Category Archives: Health Care

Distinguishing the Race-Specific Effects of Income Inequality and Mortality in U.S. Metropolitan Areas

Source: Amani M. Nuru-Jeter, Chyvette T. Williams, Thomas A. LaVeist, International Journal of Health Services, Volume 44 Number 3, 2014
(subscription required)

From the abstract:
In the United States, the association between income inequality and mortality has been fairly consistent. However, few studies have explicitly examined the impact of race. Studies that have either stratified outcomes by race or conducted analyses within race-specific groups suggest that the income inequality/mortality relation may differ for blacks and whites. The factors explaining the association may also differ for the two groups. Multivariate ordinary least squares regression analysis was used to examine associations between study variables. We used three measures of income inequality to examine the association between income inequality and age-adjusted all-cause mortality among blacks and whites separately. We also examined the role of racial residential segregation and concentrated poverty in explaining associations among groups. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10 percent black. There was a positive income inequality/mortality association among blacks and an inverse association among whites. Racial residential segregation completely attenuated the income inequality/mortality relationship for blacks, but was not significant among whites. Concentrated poverty was a significant predictor of mortality rates in both groups but did not confound associations. The implications of these findings and directions for future research are discussed.
Greater income inequality linked to more deaths for black Americans
Source: Sarah Yang, University of California, Berkeley, Press release, December 1, 2014

Greater income inequality is linked to more deaths among African Americans, but the effect is reversed among white Americans, who experienced fewer deaths, according to a new study by researchers at the University of California, Berkeley.

Low-Income Residents In Three States View Medicaid As Equal To Or Better Than Private Coverage, Support Expansion

Source: Arnold M. Epstein, Benjamin D. Sommers, Yelena Kuznetsov, and Robert J. Blendon, Health Affairs, Vol. 33 no. 11, November 2014
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From the abstract:
Expansion of Medicaid under the Affordable Care Act to millions of low-income adults has been controversial, yet little is known about what these Americans themselves think about Medicaid. We conducted a telephone survey in late 2013 of nearly 3,000 low-income adults in three Southern states—Arkansas, Kentucky, and Texas—that have adopted different approaches to the options for expansion. Nearly 80 percent of our sample in all three states favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Yet awareness of their state’s actual expansion plans was low. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability. While the debate over Medicaid expansion continues, support for expansion is strong among low-income adults, and the perceived quality of Medicaid coverage is high.

Identifying Hospitals That May Be At Most Financial Risk From Medicaid Disproportionate-Share Hospital Payment Cuts

Source: Evan S. Cole, Daniel Walker, Arthur Mora, and Mark L. Diana, Health Affairs, Vol. 33 no. 11, November 2014
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From the abstract:
Medicaid disproportionate-share hospital (DSH) payments are expected to decline by $35.1 billion between fiscal years 2017 and 2024, a reduction brought about by the Affordable Care Act (ACA) and recent congressional action. DSH payments have long been a feature of the Medicaid program, intended to partially offset uncompensated care costs incurred by hospitals that treat uninsured and Medicaid populations. The DSH payment cuts were predicated on the expectation that the ACA’s expansion of health insurance to millions of Americans would bring about a decline in many hospitals’ uncompensated care costs. However, the decision of twenty-five states not to expand their Medicaid programs, combined with residual coverage gaps, may leave as many as thirty million people uninsured, and hospitals will bear the burden of their uncompensated care costs. We sought to identify the hospitals that may be the most financially vulnerable to reductions in Medicaid DSH payments. We found that of the 529 acute care hospitals that will be particularly affected by the cuts, 225 (42.5 percent) are in weak financial condition. Policy makers should recognize that decreases in revenue may affect these hospitals’ ability to give vulnerable populations access to care.

Hennepin Health: A Safety-Net Accountable Care Organization For The Expanded Medicaid Population

Source: Shana F. Sandberg, Clese Erikson, Ross Owen, Katherine D. Vickery, Scott T. Shimotsu, Mark Linzer, Nancy A. Garrett, Kimry A. Johnsrud, Dana M. Soderlund, and Jennifer DeCubellis, Health Affairs, Vol. 33 no. 11, November 2014
(subscription required)

From the abstract:
Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health—a county-based safety-net accountable care organization in Minnesota—has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs.

The Child Opportunity Index: Improving Collaboration Between Community Development And Public Health

Source: Dolores Acevedo-Garcia, Nancy McArdle, Erin F. Hardy, Unda Ioana Crisan, Bethany Romano, David Norris, Mikyung Baek, and Jason Reece, Health Affairs, Vol. 33 no. 11, November 2014
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From the abstract:
Improving neighborhood environments for children through community development and other interventions may help improve children’s health and reduce inequities in health. A first step is to develop a population-level surveillance system of children’s neighborhood environments. This article presents the newly developed Child Opportunity Index for the 100 largest US metropolitan areas. The index examines the extent of racial/ethnic inequity in the distribution of children across levels of neighborhood opportunity. We found that high concentrations of black and Hispanic children in the lowest-opportunity neighborhoods are pervasive across US metropolitan areas. We also found that 40 percent of black and 32 percent of Hispanic children live in very low-opportunity neighborhoods within their metropolitan area, compared to 9 percent of white children. This inequity is greater in some metropolitan areas, especially those with high levels of residential segregation. The Child Opportunity Index provides perspectives on child opportunity at the neighborhood and regional levels and can inform place-based community development interventions and non-place-based interventions that address inequities across a region. The index can also be used to meet new community data reporting requirements under the Affordable Care Act.

National Health Spending In 2013: Growth Slows, Remains In Step With The Overall Economy

Source: Micah Hartman, Anne B. Martin, David Lassman, Aaron Catlin, Health Affairs, published online before print December 2014
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From the abstract:
In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or $9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase.

Michigan: Baseline Report – State-Level Field Network Study of the Implementation of the Affordable Care Act

Source: Center for Healthcare Research & Transformation (CHRT) at the University of Michigan, Rockefeller Institute of Government, Brookings Institution, Fels Institute of Government, ACA Implementation Research Network, December 2014

The Center for Healthcare Research & Transformation (CHRT) at the University of Michigan has released a baseline report on Michigan’s implementation of the Affordable Care Act (ACA), which shows that the alternative approach to passing and implementing Medicaid expansion in Michigan — a state led by a Republican governor — can be a model for other states with bipartisan or Republican-led governments seeking Medicaid expansion. This is the most recent of the state reports of the 36-state ACA implementation network, a collaborative endeavor of the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.
Press release

Immigrant Health Care Access and the Affordable Care Act

Source: Sanjay K. Pandey, Joel C. Cantor and Kristen Lloyd, Public Administration Review, Vol. 74 no. 6, November/December 2014
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From the abstract:
In spite of major coverage expansions under the Patient Protection and Affordable Care Act (ACA), a large proportion of immigrants will continue to remain outside the scope of coverage. Because various provisions of the ACA seek to enhance access, advancing knowledge about immigrant access to health care is necessary. The authors apply the well-known Andersen model on health care access to two measures—one focusing on perceptions of unmet health care needs and the other on physician visits during the last year. Using data from the New Jersey Family Health Survey, the authors find that prior to implementation of the ACA coverage expansions, immigrants in New Jersey reported lower levels of unmet health care needs despite poorer self-rated health compared with U.S.-born residents. The article concludes with a discussion of the use of Andersen model for studying immigrant health care access and the broader implications of the findings.

Local Government Strategies to Address Rising Health Care Costs

Source: Elizabeth Kellar, Christine Becker, Christina Barberot, Ellen Bayer, Enid Beaumont, Bonnie Faulk, Joshua Franzel, Mark Ossolinski, and Danielle Miller Wagner, Center for State and Local Government Excellence (SLGE) and University of Tennessee, December 2014

From the abstract:
Rising costs over the last decade have prompted many local governments to make changes to their health plans and strategies. Cost sharing, wellness program, and disease management initiatives are widely reported. Other changes cited include increased reliance on high-deductible plans, dependent eligibility audits, and altering retiree benefits.

Key findings:
– The top cost drivers of local government health care increases were increased claim costs (64 percent); prescription drugs (57 percent); an aging workforce (46 percent); insurance company price increases (45 percent) and federal health care policy (45 percent).
– Fifty-seven (57) percent of respondents increased cost sharing of premiums paid by employees and nearly half of respondents reported that their local governments changed the way health insurance is provided.
– Nineteen (19) percent of those reporting health plan changes shifted employees to a high-deductible plan with a health savings account and 14 percent established a health reimbursement arrangement.
– Disease management programs, on-site clinics, dependent eligibility audits, and regular review and rebidding of health care vendor contracts have achieved significant savings.
– Respondents reported that providing easy access to health services at work sites not only supports employee wellness, but also reduces employee absenteeism and health care costs.

State Expenditure Report (Fiscal 2012-2014 Data)

Source: National Association of State Budget Officers, 2014

This annual report examines spending in the functional areas of state budgets: elementary and secondary education, higher education, public assistance, Medicaid, corrections, transportation, and all other. It also includes data on the State Children’s Health Insurance Program and on revenue sources in state general funds.

The latest edition of NASBO’s State Expenditure Report finds that total state spending in fiscal 2014 is estimated to have grown at its fastest pace since before the recession, largely due to an increase in federal Medicaid funds as a majority of states chose to expand enrollment under the Affordable Care Act. Total state spending growth in fiscal 2013 was more modest; however, total state expenditure did return to positive growth following declines in fiscal 2012.