Category Archives: Health Care

Police services detention centres: a proposed solution for action

Source: Phil Woods, Don Leidl, Lorna Butler, Jason Stonechild & Janet Luimes, Police Practice and Research, Online ahead of print, September 9, 2016
(subscription required)

From the abstract:
Police services face daily challenges dealing with the health issues displayed by individuals in their custody. They often find themselves isolated from the services that can help the most. This paper scopes relevant literature on these challenges and some of the interprofessional interventions which have emerged to address them, such as the diversionary practices of crisis intervention teams, street triage, nurses in custody suites, and court liaison and diversion. Remote presence technology is proposed to be an innovative solution that can help to provide more efficient and effective pathways for care in Police Detention Centres. Remote presence technology has the ability to significantly affect the way interprofessional collaboration can take place for those in police custody.

2016 Employer Health Benefits Survey

Source: Kaiser Family Foundation/Health Research & Educational Trust (HRET), September 2016

From the press release:
Annual family premiums for employer-sponsored health insurance rose an average of 3 percent to $18,142 this year, a modest increase at a time when workers’ wages (2.5%) and inflation (1.1%) also grew modestly, according to the benchmark Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2016 Employer Health Benefits Survey released today. Workers on average contribute $5,277 annually toward their family premiums.

This year’s low family premium increase is similar to last year’s (4%) and reflects a significant slowdown over the past 15 years. Since 2011, average family premiums have increased 20 percent, more slowly than the previous five years (31% increase from 2006 and 2011) and more slowly than the five years before that (63% from 2001 to 2006)…..

Analysis of 2015 Census Poverty Data

Source: Economic Policy Institute and National Women’s Law Center, September 2016

NWLC Analysis of 2015 Census Poverty Data

NWLC’s detailed analysis of U.S. Census poverty, income, and health insurance data released on September 13, 2016 found that women’s poverty rates were once again higher than the poverty rates for men. The data also show that income supports such as Social Security benefits lifted the income of millions of Americans above the poverty line.

The wage gap closed by just a penny in 2015, with women working full, time, year round paid only 80 cents for every dollar paid to their male counterparts.

EPI Analysis of 2015 Census Poverty Data
New Census data show strong 2015 earnings growth across the board, with black and Hispanic workers seeing the fastest growth
September 13, 2016
Today’s Census Bureau report on income, poverty, and health insurance coverage in 2015 shows that median household incomes for all race and ethnic groups increased between 2014 and 2015.

Poverty declined in 2015 by all measures; government programs, once again, kept millions above the poverty line
September 13, 2016

Income gains in 2015 don’t reverse long-run trend toward greater inequality
September 13, 2016

By the Numbers: Income and Poverty, 2015
September 13, 2016

Superb income growth in 2015 nearly single-handedly restored incomes lost in the Great Recession
September 13, 2016

Consumer-Driven Health Plans: A Cost and Utilization Analysis

Source: Amanda Frost, Kevin Kennedy, Health Care Cost Institute, Issue Brief #12, September 2016

From the abstract:
This data brief examines the health care use and spending from 2010-2014 for people who are enrolled in consumer-driven health plans (CDHPs), and compares these trends to non-CDHP enrollees. Findings indicate that although fewer total dollars were spent on health care for CDHP enrollees, they had higher per capita out-of-pocket spending on deductibles, copays, and coinsurance.
Related:
Press Release

Health Insurance Coverage in the United States: 2015

Source: Jessica C. Barnett and Marina Vornovitsky, U.S. Census Bureau, Report Number: P60-257, September 13, 2016

From the summary:
This report presents statistics on health insurance coverage in the United States based on information collected in the 2014, 2015, and 2016 Current Population Survey Annual Social and Economic Supplements (CPS ASEC) and the American Community Survey (ACS).

Highlights
• The uninsured rate decreased between 2014 and 2015 by 1.3 percentage points as measured by the CPS ASEC. In 2015, the percentage of people without health insurance coverage for the entire calendar year was 9.1 percent, or 29.0 million, lower than the rate and number of uninsured in 2014 (10.4 percent or 33.0 million).
• The percentage of people with health insurance coverage for all or part of 2015 was 90.9 percent, higher than the rate in 2014 (89.6 percent).
• In 2015, private health insurance coverage continued to be more prevalent than public coverage, at 67.2 percent and 37.1 percent, respectively. Of the subtypes of health insurance, employer-based insurance covered 55.7 percent of the population for some or all of the calendar year, followed by Medicaid (19.6 percent), Medicare (16.3 percent), direct-purchase (16.3 percent), and military coverage (4.7 percent).
• Increases in both private health insurance coverage and government coverage contributed to the overall increase in coverage between 2014 and 2015. The rate of private coverage increased by 1.2 percentage points to 67.2 percent in 2015 (up from 66.0 percent in 2014), and the government coverage rate increased by 0.6 percentage points to 37.1 percent (up from 36.5 percent in 2014).
• Between 2014 and 2015, the greatest change in coverage was the change in direct-purchase health insurance, which increased by 1.7 percentage points to cover 16.3 percent of people for some or all of 2015 (up from 14.6 percent in 2014).
• For the second year in a row, the percentage of people without health insurance dropped for every single year of age under 65.
• In 2015, the percentage of uninsured children under age 19 was 5.3 percent. This was a decrease from 6.2 percent in 2014.
• In 2015, the uninsured rate for children under age 19 in poverty, 7.5 percent, was higher than the uninsured rate for children not in poverty, 4.8 percent.
• In 2015, non-Hispanic Whites had the lowest uninsured rate among race and Hispanic origin groups, at 6.7 percent. The uninsured rates for Blacks and Asians were higher than for non-Hispanic Whites, at 11.1 percent and 7.5 percent, respectively. Hispanics had the highest uninsured rate in 2015, at 16.2 percent.
• Between 2014 and 2015, the overall rate of health insurance coverage increased for most race and Hispanic-origin groups. Hispanics had the largest increase (3.6 percentage points), followed by Asians (1.9 percentage points) and non-Hispanic Whites (0.9 percentage points). The Current Population Survey did not measure a statistically significant difference in the health insurance coverage rate for Blacks between 2014 and 2015.
• Between 2014 and 2015, the uninsured rate decreased in 47 states and the District of Columbia. Three states (North Dakota, South Dakota, and Wyoming) did not experience a statistically significant change in their uninsured rate.

Experiences with Health Insurance and Health Care in the Context of Welfare Reform

Source: Kimberly Danae Narain and Marian Lisa Katz, Health & Social Work, Advance Access, First published online: September 8, 2016
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From the abstract:
Studies have shown that in the wake of welfare reform there has been a drop in the health insurance coverage and health care utilization of low-income mothers. Using data from 20 telephone interviews, this study explored the health insurance and health care experiences of current and former welfare participants living in Los Angeles County. This study found that half of these women had been uninsured at some point. Many of these lapses in health insurance coverage were linked to employment transitions and lack of knowledge regarding eligibility for different safety net programs. This study also found that satisfaction with access to health care was high among the insured respondents; however, barriers to care remained for many individuals, including appointment scheduling issues, limited scope of health insurance coverage, narrow provider networks, lack of care continuity, and perceived low quality of care. Better linkages between social programs assisting with health insurance coverage and improved knowledge among program clients may reduce health insurance cycling in this group. New rules for Medicaid managed care, currently being considered by the Centers for Medicare and Medicaid Services, have the potential to improve access to health care and the quality of care for these individuals.

Massachusetts Health Reform At Ten Years: Great Progress, But Coverage Gaps Remain

Source: Sharon K. Long, Laura Skopec, Audrey Shelto, Katharine Nordahl and Kaitlyn Kenney Walsh, Health Affairs, vol. 35 no. 9, September 2016
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From the abstract:
Massachusetts’s 2006 health reform legislation was intended to move the state to near-universal health insurance coverage and to improve access to affordable health care. Ten years on, a large body of research demonstrates sustained gains in coverage. But many vulnerable populations and communities in the state have high uninsurance rates, and among those with coverage, gaps in access and affordability persist.

Medicaid Expansion Affects Rural And Urban Hospitals Differently

Source: Brystana G. Kaufman, Kristin L. Reiter, George H. Pink and George M. Holmes, Health Affairs, vol. 35 no. 9, September 2016
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From the abstract:
Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the average effect of Medicaid expansion in 2014 on payer mix and profitability for urban and rural hospitals, controlling for secular trends. For both types of hospitals, we found that Medicaid expansion was associated with increases in Medicaid-covered discharges. However, the increases in Medicaid revenue were greater among rural hospitals than urban hospitals, and the decrease in the proportion of costs for uncompensated care were greater among urban hospitals than rural hospitals. This preliminary analysis of the early effects of Medicaid expansion suggests that its financial impacts may be different for hospitals in urban and rural locations.

US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues

Source: Ge Bai and Gerard F. Anderson, Health Affairs, vol. 35 no. 9, September 2016
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From the abstract:
Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with $64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospital’s system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services.

Affordable Care Act’s Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage

Source: Caroline S. Carlin, Angela R. Fertig and Bryan E. Dowd, Health Affairs, vol. 35 no. 9, September 2016
(subscription required)

From the abstract:
Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. We examined the impact of this change on women’s patterns of choosing prescription contraceptive methods. Using claims data for a sample of midwestern women ages 18–46 with employer-sponsored coverage, we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice, and our findings about long-term methods may have implications for rates of unintended pregnancy that require further study.
Related:
Early Impact Of The Affordable Care Act On Oral Contraceptive Cost Sharing, Discontinuation, And Nonadherence
Source: Lydia E. Pace, Stacie B. Dusetzina and Nancy L. Keating, Health Affairs, vol. 35 no. 9, September 2016
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