Category Archives: Health Care

Too Great a Burden: Americans Face Rising Health Care Costs

Source: Families USA, April 2009

From the summary:
To better understand the magnitude of the health care cost crisis, Families USA commissioned The Lewin Group to analyze data from the U.S. Department of Health and Human Services and the U.S. Census Bureau that reveal how many Americans face very high health care costs. This analysis allowed us to determine how many non-elderly people are in families that will spend more than 10 percent of their pre-tax income, and more than 25 percent of their pre-tax income, on health care in 2009.
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Key Findings

Nationwide Frequency and Costs of Potentially Preventable Hospitalizations, 2006

Source: H. Joanna Jiang, C. Allison Russo, and Marguerite L. Barrett, Healthcare Cost And Utilization Project, Statistical Brief #72, April 2009

Hospital care represents the largest component of overall health care expenditures. Some hospitalizations can be potentially prevented with timely and effective ambulatory care. High admission rates for these potentially preventable conditions may indicate a need for improvements in access to ambulatory care and in the quality of care provided, as well as in patient adoption of healthy lifestyles and active self-management of chronic conditions. Thus, reducing the frequency of potentially preventable hospitalizations would be an effective strategy for lowering costs while improving quality of care and patient outcomes.

This Statistical Brief presents national data from the Healthcare Cost and Utilization Project (HCUP) on rates and total costs of potentially preventable hospitalizations. Distribution of the total costs by payer is also examined. Lastly, comparisons of potentially preventable hospitalization rates by median income level of patient’s ZIP Code are presented. The Agency for Healthcare Research and Quality (AHRQ)’s Prevention Quality Indicators (PQIs)3 are used to identify hospitalizations for select chronic and acute conditions in adults and children for 2006. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.

Meeting Enrollees’ Needs: How Do Medicare And Employer Coverage Stack Up?

Source: Karen Davis, Stuart Guterman, Michelle M. Doty, and Kristof M. Stremikis, Health Affairs Web Exclusive, May 12, 2009
(subscription required)

From the press release:
Elderly Medicare beneficiaries are more satisfied with their health care, and experience fewer problems accessing and paying for care, than Americans with employer-sponsored insurance (ESI), according to a study by Commonwealth Fund researchers published today on the Health Affairs Web site.
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Employment-Based Health Insurance and Universal Coverage: Four Things People Know That Aren’t So

Source: David A. Hyman, University Illinois Law & Economics Research Paper No. LE09-010, April 1, 2009

From the abstract:
Employment-based health insurance is the Rodney Dangerfield of U.S. health policy: it gets no respect from anyone. Employment-based coverage (“EBC”) may not get much respect, but it covers roughly 177 million people – and it appears to have considerable staying power – even if the principal explanation for that staying power is nothing more compelling than inertia. Given the likely prevalence of EBC for the foreseeable future, it is worth emphasizing four important points about EBC and universal coverage. What these points have in common is that they are myths – most people believe they are true, even though they are not. The four “myths” are these:

* Employers pay for EBC;
* There are 45.7 million uninsured Americans;
* Universal coverage means everyone will have access to high quality care;
* Universal coverage will solve the cost problems of American health care.

The paper explains why each of these points are “things people know that aren’t so.” It then highlights the budgetary and collective action problems with trying to get to universal coverage without relying on EBC, at least for the foreseeable future.

Women at Risk: Why Many Women Are Forgoing Needed Health Care

Source: Sheila D. Rustgi, Michelle M. Doty, and Sara R. Collins, Commonwealth Fund, Issue Brief, May 2009

From the press release:
Women are more likely than men to feel the pinch of rising health costs and eroding health benefits, with about half (52%) of working-age women reporting problems accessing needed care because of costs, compared to 39 percent of men, a new Commonwealth Fund study finds. Women who are insured but have inadequate coverage are especially vulnerable: 69 percent of underinsured women have problems accessing care because of costs, compared to half (49%) of underinsured men.

The study, Women at Risk: Why Many Women Are Forgoing Needed Health Care, by Commonwealth Fund researchers Sheila Rustgi, Michelle Doty, and Sara Collins finds that overall, seven of 10 working-age women, or an estimated 64 million women, have no health insurance coverage or inadequate coverage, medical bill or debt problems, or problems accessing needed health care because of cost.
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National Healthcare Quality Report, 2008

Source: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, AHRQ Publication No. 090001, March 2009

Health care helps people stay healthy, recover from illness, live with chronic disease or disability, and cope with dying. Quality health care delivers these services in a way that is safe, timely, patient centered, efficient, and equitable. Unfortunately, Americans too often do not receive care that they need or they receive care that causes harm. Care can be delivered too late or without full consideration of a patient’s preferences and values. Many times, our system of health care distributes services inefficiently and unevenly across populations.

Each year since 2003, the Agency for Healthcare Research and Quality (AHRQ), together with its partners in the Department of Health and Human Services (HHS), has reported on progress and opportunities for improving health care quality, as mandated by the U.S. Congress. The information amassed for the National Healthcare Quality Report (NHQR) since its inception is a growing knowledge base that addresses two critically important questions:
◆ What is the status of health care quality in the United States?
◆ How is the quality of the health care delivered to Americans changing over time?

Hard Times in the Heartland

Source: Meena Seshamani, Joan Van Nostrand, Jenna Kennedy, Carrie Cochran, U.S. Department of Health & Human Services, 2009

Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Hard Times in the Heartland provides insight into the current state of health care in rural areas and the critical need for health care reform.

Mental Health Care: Better, Not Best

Source: Health Affairs, Volume 28, Number 3, May/June 2009
(subscription required)

From the introduction:
Clearly,well beyond implementation of parity laws,much remains to be done to improve both treatment and quality of life for the mentally ill. Robert Drake and colleagues focus on Social Security Disability Insurance, since more than a quarter of adults on SSDI have a primary psychiatric impairment.Most want to work but are limited to no more than twenty hours a week–when the evidence suggests that “supported employment” would both save money and help them do better.

What’s more, many proposals now popping up as health reform initiatives could improve mental health treatment immeasurably. Comparative effectiveness research has already established that the older generic antipsychotics work as well as a class as the newer, branded, more expensive atypical ones. And steppedup quality improvement efforts, write Audrey Burnam and colleagues, could increase the effectiveness of mental health treatments provided to veterans.

This issue of Health Affairs focuses on mental health reform. Some of the articles include:

Better But Not Best: Recent Trends In The Well-Being Of The Mentally Ill
Sherry A. Glied and Richard G. Frank

Trends In Mental Health Cost Growth: An Expanded Role For Management?

Richard G. Frank, Howard H. Goldman, and Thomas G. McGuire

Implementing Mental Health Parity: The Challenge For Health Plans

Keith Dixon

The Changing Role Of The State Psychiatric Hospital

William H. Fisher, Jeffrey L. Geller, and John A. Pandiani

Mental Illness In Nursing Homes: Variations Across States

David C. Grabowski, Kelly A. Aschbrenner, Zhanlian Feng, and Vincent Mor

Starvation Diet: Coping With Shrinking Budgets In Publicly Funded Mental Health Services

Steve Bogira

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
(subscription required)

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.