Category Archives: Health Care

For better patient care, prevent nurse burnout

Source: Futurity, January 30, 2018

“Compassion practices” can have a positive effect on nurses’ work and well-being, a new study suggests.

The phrase refers to relatively conventional organizational practices that reward and recognize caregiving work and include job-related resources to cope with stress and provide pastoral care. “We know there is a burnout epidemic among nurses.”

Nursing is among the top 10 fastest-growing occupations in the United States, but the number of nurses exiting the profession currently outpaces the number of those entering. And the turnover rate is getting even higher.

The Robert Woods Johnson Foundation recently reported that nearly 20 percent of nurses leave the profession during their first year and one in three is gone within two years…..

Related:
Compassion Practices, Nurse Well-Being, and Ambulatory Patient Experience Ratings
Source: Laura E. McClelland, Allison S. Gabriel, Matthew J. DePuccio, Medical Care, Vol. 56 no. 1, January 2018
(subscription required)

From the abstract:
Background:
Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences.

Objective:
To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients’ experience ratings in the ambulatory clinic setting.

Research Design:
Surveys were collected from ambulatory nurses in January and February of 2015 in 30 ambulatory clinics affiliated with an academic medical center. Patient experience ratings were collected April to June of 2015.

Subjects:
One hundred seventy-seven ambulatory nurses (Registered Nurses, LPNs, medical assistants), as well as 3525 adult patients from the ambulatory clinics.

Measures:
Ambulatory nurses assessed compassion practices, emotional exhaustion, and psychological vitality. Patient experience ratings were patient perceptions of courtesy and caring shown by nurses and patients’ ratings of the outpatient services.

Results:
Compassion practices are significantly and negatively associated with nurse emotional exhaustion and positively associated with nurse psychological vitality. At the clinic-level, compassion practices are significantly and positively associated with patient perceptions of caring shown by nurses and overall patient ratings of the outpatient clinic. Supplemental analyses provide preliminary evidence that nurse well-being mediates the relationship between compassion practices and patient ratings of their care experience.

Conclusions:
Our findings illustrate that compassion practices are positively associated with nurse well-being and patient perceptions of the care experience in outpatient clinics.

Delivering Public Health Insurance through Private Plan Choice in the United States

Source: Jonathan Gruber, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
The United States has seen a sea change in the way that publicly financed health insurance coverage is provided to low-income, elderly, and disabled enrollees. When programs such as Medicare and Medicaid were introduced in the 1960s, the government directly reimbursed medical providers for the care that they provided, through a classic “single payer system.” Since the mid-1980s, however, there has been an evolution towards a model where the government subsidizes enrollees who choose among privately provided insurance options. In the United States, privatized delivery of public health insurance appears to be here to stay, with debates now focused on how much to expand its reach. Yet such privatized delivery raises a variety of thorny issues. Will choice among private insurance options lead to adverse selection and market failures in privatized insurance markets? Can individuals choose appropriately over a wide range of expensive and confusing plan options? Will a privatized approach deliver the promised increases in delivery efficiency claimed by advocates? What policy mechanisms have been used, or might be used, to address these issues? A growing literature in health economics has begun to make headway on these questions. In this essay, I discuss that literature and the lessons for both economics more generally and health care policymakers more specifically.

Related:
Selection in Health Insurance Markets and Its Policy Remedies
Source: Michael Geruso Timothy J. Layton, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
Selection (adverse or advantageous) is the central problem that inhibits the smooth, efficient functioning of competitive health insurance markets. Even—and perhaps especially—when consumers are well-informed decision makers and insurance markets are highly competitive and offer choice, such markets may function inefficiently due to risk selection. Selection can cause markets to unravel with skyrocketing premiums and can cause consumers to be under- or overinsured. In its simplest form, adverse selection arises due to the tendency of those who expect to incur high health care costs in the future to be the most motivated purchasers. The costlier enrollees are more likely to become insured rather than to remain uninsured, and conditional on having health insurance, the costlier enrollees sort themselves to the more generous plans in the choice set. These dual problems represent the primary concerns for policymakers designing regulations for health insurance markets. In this essay, we review the theory and evidence concerning selection in competitive health insurance markets and discuss the common policy tools used to address the problems it creates. We emphasize the two markets that seem especially likely to be targets of reform in the short and medium term: Medicare Advantage (the private plan option available under Medicare) and the state-level individual insurance markets.

The Questionable Value of Having a Choice of Levels of Health Insurance Coverage
Source: Keith Marzilli Ericson, Justin Sydnor, Journal of Economic Perspectives, Vol. 31 no. 4, Fall 2017

From the abstract:
In most health insurance markets in the United States, consumers have substantial choice about their health insurance plan. However additional choice is not an unmixed blessing as it creates challenges related to both consumer confusion and adverse selection. There is mounting evidence that many people have difficulty understanding the value of insurance coverage, like evaluating the relative benefits of lower premiums versus lower deductibles. Also, in most US health insurance markets, people cannot be charged different prices for insurance based on their individual level of health risk. This creates the potential for well-known problems of adverse selection because people will often base the level of health insurance coverage they choose partly on their health status. In this essay, we examine how the forces of consumer confusion and adverse selection interact with each other and with market institutions to affect how valuable it is to have multiple levels of health insurance coverage available in the market.

Workplace Wellness Programs Really Don’t Work

Source: Rebecca Greenfield, Bloomberg, January 26, 2018

Workplace wellness programs have two main goals: improve employees’ health and lower their employers’ health-care costs. They’re not very good at either, new research finds.

Related:
What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study
Source: Damon Jones, David Molitor, Julian Reif, National Bureau of Economic Research, NBER Working Paper No. 24229, January 2018
(subscription required)

From the abstract:
Workplace wellness programs cover over 50 million workers and are intended to reduce medical spending, increase productivity, and improve well-being. Yet, limited evidence exists to support these claims. We designed and implemented a comprehensive workplace wellness program for a large employer with over 12,000 employees, and randomly assigned program eligibility and financial incentives at the individual level. Over 56 percent of eligible (treatment group) employees participated in the program. We find strong patterns of selection: during the year prior to the intervention, program participants had lower medical expenditures and healthier behaviors than non-participants. However, we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status in the first year. Our 95% confidence intervals rule out 78 percent of previous estimates on medical spending and absenteeism. Our selection results suggest these programs may act as a screening mechanism: even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers.

Giving States Flexibility to Change Obamacare without Changing the Law: Examining the Potential Uses of the Affordable Care Act’s State Waiver Process

Source: Michael Gusmano, John Kaelin, and Thomas Gais, Nelson A. Rockefeller Institute of Government, Policy Brief, January 19, 2018

From the press release:
In a new policy brief, researchers explore the potential of the Affordable Care Act’s 1332 waiver as a tool for widespread, state-level policy change to address challenges in Affordable Care Act (ACA) implementation.

Section 1332 of the Affordable Care Act is intended to give states the flexibility to achieve the goals of the legislation while adapting to local factors by applying for an innovation waiver. Based on the list of provisions that may be subject to the waiver, many core features of the ACA could be changed at the state level through a Section 1332 waiver, including the creation of health insurance exchanges, ACA certification standards for qualified health plans, ACA requirements related to essential health benefits (EHB), cost-sharing reduction payments and premium tax credits (with alternative funding available), and employer and individual mandates.

In their new brief, Gusmano, Kaelin, and Gais examine the waiver’s origins, powers and limitations, uses to date, and its potential role in adapting the ACA to changing and diverse circumstances. They observe, for example, a shift in the purposes of 1332 applications before and after the 2016 elections—suggesting a new function for waivers to not only pursue innovative pathways to implementation, but to help states respond quickly and effectively to rapid changes in healthcare markets. The authors also outline ways in which the waiver process may be improved…..

SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs

Source: Steven Carlson and Brynne Keith-Jennings, Center on Budget and Policy Priorities, January 17, 2018

From the summary:
New and emerging research links the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the nation’s most important anti-hunger program, with improved health outcomes and lower health care costs. This research adds to previous work showing SNAP’s powerful capacity to help families buy adequate food, reduce poverty, and help stabilize the economy during recessions…..

What the dip in US life expectancy is really about: inequality

Source: Julia Belluz, Vox, January 9, 2018

Living in the US increasingly looks like a health risk. Average life expectancy here dropped for the second year in a row, according to recent data from the Centers for Disease Control and Prevention. The grim trend stems from a toxic mixture of more drug- and alcohol-related deaths and more heart disease and obesity in many parts of the country. And it puts Americans at a higher risk of early death compared to their counterparts in other wealthy countries.

But what’s often lost in the conversation about the uptick in mortality here is that this trend isn’t affecting all Americans. In fact, there’s one group in the US that’s actually doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity….

The Bureaucratic Nightmare of Incrementalism

Source: Meagan Day, Jacobin, January 17, 2018

America’s patchwork system of social services makes it hard to care for ourselves. ….

….It’s actually less expensive to spend public money on shelter instead — and meanwhile, people who receive shelter see significantly better health outcomes, which can help them attain overall stability.

Some cities and states have recently acknowledged this calculus. Salt Lake City’s enormously successful Housing First initiative has reduced chronic homelessness in the city by 91 percent by providing housing to homeless people without requiring proof of employment, treatment, or counseling — the principle being that housing comes first, making other services easier to administer. Houston, too, has seen major improvement in both homeless people’s health outcomes and the city’s budget with its Integrated Care for the Chronically Homeless program, which uses Medicaid funding to provide permanent supportive housing units to homeless people who make at least three emergency room visits over two years.

These initiatives are a big step in the right direction, since they take into account the close relationship between health care and housing security — issues that are usually siloed to detrimental effect. But programs like these face serious obstacles. In particular, it’s extremely hard to coordinate among a kaleidoscope of separate federal, state, and local agencies, social program stipulations, and funding streams..;…

FAQ: Wide Differences in State Retiree Health Spending and Liabilities

Source: Moody’s, Sector In-Depth, December 19, 2017
(subscription required)

Retiree health benefits vary considerably among states. Despite generally greater legal flexibility to change these benefits compared to pensions, large liabilities and significant costs persist for some state employers who offer generous benefits. We do not expect new accounting rules to have a material impact on costs, but the new rules will facilitate probing credit risk, especially important for those issuers whose retiree benefits have stronger legal protections.

Medicaid and Financial Health

Source: Kenneth Brevoort, Daniel Grodzicki, Martin B. Hackmann, National Bureau of Economic Research (NBER), NBER Working Paper No. 24002, November 2017
(subscription required)

From the abstract:
This paper investigates the effects of the Medicaid expansion provision of the Affordable Care Act (ACA) on households’ financial health. Our findings indicate that, in addition to reducing the incidence of unpaid medical bills, the reform provided substantial indirect financial benefits to households. Using a nationally representative panel of 5 million credit records, we find that the expansion reduced unpaid medical bills sent to collection by $3.4 billion in its first two years, prevented new delinquencies, and improved credit scores. Using data on credit offers and pricing, we document that improvements in households’ financial health led to better terms for available credit valued at $520 million per year. We calculate that the financial benefits of Medicaid double when considering these indirect benefits in addition to the direct reduction in out-of-pocket expenditures.

Are Zero Tolerance Drug Testing Policies About to Go Up in Smoke?

Source: Nathaniel M. Glasser, Employee Benefit Plan Review, Vol. 72 no. 2, October 2017
(subscription required)

In an important recent decision, the Massachusetts Supreme Judicial Court recently held that a qualifying patient who has been terminated from employment for testing positive for marijuana as a result of her lawful medical marijuana use may state a claim of disability discrimination under that state’s anti-discrimination statute. Much like a similar decision in Rhode Island, this holding has significant implications for employers that drug test for marijuana use because 29 states plus the District of Columbia have enacted legislation legalizing medical or recreational marijuana use, or both.