Research roundup: Access to care in Mass.; Mental health spending; Gender and medical debt: How much do Americans know about health law?

Feb 11 2011

Health Affairs: Lack Of Access Due To Costs Remains A Problem For Some In Massachusetts Despite The State's Health Reforms - Based on an analysis of state data, the authors found that the percentage of people without insurance fell "to twelve-year lows in Massachusetts, from 11.5 percent (SE 0.91) in 1996 to 3.5 percent (SE 0.33) in 2008. … Between 2005 and 2008 there was a decrease in the prevalence of uninsurance in all groups." But, while "[t]he prevalence of screening for cancer and cardiovascular disease is high in Massachusetts … [p]eople with the lowest incomes were much less likely than those with the highest incomes to obtain age-appropriate mammography, Pap smears, colorectal cancer screening, or cholesterol screening," the authors report (Clark et al., February 2011).

Archives Of Pediatrics And Adolescent Medicine: Effect Of Hospital-Based Comprehensive Care Clinic On Health Costs For Medicaid-Insured Medically Complex Children - This study examines the Medicaid costs associated with care for children with multiple chronic illnesses before and after Arkansas Children's Hospital initiated a medical home program. The program "resulted in significantly fewer inpatient stays [per patient per month] with significantly shorter lengths of hospital stay. This resulted in an annual savings of $1766 [per patient per month]," the authors report. "The number of outpatient claims per child per month increased, but emergency department contacts decreased for the year after the first clinic visit compared with the year before the first clinic visit. The aggregate cost savings for Arkansas Medicaid, including the costs mentioned earlier as well as medications and other related expenses, was $1179 [per patient per month] for the year after the first clinic visit" (Casey et al., 2/7).

Health Affairs: Changes In U.S. Spending On Mental Health And Substance Abuse Treatment, 1986-2005, And Implications For Policy - "In 2005 an estimated $22 billion was spent on substance abuse treatment and $113 billion, on mental health treatment in the United States. During the study period (1986-2005) both mental health and substance abuse spending grew more slowly than all health spending: 4.8 percent annually for substance abuse, 6.9 percent annually for mental health, and 7.9 percent annually for all health," write the authors, who name several factors contributing to this change. They note: "The share of mental health spending funded by Medicaid has been increasing, from 17 percent in 1986 to 27 percent in 2002 to 28 percent in 2005. In contrast, spending from non-Medicaid state and local government sources continued to decline from 20 percent of all mental health spending in 2002 to 18 percent in 2005" (Mark et al., February 2011).

RAND: A Needs Assessment of New York State Veterans - "Mental health disorders and other types of impairments resulting from deployment experiences are beginning to emerge, but fundamental gaps remain in our knowledge about the needs of veterans returning from Iraq and Afghanistan, the services available to meet those needs, and the experiences of veterans who have tried to use these services," according to the authors of this study, which found that 22 percent of veterans in New York state had a "probable diagnosis" of post-traumatic stress disorder and/or major depression. The study found "that both VA and non-VA services are critically important for addressing veterans' needs, and that the health care systems that serve veterans are extremely complicated. Addressing veterans' mental health needs will require a multipronged approach: reducing barriers to seeking treatment; improving the sustainment of, or adherence to, treatment; and improving the quality of the services being delivered" (Farmer et al., 1/26).

Medical Care (American Public Health Association): Evaluation Of Care Management For The Uninsured - "[I]ncreasing attention has focused on the need to reduce avoidable and preventable ED [emergency department] visits and hospitalizations in the Medicaid population," as a means of controlling health costs, according to this study. They examined whether receiving assistance navigating the health system by a Care Management Program in California reduced hospitalizations and ED visits among low-income adults who were uninsured. Based on hospital encounter data obtained by the program's record system, the study found "that care managed patients had a 32 percent lower risk of visiting the ED than that comparison group," although there was "no difference in inpatient admissions between the groups" (Reema et al., February 2011).

Journal of Health Care for the Poor and Underserved: Gender Differences In Financial Hardships Of Medical Debt - This study examined five specific experiences: "being contacted by a collection agency, encountering problems paying for other necessities, putting off major purchases, having used savings, and having borrowed money." Drawing data from the 2003 Community Tracking Study (CTS) Household Survey, the authors report, "94% of respondents reported having financial hardships associated with medical debt. … Men were more likely to report utilizing savings, whereas women were more likely to report borrowing money and having problems paying for necessities as a result of incurring medical debt" (Wiltshire et al., February 2011).

Commonwealth Fund: On The Road To Better Value: State Roles In Promoting Accountable Care Organizations (ACOs) - "Supported by mature data systems and using a shared-savings model that recognizes the importance of health care outcomes, ACOs can incentivize what states want— controlled costs and better health outcomes—while addressing health care in a longitudinal and population-based way," write the authors of this report, which is based on interviews with national experts and offers several perspectives on the roles states can play in developing ACOs. Experiences are drawn from Colorado, Massachusetts, Minnesota, North Carolina, Oregon, Vermont and Washington (Purington et al., 2/4).

Kaiser Family Foundation: Pop Quiz: Assessing Americans' Familiarity With the Health Care Law - The authors write: "As the 112th Congress prepared to take office and the discussion of repeal was on the rise, the Foundation included a ten-question "quiz" on the December Kaiser Health Tracking poll to try to answer this question. The quiz asked Americans whether they thought a series of ten provisions were included in the new law, ranging from five items that are part of the law (i.e., Medicaid expansion, changes in private health insurance), to five items that popped up at times in the larger debate but are not in the ACA, such as coverage for illegal immigrants and so-called 'death panels.' ... A quarter scored an impressive grade of 7 to 10 right answers, but less than one percent responded to all 10 questions correctly. On the other end of the spectrum, roughly a third scored 0 to 4, with 2 percent failing to get a single question right. Overall, two‐thirds of Americans (65 percent) got five or more answers correct. Most people hovered around the middle, correctly answering 4 to 6 questions (2/2).