Research roundup: Docs' views of industry gifts; Chemotherapy payments; Health law and states

Jun 25 2010

Health Affairs: How Medicare's Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment -- This study examines the impact that Medicare payment cuts for chemotherapy drugs had on treatment for Medicare beneficiaries with newly diagnosed lung cancer, before and after implementation of the June 2005 new payment system, focusing on five chemotherapy drugs "in common use singly or jointly for lung cancer..."

The authors write: "Contrary to concerns about access, we found that the changes actually increased the likelihood that lung cancer patients received chemotherapy. The type of chemotherapy agents administered also changed. Physicians switched from dispensing the drugs that experienced the largest cuts in profitability ... We do not know what the effect was on cancer patients, but these changes may have offset some of the savings projected from passage of the legislation. The ultimate message is that payment reforms have real consequences and should be undertaken with caution" (Jacobson et al., 6/17).

Archives of Surgery: Physician Attitudes Toward Industry - Based on a survey of 590 physicians and medical students, the authors found "Attitudes toward industry and gifts were generally positive: 72.2% found sponsored lunches appropriate, whereas 25.4% considered large gifts appropriate. Surgeons, trainees, and those unfamiliar with institutional policies on industry interactions held more positive attitudes than others and were more likely to deem some gifts appropriate, including industry funding of residency programs and, among surgeons, receiving meals, travel expenses, and payments for attending lectures. ... Our finding of overall positive physician attitudes is notable in this time of increasing public concern about potential conflicts of interest, increasing regulation, and a move toward stricter guidelines for physician-industry interactions. Our findings suggest the importance of physician education about the influence of industry, particularly for trainees and surgical specialists" (Korenstein, Keyhani, and Ross, June 2010).

Kaiser Family Foundation/Mathematica: Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns And Trends - "As of March 2010, a record 11.1 million people - nearly one in four of all Medicare beneficiaries - were enrolled in private Medicare Advantage plans, up from 10.5 million in March 2009. The gain in enrollment occurred even though the total number of Medicare Advantage plans declined between 2009 and 2010. Notably, while most Medicare beneficiaries have dozens of private Medicare Advantage plans available in their community, enrollment is highly concentrated among a small number of firms in nearly all states ... [this market] dominance may allow them disproportionate influence over the Medicare Advantage market" according to this data spotlight (Gold, Phelps, Jacobson and Neuman, 6/22).

KHN summarized news coverage of the Medicare Advantage study (6/24).

Urban Institute/Robert Wood Johnson Foundation: What Is The Impact Of The Patient Protection And Affordable Care Act (PPACA) On The States? - This paper (.pdf) examines the benefits and costs of the new health law to states - including increases in state Medicaid spending on childless adults with incomes up to 133 percent the federal poverty level and increased administrative costs: "these state cost increases range from $21.1 billion to $43.2 billion over the 2014-2019 period, with the difference depending on the extent of beneficiary participation." But the authors note that "PPACA will generate new federal payments in other areas that will significantly exceed the rise in state Medicaid spending on low-income adults" (Holahan and Dorn, 6/21).

Urban Institute: Are State Challenges To The Legality Of The Patient Protection And Affordable Care Act Likely To Succeed? - This brief (.pdf) analyzes several arguments made against the constitutionality of the health law, and concludes: "PPACA's legal authority is strong but has two vulnerabilities. One is that the opponents' arguments will strike a philosophical chord with a majority of the Supreme Court, and that five justices could use a PPACA challenge to establish a new constitutional paradigm in place of past precedent. This is a long shot. The other vulnerability is that the opponents' passionate legal arguments will encourage noncompliance with the individual mandate ... The act's enforcement tools are weak, so this development may be more plausible" (Bovbjerg, June 2010).

Robert Wood Johnson Foundation: Charting A Path For Health Care Payment Reform - "Reforming payment is a critical piece of the ongoing, years-long effort to help American health care drive sustainable high quality, efficient and high value care," according to this paper (pdf.), which summarizes the recommendations of an advisory panel "composed of health policy experts as well as representatives of health plans, purchasers, consumer groups, health professionals, government and philanthropy" convened by RWJF. The panel called for short- and long-term strategies for payment reforms and highlighted the need for measuring "quality, cost, efficiency and value of care" as well as "whether implemented payment reforms actually work in enabling and encouraging high value care" (6/17). 

Health Affairs: The Effects Of Unequal Access To Health Insurance For Same-Sex Couples In California - "Partnered gay men are less than half as likely (42 percent) as married heterosexual men to get employer-sponsored dependent coverage, and partnered lesbians have an even slimmer chance (28 percent) of getting dependent coverage compared to married heterosexual women. This dependent coverage disparity by sexual orientation is the source of half of the uninsurance gap for all lesbians and a substantial source of the uninsurance gap for partnered lesbians and gay men in both the overall population and among employees... with the probable result that more health spending is pushed onto these individuals and onto the public" (Ponce et al., 6/24).

Journal of the National Cancer Institute: Race and Ethnicity And Breast Cancer Outcomes In An Underinsured Population -- "We conducted a retrospective review of medical records for [574] breast cancer patients who were treated at Wishard Memorial Hospital from January 1, 1997, to February 28, 2006. ... Sociodemographic characteristics were similar in the two groups ... most (84%) of the patients were underinsured. ... African American patients had poorer breast cancer-specific survival than non-Hispanic white patients. After adjustment for clinical and sociodemographic factors, the effect of race on survival was no longer statistically significant" (Komenaka, 6/23). 

Commonwealth Fund: Mirror, Mirror On The Wall: How The Performance Of The U.S. Health Care System Compares Internationally, 2010 Update - Despite spending more on health care than any other country in the world, the U.S. "ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives" compared to Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom. This report - updated from earlier ones - includes "data from the seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care" (Davis, Schoen and Stremikis, 6/23).

A separate Commonwealth Fund report (.pdf) provides an overview of the health systems of 13 countries - Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. The report highlights who and what is covered under the various country health systems as well as each system's organization of the delivery (Squires, 6/23).