Category Archives: Health Care

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries

Source: Annals of Internal Medicine

From press release (American College of Physicians):
In a new evidence-based paper, the American College of Physicians (ACP) analyzes health care in the United States and 12 other industrialized countries and identifies lessons that could be applied to the particular political and social culture of the United States to achieve a high performing health care system, including achieving universal health insurance coverage for all Americans.

In the paper, “Achieving a High Performance Health Care System with Universal Access: What the USA Can Learn from Other Countries,” published on the Web site of ACP’s flagship journal, Annals of Internal Medicine, ACP notes that spending on health care in the United States is the highest in the world and has been rising at a faster pace than spending in the rest of the economy. Yet an estimated 47 million Americans – nearly 16 percent of the population – lack health insurance protection. Even among those with health insurance coverage, wide variations exist in terms of cost, utilization, quality, and access to health care services.

Statistics: Nearly One in Five Americans Say They Can’t Afford Needed Health Care

Source: Health, United States, 2007 Edition

From the summary/news release:
Nearly one in five U.S. adults – more than 40 million people – report they do not have adequate access to the health care they need, according to the annual report on the nation’s health released today by the Centers for Disease Control and Prevention (CDC).

The report, “Health, United States, 2007,” is a compilation of more than 150 health tables prepared by CDC’s National Center for Health Statistics. The report also contains a special section focusing on access to care, which shows that nearly 20 percent of adults reported that they needed and did not receive one or more of these services in the past year – medical care, prescription medicines, mental health care, dental care, or eyeglasses – because they could not afford them.

CMS Publishes a National List of Poor-Performing Nursing Homes, Key Tool for Families Seeking Quality Care

Source: Centers for Medicare & Medicaid Services (HHS)

From press release:
The Centers for Medicare & Medicaid Services (CMS) today released the first ranking of the nation’s poor-performing nursing homes. Release of the national list of facilities, identified as special focus facilities (SFFs), is expected to offer individuals, seeking long-term health care services, and their families powerful new information when choosing nursing homes.

The creation of the list was prompted by the number of facilities that were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a ‘yo-yo’ compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and is no longer identified as an SFF, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid. CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

The CMS policy of progressive enforcement means that any nursing home, not just those identified as an SFF, that reveals a pattern of persistent poor quality is subject to increasingly stringent enforcement action. If problems continue, the severity of penalties will increase over time, ranging from civil monetary penalties, denial of payment for new admissions and, ultimately, removal from Medicare and/or Medicaid.

As of October 2007, there were 128 SFFs, out of about 16,000 active nursing homes. The number of SFFs in each state varies according to the number of nursing homes in the state. These nursing homes, at the time of their selection as an SFF, had survey results that were among the poorest five or 10 percent in each state.

Today’s list includes 54 facilities that are at the top of the poorest performers in those states and among those facilities that have failed to improve significantly.

Special Focus Facility Background Information (PDF; 15KB)

Special Focus Facility Public List (PDF; 16 KB)

2007 Nursing Home Action Plan (PDF; 993 KB)

Making the Grade on Women’s Health: A National and State-by-State Report Card

Source: National Woman’s Law Center (NWLC) and Oregon Health & Science University Center for Women’s Health (OHSU)

From press release:
While some states made some small gains in critical indicators for improving women’s health, the nation as a whole and most states are falling behind in their quest to meet national goals for women’s health, a comprehensive analysis of state policies and women’s health status finds.

Released today, Making the Grade on Women’s Health: A National and State-by-State Report Card is the fourth in a series of triennial reports to grade and rank each state based on 27 health status benchmarks developed largely using goals set by the U.S. Department of Health and Human Services’ Healthy People 2010 initiative. The report is a project of the National Women’s Law Center and Oregon Health & Science University. With major support from the Bristol-Myers Squibb Foundation as well as a number of other funders, this report reflects the importance of improving women’s health and the substantial commitment required to do so.

Making the Grade gives the nation an overall grade of “unsatisfactory” for meeting only three of 27 benchmarks – the percent of women 40 and over who receive regular mammograms, the percent of women who annually see a dentist, and the percent of women 50 and over who receive screenings for colorectal cancer.

No state receives an overall “satisfactory” grade for women’s health status, although three states receive a “satisfactory minus.” This is down from eight states that received a “satisfactory minus” in 2004. Vermont receives a “satisfactory minus” and ranks No. 1, followed by Minnesota and Massachusetts. Twelve states receive failing grades, up from six states that failed in 2004. Mississippi ranks last. The other 11 failing states are Louisiana, Arkansas, Indiana, Oklahoma, West Virginia, Kentucky, Tennessee, the District of Columbia, South Carolina, Texas and Alabama. The remaining states receive “unsatisfactory” marks.

National Report Card
Key Findings
State by state reports are also available.

A Roadmap to Health Insurance for All: Principles for Reform

Source: Commonwealth Fund

From press release:
Health insurance reform plans that build on a mix of private and public health insurance, where costs are shared among government, employers, and enrollees would have great potential to move the system to high performance and would be the most practical to implement according to a new report released today by The Commonwealth Fund Commission on a High Performance Health System. Commissioners are a diverse group of leading health policy experts from government, private industry, health care delivery organizations, academia, and professional associations.

Affordable, comprehensive health insurance coverage for all Americans is essential to achieving a high performance health system, say the report authors, because coverage helps to ensure access to essential preventive services; improve overall health; cut down on inefficiencies like duplicate medical tests; reduce administrative costs; and eliminate costly uncompensated care for uninsured and underinsured families.

However, the way coverage reform plans are designed will be critical to their success and ability to offer all participants access to high-quality, efficient, and equitable health care, according to the analysis, A Roadmap to Health Insurance for All: Principles for Reform, prepared for the Commission by Sara Collins, Assistant Vice President at The Commonwealth Fund and colleagues. The report is the first of three major policy reports the Commission will issue this Fall.

Full Report (PDF; 487 KB)

Spending by Employers on Health Insurance: A Data Brief

Source: Congressional Research Service

To attract and maintain a skilled workforce, many businesses provide health insurance and other benefits for their employees. As the cost of health insurance rises, employers face a growing challenge paying for benefits while managing labor costs to succeed in a competitive market. All types of businesses report problems, including both small businesses and firms with thousands of employees and retirees. Despite concerns about the cost of benefits, small and large employers together provide health coverage for most Americans, about 60% of the population in 2006.1 But as the amount that employers pay for health insurance has been increasing — both absolutely and as a share of labor costs — the percent of the population covered has been decreasing.

To describe employer contributions for health insurance, this report presents data from two employer surveys. The first, conducted by the Kaiser Family Foundation and the Health Research and Educational Trust, provides information on premiums for employer-sponsored health insurance. The second, from the Department of Labor, provides information on employer costs for employee compensation, including costs for wages and salaries, health insurance, and other benefits.

Presidential Politics and the Resurgence of Health Care Reform

Source: New England Journal of Medicine

The 2008 presidential election will not resolve the debate over health care reform, but the results will go a long way toward determining the future of U.S. health policy. It would be a mistake, however, to read the candidates’ plans too literally. A plan offered during the primaries usually looks different in key respects from the plan that a newly elected president takes to Congress, to say nothing of any legislation that Congress actually passes. Still, it is clear that there is a wide partisan gap on health care reform that reflects ideological divisions over the roles that government and market forces should play in the health care system. And the further U.S. health policy moves from incrementalism, the more that partisan divide is likely to be exposed.

The Fate of SCHIP — Surrogate Marker for Health Care Ideology?

Source: New England Journal of Medicine

How prominently SCHIP and the health care needs of uninsured children will figure in election-year debates is anybody’s guess, but one thing is certain: However the SCHIP saga ends, it will not lay to rest the larger issue of what level of public support uninsured people deserve as our employer-based insurance system continues to erode.

Prescription Drugs and Medicare Part D: A Report on Access, Satisfaction, and Cost

Source: AARP Policy & Research

Access, satisfaction, and cost issues related to prescription drugs in general and the Medicare Part D prescription drug benefit specifically were examined in this October 2007 telephone survey of 400 adults aged 50-64 not yet eligible for Medicare and 400 Medicare beneficiaries aged 65 and older with the drug benefit. Results suggest that people aged 50 and older are generally satisfied with their access to brand name and generic prescription drugs and are willing to talk to their physicians and other health professionals about their prescription drug options. Older adults who have Medicare Part D drug coverage report high levels of satisfaction with the plan and their premiums, with many stating that prescription drugs are more affordable now than they were prior to their enrollment.

Full Report (PDF; 462 KB)

Commission of Nation’s Leading Health Care Experts Issues Reform Recommendations for Next President

Source: Commonwealth Fund

Ensuring that everyone in the United States has health insurance is essential, but it is not enough to drive the kind of reform the health system needs, according to a new report released today by the Commonwealth Fund Commission on a High Performance Health System.

Guaranteeing affordable health insurance for all, changing the way doctors and other health care providers are paid, better organizing and coordinating care delivery, investing in implementing an electronic information system in a reasonable period of time (aiming for five years), and establishing national goals and doing what it takes to reach them through strong national leadership should all be on the next President’s health care agenda, says the report. Members of the commission are a diverse group of leading health policy experts from government, private industry, health care delivery organizations, academia, and professional associations.

Full Report (PDF; 187 KB)