What's New with HCFO - November 21, 2008 (Print All Articles)
Implications of the Economic Downturn on Health Care Access
The recent economic downturn has adversely affected job security, investments and retirement accounts, and consumer spending. In October 2008, the unemployment rate was 6.5 percent, 1.7 percent higher than the unemployment rate the previous year, and 0.4 percent higher than September 2008.1 Some predict that the unemployment rate could increase to more than 8 percent.2 Increased unemployment affects consumer spending, sales and income tax revenue, and access to affordable health insurance and care. As individuals lose eligibility for employer-sponsored insurance (ESI), they may turn to the individual insurance market, gain eligibility for public insurance, such as Medicaid or State Children’s Health Insurance Program (SCHIP), or become uninsured. In addition, the current economy has adversely impacted states’ and the federal government’s budgets. Thus, meeting the demand for public health insurance coverage may prove challenging. The weakened economy, coupled with the pervasive problem of rising health care costs, will be a complex challenge for the Obama administration to tackle in 2009.
Individual Impact
The rising unemployment rate and economic uncertainty may lead to changes in people’s insurance coverage. Recent reports from the Census Bureau show that the number of uninsured individuals decreased in 2007 to 45.7 million people.3 Despite this decline, the number of people covered by either ESI or private insurance did not increase. In fact, both types of insurance saw declines in their overall enrollees in 2007.4 However, government programs saw an increase in the number of people enrolled, with Medicaid enrollees increasing by 1.3 million people.5 Instead of people transitioning to the private insurance market, they are increasingly relying on government programs to obtain health care.6 There has been considerable concern about the potential of public insurance crowding out private insurance coverage. HCFO recently funded Helen Levy, Ph.D., from the University of Michigan to look at the crowd-out phenomenon in SCHIP.7 Her work seeks to identify whether switching to public coverage by low-income families is beneficial by freeing up household resources that otherwise would have been allocated for out-of-pocket medical spending. The researchers will also examine how SCHIP has improved the material well-being and the categories of spending that have increased as a result for these families.
Rising health care costs and the weakened economy may also cause employers to increase employee cost sharing or discontinue health benefits. Affordability issues in obtaining either ESI or private insurance will increasingly become a barrier for people, especially as the unemployment rate continues to rise. Even those individuals who have health insurance coverage are reporting affordability problems relating to their health care costs. Many people are delaying or not receiving their medical care to cut back on their costs. In 2007, 59 million people reported skimping on their health care due to factors such as cost and health system barriers.8 The economic woes are also affecting people’s ability to payoff medical bills and causing an increase in medical debt. In 2007, 57 million people reported having trouble paying their medical bills and of those, 42.5 million individuals actually had some form of health insurance coverage.9 With such high numbers facing problems paying their medical bills, it is no surprise that people would limit or delay seeking necessary health care.
Even for those individuals who have ESI, increases in health insurance cost may result in lower wages. Brad Herring, Ph.D., of Johns Hopkins University, is currently studying how rising health care costs affect worker compensation.10 He will be looking at how increases in health care premiums are transferred to workers in the form of lower wages.
Finally, in spite of the fact that the majority of individuals get their insurance through ESI, a significant number still obtain insurance through the individual market. However, the individual market is different than large and small group health plans, with different underwriting and risk segmentation that make the market challenging for many people. The individual market has different regulatory restrictions, products, sales channels, and companies selling the products.11 The overall structure of the individual market also differs in its transient nature where people are constantly entering and exiting the market, increasing the likelihood of adverse selection.12 For more information on the individual market and its potential role in health reform, please see the HCFO report, The Individual Insurance Market: A Building Block for Reform?, and the companion policy brief, at http://www.hcfo.net/pdf/synthesis0508.pdf.
State Impact
A weakened economy not only impacts individuals, but also state governments, the majority of which must balance their budget each year.13 Increased unemployment increases demand for public support while decreasing the amount of revenue raised by the state. A 1 percent increase in unemployment, for example, may result in a 3 to 4 percent decrease in state General Fund revenue.14 Moreover, a recent Kaiser Family Foundation study found that a 1 percent increase in the unemployment rate may subsequently increase Medicaid and SCHIP enrollment by 1 million individuals, resulting in a $1.4 billion increase in state Medicaid and SCHIP spending.15 In addition, a weakened economy may stymie health care reform efforts or sustainability of reform.16
A recent report estimates that 41 states are experiencing or will experience a budget shortfall in 2009.17 As state budgets are constrained, policymakers will be faced with difficult budgetary decisions. To finance Medicaid during periods of economic slowdowns, states have traditionally used “rainy day” funds, borrowed funds from the federal government, or implemented cost-containment measures.18 In 2003, the state of Oregon, for example, experienced a massive budget shortfall which led state administrators to reduce Medicaid expenditures by cutting benefits and increasing cost sharing. In a related HCFO study, Jeanene Smith, M.D., administrator at the Office for Oregon Health Policy and Research, examined the impact of the cost sharing and benefit reductions on former and current Oregon Health Plan (the state’s Medicaid program) beneficiaries.19 The researchers found that lower income beneficiaries were more likely to drop out of the program as a result of stricter premium payment rules.20 (Visit http://www.hcfo.net/pdf/findings0708.pdf for additional findings.)
Federal Impact
In addition to affecting individuals and state governments, the economic downturn will have serious implications for the federal government’s financing and budget. The Congressional Budget Office (CBO) estimates that the federal deficit in 2008 will be near $407 billion dollars, a substantial increase from the deficit of $161 billion in 2007.21 Moreover, the passage of the Emergency Economic Stabilization Act of 2008—which is estimated to cost approximately $700 billion—will further constrain future spending. CBO also predicts that the fiscal future will depend heavily on health care costs, which continue to rise, and on the aging elderly population.22 As more and more adults age into the Medicare program, resources will continue to be squeezed. Currently, Medicare accounts for 14 percent of the total federal budget and 22 percent of national health care spending.23 Between 2008 and 2017, Medicare spending is projected to increase by 7.5 percent annually.24
The deficit and projected spending increases for Medicare are extremely important to watch because of the potential for funds that support the Medicare program to run out. Experts warn that by 2019 there will be insufficient funds in Medicare Part A trust to fully pay claims, and federal subsidies may be required.25 With only 10 years remaining until the projected shortfall, many are concerned about how to make programmatic changes to sustain the program.
While the federal government wrestles with ensuring Medicare’s future, the cry for reform of the current health care system is growing louder and louder. While health care ceased to be the top issue on voters’ minds as the financial crisis gripped the United States, it is still a priority. Rising health care costs are being felt by everyone, and Americans are eager for a strategy to contain costs.26 In a recent survey by the Employee Benefit Research Institute (EBRI), 51 percent of respondents said that even though there are some positive aspects of the health care system, major changes are still needed.27 This high demand for reform will be difficult to achieve given the large deficit and continuing financial instability; however, it is an issue that is clearly on the public’s and the Obama Administration’s minds.
The following are select grants from HCFO's portfolio that address issues related to health insurance access and the economy. For other HCFO grants, see www.hcfo.net.
HCFO Grants:
Title: Consequences of SCHIP for Household Well-Being
Institution: University of Michigan
Principal Investigator: Helen Levy, Ph.D.
Grant Duration: October 2008 - September 2009
The researchers will explore the consequences of State Children's Health Insurance Program (SCHIP) expansions, including "crowd out,"--the term used to describe the phenomenon of individuals dropping private health insurance coverage in response to expanded availability of public coverage. The researchers hypothesize that switching from private to public coverage reduces a family's out-of-pocket medical spending, freeing up more resources for other uses, making crowd-out a "windfall" not a "problem" for low-income families. They will address the following research questions: (1) How have expansions of SCHIP improved the material well-being of the low-income families the program is intended to assist, and (2) What categories of spending increase as a result of gaining eligibility for coverage? The objective of the proposed project is to reconsider the context for crowd-out and reframe the debate over SCHIP expansions with a renewed emphasis on the benefits rather than merely the costs of coverage expansions.
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
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: Economic Impact of Adverse Health Events on the Uninsured Near Elderly
Institution: Northwestern University, Kellogg School of Management
Principal Investigator: David Dranove, Ph.D.
Grant Duration: November 2007 - October 2008
The researchers will assess how insurance status affects personal wealth and earnings in the population nearing age 65 that have a heightened probability of adverse health but have not yet qualified for Medicare. Specifically, they will analyze: 1) the extent to which measurable dimensions of household wealth (e.g., total net worth, home equity, funds in retirement plans) fall after an adverse health event; 2) the extent to which individuals in the U.S. who lack health insurance suffer disproportionate losses in household wealth; 3) whether the probability of sentinel financial events, including loss of home and loss of estate, increases after an adverse health event; and 4) the extent to which the probability of a sentinel financial event is higher for individuals who lack health insurance. The objective of this study is to better understand the indirect effects of lack of insurance on individuals’ overall financial well-being.
Title: How Do Rising Healthcare Costs Affect Worker Compensation?
Institution: Johns Hopkins University (Bloomberg School of Public Health)
Principal Investigator: Bradley Herring, Ph.D.
Grant Duration: November 2007 - March 2009
The researchers will measure the extent to which increases in health insurance premiums are borne by workers in the form of lower wages relative to the extent to which they are borne by employers in the form of lower profits. They will also examine whether there are significant differences in this relationship between small and large firms and between low and high income workers. Finally, they will examine the extent to which any wage offsets vary by the expected health care costs across groups of workers with different characteristics, such as age, gender, health status, and family size. The objective of the study is to better understand where the burden of rising health care costs falls, so as to develop appropriate policy incentives.
Title: Surviving the Perfect Storm: Impacts of Benefit Reductions and Increased Cost Sharing in a Medicaid Program
Institution: Office of Oregon Health Policy and Research
Principal Investigator: Jeanene Smith, M.D.
Grant Duration: June 2004 - August 2006
How have benefit reductions and increased cost sharing impacted the Oregon Health Plan (OHP)? The researchers are examining: (1) impacts on economic viability, including whether cost savings accrue to Medicaid or whether additional costs will be incurred as beneficiaries shift from one benefit to another; (2) impacts on access, including whether access and continuity of care will be compromised as a result of cost sharing and benefit reduction strategies; and (3) impacts on coverage, including the degree to which Medicaid beneficiaries leave the program due to these changes. The objective of this study is to inform state decision makers who continue to seek efficient cost-saving strategies and consider competing approaches for maintaining and rebuilding benefits following reductions in Medicaid and reshaping publicly financed health care.
Title: The Dynamics of Health Insurance Coverage: 1996 to 2000
Institution: The Urban Institute
Principal Investigator: Linda Blumberg, Ph.D.
Grant Duration: September 2003 - October 2005
What are the effects of certain insurance market reforms that were designed to expand coverage? Researchers at the Urban Institute examined the dynamics of health insurance for children and adults under age 65 from 1996 to 2000, a dynamic period characterized by the implementation of national welfare reform, SCHIP, and an economic boom. They documented the patterns of insurance coverage and public program eligibility, estimating the impact of the implementation of SCHIP on insurance coverage for eligible children and previously Medicaid eligible children, and assessing the extent to which the economic expansion affected the insurance coverage of previously uninsured adults. The objective of this project was to inform the design of more effective strategies to maintain or increase insurance coverage and to understand better the determinants of participation and crowd-out that can be useful when considering coverage expansions. The findings will also help to better predict the implications of reductions in coverage resulting from states’ efforts to balance their budgets or in the economic context of a recession.
Title: The Effect of Price on Health Plan Choices of Retirees
Institution: University of California Irvine Graduate School of Management
Principal Investigator: Thomas C. Buchmueller, Ph.D.
Grant Duration: March 2002 - February 2003
What is the price sensitivity and related health plan choices of Medicare-eligible retirees? Building on previous HCFO-funded research and analyzing data from a large western employer, the researcher analyzed the following: 1) What is the effect of out-of-pocket premiums on the health plan choices of Medicare-eligible retirees? 2) How price-sensitive are early retirees (under 65)? and 3) How responsive are retirees to financial incentives for declining coverage? The objective of this study was to educate decision makers who develop Medicare reforms by providing credible estimates of the price sensitivity of Medicare beneficiaries. In addition, the researcher sought to inform policymakers about how retirees respond to financial incentives and the impact this response might have on how insurance costs are allocated.
Title: The Safety Net and Employer-Provided Health Insurance
Institution: Northwestern University
Principal Investigator: Anthony T. LoSasso, Ph.D.
Grant Duration: October 2001 - March 2004
How does the health care safety net affect the private insurance market? The researchers examined how the structure and characteristics of the safety net (i.e., hospitals and federally qualified health centers [FQHCs]) affect employees’ decisions to accept coverage for themselves and their dependents and employers’ decisions to offer coverage. The researchers posited that a stronger safety net may lead employees to accept jobs without health insurance or to refuse coverage if offered. At the same time, they suggested that a stronger safety net may prompt employers not to offer coverage, especially for smaller employers with many low-wage, low-skill workers. The researchers used Current Population Survey (CPS) data from 1988 to 1999 and Medical Expenditure Panel Survey (MEPS) data from 1996 to 1999. This study informs policymakers about the decision of employees to accept and employers to offer health insurance coverage and how the safety net influences those decisions.
Title: Patterns of Individual Coverage
Institution: University of Southern Maine, Muskie School of Public Service
Principal Investigator: Andrew F. Coburn, Ph.D
Grant Duration: October 2001 - June 2003
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? The objective of the study was to better inform the policy debate, at both the federal and state levels, about the best options for sustaining affordable individual insurance coverage.
1 “Employment Situation Summary,” News Release, U.S. Bureau of Labor Statistics, November 7, 2008. Also see http://data.bls.gov/cgi-bin/print.pl/news.release/empsit.nr0.htm
2 Lander, M. “A Towering Economic To-Do List for Obama,” The New York Times, November 6, 2008. Also see www.nytimes.com/2008/11/06/business/06challenges.html?8br.
3 DeNavas-Walt, C. et al. “Income, Poverty, and Health Insurance Coverage in the United States: 2007,” Current Population Reports, U.S. Census Bureau, August 2008, p. 60-235. See also www.census.gov/prod/2008pubs/p60-235.pdf.
4 Ibid.
5 Ibid.
6 For more information on the reported decline in insurance coverage and its implications, please see the HCFO September Hot Topic "Insurance Coverage: Is a Reported Decline in the Number of Uninsured Good News?" at http://news.hcfo.net/ahhcfo/issues/2008-09-19/.
7 www.hcfo.net/grantees/grant.cfm?GrantNo=65093
8 Cunningham, P. and L. Felland. “Falling Behind: Americans’ Access to Medical Care Deteriorates, 2003-2007,” Tracking Report, Center for Studying Health System Change, No. 19, June 2008. See also www.hschange.com/CONTENT/993/993.pdf.
9 Cunningham, P. “Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007,” Tracking Report, Center for Studying Health System Change, No. 21, September 2008. See also www.hschange.com/CONTENT/1017/1017.pdf.
10 www.hcfo.net/grantees/grant.cfm?GrantNo=63309
11 Kirk, A. "The Individual Insurance Market: A Building Block for Health Care Reform?" Report, AcademyHealth, May 2008. Also see www.hcfo.net/pdf/synthesis0508.pdf; Rogal, D. “The Individual Insurance Market: A Building Block for Health Care Reform?” HCFO Policy Brief, AcademyHealth, May 2008. Also see www.hcfo.net/pdf/policybrief0508.pdf.
12 Ibid.
13 Johnson, N. and A. Nicholas. “State Revenues Plummet: July-September Revenue Numbers are Worst in Years,” Center on Budget and Policy Priorities.” October 27, 2008. Also see www.cbpp.org/10-24-08sfp.htm.
14 Dorn, S. et al. “Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses,” Executive Summary, Kaiser Commission on Medicaid and the Uninsured, April 2008. Also see www.kff.org/medicaid/upload/7770.pdf; K. Rueben, Urban Institute, February 2008. Unpublished estimates are based on data from the National Association of State Budget Officers.
15 Dorn, S. et al. “Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses,” Executive Summary, Kaiser Commission on Medicaid and the Uninsured, April 2008. Also see www.kff.org/medicaid/upload/7770.pdf.
16 Altman, D. “Perspectives on State Health Reform.” Pulling it together…, Kaiser Family Foundation. June 11, 2008. Also see www.kff.org/pullingittogether/061108_altman.cfm.
17 McNichol, E.C., and I.J. Lav. “State Budget Troubles Worsen,” Center on Budget and Policy Priorities, November 11, 2008. Also see www.cbpp.org/9-8-08sfp.htm.
18 “Strategies to Help States Address Increased Expenditures during Economic Downturns,” Medicaid, Government Accountability Office, October 2006.
19 www.hcfo.net/grantees/grant.cfm?GrantNo=51304
20 Campion, K. “Surviving the Perfect Storm: Impacts of Benefit Reductions and Increased Cost Sharing in a Medicaid Program,” HCFO Findings Brief, AcademyHealth, Vol. XI, No. 4, July 2008. Also see www.hcfo.net/pdf/findings0708.pdf.
21 “The Budget and Economic Outlook: An Update,” Congressional Budget Office, Pub. No. 3172, September 2008. Also see www.cbo.gov/ftpdocs/97xx/doc9706/09-08-Update.pdf.
22 Ibid.
23 “Medicare Spending and Financing,” Fact Sheet, The Henry J. Kaiser Family Foundation, September 2008. Also see www.kff.org/medicare/7305.cfm.
24 Ibid.
25 “Medicare Now and in the Future,” Health Care and the 2008 Elections, The Henry J. Kaiser Family Foundation, October 2008. Also see www.kff.org/medicare/upload/7821.pdf.
26 For more information on health care costs see March 2008 HCFO Hot Topic, “Health Care Costs—Challenges and Solutions.” www.hcfo.net/topic0308.htm
27 Helman, R. et al. “The 2008 Health Confidence Survey: Rising Costs Continue to Change the Way Americans Use the Health Care System,” Notes, Employee Benefit Research Institute, Vol. 29 No. 10, October 2008. Also see www.ebri.org/pdf/notespdf/EBRI_Notes_10-2008.pdf.
Grantee Spotlight: Stephen Zuckerman, Ph.D., and Timothy Waidmann, Ph.D.
Stephen Zuckerman, Ph.D. Timothy Waidmann, Ph.D.
Stephen Zuckerman, Ph.D., principal research associate in the Health Policy Center of the Urban Institute, and Timothy Waidmann, Ph.D., senior research associate in the Health Policy Center of the Urban Institute, are currently the co-principal investigators on a HCFO study examining the impacts of undocumented immigrants on the U.S. health care system. This project will also explore how efforts to secure citizenship for undocumented immigrants could increase access to public and private insurance for this population. The researchers will consider how much undocumented immigrants have contributed to the rate of uninsurance and to growth in the numbers of non-elderly uninsured in recent years. They will examine how much uncompensated care U.S. providers deliver to undocumented immigrants who lack health insurance coverage, and also to what extent undocumented children and adults would qualify for Medicaid or SCHIP coverage if they became legal residents. Through this research, Dr. Zuckerman and Dr. Waidmann hope to provide current estimates of the actual burden of undocumented immigrants on the health care system to help inform public discussion on policy options.
Dr. Zuckerman has more than two decades of experience studying issues related to health economics and health policy. Currently, his research interests include state health policy, Medicaid managed care, pay for performance, and Medicare physician payment. This work also addresses such issues as the cost of practices becoming medical homes, crowd-out of private coverage by SCHIP, state coverage expansion for adults, the health care safety net, and survey approaches for measuring insurance coverage.
Dr. Zuckerman received his Ph.D. in economics from Columbia University. Before joining the Urban Institute, he worked at the American Medical Association’s Center for Health Policy Research. He also directed the health care component of the National Survey of America’s Families (NSAF) and the Assessing the New Federalism’s household survey. Additionally, Dr. Zuckerman led the evaluation of the Medicaid waiver program operating in Los Angeles County. Between 2000 and 2002, Dr. Zuckerman served as the principal investigator on a HCFO study which examined the impact of Medicaid managed care on access to care and service use. More information about this grant and resulting publications can be found here.
Dr. Waidmann has experience in a variety of areas in health policy, including aging, disability, long-term care, Medicare, and vulnerable populations. His ongoing research includes projects examining the population health impacts of geographic variation in medical care utilization among the elderly, a Medicare buy-in program for the near-elderly, and the testing of alternative specifications of health status in econometric models of retirement. Before joining the Urban Institute, his research focused on the economics and demography of health, disability, and retirement. Dr. Waidmann has also conducted research on the welfare economics of social insurance and the effects of government social insurance programs on labor force behavior.
Dr. Waidmann received his M.A. and Ph.D. in economics from the University of Michigan. Prior to joining the Urban Institute, Dr. Waidmann was an assistant professor of public health policy and administration at the University of Michigan. He was also a National Institute on Aging Post-doctoral Research Fellow in the Population Studies Center and Survey Research Center at the University of Michigan.
For more information about Stephen Zuckerman, Ph.D., and a list of his publications, please see http://www.urban.org/health_policy/about/zuckerman.cfm?page=1.
For more information about Timothy Waidmann, Ph.D., and a list of his publications, please see http://www.urban.org/health_policy/about/waidmann.cfm?page=1.
New HCFO Grant!
Institution: University of Minnesota
Title: Accountable Care Teams for Disabled Medicaid Beneficiaries
Principal Investigator: David Knutson
Duration: 11/1/08 – 7/31/09
Paragraph Summary: The researchers will identify health care providers who share a common patient population (accountable care teams), using a technique known as “network methodology.” These teams could serve as a medical home for their patients. If successful, the process of identifying accountable groups of providers could also support value-based purchasing. The researchers will employ the network methodology to identify provider “clusters” – those who are densely interconnected through serving a common patient population, in this case disabled Medicaid patients in Minnesota. They will then (1) assess the “fit” of the clustering with observations about care organization in Minnesota, and (2) develop measures of cluster cohesiveness. The objective of the project is to introduce a new technology for identifying accountable groups of providers that can be the basis of medical homes/care teams and inform efforts to implement value-based purchasing of health care.
Spotlight on Grantee Publications
Susan H. Busch, Ph.D, associate professor at Yale University, and Colleen L. Barry, Ph.D., assistant professor at Yale University, published the article “New Evidence on the Effects of State Mental Health Mandates,” in the Fall 2008 issue of Inquiry. The article highlights findings from a HCFO-sponsored study that examined the financial impact of state mental health parity laws on children and families.
Ethan A. Halm, M.D., associate chief in the division of general internal medicine at Mount Sinai School of Medicine, and colleagues published the article, “Does Managed Care Affect Quality? Appropriateness, Referral Patterns, and Outcomes of Carotid Edarterectomy,” in the November 2008 issue of American Journal of Medical Quality. The article details findings from a HCFO study—led by Mark R. Chassin, M.D. formerly of Mount Sinai Medical School and currently president of the Joint Commission—that examined the effectiveness of specific managed care interventions to reduce overuse of carotid endarterectomy.
David Grembowski, Ph.D., professor at the University of Washington, and colleagues published the article, “Evaluation of the Group Health Cooperative Access Initiative: Study Design Challenges in Estimating the Impact of a Large-Scale Organizational Transformation,” in the October/December 2008 issue of Quality Management in Health Care. The article highlights findings from a HCFO-sponsored study that evaluated the impact of six patient-centered changes—designed to improve quality by increasing enrollee access to physicians and information—in Group Health Cooperative's (GHC's) delivery system.
This Month in the News
Mythreyi Bhargavan, Ph.D., director of research at the American College of Radiology, and Jonathan H. Sunshine, Ph.D., senior director of research at the American College of Radiology, presented preliminary findings from their HCFO study at the American Public Health Association (APHA) Conference in San Diego, October, 25–29. Their study explores the extent to which small area variation in health care utilization and expenditures is accounted for by physicians with a financial self-interest, particularly as it relates to imaging procedures.
Lawrence P. Casalino, M.D., Ph.D., was appointed chief of the Division of Outcomes and Effectiveness Research in the Department of Public Health at Weill Cornell Medical College and New York-Presbyterian Hospital/Weill Cornell Medical Center.
Hal S. Luft, Ph.D., director of the Palo Alto Medical Foundation Research Institute, published the book, Total Cure: An Antidote to the Health Care Crisis, which presents a new proposal for health care reform.
Judith H. Hibbard, Dr.P.H., was interviewed in the October 28, 2008 Oregonian article, “Remembering to Put Quality into Health Care.” In this interview, Hibbard discussed health care quality, quality measurement and reporting, and patient activation. Hibbard completed HCFO-sponsored studies that examined consumer-directed health plans, public reporting, and methods for presenting quality information to assist consumers to make health plan decisions.
HCFO Releases New Findings Briefs
Medicare Spending on HMOs and Stand-Alone Drug Plans: What is it Worth to Beneficiaries?
The development of a prescription drug benefit under Medicare included key financial expansions in the program—the establishment of subsidized stand-alone prescription drug plans (PDPs) and increased payments to HMOs. A key question for policymakers planning future Medicare budgets is whether one of these expansions is more valuable to beneficiaries than the other. To assist policymakers in answering this question, Steven Pizer, Ph.D., assistant professor at Boston University School of Public Health, and colleagues examined how well each of the two expansions improved the welfare of Medicare beneficiaries per dollar of additional federal spending. The researchers found that while costs per enrollee were similar for beneficiaries in PDPs and HMOs, the addition of PDPs produced nine times as much value for beneficiaries per government dollar as the increase in payments to HMOs.
Should Healthy Medicare Beneficiaries Postpone Enrollment in Part D?
In 2006, the federal government added a voluntary outpatient prescription drug benefit to the Medicare program through the Medicare Prescription Drug, Improvement, and Modernization Act (MMA): Medicare Part D. Given the monthly out-of-pocket premiums and cost-sharing, “healthy” Medicare beneficiaries who do not regularly take prescription drugs wonder whether or not it is cost effective for them to enroll in Part D. Part D premiums, however, depend on when a Medicare beneficiary enrolls in a prescription drug plan. To help answer the question of whether healthy 65-year-old Medicare beneficiaries should enroll in Part D as soon as they are eligible or postpone enrollment until they contract a drug-intensive condition, Bryan Dowd, Ph.D., Mayo Professor and Director of Graduate Studies in the Division of Health Services Research and Policy at the University of Minnesota School of Public Health, and colleagues examined the differences in lifetime out-of-pocket prescription drug expenditures depending on when beneficiaries enroll in Part D. The researchers found that the total lifetime expected out-of-pocket costs are minimized if healthy 65-year-old Medicare beneficiaries enroll in Part D immediately upon eligibility rather than waiting until they contract a drug-intensive condition.
Coverage Ideas from the Field: Call for Proposals
The Robert Wood Johnson Foundation (RWJF) is optimistic about the renewed interest in health care reform across the nation, and anticipates various reform ideas to be discussed by Congress and the new president in the next year and beyond. In order to further the health care debate, however, there are critical issues related to health care coverage that need to be addressed – including better understanding of how to design, implement, administer and sustain policies to expand health care coverage.
RWJF’s Coverage Team is now accepting proposals on a broad range of applicant-initiated projects to support efforts at national health reform. Up to $2 million will be allocated to support grants up to $400,000 for this purpose. The grant period will begin in April 2009 and extend for up to 18 months. With this solicitation, the Foundation will fund projects that will inform and advance the debate and build on the momentum that will drive federal policymakers to act.
New Data for Researchers
New Report on End-of-Life Care in Nursing Homes
The National Center for Health Statistics (NCHS) released a report titled, “End-of-Life Care in Nursing Homes: 2004 National Nursing Home Survey.” The report summarizes services delivered to current nursing home residents assigned to a hospice unit or otherwise receiving services designated as hospice, palliative, or end of life care at the time of the 2004 National Nursing Home Survey (NNHS).
In 2004, 2.5 percent of current nursing home residents in the United States were receiving end-of-life care. This percentage reflects an increase from 1.8 percent in 1999. Approximately 70 percent of residents receiving end-of-life care required assistance with all five activities of daily living, and a similar percentage were moderately to severely impaired in their ability to make decisions. More than 90 percent of residents receiving end-of-life care had at least one advance directive. While 40 percent were reported to have pain in the past seven days, approximately 75 percent had standing orders for pain management. The results of this study suggest that residents receiving end-of-life care in the nursing home consisted of a broad range of residents who differed in function, cognition, reported pain, and diagnoses, yet they appeared to have received similar end-of-life care.
The report can be found at: http://www.cdc.gov/nchs/data/nhsr/nhsr009.pdf
The documentation and public use micro-data files for the 2004 NNHS may be downloaded at: http://www.cdc.gov/nchs/nnhs.htm.
Announcements
National Health Policy Conference Examines the Future of Health Reform
The 2009 National Health Policy Conference (NHPC) is your first chance to hear directly from the new Administration and Congress about their plans to tackle the health policy challenges facing our country. Don't miss the Administration and Congressional plenary sessions which will feature senior officials from the Obama Administration and Congress. Other confirmed panels include:
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The Impact of Health Care Reform on Public Programs
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State Lessons for Health Care Reform
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The Impact of Health Care Reform on Employers
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Report from the Leaders’ Project: How to Fund Health Care Reform
Register by December 22 to save.
Annual Research Meeting
2009 Call for Abstracts Now Open
The AcademyHealth Annual Research Meeting (ARM) is the premier forum for health services research with presentation of cutting-edge health services research. The call for abstracts for the 2009 meeting is now open. Abstracts are invited for three categories: 1) call for papers, 2) call for posters, and 3) call for panels. The 2009 ARM features 21 themes. Details on the specific theme topics and instructions for submitting an abstract can be found in the Call for Abstracts Brochure.
Don't miss this opportunity to present your work to more than 2,000 health services researchers, providers, and key health care decision makers. Submit your abstract or panel proposal by January 15 to be considered for presentation at the ARM, June 28-30, 2009 in
NCHS/AcademyHealth Health Policy Fellowship
Applications Due January 5, 2009
The
For more information on the fellowship and to download an application, visit the fellowship Web site.
Long-Term Care: Call for Commissioned Papers
Applications Accepted Beginning December 1
The Commonwealth Fund and AcademyHealth are holding a competition to prepare a paper comprising an overview and synthesis of an important issue in long-term care. It will form the basis for one of the substantive sessions at the June 2009 Colloquium, which also will include real world discussants and table discussions among colloquium participants.
The selected author will be awarded $5,000 (plus travel expenses) for the paper’s preparation and presentation at the Colloquium on June 27, 2009 in
For more details, visit the 2009 Colloquium Call for Commissioned Papers Web site.
Building Bridges 2009 Policy Seminar
February 4, 2009
8:30 a.m. – 12:30 p.m.
Join key policymakers and researchers for The Commonwealth Fund's Building Bridges: Making a Difference in Long-Term Care 2009 Policy Seminar. Tamara Konetzka, Ph.D.,
Separate registration for the policy seminar is required (see "adjunct meetings" on the registration form). For more information, contact ltc@academyhealth.org or visit the Building Bridges Web site.