Research Roundup: Health costs at life's end; Assessing hospital quality; Surgeons' burnout; Per capita Medicaid spending

Feb 25 2011

Annals of Internal Medicine: Determinants Of Medical Expenditures In The Last 6 Months Of Life - Identifying factors about patients in the final six months of life that affect the level of care needed "may reveal opportunities for patient-centered interventions to predict and to reduce medical costs," write the authors, while noting that the study had "a large proportion of unexplained variation." Based on their analysis of the Medicare expenditures of 2,394 Health and Retirement Study decedents aged 65.5 years or older, they report that "patient-level characteristics, including functional decline, chronic disease, caregiver support, and race and ethnicity, are significant determinants of Medicare expenditures at the end of life, independent of regional characteristics."  Among the risk factors for higher expenditures: "Decline in function; Hispanic ethnicity; and certain chronic diseases, including diabetes." At the same time, nearby family and dementia "were associated with lower expenditures, and advance care planning had no association" (Kelley et al., 2/15).

Archives of Surgery: Using Hospital Outcomes To Predict 30-Day Mortality Among Injured Patients Insured by Medicare - Quality of care for injured patients is often measured by deaths in the hospital. The researchers were looking for a better measure that would include deaths of patients shortly after leaving the hospital. They determined that Medicare data does provide some options: "As the population of patients treated in regional trauma centers ages, health care policy makers seeking information on the quality of trauma care need to expand their measures beyond the traditional focus on hospitalization survival. Although administrative data can provide modestly precise prediction, a similar method using registry or medical records data might be more accurate" (Gorra, Clark and Mullins, February 2011).

Archives of Surgery: Relationship Between Work-Home Conflicts And Burnout Among American Surgeons - This study compares men and women surgeons on professional characteristics, personal factors and work-home conflicts, as reported by a survey of the American College of Surgeons: "Work-home conflicts appear to be a major contributor to surgeon burnout and are more common among women surgeons." The survey found that women surgeons were "less likely to be married, less likely to have been divorced, and less likely to have children. ... Among married surgeons, nearly twice as many women had a spouse/partner who worked outside the home" -- 83 percent compared to nearly 48 percent. Additionally, the survey found that women surgeons had children later in life than men surgeons (Dyrbye et al., February 2011).

Kaiser Family Foundation: Reconciliation Of Advance Payments For Health Insurance Subsidies - This brief, about health insurance in the new exchanges, or marketplaces, to be established in 2014 under the new federal health law, "explains how advanced payment for health insurance subsidies will work under health reform and examines issues related to potential tax liability for those receiving such subsidies whose circumstances change during the year." The brief notes: "The possibility of having to repay some of the advance payments they receive may discourage people from taking advantage of the advance payments, leading to fewer people obtaining coverage. Currently, repayment obligations are capped, except for those with incomes above 500% of the poverty level, but the amounts may still pose financial challenges for many families"  (2/15).

Kaiser Commission on Medicaid and the Uninsured: Medicaid Spending Growth Over The Last Decade And The Great Recession, 2000-2009 - Although Medicaid spending "has risen faster than growth in national health expenditures and the gross domestic product (GDP)" between 2000-2009, the program's spending growth in 2008 and 2009 "were largely due to enrollment growth," write the authors of this report. "On a per enrollee basis, however, growth in Medicaid spending (the national average, not necessarily specific states) is slower than both growth in national health expenditures per capita and increases in private health insurance premiums. … Although Medicaid spending per enrollee has risen 1.6 percentage points faster than growth in GDP per capita (3.0 percent) over the last decade (2000-2009), its per capita growth has been far below the rise in overall per capita health spending in America, which has risen 2.9 percentage points per year faster than GDP per capita over this same period," they write (Holahan, Clemans-Cope, Lawton and Rousseau, 2/23).

Kaiser also features a fact sheet summarizing the report and an updated data snapshot on how Medicaid enrollment increased between June 2009 and June 2010.

Robert Wood Johnson Foundation: Mental Disorders And Medical Comorbidity - The incidence of having a medical condition in conjunction with a mental disorder "is the rule rather than the exception," with more than 68 percent of adults with a mental disorder reporting that they also have at least one general medical disorder, according to this review that explores the best approaches for targeting these combined issues and the cost burdens associated with treating this group. The review also highlights provisions within the Patient Protection and Affordable Care Act that could benefit the population living with medical and mental conditions (Druss and Walker, February 2011).