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October Health Affairs Issue: Economic Trends And Quality Trade-Offs

October 7th, 2013

Health Affairs’ October issue, released today, evaluates the successes, the costs, and the quality trade-offs of improving physical and mental health in the United States. As Founding Editor John Iglehart says in his October letter, “Medical advances…have extended life expectancy and reduced the prevalence of diseases that stalk modern society. Paradoxically, though, for every success, an equally difficult challenge remains.” Also, with multiple shootings and related incidents fresh in our collective memories, the issue contains a discussion about the cost barriers to mental health care.

Some of the notable articles in the issue are discussed below. The Goldman and Herrera articles will be discussed at a National Press Club briefing tomorrow, Tuesday October 8, from 8:30-11:00 AM. The briefing is supported by the Alliance for Aging Research, MetLife Foundation, Aetna Inc., and the National Pharmaceutical Council.

Barriers to Mental Health Care. As American society knows all too well, many people with mental illness do not get treatment. Kathleen Rowan and coauthors at the University of Minnesota analyzed data from the Integrated Health Interview Series of working-age adults who were interviewed between 1999 and 2010. They found a significant increase in the percentage of the population classified as having moderate mental health problems, from 3.7 percent in 1999 to 5.1 percent by 2010. There was also a significant increase in the proportion of this group who had public health coverage (from 25.9 percent to 34.8 percent) and a decline in those with private coverage (from 50.2 percent to 39.8 percent.)

Rowan and coauthors point out that public insurance typically provides coverage with limited to no out-of-pocket costs and fewer treatment limits than private coverage. Although the researchers see the Affordable Care Act as an important opportunity to expand health insurance coverage to people with mental health disorders, they caution that those now eligible to purchase private insurance might still encounter financial hurdles to accessing care.

The Health and Economic Benefits of “Delayed Aging.” Although most medical research focuses on managing or eradicating individual diseases, Dana Goldman of the University of Southern California and coauthors demonstrate the value of an alternative approach to addressing the underlying biological mechanisms of disease. Using the Future Elderly Model—a simulation of future health and spending of older Americans—the authors compared a delayed aging approach with optimistic “disease specific” scenarios, evaluating impacts on longevity, disability, and major entitlement program costs.

Goldman and his colleagues estimate that delayed aging could increase life expectancy by an additional 2.2 years and generate more than $5 trillion in social value. When aging is delayed, say the authors, all fatal and disabling disease risks are also lowered. Although delayed aging would also greatly increase entitlement outlays, the researchers demonstrate that these costs can be managed through modest policy changes, such as indexing the eligibility ages for Social Security and Medicare.

  • On a related topic, Ankur Pandya of Weill Cornell Medical College and coauthors looked at the impact of some of the future risk factors for cardiovascular disease. Using nine National Health and Nutrition Examination Survey waves from 1973 to 2010, the authors forecast disease risk and prevalence from 2015 to 2030. They found that despite continued improvements in the disease’s treatment and declining smoking rates, increasing obesity rates, the aging population, and declining mortality from the disease should cause a rise in health care costs, disability, and reductions in the quality of life associated with increased disease prevalence. “Prevention efforts should be intensified,” the authors urge, to curb the imminent spike in cardiovascular disease forecasted by their model.

How Does the Quality of Hospital Care Vary by Insurance Type? A considerable body of health policy research has documented differences in hospital characteristics as contributing factors to differences in the quality of care. Christine Spencer of the University of Baltimore and coauthors from Johns Hopkins University examined the extent to which a patient’s type—or lack—of insurance may also play a role. They compared hospital quality for patients according to their insurance status using pooled 2006–08 State Inpatient Database records from the Agency for Healthcare Research and Quality (AHRQ). They measured within-hospital quality based on AHRQ’s innovative Inpatient Quality Indicators. Mortality due to heart attacks, pneumonia, and hip replacement were among the indicators examined.

Among the authors’ findings: Within hospitals, patients with private insurance had lower risk-adjusted mortality rates than Medicare patients for 12 out of the 15 indicators examined. Spencer and coauthors recommend that policy makers pay particular attention to how well patients fare under various insurance plans, because the type of insurance does appear to make a difference in the care that hospitals provide.

No Slowdown in Spending for Consumers, Who Picked Up More of the Medical Care Bill. A study, by Carolina Herrera of the Health Care Cost Institute and co-authors looked at spending on medical services and prescriptions between 2007 and 2011. During this time, spending per person rose at an average annual rate of 4.9 percent, faster than the economy. Per-person spending on medical care increased an average of 5.3 percent annually, while per-person spending on prescriptions grew an average of 3.3 percent each year. Out-of-pocket spending for medical care increased an average of 8 percent each year, compared to a 4.9 percent increase in spending by employers and insurers.

The authors noted that while spending growth may have slowed after the recession, consumers didn’t see their out-of-pocket medical spending growth slow.

Three other papers of interest in the October issue:

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1 Response to “October Health Affairs Issue: Economic Trends And Quality Trade-Offs”

  1. The_ID_Consult Says:

    We enjoyed this month’s issue on Economic Trends and Quality Trade-Offs. The focus of reducing hospital readmissions is top-of-mind for many hospital administrators and hospital-based practitioners as recently discussed in “Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing”, ( McHugh MD, Berez J, Small DS, Health Aff October 2013 vol. 32 no. 10 1740-1747). With the implementation of the Medicare Hospital Re-Admission Reduction Program, hospitals with excessive readmissions receive payment penalties, which compounds financial distress they are facing due to declining utilization rates, (see recent Health Affair’s blog: “Decline In Utilization Rates Signals A Change In The Inpatient Business Model”). Moreover, Medicare’s “no payment” policy for certain Hospital Acquired-Conditions puts hospitals at further financial risk.

    One of the answers to these financial vulnerabilities may lie in utilizing the appropriate healthcare personnel. A study by the Infectious Diseases Society of America recently published in Clinical Infectious Diseases ( found that when an ID physician is consulted, hospitalized patients with severe infections (for example those related to a prosthetic joint or central line vascular access) experience an average 3.7 percent fewer days in an intensive care unit. The study also found that consultation with an ID specialist minimizes the likelihood that such patients will be readmitted to the hospital within 30 days. These findings are significant given the fact that severe infection can be the root cause of a readmission, payment penalty, “no payment, or even worse yet, patient mortality.

    Early involvement by an ID physician has an even greater impact, according to the study: patients seen by an ID physician within two days of being admitted to the hospital have an average 3.8 percent fewer days in the hospital, and total Medicare costs for these patients are nearly 6.2 percent lower. Most importantly, the researchers found that patients treated by ID specialists are 9 percent less likely to die in the hospital and 12 percent less likely to die after discharge.

    Whether it be nurses, ID physicians or other specialists, the value of specific healthcare practitioners in terms of meaningful outcomes (quality of care, reduced mortality, readmissions and costs) must be considered. By focusing on “system factors” such as those addressed in these studies, administrators may be able to achieve higher quality of care while addressing readmission rate concerns.

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