Research roundup: Health law's effects on consumer spending; Mass. experience finds increased use of laparoscopic surgery

Oct 5 2013

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

Rand Corporation: Effects of the Affordable Care Act On Consumer Health Care Spending And Risk of Catastrophic Health Costs 
The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels (Nowak, Eibner, Adamson and Saltzman, 10/1).

Journal of Health Management, Policy and Innovation: Examples of How Health Insurance Exchanges Can Create Greater Value for Consumers: Lessons From Three Other Marketplaces 
By examining how other markets provide greater value for consumers we can anticipate certain choices that HIXs [health insurance exchanges] can make to provide higher-value insurance plans to buyers, as well as certain pitfalls they should avoid. The most important choice might be whether to function only as a clearinghouse for all qualified health plans (QHPs) that want to sell through the exchange, or to adopt an 'active purchaser' model that limits the choices available through the exchange. ... These choices will ultimately drive the success of HIXs, which we define in terms of enrollment and quality of care (Lieberthal et al., Oct. 2013). 

Annals of Oncology: Discrepancies In Cancer Incidence And Mortality And Its Relationship To Health Expenditure In The 27 European Union Member States
We hypothesized that increased health expenditure would be associated with better cancer outcome and that this would be most apparent in breast cancer, because of the availability of effective screening methods and treatments. Using publically available data from the World Health Organization, the International Monetary Fund, and the World Bank, we assessed associations between cancer indicators and wealth and health indicators. ... Higher wealth and higher health expenditures were associated both with increased cancer incidence and decreased cancer mortality. In breast cancer, the association with incidence was stronger (Ades et al., 10/1).

Clinical Infectious Diseases: Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality And Lower Healthcare Costs
We used administrative fee-for-service Medicare claims to identify beneficiaries with inpatient hospitalizations between 2008 and 2009 involving at least one of 11 infections. ... The ID [infectious disease] intervention cohort demonstrated significantly lower mortality and readmissions compared to the non-ID intervention cohort. Medicare charges and payments were not significantly different; ... ID interventions are associated with improved patient outcomes. Early ID interventions are associated with improved outcomes and reduced costs for Medicare beneficiaries with select infections (Schmitt et al., 9/25).

Stroke: Effect Of Socioeconomic Status On Inpatient Mortality And Use of Postacute Care After Subarachnoid Hemorrhage Background And Purpose
This study investigated socioeconomic status-related differences in risk of inpatient mortality and use of institutional postacute care after subarachnoid hemorrhage in the United States and Canada. ... The cohort consisted of 31,631 US patients and 16,531 Canadian patients. Mean age (58 years) and crude inpatient mortality rates (22%) were similar in both countries. A significant income–mortality association was observed among US patients, which was absent among Canadian patients  (Jaja et al., 10/1).

JAMA Surgery: Massachusetts Health Care Reform and Reduced Racial Disparities in Minimally Invasive Surgery
Racial disparities in receipt of minimally invasive surgery (MIS) persist in the United States and have been shown to also be associated with a number of driving factors, including insurance status. However, little is known as to how expanding insurance coverage across a population influences disparities in surgical care. ... The 2006 Massachusetts health care reform serves as a unique natural experiment to analyze the impact of expanded health insurance coverage on the delivery of surgical care for government-subsidized and uninsured patients. ...our data show that after health care reform in Massachusetts, racial/ethnic disparities in the probability of undergoing MIS disappeared in Massachusetts, while variation by patient race/ethnicity persisted in other states (Loehrer et al., 10/3).

JAMA Internal Medicine: Antibiotic Prescribing To Adults With Sore Throat In The United States, 1997-2010
Antibiotic prescribing to patients who are unlikely to benefit is not benign. All antibiotic prescribing increases the prevalence of antibiotic-resistant bacteria. The financial cost of unnecessary antibiotic prescribing to adults with sore throat in the United States from 1997 to 2010 was conservatively $500 million. ... despite decades of effort, we found only incremental improvement in antibiotic prescribing for adults making a visit with sore throat. Combining our previous and present analyses, the antibiotic prescribing rate dropped from roughly 80% to 70% around 1993 and dropped again around 2000 to 60%, where it has remained stable. This still far exceeds the 10% prevalence of [group A Streptococcus infection] GAS among adults seeking care for sore throat. The prescription of broader-spectrum, more expensive antibiotics, especially azithromycin, was common. Prescribing of penicillin, which is guideline-recommended, inexpensive, well-tolerated, and to which GAS is universally susceptible, remained infrequent (Barnett and Lindner, 10/3).

The Heritage Foundation: Obamacare's Insurance Exchanges: "Private Coverage" in Name Only
A health insurance exchange is essentially a mechanism that enables people to choose among different health insurance options. Yet, the declared purposes-;and resulting effects-;of the Obamacare exchanges are very different from those of consumer-oriented approaches. Consumer-choice health insurance exchanges facilitate defined-contribution financing of health insurance. They increase not only the number, but also the variety, of health plan choices. The objective is not merely to increase supplier competition, but also to make suppliers more responsive to the preferences of individual consumers. A different type of exchange operates on a government "procurement model." A good example is a state that contracts with selected managed care plans to insure Medicaid enrollees. In those cases, while a private insurer may provide the coverage, the covered individuals have little or no say in the decision. The Obamacare health insurance exchange system, though often sold as a mechanism to provide consumer choice and competition, is, in fact, a vehicle for the detailed federal regulation of insurance. Americans can expect less choice and less competition (Moffitt and Haislmaier, 9/26).

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

MedPage Today: Family Docs Worried About Payment Reform
Aspects of health reform are some of the biggest disrupting factors facing family medicine today, a recent survey of family physicians showed. Nearly half (49%) of respondents identified payment reform as a disrupting factor, a satisfaction survey of American Academy of Family Physicians (AAFP) members showed. The survey was presented here at the AAFP Scientific Assembly. Almost a third (31%) said preserving bonus payments for primary care under the Affordable Care Act (ACA) was a concern (Pittman, 9/27).

Medscape: Primary Care Malpractice Cases 'More Difficult To Defend'
Primary care practices account for fewer than 1 in 10 malpractice cases, but those cases are far more likely to be either settled or lost in a jury trial compared with non-general medical claims, according to a new study published online today in JAMA Internal Medicine. In short, such cases in the primary care realm "seem more difficult to defend," write study author Gordon Schiff, MD, the associate director of the Center for Patient Safety Research and Practice at Harvard Medical School, Boston, Massachusetts, and coauthors (Lowes, 10/3).

Medscape: Telemedicine Eases Rising Burden Of Macular Degeneration
Telemedicine is as effective as a face-to-face office consultation for the follow-up evaluation of patients with age-related macular degeneration. Retreatment decisions made during office consultations and those made by a remote ophthalmologist were in agreement 90% of the time, a new study has found (McNamara, 10/1).

Medscape: Residents Learn From Fall-Prevention Program
A simple program to educate family practice residents can significantly increase their ability to prevent falls in elderly patients, a new study shows (Harrison, 10/1).

Reuters: Insurance May Narrow Race Gap In Access To Surgery
Wider insurance coverage erased racial differences in who got minimally invasive surgery in Massachusetts, according to a new study. After the state increased access to insurance in 2006, racial disparities in the proportion of people having gallbladders or appendixes removed with minimally invasive techniques - versus traditional "open" surgery - disappeared, researchers found (Seaman, 10/2).

Medpage Today: Out-Of-Pocket Costs Projected To Fall Under ACA
Most Americans flocking to HealthCare.gov this week to sign up for health coverage under the Affordable Care Act (ACA) will see their out-of-pocket costs fall with expanded insurance options, an analysis found. "Decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured," a study from the RAND Corporation found. "In some cases, these reductions will be dramatic." However, total health spending -- which includes out-of-pocket costs and spending on health insurance premiums -- will increase for many newly insured people, except those who will be covered by Medicaid (Pittman, 10/3).