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This is the Health Chairs e-Bulletin for June 2005.
Building Blocks
We have just printed a new and improved set of introductions to a dozen important health policy topics in the form of a series of “Frequently Asked Questions.” This Building Blocks: An Orientation to Health Policy for State Legislators is designed to help you get your members up to speed by giving them background on topics that may be unfamiliar. Individual FAQs are also available for downloading at http://www.ncsl.org/programs/health/forum/faqpreface.htm
Shocking Factoid
The average annual medical cost for a family of four in 2005 is $12,214.
Source: Milliman Medical Index 2005 http://www.milliman.com/mmi/Milliman_Medical_Index_Final.pdf
Access to Chronic Care
A number of papers on the uninsured were issued in conjunction with this year’s Cover the Uninsured Week, in early May. A Commonwealth fund report looks at rapid growth in uninsured young adults, and offers some policy options including extending family coverage—private and public -- to older children, and having colleges require that their students have insurance. http://www.cmwf.org/newsroom/newsroom_show.htm?doc_id=275328
A provocative paper from the National Center for Policy Analysis, Consumer Driven Health Care: The Changing Role of the Patient suggests such things as greater self care through use of home tests and internet-based consultation, on-line auctions of physician services and more overseas referrals as ways to hold costs down. http://www.ncpa.org/pub/st/st276/
The Commonwealth Fund has just published the first issue of States in Action: A Quarterly Look at Innovations in Health Policy, a new electronic quarterly dealing with state health policy issues. Long articles about some state and county-level access efforts, a profile of Minnesota’s quality purchasing initiative, and links to more resources. http://www.cmwf.org/publications/publications_show.htm?doc_id=276919
Disparities
The Kaiser Family Foundation hosted a May meeting on Indian Health Care in the 21st Century: A Case Study in Disparities. In addition to being able to hear speakers and see their slides, you can follow links from this to the current issue of AJPH, which includes articles on Indian health care issues nationally as well as projects and studies in Montana, Wyoming and Maine, among others. Webcast and links at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1423
Medicaid
An October 2004 report by Mark Merlis for the Congressional Research Service on Medicaid Reimbursement Policy includes sections on reimbursement policies for acute care, long term care, managed care and prescription drugs. The report, the first of a projected series on Medicaid, is now available at http://www.cq.com/flatfiles/editorialFiles/temporaryItems/20041101Medicaid.pdf
Chronic Illness
If you have been struggling to estimate the unmet health needs of the uninsured…are they sicker or healthier than people with insurance?...you’ll be interested in a new analysis of national survey data (the 2003 National Health Interview Survey) from the Urban Institute that compares rates of chronic illness in the uninsured and insured. "Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey," by Amy J. Davidoff and Genevieve M. Kenney finds that “almost half of uninsured adults with chronic conditions forgo needed medical care or prescription drugs,” making them about 4.5 times more likely than their insured counterparts to report doing without needed care.
A CBO report on high cost Medicare beneficiaries makes a related point. A quarter of all beneficiaries accounted for 85 percent of spending in 2001. The questions for policymakers are: Can you identify who they will be? And, can you do anything to mitigate their high costs? http://www.cbo.gov/showdoc.cfm?index=6332&sequence=0&from=7
Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services.
A California analysis also features the very different costs faced by people with and without chronic illnesses. For example, “A chronically ill individual earning $29,458 (average per capita, after-tax disposable California income) with a limited PPO plan could end up facing costs that amount to nearly 40 percent of his or her income.” http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=110807
People with chronic conditions are becoming more likely to skip needed drugs because of their costs This especially affects people with low incomes or who are uninsured, but being insured is no solution—especially for Blacks, according to a new study from the Center for Studying Health System Change. An Update on Americans' Access to Prescription Drugs http://www.hschange.org/CONTENT/738/
Prescription Drug Policy
New from NCSL: An update of state laws related to prescription drugs. "2005 Prescription Drug State Legislation" tallies legislation in 21 different Rx topics, ranging from bulk purchasing, subsidy and discount plans, to Medicare changes, PBM regulation and clinical trials. The online report is located at http://www.ncsl.org/programs/health/drugdisc05.htm
A second updated report "2005 Medicare and State Pharmaceutical Coordination Legislation" focuses on the 70+ bills in 39 states that respond or relate to the federal MMA.
Long-Term Care
The GAO just published testimony on Long-Term Care Financing: Growing Demand and Cost of Services Are Straining Federal and State Budgets. The analysis includes analysis of funding and trends, and projections of the impact of increasing private LTC insurance. http://www.gao.gov/docdblite/details.php?rptno=GAO-05-564T
Source: GAO analysis of 2003 data from the Centers for Medicare and Medicaid Services and The MEDSTAT Group.
Providers and Facilities
Three on Quality and Safety
HealthGrades has released its second annual assessment of Patient Safety in American Hospitals. The report uses AHRQ’s Patient Safety Indicators to measure safety incidents in almost every hospital, using three years of Medicare data (2001-2003). Incidents measured by sixteen patient safety indicators (PSIs) studied cost the Medicare system roughly $2.91/year in extra inpatient costs. The study identifies top-performing hospitals and trends in the safety issues. The measures may be useful to states looking for benchmarks. http://www.healthgrades.com/media/DMS/pdf/PatientSafetyInAmericanHospitalsReportFINAL42905Post.pdf
The race is on to measure ambulatory care quality—what happens outside the hospital. The Ambulatory Care Quality Alliance (AQA), which includes providers, consumers and payers –sponsors include the Association of Health Insurance Plans (AHIP), major primary care physicians’ associations, and AHRQ has selected a “starter set” of 26 clinical performance measures. http://www.aafp.org/x34164.xml
The National Quality Forum issued a draft set of ambulatory care standards for comment earlier this year. http://www.qualityforum.org/txWEBambreport04-29-05.pdf
Advances in Patient Safety: From Research to Implementation. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD)-Health Affairs have posted the results of five years of federal efforts to improve patient safety and understand medical errors into four volumes of articles. Articles may be accessed individually, or the complete volumes may be downloaded at http://www.ahrq.gov/qual/advances/
Trends and Prices
The American Hospital Association (AHA) has released Trendwatch 2005, a series of slides showing factors that affect health systems. Lots of trend charts, and a few slides with state information on such things as hospital beds, physicians, and average hospital length of stay. http://www.ahapolicyforum.org/ahapolicyforum/trendwatch/chartbook2005.html
The Kentucky Hospital Association has just started a web site listing average charges and length of stay for each hospital. The site, designed to encourage comparison shopping, includes adjustments for severity and lists average patient age. https://www.kyha.com/Pricing/main.asp
Two on Charity Care
Rising numbers of uninsured and uninsured people lead to more uncompensated care for providers. How much of this should be considered bad debt, what part is charity care, and how should that determination be made? A new PriceWatershouseCoopers report, written for hospitals, describes trends and policies around charity care, including federal and state laws and decisions around such issues as prices charged to self-pay patients, determining ability to pay, posting notices about charity care policy, debt collection, funds for the underinsured and reporting requirements. http://healthcare.pwc.com
The Government Accountability Office (GAO) has issued a report comparing the value of community benefits including uncompensated care provided by for-profit, nonprofit and public hospitals in five states: California, Florida, Georgia, Indiana and Texas. http://www.gao.gov/new.items/d05743t.pdf
The CDC has issued a report on trends in emergency department use. http://www.cdc.gov/nchs/data/ad/ad358.pdf
Medical Malpractice
The Kaiser Family Foundation has released a roundup of Medical Malpractice Law in the United States available at http://www.kff.org/insurance/7328.cfm. According to Kaiser’s web site, the report “discusses the legal changes that states have made in response to concerns about rising medical malpractice costs, including limits on damages and attorney compensation, joint and several liability reforms, and alternative dispute resolution. It also highlights recent tort reform proposals for medical malpractice claims, including patient compensation funds, aligning malpractice law and patient safety concerns, and expanding risk pools. The Foundation also posted state-specific data on medical malpractice claim payments on statehealthfacts.org”
Two web specials from Health Affairs feature two articles on medical malpractice including an analysis of how caps have affected physician availability. Reprints are available on line: “The Growth Of Physician Medical Malpractice Payments: Evidence From The National Practitioner Data Bank” http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.240v1 and “Have State Caps On Malpractice Awards Increased The Supply Of Physicians?” http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.250v1
Challenging Conventional Wisdom
Look at all those lawyers telling middle-income elders how to cheat by transferring their assets to get on Medicaid. If that hemorrhage can be stopped it will help keep program costs manageable, won’t it? Probably not, concludes Ellen O’Brien in an issue brief just released by Georgetown University Long-Term Care Financing Project, Medicaid’s coverage of nursing home costs: Asset shelter for the wealthy or essential safety net?
“Moving beyond anecdote, empirical studies reveal that the most disabled older people lack the financial resources to warrant making a transfer; that asset transfers, when they do happen, are modest; and that most older people of modest means are more likely to conserve rather than exhaust assets when their health declines. Asset transfers are not significant contributors to Medicaid costs now, and implementing policies designed to further limit them is unlikely to significantly reduce Medicaid costs.” http://ltc.georgetown.edu/pdfs/nursinghomecosts.pdf
Webcast
The theme of this year’s Princeton Conference, convened May 19 and 20 by the Council on Health Care Economics and Policy – was How Will the States Pay for Health Care? In the end, there were no breakthroughs, but you may enjoy some of the discussion along the way. http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1427
Tell us about your favorite on-line resources, and what issues you want to see us cover with an e-mail to Kala.ladenheim@ncsl.org
Have any questions you'd like answered? A topic for which you’d like us to gather resources? Do you have a report of your own you'd like to share with your peers? Drop us a line…
Dick Merritt, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8698 fx: 202-737-1069
dick.merritt@ncsl.org
Kala Ladenheim, Ph. D. Program Manager
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
kala.ladenheim@ncsl.org
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