Research roundup: Evaluating health bills, attitudes about uninsured, improving emergency rooms

Mar 15 2010

Urban Institute: The Cost Of Uncompensated Care With And Without Health Reform - This report analyzes various health bills. "The cost of uncompensated care will fall from $62.1 billion in 2009 to $46.6 billion in 2019 under the Senate bill, and to $36.5 billion in 2019 with the House bill. Without reform, the cost of uncompensated care will increase to between $107 and $141 billion in 2019, depending on growth in the economy and health care costs. ... Without health reform, the number of uninsured and the amount of uncompensated care will grow substantially. This will translate into increased pressure on state and local government to finance the growing cost of the uninsured" (Holahan and Garrett, 3/9).

Health Affairs: A Partisan Divide On The Uninsured - Based on a "random-digit-dial telephone survey" including over 1,000 adults, conducted June 17-20 2009  the authors found "the majority of survey respondents (56 percent)… perceived that the uninsured are able to get necessary medical care," however, less than 31 percent believed their care was as good as that received by an insured person. "Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain," the authors write (Oakman et al., 3/11).

Kaiser Family Foundation: Comparison Of Expenditures In Nongroup And Employer-Sponsored Insurance: 2004-2007 -  Based on pooled data from the Medical Expenditures Panel Survey Household Component 2004-2007, this brief reports, "The average and median annual amounts paid by private health insurance are higher for ESI [employer-sponsored insurance] enrollees than for nongroup enrollees for most age groups," however "nongroup insurance is less likely than employer-sponsored health insurance to pay for health care expenditures that people have, leaving nongroup enrollees to pay for a relatively high share of their health care expenditures out-of-pocket." The brief also finds "nongroup enrollees are more likely than ESI enrollees to classify their health status as excellent."

"These findings raise some important considerations for policy makers evaluating different options for covering the uninsured. … Policymakers should be careful not to assume that they could insure many of the currently uninsured at the premium levels now observed in the nongroup market" (March 2010).

Mathematica Policy Research: Quality's New Frontier: Reducing Hospitalizations And Improving Transitions In Long-Term Care - This brief "identifies ways to measure and reduce potentially avoidable hospitalizations and improve the quality of long-term care for people in nursing homes and other home- and community-based service settings." The authors write: "We also need to explore how to adapt effective interventions from other settings to the long-term care field, scale up the most promising practices, and change underlying financial incentives" (Lipson and Simon, March 2010).  

Robert Wood Johnson Foundation: Improving Patient Flow And Reducing Emergency Department (ED) Crowding - This issue brief tracks the progress of the Urgent Matters Learning Network II (LN II) initiative, "a collaborative of six participating hospitals nationwide that are working together over an 18-month period to identify, develop and implement strategies to improve patient flow and reduce [Emergency Department] crowding." Some of the focus is on getting patients' pain managed more quickly (Feb. 2010).

Annals of Family Medicine: Physician Office vs Retail Clinic: Patient Preferences In Care Seeking For Minor Illnesses - This study examines how cost of care and appointment wait time influence a consumer's willingness to seek care at retail clinics or physician's office. "Willingness-to-pay estimates suggest that, all else being equal, a cost savings of $31.42 would be required for the respondents to seek care from a nurse practitioner at a retail clinic. Similarly, a cost savings of $82.12 would be required for them to choose to wait 1 day or more. Overall, a savings of $167.77 would be required for the respondents not to seek medical care for their symptoms (ie, they would seek care if the cost is less than $167.77). ... Primary care physician practices, especially in competitive markets, are therefore likely to derive greater competitive advantage by addressing patient convenience features (such as same-day scheduling, walk-in hours, and extended hours) than by reducing fees" (Ahmed and Fincham, March/April 2010).

Commonwealth Fund: The Massachusetts Child Psychiatry Access Project: Supporting Mental Health Treatment In Primary Care - This case study examines a program in Massachusetts aimed at increasing primary care providers' access to child psychiatrists and mental health specialists. As of July 2009, the Massachusetts Child Psychiatry Access Project (MCPAP) had enrolled 365 primary care practices "believed to cover at least 95 percent of the approximately 1.5 million children in the Commonwealth. .... MCPAP's success in supporting primary care providers may be a model that is adaptable beyond children's mental health" and "may also offer a model for leveraging other scarce specialty resources," author of the case study writes (Holt, March 2010).

Kaiser Family Foundation/Center for Children and Families at the Georgetown University Health Policy Institute:  CHIP TIPS: Children's Oral Health Benefits - In addition to expanding dental coverage for children, the new requirement under the Children's Health Insurance Program Reauthorization Act (CHIPRA) that all CHIP programs cover comprehensive dental benefits "calls for improved access to information on dental providers and covered dental benefits for Medicaid and CHIP enrollees; Allows federally-qualified community health centers (FQHC) to contract with private practice dental providers to provide oral health services; Compels states to report on certain oral health services; and Includes dental care among the initial core set of child health quality measures to be developed by the Health and Human Services (HHS) Secretary, and requires the Secretary to provide information on efforts to improve dental care in reports to Congress on the quality of children's health care under Medicaid and CHIP," according to the brief (March 2010).