Health Policy Research Roundup: Length of hospital stays, analyses of Obama's reform proposals

Feb 27 2010

Archives Of Internal Medicine: Hospital Cost Of Care, Quality Of Care, And Readmission Rates - This study compares patients treated for pneumonia and congestive heart failure (CHF) and finds that high-cost hospitals don't always deliver better care. The researchers, who based their analysis on the data from 3,146 hospitals in the 2004 to 2006 Medicare Provider Analysis and Review (MedPAR), report that "risk-adjusted costs of care for CHF and pneumonia varied widely between hospitals, although hospital cost-of-care patterns seemed stable over time and correlated across conditions." They conclude, "Most evidence did not support the penny-wise and pound-foolish hypothesis that low-cost hospitals discharge patients earlier, only to increase readmission rates and incur greater inpatient cost of care over time" (Chen et al., 2/22).

Kaiser Health News summarized the news coverage of this study.

Health Affairs: Unchecked Provider Clout In California Foreshadows Challenges To Health Reform - "In current health reform discussions and proposed legislation, providers' growing market power to negotiate higher payment rates from private insurers is the 'elephant in the room' that is rarely mentioned," write the authors of this study that examines the negotiating environment in California and is based on a series of interviews with hospital executives, physician organizations, insurance brokers, large employers and other stakeholders: "Here, in our study of the current negotiating environment in California, we explain that growing market power for providers caused a shift that gave providers a stronger bargaining position over health plans, leading in turn to higher insurance premiums."

"Unless market mechanisms can be found to discipline providers' use of their growing market power, it seems inevitable that policy makers will need to turn to regulatory approaches, such as putting price caps on negotiated private-sector rates and adopting all-payer rate setting," the authors conclude (Berenson, Ginsburg and Kemper, 2/25).

Health Services Research: Trends In Hospital Cost and Revenue, 1994-2005: How Are They Related to HMO Penetration, Concentration, and For-Profit Ownership? - This study examines the relationship between the HMO market structure and recent trends in hospital cost and revenue growth. Based on an analysis of the "hospital costs and revenues among all short-term, general, nonfederal hospitals located in metropolitan statistical areas (MSAs) in the United States between 1994-2005," the authors find "a 10 percentage point increase in HMO enrollment is associated with 4.1-4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1-2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19-27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization" (Shen, Wu and Melnick, Feb. 2010).

UCLA Center For Health Policy Research: Health And Health Care Access Among California Women Ages 50-64 - This policy brief examines the health issues facing the roughly 3 million women, ages 50-64, in California. "Using data from the 2007 California Health Interview Survey, the authors found that one-quarter of women who had never married and 21 percent of divorced, separated, or widowed women were uninsured -- percentages that are more than twice the rates of married women" (Wyn and Peckham, Feb. 2010).

RAND: Analysis of President Obama's Health Reform Proposal - This report examines what effect the proposal President Obama put forth Monday for overhaul of the nation's health system would have on the nation's uninsured between 2010 and 2019, using the COMPARE microsimulation model: "the President's Plan will reduce the number of uninsured by 30 million relative to the status quo …" and "would result in about 1 million more people obtaining insurance through the nongroup or Exchange market than the Senate bill." The authors also note, "Total spending on Medicaid under the President's Plan would be slightly lower than the level we previously found for the Senate bill and subsidy costs would also be lower" (2/22).

Kaiser Family Foundation: Summary Of Key Medicare Provisions In White House Proposal And House And Senate Health Reform Bills - This brief (.pdf) examines the differences between the White House proposal for comprehensive health overhaul to those passed by the Senate (H.R. 3590) and House (H.R. 3962) in Medicare provisions, including changes to Medicare Advantage, Medicare Part D and provider payment reforms (2/23).

Urban Institute: Who Would Be Hurt The Most By A Failure To Enact Comprehensive Reforms? - As Congress continues to debate a comprehensive health care overhaul, this paper concludes that the people who would be most adversely affected with reform are "the self-employed, those working for small employers, those with health problems, older working-age adults and early retirees, the low-incomes, and others without access to employer-based insurance" (Blumberg, 2/24).

National Center For Health Statistics: Access To And Utilization Of Medical Care For Young Adults Aged 20-29 Years: United States, 2008 - In 2008, nearly one-third (13 million) of all U.S. adults, ages 20-29, lacked health insurance - a rate of more than twice that reported in adults between 30-64, this study reports. Drawing data from the 2008 National Health Interview Survey, the study authors find uninsured adults ages 20-29 were less likely than those with private insurance or Medicaid to report having a usual source of medical care and more than four times as likely as those with private insurance and two times as likely as those with Medicaid to report an unmet medical need (Cohen and Bloom, Feb. 2010).

Kaiser Health News summarized the news coverage of this study.

Institute Of Medicine: A Population-Based Policy And Systems Change Approach To Prevent And Control Hypertension - "Nearly one in three adults [in the U.S.] has hypertension, which places huge economic demands on the health care system, estimated at $73.4 billion in direct and indirect costs in 2009 alone," write the authors of this report that highlights priority areas for the CDC's work in the area of hypertension prevention and control. The IOM recommendations call for the CDC to engage with partners in the public and private sectors to promote policies that encourage people to increase exercise, cut calories and decrease sodium consumption. The report advocates the elimination or reduction "of deductibles and co-payments for anti-hypertensive medications" (Fleming et al., 2/22).

Kaiser Family Foundation: U.S. Federal Funding For HIV/AIDS: The President's FY 2011 Budget Request - This factsheet (.pdf) provides a breakdown of President Barack Obama's request for combined domestic and global HIV/AIDS activities in the FY 2011 budget and compares trends in funding in recent years. "The largest component of the federal AIDS budget is health care for people living with HIV/AIDS in the U.S., which totals $14.1 billion in the FY 2011 request (52% of the total and 69% of the domestic share) ... This represents a 7% increase over FY 2010, primarily due to increased mandatory spending for Medicaid and Medicare" (2/17).

Pew Center On The States: The Cost Of Delay: State Dental Policies Fail One In Five Children - Roughly one in five low-income children living in the U.S. goes without dental care each year, and this report concludes that two-thirds of all states have yet to implement "proven, cost-effective policies that could dramatically improve disadvantaged children's dental health." The report grades the states on whether and how well they employed eight policies that have been previously shown to improve dental care for children, ranging from such cost-saving preventive measures to help protect teeth - such as sealants and fluoridation - to innovative ways to expand the pool of skilled professionals who can provide the care (Feb. 2010).

Mathematica Policy Research: Using Professionally Trained Interpreters To Increase Patient/Provider Satisfaction: Does It Work? - The researchers compared the reported satisfaction by patients and providers following visits when interpreter services from a professionally trained medical interpreter were used to those when the emergency room's telephone language line or ad hoc interpreter services were used. Ninety-six percent of patients who received the professionally trained medical interpreter reported being "very satisfied" with their ability to communicate with their provider compared to 23 percent who received the other services. Similar results were reported in triage nurses, doctors and discharge nurses. (Bagchi et al., Feb. 2010).