In recent years issues of hospital mergers and acquisitions have figured prominently on the public agenda. However, another trend in the health care marketplace, health insurance plan consolidation, has received somewhat less attention from policymakers and the press. The health insurance industry has also undergone its own period of increased consolidation and the role of private health plans in the escalation of health care costs is often scrutinized by policymakers and researchers who study health care markets. Research on health plan consolidation and concentration can help to illuminate the potential consequences of this activity for health care markets.

Emergency department (ED) crowding has become increasingly common in the United States. When EDs are overextended or lack the resources to treat different types of patients, they may initiate ambulance diversion, which temporarily closes the ED to ambulance traffic. For patients suffering from acute, time-sensitive conditions, diversion can cause delays in treatment and potentially worsen the the prognosis. HCFO-funded work by Yu-Chu Shen, Ph.D., of the Naval Postgraduate School, and Renee Hsia, M.D., M.Sc., of the University of California San Francisco, examined the impact of ambulance diversion on patient outcomes for patients suffering from acute myocardial infarction (AMI).

More Than 20,000 Emergency Room Visits for Air and Paintball Gun Injuries in 2008

Hospital emergency departments (EDs) saw more than 20,000 injuries due to air and paintball guns in 2008, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). This represents a 20 percent decrease in ED visits for injuries caused by air and paintball guns from 2006.

These findings are based on data described in Statistical Brief #119: Emergency Department Visits for Injuries Caused by Air and Paintball Guns, 2008. The report uses data from the Nationwide Emergency Department Sample (NEDS).

Hospitalizations for Eating Disorders Declined, but Big Increase Seen in Pica Disorder

After a steep and steady increase from 1999 to 2007, hospital stays principally for eating disorders declined by 23 percent from 2007 to 2008 and 2008 to 2009, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). The severity of eating disorders also lessened, with symptoms like irregular heartbeat and menstrual disorders declining by 39 percent and 46 percent, respectively.

From 1999 to 2009, however, hospitalizations jumped 93 percent for patients with an eating disorder called pica, wherein individuals eat largely non-edible substances such as clay, dirt, chalk, and feces. Women and children, including those with autism and other mental or developmental disorders, are most likely to suffer from pica.

These findings are based on data described in Statistical Brief #120: An Update on Hospitalizations for Eating Disorders, 1999 to 2009. The report uses data from the Nationwide Inpatient Sample (NIS).

Hospital Readmissions for COPD Highest Among Black Patients

For patients age 40 and older with chronic obstructive pulmonary disease (COPD), hospital readmissions within 30 days of initial treatment were 30 percent higher among Blacks than Hispanics or Asians and Pacific Islanders, and about 9 percent higher than Whites in 2008, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).

These findings are based on data described in Statistical Brief #121: Readmissions for Chronic Obstructive Pulmonary Disease, 2008. The report uses data from the State Inpatient Databases (SID) for 15 states: Arkansas, California, Florida, Hawaii, Louisiana, Massachusetts, Missouri, Nebraska, New Hampshire, New York, South Carolina, Tennessee, Utah, Virginia, and Washington.

For information about the NEDS, NIS, SID and other AHRQ databases, go to http://www.ahrq.gov/data/hcup/datahcup.htm.

Jennifer Mellor, Ph.D., is a professor of economics, director of the Schroeder Center for Health Policy, and faculty affiliate of the Thomas Jefferson Program in Public Policy at the College of William & Mary. Since February 2011, Dr. Mellor has been serving as the principal investigator on her first HCFO grant, using Florida ambulatory and inpatient discharge data from 1997 to 2008, together with data from Medstat’s MarketScan database and the American Hospital Association, to study the effects of the Medicare Outpatient Prospective Payment System (OPPS) on volume by payer and site of care.

Steve Zuckerman, Ph.D., and colleagues published “Undocumented Immigrants, Left Out of Health Reform, Likely to Continue to Grow as Share of the Uninsured,” October 2011, in Health Affairs.

Renee Hsia, M.D., and Yu-Chu Shen, Ph.D. published, “Rising Closures of Hospital Trauma Centers Disproportionately Burden Vulnerable Populations,” October 2011, in Health Affairs.

Grantees in the News

Following publication in Health Affairs, HCFO-funded work led by Glenn Melnick, Ph.D., has been highlighted in several media outlets. The focus of his work, market consolidation, was the subject of a September 9, 2011 House Ways and Means Subcommittee hearing on the implications of hospital mergers and acquisitions.

HCFO-funded work led by Patricia Ketsche, Ph.D., and E. Kathleen Adams, Ph.D., was highlighted in The Financial. The article, "Hidden Health Care Costs Hit Low-Income Families Hardest," details their findings that low-income families bear a disproportionate burden in the financing of national health spending. Their work was also featured on the website MDLinx.com in an article titled, “Low-Income Families Pay a Higher Share of Income Toward National Health Care Spending Than Higher-Income Families Do.” Finally, the results from their study were featured in the September 2011 issue of the Robert Wood Johnson Foundation’s Advances Newsletter.

HCFO grantees Renee Hsia, M.D., and Stephen Zuckerman, Ph.D., were featured at a Health Affairs briefing in Washington, D.C. on October 6, 2011. The briefing unveiled the journal’s “Agenda for Fighting Disparities” issue, which features articles from Hsia and Zuckerman based on their HCFO-funded work. Zuckerman’s presentation and comments were also highlighted on Kaiser Health News’s Capsules Blog in a post titled, “Researchers Press for More Action on Health Disparities.”

HCFO-funded work led by Renee Hsia, M.D., and Yu-Chu Shen, Ph.D., was highlighted in a recent Associated Press article. The article, "Study: 69M Must Travel Longer to a Trauma Center" details the study's findings on decreased trauma center access for vulnerable populations.

 
RWJF Releases

The Robert Wood Johnson Foundation released the content alert “A Closer Look at Disparities in Health Care” on October 6. It highlights findings from HCFO-sponsored studies led by Stephen Zuckerman, Ph.D., and Renee Hsia, M.D. and Yu-Chu Shen, Ph.D.

HCFO News

A HCFO Findings Brief, The Individual and Program Impacts of Eliminating Medicaid Dental Benefits in the Oregon Health Plan, was highlighted in the September 19, 2011 newsletter (page 3) of the State Health Access Data Center (SHADAC) and the State Health Access Reform Evaluation (SHARE) Program. The Findings Brief details the HCFO-funded research of Neal Wallace, Ph.D., of Portland State University.

HCFO Webinar Archive Now Available

Getting and Using Medicare Data: What I Wish I Had Known Before I Started My Research

The HCFO program, in collaboration with AcademyHealth’s Methods Council, hosted a webinar on best practices for obtaining and using Medicare data for research on September 27, 2011. Two experienced HCFO researchers, Jack Hoadley, Ph.D. of Georgetown University and Jim Reschovsky, Ph.D. of the Center for Studying Health System Change, shared some of their accumulated wisdom in getting and working with Medicare data in their research. In addition, Barbara Frank, M.P.H., M.S., from the Research Data Assistance Center (ResDAC) at the University of Minnesota provided additional resources, tips, and best practices drawn from her organization’s role as a CMS contractor assisting researchers in obtaining and working with Medicare data.

The webinar recording and materials can be accessed online: http://www.academyhealth.org/Training/ResourceDetail.cfm?ItemNumber=7764

Registration is now open for the National Health Policy Conference. Register today and be among the first to learn to learn where health policy is headed in 2012.

Two Alice S. Hersh student scholarships are available to attend the National Health Policy Conference. Application Deadline: November 15.

NCHS/AcademyHealth Health Policy Fellowship. Application Deadline: January 9, 2012.

Medical Care Research and Review (MCRR) Announces a Call for Review Papers.