Research roundup: Medicaid's long-term care bill; work-based coverage and the health law

Oct 29 2011

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Primary Care Utilization And Colorectal Cancer Outcomes Among Medicare Beneficiaries -- This study examined Medicare data on beneficiaries diagnosed with colorectal cancer between 1995 and 2005 who ranged from 67 to 85 years old. The authors found, "Medicare beneficiaries with (colon cancer) had better outcomes if they had more primary care utilization before diagnosis. Even within this universally insured population, 28% of Medicare beneficiaries with (colon cancer) had no or only 1 contact with (primary care physicians) in the 3 to 27 months before the diagnosis. These patients had increased risk of not ever receiving (colon cancer) screening" and of having the cancer at a more advanced stage and higher risks of death from the disease (Ferrante et. al., 10/24).

Kaiser Family Foundation: Medicaid's Long Term Care Users: Spending Patterns Across International And Community-Based Settings -- "The nation's primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions. This issue brief provides an overview of long-term care users and their acute and long-term care service spending. The report finds that although the individuals who rely on long-term care are diverse and comprised only six percent of the Medicaid population in 2007, they accounted for nearly half of total Medicaid spending that year," the authors write (O'Malley Watts, Lawton and Young, 10/26). 

The Urban Institute/Robert Wood Johnson Foundation: Why Employers Will Continue To Provide Health Insurance: The Impact Of The Affordable Care Act -- Some benefits consultants have suggested that the 2010 health care law will reduce the number of employers providing insurance. This analysis disagrees. Employers, the authors note, have been offering coverage to their employees for decades without any mandate or threat of government penalties: "they do it for good economic reasons--they are competing for labor--and these economic reasons will determine whether they continue to do so or change their behavior. ... some employers may seek immediate financial gain in benefit reduction as markets adjust to new circumstances. But over time, coverage reductions inevitably would make the workers that employers most want to keep worse off, and if those workers sought employment elsewhere as a result then the firm would be worse off as well. It is therefore unlikely that large numbers of employers currently providing insurance coverage will change their decisions to offer it" (Blumberg, Buettgens, Feder and Holahan, 10/26).

National Bureau Of Economic Research: Organizational Economics And Physician Practices -- Some economist maintain that the biggest problem with the health care delivery system is poor physician incentives. "From this perspective, the continuing dominance of fee-for-service payment systems and flawed payment rates within these systems create strong incentives for physicians to deliver high-cost services. Incentives to improve care quality are largely indirect and weak – patients presumably seek out higher quality physicians but have little ability to evaluate physician quality." The authors suggest that using the accountable care organization model in the 2010 health law will help provide an integrated care delivery system. They also suggest complications could arise when integrating hospitals and physicians (Rebitzer and Votruba, October 2011).