Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.
National Bureau Of Economic Research: Comparison Friction: Experimental Evidence From Medicare Drug Plans – Defining comparison friction as "the wedge between the availability of comparative information and consumers' use of it," the authors determined that providing prescription drug pricing information, even though it was free and accessible in other ways, increased the amount of "plan-switching" in the group to 28 percent compared to 17 percent in another that did not get the individual information. Participants who were provided cost information also saved about $100 more per year. "Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice" (Kling et. al., September 2011).
Health Affairs: Today's Meaningful Use Standard For Medication Orders By Hospitals May Save Lives; Later Stages May Do More – The federal government has an incentive program for hospitals and doctors that meet standards for the "meaningful use" of electronic health record systems. This study focused on a patient’s first 30 days of being hospitalized for heart attacks, heart failure or pneumonia—the most common hospitalizations among Medicare beneficiaries--to evaluate the relationship between electronic medication orders and mortality. The authors report that "the initial meaningful-use threshold for hospitals—which requires using electronic orders for at least 30 percent of eligible patients—is probably too low to have a significant impact on deaths from heart failure and heart attack among hospitalized Medicare beneficiaries. However, the proposed threshold for the next stage of the program—using the orders for at least 60 percent of patients, a rate some stakeholders have said is too high—is more consistently associated with lower mortality" (Jones et. al., 9/15).
Clinical Orthopaedics And Related Research: Are African American Patients More Likely To Receive A Total Knee Arthroplasty In a Low Quality Hospital? – This study tries to determine if black Medicare patients seeking a knee replacement surgery were more likely to go to a hospital that had a high risk of post-surgery complications or death. The researchers devised a measure of hospital quality and then looked at racial trends for knee replacements. They found that 8 percent of African American patients were treated in high-quality hospitals, compared to 9.2 percent of white patients. Also, they reported, that 14.7 percent of black patients sought surgery in low-quality hospitals, compared to 12.7 percent of white patients (Cai et. al., 8/31).
The Archives Of Internal Medicine: Communicating Uncertainties About Prescription Drugs To The Public -- Researchers set out to explore how well the public understands the role of the FDA in approving drugs. The federal agency's approval "does not mean that the FDA believes benefits are large (or important) or that all serious side effects are known. ... Uncertainties are greatest in the first few years after approval and for drugs approved solely on the basis of a surrogate outcome," the authors note. Yet a survey of nearly 3,000 people found that 39 percent believe the FDA approves only "extremely effective" drugs and a quarter of the participants said it approved only drugs without serious side effects. However, when given brief explanations about the uncertainties of drugs, many drug choices improved among the participants (Schwartz and Woloshin, 9/12).
The Kaiser Family Foundation/Health Management Associates: A Profile Of Medicaid Managed Care Programs In 2010: Findings From A 50-State Survey -- This report examined managed care plans used by states to provide care to Medicaid enrollees and how states monitor quality and enrollees' access issues. Researchers found that two-thirds of Medicaid enrollees are in comprehensive managed care plans and that Medicaid managed care will continue to grow, "driven by budget pressures to contain Medicaid spending and by the influx of millions of new adult Medicaid enrollees" when the federal health law comes fully online in 2014. As states grapple with that growth, they will have varied experiences from around the country to consider (Gifford et. al, 9/13).
KHN covered this report: Squeezed States Embrace Even More Medicaid Managed Care (Weaver, 9/13)
The Robert Wood Johnson Foundation/Urban Institute: Making the Cut: How Does Medicare Decide What To Pay For? -- This paper, written by four former senior officials at the federal Centers for Medicare and Medicaid Services, looks at the process under which Medicare officials decide what treatments will qualify for coverage and lays out ways to improve the process: "the process for making coverage decisions in the Medicare program underperforms as a policy tool and falls short of its potential to contribute to improved health outcomes for Medicare beneficiaries. The coverage process as currently applied does not prevent ineffective, unproven and/or harmful technologies from widespread adoption in Medicare, fails to identify and promote broad use of effective and high-value services, and is poorly coordinated with other Medicare policy mechanisms" (Tunis et.al, 9/6).