Research Roundup: Medicaid Co-Payments, Access To Docs Causes Worse Health

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

Pediatrics: Disparities In Child Access To Emergency Care For Acute Oral Injury -- This study looked at the "impact of insurance status on dental practices' willingness to schedule an appointment for a child with a symptomatic fractured permanent front tooth." Six researchers posed as mothers of 10-year-old boys who all had the same injury but different coverage: Medicaid/Children's Health Insurance Program (CHIP) or private Blue Cross dental insurance. The results: "only 36.5% of Medicaid beneficiaries obtained any appointment compared with 95.4% of Blue Cross–insured children with the same oral injury. ... These results have implications for developing policies that improve access to oral health care" (Bisgaier, et. al., 5/23).

Medical Care (APHA): Impact Of Medicaid Co-payments On Patients With Cancer: Lessons For Medicaid Expansion Under Health Reform -- Using 1994-2004 data from more than 10,000 cancer patients (ages 18-64) in Georgia, South Carolina and Texas, the study found that "Medicaid patients with cancer when faced with even moderate co-payments change their health-seeking behavior." They were more likely to cut down on taking their prescription medicine and visit the emergency room more. "Overall, total 6-month cost was more than $2000 higher per patient ... state Medicaid programs should reconsider the use of co-payments as they do not decrease overall cost, but instead could potentially result in negative consequences," the author concludes (Subramanian, 5/13). 

 Journal Of The American Medical Association: Primary Care Physician Workforce and Medicare Beneficiaries' Health Outcomes -- Using a cross section of Medicare beneficiaries 65 or older, researchers examined whether more primary care physicians in a population area resulted in better health. They conclude: "Using the most commonly-used national measure of primary care physician workforce, we found that Medicare beneficiaries residing in areas with the highest level of adult primary care physicians per population had modestly lower mortality and fewer ACSC hospitalizations, but did not observe a consistent stepwise association (ie, improved outcomes were not associated linearly with increasing primary care physicians per population)" (Chang et. al., 5/25).

PLoS Medicine: Medical Students’ Exposure To And Attitudes About The Pharmaceutical Industry: A Systematic Review -- The authors did a literature review and found that "40%–100% of medical students reported interacting with the pharmaceutical industry. A substantial proportion of students (13%–69%) were reported as believing that gifts from industry influence prescribing. Eight studies reported a correlation between frequency of contact and favorable attitudes toward industry interactions. Students were more approving of gifts to physicians or medical students than to government officials. Certain attitudes appeared to change during medical school"  (Austad, Avorn, Kesselheim, 5/24).

The Scan Foundation: Transforming California's System Of Care For Older Adults And People With Disabilities: A Look At The State's Administrative And Fiscal Organization -- This policy brief explains "how fragmented and siloed services are for vulnerable older adults and for people with disabilities in California. Most importantly, for [the] vulnerable individuals and their caregivers, there is no person, program, or entity that is fully responsible for assessing needs and coordinating across all the programs and services that may be available to them." Some of the authors' recommendations include: "improve the flow of information across programs and between counties and the state...realign the financing requirements for IHSS [In Home Supportive Services program] back to the state level... [and] explore opportunities put forth by the federal government to streamline the landscape of LTSS [Long Term Services and Support] funded through Medicaid waivers" (Shugarman, Whitenhill and Steenhausen, 5/20).

Journal Of General Internal Medicine: Health Care Consumers' Attitudes Towards Physician and Personal Use of Health Information Exchange -- This telephone survey gauged the attitudes of health care consumers about the Health Information Exchange (HIE) - "the electronic transmission of patient medical information across health care institutions." Supporters of physician HIE use were "more likely to be caregivers for chronically ill individuals, earn more than $100,000 yearly and believe physician HIE would improve the privacy and security of their medical records," men and/or frequent Internet users.    The authors conclude that "consumer outreach to gain further support for ongoing personal and physician HIE efforts is needed and should address consumer security concerns and potential disparities in HIE acceptance and use," (O'Donnell, et. al., 5/17).

The Urban Institute: Patient-Centered Medical Home Recognition Tools: A Comparison of Ten Surveys' Content and Operational Details -- This report "compares ten provider survey tools designed to measure the extent to which a practice is a 'patient-centered medical home' (PCMH)." Two types of tools were examined. "Off the shelf" products were usually free to download, but cost “thousands of dollars for practices to use and apply for recognition.” The others, "one-offs," were free to use and "were either designed or appropriated for use in only one or a few states’ PCMH recognition programs." The authors note: "Our analysis compares these ten tools' operational details (e.g., price, whether a site visit is required) and their content emphases (i.e., the different practice capabilities that the tools emphasize)" (Burton, Devers and Berenson, 5/17). 

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