What's New with HCFO - October 19, 2007 (Print All Articles)

Medicare Advantage Under Scrutiny

One of the most fundamental issues currently facing Medicare is the program’s long-term financial stability.1  As Medicare spending continues to increase, examining current spending and trends has become increasingly important.  In particular, Medicare Advantage2 has become a subject of high interest because of its recent growth in enrollees and its impact on Medicare spending.  Currently, a record number of health insurance companies are contracting with the government to offer Medicare Advantage plans, and enrollment in these programs is an at all-time high and expected to continue to grow.3

Medicare Private Health Plans

Medicare Health Maintenance Organizations (HMOs) have been a benefit option under Medicare since the HMO Act of 1976.  The Balance Budget Act of 1997 created the option for Medicare beneficiaries to receive their coverage through private health insurance plans, rather than through original Medicare Parts A and B.4  As part of this act, additional types of private health plans were authorized in addition to Medicare HMOs, including Preferred Provider Organizations (PPOs), Provider Sponsored Organizations (PSOs), Private Fee-For-Service (PFFS) plans, and high deductible plans linked to Medical Savings Accounts (MSAs).  These programs were known as "Medicare+Choice" or "Part C" plans.

More changes were made to Medicare+Choice with the Medicare Modernization Act (MMA) of 2003.  Medicare+Choice became known as Medicare Advantage (MA), and new regional PPOs and Special Needs Plans (SNPs) for dual eligibles and other vulnerable populations were created.  In addition, payment rates to Medicare Advantage plans were raised.

Of the near 44 million elderly and disabled people on Medicare, 20 percent (8.7 million) receive their Medicare benefits through Medicare Advantage plans.5 About 80 percent of Medicare Advantage beneficiaries are in HMOs or PPOs, which both have comprehensive networks of providers and use care management services to promote better coordination and effective use of care.  PFFS plans allow enrollees to obtain care from any provider and are not required to have a network of providers. 

The primary goal of the Medicare Advantage program was to offer beneficiaries the choice of enrolling in private health plans. To date, there has been success in providing additional benefits to enrollees and in lowering cost-sharing.  The addition of PFFS plans has also increased access to coverage, particularly for people living in rural areas.  

Enrollment Trends

Recently, Medicare Advantage plans have become the subject of much debate. These plans are currently growing faster than other Medicare options, in both the number of plans and enrollees.  With this growth, particular attention has been paid to increasing costs of the program, creating disagreement regarding size of payments to Medicare Advantage plans and the added benefits that are financed with those payments. 

Plan participation and enrollment in Medicare Advantage has fluctuated over the past decade.  Although there was a significant drop in enrollment between 1999 and 2002, between 2003 and 2007, Medicare Advantage enrollees increased from 5.3 million to 8.7 million, and the number of contracts grew from 285 to 602.6  Of these increases, the greatest growth in recent enrollment has been in the PFFS plans.  Between 2005 and 2007, enrollment in these plans increased from 208,990 to 1,327,826 enrollees.7  

Medicare Advantage Payment Rates

Medicare pays MA plans a capitated rate to provide Part A and B benefits to enrollees. For many years, payments to HMOs were generally set at 95 percent of FFS costs in each county.8  As part of changes made by the MMA Act of 2003, since 2006, a bidding system has been used to determine payment for MA plans.  Private plans submit bids reflecting the per capita payment for which they are willing to provide Medicare’s Part A and B benefits.  These bids are compared to county-level benchmarks; the maximum payments that the government will make for enrollees in private plans.  Currently, benchmarks are required to be at least as great as per capita FFS expenditures in every county. 

Recent discussions have focused on the issue that many county benchmarks are higher than FFS expenditures. The Congressional Budget Office (CBO) calculates that benchmarks are 17 percent higher, on average, than projected per capita FFS expenditures nationwide.  CBO determined that this varied between different MA plans, with PFFS plans exhibiting the largest differential at an average of 19 percent above per capita FFS, while other MA plans average approximately 12 percent higher than traditional FFS.9 

If plans bid less than the county benchmark, Medicare retains 25 percent of the savings, while the plan receives the other 75 percent as a rebate, which must be used to provide supplemental benefits or decrease premiums for enrollees. Because Medicare Part A and B costs are still distributed across all Medicare enrollees, this leads to a question about the extent to which Medicare distributes extra benefits equitably across Medicare populations. 

PFFS Plans

Rapidly increasing enrollment in private plans has been driving the increased cost of Medicare Advantage plans. Although partially offset by decreasing enrollment and spending in FFS Medicare, shifts in enrollment to Medicare Advantage results in higher net costs for the Medicare program overall.10 

PFFS plans are particularly unique in comparison to other Medicare Advantage plans because in addition to not having to build a network of providers, they do not have to report quality measures, have CMS review and approve bids, offer Part D coverage, or have an out-of-pocket limit on enrollee expenditures.

The addition of PFFS plans to Medicare Advantage was successful in increasing access and coverage.  It has increased the number of plans enrolled in Medicare Advantage, as well as the benefits offered.  While this has encouraged participation of private plans, some feel the current MA program offers few incentives for efficiency.11  While PFFS plans help to reach the goals of meeting health care service needs of beneficiaries, these plans undermine goals of financial neutrality.12 

Future Challenges

On average, every Medicare beneficiary is paying about $2.00 more per month in Part B premiums to finance the payments being made in MA that exceed Medicare FFS expenditure levels.13  It is argued that this is causing uneven distribution of benefits across beneficiaries, and that there are more targeted, less costly ways to provide these benefits. MedPAC recommends that benchmarks should be set at 100 percent of Medicare FFS expenditures.14  This could increase efficiency and promote the use of potential savings to provide extra benefits to enrollees. While this strategy may force plans to become more efficient, it could result in fewer plan offerings and less generous benefits, which has been one of the successes of the Medicare Advantage plans.  

CBO projects that payments to Medicare Advantage plans will increase from $60 billion in 2006 to $77 billion in 2007 and $196 billion by 2017.15  In addition to rising costs, it is projected that enrollment in Medicare Advantage plans will grow at an average rate of about 7 percent over the next ten years, while regular Medicare is only expected to have a 2.5 percent growth rate over the same time.  CBO also addressed the potential to decrease Medicare spending by reducing benchmarks to FFS spending, noting that it would reduce federal spending, but also make the program less attractive to beneficiaries and health plans, which could affect participation and enrollment rates.16

The scrutiny of the Medicare Advantage program is likely to continue as policymakers weigh the benefits and costs of this model of coverage. Foremost in their minds will be the question, “how does Medicare Advantage impact the Medicare system and its prospects for remaining fiscally stable while continuing to meet the health care needs of beneficiaries?”   

The following selected grants from HCFO's portfolio may help inform policy makers who are working to address current issues around Medicare Advantage. For other Medicare Advantage related grants see www.hcfo.net.

Title: Examining the Impact of Informational Messages on Seniors' Choice of Medicare Drug Plans
Institution: Princeton University
Principal Investigator: Eldar Shafir, Ph.D.
Grant Duration: August 2007–July 2008

The applicants will examine how well people choose from among the large set of alternatives in the Part D plan and evaluate whether psychologically attuned interventions can help improve those choices. Specifically, they will evaluate people’s actual choice of plan in light of the medications they use and then experimentally increase the availability of or access to cost information. They will encourage clients to explicitly consider their personal preferences (such as their attitude toward the use of generic medications or mail order prescription drug services) to see how the availability of such considerations might influence chosen plan quality and beneficiary satisfaction with the chosen plan. The objective of this study is to inform policies surrounding Part D and other policies relying on consumer choice in complicated environments.

Title: Impact of MMA Part D on Medicare Residents in Nursing Homes
Institution: University of Massachusetts Medical School
Principal Investigator: Becky Briesacher, Ph.D.
Grant Duration: January 2007–June 2008

The applicants will evaluate the impact of the transfer of prescription drug coverage for dual-eligibles (Medicare and Medicaid) living in nursing homes from Medicaid to Medicare Part D, as required by the MMA. In particular, they will: 1) measure the rates of enrollment into Medicare Part D for nursing home residents from 2005 to 2007; 2) assess the impact of Medicare Part D on overall prescription drug utilization patterns; 3) identify the major drug classes most affected by the program, including an examination of benzodiazepines and their exclusion from Part D coverage; and 4) determine the impact of Medicare Part D on overall rates of hospitalizations and falls, as indicators of quality care. The objective of the project is to better inform state and federal policymakers about the impact of Medicare Part D on drug utilization, as well as quality (measured by hospitalizations and falls).

Title: Study on Informed Choice of Drug Coverage for Medicare Beneficiaries
Institution: University of Minnesota School of Public Health
Principal Investigator: Bryan E. Dowd, Ph.D.
Grant Duration: August 2006–July 2007

Is Medicare Part D drug benefit a cost-effective option for healthy Medicare beneficiaries? The researchers hypothesize that seniors use current expenditures to estimate their need for coverage, which could result in a significant underestimate of the true risk. The objective of the project is to evaluate the cost-effectiveness of Medicare Part D for healthy beneficiaries and provide accurate lifetime drug cost information to help seniors make more informed decisions regarding Medicare Part D coverage.

Title: Medicare Beneficiaries Response to Coverage Gaps Versus Actuarially Equivalent Continuous Coverage for Prescription Drugs
Institution: University of Maryland at Baltimore
Principal Investigator: Bruce Stuart, Ph.D.
Grant Duration: July 2006–June 2007

Are Medicare beneficiaries likely to react differently when faced with the donut-hole “gap” in Medicare Part D than they would with actuarially equivalent continuous coverage? The researchers propose to challenge the hypothesis that actuarially equivalent, but structurally different cost sharing arrangements have similar impacts on beneficiaries' prescription drug utilization patterns. The researchers would also determine whether the relationship between use and benefit structure is sensitive to the overall generosity of insurance coverage. This project builds on Stuart's previous HCFO grant assessing the effects of gaps in drug coverage for Medicare beneficiaries with common chronic diseases. That study found that gaps in drug coverage lead to reduced utilization rates and that the effects are magnified for those with common chronic diseases such as diabetes, COPD, and mental illness. This project would extend the understanding of how Medicare beneficiaries react to benefit structure, but would also be useful to private payers as they search for a cost sharing formula that contains costs while minimizing disruption in medication regimens. The objective of this project is to provide policymakers with a better understanding of how Medicare beneficiaries behave when faced with alternative cost-sharing structures.

Title: Medicare Health Plan Decisions: Will Regional Competitive Bidding Work?
Institution: Boston University School of Public Health
Principal Investigator: Steven D. Pizer, Ph.D.
Grant Duration: July 2004–December 2006

What is the market entry and exit behavior of health plans (HMOs and PPOs)? The project modeled this behavior in order to provide input to policymakers trying to enhance private plan participation in Medicare. The researchers determined whether plans will require higher premiums or more extensive risk sharing to induce them to enter counties or regions with low population densities. They also modeled the enrollment and disenrollment from health plans to determine whether differences in the service area definitions (county versus regional service areas) may exacerbate adverse selection and cause instability in plan premiums and participation. The objective of this study was to help provide information to federal policymakers implementing Medicare Advantage (formerly Medicare+Choice) and planning for private plan competition demonstrations.

Title: Managed Care and Medicare Expenditures
Institution: University of Michigan
Principal Investigator: Michael E. Chernew, Ph.D.
Grant Duration: January 2004–December 2004

How do Medicare+Choice (M+C) payment rates affect M+C and FFS utilization and expenditures? The researchers: 1) assessed the impact of changes in payment rates to Medicare HMOs on enrollment in HMOs by Medicare beneficiaries; 2) assessed the aggregate impact of Medicare HMO enrollment on FFS Medicare utilization and expenditure; and 3) disaggregated the impact of Medicare HMO enrollment on FFS Medicare utilization and expenditure into a spillover effect and a selection effect. This study revises the assumptions surrounding the impact of managed care on Medicare expenditures in order to assist policymakers in assessing the financial health of the Medicare Trust Funds.

Title: Managed Care’s Spillover Effects on the Quality of Diabetes Care for Medicare Patients
Institution: Mount Sinai School of Medicine
Principal Investigator: Paul L. Hebert, Ph.D.
Grant Duration: January 2002–July 2003

How does increased managed care penetration affect quality of care in the non-managed care sector? Paul L. Herbert, Ph.D., at Mount Sinai School of Medicine used data from the Physician Survey of the CTS and the National Diabetes Cohort to examine whether efforts to monitor the quality of care in managed care organizations (MCOs) have had similar spillover effects on the non-managed care market – particularly for chronic conditions such as diabetes. Specifically, the researchers examined whether: 1) increased managed care market penetration affects the provision of diabetes-specific preventive care to Medicare beneficiaries in the non-managed care sector; and 2) increased managed care market penetration affects the provision of high-cost medical services to Medicare beneficiaries with diabetes in the non-managed care sector. The study also examined whether managed-care-induced changes in health care use have implications for “avoidable” hospitalizations for persons with diabetes. This study better informs policymakers of the system-wide consequences of health care cost-containment policies that encourage expanded use of managed care.

Title: Medicare Risk-Contracting: Impact on Access and Quality for Medicare HMO Enrollees and Vulnerable Populations
Institution: University of Southern California
Principal Investigator: Glenn A. Melnick, Ph.D.
Grant Duration: February 2001–January 2005

What are the effects of Medicare managed care on access and quality (compared to Medicare fee-for-service) for the general population of managed care beneficiaries and vulnerable populations, in particular? Based on previous studies finding that managed care works best for those who know how to work the system, the researchers at the University of Southern California hypothesize that vulnerable populations are more likely to plan than their non-vulnerable equivalents. They will test this hypothesis at both the patient and plan levels, examining the following questions: 1) Do vulnerable populations enrolled in Medicare managed care receive different levels or quality of care than their less vulnerable counterparts? and 2) Do health plan characteristics (e.g. type of ownership, organizational structure, or experience with Medicare risk contracting) influence the level of care vulnerable populations receive? The goal of this study is to provide policymakers with a deep and broad analysis of the experiences of Medicare managed care enrollees. They will also conduct a series of case studies to assess the technical feasibility of adding outpatient, pharmacy, and long-term care data from health plans to the OSPHD database.


 

 

 

1 “MedPAC Chair Discusses Challenges in Interview with The Hill.” Kaiser Daily Health Report. September 21, 2007. Also see http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=47673
2 “Medicare Advantage Plans.” U.S. Department of Health and Human Services. See http://www.medicare.gov/Choices/Advantage.asp
3 Kaiser Family Foundation, "Medicare Advantage: Key Issues and Implications for Beneficiaries," Testimony of Patricia A. Neuman, Hearing of the House Committee on the Budget, United States House of Representatives, June 28, 2007. Also see www.house.gov/budget_democrats/hearings/TN_final_testimony.pdf
4 “Medicare Advantage,” Medicare Fact Sheet, The Henry J. Kaiser Family Foundation, June 2007. Also see, www.kff.org/medicare/upload/2052-10.pdf
5 ibid.
6 “Medicare Advantage,” Medicare Fact Sheet, The Henry J. Kaiser Family Foundation, June 2007. Also see, www.kff.org/medicare/upload/2052-10.pdf
7 Miller, M. “The Medicare Advantage Program and MedPAC Recommendations.” Statement before the Committee on the Budget. U.S. House of Representatives, June 28, 2007.
8 “Medicare Advantage,” Medicare Fact Sheet, The Henry J. Kaiser Family Foundation, June 2007. Also see, www.kff.org/medicare/upload/2052-10.pdf
9 Orszag, P.R. “CBO Testimony: The Medicare Advantage Program” Statement before the Committee on the Budget. U.S. House of Representatives, June 28, 2007. 
10 ibid.
11 Miller, M. “The Medicare Advantage Program and MedPAC Recommendations.” Statement before the Committee on the Budget. U.S. House of Representatives, June 28, 2007.
12 ibid.
13 ibid.
14 ibid.
15 Orszag, P.R. “CBO Testimony: The Medicare Advantage Program” Statement before the Committee on the Budget. U.S. House of Representatives, June 28, 2007. 
16 ibid.

Grantee Spotlight-Korbin Liu, Sc.D.

Korbin Liu, Sc.D.
In Memoriam 1944-2007

Korbin Liu, Sc.D., was a principal research associate at the Urban Institute, an organization that analyzes policies and evaluates programs with the intent of informing community development and fostering social, civic, and economic interests. Dr. Liu’s principal research area was long-term care, which included work on Medicare, Medicaid, and those dually eligible for both programs.  Key elements of his work addressed nursing home use, long-term care payments and costs, and the costs of end-of-life care.  Information about Dr. Liu’s body of work can be found at http://www.urban.org/expert.cfm?ID=KorbinLiu

Dr. Liu earned his Sc.D. in Population Sciences from Harvard University, an M.S. in Public Health from the University of Massachusetts, and an A.B in Biology from Amherst College. Prior to working at the Urban Institute, Dr. Liu worked at the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services), the Public Health Service, and the National Center for Health Services Research and Health Care Technology Assessment. Dr. Liu also was a Teaching Fellow at Harvard University while he was earning his doctorate.

Dr. Liu’s HCFO-funded research examined those who were dually eligible for Medicare and Medicaid and the factors that affect their end-of-life care. The goal of this research was to improve current policies and care for this population of individuals. Dr. Liu completed two publications based on his HCFO-funded study. Published in Health Care Financing Review, “End-of-Life Medicare and Medicaid Expenditures for Dually Eligible Beneficiaries” discussed the use of Medicare and Medicaid services for beneficiaries during the last year of life and concluded that policy must consider the interaction between Medicare and Medicaid. In an article published in Inquiry, Dr. Liu presented results from research that show that 75 percent of dual eligibles used nursing home care in the last year of their life.

Dr. Liu died in August 2007 after battling cancer. His contribution to health services research will not soon be forgotten.

New HCFO Grants Announced

Title: Identifying Best Practices in the Coordination of Care
Grantee Institution: Center for Studying Health System Change
Principal Investigator: Ann S. O’Malley, M.D., M.P.H.
Grant Period: October 2007–September 2008
Paragraph Summary: The researchers will examine how care is coordinated in ambulatory care settings. Specifically, they will identify and document “best practices” in physician offices that have developed care coordination processes and determine the financial implications of increased coordination. For example, the researchers will assess whether a periodic care coordination fee or itemized billing for coordination activities is more efficient. They will also examine a group of “average practices” to assess how they set priorities for coordination activities and what barriers they encounter. The objective of the proposed project is to better inform the replication of organized care coordination processes in medical practices.  

Title: Paying Physician Group Practices for Quality: A Regional Natural Experiment
Grantee Institution: University of Washington School of Public Health and Community Medicine
Principal Investigator: Douglas A. Conrad, Ph.D.
Grant Period: October 2007–March 2009
Paragraph Summary: The researchers will evaluate the impact of a quality-based scorecard and financial incentives developed by Premera Blue Cross in Washington State. They will compare clinics exposed to two waves of a progressive “paying for quality” intervention with a control group of clinics not subject to the intervention. Specifically, the researchers will assess the joint effects of quality-based financial incentives and the quality scorecard on physicians’ clinical quality, patient satisfaction, and efficiency in caring for patients.  They will distinguish the effects on quality, patient satisfaction, and efficiency of providing information to medical groups relative to their performance on an array of clinical quality measures from the incremental effect on quality and efficiency of clinical quality-based financial incentives. The objective of the project is to assist organizational leaders and public policymakers to craft more cost-effective quality incentives. 

Title: Effects of Prior Authorization of New Medications among Medicaid Beneficiaries with Bipolar Disorder
Grantee Institution: Harvard Pilgrim Health Care Inc.
Principal Investigator: Stephen B. Soumerai, Sc.D.
Grant Period: October 2007–March 2009
Paragraph Summary: The researchers will evaluate the effects of prior authorization of new medications among Medicaid beneficiaries with bipolar disorder in the state of Maine.  As part of their study, they will: (1) describe baseline demographic and clinical characteristic and patterns of treatment; (2) examine the impact of prior authorization on utilization and expenditures of preferred versus non-preferred atypical antipsychotic (AA) agents and anticonvulsant (AC) agents among patients continuously enrolled for the entire study period in Maine and New Hampshire (comparison state); and (3) examine the impact of prior authorization on rates of hospital admission and rates of cessation of all medical treatment, two potential adverse outcomes. The objective of the project is to examine the effect of prior authorization, an increasingly popular drug utilization management policy for patients with chronic mental illness, on medication use and associated outcomes.


Spotlight on Grantee Publications

Steven D. Pizer, Ph.D., assistant professor at Boston University School of Public Health, and colleagues recently published the article, “Predicting Risk Selection Following Major Changes in Medicare” in the June 7, 2007 issue of Health Economics. The article details HCFO-sponsored research examining market entry and exit behavior of private health plans in Medicare. 



Ted von Glahn, director of consumer engagement for the Pacific Business Group on Health, and colleagues recently published the article, “Patient Samples for Measuring Primary Care Physician Performance: Who Should Be Included?” in the October 2007 issue of Medical Care. This article highlights HCFO-sponsored research examining the impact of patient-reported physician performance information on patient selection of physicians.



Mark A. Hall, J.D., professor at Wake Forest University, and colleagues published the article, “Effects of State Managed Care Patient Protection Laws on Physician Satisfaction,” in the October 2007 issue of Medical Care Research and Review.  The article details HCFO-sponsored research on the effects of state managed care patient protection laws on patients, providers, plans, and network, corporate, and market structures.

Grantees in the News

The September 10, 2007 Broadside Online article “New Faculty Join Mason this Year” introduced Jack Hadley, Ph.D., as a new senior health services researcher and professor in the College of Health and Human Services at George Mason University.

The University of Arkansas for Medical Sciences announced the appointment of Glen Mays, Ph.D., to chair of the Department of Health Policy and Management in the Fay W. Boozman College of Public Health. 

Michael A. Stoto, Ph.D., served as a panelist at the September 21, 2007 California Health Policy Forum session titled, “Public Health Regionalization: Opportunities and Lessons Learned (Part 3).” In addition, he wrote the California Health Policy Forum September 2007 issue brief, “Regionalization in Local Public Health Systems.” In this brief, Dr. Stoto summarized his HCFO-sponsored research examining and comparing the rationale, approach, and impact of regionalization in states such as Massachusetts and Nebraska. 

HCFO Findings Brief: Medicare Advantage and the Impact of Medicare HMOs on Inpatient Utilization

Glenn A. Melnick, Ph.D., and researchers at the University of Southern California conducted research examining the differences in hospital utilization for Medicare fee-for-service (FFS) and Medicare risk health maintenance organization (HMO) enrollees. They found that inpatient utilization was less for Medicare HMO enrolles than Medicare FFS enrollees. While the data that was analyzed preceded the establishment of Medicare Advantage, findings from this longitudinal study are relevant to the current debate about whether Medicare Advantage plans use health care resources efficiently.  For more...

 

HCFO Researchers and Staff to Participate in APHA Panel

APHA Annual Meeting Session: Moving Public Health Systems Research from Infancy to Adolescence: Research Needs, Stakeholder Priorities, and a Joint Agenda

November 5, 2007, 8:30 a.m.- 10:00 a.m. (Session #3011.0)

In their formative article, Behind the Curve? What We Know and Need to Learn from Public Health Systems Research, Glen P. Mays, Ph.D., Paul K. Halverson, Dr.P.H., and F. Douglas Scutchfield, M.D., define Public Health Systems Research (PHSR) as a field of study that examines the organization, financing, and delivery of public health services within communities, and the impact of these services on population health. This discipline has been built and strengthened by PHSR researchers contributing to the knowledge base, private and public organizations funding such research, and variety of stakeholders along the translation continuum who use PHSR findings to guide policymaking. However, as PHSR moves from its infancy to its adolescence, unavoidable questions—practical and philosophical—face this field. This panel seeks to continue the PHSR consensus-building dialogue by addressing the diverse interests that shape this emerging field and posing a strategy for moving it forward.

Speakers include:

Susan Allan, M.D., Public Health Director, Oregon Department of Human Services
Ron Bialek, M.P.P., Executive Director, Public Health Foundation
Glen Mays, Ph.D., Chair, Department of Health Policy and Management, School of Public Health, University of Arkansas for Medical Sciences
Kate Papa, M.P.H., AcademyHealth

Information about this session can be found at http://apha.confex.com/apha/135am/techprogram/session_21626.htm

New Data for Researchers

NCHS releases health insurance coverage data

Last month, NCHS published Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-March 2007.  The report presents three key measures of health insurance coverage: persons who currently lack coverage; persons uninsured at any point in time in the previous year; and, persons who have experienced lack of coverage for more than one year. In the first quarter of 2007, 14.2 percent of individuals were uninsured at the time of the interview, 17.8 percent had been uninsured for some part of the previous year, and 10.3 percent had been uninsured for more than a year.

NCHS publishes each of these estimates quarterly, within six months of the close of each quarter. Complete calendar-year data from the National Health Interview Survey (NHIS) are released during the summer following the end of each data collection year. Currently, users can access calendar year 2006 questionnaires, data and related documentation on the web. The health insurance segment provides a full range of data items addressing health insurance, including type of health care coverage and managed care arrangements, that can be analyzed in relation to health behaviors, health care access and utilization, poverty status, and a variety of demographic variables.

AHRQ releases 2005 versions of the HCUP inpatient and outpatient hospital databases

The Agency for Healthcare Research and Quality (AHRQ) sponsors the Healthcare Cost and Utilization Project (HCUP).  HCUP is a group of health care databases and related software tools and products that is sponsored by a federal-state-industry partnership.  HCUP is a rich resource for researchers and policy-makers who are interested in identifying, tracking, and analyzing national, regional, and state-level trends in health care utilization, access, charges, quality, and outcomes. The HCUP databases contain a core set of clinical and non-clinical information on all patients, regardless of payer—including Medicare, Medicaid, private insurance, and the uninsured. In addition to the core set of uniform data elements common to all databases, some databases also include other valuable elements, such as the patient's race.  Researchers may also conduct multi-year trends analyses using HCUP data.

HCUP produces five types of databases:  The Nationwide Inpatient Sample (NIS), Kids’ Inpatient Database (KID), State Inpatient Databases (SID), State Ambulatory Surgery Databases (SASD), and State Emergency Department Databases (SEDD):

Nationwide Inpatient Sample (NIS): The NIS is the largest all-payer inpatient care database in the United States, containing data from approximately 8 million hospital stays each year. The NIS databases are available for data years 1988 to 2005. 

Kids’ Inpatient Database (KID): The KID is a database of hospital inpatient stays for children and allows researchers to study a broad range of conditions and procedures related to child health issues. The KID includes a sample of pediatric discharges from 2,500 to 3,500 U.S. community hospitals. Currently, the following data years are available for the KID: 1997, 2000, and 2003. 

State Inpatient Databases (SID): The SID contain the universe of the inpatient discharge abstracts in participating states, translated into a uniform format to facilitate multi-state comparisons and analyses. Together, the SID encompass about 90 percent of all U.S. community hospital discharges. The SID databases are available for data years 1990 to 2005.

State Ambulatory Surgery Databases (SASD) : The SASD capture surgeries performed on the same day that patients are admitted and released.  All of the databases include abstracts from hospital-affiliated ambulatory surgery sites and some contain the universe of ambulatory surgery encounter abstracts for that state, including records from both hospital-affiliated and freestanding surgery centers. The SASD databases are available for data years 1997 to 2005.

State Emergency Department Databases (SEDD): The SEDD capture information on all hospital-affiliated emergency department visits that do not result in an admission. The SEDD contain the emergency department encounter abstracts in participating states, translated into a uniform format to facilitate multi-state comparisons and analyses. The SEDD databases are available for data years 1999 to 2005.

HCUP databases are available from the HCUP Central Distributor. For additional information about the HCUP databases and related products, please visit the HCUP User Support Website at: http://www.hcup-us.ahrq.gov/.

New Online Statistical Report on Hospital-Based Care — HCUP Facts and Figures

The Agency for Healthcare Research and Quality (AHRQ) released a new statistical report entitled HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2005. Using the Nationwide Inpatient Sample (NIS) databases, this report presents information about hospital care in 2005, as well as trends in care from 1993 to 2005.  HCUP Facts and Figures features an overview of hospital-related topics, including general characteristics of U.S. hospitals and the patients being treated, information about the most common diagnoses, conditions, and procedures associated with inpatient stays, data focusing on the costs and charges associated with hospitalizations, and a discussion of uninsured hospitalizations.

Selected highlights of hospital-based care in 2005 include:

  • From 1997 to 2005, the number of community hospitals declined from 5,060 hospitals to 4,936 hospitals. Despite this decline, the volume of hospital stays grew by 4.5 million. Hospitals were able to accommodate this increase in discharges primarily because of a four percent reduction in the average length of stay.
  • The average cost per hospital inpatient stay in 2005 was $7,900, up an average of 5.7 percent annually since 1997.
  • Among the most frequent reasons for hospitalizations were childbirth and newborns, which together accounted for nearly 1 out of 4 (23 percent) of all hospitalizations in 2005.
  • Blood transfusions were the most common procedure performed during a hospitalization in 2005, occurring in six percent of all discharges.
  • Six of the 20 most costly conditions associated with hospitalization were related to the heart. These 6 conditions (coronary artery disease, heart attack, congestive heart failure, irregular heart beat, stroke, and non-specific chest pain) together accounted for 17 percent of all community hospital costs in 2005.
  • Diabetes-related hospitalizations occurred at a higher rate in lower-income communities.

Some notable trends in hospital-based care include:

  • The total number of inpatient bariatric surgeries increased 15-fold from 1995 to 2004, but stabilized in 2005.
  • The number of hospital stays for septicemia (sepsis) rose 30 percent from 1997 to 2005.
  • The number of cesarean-sections grew 67 percent between 1996 and 2005.

To access HCUP-related publications, please visit the Reports section of the HCUP User Support Website.

 

Announcements

Health Policy Orientation
Limited Space Still Available

Register today for the Health Policy Orientation. This seminar offers an in-depth understanding of formal and informal policymaking processes and the players who shape health policy.

The Orientation is ideal for health policy fellows and analysts, public officials, federal or state government employees, private sector health care employees, and consultants who wish to get a behind-the-scenes look at health policymaking in Washington. The agenda features presentations by leading experts, group discussions, hands-on tutorials, and a congressional site visit. 

Limited space is still available. The Orientation will be held at The Barbara Jordan Conference Center, October 22-25, in Washington, D.C.  For more information, visit the Orientation Web site at www.academyhealth.org/orientation.

National Health Policy Conference
Feb. 4-5, 2008

AcademyHealth invites you to share your perspective on what's shaping the nation's policy agenda at the National Health Policy Conference. This unique conference brings together leading researchers, advocates, and policymakers for plenary sessions, discussion panels, and networking. In addition to the annual overview of the administration and congressional policy agendas, the 2008 National Health Policy Conference will feature three topic tracks:

  • Ensuring Equitable Access
  • Fostering Better Care with Better Value
  • Managing System Stressors

The National Health Policy Conference will be held Feb. 4-5, 2008 at the Capital Hilton in Washington, D.C. To view registration information and updated conference agenda, visit www.academyhealth.org/nhpc.

National Congress on the Un and Under Insured to Feature Leaders in Health Policy and Health Services Research

AcademyHealth is a co-sponsor for The National Congress on the Un and Under Insured, December 9-12, 2007, at the Hyatt Regency on Capitol Hill in Washington, D.C. The Congress will feature leading thinkers in health policy and health services research with expertise in the un and under insured in the United States. The discussion will include practical local and regional solutions to state and national health reform.

* December 9 - 12, 2007
* Hyatt Regency on Capitol Hill, Washington, DC

For more information, visit www.UninsuredCongress.com or email registration@hcconferences.com

NCHS/AcademyHealth Health Policy Fellowship
Call for Applications

The Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) and AcademyHealth are seeking applications for their 2008 Health Policy Fellowship. The aim of the fellowship is to foster collaboration between NCHS staff and visiting scholars on a wide range of topics of mutual concern. The fellowship allows visiting scholars to conduct new and innovative analyses and participate in developmental and health policy activities related to the design and content of future NCHS surveys, and offers access to the data resources provided by the CDC.

Applicants may be at any stage in their careers, from doctoral students to senior investigators. The application deadline is Jan. 7. For more information on eligibility and application requirements, visit the fellowship Web site at www.academyhealth.org/nchs.

25th Annual Research Meeting
Call for Abstracts Opens November 1

Washington, D.C. will host the 25th Annual Research Meeting (ARM) June 8-10, 2008. The call for abstracts opens November 1, and closes January 15. Abstracts are invited for three categories: (1) call for papers, (2) call for posters, and (3) call for panels. For more information on abstract guidelines, visit www.academyhealth.org/arm/abstracts. Full details on the conference are available at www.academyhealth.org/arm.