Research roundup: Massachusetts health reform; Role of race and insurance in kidney transplantation

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Aug 3 2012

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

Journal of General Internal Medicine: Access to Care After Massachusetts' Health Care Reform: A Safety Net Hospital Patient Survey -- Policy analysts have long said that Massachusetts and its 2006 health reform law provide great insight into the federal health law and how its expansion of insurance coverage will play out. In this study, 431 patients at a Massachusetts safety net hospital were interviewed about their access to health care since the state's coverage expansion. Researchers found that publicly and privately insured patients now had similar access to a usual source of care; they also utilized health care services at a similar rate. Publicly insured patients were significantly more likely, however, to report delaying or not seeing a specialist, or not getting a medication or test, because of cost sharing under their health plan. The authors write that policymakers at the state and federal level "should carefully evaluate the impact of various levels of cost sharing on access to care, and should design and offer forms of insurance that will not discourage the receipt of useful health care services" (McCormick et al, 7/25).

Medicare & Medicaid Research Review: Financial Performance of Health Plans in Medicaid Managed Care -- An increasing number of states are moving toward Medicaid managed care as a way to handle the financial burden of the Medicaid program. This study compares the financial health of 170 Medicaid managed care plans and finds that companies focused on Medicaid, rather than Medicare or a commercial plan, spent significantly less on medical care and had higher operating profit margins. The author writes that plans not specializing in Medicaid are often losing money from the venture, partly because these plans "may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization" (McCue, 7/26).

Journal of General Internal Medicine: "Did I Do as Best as the System Would Let Me?" Healthcare Professional Views on Hospital to Home Care Transitions -- For providers, better coordinating the transition from hospital to home is important for reducing readmissions and improving the quality of care. In this study, researchers conducted focus groups and interviews with several health care providers involved in those transitions: physicians, nurses, case managers and others. Many pointed to poor communication between each type of provider, as well as a lack of standardization, as causes of poor transitional care. The authors recommend that hospitals establish better protocols for discharge and require further training for all providers involved in care transitions (Davis et al, 7/25).

Clinical Journal of the American Society of Nephrology: Association of Race and Insurance Type with Delayed Assessment for Kidney Transplantation among Patients Initiating Dialysis in the United States -- Previous research has shown that black patients are less likely than white patients to receive kidney transplantations. This study looks at both race and insurance status to determine how those factors might affect whether or not a patient has received an assessment for transplantation -- one of many steps in the process. Researchers used a national database of more than 420,000 patients with kidney disease and found that black patients were 5 percent more likely to report not having been assessed, while patients on Medicaid were 33 percent more likely. This insurance disparity was even more pronounced among younger patients, who might have the most to gain from a transplant, the authors note. They recommend changes to the transplant system, including making the start of dialysis, rather than formal assessment and admission, the patient's start time on the transplant wait list (Johansen, 7/27).

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

Reuters: Price Of Life-Saving Allergy Injections Has Spiked
The cost of self-administered epinephrine injections, which are used to stop life-threatening allergic reactions, has more than doubled over the past 25 years, according to a new analysis. The researchers found that the average cost - adjusted for inflation - of one injection increased from about $36 in 1986 to about $88 in 2011. The analysis, however, cannot say why the cost is going up (Seaman, 7/31).

Reuters: More U.S. Women Choosing IUDs For Birth Control: Study
A growing number of U.S. women appear to be opting for intrauterine devices (IUDs) as their birth control method, with the number more than doubling in just two years in one study. Researchers, whose findings were published in the journal Fertility & Sterility, said this is good news, since IUDs and contraceptive implants are the most effective forms of reversible birth control. But in the United States they are still far from popular, with use lagging well behind birth control pills and condoms (8/2).

Reuters: Black Arthritis Patients Get Fewer Potent Drugs
Black people with rheumatoid arthritis are less likely than whites to be on powerful drugs that ward off further joint damage and disability, according to a new study from California. … Dr. Kenneth Saag, an immunologist from the University of Alabama at Birmingham, called the findings "unsettling." He said black people with rheumatoid arthritis may know fewer members of their community who are on biologic DMARDs, and so aren't as comfortable trying them. Or, doctors could have misconceptions about arthritis not being as severe in certain types of patients (Pittman, 8/2).

Reuters: Program Cuts Medically Unnecessary Scheduled Births
A quality improvement program can cut by 60 percent the number of deliveries scheduled a few weeks before the due date, according to a new study. "To me this (study) is a success story on how to do it," said Dr. Kenneth Leveno, the chair in obstetrics and gynecology at UT Southwestern Medical Center, who was not involved in the research (Grens, 8/2).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.