.8% for high blood pressure.
Of the 45 states that participated in the survey, most states delivered several services on-site, including inpatient and outpatient mental health care (27 and 44 states, respectively), care for chronic diseases (31 states), long-term or nursing home care (35 states), and hospice care (35 states). For inpatient and outpatient medical, dental, and emergency care, most states delivered services using a combination of on-site and off-site care locations. Most states delivered selected diagnostic procedures and radiologic tests off-site. Telemedicine was most commonly used for psychiatry (28 states).

CNA Training Requirements and Resident Care Outcomes in Nursing Hom

Source: Alison M. Trinkoff, Carla L. Storr, Nancy B. Lerner, Bo Kyum Yang and Kihye Han, The Gerontologist, Advance Access, First published online: April 8, 2016

From the abstract:
Purpose of the Study: To examine the relationship between certified nursing assistant (CNA) training requirements and resident outcomes in U.S. nursing homes (NHs). The number and type of training hours vary by state since many U.S. states have chosen to require additional hours over the federal minimums, presumably to keep pace with the increasing complexity of care. Yet little is known about the impact of the type and amount of training CNAs are required to have on resident outcomes.

Design and Methods: Compiled data on 2010 state regulatory requirements for CNA training (clinical, total initial training, in-service, ratio of clinical to didactic hours) were linked to 2010 resident outcomes data from 15,508 NHs. Outcomes included the following NH Compare Quality Indicators (QIs) (Minimum Data Set 3.0): pain, antipsychotic use, falls with injury, depression, weight loss and pressure ulcers. Facility-level QIs were regressed on training indicators using generalized linear models with the Huber-White correction, to account for clustering of NHs within states. Models were stratified by facility size and adjusted for case-mix, ownership status, percentage of Medicaid-certified beds and urban-rural status.

Results: A higher ratio of clinical to didactic hours was related to better resident outcomes. NHs in states requiring clinical training hours above federal minimums (i.e., >16hr) had significantly lower odds of adverse outcomes, particularly pain falls with injury, and depression. Total and in-service training hours also were related to outcomes.

Implications: Additional training providing clinical experiences may aid in identifying residents at risk. This study provides empirical evidence supporting the importance of increased requirements for CNA training to improve quality of care.

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

Source: Benjamin D. Sommers, Robert J. Blendon, E. John Orav, Arnold M. Epstein, JAMA Intern Mededicine, Online First, Published online August 8, 2016
(subscription required)

From the abstract:
Importance: Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the “private option”). In addition, while coverage gains from the ACA’s Medicaid expansion are well documented, impacts on utilization and health are unclear.

Objective: To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA.

Design, Setting, and Participants: Differences-in-differences analysis of survey data from November 2013 through December 2015 of US citizens ages 19 to 64 years with incomes below 138% of the federal poverty level in Kentucky, Arkansas, and Texas (n = 8676). Data analysis was conducted between January and May 2016.

Exposures: Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas.

Main Outcomes and Measures: Self-reported access to primary care, specialty care, and medications; affordability of care; outpatient, inpatient, and emergency utilization; receiving glucose and cholesterol testing, annual check-up, and care for chronic conditions; quality of care, depression score, and overall health.

Results: Among the 3 states included in the study, Arkansas, Kentucky, there were no differences in sex, income, or marital status. Respondents from Texas were younger, more urban, and disproportionately Latino compared with those in Arkansas and Kentucky. Significant changes in coverage and access were more apparent in 2015 than in 2014. By 2015, expansion was associated with a 22.7 percentage-point reduction in the uninsured rate compared with nonexpansion. Expansion was associated with significantly increased access to primary care, fewer skipped medications due to cost, reduced out-of-pocket spending, reduced likelihood of emergency department visits, and increased outpatient visits. Screening for diabetes, glucose testing among patients with diabetes, and regular care for chronic conditions all increased significantly after expansion. Quality of care ratings improved significantly, as did the share of adults reporting excellent health. Comparisons of Arkansas vs Kentucky showed increased private coverage in the former, increased Medicaid in the latter, and higher diabetic glucose testing rates in Kentucky, but no other statistically significant differences.

Conclusions and Relevance: In the second year of expansion, Kentucky’s Medicaid program and Arkansas’s private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion.

Related:
Press release

Overview of Health Insurance Exchanges

Source: Namrata K. Uberoi, Annie L. Mach, Bernadette Fernandez, Congressional Research Service, CRS Report, R44065, July 1, 2016

….This report provides an overview of the various components of the health insurance exchanges. The report includes summary information about how exchanges are structured, the intended consumers for health insurance exchange plans, and consumer assistance available in the exchanges, as specified in the ACA. The report also describes the availability of financial assistance for certain exchange consumers and small businesses and outlines the range of plans offered through exchanges. Moreover, the report provides a brief summary of the implementation and operation of exchanges since 2014….

Gender-Based Discrimination in the Workplace: Why Courts Tell Employers That Breastfeeding Discrimination Is Legal

Source: Ashley M. Alteri, Review of Public Personnel Administration, Vol. 36 no. 3, September 2016
(subscription required)

From the abstract:
In March 2010, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act were signed into law. These Acts include a provision governing “reasonable break time for nursing mothers” for those employers and employees covered under the Fair Labor Standards Act. However, neither these Acts, nor the Pregnancy Discrimination Act, nor Title VII, nor the Americans with Disabilities Act expressly protect women from discrimination resulting from her choice to lactate at work (to include either feeding a child directly from the breast or by expressing milk to be used at a later time). Accordingly, this article examines how federal courts have treated claims of breastfeeding discrimination at work. Although courts have generally been unsympathetic to these claims, employers should consider proactive accommodation measures because recent cases indicate that courts may be willing to entertain these claims.

The High Health Costs of TPP’s “Free Trade”

Source: Joseph Stiglitz, Public Citizen, Global Trade Watch, 2016

Despite protests from industry lobbyists who are upset that they did not get everything they wanted, big pharmaceutical companies are some of the biggest winners in the Trans-Pacific Partnership (TPP). This supposed “free trade” agreement between the United States and 11 countries in the Americas and Asia would enshrine expansive monopoly protections for intellectual properties that shield drug makers from competition and provide them with new powers to challenge government decisions aimed at managing health care costs. A win for Big Pharma here will leave virtually everyone else worse off, with their higher profits coming at the expense of higher health care costs for consumers and taxpayers, avoidable deaths and suffering, and health innovations being brought to market at a slower pace….