Research Roundup: Options To Cut Health Spending; Covering Teenagers

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Journal Of The National Cancer Institute: Survival Disparities In African American And White Colo-Rectal Cancer Patients -- Researchers analyzed results from 12 controlled clinical trials to understand disparities between black and white survivors of colorectal cancer. They found that black patients' overall survival was significantly worse than whites, with black five-year survival rates 68 percent compared to 73 percent for white patients. However, African Americans had "similar recurrence-free interval, compared with white patients. The differences in survival may be mostly because of factors unrelated to the patients' adjuvant colon cancer treatment," such as biological differences, differences in general health, and general disparities in health care (Yothers et. al, 10/12).

The Urban Institute: Containing The Growth Of Spending In The U.S. Health System -- Researchers in this report examined health care spending and the reasons for "persistent high rates of growth" and look for savings beyond what the 2010 federal health law offers. They analyzed eliminating the tax exclusion for health insurance, malpractice reform, better management of chronic care and setting rates for providers through exchanges or a public plan and found that "it seems possible to achieve savings of 5.0 to 10 percent over and above the savings that would occur if policies developed by the (health law) were successful. ... most of these policies by themselves would not necessarily achieve major reductions in spending. But a combination of several of these policies should lead the nation to a rate of growth closer to the increase in GDP" (Holahan et.al, 10/5).

Health Services Research Journal: Medical Spending And The Health Of The Elderly -- Researchers analyzed a sample of "17,438 elderly (age >64) beneficiaries who entered the Medicare Current Beneficiary Survey in the fall of each year from 1991 to 1999, were not institutionalized at baseline, stayed in fee-for-service Medicare for the entire observation period, and survived for at least 2 years." They created a baseline measure of individuals' health and compare that to Medicare financial claims and concluded that, on average, "greater medical spending is associated with better health status of Medicare beneficiaries, implying that across-the-board reductions in Medicare spending may result in poorer health for some beneficiaries." But, they emphasize, that the results do "not imply that all medical spending for all medical conditions and situations necessarily has the same positive effects on health" (Hadley et. al, October 2011).

Journal of General Internal Medicine: Inappropriate Medication In A National Sample Of U.S. Elderly Patients Receiving Home Health Care -- Researchers looked at more than 3,000 patients over the age of 65 included in a national survey in 2007 and found 38 percent had at least one medication that was potentially inappropriate. Inappropriate medication use "in older home health patients is high despite potential mechanisms for improved safety. Policies to improve the review and reconciliation processes within home health agencies and to improve physician-home health clinician collaboration are likely needed to lower the prevalence," the authors conclude (Bao et. al, 10/6).

Kaiser Commission on Medicaid and the Uninsured/Georgetown University Health Policy Institute: Examining Medicaid Managed Long-Term Service And Support Programs: Key Issues To Consider -- This issue brief examines key issues for states that are considering shifting their Medicaid patients from a fee-for-service model to managed care plans. If these managed care plans "are to succeed, careful design based on a thorough understanding of the strengths and needs of the various populations that use them is important. … It is essential for states to have time, expertise, and financial resources to consult with stakeholders, shape programs, attend to administrative details, clarify expectations, and monitor program operations so that they can strike the right balance between managing care and managing costs" (Summer, 10/12).

Kaiser Family Foundation: Adolescent Health: Coverage And Access To Care -- This issue brief "provides a broad-based grounding in adolescent health and related policy by examining access to health services for adolescents, their insurance coverage, and the role of state and federal policies in shaping access to care," including the 2010 federal health law.  The law, for example, guarantees that "insurance companies are no longer able to exclude children based on pre-existing conditions." And the law will grant $50 million to expand School-Based Health Centers. But the authors warn that there are "many teen populations, including the undocumented, [that] will lack access to coverage and newly supported services in the (health law), and will continue to rely on a wide range of safety nets" (Cullen and Salganicoff, 10/12).

This column has been corrected to indicate that the Health Services Research Journal study on medical spending and the health of the eldery did not find that "medical spending for all medical conditions and situations necessarily has the same positive effects on health."

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