What's New with HCFO - March 15, 2007 (Print All Articles)

Individual Insurance Market and Tax Credits

In his January 23, 2007, State of the Union Address, President Bush proposed two initiatives for increasing health insurance coverage. His two-pronged initiative comprises a standard deduction for individuals and families who purchase private health insurance in the individual market, as well as federal subsidies to states that provide private health insurance options to low-income individuals and individuals whose prior health histories make them difficult to insure.

For years, policymakers and researchers have explored various reforms of the individual insurance market, contending that it could be a vehicle for incrementally increasing access to and affordability of health insurance coverage.¹ Conventional wisdom holds that those with group coverage experience certain market advantages, including lower premiums, economies of scale, a more diverse risk pool, and better provision of information about benefit packages, prices, available providers, and other factors important to health care coverage and delivery. However, those in the individual market sometimes enjoy more choice among insurance products and plan choice is not controlled by their locus of employment.²

The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensured access to the individual market for those leaving group coverage. A close look at six states’ attempts to reform the individual market, making it more accessible and affordable, revealed a range of regulatory changes – all of which moved beyond HIPPA – including mandating a standard benefit package, implementing rating restrictions, requiring a rate approval process, requiring insurers offering group insurance in the state to also offer individual coverage, and implementing risk adjustment or reinsurance.³ But, even in the states with the most comprehensive reforms, evidence showed that state reform of the individual market did not significantly increase health insurance coverage.

Based on the evidence available by 2000, there was consensus that additional analysis was needed to explore the cost of subsidizing coverage for high risk populations, as well as to better understand how various modifications to the tax structure would affect the individual market.⁴ Significant work on those topics was subsequently supported by HCFO and now serves as a resource to inform the current policy debate.

Joel Cantor and colleagues at Rutgers, The State University of New Jersey, examined trends in enrollment in New Jersey’s Individual Health Coverage Program (IHCP), implemented in 1993. Two key components of the IHCP were pure community rating and guaranteed issue/renewal of coverage. Despite positive early evaluations Cantor found, under his HCFO-funded study, that the program’s stability was fragile. He also concluded that even as opportunities increased for job-related insurance coverage, the IHCP retained its high-risk enrollees.⁵ Under a separate HCFO grant, Katherine Swartz and Deborah Garnick also studied reform of New Jersey’s individual insurance market. Based on the first four year’s of New Jersey’s IHCP, they identified three significant lessons for state and federal policymakers seeking to expand insurance coverage without increasing entitlement programs: 1) a market can be created for all residents, and carriers can agree to a mechanism for subsidizing those carriers that incur losses; 2) plans for setting up incentives for firms to behave in intended ways may not work; and 3) even competitive insurance markets cannot drive the cost of health insurance so low that healthy, low-income people will decide to purchase it.⁶

Further examination of guaranteed renewability and risk variation in individual insurance markets was conducted under two HCFO grants to Mark Pauly at the University of Pennsylvania. He examined the relationship between expected medical expense and actual paid premiums for households with individual insurance and found that premiums were not as dependent on expected medical risk as anticipated. To the extent that premiums were associated with medical risk, it was only for specific risk characteristics. Premiums for those enrolled in HMOs or in markets with a high penetration of managed care insurers were less closely associated with expected medical risk.⁷ In a second study, Pauly explored whether individual insurance market provisions for guaranteed renewability at class-average rates protected consumers with high-cost chronic conditions from premium fluctuations. He found that such protection was feasible in competitive insurance markets, but concluded that HIPAA’s guaranteed renewability provision alone was insufficient, because it failed to require that premiums be the same for all insured persons in a rating class. However, Pauly noted at the time of his research that all but three states had implemented such a requirement.⁸

Another HCFO-funded project, conducted by Andrew Coburn and colleagues at the University of Southern Maine, explored the extent to which individual insurance provides transitional versus long-term coverage. They also looked at participants’ insurance status before and after being covered by an individual plan. They found that most people enter the individual insurance market from employer coverage and also exit the individual insurance market to employer coverage. However, while bridging gaps in employer coverage is an important function of the individual insurance market, this study found that “an important minority” maintain individual insurance coverage for more than two years. Those who are employed by small businesses and the self-insured tend to spend the longest periods in the individual insurance market.⁹

Tax credits have been proposed as a way to finance increased coverage. Karen Pollitz, at Georgetown University, examined the health care tax credit mandated as part of the Trade Adjustment Act of 2002. She found that the administrative costs of delivering the tax subsidy were quite high and posited that they were likely to increase if the tax credit program were expanded to a larger population.¹⁰

In the coming year, as President Bush’s proposals are considered by Congress, there is likely to be continued debate about the potential for the individual insurance market to serve as a vehicle for increased insurance coverage. Central to that debate will be evidence about how subsidies and tax credits are likely to influence the behavior of those currently uninsured.

HCFO Funded Research

Commissioned papers and commentary in the Journal of Health Politics, Policy, and Law, Vol. 25, No. 1, February 2000.

Berry, J. and R. White, “An Insurer’s Perspective on Reform”, pp. 205-210.
Chollet, D.J., “Consumers, Insurers, and Market Behavior”, pp. 27-44.
Feldvebel, A.K. and D. Sky, “Commentary: A Regulator’s Perspective on Other States’ Experiences”, pp. 197-204.
Hackey, R.B., “Commentary: The Politics of Reform”, pp. 211-224.
Hall, Mark A., An Evaluation of New York’s Reform Law, pp. 71-100.
Hall, M.A., “An Evaluation of Vermont’s Reform Law”, pp. 101-132.
Kirk, A.M., “Riding the Bull: Reform in Washington”, Kentucky, and Massachusetts, pp. 133-174.
Nichols, L.M., “What Have We Learned So Far?” pp. 175- 196.
Oliver, T.R., “Commentary: Dynamics Without Change”, pp. 225-232.
Pauly, M.V. and A.M. Percy, “Cost Performance: A Comparison of the Individual and Group Health Insurance Markets”, pp. 9-26.
Peterson, M.A., “Editor’s Note”, pp. 1-2.
Rogal, D.L. and A.K. Gauthier, “Introduction: The Evolution of the Individual Insurance Market”, pp. 3-8.
Swartz, K. and D.W. Garnick, “Lessons from New Jersey”, pp. 45-70.

Title: Monitoring the Early Experience with Federal Health Insurance Tax Credits
Institution: Georgetown University
Grant Period: February 2004 – July 2005
Principal Investigator: Karen Pollitz, MPP

As part of the Trade Adjustment Assistance Act of 2002, Congress created a new, refundable, advance-payable health care tax credit. This tax credit can be viewed as a small-scale demonstration of health insurance tax credits as a way to expand coverage more broadly. This project examined five aspects of the tax credit. It (1) it described the qualified coverage options established in every state; (2) it will explore the reasons why states decide to establish different coverage arrangements; (3) it will examine enrollment statistics to determine the impact of state coverage decisions; (4) it will explore the availability of data on state-based coverage programs for evidence that premium subsidies reduce adverse selection; (5) it will review available data on people who claim the tax credit and the premiums they pay. The purpose of this study is to provide policymakers with objective and timely information that will help them monitor and understand the early operations of this program.

Title: Sustaining Individual Health Insurance Markets Under Community Rating and Open Enrollment
Institution: Rutgers, The State University of New Jersey
Grant Period: April 2002 – September 2003
Principal Investigator: Joel Cantor, Sc.D.

What is the extent of risk selection in New Jersey’s Individual Health Coverage Program (IHCP), which was implemented in 1992 as part of the state’s individual market reforms? What are the policy options for sustaining access to individual health plans and describe the role of the non-group coverage in New Jersey’s health care insurance market? Using data from The Robert Wood Johnson Foundation-funded New Jersey Family Health Survey (NJFHS), the researchers aimed to answer the following questions: (1) How has the distribution of risk changed in the IHCP since 1995-6 and what are the implications of those changes for the viability of community rating and related reforms? (2) What is the potential impact on current or potential IHCP enrollees of adopting modified community rating? and (3) What role does the IHCP play in the continuum of coverage in New Jersey? The objective of this study was to analyze changes in New Jersey’s individual insurance market to inform state policymakers considering reforms to make non-group markets accessible and viable. The researchers supplemented the NJFHS data with a sample of 600 non-group subscribers (subscriber lists provided by top 4 or 5 carriers in state who cover 95% of lives in the individual market). Using the same methodological approach utilized by Swartz and Garnick in the early years of the IHCP, they assessed the risk of medical expenditures of adult IHCP enrollees compared to that of a contrast population comprised of individuals with non-small-group employment-based insurance. They also compared the IHCP enrollees with the entire employer-group market and the uninsured.

Title: Guaranteed Renewability in Individual and Group Health Insurance: Functioning and Future Prospects
Institution: University of Pennsulvania, The Wharton School
Grant Period: November 2001 – October 2002
Principal Investigator: Mark V. Pauly, Ph.D.

If private insurers can be encouraged to improve the protection offered by their products, is it possible that those improvements can benefit consumers and obviate the need for regulation with undesirable side effects? This project focused on the individual and small group insurance markets; namely, the sharp increases in premiums which occur when an individual incurs large medical expenses. The researchers carried out three research tasks, summarized as follows: 1) Estimated the age profile of premiums for an “optimal,” benchmark guaranteed renewability (GR) policy that would cover claims (including the expenses of high-risk insureds) but not be priced so high that low-risks would leave for a cheaper policy. 2) Used data from MEPS, longitudinal claims data bases, and the Health and Retirement Survey to calibrate an empirically based, “exploratory” model derived from the optimal policy described in (1) that they can use in task #3. 3) Simulated hypothetical case studies that members of the Society of Financial Service Professionals, participating in “virtual focus groups,” evaluated on the basis of degree of realism. This study explored the effects of guaranteed renewability on public policy, (particularly if it could provide protection to high risks in a population) and informed insurance firms and insurance regulators about how to make it work better.

Title: Patterns of Individual Coverage
Institution: University of Southern Maine, Muskie School of Public Service
Grant Period: October 2001 – June 2003
Principal Investigator: Andrew F. Coburn, Ph.D.

How do the dynamics of the individual insurance market inform how long participants remain covered? What factors affect the length of participation and subsequent insurance status? Researchers at the University of Maine examined three specific questions: 1) Who uses the individual insurance market? 2) What role does individual insurance play in providing longer-term versus bridge coverage; and 3) What are the patterns of entry into and exit from the individual insurance market? This study better informs the policy debate, at both the federal and state levels, about the best options for sustaining affordable individual insurance coverage.

Title: Premium Variation and Insurance Demand in the Individual Market
Institution: University of Pennsylvania, The Wharton School
Grant Period: March 1999 – October 2000
Principal Investigator: Mark V. Pauly, Ph.D.

What effect does prior risk have on the premiums faced by purchasers in the non-group health insurance market? Researchers at the University of Pennsylvania’s Wharton School analyzed the extent to which premiums paid for non-group health insurance vary with the purchaser’s prior risk, and how this relationship varies with income, family size, presence or absence of strong individual insurance product community rating laws, managed care competition and penetration, and provider competition. Using the Community Tracking Study Household Survey, along with data from the Medical Expenditure Panel Survey (MEPS), the Area Resource File and the InterStudy Survey, they examined whether purchases in the individual market were affected by these factors differently than purchases in the group market. Part of this analysis involved constructing measures for each individual’s projected health care expenses, based on known predictors of health spending. The study’s objectives were to: 1) look at the extent to which non-group premiums vary with individual characteristics such as age, gender, family size, and poor health status; 2) examine the overall variation in non-group premiums for various population subgroups; 3) assess how local market conditions or community rating laws affect the variation of risk selection along the premium scale; 4) examine how much variation exists in benefit design and other plan characteristics within the non-group market; and 5) examine if otherwise similar families choose differently from a choice of non-group plans than from a choice of group plans.

Title: Expansion of the Evaluation of the Effects of New Jersey’s Individual Health Coverage and Access Programs
Institution: Harvard School of Public Health
Grant Period: May 1998 – April 1999
Principal Investigator: Katherine Swartz, Ph.D.

Using data collected during a previous HCFO evaluation of the market for individual health insurance coverage in New Jersey, the researchers wrote three papers: 1) The Effect of Subsidies on the Decision to Purchase Health Insurance Among Low Income Individuals: Lessons from the 'Health Access New Jersey' Program; 2) Meeting Information Needs: Lessons Learned from New Jersey’s Individual Health Insurance Reform Program; 3) Satisfaction with Health Plans Among People Insured in the Individual Health Insurance Market in New Jersey. In addition, they completed drafting five additional papers begun under the original grant. The objective of this project was to provide state and national policymakers considering various insurance market reforms with further information about how well these reforms have allowed New Jersey to meet its program goals.

Title: An Evaluation of the Primary and Secondary Effects of Insurance Market Reform
Institution: Bowman Gray School of Medicine
Grant Period: September 1996 – December 2000
Principal Investigator: Mark A. Hall, J.D.

What are the effects of state health reforms? Researchers at the Bowman Gray School of Medicine evaluated insurance market reforms in 12 states. The effects within a single carrier's various lines of business will be compared among carriers within a given state, and these statewide patterns were compared across states. The study consisted of intensive case studies of insurance market reforms and their effects in a non-random sample of six states that have enacted varying reforms, and a less intensive study of an additional six states. The researchers conducted: 1) two rounds of open-ended interviews of key informants; 2) participant observational studies of insurance agents; 3) content analyses of sales literature and news articles; and 4) statistical analyses of archival documents and secondary data. The objective of this study was to inform lawmakers and the public policy community about whether and how these reforms have achieved their multiple purposes or caused negative consequences, as well as about how the reforms might be improved.

Title: Evaluation of Reforms of the Market for Individual health Insurance Coverage in New Jersey
Institution: Harvard University School of Public Health
Grant Period: September 1995 – December 1997
Principal Investigator: Katherine Swartz, Ph.D.

Researchers at Harvard University and Brandeis University conducted a three part evaluation of reform of New Jersey's individual health insurance market implemented in August 1993. By gathering information from interviews with state officials and insurance executives, as well as from a survey of people enrolled in the individual insurance program, the researchers examined who enrolls in individual policies, what aspects of the reforms most influenced their choices, and what key players perceive as the strengths and weaknesses of the reforms. The objective of this project was to provide state and national policymakers considering various insurance market reforms with information about how well these reforms have allowed New Jersey to meet its program goals.

Title: Evaluation of State Initiatives to Expand Health Insurance Among Small Businesses
Institution: Wayne State University Institute of Gerontology
Grant Period: December 1992 – February 1995
Principal Investigator: Gail A. Jensen, Ph.D.

Are states' efforts to encourage small businesses to offer their employees health insurance successful? This study was designed to evaluate whether three sets of state initiatives -- waiving mandated benefit requirements, subsidizing premiums and reforming the small group insurance market -- have led to an increase in the availability of insurance among employees of small firms. Results from the study helped states to understand the potential effects of implementing legislative mandates to reform the small group market and the relative impact of three types of initiatives on expanding coverage among small businesses.

¹ Peterson, M., “Editor’s Note,” Journal of Health Politics, Policy, and Law, Vol. 25, No. 1, February 2000, p. 1.
² Rogal, D.L. and A.K. Gauthier, “Introduction: The Evolution of the Individual Insurance Market,” Journal of Health Politics, Policy, and Law, Vol. 25, No. 1, February 2000, p. 3.
³ Nichols, L.M., “State Regulation: What Have We Learned So Far?” Journal of Health Politics, Policy, and Law, Vol. 25, No. 1, February 2000, p. 188.
⁴ Rogal, D.L. and Gauthier, A.K., “Introduction: The Evolution of the Individual Insurance Market,” Journal of Health Politics, Policy, and Law, Vol. 25, No. 1, February 2000, p. 7.
⁵ Monheit, A.C., Cantor, J.C., et. al., “Market Watch: Community Rating and Sustainable Individual Health Insurance Markets in New Jersey,” Health Affairs, July/August 2004.
⁶ Swartz, K. and Garnick, D., “Lessons from New Jersey,” Journal of Health Politics, Policy, and Law, February 2000.
⁷ Herring, B. and Pauly, M.V., “Premium Variation in the Individual Health Insurance Market,” International Journal of Health Care Financing and Economics, March 2001.
⁸ Patel, V. and Pauly, M.V., “Guaranteed Renewability and the Problem of Risk Variation in Individual Health Insurance Markets,” Health Affairs, web exclusive, August 28, 2002.
⁹ Ziller, E., Coburn, A., et. al., “Patterns of Individual Health Insurance Coverage, 1996-2000,” Health Affairs, November/December 2004.
¹⁰ Pollitz, K., “Health Insurance Tax Credits: Layers of Complexity Underlie ‘Simple’ Health Insurance Subsidy,” Georgetown University, 2005.

Grantee Spotlight- Mark Pauly, Ph.D.

In President Bush’s January 23, 2007 State of the Union address he proposed changes to the federal tax code as well as other incentives to increase health insurance coverage. He proposed a standard deduction for individuals and families who purchase private health insurance in the individual market. In addition, he advocated grants to states that provide incentives for coverage for low-income citizens. Proponents of the President’s plan argue it would eliminate the current bias in favor of health insurance obtained through employers. Mark V. Pauly, Ph.D., Bendheim Professor of Health Care Systems, Business and Public Policy, Insurance and Risk Management, and Economics, at the University of Pennsylvania, has focused much of his research on the individual insurance market, particularly how it might be used in combination with tax incentives, to expand health insurance coverage.

Much of Dr. Pauly’s research can help inform the debate about how the President’s proposals are likely to affect the health insurance market. Dr. Pauly has studied consumer behavior and found that both group and individual insurance coverage have advantages and disadvantages. He argues that group insurance in an organization is supported by the current tax structure where income compensation received in the form of employer-paid insurance premiums is excluded from income and payroll taxes. He notes that group insurance is moderately less costly than individual insurance, but consumers who use the individual insurance market have a wider choice of portable and stable insurance options. For workers in very small firms, the difference in costs can be quite small.

Some of Dr. Pauly's work provides descriptive evidence on how group and individual markets operate. In a project partially supported by HCFO, he examined the contention that group insurance "pools risk" more effectively than individual insurance. Dr. Pauly’s findings suggest that differences between the markets are smaller than they are commonly believed to be. He found some degree of adverse selection in group insurance, which limits the degree of risk pooling. Older workers covered by group insurance appear to forgo larger amounts of wages (to reflect the higher cost of their coverage) than do younger workers. In the individual insurance market, current state and federal law requires “guaranteed renewability at class average premiums” so an insurer will not single out people who become higher risk for higher than average premium increases. This has resulted in premiums actually paid for individual insurance that vary much less than proportionately with risk.

Dr. Pauly also has studied the effects of subsidies on insurance markets. His research promotes a flexible tax credit/voucher system. His research suggests that such a tax credit would assist people in obtaining insurance and provide tax equity. Much of Dr. Pauly’s past and ongoing research is applicable to the current policy debate regarding the restructuring of federal tax incentives to promote the purchase of health insurance. His work also can better inform discussions about the potential impact of various state-based incentives to increase coverage among those with low incomes.

Before his appointment to the Wharton School in 1983, Dr. Pauly was on the faculty at Northwestern University. He has served as Executive Director of the Leonard Davis Institute of Health Economics and Vice Dean for Doctoral Programs at the University of Pennsylvania. He was commissioner on the Physician Payment Review Commission, and also has served on state commissions to study insurance and on Institute of Medicine panels looking at accountability in Medicare, vaccine financing, and substance abuse treatment.

In addition to continuing his research on the private insurance market in the United States, he is studying the prospects for private health insurance in developing countries. Dr. Pauly and colleagues published their work in this area in a 2006 Health Affairs article which identified three possible causes of small or nonexistent markets for private insurance in developing countries: inadequate demand because of low risk-aversion or misperception; restrictions on supply due to regulation; and high administrative costs. Pauly has recently shifted his attention to examining conceptual foundations for cost-benefit analysis of drugs and incentives in managed care.

Dr. Pauly received his Ph.D. in economics from the University of Virginia, a M.A. in economics from the University of Delaware, and an A.B. in classical languages from Xavier University.

For more information on Mark Pauly and a list of selected publications please go to http://www.wharton.upenn.edu/faculty/pauly.html.

2007 Special Topic Solicitation in PHSR

The Robert Wood Johnson Foundation (RWJF) has issued a HCFO special topic solicitation on Public Health Systems Research (PHSR). This is the third year that the Foundation has solicited PHSR applications. It is expected that another solicitation will be released next year.

PHSR is a field of inquiry examining the organization, financing, and delivery of pubic health services at local, state, and national levels, and the impact of these activities on population health. This research provides a better understanding of the demands placed on public health systems, the services they provide, and the capacity, funding, and organizational structure needed to support these activities. Ultimately, this research will facilitate better allocation and use of public health resources. PHSR grants should contribute to this evidence base and assist practitioners and policymakers in examining these issues, identifying possible solutions, and improving performance.

Application Procedure
This solicitation is open to all qualified applicants. Unlike the general HCFO grantmaking process, this solicitation features a batched application process. Therefore, all proposals submitted under this solicitation will be reviewed simultaneously and competitively. All applicants are required to submit a brief proposal on or before April 11, 2007. To access the solicitation and application instructions, please visit http://hcfo.net/phsr/2007solicitation.htm. Frequently Asked Questions can be found at http://hcfo.net/phsr/faqs.htm. Upon review of the brief proposals, projects will be invited to submit full proposals. Please do not submit a full proposal unless invited to do so.

Two New HCFO Grants Announced

Title: The CMS Pay for Performance Initiative: Are Some Quality Scoring Methods Better Than Others?
Grantee Institution: Massachusetts General Hospital Institute for Health Policy
Principal Investigator: Joel S. Weissman, Ph.D.
Grant Period: March 01, 2007 – August 31, 2008
Paragraph Summary: The researchers will examine the quality of hospital care. Using patient-level data from a large sample of hospitals collected by the Hospital Quality Alliance (HQA), they will estimate the proportion of patients receiving recommended care, create new measures of patient care quality, and simulate the impact of several pay-for-performance (P4P) scoring methods on hospital rankings. They will also examine the extent to which care varies by race, ethnicity, or insurance status within and across hospitals. The objective of the study is to assist CMS, other public and private payers, and accrediting organizations in developing strategies to improve hospital performance measurement and payment methods, and, ultimately, the quality of patient care.

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Title: Physicians' Responses to Variations in Medicare Fees for Specific Services
Grantee Institution: Center for Studying Health System Change
Principal Investigator: James D. Reschovsky, Ph.D.
Grant Period: March 01, 2007 – June 30, 2008
Paragraph Summary: The researchers will examine how physicians’ provision of specific medical services to Medicare fee-for-service (FFS) beneficiaries responds to variations in Medicare physician fees for those services, physicians’ characteristics, and to local market factors. The study will test whether the quantities of specific services physicians provide to their Medicare FFS patients are:1) positively related to the Medicare fee for each service; 2) inversely related to the fees paid by private insurance and to the level of demand from non-Medicare patients; and 3)positively related to indicators of physicians’ incentives to “induce demand.” Potential outcomes include: 1) indicating the percentage change in service volume for a particular fee change; 2) estimating how service volumes vary with local market conditions; 3) characterizing physician opportunities and underlying incentives to induce demand; and 4) identifying services for which service-specific fee adjustments might be an effective tool to constrain unnecessary use. This project expands upon a previous study by the applicants that investigated overall provision of total Medicare services by physicians. The objective of the project is to fill a gap in past and current physician payment research by assessing if changing relative prices of specific services will contribute to meeting the broad policy goals of discouraging the provision of services that unnecessarily add to cost growth without improving quality or outcomes.

Spotlight on Grantee Publication

Robert J. Town, Ph.D., professor in the department of Health Services Research and Policy at the University of Minnesota, is the co-author of an article titled, “Revisiting the Relationship between Managed Care and Hospital Consolidation,” that appeared in an early online issue of HSR. The article describes HCFO-sponsored research examining whether the rise in managed care during the 1990s caused the increase in hospital concentration.

Current HCFO grantee publications and recent grant findings will be regularly featured in the results section of our Web site.

This Month in the News

Katherine Swartz, Ph.D., professor of helath policy and economics at the Harvard School of Public Health, was quoted in a March 5, 2007 article in The New York Times that examined the growing population of the uninsured that are middle-class individuals. Swartz stated that, “the soaring cost of health care was a major reason for the increase in the number of uninsured.” She noted that, “Companies have become more aggressive in hiring people as temporary or contract workers with no fringe benefits.”

Karen L. Pollitz, M.P.P., research professor at the Georgetown University Health Policy Institute, was featured in a March 5, 2007 article in The New York Times that examined the growing population of the uninsured that are middle-class individuals. Pollitz stated that, “in the individual market, the federal protections provide precious little help to people seeking coverage.”

Gail Jensen, Ph.D., research fellow at The Independent Institute and professor of Gerontology and Economics at Wayne State University, was featured in a March 5, 2007 Connecticut Business News Journal article that examined how state mandates on health insurance affect costs.

Jack Hadley, Ph.D., principal research associate at the Urban Institute, was featured in a February 13, 2007 Christian Science Monitor article that discussed how businesses are looking for new solutions to rising health care costs. Hadley noted that, “whatever kind of reform we have will be a mixture of approaches.” Additionally, he stated that, “he expects that employers will end up covering a smaller share of American workers.”

Meredith B. Rosenthal, Ph.D., and R. Adams Dudley, M.D., M.B.A., provided commentary on pay-for-performance in a recent issue of the Journal of the American Medical Association. They reviewed five key design elements that “economic theory or available data suggest would be important determinants of [pay-for-performance programs’] influence.”

A number of HCFO grantees have been announced as part of the agenda for the AcademyHealth Annual Research Meeting, taking place in Orlando, Florida June 3-5, 2007.
* Jon Christianson, Ph.D. – Conference Chair, and Welcoming Remarks;
* Genevieve Kenney, Ph.D. – Chair, “SCHIP Reauthorization;”
* Paul B. Ginsburg, Ph.D. – Chair, “Ten+ Years of the Community Tracking Study: What Have We Learned?;”
* Christopher Murtaugh, Ph.D. – Chair, “Long-Term Care;”
* John Holahan, Ph.D. – Chair, “The Massachusetts Plan as a Proposal for Expanding Access: A Midterm Assessment of the Plan & Implications for Other States;”
* Gloria Bazzoli, Ph.D. – Chair, “Specialty Services: The New Front for Health Provider Competition;”
* Bradford H. Gray, Ph.D. – Chair, “Help with Publishing Instead of Perishing;”
* Douglas Wholey, Ph.D. – Chair, “Network Analysis;”
* Kenneth Thorpe, Ph.D. – Chair, “Pragmatic Health Reform: Second-Order Strategies from Europe;”
* James Robinson, Ph.D. – Chair, “Insurance Coverage & Payment for Biotechnology & Medical Devices;”
* David Blumenthal, Ph.D. – Chair, “The Electronic Health Record: From Research to Policy;”
* Stephen Zuckerman, Ph.D. – Chair, “Medicaid, SHCIP & State Health Initiatives;”
* David Knutson, Ph.D. – Chair, “Management and Organization;”
* Michael Chernew, Ph.D. – Chair, “Issues in Cost-Effectiveness Analysis;”
* Meredith Rosenthal, Ph.D. – Chair, “Measuring Efficiency of Health Care;” and,
* Judith Hibbard, Dr.P.H. – Chair, “Measuring and Supporting Consumer Engagement & Informed Choice.”

New HCFO Findings Brief

Due to its unique properties, the current health care market poses challenges that may hinder widespread adoption and slow development of pharmacogenomics (PGx). Research conducted by Louis F. Rossiter, Ph.D., at the Schroeder Center for Healthcare Policy at the College of William & Mary, examined the current market system to determine whether or not PGx could flourish in the current financing, delivery, and payment environment. According to Rossiter, “PGx products and services may be used inefficiently because the current system relies more on a trial and error approach, rather than on an individualized one which is offered by PGx.” Additionally, PGx faces challenges in the way of competition from large pharmaceutical firms, the absence of a “blockbuster drug” to motivate investment in research and development, and a lack of cost-effectiveness studies that could encourage adoption and public and private reimbursement of products and services.

To download a full copy of the Findings Brief, please visit the HCFO Web site.

2005 National Hospital Discharge Survey Data Available For Researchers

The National Center for Health Statistics (NCHS) announces the release of the 2005 National Hospital Discharge Survey (NHDS) micro-data file and documentation. The NHDS is an annual survey of inpatient hospital use that has been conducted continuously since 1965. The survey covers inpatients discharged from a national probability sample of nonfederal, short-stay hospitals in the 50 states and Washington, D.C. Data are collected on hospitals, the patients they serve, and the inpatient care delivered. The 2005 public use file contains data from 375,000 inpatients receiving care at 444 hospitals. These data can be used to produce unbiased, national estimates of inpatient hospital services delivered, and to examine the ways that hospital service delivery varies over time and according to patient and hospital characteristics. Hospital variables available for analysis include ownership and bed size. Patient variables include demographic characteristics, primary and secondary diagnoses, expected source of payment, and source and type of admission. Variables describing the use of care and other aspects of clinical management include procedures performed, length of stay, and inpatient mortality.

A downloadable data file in ASCII format is available, along with complete survey documentation. For SAS users, a SAS program is also available on the web for data input. Links to the data file and documentation can be accessed at the NHDS homepage: http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm

The NHDS is one component of the National Health Care Surveys, a family of surveys which collect data on health care providers, their patients, and the care delivered across the spectrum of health care providers. For information on long term care, inpatient care, ambulatory surgery, and ambulatory medical care components of the National Health Care Surveys, please visit www.cdc.gov/nchs/nhcs.htm.

Job Opportunities at AcademyHealth

Research Assistant job opening

AcademyHealth is currently seeking a Research Assistant to assist with major programs and projects of AcademyHealth. In particular, the incumbent would provide staff support for the Research, Policy and Dissemination Team’s Changes in Health Care Financing and Organization (HCFO) initiative, a Robert Wood Johnson Foundation-sponsored program. This program supports the research community by funding research that examines major changes in health care financing, its effects on costs, access and quality, and the public health system. It also bridges the gap between research and policy by translating findings and disseminating them to appropriate stakeholders. The Research Assistant would assist with a variety of substantive and administrative tasks to support HCFO’s grantmaking, convening and dissemination activities and assist in the development of policy and research syntheses. In addition, the incumbent would provide support to other activities of AcademyHealth, including its work on long-term care, public health, and other projects as necessary. For more information, please visit http://www.academyhealth.org/about/employment.htm. Interested candidates can send cover letter and resume to jobs@academyhealth.com.

Long-Term Care Internship

AcademyHealth is currently seeking a summer intern to work on follow-up activities related to the June 2006 LTC Colloquium, “Building Bridges: Making Difference in Long-Term Care.” In particular, this individual would assist with the preparation of the colloquium summary (web-based). Please see http://www.academyhealth.org/ltc/ for additional information on the colloquium and to view the 2006 meetings summary. If the intern is able to begin work in late May, s/he would also have the opportunity to attend the 2007 colloquium in Orlando, Florida on June 3-5, 2007. If the internship begins later, the intern would assist in preparing the report using meeting transcripts and background materials, including commissioned papers and PowerPoint presentations. Candidates must have some background in health policy and long-term care. Fluency with Microsoft Office, as well as some experience writing for the Internet is desired. The internship is non-paid and runs through mid-May to August. A workweek of 30-40 hours is expected. Interested candidates can send cover letter and resume to jobs@academyhealth.org

Attend the AcademyHealth 2007 Annual Research Meeting (ARM)

Attend the AcademyHealth 2007 Annual Research Meeting (ARM)

June 3-5 * Walt Disney World Swan and Dolphin * Orlando, Fla

Attend the 2007 ARM and see what health services researchers around the world are doing, learn new research methods, and network with colleagues at THE conference for health services research.
Presentation of cutting-edge health services research is the cornerstone of the ARM, offering opportunities for researchers to share important findings with policymakers and providers who can put the research into action! Details on the specific theme topics and the preliminary agenda can be found online.

Hone Your Skills with Methods Seminars

Attend pre- and post-conference seminars in health services research methods to learn about hierarchical modeling, Bayesian methods, endogenous explanatory variables, and HCUP and NHANES data. Additional registration required.

Explore Your Area of Focus at the Interest Group Meetings

Interest Groups provide a forum for members to share information, network with their peers, and learn more about a topic. Enhance your meeting experience by attending AcademyHealth's Interest Group meetings and participating in discussions on topics of interest to you. Additional registration required.

Building Bridges: Making a Difference in Long-Term Care - 2007 Colloquium

Saturday, June 2
Orlando, FL

The 2007 Colloquium will focus on two issues:

Conflicting Incentives for Long-term Care: Medicare and Medicaid

David Grabowski, Ph. D., at Harvard Medical School’s Department of Health Care Policy will prepare a background paper and explore the sometimes conflicting incentives within the Medicare and Medicaid programs in terms of the provision and financing of long-term care, as well as the implications of those incentives for quality, financing, and ultimately policy. Grabowski will synthesize what is known, develop a research agenda, and identify methodological concerns and obstacles to building an evidence base to inform the policy debate.

Consumer Preparedness for Long-term Care

This year’s colloquium will feature a new forum format designed to stimulate discussion among an expert panel and colloquium participants. The goal of this facilitated discussion will be to engage the dynamic panel in a discussion of issues related to long-term care planning. In addition, the facilitator will elicit the experts’ and colloquium participants’ sense of which issues were most important to policymakers and practitioners, as well as where research efforts should be focused. Following the colloquium, AcademyHealth will prepare an issue brief synthesizing the discussion and outlining research and policy agendas.

The meeting will be held on Saturday, June 2 from 8:30 a.m. until 4 p.m, in conjunction with AcademyHealth's Annual Research Meeting in Orlando, FL.

For more information on AcademyHealth and The Commonwealth Fund, see www.academyhealth.org and www.cmwf.org.

Inquiries can be directed to Christal Stone at 202.292.6765 or ltc@academyhealth.org.