Research Roundup: Disabled Medicare Enrollees' challenges; Increasing ER visits; costs/benefits of Part D

Aug 16 2010

Health Affairs: Medicare Doesn't Work As Well For Younger, Disabled Beneficiaries As It Does For Older Enrollees - This paper examines "how well Medicare works for [the 8 million] nonelderly disabled beneficiaries compared to the elderly, based on findings from a nationally representative survey of noninstitutionalized Medicare beneficiaries conducted in 2008 by the Kaiser Family Foundation." 

"Compared to less than 20 percent of the elderly, roughly half of nonelderly disabled Medicare beneficiaries reported problems paying for health care services, and put off or did not get care because of cost concerns. For both nonelderly and elderly beneficiaries, cost-related barriers were most frequently cited for dental services, followed by prescription drugs, over-the-counter medications, and visits to doctors. ... Moreover, among those who reported delays or not getting services due to costs, a larger share of nonelderly beneficiaries reported experiencing negative consequences as a result," such as "the worsening of existing medical problems, physical pain, and stress or anxiety."  The article also describes differences between the beneficiaries in health care use, access to prescription drugs through Medicare Part D, and experiences with supplemental coverage (Cubanski and Neuman, 8/12).

Archives of Internal Medicine: Impact Of Medicare Part D On Seniors' Out-Of-Pocket Expenditures On Medications - "The implementation of Medicare Part D was driven by concerns that cost sharing for prescription medications was placing an increasing financial burden on seniors and by documented evidence that cost sharing has negative effects on adherence to therapy and health care utilization," according to this study based on Medical Expenditure Panel Survey (MEPS) data. "Mean out-of-pocket annual expenditures on all medications decreased by 32% … from $1011 to $691, in the year after Medicare Part D was implemented compared with the year before in all Medicare beneficiaries participating in the MEPS."

"Although the implication of these findings is that Medicare Part D has achieved some of its intended effect of reducing Medicare beneficiaries' out-of-pocket expenditures on medications, a question remains about whether the financial gain derived by beneficiaries is sufficient given the high public cost of the program," the authors write. "This is highlighted by the considerable gap between the reduction in out-of-pocket expenditures experienced by all Medicare beneficiaries in this study and the per capita investment in this program in 2006 ($320 vs $1742)" (Millett et al., 8/9).

Archives of Internal Medicine: Ambulatory Antibiotic Use And Prescription Drug Coverage In Older Adults - Researchers analyzed data from a large Medicare Advantage plan two years before the 2006 implementation of Medicare Part D and two years after it went into effect, specifically focusing on the rates of antibiotic use among those with pneumonia and other acute respiratory tract infections (ARIs).  

"In summary, use of antibiotics increased as individuals gained better drug coverage, especially for broad spectrum, newer, and more expensive antibiotics. We found increases in the likelihood of antibiotic treatment for pneumonia and other ARIs," the authors report. "These increases took place against a backdrop of national declines in antibiotic use overall. Our study suggests that reimbursement may play a role in addressing the substantial role of inappropriate antibiotic prescribing and use" (Zhang, Lee and Donohue, 8/9).

Journal of the American Medical Association: Trends And Characteristics Of US Emergency Department Visits, 1997-2007 - Using "the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual, national probability sample survey of hospital [emergency departments] conducted by the National Center for Health Statistics," this study found that "between 1997 and 2007, the total annual visits to US EDs increased by 23%—corresponding to an estimated 21 million additional ED visits nationwide. This is roughly twice the rate of growth of the US population over the same time period. Persons insured by Medicaid, particularly nonelderly adults, accounted for a large proportion of this increase. ... One possible explanation for these trends is that adults with Medicaid are experiencing increasing difficulties in accessing primary care" (Tang et al., 8/11).

Kaiser Family Foundation: Optimizing Medicaid Enrollment: Spotlight On Technology - This spotlight paper (.pdf) - the first in a series on the technology that states are using to develop innovative ways to increase and simplify Medicaid enrollment - profiles Louisiana's "Express lane eligibility" (ELE), a program "that allows state Medicaid and CHIP agencies to rely on eligibility findings from other public programs such as SNAP (Supplemental Nutrition Assistance Program, formerly Food Stamps) or Head Start, and/or tax return data, to identify, enroll, and recertify children ..."  

"In February 2010, the month after ELE was launched, Medicaid enrolled more than 10,000 children in one stroke using the new process ... Despite a 12% reduction in the Medicaid workforce in the last two years, neither the volume nor the quality of eligibility processing has declined. ... States that harness the potential of ELE to enroll children in Medicaid today are likely to realize not only important gains in children's coverage, but also system efficiencies that can help states prepare for the new pressures on Medicaid eligibility and enrollment processes when the Medicaid expansion under health reform is implemented in 2014," the authors write (8/4).

Kaiser Family Foundation: Explaining Health Reform: Benefits And Cost-Sharing For Adult Medicaid Beneficiaries - "Under health reform, Medicaid eligibility will be expanded to reach nearly everyone under age 65 with income below 133 percent of the federal poverty level. As a result, millions of uninsured adults, including many with very low income and significant health needs, will become eligible for the program. This  brief provides details of the benefit and cost-sharing rules that will govern the coverage available to these newly eligible adults Medicaid beneficiaries, and it identifies key considerations for state policymakers making Medicaid benefit design choices" (Guyer and Paradise, 8/9).

Urban Institute: How Will The Patient Protection And Affordable Care Act Affect Small, Medium, And Large Businesses? - This brief (.pdf) examines what the Patient Protection and Affordable Care Act (PPACA) will mean for businesses, according to the size of the employer. The brief includes information about the financial obligations and assistance employers will be eligible for under the health law and notes any changes to the health insurance options currently offered by employers (Blumberg, 8/1). 

The Urban Institute features two additional papers on the impact of health reform on the economy and the national deficit.

Institutes of Medicine: Assessing The Effects Of The Gulf Of Mexico Oil Spill On Human Health - This document compiles the observations and ideas presented during a recent workshop convened "to inform efforts to monitor the health effects of the Gulf oil spill and to communicate information concerning these risks to the public. ... While it is difficult to predict the full magnitude of the Gulf oil disaster's impact on human health, there is an opportunity to help the communities whose well-being is in jeopardy and to prevent or mitigate similar experiences in the future, according to the many workshop participants ... [Nancy] Adler [chair of the workshop]  stated that surveillance systems could be developed to accurately inform decision makers and the public about the real risks to the physical and psychological health related to Deepwater Horizon disaster" (8/10).

Mathematica: Aging In Place: Do Older Americans Act Title III Services Reach Those Most Likely To Enter Nursing Homes? - "AoA [Administration on Aging] services help the elderly 'age in place'—or remain in their homes and communities even as their health and functioning decline—by targeting the most vulnerable older adults," write the authors of this report about a 2009 AoA survey. "'As the elderly population in the United States increases and there is a growing emphasis on community living, identifying services that allow the elderly to remain in their homes is becoming increasingly important,' says Jody Schimmel, co-author and senior researcher at Mathematica, 'Our analysis showed that AoA is reaching some of those most at risk of entering a nursing home, and that clients report that Title III services play an important role in helping them live independently in the community.'" Title III services include "case management, home-delivered meals, and homemaker services." (Altshuler and Schimmel, July 2010).