Category Archives: Health Care

Use of Electronic Health Records in U.S. Hospitals

Source: Ashish K. Jha, Catherine M. DesRoches, Eric G. Campbell, Karen Donelan, Sowmya R. Rao, Timothy G. Ferris, Alexandra Shields, Sara Rosenbaum, and David Blumenthal, New England Journal of Medicine, Vol. 360 no. 16, April 16, 2009
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From the abstract:
Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals.

On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems.

The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.

The Effect of an Employer Health Insurance Mandate on Health Insurance Coverage and the Demand for Labor: Evidence from Hawaii

Source: Thomas C. Buchmueller, John DiNardo, Robert G. Valletta, Institute for the Study of Labor, IZA Discussion Papers, IZA DP No. 4152, April 2009

Over the past few decades, policy makers have considered employer mandates as a strategy for stemming the tide of declining health insurance coverage. In this paper we examine the long term effects of the only employer health insurance mandate that has ever been enforced in the United States, Hawaii’s Prepaid Health Care Act, using a standard supply-demand framework and Current Population Survey data covering the years 1979 to 2005. During this period, the coverage gap between Hawaii and other states increased, as did real health insurance costs, implying a rising burden of the mandate on Hawaii’s employers. We use a variant of the traditional permutation (placebo) test across all states to examine the magnitude and statistical properties of these growing coverage differences and their impacts on labor market outcomes, conditional on an extensive set of covariates. As expected, the coverage gap is larger for workers who tend to have low rates of coverage in the voluntary market (primarily those with lower skills). We also find that relative wages fell in Hawaii over time, but the estimates are statistically insignificant. By contrast, a parallel analysis of workers employed fewer than 20 hours per week indicates that the law significantly increased employers’ reliance on such workers in order to reduce the burden of the mandate. We find no evidence suggesting that the law reduced employment probabilities.

Health Insurance Coverage of New York’s Home Care Aides: Findings from a 2008 Survey of Home Care Employers Outside New York City

Source: Paraprofessional Healthcare Institute, Health Care for Health Care Workers, April 2009

New York State’s home care workers, who each day serve our health care system, too often lack access to affordable, quality health insurance coverage. At the same time, employers find it challenging to recruit and retain enough workers to meet the increasing demand for services. While lack of adequate, affordable health insurance for home care workers and their families is known to contribute to workforce instability and vacancies, accurate and timely data on the availability of health insurance is simply not available to guide New York policymakers.

There are numerous reasons for policymakers to make this a priority. Direct-care workers comprise the largest group of workers in the state’s health sector and their numbers are expected to continue to grow. In addition, these workers are employed by agencies that are heavily dependent on public funds to provide services; i.e., these workers could be described as subcontracted “public employees.” In addition, direct-care workers face high rates of chronic health conditions and workplace injuries. This situation, in concert with low rates of insurance coverage, contributes to high rates of turnover, which undermines the quality of services for consumers.
See also:
Is New York Prepared to Care?
Press release

Medicare Advantage Plans

Source: Health Affairs and the Robert Wood Johnson Foundation, Health Policy Brief, April 29, 2009

From the RWJF summary:
Medicare was created in 1965 to provide government-subsidized health insurance for elderly and disabled Americans. Since the 1970s, beneficiaries have had the option of leaving traditional Medicare and enrolling in privately run health insurance plans that participate in what is now called the “Medicare Advantage” program.

This year, the government will pay these private plans an average of 14 percent — or about $12 billion — more than it would pay for people in traditional Medicare. “This added cost contributes to the worsening long-range financial stability of the Medicare program,” said the Medicare Payment Advisory Commission (MedPAC), a nonpartisan group Congress established to monitor Medicare, in a March 2009 report to Congress.

MedPAC has proposed calculating the payments differently, to eliminate the extra cost of Medicare Advantage and to slow Medicare’s growing costs. Others, including the Obama administration, want the plans to bid against each other for Medicare contracts in the hope of achieving greater savings to put toward health reform.

Health Care Opinion Leaders Survey

Source: Commonwealth Fund/ Modern Healthcare, Press Release, April 27, 2009

Health care leaders believe the U.S. must rein in the growth of health spending, and most believe it is possible to keep the share of gross domestic product (GDP) now spent on health care steady over the next 10 years. Nearly all respondents (96%) to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey agreed that spending must slow and large majorities expressed support for a range of strategies to reduce costs, including many of those outlined in President Obama’s budget blueprint. Currently, the nation as a whole spends 17 percent of GDP on health care; that proportion is projected to grow to 21 percent by 2020.

Young and Vulnerable: The Growing Problem of Uninsured Young Adults and How New Policies Can Help

Source: Sara R. Collins, Hearing on “Health Insurance Options for Young Adults,” Invited Testimony, New York City Council, Committee on Health, April 23, 2009

Adults ages 19 to 29 are among the largest and fastest growing segment of the population without health insurance in the United States. There were 13.2 million uninsured young adults nationwide in 2007, according to the latest available Census data. There are an estimated 750,000 uninsured young adults in the state of New York out of approximately 2.6 million uninsured residents under age 65. Young adults are disproportionately represented among people who lack health insurance, accounting for nearly 30 percent of the 45 million uninsured people under age 65, even though they comprise just 15 percent of the population.

The Economic Crisis: The Toll on the Patients and Communities Hospitals Serve

Source: American Hospital Association, April 27, 2009

Six out of ten hospitals nationally are seeing a greater proportion of patients without insurance coming through their emergency departments and nearly half have reduced staff according to a March 2009 survey of hospitals.

• The economy is taking its toll on the patients and communities
hospitals serve. For the majority of hospitals:
– The proportion of emergency department patients without insurance is increasing.
– A higher proportion of patients are unable to pay for care and many hospitals are seeing more patients covered by Medicaid and other public programs for low income populations.
– Fewer patients are seeking inpatient and elective services raising concerns that individuals are putting off needed care.
– Community need for subsidized services such as clinics, screenings and outreach is increasing even as charitable contributions are down for many hospitals.
• Nine in 10 hospitals have made cutbacks to address economic concerns.
– Nearly half have reduced staff.
– Eight in 10 have cut administrative expenses.
– One in five have reduced services communities depend on including behavioral health, post acute care, clinic, patient education and other services that require subsidies.

Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP

Source: Stan Dorn, Urban Institute, April 2009

Automated enrollment strategies have achieved remarkable results with a range of public and private benefit programs, dramatically increasing program participation while lowering ongoing operating costs and reducing erroneous eligibility determinations. The recently passed Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) should make such steps much easier for states to take in helping eligible but uninsured children obtain and retain health coverage. After describing relevant provisions in CHIPRA, this paper explores the potential use of automated strategies to achieve four goals:
• Identifying uninsured children;
• Determining their eligibility for Medicaid and the Children’s Health Insurance Program,
or CHIP (formerly called “the State Children’s Health Insurance Program,” or SCHIP);
• Enrolling eligible children into coverage; and
• Retaining eligible children.

The paper catalogs options that states could consider. No state would do everything described here.

Child Health Services: A Framework for States

Source: Paul Dworkin, Lisa Honigfeld, Judith Meyers, Child Health and Development Institute, March 2009

From the summary:
The Child Health and Development Institute of Connecticut has released a report, A Framework for Child Health Services: Supporting Healthy Child Development and School Readiness of Connecticut’s Children, that offers a strategic vision and a series of specific recommendations for strengthening and integrating children’s health services into a comprehensive system of early childhood services.