Research roundup: Raising seniors' co-pays increases costs; The stimulus and safety net providers

Jan 30 2010

New England Journal of Medicine: Increased Ambulatory Care Copayments And Hospitalizations Among The Elderly - This study examines the consequences of increasing copayments for outpatient care of Medicare enrollees in managed-care plans. "As compared with matched control plans in which copayments for ambulatory care were unchanged, Medicare plans that increased these copayments by an average of 95% for primary care and 74% for specialty care had a reduction in the number of outpatient visits but an increase in hospital admissions, in the number of days of hospital care, and in the proportion of enrollees who used hospital care," the authors write.

They estimate that "for every 100 elderly enrollees exposed to this level of increased cost sharing for ambulatory care, there would be 20 fewer outpatient visits during the first year after the increase but more than 2 additional admissions for acute care and approximately 13 additional inpatient days in the year after the increase. The effects of copayment increases on the subsequent use of inpatient care were magnified for enrollees living in areas with low income and low educational levels, for black enrollees, and for enrollees who had hypertension, diabetes, or a history of acute myocardial infarction as compared with the effects observed for the entire study cohort." (Trivedi, Moloo and Mor, 1/28).

Health Affairs: Evidence That Value-Based Insurance Can Be Effective - In "value-based insurance" design programs, patients have lower copayments for some medical services, often related to treating chronic disease. As employers face growing pressure to control health care costs,these have been regarded by some as a mechanism by which to save costs. The authors write: "Our analysis suggests that the intervention by the large employer described [in this paper] broke even (or even saved money) from a broader employer and employee cost perspective. A more targeted intervention, focusing on high-risk patients, would likely have a more favorable financial profile because nearly the same number of averted clinical adverse events would be spread over the smaller higher-risk denominator," they conclude (Chernew et al., 1/21).

Center for Studying Health System Change: This study examines the recession's effect on safety net providers and the extent to which the American Recovery and Reinvestment Act (ARRA) helped to soften the impact. Based on a series of interviews that took place between July 2008 and July 2009 with representatives from safety net hospitals, community health centers and free clinics from five communities -- Cleveland; Greenville, S.C.; northern New Jersey; Phoenix; and Seattle - the authors conclude that the stimulus funding "has assisted hospitals and health centers in weathering the economic storm, helping to offset reductions in state, local and private funding. And, the economic downturn has generated some potential benefits, including lower rents and broader employee applicant pools." However, many providers believe the full impact of the recession had yet to be felt (Felland et al., Jan. 2010).

Guttmacher Institute: U.S. Teenage Pregnancies, Births And Abortions: National And State Trends By Race And Ethnicity - The most up-to-date national and state statistics on teenage pregnancy, birth and abortion in the U.S. finds that "for the first time since the early 1990s, overall rates of pregnancy and birth - and to a lesser extent, rates of abortion - among teenagers and young women [ages 15-19] increased from 2005 to 2006 ...," write the authors of this report (.pdf). "In addition to the increases in teenage pregnancy, birth and abortion rates, the data presented here indicate that there are still large and long-standing disparities in rates by race and by state. These disparities echo those seen among unintended pregnancy rates, which are several times higher for women of color" (Kost, Henshaw and Carlin, Jan. 2010).

Kaiser Family Foundation: Building An Express Lane Eligibility Initiative: A Roadmap Of Key Decisions For States -  "The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states new options to reach and enroll the estimated 5 million eligible but uninsured low-income children into Medicaid and CHIP. One key tool provided to states by the law is Express Lane Eligibility (ELE), which allows state Medicaid and CHIP agencies to borrow and rely on eligibility findings from other need-based programs, such as Head Start and the National School Lunch Program, to determine and/or renew Medicaid or CHIP eligibility for children.Under the ELE initiative, Congress gives states significant flexibility to design and build enrollment and retention initiatives that meet their unique needs. ... This brief provides an overview of those key decisions that a state will need to address"  (Morrow and Artiga, Jan. 2010).

Robert Wood Johnson Foundation: HIT Adoption And The American Recovery And Reinvestment Act Of 2009 - This brief examines the concept of "meaningful use," as it pertains to the incentives offered for the adoption of electronic health records by Medicaid and Medicare providers, and outlines the challenges: "A strong standard that requires evidence of advanced use of technology in order to receive incentive payments may result in limited adoption among providers … by contrast, setting the meaningful use bar too low means that adoption may yield very little in the way of measurable improvement in quality and information." (1/26).