Health Policy

Low Cognitive Ability and Poor Skill with Numbers May Prevent Many from Enrolling in Medicare Supplemental Coverage

Low Cognitive Ability and Poor Skill with Numbers May Prevent Many from Enrolling in Medicare Supplemental Coverage
Health Affairs. 2012; 31(8): 1847-1854. doi: 10.1377/hlthaff.2011.1000

Chan, Sewin and Brian Elbel
08/01/2012

Because traditional Medicare leaves substantial gaps in coverage, many people obtain supplemental coverage to limit their exposure to out-of-pocket costs. However, some Medicare beneficiaries may not be well equipped to navigate the complex supplemental coverage landscape successfully because of their lower cognitive ability or numeracy—that is, the ability to work with numbers. We found that people in the lower third of the cognitive ability and numeracy distributions were at least eleven percentage points less likely than those in the upper third to enroll in a supplemental Medicare insurance plan. This result means that many Medicare beneficiaries do not have the financial protections and other benefits that would be available to them if they were enrolled in a supplemental insurance plan. Our findings suggest that policy makers may want to consider alternatives tailored to these high-need groups, such as enhanced education and enrollment programs, simpler sets of plan choices, or even some type of automatic enrollment with an option to decline coverage.

HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Different Non-HIV Health Services In Sub-Saharan Africa

HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Different Non-HIV Health Services In Sub-Saharan Africa
Health Affairs July 2012 31:1406-1414

Grépin, Karen
07/10/2012

Donor funding for HIV programs has increased rapidly over the past decade, raising questions about whether other health services in recipient-country health systems are being crowded out or strengthened. This article—an investigation of the impacts of increased HIV donor funding on non-HIV health services in sub-Saharan Africa during 2003–10—provides evidence of both effects. HIV aid in some countries has crowded out the delivery of childhood immunizations, especially in countries with the lowest density of health care providers. At the same time, HIV aid may have positively affected some maternal health services, such as prenatal blood testing. These mixed results suggest that donors should be more attentive to domestic resource constraints, such as limited numbers of health workers; should integrate more fully with existing health systems; and should address these constraints up front to limit possible negative effects on the delivery of other health services.

From Endeavor to Achievement and Back Again: Government's Greatest Hits in Peril

From Endeavor to Achievement and Back Again: Government's Greatest Hits in Peril
In To Promote the General Welfare: The Case for Big Government. Steven Conn, Ed., Oxford Univeristy Press

Paul C. Light
07/01/2012

"These 10 articles from leading scholars address federal government activism in such areas as health, education, transportation, and the arts. In some areas, federal involvement has been direct; for example, while school public systems are governed locally, Washington provides about 10% of k–12 funding. Similarly, antipoverty programs, such as the New Deal’s Social Security Act and Aid for Dependent Children, have played a major role in reducing the poverty rate from around 40% in 1900 to 11.2% in 1974. At other times, Washington has exerted influence more subtly, through regulations and research. Examples include the 1933 Glass-Steagall Act, which mandated the separation of investment and commercial banking and the WWII-era research that yielded compounds to prevent and cure malaria, syphilis, and tuberculosis. Further, as public policy scholar Paul C. Light points out in a fascinating concluding piece, more than two-thirds of leading governmental initiatives have been supported by both Democratic and Republican administrations. However, Light adds, the massive tax cut in 2001 “continue[s] to constrain federal investment in problem solving.” The scholars brought together by Ohio State historian Conn (History’s Shadow) persuasively demonstrate how the growth of “big government” throughout the 20th century has benefited ordinary Americans so comprehensively and unobtrusively that they have often taken it for granted."

Publishers Weekly

http://www.publishersweekly.com/978-0-19-985855-2

Growing Older in Hong Kong, New York and London

Growing Older in Hong Kong, New York and London
The Hong Kong Jockey Club Charities Trust. Hong Kong, 2012.

P. Chau, J. Woo, M. Gusmano, D. Weisz, and Rodwin, V.
05/08/2012

Declining birth rates, increasing longevity and urbanization have created a new challenge for cities: how to respond to an ageing population. Although population ageing and urbanization are not new concerns for national governments around the world, the consequences of these trends for quality of life in cities has only recently started to receive attention from policy makers and researchers. Few comparative studies of world cities examine their health or long-term care systems; nor have comparisons of national systems for the provision of long-term care focused on cities, let alone world cities.

By extending the work of the CADENZA and World Cities Projects , this report investigates how three world cities -- Hong Kong, New York and London -- are coping with this challenge. These world cities are centers of finance, information, media, arts, education, specialized legal services and advanced business services, and contribute disproportionate shares of GDP to their national economies. But are these influential centers prepared to meet the challenge posed by the “revolution of longevity?” How will these world cities accommodate this revolutionary demographic change? Are they prepared to implement the health and social policy innovations that may be required to serve their residents, both old and young? Will they be able to identify the new opportunities that increased longevity may offer? Can they learn from one another as they seek to develop creative solutions to the myriad issues that arise? Finally, can other cities learn from the experience of these three cities as they confront this challenge?

To address these questions, we examine comparable data on the economic and health status of older persons, as well as the availability and use of health, social and long-term care across and within these cities. In the report “How Well Are Seniors in Hong Kong Doing? An International Comparison”, a first attempt was made to compare the situation in Hong Kong with five economically developed countries. This report extends this study by comparing the situation in Hong Kong with two other world cities—New York City and London, which are more comparable in terms of population size and economic characteristics.

Medicare’s Flagship Test Of Pay-For-Performance Did Not Spur More Rapid Quality Improvement Among Low-Performing Hospitals

Medicare’s Flagship Test Of Pay-For-Performance Did Not Spur More Rapid Quality Improvement Among Low-Performing Hospitals
Health Affairs; 31(4):797-805.

Ryan, Andrew M., Jan Blustein, Lawrence P. Casalino.
04/01/2012

Medicare’s flagship hospital pay-for-performance program, the Premier Hospital Quality Incentive Demonstration, began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, we found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, we found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. Our findings raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.

Efficiency Considerations of Donor Fatigue, Universal Access to ARTs and Health Systems

Efficiency Considerations of Donor Fatigue, Universal Access to ARTs and Health Systems
Sex Transm Infect 2012;88:75-78

Grépin, Karen
03/01/2012

Objectives: To investigate trends in official development assistance for health, HIV and non-HIV activities over time and to discuss the efficiency implications of these trends in the context of achieving universal access to treatment and health systems.

Methods: Official development assistance for health, HIV programmes and non-HIV programmes were tracked using data from 2000 to 2009. A review of the literature on efficiency, treatment and health systems was conducted. Findings The rate of growth of donor funding to HIV programmes has slowed in recent years at levels below those required to sustain programmes and to move towards universal access to treatment. These trends are likely due to increased pressure on foreign aid budgets and donor fatigue for HIV programmes.

Conclusions: There is great need to consider how the limited resources available can be used most efficiently to increase the number of lives saved and to ensure that these resources also benefit health systems. Improving efficiency is much more than just improving the productive efficiency and also about ensuring that resources are going to where they will be the most beneficial and making investments that are the most efficient over time. These choices may be essential to achieving the goal of universal access to treatment as well as the sustainability of these programmes. 

Valuing Improvement in Value Based Purchasing

Valuing Improvement in Value Based Purchasing
Circulation:  Cardiovascular Quality and Outcomes.  5:163-170  

Borden, William and Jan Blustein.
03/01/2012

Background

Medicare will soon implement hospital value-based purchasing (VBP), using a scoring system that rewards both achievement (absolute performance) and improvement (performance increase over time).  However, improvement is defined so as to give less credit to initial low performers than initial high performers.  Since initial low performers are disproportionately hospitals in socioeconomically disadvantaged areas, these institutions stand to lose under Medicare’s VBP proposal. 

 

Methods

We developed an alternative improvement scale, and applied it to hospital performance throughout the US.   Using 2005-2008 Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), we calculated hospital scores using Medicare’s proposal and our alternative.  Hospital performance scores were compared across 5 locational dimensions of socioeconomic disadvantage: poverty, unemployment, physician shortage, high school and college graduation rates.

 

Results

Medicare’s proposed scoring system yielded higher overall scores for the most locationally advantaged hospitals for 4 out of 5 dimensions in AMI and 2 out of 5 for HF.  Using our alternative, differences in overall scores between hospitals in the most and least advantaged areas were attenuated, with locationally advantaged hospitals having higher overall scores for 3 out of 5 dimensions in AMI and 1 out of 5 dimensions for HF. 

 

Conclusions

Using an alternative VBP formula that reflects the principle of “equal credit for equal improvement,” resulted in a more equitable distribution of overall payment scores, which could allow hospitals in both socioeconomically advantaged and disadvantaged areas to succeed under VBP.

 

 

The economic burden placed on healthcare systems by childhood obesity

The economic burden placed on healthcare systems by childhood obesity
Expert Rev Pharmacoecon Outcomes Res. 2012 Feb;12(1):39-45.

Trasande L and Brian Elbel.
02/01/2012

The obesity epidemic has transformed children's healthcare, such that diabetes, hypertension and the metabolic syndrome are phrases more commonly used by child health providers than ever before. This article reviews the economic consequences of this epidemic for healthcare delivery systems, both in the short term when obesity has been associated with increased utilization, and in the long term where increased likelihood of adult obesity and cardiovascular disease is well documented. Large investments through research and prevention are needed and are likely to provide strong returns in cost savings, and would optimally emerge through a cooperative effort between private and government payers alike. 

From Research to Health Policy Impact

From Research to Health Policy Impact
Health Services Research, 2012. Volume 47 / Issue 01 / February 2012, pp 337-343, Published online

Carolyn M. Clancy, Sherry A. Glied and Nicole Lurie
01/12/2012

The opportunities for researchers to improve health and health care by contributing to the formulation and implementation of policy are almost unlimited. Indeed, the availability of these opportunities is a tribute to a generation of health services researchers questioning existing policies or studying essential "Why?" and “What if?” questions using rigorous analysis. Moreover, the steady albeit uneven transition of health care delivery from a paper-based cottage industry toward an enterprise that provides transparent information to clinicians, patients, policy makers and the public, and potentially vast amounts of data to policy researchers, combined with the expectations of an increasingly information-savvy public, have increased the focus on health care quality, access, and costs.

Our health care system, like those in other countries, confronts continued pressures from increasing costs; inconsistent quality; avoidable patient harms; pervasive disparities in health and health care associated with individual characteristics such as race, ethnicity, income, education and geography; and poor population health outcomes. The persistence of many of these challenges reflects, in part, a failure of science alone to improve heath. Strategies to address many of these challenges exist in the laboratory, but the contribution of this science to the health of the public is limited by a research enterprise that values discovery of new knowledge far more than its successful application.

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