Source: Lew McCreary, Harvard Business Review, Vol. 88 no. 9, September 2010
(subscription required)
A blend of anthropology, journalism, and empathy can lead to radical improvements in the quality of health care delivery - or any people-based business - without requiring expensive technology.
Source: M.D. Kogan and Others, New England Journal of Medicine, August 26, 2010
(subscription required)
Policy discussions on children's health insurance have been devoted largely to reducing the number of uninsured children. As compared with children who have health insurance, those lacking insurance are more likely to have needed care that is delayed or forgone; less access to preventive, specialist, or long-term care; lower utilization rates; care that imposes a high financial burden on their families; and poor health outcomes. Children with intermittent health insurance (i.e., periods without insurance throughout the year) are at greater risk for delayed care, unmet health care needs, lack of a usual source of care, and nonreceipt of well-child care.
Considerably less attention has been devoted to the problem of underinsurance, or insurance that does not sufficiently meet the child's needs. Recently, the American Academy of Pediatrics issued a policy statement highlighting the importance of this issue. The major problems cited were cost-sharing requirements that are too high, benefit limitations, and inadequate coverage of needed services. Although some studies have addressed underinsurance among adults and others have addressed the adequacy of coverage for children with special health care needs, more information is needed about the adequacy of health insurance for all children.
New York State's assumption of county Medicaid administration could reduce costs, but big savings will depend on improved administrative processes, according to this Institute report. The report examines differences in Medicaid nursing home eligibility denials among counties as an illustration of the challenges the state will face in taking over administration of Medicaid.
See also:
Press release
Source: Paul Fronstin, Employee Benefit Research Institute, EBRI Issue Brief, No. 345, August 2010
This report by EBRI provides a detailed summary of what is known about consumer-driven health plans, a relatively new option for paying for medical expenses that first began to appear nearly a decade ago. Consumer-driven health plans (CDHPs) consist of both health reimbursement arrangements (HRAs) and health savings accounts (HSAs). The EBRI report examines trends in offer rates and enrollment, differences in premiums between CDHPs and other types of insurance, and discusses the drivers of the premium differences.
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Press release
Health Care Spending: 1998, 2003, and 2008: "How have rising health care costs affected household budgets? That question was raised many times before the passage of the Affordable Care Act, whose goal--as the act's name implies--is to make health care more affordable for American families. This analysis of Consumer Expenditure Survey (CE) data from the 1998, 2003, and 2008 Interview Surveys provides a picture of nominal out-of-pocket health care spending among households categorized by the age of the reference person. The expenses analyzed were total health care and its components: health insurance, medical services, prescription drugs, and medical supplies."
Source: Jerrell D. Coggburn, Center for State and Local Government Excellence, August 2010
From the summary:
This new issue brief finds that the economy has slowed the ability of local governments to address long-term funding of their retiree health care obligations.
The brief follows up on a 2009 survey in which 206 local governments indicated they were likely to adopt a long-term strategy to strengthen their retiree health care funding, including
* establishing a Section 115 trust (governmental); medical subaccount [401(h)]; or Voluntary Employee Beneficiary Association (VEBA) trust [501(c)(9)];
* issuing OPEB bonds;
* increasing the years of service for vesting for RHC;
* increasing the age at which RHC is available;
* terminating retiree health care for all new hires.
Since then, the economy, insufficient revenues, and competing budget priorities have posed the greatest impediment to their plans.
The new brief finds that many jurisdictions are making sweeping changes in their retiree health care plans:
* 36 percent have increased or plan to increase the years of service required to vest.
* 11 percent have increased the retirement age.
* 39 percent have eliminated or plan to eliminate retiree health benefits for new hires.
Source: David Raths, Governing, Vol. 23 no. 10, July 2010
The huge challenges of implementing a $30 billion program are just beginning to hit the states.
Institute experts have applied an interactive measure that proves better at explaining wide variations in states' long-term care spending than individual measures analyzed in previous research. The index considers multiple factors, including coverage policies, nursing home payment rates and others. It may assist states in developing new policies to enhance care for elderly and disabled residents, while limiting costs.
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Press release
Source: William P. Kratzke, University of Memphis Law Review, Vol. 40, No. 279, 2009
From the abstract:
The focal point of health care in the United States is employment-based group health insurance. Such insurance provides and controls the access of millions of working Americans to health care. It also does much to define the nature and content of health care itself. Americans' insurance companies usually pay for specific services that they receive. For millions of other Americans who participate in a health care program such as Medicare or Medicaid, the program names the price it will pay for individual health care services. Many providers regard those prices as too low. Employment-based group insurance is the source from which such providers may seek subsidization of the care they provide participants in such programs, i.e., by charging those with such insurance more. By establishing programs or rules, government in essence mandates private-sector payment of subsidies, e.g., those for Medicare, Medicaid, or MTALA. Employment-based group health insurance provides the wherewithal to pay for the health care of most Americans and to cross-subsidize the care of most of the very substantial remainder. Private entities administer the subsidies and do so without much outside oversight and with very little accountability to other participants in the health care system.
Source: Robert Berenson and Eugene Rich, Journal of General Internal Medicine, Vol. 25 no. 6, June 2010
(subscription required)
From a Commonwealth Fund summary:
"Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well," write the authors of this article in a special supplement to the Journal of General Internal Medicine. At the same time, the alternatives, including bundled payment, capitation, and salaried physicians, "each have their own problems," they say. The authors explore the history of primary care physician reimbursement and the current system within that context, and illustrate why physician payment mechanisms are "inadequate for even basic primary care services, let alone the fully implemented medical home." They argue that new, hybrid payment models combining the best features of the standard approaches "will likely be required to restore primary care to its proper role in the U.S. health care system and to promote and sustain the development of patient-centered medical homes."
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