Research roundup: Gastric bypass costs, paying for psychotherapy

Jul 21 2012

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Archives of Surgery: Health Expenditures Among High-Risk Patients After Gastric Bypass and Matched Controls -- A few studies have shown that bariatric surgery can help reduce health care spending by obese patients, particularly those with conditions such as diabetes. This latest study looked at 847 patients who received bariatric surgery through the Veterans Affairs medical system. Inpatient and outpatient spending both before and after surgery were compared to 847 obese patients who did not have the operation. Researchers found that there was no significant difference in patients' health care expenditures after three years. Despite that, the authors add that "many patients may still choose to undergo bariatric surgery given the strong evidence of significant reductions in body weight and comorbidities and improved quality of life" (Maciejewski et al, 7/17).

Health Services Research: Impact of Deductibles On Initiation And Continuation Of Psychotherapy For Treatment Of Depression -- An increasing number of insurance plans have high deductibles, which are expected to reduce overall costs by making patients pay more attention to the care they choose. But these plans could also discourage patients from necessary services. In this study, researchers looked at the effect of a range of deductibles on patients seeking psychotherapy for depression. Among patients who had met their deductible, there was no significant effect from deductible size on whether they began or continued psychotherapy. However, those patients who hadn't yet met between $100 to $500 of their deductible were significantly less likely to make an initial visit (Fishman et al, August 2012).

Annals of Emergency Medicine: A Novel Approach To Identifying Targets For Cost Reduction In The Emergency Department -- Policymakers frequently recommend reducing emergency department visits for minor and preventable illness as one way to reduce health care spending. Authors of this paper, however, propose a different strategy, based on a new framework for analyzing ED visits. The researchers divide visits into three categories -- emergencies, intermediate/complex conditions and minor injury/illness -- and based on federal data they estimate that the middle category accounts for the greatest share of costs. Intermediate/complex conditions, the authors write, "have the most potential for substantial cost savings, mainly through reduced admissions yet also to a lesser degree from streamlined ED evaluations" (Smulowitz, Honigman and Landon, 7/16).

Health Services Research: Medicaid, Hospital Financial Stress, And The Incidence Of Adverse Medical Events For Children -- Initiatives to encourage better hospital care will likely adjust Medicare or Medicaid payment based on factors including the rate of adverse events. This study uses federal data and a survey by the American Hospital Association to look at how the stress of Medicaid reimbursement might correlate with the rate among children of adverse events, such as hospital-acquired infections, accidental lacerations or after-surgery respiratory failure. Researchers found that children at community hospitals with a heavy reliance on Medicaid were 62 percent more likely to experience an adverse event than at other hospitals. The authors write that "adverse events may be in part due to factors outside the control of hospital management and medical staff and that Medicaid itself may be playing a contributing role in the occurrence of some of these events" (Smith et al, August 2012).

Here is a selection of excerpts from news coverage of other recent research:

The Associated Press: CDC: Whooping Cough Rising At Alarming Rate In US
The U.S. appears headed for its worst year for whooping cough in more than five decades, with the number of cases rising at an epidemic rate that experts say may reflect a problem with the effectiveness of the vaccine. Nearly 18,000 cases have been reported so far -; more than twice the number seen at this point last year, the Centers for Disease Control and Prevention said Thursday. At this pace, the number for the entire year will be the highest since 1959, when 40,000 illnesses were reported (Stobbe, 7/19).

Medscape: Millions of US Women Lack Adequate Healthcare
A new Commonwealth Fund report shows that women in the United States are in much worse shape, healthcare-wise, than women in 10 nations that have universal healthcare. Even insured American women are more likely to go without needed healthcare because of the cost and difficulty paying medical bills. The report was published online July 13 (Brown, 7/13).

Boston Globe: Surgery Offers No Advantage For Early Prostate Cancer, Study Finds
The vast majority of men ­diagnosed with early-stage prostate cancer have surgery or other harsh treatments that can cause permanent side effects, but a study published Wednesday found that men in their 60s who had surgery did not live significantly longer than those whose cancers were merely monitored. The clinical trial, performed at Massachusetts General Hospital and elsewhere, could be a turning point, shifting doctors toward more conservative treatment of men who are diagnosed with prostate cancer that has not spread beyond the gland, the authors said (Kotz, 7/18).

Medscape: Program For Preventing Stroke, Dementia In Primary Care A special prevention program that encouraged primary care doctors to identify and treat vascular risk factors in their older patients successfully reduced the need for long-term care dependence, according to a new study published in the Journal of the American Heart Association (Lowry, 7/18).