Research Roundup: Revamping Public Health Law; Pay-For-Performance

Shefali S. Kulkarni compiled this selection of recently released health policy studies and briefs. 

Health Affairs: New Cardiac Surgery Programs Established From 1993 To 2004 Led To Little Increased Access, Substantial Duplication Of Services -- This study, using Medicare data from 1993-2004, finds that although the number of coronary artery bypass surgeries declined, 301 new cardiac surgery units opened. "Forty-two percent of the new programs opened in communities that already had access to cardiac surgery, which suggests that their creation has led to a fight for shares of a shrinking market. New programs were much more likely to open in states that did not require them to show a certificate-of-need." The study finds that a push for certificate of need would greatly reduce health care spending and duplicative services (Lucas et. al., 6/23).

Archives Of Surgery: Receipt Of Appropriate Surgical Care For Medicare Beneficiaries With Cancer -- This study examines "practice guidelines to investigate whether appropriate surgical care was provided to Medicare beneficiaries" with breast, colon, gastric, rectal, or thyroid cancer diagnosed between January 2000 and December 2005.  The authors write: "we found that more than 90% of all patients received recommended care for 7 of the 11 guidelines examined at an aggregate patient level. We also identified 6 measures for which at least half of the institutions were concordant with the guidelines 100% of the time. These high concordance rates suggest that the factors influencing clinical decision making are adequately captured in the current guidelines and that surgeons recognize the importance of these therapies." But when it came to some guidelines for examining lymph nodes, "concordance rates were low and few hospitals provided appropriate care to all patients." The authors conclude: "Given the current national focus on quality in health care, there is increasing pressure to develop measures to determine whether patients are getting appropriate care; however, within the surgical disciplines, there is a paucity of data to support what constitutes appropriate care" (Greenberg et. al., 6/20).

Health Affairs: Analysis Raises Questions On Whether Pay-For-Performance In Medicaid Can Efficiently Reduce Racial And Ethnic Disparities -- In 2006, Massachusetts began using Medicaid payment incentives to reduce racial and ethnic disparities in hospitals. The effort "was based on the assumptions that there were racial and ethnic disparities in the treatment of patients within the state's hospitals and that every hospital's patient population was sufficiently diverse to make a statewide intervention sensible. Our analysis does not support either assumption," the authors write. Massachusetts officials have ended the program, "implicitly acknowledging that the measures needed to be revised. However, interest in cultural competence—a major issue targeted by the structural measures—is growing nationwide" (Blustein et. al., June 2011).

Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Enhanced Medicaid Match Rates Expire in June 2011 -- The authors write: "This fact sheet discusses the role played by the enhanced federal Medicaid matching funds available to states through the American Recovery and Reinvestment Act of 2009 (ARRA), and the implications for state Medicaid programs as that extra assistance expires June 30, 2011. States used the ARRA enhanced Medicaid funding to address Medicaid funding shortfalls during the economic downturn, and to mitigate program cuts and address budget shortfalls. ... The loss of enhanced federal revenues means increases in the state share of Medicaid for all states, increases that are particularly significant in states that continue to experience high unemployment" (6/22).

Employment Benefit Research Institute: Tracking Health Insurance Coverage By Month: Trends In Employment-Based Coverage Among Workers, And Access To Coverage Among Uninsured Workers, 1995‒2009 -- "This analysis examines employment-based health benefit coverage rates on a monthly basis from December 1995 to December 2009, to allow for more accurate identification of changes in trends, and to more clearly show the effects of recessions and unemployment on changes in coverage." The author notes: "While the percentage of workers with coverage has ebbed and flowed with the economy and health care costs, trends in the percentage of workers offered coverage and the percentage of workers taking coverage when offered have remained steady." and concludes: "The general trend in the percentage of uninsured workers reporting cost as a reason for not having coverage has been upward" (Fronstin, June 2011). 

Health Affairs / Robert Wood Johnson Foundation: Medicare Advantage Plans --"One in four enrollees in Medicare, the federal health insurance plan for the elderly and disabled, receive their benefits through private health plans called "Medicare Advantage" plans. ... However, Medicare Advantage plans also cost the federal government about 10 percent more than the traditional Medicare fee-for-service program. This is a primary reason why the Medicare Advantage program was targeted for cost reductions in the Affordable Care Act of 2010. This policy brief examines the background of Medicare Advantage plans, changes mandated by health care reform, and issues that may emerge from ongoing legislative and legal challenges," according to the author (Cassidy, 6/16).

Institute of Medicine: For The Public's Health Revitalizing Law And Policy To Meet New Challenges -- The Robert Wood Johnson Foundation asked the Institute of Medicine to "examine the legal and regulatory authority for public health activities, to identify past efforts to develop model public health legislation, and to describe the implications of the changing social and policy context for public health laws and regulations." The IOM committee suggests that public health laws should be systemically revised, "given the enormous transformations in the practice, context, science, and goals of public health agencies and changes in society as a whole, especially in the past two to three decades." The committee recommends that states enact laws giving local health departments the ability to deliver 10 essential services, which include identifying community health problems, probing health hazards and evaluating services. The panel also called for states to enact "a minimum, uniform standard of public health practice" (6/21).

The American Journal Of Public Health: Estimated Deaths Attributable To Social Factors In the United States -- Researchers "conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality," and found that "245,000 deaths in the United States in 2000 were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality, and 39,000 to area-level poverty." They concluded that there is a need for a “broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations,” (Galea et. al., 6/16).

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