Category Archives: Health Care

Workers’ compensation: Poor quality health care and the growing disability problem in the United States

Source: Gary M. Franklin, Thomas M. Wickizer, Norma B. Coe, Deborah Fulton-Kehoe, American Journal of Industrial Medicine, Early View, first published online: October 20, 2014
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From the abstract:
The proportion of working age citizens permanently removed from the workforce has dramatically increased over the past 30 years, straining both Federal and State disability systems designed as a safety net to protect them. Almost one-third of these rapidly emerging disabilities are related to musculoskeletal disorders, and three of the top five diagnoses associated with the longest Years Lived with Disability are back, neck and other musculoskeletal disorders. The failure of Federal and state workers’ compensation systems to provide effective health care to treat non-catastrophic injuries has been largely overlooked as a principal source of permanent disablement and corresponding reduced labor force participation. Innovations in workers’ compensation health care delivery, and in use of evidence-based coverage methods such as prospective utilization review, are effective secondary prevention efforts that, if more widely adopted, could substantially prevent avoidable disability and provide more financial stability for disability safety net programs.

Workplace Health Promotion and Labour Market Performance of Employees

Source: Martin Huber, Michael Lechner, Conny Wunsch, Centre for Economic Policy Research (CEPR), CEPR Discussion Paper No. DP10055, July 1, 2014
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From the abstract:
This paper investigates the average effects of (firm-provided) workplace health promotion measures in form of the analysis of sickness absenteeism and health circles/courses on labour market outcomes of the firms’ employees. Exploiting linked employer-employee panel data that consist of rich survey-based and administrative information on firms, workers and regions, we apply a flexible propensity score matching approach that controls for selection on observables as well as on time-constant unobserved factors. While the effects of analysing sickness absenteeism appear to be rather limited, our results suggest that health circles/courses increase tenure and decrease the number of job changes across various age groups. A key finding is that health circles/courses strengthen the labour fo

The New Full-Time Employment Taxes

Source: Casey B. Mulligan, National Bureau of Economic Research (NBER), NBER Working Paper No. w20580, October 2014
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From the abstract:
The Affordable Care Act introduces or expands taxes on incomes and full-time employment, beginning in 2014. The purpose of this paper is to characterize the new full-time employment taxes from the perspective of a household budget constraint, measure their magnitude, and assess their likely consequences for employee work schedules. When the ACA is fully implemented, full-time employment taxes will be prevalent and often as large as what workers can earn in five hours of work per week, 52 weeks per year. The economic significance of the ACA’s full-time employment taxes varies by demographic group: they are non-monotonic in age, increasing with family size, and negatively correlated with schooling.

The Early Impact of the Affordable Care Act State-by-State

Source: Amanda Ellen Kowalski, National Bureau of Economic Research (NBER), NBER Working Paper No. w20597, October 2014
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From the abstract:
I examine the impact of state policy decisions on the early impact of the ACA using data through the first half of 2014. I focus on the individual health insurance market, which includes plans purchased through exchanges as well as plans purchased directly from insurers. In this market, at least 13.2 million people were covered in the second quarter of 2014, representing an increase of at least 4.2 million beyond pre-ACA state-level trends. I use data on coverage, premiums, and costs and a model developed by Hackmann, Kolstad, and Kowalski (2013) to calculate changes in selection and markups, which allow me to estimate the welfare impact of the ACA on participants in the individual health insurance market in each state. I then focus on comparisons across groups of states. The estimates from my model imply that market participants in the five “direct enforcement” states that ceded all enforcement of the ACA to the federal government are experiencing welfare losses of approximately $245 per participant on an annualized basis, relative to participants in all other states. They also imply that the impact of setting up a state exchange depends meaningfully on how well it functions. Market participants in the six states that had severe exchange glitches are experiencing welfare losses of approximately $750 per participant on an annualized basis, relative to participants in other states with their own exchanges. Although the national impact of the ACA is likely to change over the course of 2014 as coverage, costs, and premiums evolve, I expect that the differential impacts that we observe across states will persist through the rest of 2014.

The War on Poverty’s Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans

Source: Martha J. Bailey, Andrew Goodman-Bacon, National Bureau of Economic Research (NBER), NBER Working Paper No. w20653, October 2014

From the abstract:
This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance.

Political Polarization, Anticipated Health Insurance Uptake and Individual Mandate: A view from the Washington State

Source: Anirban Basu, Norma B. Coe, David E. Grembowski, Larry Kessler, National Bureau of Economic Research (NBER), NBER Working Paper No. 20655, November 2014
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From the abstract:
The politicization of the Affordable Care Act (ACA) was extreme, with the popular moniker of “Obamacare” and 54 House attempts to repeal the law in the four years after passage. Our study set out to understand Washington state public’s preferences about enrolling into ACA driven health insurance programs, the role that political polarization may play on the chances that the uninsured would enroll and the extent to which individual mandate may influence these choices. A representative mail survey among the registered voters of Washington State. We find that 27% have not ruled out purchasing insurance through the Exchange, but their ambiguity is most likely driven by conflicts between health care needs and financial worries on one hand and their political views on the other. Overall, compared to the insured population in 2013, uninsured are significantly more likely to enroll through the Exchange even after all adjustments including medical needs and financial worries. This highlights that the individual mandate may have an independent effect on enrollment for the uninsured. However, the individual mandate effect is found to be negligible for the uninsured who blamed the Democrats and/or President Obama for the 2013 governmental shutdown. Political polarization appears to have a trickle down affect at the individual choices even beyond medical needs and financial worries. Alternative strategies, for example bipartisan outreach, may be necessary to convince certain groups of eligible beneficiaries to consider enrollment through the Exchange.

2015 OEP: Emerging trends in the individual exchanges

Source: McKinsey Center for U.S. Health System Reform, Intelligence Brief, September 2014

From the abstract:
The 2015 open enrollment period (OEP) begins in about seven weeks. To develop a preliminary understanding of how it is likely to differ from last year’s, we analyzed all available data from the state exchanges as of September 15, 2014. We began by collecting the carrier participation data released by 40 states and the District of Columbia; collectively, these localities contain nearly 80 percent of the population eligible for qualified health plans (QHP) in the United States. We then examined data from the 19 localities (18 states and D.C.) that released complete rate filings, which collectively contain 44 percent of the QHP-eligible population. (To simplify the discussion in this Intelligence Brief, we refer to the first group as “41 states” and the second group as “19 states.”) For comparison with 2014 carriers and products, we used the comprehensive exchange offering database we developed during that OEP. Because detailed information about 2015 rate filings is currently available from only 19 states, many of our analyses focused on silver plans, the products purchased most often during the 2014 OEP.

Real-time tracker of 2015 individual exchange filings

Key Study On Obamacare 2015 Premium Rates Is Out And You Won’t Believe What’s Going To Happen
Source: Rick Ungar, October 31, 2014

… So, how do we explain the McKinsey findings, which reveal some awfully good news when it comes to premium rates, as Obamacare begins its second year sign up period beginning November 15?
We explain it by simply pointing out that when your sole approach to a program is based on your preferred political point of view, the truth may sometimes disappoint—even when the truth comes in the form of some pretty good news.

Here are the bullet points of the study:
• Despite the cries of the Obamacare bashers that insurance companies would leave the exchanges in droves once they discovered how much money they are losing, it turns out that competition and choice are increasing as we head into 2015.

According to the McKinsey study, “In the 41 states releasing exchange participation carrier data, the number of health insurers increased by 26 percent between 2014 and 2015. In the 19 states with complete fillings, the number of products grew 66 percent, with most in the silver tier.”
• While 65 percent of existing policies will see an increase in premium costs for 2015, the medium increase will be just 4 percent. ….

The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001-2010

Source: Kelly R. Reveles, Grace C. Lee, Natalie K. Boyd, Christopher R. Frei, American Journal of Infection Control, Vol. 42, Issue 10, 2014

From the abstract:
Background: Clostridium difficile infection (CDI) incidence is a growing concern. This study provides national estimates of CDI over 10 years and identifies trends in mortality and hospital length of stay (LOS) among hospitalized adults with CDI. …

Results: These data represent 2.2 million adult hospital discharges for CDI over the study period. CDI incidence increased from 4.5 CDI discharges per 1,000 total adult discharges in 2001 to 8.2 CDI discharges per 1,000 total adult discharges in 2010. The overall in-hospital mortality rate was 7.1% for the study period. Mortality increased slightly over the study period, from 6.6% in 2001 to 7.2% in 2010. Median hospital LOS was 8 days (interquartile range, 4-14 days), and remained stable over the study period.

Conclusions: The incidence of CDI among hospitalized adults in the United States nearly doubled from 2001-2010. Furthermore, there is little evidence of improvement in patient mortality or hospital LOS.

2015 Segal Health Plan Cost Trend Survey

Source: Segal Group, 2014

Health benefit plan cost trend rates for 2015 are forecast to drop slightly for some coverage, but to increase substantially for prescription drug coverage, according to data compiled in the 2015 Segal Health Plan Cost Trend Survey, Segal’s eighteenth annual survey of managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs). Trend is the forecast of annual gross per capita claims cost increases. The survey captured data on trend projections for the following types of medical coverage for active participants and retirees under age 65: fee-for-service (FFS)/indemnity plans, high-deductible health plans (HDHPs), open-access preferred provider organizations (PPOs)/point-of-service (POS) plans, PPOs/POS Plans (with PCP gatekeepers) and health maintenance organizations (HMOs). In addition, the survey compiled data on trend projections for various types of medical coverage for Medicare-eligible retirees, prescription drug carve-out, dental and vision. This report presents the survey results, including components of trend, in graphs and tables with observations on key findings. To assess the accuracy of projections, trend projections are compared to actual data. Actual trends for 2013 (the most recent full year for which actual data is available), were the lowest reported in more than 12 years for managed care plans (HMOs and PPOs/ POS plans). The report also compares trend data to increases in the consumer price index for all urban consumers (CPI-U) and wages. It concludes with Segal’s commentary on top health care cost-management strategies….

Satisfaction With Health Coverage and Care: Findings from the 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

Source: Paul Fronstin, Employee Benefit Research Institute (EBRI), EBRI Notes, Vol. 35 No. 8, August 2014

From the abstract:
This paper examines satisfaction with various aspects of health care by type of health plan. It examines satisfaction among three groups of health-plan enrollees: those with a consumer-driven health plan (CDHP), those with a high-deductible health plan (HDHP), and those with traditional coverage. The findings presented in this paper are derived from the 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS), an online survey that examines issues surrounding consumer-directed health care, including the cost of insurance, the cost of care, satisfaction with health care, satisfaction with health care plans, reasons for choosing a plan, and sources of health information. This paper also presents trends in satisfaction using findings from the 2005-2007 EBRI/Commonwealth Fund Consumerism in Health Care surveys, and the 2008-2012 CEHCS. The overall satisfaction rate among CDHP enrollees increased in most years of the EBRI/Greenwald & Associates CEHCS, while it decreased in most years among traditional enrollees. Differences in out-of-pocket costs may explain some of the differences in overall satisfaction rates. In 2013, 44 percent of traditional-plan participants were extremely or very satisfied with out-of-pocket costs (for health care services other than for prescription drugs), while 20 percent of HDHP enrollees and 31 percent of CDHP participants were extremely or very satisfied. Satisfaction has been trending upward among CDHP enrollees. CDHP and HDHP enrollees were less likely than those in a traditional plan both to recommend their health plan to friends or co-workers and to stay with their current health plan if they had the opportunity to switch plans. The percentage of HDHP and CDHP enrollees reporting that they would be extremely or very likely to recommend their plan to friends or co-workers has been trending upward, while it has been flat among individuals with traditional coverage.