Health Affairs

In the May Health Affairs Narrative Matters essay, two graduate students describe their fight with the bureaucracy to gain coverage for their son under the Children’s Health Insurance Program, and they express the hope that provisions of the Affordable Care Act will cut the red tape. The article, “To Cover Their Child, One Couple Navigates A Health Insurance Maze In Pennsylvania, is by Ari Friedman, a fifth-year medical-doctoral student in health economics at the University of Pennsylvania’s Perelman School of Medicine and Wharton School, and Tara Mendola is a sixth-year graduate student in comparative literature at New York University.

A new study, released today as a Web First by Health Affairs, reports that cancer patients in Washington state were 2.65 times more likely to file for bankruptcy than people without cancer. Of 197,840 cancer patients age 18 or older in the western district of Washington between 1995 and 2009, 4,408 (2.2 percent) filed for bankruptcy protection after being diagnosed with cancer. Among a control group of 197,840 people from that same region who did not have cancer, only 2,291 (1.1 percent) filed for bankruptcy.

“Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients,” conclude Scott Ramsey of the Fred Hutchinson Cancer Research Center and coauthors. “As a policy issue, there may be a role for employers and governments in creating programs or incentives to reduce the likelihood of financial insolvency, given that bankruptcies are ‘lose-lose’ events for debtors and creditors alike.”

The list of most-read Health Affairs Blog posts for April includes four posts in Tim Jost’s ongoing series on implementing the Affordable Care Act; number one on the top-ten list is Tim’s post about proposed regulations on health insurance exchange navigators. The list also includes posts on accountable care organizations, patient-centered care, controlling health care costs. and more.

The full list is below:

If you missed last week’s Health Affairs briefing on our May issue, “Tackling The Cost Conundrum,” or if you just want to see it again, video and speaker materials are now available on the Health Affairs website. You can watch the whole briefing or select particular panels or speakers.

At Managed Care Matters, Joe Paduda presents highlights of recent health policy blogging in a new Health Wonk Review. Among the pieces Joe highlights are Health Affairs Blog posts by John Holahan & Stacey McMorrow and Charles Roehrig on the causes and likely longevity of the recent slowdown in health spending growth.

Health Affairs’ May issue, released today, analyzes the recent slowing in the growth of health care expenditures and explores whether the trend will last. The issue also addresses major cost drivers in Medicare and presents proposals for putting the program on a more sustainable path. Another article tracks federal spending on mental health during severe state budget constraints throughout the recession.

As Health Affairs Founding Editor John Iglehart notes on his “From The Founding Editor” page (quoted at length below), the new thematic volume, “Tackling The Cost Conundrum,” continues the journal’s coverage of a topic that has been a “driving theme” of the journal since its inception. The May issue will be discussed at a National Press Club briefing tomorrow morning, Tuesday, May 7. The issue and briefing are supported by a grant from the Robert Wood Johnson Foundation.

Researchers writing in the new issue are cautiously optimistic that the slowdown in health care spending is here to stay. A study by Michael Chernew, Alexander Ryu, and colleagues at Harvard Medical School looks at two factors potentially contributing to the record slowdown in growth to 3.1 percent during 2007-11: job loss and benefit changes shifting costs to the insured. Analyzing National Health Expenditure Accounts and large-employer data, the authors found that benefit design changes that increased enrollees’ out-of-pocket costs were responsible for about one-fifth of the observed decrease in the rate of growth. However, the slowdown occurred even when benefit generosity at large firms was held constant. The authors suggest that other factors are largely responsible and that major events, such as health reform, shifts in payment methodology, and the transformation of the delivery system’s organization may contribute to a longer-term trend of slower spending growth.

In a related article, David Cutler and Nikhil Sahni of Harvard University conclude that fundamental changes, including less-rapid development of imaging technology and new pharmaceuticals, increased patient cost-sharing, and greater provider efficiency, led to the majority of the slowdown in health care spending growth; if this path continues for the next ten years, public-sector health care spending could wind up $770 billion under projections, they write.

US presidents and policymakers have for decades struggled with the issue of ballooning health care costs and were unsuccessful, or unmotivated, in finding a path to lasting cost containment. Recently, though, there has been progress. The forthcoming issue of Health Affairs, “Tackling the Cost Conundrum,” explores the slowing growth of health care expenditures of late and examines whether it is a temporary or lasting phenomenon; the issue also examines major cost drivers and presents proposals for putting Medicare on a more sustainable path.

Please join Health Affairs Founding Editor John Iglehart on Tuesday, May 7, at the National Press Club in Washington, DC, for a Health Affairs briefing at which we unveil the May 2013 thematic issue, “Tackling the Cost Conundrum.” The thematic issue and briefing are supported by a grant from the Robert Wood Johnson Foundation.

WHEN & WHERE:
.
Tuesday, May 7, 2013
9:00 a.m. – 12:30 p.m.
National Press Club
529 14th Street NW (Metro Center)
Washington, DC
Register Now

Follow live Tweets from the event @HA_Events, and join in the conversation with the hashtag #HA_Costs.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the association’s comprehensive guide that sets the classification, diagnosis, and treatment of mental disorders across the United States and the world. In an April 24 Health Affairs Web First analysis and commentary, Helena Hansen of New York University and coauthors argue that the revision process for the DSM-5 missed crucial population-level and social determinants of mental health disorders and their diagnoses.

Some of these include environmental factors triggering biological responses that manifest in behavior; differing cultural perceptions in defining normal and abnormal behaviors; and institutional pressures, such as insurance reimbursements, disability benefits, and pharmaceutical marketing. At stake, the authors believe, are billions of dollars in insurance payments and the accurate diagnoses and treatment of patients.

To address future DSM revisions, the Hansen and her colleagues propose the formation of an independent, multidisciplinary task force; the commentary outlines how this task force would operate.

Over at InsureBlog, Hank Stern hosts a “Money Tree” edition of the Health Wonk Review. Hank highlights a number of great posts, including a Health Affairs Blog post by Paul Ellwood — known as the father of managed care — proposing a framework for holding health spending constant as a percentage of GDP.

US presidents and policymakers have for decades struggled with the issue of ballooning health care costs and were unsuccessful, or unmotivated, in finding a path to lasting cost containment. Recently, though, there has been progress. The forthcoming issue of Health Affairs, “Tackling the Cost Conundrum,” explores the slowing growth of health care expenditures of late and examines whether it is a temporary or lasting phenomenon; the issue also examines major cost drivers and presents proposals for putting Medicare on a more sustainable path.

Please join Health Affairs Founding Editor John Iglehart on Tuesday, May 7, at the National Press Club in Washington, DC, for a Health Affairs briefing at which we unveil the May 2013 thematic issue, “Tackling the Cost Conundrum.”

WHEN & WHERE:
.
Tuesday, May 7, 2013
9:00 a.m. – 12:30 p.m.
National Press Club
529 14th Street NW (Metro Center)
Washington, DC
Register Now

Follow live Tweets from the event @HA_Events, and join in the conversation with the hashtag #HA_Costs.

In the Narrative Matters essay in the April Health Affairs issue, Laura Blinkhorn and Mascha Davis write about how working with an obese woman in a Gabon hospital led them to seek solutions to obesity and its related health problems in the developing world. “Public health campaigns, government regulation, and improved education are necessary to bring about real change,” write Blinkhorn, a fourth-year medical student at the Pritzker School of Medicine, University of Chicago, and Davis, a registered dietician and public health professional who lives in Addis Ababa, Ethiopia, and works for Catholic Relief Services.

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation discusses per capita caps, a proposed reform to Medicaid that would limit the amount of federal spending per beneficiary. The proposal’s supporters contend that it could help control the growth of federal spending on Medicaid. Critics disagree, saying that instead of slowing the rate of spending growth, it would only shift the costs to the state, ultimately limiting poor Americans’ access to care.

A belated nod to the latest Health Wonk Review, posted last week by Louise Norris at Colorado Health Insurance Insider. Louise has assembled a number of great posts, including Peter Neumann and James Chambers’ Health Affairs Blog post on Medicare’s reset of its “coverage with evidence development” policy.

In six months, open enrollment for the Affordable Care Act’s health insurance marketplaces will begin around the country. Massachusetts’ experience has proven to be instructive. In 2006, the state created an insurance exchange, called the Commonwealth Health Insurance Connector Authority. The Connector, which began offering unsubsidized commercial insurance products in 2007, now provides an array of options for consumers, including subsidized coverage to people with incomes below 300 percent of the poverty level.

A new study, released today as a Web First by Health Affairs, surveyed 393 families in unsubsidized Connector plans. It found that 38 percent of surveyed families reported financial burden associated with their health care and 45 percent reported higher-than-expected out-of-pocket costs. This study is one of the first to evaluate the prevalence of and risk factors for financial burden and unexpected costs among families in unsubsidized health insurance exchange plans.

Health Affairs, the nation’s leading peer-reviewed journal of health policy thought and research, announced today that founding editor John Iglehart will return to lead the publication. Mr. Iglehart, a highly respected editorial executive who led Health Affairs for its first 25 years until retiring in 2007, also will help lead a nationwide search for a Vice President and Editor-in-Chief for the journal. He will be supported during this time by Executive Editor Donald Metz and Executive Publisher Jane Hiebert-White, who will continue in their current roles at Health Affairs. Mr. Iglehart recruited the two executives and worked with them at the journal for more than 20 years.

Susan Dentzer, who had been Vice President and Editor-in-Chief, is leaving to pursue a new opportunity.

“We are excited to welcome John Iglehart back to Health Affairs, which has long been a cornerstone of Project HOPE’s work to provide lasting solutions to global health problems,” said Dr. John P. Howe, III, M.D., President and CEO of Project HOPE. “John is well known by the leading scholars, practitioners and policy makers in health care. We look forward to this new chapter in his legendary stewardship of Health Affairs, continuing and building further on its stature as the preeminent journal of health policy thought and research.”

Dr. Howe continued, “We thank Susan Dentzer for her contributions and wish her well in her new endeavor.”

On Monday, March 25, the Supreme Court will hear arguments concerning the legality under antitrust laws of “pay for delay” or “reverse payment” settlements, in which a brand-name drug manufacturer pays a patent challenger to keep the generic competitor out of the market until an agreed-upon date. A Health Affairs Blog post written last year, when the Supreme Court decided to take the case, FTC v. Watson Pharmaceuticals, provides a great overview of the issues that will be before the Justices on Monday.

In the post, Bill Sage of the University of Texas and John Golden of Harvard, examine the legal issues surrounding these controversial settlements. They also point out that, in deciding the case, “the Court will influence a much larger debate over innovation in health care markets.

A Health Affairs Web First study released yesterday finds that five European countries have adopted aspects of patient-centered medical homes, a US model for comprehensive care. However, additional efforts are needed to fully implement this concept outside the United States. The data was gathered through a survey, questioning 6,428 patients who had one of eight common chronic illnesses. Also, 152 primary care providers across five European countries (Belgium, Denmark, Germany, the Netherlands, and England) were queried.

Marjan Faber of Radboud University in the Netherlands and coauthors found that each country offered high quality of care for its patients — between 87 and 98 percent of patients in Germany, Belgium, the Netherlands, and Denmark had a single primary care physician. The rate was lower in England — 74 percent — where more primary care tasks are typically delegated to nurses. Although the survey demonstrated agreement in most areas between patients and physicians in evaluating their primary care experience, significant differences did emerge in the Belgian, Dutch, and English samples on frequency of illness self-management instructions

At the Health Business Blog, David Williams gives us a lot to chew in a Health Wonk Review posted yesterday. David leads with David Satcher’s Health Affairs Blog tribute to C. Everett Koop and follows with many interesting posts.

Enjoy all the posts in this Wonk Review. And congratulations to David and the Health Business Blog on eight great years.

David Muhlestein’s survey of the Accountable Care Organization landscape leads the Health Affairs Blog most-read list for February. Also on the month’s top-ten list are three posts dealing with patient engagement by Chas Roades, Paul Wicks and John Hixson, and David Rothman. These posts accompanied the publication of Health Affairs’ February issue, “New Era of Patient Engagement.”

The most-read list also includes two posts by Tim Jost on implementing the Affordable Care Act, as well as posts on medical education, pharmaceutical pricing, and the process of setting Medicare reimbursement rates for physicians in different specialties. The full list appears below:

The March issue of Health Affairs, released today, includes a variety of articles revolving around health and wellness, including an examination of mortality rates among American men and women by county. The issue also addresses whether physicians will see a return on investment from the adoption of electronic health records (EHRs), and it raises questions about cost savings from workplace wellness programs and the impact on less healthy workers.

Female mortality rates increased in 42.8 percent of counties in the United States during 1992–2006. Although mortality rates are falling in most counties in the United States, female mortality rates increased in 1,224 counties, compared to an increase in 108 counties for men, write David Kindig, professor emeritus of population health sciences at the University of Wisconsin–Madison, and Erika Cheng, a doctoral candidate there. Their study is the first to examine the relationship between socioeconomic and behavioral factors and mortality at the county level.

The authors found that for both men and women, factors associated with lower mortality included having a college degree, higher median household income, Hispanic ethnicity, and living in a higher population density area. For women, living in counties in the South and West was associated with a 6 percent higher mortality rate than living in the Northeast. Smoking rates were also a key factor in higher mortality rates. The researchers recommend targeted approaches that are suited to the unique needs of a county; they observe that investments in health care, public health, behavioral change, and social and physical environment will be needed to improve mortality rates.