Health Policy Research Roundup

Dec 4 2009

UCLA Center For Health Policy Research: Health Disparities Among California's Nearly Four Million Low-Income Nonelderly Adult Women - Using data from the 2007 California Health Interview Survey, the authors of this policy brief compare low-income women, ages 18-64, to others. The report finds the low-income women are four times more likely to report fair or poor health and are more likely to report a health condition that interferes with basic physical activities, such as walking or climbing stairs. The report also found, "Low-income women ages 40-64 have higher rates of diabetes, high blood pressure and heart disease than women with family incomes at or above 400% [of the federal poverty level], and a similar rate of asthma" (Peckham and Wyn, Nov. 2009).

Journal of the American Medical Association: Effectiveness Of Public Report Cards For Improving The Quality of Cardiac Care - "Although there has been considerable debate [over mandating the public release of hospital performance data,] few empirical data exist to determine whether publicly released report cards on hospital performance improve the overall quality of care provided," write the authors of this randomized trial in Ontario that examined whether releasing hospital data would improve the quality of cardiac care. The study found that a designed release of information on two types of heart treatments did not produce significant system improvement at the hospitals tested (Tu et al., 11/18).

Arthritis Care & Research: Patient Responsibility For Medical Decision Making And Risky Treatment Options - Patients viewed "a video in which a physician described the availability of a new medication associated with a rare risk of a serious side effect." Patients were then asked to assess their willingness to take the medicine -- one where the doctor advised and prescribed the treatment presented in the video (minimizing patient choice); one where patient left decision entirely open to patient (maximizing patient choice). "The willingness of the subject to take the proposed medication was lower and their worry about the risk of the adverse event was greater in the high compared with the low involvement condition," the authors write, suggesting that increasing "patient responsibility in medical decision-making may decrease the patient's willingness to accept risky treatment options" (Fraenkel and Peters, 11/30).

RAND Health: Does Price Transparency Legislation Allow The Uninsured To Shop For Care? - This study examines the response rates of California hospitals to a patient price request and compares the price estimates received to Medicare reimbursement. Among other things, the authors found that despite legislation in California that requires hospitals to provide an uninsured person "with a written estimate of the amount the hospital will require the person to pay for the healthcare services, procedures, and supplies ... based upon an average length of stay and services provided for the person's diagnosis," only 28 percent of hospitals (98/353) responded - to varying degrees - regarding the request. According to the authors, "Fifteen percent did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered" (Farrell, Finocchio, Trivedi and Mehrotra, 11/21).

Mathematica Policy Research: Practical Lessons For Health Reform From The Military Health System - This policy brief assesses the impact universal access has on health disparities. The researchers "conducted a retrospective, cross-sectional, cohort study of children enrolled in TRICARE Prime, a benefit similar to what health maintenance organizations (HMOs) offer." The authors note, "Despite universal health insurance coverage and access to military treatment facilities for these groups, we found evidence of racial and ethnic differences in asthma prevalence, treatment, and outcomes. Compared with white children, African American children were significantly more likely to be diagnosed with asthma, more likely to have an asthma-related hospitalization and/or ED visit, and less likely to visit an asthma specialist" (Croghan, Purcell and Stewart, Nov. 2009).

Health Affairs: Patient Safety At Ten: Unmistakable Progress, Troubling Gaps - To coincide with the tenth anniversary (Dec. 1) of the Institute of Medicine report on medical errors, To Err Is Human, Robert M. Wachter,  of the Department of Medicine at UCSF examines where things stand today in 10 patient-safety domains, as a follow-up to a similar analysis he made in 2004. Wachter writes, "In my view, the activities chronicled in this paper represent unmistakable progress, even though hard evidence of improved outcomes remains elusive because of our rudimentary measurement capacity in safety. … My own assessment is that our progress deserves an overall grade of B−, a slight improvement on my 2004 grade of C+. … Most of our changes have constituted real progress, and even our missteps have yielded valuable lessons. Moreover, in a further sign of the field's maturation, previously unaddressed areas (such as diagnostic errors) are being placed on the safety field's agenda, and we are beginning to consider how to prioritize safety interventions" (Wachter, 12/1).

Kaiser Family Foundation: Medicaid Home And Community-Based Service Programs: Data Update - "Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades," write the authors of this issue paper that summarizes "the main trends to emerge from the latest (2006) expenditures and participant data for the three Medicaid HCBS programs" and "findings on eligibility criteria, provider, service and waiting lists for all three programs" (Ng, Harrington and O'Malley Watts, 11/24).

Kaiser Family Foundation: State Medicaid Coverage Of Perinatal Services: Summary Of State Survey Findings - "Over the past two decades, Medicaid has evolved into the nation's largest payor of maternity related services." It covers "more than four in 10 births nationwide, and in several states covers more than half of total births." This brief uses data drawn from a 2007-2008 survey conducted in collaboration with George Washington University. A companion report, also based on the survey findings, features "state-by-state policies on coverage of key areas in reproductive health for low-income women, including contraception, preconception care, screenings for sexually transmitted diseases and coverage within special state Medicaid family planning programs," according to a Kaiser Family Foundation description of the brief  (Ranji, Salganicoff, Stewart, Cox and Doamekpor, 11/23).