Research roundup: The health of the U.S.; doctors aren't paid to talk; savings from high-deductible plans

Aug 17 2013

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Journal of the American Medical Association: The State of US Health, 1990-2010
Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. ... From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and [healthy life expectancy] increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. The United States spends the most per capita on health care across all countries, lacks universal health coverage, and lags behind other high-income countries for life expectancy and many other health outcome measures. High costs with mediocre population health outcomes at the national level are compounded by marked disparities across communities, socioeconomic groups, and race and ethnicity groups. ... With increasing focus on population health outcomes that can be achieved through better public health, multisectoral action, and medical care, it is critical to determine which diseases, injuries, and risk factors are related to the greatest losses of health and how these risk factors and health outcomes are changing over time (US Burden of Disease Collaborators, et al, 8/14).

JAMA Internal Medicine: Medicare Payment For Cognitive Vs. Procedural Care
Health care costs in the United States are rising rapidly, and consensus exists that we are not achieving sufficient value for this investment. Historically, US physicians have been paid more for performing costly procedures that drive up spending and less for cognitive services that may conserve costs and promote population health. ... Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health care system's emphasis on procedural care. We demonstrate that 2 common specialty procedures [a screening colonoscopy and extracting cataracts] can generate more revenue in 1 to 2 hours of total time than a primary care physician receives for an entire day's work (Sinsky and Dugdale, 8/12).

Employee Benefit Research Institute: Health Care Spending After Adopting A Full-Replacement, High-Deductible Health Plan With A Health Savings Account: A Five-Year Study
This study reports experience over five years from a single large employer in the Midwestern United States that adopted a high-deductible health plan with a health savings account (HSA) for all employees. This study represents one of the longest observation periods reported with a full-replacement [consumer directed health plan], and it is one of the few studies with a matched control group. ... Results show that spending was reduced significantly in the inaugural year of the HSA plan in medical, pharmacy, and total-claims categories. Further, the magnitude of the cost savings was greatest in this first year but the cost savings continued over the succeeding three years albeit at a slower pace (Fronstin and Roebuck, August 2013).

George Washington University School of Public Health and Health Services: The Bipartisan Senate Immigration Bill: Implications For Health Coverage And Health Access
Large disparities in health insurance coverage and access to care now exist, when non-citizen immigrants are compared with citizens. The changes in immigrants' health coverage and access as a result of the Senate bill would be modest and gradual. From the start, a bipartisan agreement was struck that unauthorized immigrants would remain ineligible for premium assistance or cost-sharing reductions under the ACA for many years while they are on the path to citizenship, that is, when they are in Registered Provisional Immigrant (RPI) status. Recognizing this, provisional immigrants are not subject to the ACA requirement that people must purchase insurance or pay a tax penalty. They would be permitted to buy insurance from the health insurance marketplaces (that is, the health insurance exchanges), but since federal subsidies would not be available, relatively few would be able to afford coverage. However, prior experience indicates that legalization will help these immigrants get better jobs, which could increase employer-sponsored private coverage for them and their families. They would become eligible for ACA benefits many years later, after attaining lawful permanent resident (LPR or "green card") status (Ku, 8/8).

The Rand Corp.: Delaying the Employer Mandate: Small Change In The Short Term, Big Cost In The Long Run
In July 2013, the Obama administration announced that it would delay enforcement of the Affordable Care Act's (ACA's) penalty on large employers (those with 50 or more workers) that do not offer affordable health insurance coverage to their employees. ... Given the complexity of the issues surrounding the implementation of health care reform, we felt an objective, analytically rigorous review of the impact of the one-year delay of the employer mandate would help inform debate on the issue. ... postponing the employer mandate for one year won't have a large effect on insurance coverage or firm offer rates. However, a one-year delay in implementation of the mandate will result in a 6-percent reduction (or $11 billion) in federal inflows from employer penalties. A full repeal of the employer mandate would cause revenue to fall by $149 billion over the next ten years, providing substantially less money to pay for other components of the law (Price and Saltzman, 8/8).

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

Medscape: AAP Recommendations For Male Adolescent, Young Adult Health
Pediatricians have the opportunity to improve the health of their adolescent male patients, according to a review published online August 12 in Pediatrics. The authors highlight objectives and practices for chronic illness, mortality, unintentional injury and violence, mental health and substance use, and reproductive and sexual health in young men. "Adolescent and young adult male health receives little attention, despite the potential for positive effects on adult quality and length of life and reduction of health disparities and social inequalities," write David L. Bell, MD, MPH, from the Department of Pediatrics and the Department of Population and Family Health, Columbia University Medical Center, New York City, and colleagues. "Pediatric providers, as the medical home for adolescents, are well positioned to address young men's health needs" (Barclay, 8/12).

Medscape: Electronic Patient–Physician Communications Face Barriers
Telephone calls and emails by patients can be very efficient, but these electronic communications may never be widely used unless physicians are reimbursed for them and are given extra time to do the work, according to a new study published in the August issue of Health Affairs. Despite the potential advantages associated with e-communications, a 2008 study has found that less than 7% of physicians regularly communicate with their patients electronically (Page, 8/12).

Medscape: HIV Occupational Exposure: USPHS Updates Guidelines
After any occupational exposure to HIV, healthcare personnel (HCP) should immediately receive a postexposure prophylaxis (PEP) regimen containing at least 3 antiretroviral drugs, according to updated guidelines published in the September issue of Infection Control and Hospital Epidemiology. The current recommendations from the United States Public Health Service (USPHS) update the 2005 guidelines for management of HCP with occupational HIV exposure and use of PEP. A major change in the recommendation refers to the number of drugs included in the PEP regimen. The previous guidelines recommended evaluating the risk level associated with specific exposures to help determine the optimal number of antiretroviral drugs for PEP. In contrast, the current recommendations call for consistent use of a combination of 3 or more drugs for all occupational exposures to HIV (Barclay, 8/9).

Modern Healthcare: Limiting Residents' Work Hours Didn't Hurt Patient Safety, But Cut Time Spent With Patients, Studies Say
Patient-safety issues raised by the critics of limits on resident duty hours have not materialized. But concerns about doctors-in-training spending less time with patients appear to be valid, according to two new studies in the Journal of General Internal Medicine. The Accreditation Council for Graduate Medical Education set an 80-hour weekly work limit (averaged over four weeks) in 2003. Further limits, including restricting first-year residents to 16-hour shifts went into effect in 2011 (8/15).