Research Roundup: Middle class health cost burden, disparities and cancer, summary of new health law

Mar 26 2010

Health Affairs: The Growing Financial Burden Of Health Care: National And State Trends, 2001-2006 - This paper examines the ratio of total out-of-pocket spending for health care and insurance to total family income, using data from the Medical Expenditure Panel Surveys for 2001-2006. "The results show considerable state-to-state variation associated mainly with differences in family income and, to a lesser extent, out-of-pocket spending for insurance premiums. Nationally, middle- and higher-income people with private insurance experienced the largest increases in financial burden."

"To stem the increase in financial burden among families at higher income levels—and to sustain proposed subsidies to lower-income people—it will be essential to combine cost containment efforts in health care along with achieving real gains in family income" (Cunningham, 3/25).

Kaiser Family Foundation: Summary Of Coverage Provisions In The Patient Protection And Affordable Care Act And The Health Care And Education Reconciliation Act of 2010 - This summary describes the main features of the reconciliation bill, "including the individual mandate requirements, expansion of public programs, health insurance exchanges, changes to private insurance, employer requirements and cost and coverage estimates" (3/23).

Cancer: Race Versus Place of Service in Mortality Among Medicare Beneficiaries With Cancer - "It has been demonstrated repeatedly that cancer-related mortality among African-American cancer patients is higher than among Caucasian cancer patients, although the causal factors are not clear."  This study compared "differences in mortality for African-American and Caucasian patients with lung, breast, colorectal, or prostate cancer in the Medicare population." Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify cancer cases and SEER-Medicare Hospital File to determine where treatments were received, the authors find that although African Americans have higher mortality rates than Caucasians across all cancer care settings, "when African-American and Caucasian cancer patients attend similar types of specialized cancer care settings, all-cause mortality and cancer-specific mortality are similar."

"If it is determined that these results are generalizable to other cancer care settings, then patients, referring physicians, healthcare organizations, and policy makers should place a premium on reliable, facility-level, quality reporting to maximize equal benefits for all patients"  (Onega et al., 3/22).

American Journal of Medical Quality: Cataract Surgery Among Veterans 65 Years of Age And Older: Analysis Of National Veterans Health Administration Databases - Institutional rates of cataract surgery for patients who receive care at Veterans Health Administration "differ substantially from those of Medicare beneficiaries, which are approximately 5.5-fold greater," the authors of this study found after analyzing VHA data sets "for fiscal years 2000 through 2007. ... the difference is too great to be explained by demographic factors or secular trends in surgery."

"We don't know yet what exactly accounts for the five and a half fold difference in surgery rates between the two systems," Dustin French, lead author on the study, said in a Indiana University School of Medicine press release. "It may be related to how the two systems are funded by the government, it could be a difference between physician-driven decisions or it may be related to a lack of ophthalmologists within the VA system or it could be more than one of these factors," he said (March 2010).

Urban Institute: What If All Physician Services Were Paid Under The Medicare Fee Schedule? An Analysis Using Medical Group Management Association Data - "A primary goal of the 1992 Medicare physician payment reforms based on a resource-based relative value scale (RBRVS) was to create an economically neutral fee schedule -- one that rewards all physician work equally," write the authors of this brief (.pdf) how they examined payments "as if all physician services were paid under the Medicare fee schedule."

"This analysis confirms that there are substantial differences in the actual hourly and annual compensation across specialties, with a number of specialties exhibiting compensation ratios exceeding 2:1 when compared to family medicine," the authors write. "[T]he 2010 Medicare Fee Schedule will phase in some significant changes in relative values, particularly for practice expenses, which are likely to produce some increase in payments for services provided by primary care and other non-procedural specialties, with commensurate reductions in payments for certain technologically-based services provided particularly by cardiologists and radiologists" (Berenson, Zuckerman, Stockley et al., 3/19).

Robert Wood Johnson Foundation/George Washington University: Accountable Care Organizations: Implications For Antitrust Policy - "Proposals in both the House and Senate to encourage physician and hospitals to join forces and form a single delivery organization have raised antitrust questions. A new brief from the George Washington University School of Public Health & Health Services examines the debate around creating accountable care organizations (ACOs) to serve Medicare and Medicaid patients." The authors "examine the role of ACOs in the proposed legislation and conclude that they are in keeping with longstanding antitrust policies." They write: "How the federal government coordinates these policy levers to produce a greater push toward integration, technology-enabled health care, quality improvement and the production of comprehensive health information, should be counted as one of the most closely watched follow-on activities of health reform" (Burke and Rosenbaum, March 2010).

Kaiser Family Foundation: Aging Out Of Medicaid: What Is The Risk Of Becoming Uninsured? - This policy brief (.pdf) examines the challenges young adults previously enrolled in Medicaid/CHIP face after they reach 19, at which point they often lose eligibility for CHIP and face "more limited Medicaid eligibility criteria for adults." Based on data from 2003-2007, the authors find 42 percent of individuals who were previously covered by Medicaid or CHIP are uninsured after turning 19.  "Recent efforts to target uninsured young adults have focused on extending dependent coverage, but this would have a limited reach for those aging out of Medicaid because most of their parents do not have private coverage. Extending Medicaid eligibility for children to age 21 in all states would help children maintain their coverage" (Schwartz and Damico, March 2010).