Research roundup: Medicare spending, community health centers, children's dental services

Feb 6 2010

Health Affairs: Prices Don't Drive Regional Medicare Spending Variations - "Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon.

How much of these differences can be explained by Medicare's paying more to compensate for the higher cost of goods and services in such areas?" After performing a price-adjustment analysis on Medicare spending in 306 Hospital Referral Regions, the authors - most from Dartmouth Institute for Health Policy - found that "utilization—not local price differences—drives Medicare regional payment variations, along with special payments for medical education and care for the poor." The study "has also demonstrated there are also substantial variations in what Medicare pays for the same medical services across regions—particularly for Part A hospital services" (Gottlieb et al., 1/28).

Kaiser Family Foundation: Medicare Advantage 2010 Data Spotlight: Benefits and Cost-Sharing - "This data spotlight examines trends in benefits and cost-sharing for Medicare Advantage plans in 2010, including the wide variations found across plans..."  Based on an analysis of 2,864 Medicare Advantage plans in 2010, the authors write: "Trends since 2008 present a mixed picture. On the one hand, the share of plans with limits on out-of-pocket spending has increased, while cost-sharing for primary care and specialist office visits has remained virtually unchanged. On the other hand, average cost-sharing for certain services (inpatient hospital stays and skilled nursing facility stays) has increased since 2008 (36 percent and 18 percent, respectively), appearing to shift greater costs to the subset of beneficiaries with the greatest medical needs" (Gold, Hudson, Jacobson and Neuman, 2/2).

Health Affairs: Funding Growth Drives Community Health Center Services - "Federal grants to federally qualified health centers" grew from $550 million in 1990 to $925 million to nearly $2 billion in 2007. And, the number went from "roughly 750 centers in 2001 to the recently reached milestone of 1,200 centers in December 2007," write the authors of this paper examining the impact of federal, state, local and private grants on the centers' ability to expand services, staff and provide more uncompensated care. Using 1996-2006 Uniform Data System information, they found investments made in the centers led to increases in mental health and counseling services and treatment for more uninsured patients (Sasso and Byck, Feb. 2010).

Medical Care Research And Review: Hospital Executives' Perspectives On Pay-For-Performance And Racial/Ethnic Disparities In Care - Based on interviews with senior executives at 28 hospitals, the authors report the executives are "largely skeptical" of pay-for-performance programs' effect on disparities and "question whether these programs are designed to support quality improvement or to contain costs. ... Hospital executives from both safety net and non-safety net hospitals by and large agree with the hypothesis that P4P may simply reward wealthier hospitals, potentially creating an environment in which safety net hospitals—which disproportionately serve minority patients—are increasingly unable to compete with non-safety net hospitals."

"Other approaches, such as identifying successful strategies in high-performing hospitals with few disparities and developing tools to adapt and replicate such models in poorer performing hospitals and those with greater disparities, may be of greater benefit in national efforts to eliminate disparities in health care" (Weinick et al.,1/6).

Kaiser Family Foundation: Medicaid and Managed Care: Key Data, Trends, and Issues - "About 70 percent of Medicaid enrollees receive some or all of their services through managed care." This policy brief (.pdf) describes Medicaid's increasing reliance on managed care and highlights possible difficulties: "The possibility of a major expansion of Medicaid underscores both the opportunities and challenges associated with Medicaid managed care. Managed care could translate into access to needed care for a long-underserved adult population. Alternatively, if plan or provider participation is inadequate, Medicaid eligibility is unstable, or the unique needs of the Medicaid population are overlooked, concerns about access could grow" (KCMU, 2/2)

Pediatrics: Association Between Parents And Children's Use Of Oral Health Services - This study (.pdf), based on the 2007 National Health Interview Survey, found that children are more likely to visit the dentist, regardless of the child's insurance status. "Comprehensive strategies that are designed to enhance awareness of the importance of oral health and to eliminate financial barriers to accessing care could have a positive effect on children's use of oral health services," the study authors conclude. "Family-centered approaches to oral health delivery, education, and promotion could potentially influence the oral health values of the entire family unit, with long-term impact on their oral health behaviors and status" (Isong, Zuckerman, Rao, Kuhlthau, Winickoff and Perrin, 2/1).