What's New with HCFO - March 14, 2008 (Print All Articles)

Health Care Costs – Challenges and Solutions

Per person spending on health care by individuals and the government is expected to increase from an average of $7,026 in 2006 to $13,101 in 2017, with the burden falling most heavily on public payers. And while the growth rate may not continue accelerating, the real level of health care costs is expected to account for an increasingly larger portion of the U.S. economy.¹ Economists and actuaries at the Centers for Medicare and Medicaid Services (CMS) project that national health care spending will reach $4.3 trillion by 2017—nearly one-fifth of the economy—largely driven by medical price inflation and the volume and intensity of services.² Without restraint on future health care spending, the economic stability of the country is at risk.³

Policymakers predict that health care dollars will shift among various sectors over time. Growth in prescription drug spending will likely be tempered by increased use of generic equivalents in the next ten years. Similarly, the hospital sector is expected to experience a slowdown in total spending by 2017. On the other hand, costs associated with physician services are likely to increase, with Medicare covering 24 percent of that spending in ten years. The home health/long-term care (LTC) sector will feel the burden of the baby boomers most acutely with Medicare and Medicaid assuming a projected increase from covering 75 percent of those costs in 2006 to 84 percent in 2017.⁴ While shifts may occur, overall cost reduction is not expected.

Many factors drive up health care costs, each at varying degrees. These factors include inappropriate and/or overutilization of medical care, regional variation in services and spending, administrative inefficiency associated with the various components of the payer/provider/patient interface, a growing uninsured population, insufficient preventive services, the ever-expanding market for new technologies and pharmaceuticals, the aging population, patients’ lack of price sensitivity, defensive medicine resulting from malpractice threats, and poor lifestyle choices leading to conditions like obesity.⁵

Of these, the Congressional Budget Office (CBO) cites new medical technologies and services as the most critical cost driver, outpacing even the effects of the aging baby boomers on health care cost growth.⁶ 

Rising health care cost growth burdens consumers, employers, providers, public insurers and private insurers. Each of these stakeholders is faced with multiple and often competing financial challenges related to accessing, delivering, and/or paying for health care. This makes developing solutions all the more complicated.

New Grants

In a series of newly funded HCFO grants, researchers will explore some of the myriad causes of health care cost growth and propose various solutions, with an ultimate goal of improving value and increasing coverage.

Variation

Both researchers and policymakers cite variation in heath care as one of the key cost drivers.⁷ Higher spending in some parts of the country may be the result of intensity of treatment.⁸ Or it may be the result of individuals’ personal characteristics.⁹ Regardless of the underlying cause of the variation, what may be more troubling is the fact that increased spending is not correlated with higher quality care.¹⁰

In a new HCFO study, Michael Chernew, Ph.D., Harvard Medical School, will examine variation in cost growth in both the Medicare and commercial markets. Most research and policy initiatives are aimed at managing the level of costs, as opposed to cost growth. Chernew posits that the trajectory of cost growth, as a portion of the overall economy, is of particular concern since the factors contributing to high levels of health care costs may not be the same as factors related to cost growth.¹¹

To date, the reasons why Medicaid costs vary across the country, while important, have largely been unexplored. Richard Kronick, Ph.D., University of California, San Diego, will explore the level of variation in services and payments across state Medicaid programs and across hospital referral regions within states. The study will crystallize the impact of policy choices on benefit limits and payment rates on Medicaid costs and utilization.

High-Cost Medicare Patients

The top five percent of costliest Medicare beneficiaries account for nearly half of Medicare spending.¹² But what makes these patients high cost—is it the demand side of the equation, the supply side, or a combination? In a new HCFO study, James Reschovsky, Ph.D., of the Center for Studying Health System Change will focus on key physician, practice and market characteristics associated with Medicare payment and utilization. Findings from this study will inform Medicare reimbursement strategies, which have a large influence on how physicians practice.

High-Cost Commercial Patients

Despite the fact that Medicare is often characterized as the “leader” in terms of payment policy, private payers also play a significant role in the level of health care spending. A reciprocal spillover effect between public and private insurers may be possible, to the extent one side or the other is successful in its efforts to curb health care cost growth. In a new HCFO study, Kate Bundorf, Ph.D., Stanford University, and Anne B. Royalty, Ph.D., Indiana University-Purdue University Indianapolis, will explore how changes in prices and the number and types of services among the privately insured create differential effects on various categories of spending and demographic groups. Findings from this study will be particularly important as policymakers develop mechanisms to optimize benefits as they expand coverage.

Affordability

As policymakers grapple with reform efforts to cover the uninsured, they must consider the issue of affordability, particularly in light of the debate between voluntary take-up and enforcement of mandated health insurance. Lisa Clemans-Cope, Ph.D., of the Urban Institute has been funded by HCFO to examine how various measures of affordability affect access to coverage for those who are uninsured and those whose chronic conditions result in high health care expenditures.

Care Coordination

Among the ideas suggested as a possible cure for health care cost growth is a change in treatment paradigm from individualized care to coordinated care. This may take the form of managing a specific disease across a targeted population, or managing episodes of care across multiple providers. In a HCFO study by Deborah Peikes, Ph.D., and Randall Brown, Ph.D., of Mathematica Policy Research Inc., the researchers will test the features of different disease management and care coordination programs. They will identify those interventions which appear to be most effective, most replicable, and most economical. Looking instead at the supply side, Eric Schneider, M.D., Harvard School of Public Health, will examine the fragmented nature of the current health care system, especially as it relates to higher, episode-specific costs of care.

Healthy Behavior

Many hold the logical assumption that healthy behavior leads to lower health care costs,¹³ but does the empirical evidence support that assumption? In his HCFO-funded study, Bruce Stuart, Ph.D., of the University of Maryland, Baltimore will identify those disease states and beneficiary segments which show the greatest promise for improved compliance and persistence in the use of preventive therapies. The researchers will explore possible links between low spending consumers and behavior, prevention, race and socioeconomic status. Findings from this study will help inform policymakers' and practitioners' to develop optimally targeted interventions.

Conclusion

With multiple factors contributing to rising health care cost growth, there will likely need to be multiple options for arresting or at least mitigating that trend. Currently, researchers and policymakers are examining whether comparative effectiveness could inform and improve clinical care and achieve savings.¹⁴ In addition, limiting benefits to only those therapies that provide clear value to patients may result in valuable cost containment.¹⁵ Finally, reforming provider payment incentives and educating consumers to make better health care decisions hold promise. The HCFO-funded research, described above, may provide additional options. Finding a solution is critical because we will face increasingly difficult decisions about the way health care is delivered and paid for in the coming decades.¹⁶

For more information on these studies and other HCFO studies addressing health care costs, visit http://www.hcfo.net/grantees/grantslist.cfm

Title: Variation in Health Care Cost Growth
Applicant: Harvard Medical School
PI: Michael Chernew, Ph.D.

Title: Small Area Variation in Medicaid Utilization and Expenditures: Implications for Cost Containment and Quality of Care
Applicant: University of California, San Diego
PI: Richard Kronick, Ph.D.

Title: Cost and Efficiency in Treating High-Cost Medicare Beneficiaries: The Role of Physician Practice and Health System Factors
Applicant: Center for Studying Health System Change
PI: James D. Reschovsky, Ph.D.

Title: Sources of Health Care Cost Growth
Applicant: Stanford University
PI: M. Kate Bundorf, Ph.D., and Anne B. Royalty, Ph.D.

Title: Defining Affordability for the Uninsured and People with Chronic Conditions
Applicant: The Urban Institute
PI: Lisa H. Clemans-Cope, Ph.D.

Title: Can Disease Management Control Costs?
Applicant: Mathematica Policy Research, Inc.
PI: Deborah Peikes, Ph.D./Randall Brown, Ph.D.

Title: How does Fragmentation of Care Contribute to the Costs of Care?
Applicant: Harvard School of Public Health
PI: Eric C. Schneider, M.D.

Title: Medicare Spending, Disparities, and Returns to Healthy Behaviors
Applicant: University of Maryland, Baltimore
PI: Bruce Stuart, Ph.D.

1 Keehan, S., et al., “Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare,” Health Affairs Web Exclusive, February 26, 2008, W-145. http://content.healthaffairs.org/cgi/reprint/hlthaff.27.2.w145v1
2 ibid.
3 CBO Testimony, Statement of Peter R. Orszag, “Growth in Health Care Costs,” before the Committee on the Budget, United States Senate, January 31, 2008,  http://www.cbo.gov/ftpdocs/89xx/doc8948/01-31-HealthTestimony.pdf
4 ibid.
5 According to the Congressional Budget Office, health care spending for normal weight individuals in 2001 was $2,783, as compared with $3,737 for someone obese and $4,725 for a morbidly obese person.  CBO Testimony, Statement of Peter R. Orszag, “Growth in Health Care Costs,” before the Committee on the Budget, United States Senate, January 31, 2008,  http://www.cbo.gov/ftpdocs/89xx/doc8948/01-31-HealthTestimony.pdf
6 ibid.
7 Dartmouth Atlas Project, www.dartmouthatlas.org; CBO Paper, Peter R. Orszag, “Geographic Variation in Health Care Spending,” February 2008, http://www.cbo.gov/ftpdocs/89xx/doc8972/02-15-GeogHealth.pdf
8 Baicker, K., and A., Chandra, "Medicare Spending, The Physician Workforce, and Beneficiaries’ Quality of Care,” Health Affairs Web Exclusive, April 7, 2004. W4-188.
9 HCFO Grant # 63091 - http://www.hcfo.net/grantees/grant.cfm?GrantNo=63091
10 CBO Paper, Peter R. Orszag, “Geographic Variation in Health Care Spending,” February 2008, http://www.cbo.gov/ftpdocs/89xx/doc8972/02-15-GeogHealth.pdf; Baicker, K., and P., Orszag – Presentations at AcademyHealth National Health Policy Conference, February 4, 2008, http://www.academyhealth.org/nhpc/2008/Baicker.ppt; http://www.academyhealth.org/nhpc/2008/Orszag.ppt
11 See also, Moon, M. – Presentation at AcademyHealth National Health Policy Conference, February 4, 2008, http://www.academyhealth.org/nhpc/2008/Moon.ppt
12 Lieberman, S.J., et al., “Reducing the Growth of Medicare Spending: Geographic Versus Patient-Based Strategies,” Health Affairs Web Exclusive, December 10, 2003. W3-605.
13 See, Schoen, C., et al. “Bending the Curve, Options for Achieving Savings and Improving Value in U.S. Health Spending,” The Commonwealth Fund Commission on High Performance Health System, December 2007; http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=620087; But see, van Baal P.H.M., et al., “Lifetime Medical Costs of Obesity: No Cure for Increasing Health Expenditure,” PLoS Medicine, Vol. 5, No. 2, e29 doi:10.1371/journal.pmed.0050029 (noting that a decrease in health care costs associated with obesity-related diseases is offset by cost increases due to diseases unrelated to obesity in life-years gained) http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050029&ct=1&SESSID=53a8fc4a1cf53efa9c25468afffb3346
14 CBO Paper, Philip Ellis, “Research on the Comparative Effectiveness of Medical Treatments: Issues and Options for an Expanded Federal Role,” December 2007, http://www.cbo.gov/ftpdocs/88xx/doc8891/12-18-ComparativeEffectiveness.pdf
15 Garber, A., et al., “The Promise of Health Care Cost Containment,” Health Affairs, Vol. 26, No. 6, November/December 2007.
16 Keehan, S., et al., “Health Spending Projections Through 2017: The Baby-Boom Generation is Coming to Medicare,” Health Affairs Web Exclusive, February 26, 2008, W-145. http://content.healthaffairs.org/cgi/reprint/hlthaff.27.2.w145v1

Grantee Spotlight: Henry J. Aaron, Ph.D.

Henry J. Aaron, Ph.D., is the Bruce and Virginia MacLaury Senior Fellow in the Economics Studies Program at the Brookings Institution. In addition to being a member of the Institute of Medicine and the American Academy of Arts and Sciences, Dr. Aaron serves as a member of the board of directors for Abt Associates and the Center for Budget and Policy Priorities. He is a member of the visiting committee of the Harvard Medical and Dental Schools and has served on the visiting committee of the Harvard Department of Economics. Dr. Aaron’s research domains include social security, tax and budget policy, and health care financing reform. In the health care field specifically, Dr. Aaron’s research focuses on health care costs, financing, rationing, and public programs, including Medicare and Medicaid.

Dr. Aaron holds an M.A. in Russian Regional Studies and a Ph.D. in economics from Harvard University, and a B.A. in political science and economics from the University of California, Los Angeles. He has worked at the Brookings Institution most of the time since 1967 and taught economics at the University of Maryland from 1967 through 1989. In 1977 and 1978, he served as Assistant Secretary of Planning and Evaluation at the Department of Health, Education, and Welfare and, in 1979, chaired the Advisory Council on Social Security. He was later a founding member, vice president, and board chair of the National Academy of Social Insurance

In 2006, Dr. Aaron completed HCFO-sponsored research that examined whether rationing was necessary to control health care spending. With this grant, Dr. Aaron updated his 1984 book, The Painful Prescription: Rationing Health Care, that compared health care in the United States to that of Great Britain. At the time, the United States found the concept of rationing, which was already practiced in Great Britain, inconceivable. Dr. Aaron chose new interventional and diagnostic radiology and coronary artery disease technologies to test the premises asserted in his original publication and to compare the provision and use of these technologies in the United States and Great Britain. He found that U.S. physicians used more of these medical services, sometimes with little added value, than do physicians in Great Britain. Moreover, U.S. physicians tended to prescribe a greater number of high-cost interventions when low-cost interventions were equally appropriate.

To combat rising health costs, U.S. policymakers may consider rationing as a solution. As evidenced by planning administrators in Great Britain, however, efficient rationing is challenging because it is difficult to estimate the value of medical technology. Dr. Aaron notes, “Intelligent health care rationing—limiting the availability of care that costs society more to produce than it is worth to patients—is not a horror to be avoided. It’s a regretfully necessary limit to sustain fair access to health care that is worth what it costs.”

Two policy briefs, Treatment of Coronary Artery Disease: What Does Rationing Do? and Health Care Rationing: What it Means, the book, Can We Say No? The Challenge of Health Care Rationing co-authored by Dr. Aaron, and the article “Health Care Rationing: Inevitable but Impossible” (Georgetown Law Journal. January 2008) resulted from this HCFO project.

For more information about Dr. Aaron and a list of publications, please visit
http://www.brookings.edu/experts/aaronh.aspx.

HCFO Announces Cost Solicitation Grants!

Title: Can Disease Management Control Costs?
Institution: Mathematica Policy Research, Inc.
Principal Investigator: Deborah Peikes, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will test the ability of disease management (DM) and care coordination (CC) programs to control health care costs, examine which features make certain programs effective, for which target populations, and how they can be replicated. They will build on prior work for CMS' Medicare Coordinated Care Demonstration that estimated program impacts over the first four years of program operations, described the basic features of the 15 programs’ interventions, and linked program features to overall program effectiveness. Five interrelated studies would determine: 1) the effects of DM/CC on costs over a longer follow-up period and the types of beneficiaries for whom DM/CC is most effective; 2) the operational features of DM/CC programs that were able to reduce costs and how they can be replicated; 3) what features of the DM/CC programs did not work and why; 4) whether intensifying contacts at the time of hospital discharge contributes to reducing costs; and 5) whether DM/CC interventions are more effective at reducing costs if the doctor has a greater number of patients receiving the intervention. The objective of this study is to help decision makers determine whether to offer disease management and care coordination to Medicare beneficiaries, as well as chronically ill patients with commercial insurance and Medicaid, and will provide information about how best to implement this intervention.

Title: Cost and Efficiency in Treating High-Cost Medicare Beneficiaries: The Role of Physician Practice and Health System Factors
Institution: Center for Studying Health System Change
Principal Investigator: James D. Reschovsky, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will examine key physician practice and market characteristics that may contribute to high costs and inefficient care in the Medicare program. The study is composed of three phases. In phase one, they will analyze the treatment of high-cost Medicare beneficiaries in order to identify key physician, practice, and market characteristics associated with differences between actual and predicted Medicare payments and medical care use. In phase two, they will examine whether the factors associated with greater than predicted resource use affect high-cost beneficiaries’ health outcomes. Finally, the researchers will examine possible sources of geographic cost variations for high-cost beneficiaries and the extent to which these variations reflect differences in patient characteristics or supply-related factors and practice patterns of providers in a particular region. The objective of this project is to identify potential policy levers that can influence cost effectiveness in the delivery of medical care to high-cost Medicare patients.

Title: Variation in Health Care Cost Growth
Institution: Harvard Medical School
Principal Investigator: Michael Chernew, Ph.D.
Grant Duration: March 2008 – February 2009
Paragraph Summary: The researchers will investigate the factors related to variation in cost growth in the Medicare and commercial sectors. Specifically, the researchers will determine: (1) whether the factors related to the rate of growth in the Medicare program are the same factors that are related to level of cost; (2) whether the factors associated with cost growth in commercial markets are the same as those related to Medicare cost growth; and (3) the extent to which cost growth varies between employers and health plans and what factors are related to that variation in cost growth. While most research and policy initiatives are aimed at managing the level of costs as opposed to cost growth, the researchers suggest that additional attention must be devoted to understanding and developing initiatives relating to the trajectory of cost growth, since the factors related to high levels of costs may not be the same as factors related to cost growth. The objective of this study is to provide knowledge that will support development of cost containment approaches that address cost growth. 

Title: Defining Affordability for the Uninsured and People with Chronic Conditions
Institution: The Urban Institute
Principal Investigator: Lisa H. Clemans-Cope, Ph.D./Cynthia D. Perry, Ph.D.
Grant Duration: March 2008 – February 2009
Paragraph Summary: The researchers will examine affordability of health insurance. In particular, they will study how different measures of affordability affect access to health insurance for: 1) those that are currently uninsured; and 2) those that have chronic health conditions requiring persistently high health care expenditures. The researchers will use alternative measures of affordability (health care spending falling below a given standard of spending as a percent of family income) to: 1) describe the availability of affordable health insurance among the currently insured and uninsured populations; and 2) explain why take-up of health insurance varies, given affordability. The objective of this project is to provide empirical evidence of various measures of affordability to inform policy choices for increasing coverage and ensuring equitable financial burdens for those who acquire coverage.

Title: How Does Fragmentation of Care Contribute to the Costs of Care?
Institution: Harvard University School of Public Health
Principal Investigator: Eric C. Schneider, M.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will develop new measures of care fragmentation that can be used to assess fragmentation within episodes of care and evaluate the relationship between care fragmentation and the costs of care for Medicare beneficiaries. They hypothesize that a higher degree of fragmentation of care will be associated with higher episode-specific costs of care after controlling for type of clinical episode, severity of clinical episode, clinical comorbidities, and the sociodemographic characteristics of patients. To test this hypothesis, the researchers will modify existing measures of fragmentation and develop new measures based on their relevance for episodes of care, select an approach to measuring costs, and select the clinical episodes for which they will test for the association between fragmentation and costs. The objective of this study is to improve quality and reduce the growth of health care costs in the U.S. by assisting the Medicare program and other insurers to measure and monitor fragmentation and target improvements to episodes with higher fragmentation.

Title: Medicare Spending, Disparities, and Returns to Healthy Behaviors
Institution: University of Maryland, Baltimore
Principal Investigator: Bruce Stuart, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will examine persistently low cost Medicare beneficiaries and determine the extent to which health behavior, preventive services, race and socioeconomic status (SES) appear to be related to low spending. Specifically, the researchers will (1) estimate cost savings in traditional Medicare spending associated with persistently good health behavior and preventive measures; (2) identify population characteristics that can be used to optimally target preventive interventions; and (3) develop simulation models to show how selectively reducing beneficiary cost sharing for primary and secondary preventive measures can achieve significant costs offsets in reduced spending on traditional Medicare services – this mechanism is referred to as “value-based insurance design.” The objective of the proposed project is to identify which disease states and beneficiary segments show the greatest promise for improved compliance and persistency in use of preventive therapies.

Title: Small Area Variation in Medicaid Utilization and Expenditures: Implications for Cost Containment and Quality of Care
Institution: University of California, San Diego
Principal Investigator: Richard Kronick, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will investigate the variation in Medicaid services and payments and explore the implications of these variations for cost containment options. They will compare the services received and cost of care for Medicaid beneficiaries across state Medicaid programs and across hospital referral regions (HRRs) within states. Specifically, the researchers will determine: (1) how much variation there is across states, across HRRs within states, and in Medicaid expenditures per beneficiary; (2) the extent to which variation in expenditures per beneficiary is due to variation in the rate of use of services, and the extent to which it is a result of variation in the rate of payment per unit of service; and (3) whether variation in the use of services and in expenditures per beneficiary is related to variations in the quality of care or the outcomes of care for Medicaid beneficiaries. The objective of this study is to provide policymakers with an understanding of the impact of policy choices regarding benefit limits and payment rates on costs and utilization, and their implication for quality of care.      

Title: Sources of Health Care Cost Growth
Institution: Stanford University
Principal Investigator: M. Kate Bundorf, Ph.D./Anne B. Royalty, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will study the sources of cost growth among the privately insured by analyzing the contributions to higher spending of changes in prices and changes in the number and types of services performed. They will also examine how changes in prices and changes in the number and types of services have differentially affected different categories of spending and different demographic groups. These findings for the privately insured will also be compared to trends in cost growth in public programs. The researchers will explore which policies or benefit designs will be more effective in reducing spending, as well as whether costs are driven more by increased utilization of certain types of services or by increases in the prices of particular services. In addition, the researchers suggest that the findings will be useful in developing policies to expand coverage by identifying the sources of cost increases that may affect coverage rates. The objective of this study is to provide information for policymakers to design interventions to reduce health spending in ways that benefit consumers. 

Spotlight on Grantee Publications

E. Kathleen Adams, Ph.D., Emory University, Rollins School of Public Health, and Bradley Herring, Ph.D., Johns Hopkins University, Bloomsberg School of Public Health, published the article, “Medicaid HMO Penetration and Its Mix: Did Increased Penetration Affect Physician Participation in Urban Markets?” in the February 2008 issue of Health Services Research. This article details HCFO-sponsored research that examines the effect of Medicaid HMOs on access, mix of utilization, and health care expense.

Grantees in the News

Findings from a HCFO-sponsored study led by Glenn A. Melnick, Ph.D., of RAND, were highlighted in the February 5, 2008 San Francisco Chronicle article, “Hospitals Sock it to the Uninsured.” This study examines trends in hospital charges and net revenues to determine whether hospital prices paid by uninsured individuals systematically differ from those paid by insured individuals. Dr. Melnick notes, “Hospitals have started to adjust prices to the uninsured somewhat, but not substantially. The study shows they continue to raise prices to the uninsured during this period.” 

Jill R. Horwitz, Ph.D., J.D., M.P.P., assistant professor at the University of Michigan Law School, was quoted in the February 20, 2008 New York Times article, “Hospital’s Accounting is Under Fire by a Union.” This article examines the financial reporting requirements for uncompensated and charity care for not-for-profit hospitals. Dr. Horwitz’s HCFO-sponsored study examines the medical service provision in markets with different mixes of for-profit, not-for-profit, and government hospitals.

New Data for Researchers

AHRQ Releases 2006 State Data from the Agency’s HCUP

The Agency for Healthcare Research and Quality (AHRQ) recently released state data for the 2006 data year from the Agency’s Healthcare Cost and Utilization Project (HCUP). HCUP is a federal-state-industry partnership that brings together the data collection efforts of state data organizations, hospital associations, private data organizations, and the federal government to create a national information resource of encounter-level health care data.

The State Inpatient Databases contain the universe of inpatient discharge abstracts for participating states. Currently, SID data from the 2006 data year are available for Arizona, California, Colorado, Florida, Iowa, Kentucky, Nevada, New Jersey, North Carolina, Oregon, Utah, Washington, West Virginia, and Wisconsin. These new additions complement the numerous SID files that are already available for the years 1994-2005.

The State Ambulatory Surgery Databases feature ambulatory surgery encounter abstracts from hospital-affiliated, and in some cases, freestanding, ambulatory surgery sites within participating states. This most recent release adds 2006 data files for California, Colorado, Iowa, Kentucky, New Jersey, North Carolina, and Wisconsin, to the existing collection of SASD files already available for the years 1997-2005.

The State Emergency Department Databases contain discharge information on all emergency department (ED) visits that do not result in a hospital admission. AHRQ is pleased to add 2006 data files for Arizona, California, Iowa, New Jersey, and Wisconsin to the existing collection of SEDD files that are already available for the years 1999-2005.

Like all HCUP databases, the SID, SASD, and SEDD contain uniformly formatted data built around a core set of more than 100 clinical and non-clinical variables for all patient encounters, regardless of payer (i.e., Medicare, Medicaid, private insurance, self-pay). The core variables include all-listed diagnoses and procedures, patient demographics, expected payment source, total charges, and hospital identifiers, along with safeguards to protect the privacy of individual patients, physicians, and hospitals. Complete descriptions of the SID, SASD, SEDD, and other HCUP databases are available on the HCUP User Support (HCUP-US) Website (http://www.hcup-us.ahrq.gov/databases.jsp).

As 2008 progresses, these and other 2006 databases will be available through the HCUP Central Distributor. For more information or to obtain any SID, SASD, and/or SEDD files (including the necessary Data Use Agreement forms and application kits), please visit the HCUP Central Distributor page on the HCUP-US Website, or contact the Central Distributor by e-mail at HCUPDistributor@ahrq.gov.

NCHS Data Announcement

NCHS and U.S. Census Bureau Allow Access to NCHS data at
Census Bureau Research Data Centers

The National Center for Health Statistics (NCHS) and the U.S. Census Bureau have taken a step toward allowing access to NCHS data at nine Census Bureau Research Data Centers around the country. Recently, the first NCHS data set was sent to Cornell University—one of the nine Census sites. This represents a major step forward in NCHS's efforts to expand access to its data files. By making its data available through Research Data Centers, NCHS can provide secure access to the full range of health and vital statistics information that it collects, while continuing to protect the confidentiality of the respondents and records. For more information about the NCHS Research Data Center, go to http://www.cdc.gov/nchs/r&d/rdc.htm

AcademyHealth Announcements

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