Research Roundup: Medicare Spending Grows During Recessions; Docs Discriminate Against Obese People; Too Much Hospital Smoking

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.  

Health Affairs: State Unemployment In Recessions During 1991-2009 Was Linked To Faster Growth In Medicare Spending –  Although overall health care spending fell during the 2007-2009 recession, Medicare spending growth increased. Using 1991-2009 data, researchers found that "Higher unemployment rates across states and over time [1991-2009] were associated not only with faster Medicare spending growth, but also with more Medicare spending per capita – more hospital spending and more hospital use by free-for-service Medicare beneficiaries.”  They conclude that "One of many possible explanations may be that health care providers have greater capacity, inclination, and financial incentive to treat Medicare patients during recessions as a result of slackening demand from the non-Medicare population (McInerney and Mellor, 11/2012).

PLOS ONE: Implicit And Explicit Anti-Fat Bias Among A Large Sample Of Medical Doctors By BMI, Race/Ethnicity And Gender – Findings from previous research suggests that weight discrimination exists among Americans. Many patients have also reported that they have been mistreated by health care providers. In this study, researchers aimed to determine if some medical doctors (MDs) possess any bias based on their patients’ weight. “We found that MDs’ implicit and explicit attitudes about weight follow the same general pattern seen in the very large public samples that hold strong implicit and explicit anti-fat bias,” the authors write, and conclude that "implicit and explicit anti-fat bias is as pervasive among MDs as it is among most people in society" (Sabin, Marini and Nosek, 11/2012).

JAMA: Association Of Race And Sex With Risk Of Incident Acute Coronary Heart Disease Events – Guided by previous findings that showed disparities in the incidence of heart disease (CHD) among white and black individuals, researchers aimed to determine if the disparities continued. They found that black men and women in the US were more likely to die from CHD than whites. They conclude that the “excess risk factor burden among black men and women continues to be a major public health challenge, along with their high risk for death as the presentation of CHD. Increase emphasizes on optimizing well-established risk factors among blacks could potentially reduce these disparities." Reuters quoted the lead author as saying the result is "distressingly similar" to racial differences seen in data from the 1990s, despite public health efforts to address them (Safford et al., 11/7).

Archives Of Internal Medicine: Prevalence And Predictions Of Smoking By Inpatients During A Hospital Stay – The authors write: "Accredited U.S. hospitals prohibit smoking inside hospital buildings," though some allow smoking outdoors. Researchers surveyed more than 5,000 patients from Massachusetts General Hospital during and 2 weeks after their hospitalization to assess the proportion of smoking. Between 2007 to 2010, “18.4% reporting having smoked during their hospital stay … Patients were more likely to report having smoked while hospitalized if they were young, had more severe cigarette cravings, did not report planning to quit, had longer hospital stays, and were not admitted to a cardiac unit.” The researchers write that “a clear policy prohibiting patients from leaving the hospital to smoke may be necessary to prevent smoking by inpatients” (Regan, Viana, Reyen and Rigotti, 11/5).

Here is a selection of news coverage of other recent research:

Inside Health Policy: Avalere Health: CMS Likely To Grant Flexibility On Medicaid Expansion
With the elections over, the consulting firm Avalere Health predicts that CMS will grant states the flexibility to expand Medicaid to people earning up to 100 percent -- rather than 138 percent -- of the federal poverty level, and that most states will end up at that threshold. ... States are under no strict deadline to decide whether to take up the reform law's voluntary Medicaid expansion (Lotven, 11/7).

USA Today: Diabetes: Effect Of Weight Loss Thrown Into Question
A recent study showed that obese people with diabetes who lost a modest amount of weight didn't lower their risk of having a heart attack or stroke, but the weight loss did help improve many other health factors. ... "[W]e did show the benefits of weight loss for improving depression, quality of life, sleep apnea, incontinence, fitness, physical function and blood sugar control," says Rena Wing, a professor of psychiatry and human behavior at Brown University and chairman of the Look AHEAD (Action for Health in Diabetes) study. The research was financed by the National Institutes of Health (Hellmich, 11/7).

Reuters: Hospital Guidelines Not Linked To Readmissions: Study
Procedural guidelines designed to ensure patients get quality care while in the hospital are also thought to reduce the chances a patient will need to be readmitted down the line, but a new study suggests there's little connection between the two.... Overall, they found that hospitals with the best scores for following guidelines did not have "meaningfully" lower readmissions than hospitals with the worst scores. "Even when the associations were statistically significant, the differences in the readmission rates of high and low-performing hospitals were small," the team writes in the Journal of General Internal Medicine (Seaman, 11/8).

Reuters: Values Exercise Improves Doctor-Patient Communication
A short waiting room exercise encouraging African American patients to reflect on their personal values helped improve communication between the patients and their white doctors, in a new study. However, those patients didn't rate their trust in their doctor or satisfaction with the appointment any higher, compared to those who didn't do the "values affirmation" exercise (Pittman, 11/7).

Reuters: Human Enhancements At Work Pose Ethical Dilemmas
Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation. Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas (Kelland, 11/7).

This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.