Archives: August 2005

Wed Aug 31, 2005

Income Stable, Poverty Rate Increases, Percentage of Americans

Real median household income remained unchanged between 2003 and 2004 at $44,389, according to a report released today by the U.S. Census Bureau. Meanwhile, the nation�s official poverty rate rose from 12.5 percent in 2003 to 12.7 percent in 2004. The percentage of the nation�s population without health insurance coverage remained stable, at 15.7 percent in 2004. The number of people with health insurance increased by 2.0 million to 245.3 million between 2003 and 2004, and the number without such coverage rose by 800,000 to 45.8 million.

These findings are contained in the Income, Poverty, and Health Insurance Coverage in the United States: 2004 [PDF] report. The report�s data were compiled from information collected in the 2005 Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS).

Source of Estimates and Statistical Accuracy
As with all surveys, the estimates may differ from the actual values because of sampling variation or other factors. All statements in this news release have undergone statistical testing, and all comparisons are significant at the 90-percent confidence level, unless otherwise noted.

Also released today were tabulations from the 2004 American Community Survey (ACS), some of which are included in the report: Income, Earnings and Poverty from the 2004 American Community Survey [PDF].

The ACS is a powerful new tool. In the past, local policymakers had to choose between using old local data from the last census and new national data. The ACS provides a new level of local timeliness, giving policymakers current local data. Gathered from the largest household survey in the United States, the ACS data herein is based on the collection of information from 800,000 addresses sampled during the 2004 survey period.

The fact sheet, Differences Between the Income and Poverty Estimates From the American Community Survey and the Current Population Survey Annual Social and Economic Supplement, provides information on the differences in concepts and purposes of the ACS and the CPS.

Current Population Survey

The 2005 Current Population Survey Annual Social and Economic Supplement shows the following results:



* 2004 marked the second consecutive year in which real median household income showed no change.

Race and Hispanic Origin

* Real median household income did not change between 2003 and 2004 for non-Hispanic whites, blacks or Asians or for households with Hispanic householders.

* Black households had the lowest median income in 2004 ($30,134) among race groups. Asian households had the highest median income ($57,518). The median income for non-Hispanic white households was $48,977. Median income for Hispanic households was $34,241.

* Comparison of two-year moving averages (2002-2003 and 2003-2004) showed that the real median income for households with householders who reported American Indian and Alaska native as their race was statistically unchanged. The same was true for native Hawaiian and other Pacific islander households.


* Real median household income remained unchanged between 2003 and 2004 in three of the four census regions � Northeast ($47,994), West ($47,680) and South ($40,773). The exception was the Midwest, where income declined 2.8 percent, to $44,657. The difference in income between the Northeast and West was not statistically significant.

* The South continued to have the lowest median household income of all four regions. The Northeast and West had the highest incomes among regions.


* Real median income remained unchanged for native as well as for foreign-born households between 2003 and 2004. Native and foreign-born households had a median income in 2004 of $45,319 and $39,421, respectively.


* Real median earnings of men age 15 and older who worked full-time, year-round declined 2.3 percent between 2003 and 2004, to $40,798. Women with similar work experience saw their earnings decline by 1.0 percent, to $31,223. Reflecting the larger fall in the earnings of men, the ratio of female-to-male earnings for full-time, year-round workers was 77 cents on the dollar, up from 76 cents in 2003.



* There were 37.0 million people in poverty (12.7 percent) in 2004, up from 35.9 million (12.5 percent) in 2003.

* There were 7.9 million families in poverty in 2004, up from 7.6 million in 2003. The poverty rate for families remained unchanged at 10.2 percent. The poverty rate and the number in poverty showed no change for the different type of families.

* As defined by the Office of Management and Budget and updated for inflation using the Consumer Price Index, the average poverty threshold for a family of four in 2004 was an income of $19,307; for a family of three, $15,067; for a family of two, $12,334; and for unrelated individuals, $9,645.

Race and Hispanic Origin (Race data refer to people reporting a single race only.)

* In 2004, the poverty rate declined for Asians (9.8 percent in 2004, down from 11.8 percent in 2003), remained unchanged for Hispanics (21.9 percent) and blacks (24.7 percent) and rose for non-Hispanic whites (8.6 percent in 2004, up from 8.2 percent in 2003).

* The poverty rate of American Indians and Alaska natives did not change when comparing two-year averages for 2002-2003 and 2003-2004. The same was true of native Hawaiians and other Pacific islanders.


* For all children under 18, both the 2004 poverty rate (17.8 percent) and the number in poverty (13.0 million) were unchanged from 2003.

* The poverty rate increased for people 18 to 64 years old (from 10.8 percent in 2003 to 11.3 percent in 2004), but declined for those age 65 and older (from 10.2 percent in 2003 to 9.8 percent in 2004).


* The native-born population had increases in both their poverty rate (from 11.8 percent in 2003 to 12.1 percent in 2004) and their number in poverty (from 30.0 million in 2003 to 31.0 million in 2004). Foreign-born naturalized citizens had a 2004 poverty rate of 9.8 percent, compared with 21.6 percent for those who had not become citizens; both rates were unchanged from 2003.


* The Midwest was the only region to show an increase in their poverty rate � 11.6 percent in 2004, up from 10.7 percent in 2003. In 2004, the poverty rates for the Northeast (11.6 percent), South (14.1 percent) and West (12.6 percent) were unchanged from 2003. The South continued to have the highest poverty rate.

Health Insurance Coverage


* The percentage of the nation�s population without health insurance coverage remained unchanged, at 15.7 percent in 2004.

* The percentage of people covered by employment-based health insurance declined from 60.4 percent in 2003 to 59.8 percent in 2004.

* The percentage of people covered by government health insurance programs rose in 2004, from 26.6 percent to 27.2 percent, driven by increases in the percentage of people with Medicaid coverage, from 12.4 percent in 2003 to 12.9 percent in 2004.

* The proportion and number of uninsured children did not change in 2004, remaining at 11.2 percent or 8.3 million.

Race and Hispanic Origin (Race data refer to those reporting a single race only.)

* The uninsured rate in 2004 was 11.3 percent for non-Hispanic whites and 19.7 percent for blacks, both unchanged from 2003. The uninsured rate for Asians declined from 18.8 percent to 16.8 percent.

* The uninsured rate for Hispanics, who may be of any race, was 32.7 percent in 2004 � unchanged from 2003.

* Based on a three-year average (2002-2004), 29.0 percent of people who reported American Indian and Alaska native as their race were without coverage, higher than the rate for native Hawaiians and other Pacific islanders (21.8 percent) and for those of other race groups, but lower than that of Hispanics. Comparisons of two-year moving averages (2002-2003 and 2003-2004) showed that the uninsured rates for American Indians and Alaska natives and for native Hawaiians and other Pacific islanders did not change.


* While the proportion of the foreign-born population without health insurance in 2004 (33.7 percent) was unchanged from 2003, the rate for the native-born population increased (from 13.0 percent in 2003 to 13.3 percent in 2004).


* The Midwest had the lowest uninsured rate in 2004 (at 11.9 percent), followed by the Northeast (13.2 percent), the West (17.4 percent) and the South (18.3 percent).

American Community Survey

The national findings regarding median income and poverty rate are consistent between the CPS and the ACS. When examining localities of 250,000 or more residents, the 2004 American Community Survey shows the following results concerning income, poverty and earnings:


* For counties of 250,000 or more people in 2004, median household income ranged from $88,133 in Fairfax County, Va., to $24,778 in Hidalgo County, Texas. For cities of similar size, median household incomes ranged from $71,765 in San Jose, Calif., to $24,031 in Miami, Fla.

* Among the 37 counties with populations of 1 million or more in 2004, 32 experienced no statistically significant change in median household income from 2003 to 2004. Three counties (King, Wash.; Palm Beach, Fla.; and Philadelphia, Pa.) experienced declines; two counties (Fairfax, Va.; and Orange, Calif.) showed increase.


* Among counties with 250,000 or more people in 2004, poverty rates ranged from 2.6 percent in Johnson, Kan., to 43.6 percent in Hidalgo, Texas. Among places of a similar size, the poverty rates ranged from 7.4 percent for Anchorage, Alaska, to 33.6 percent for Detroit.

* Among the 37 counties with 1 million or more people in 2004, seven experienced changes in their poverty rates between 2003 and 2004. Of those seven, Broward, Fla., and Oakland, Mich., showed decreases, while Allegheny, Pa., Bronx, N.Y.; King, Wash.; Nassau, N.Y.; and Wayne, Mich., had increases. Among the nine cities of this size, New York, N.Y., saw its poverty rate rise, while poverty in the other places remained unchanged.


* Connecticut, Maryland, Massachusetts, New Jersey and the District of Columbia had among the highest median earnings for both men and women who worked full-time, year-round.

* In each of the 50 states and the District of Columbia, women�s earnings were less than men�s in 2004. The District of Columbia was the area with the greatest parity between men�s and women�s earnings. There, women earned 91 cents for every dollar that men earned.

Earnings by Industry

* Among the 20 major industry sectors, men earned the most in 2004 in the management of companies and enterprises sector ($77,754). For women, there were five sectors where median earnings were about $40,000 or more: management of companies and enterprises ($41,608); mining ($41,516); professional, scientific and technical services ($41,398); utilities ($40,981); and information ($40,447).

* In each of the major industry sectors, men earned more than women. The sectors where the earnings gap between men and women was the largest were management of companies and enterprises, where women earned 54 cents for every dollar that men earned; finance and insurance (57 cents); and professional, scientific and technical services (60 cents).

Earnings by Occupation

* Among the 22 major occupational groups, men earned the most in legal occupations, such as lawyers, judges and law clerks (more than $100,000). Among women, those in computer and mathematical occupations had the highest median earnings ($56,585).

* Among the major occupational groups, women�s earnings as a percentage of men�s earnings were about 90 percent or higher for the following groups: installation, maintenance and repair; community and social services; construction and extraction; and healthcare support. In contrast, women�s earnings as a percentage of men�s earnings were about 65 percent or less for legal occupations, sales and related occupations and healthcare practitioner and technical occupations.

Estimates from the CPS ASEC may not match the estimates from the ACS because of differences in the questionnaires, data collection methodology, reference period, processing procedures, etc. Both are surveys and are subject to sampling and nonsampling errors. All comparisons made in the report have been tested and found to be statistically significant at the 90-percent confidence level, unless otherwise noted.

For additional information on the CPS data, visit this. For additional information on ACS data, visit this.

Posted by: Duncan Kinder on Aug 31, 05 | 3:55 pm | Profile

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Tue Aug 30, 2005

Pay for Performance In Columbus

United Healthcare and Aetna are introducing a trial program in Columbus, OH, which will encourage patients to seek doctors whom the insurers rate more highly. According to MSNBC,Columbus doctors are expressing concern that this program will evolve into a "pay for performance" program. One problem apparently, is that "performance" is unclear.

Posted by: Duncan Kinder on Aug 30, 05 | 12:06 pm | Profile

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Sat Aug 27, 2005

UAW: No Reduction in Health Benefits without Matching Cuts in Executive Pay

United Auto Workers union President Ron Gettelfinger is demanding General Motors Corp. cut executives and salaried workers' pay if it wants union help in trimming the automaker's $5.6 billion annual health care bill.

In addition, Gettelfinger said Friday he wants Blue Cross Blue Shield of Michigan to slash administrative costs in the union's health care plan. And he said GM's 12-member board of directors also should take a pay cut.

Read the entire story at

Posted by: Duncan Kinder on Aug 27, 05 | 5:31 pm | Profile

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Evidence Based Design for Hospitals

Designing hospitals so they are pleasing reportedly reduces medical errors, patient stays, and even patient falls, according to the Daytonal Beach News.

Posted by: Duncan Kinder on Aug 27, 05 | 5:21 pm | Profile

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Thu Aug 25, 2005

New Survey: Millions of Family Caregivers Go Without Needed Health Care, Have Problems Paying Medical Bills

Sixteen million working-age adults now spend time caring for a sick or disabled family member, yet more than half of those adults�9 million�have health problems of their own, according to new survey data released today by The Commonwealth Fund.

Caregivers ages 19 to 64 are more likely than non-caregivers not to work, to miss days of work if they are employed, and to lack health insurance coverage. In fact, half of all caregivers reported not getting needed care themselves due to cost issues, and three out of five caregivers reported having problems paying medical bills, according to the report, A Look at Working-Age Caregivers' Roles, Health Concerns, and Need for Support, by Fund staff Alice Ho, Sara Collins, Karen Davis, and Michelle Doty.

"Informal caregivers are playing an increasingly critical support role in the U.S. health care system, especially as the U.S. population continues to age and many people face shorter hospital stays," said Commonwealth Fund President Karen Davis. "But this study shows that there are health and financial implications for caregivers. They have real needs themselves that go unmet."

Many caregivers do not have paying jobs and those who are working have high rates of absenteeism. Just 51 percent of caregivers reported working full time, compared with three-fifths of non-caregivers. Caregivers who are employed were nearly twice as likely as employed non-caregivers to miss six or more days of work during the year.

Caregivers often find themselves financially at risk and unable to obtain health care. One-half of all caregivers reported not getting needed health care due to cost, compared with 35 percent of non-caregivers. Sixty percent of caregivers reported problems with their medical bills, compared with 39 percent on non-caregivers, according to the survey.

The Commonwealth Fund Biennial Health Insurance Survey, which was conducted from September 2003 through January 2004, surveyed 4,052 adults ages 19 and older in the United States.

According to the survey, women represent two-thirds of all caregivers. Older women in particular are the most likely to be caring for a sick or disabled family member, compared with any other age group or gender. Women ages 50 to 64 are two and a half times more likely to provide care than women ages 19 to 29.

A disproportionate number of caregivers are from lower-income households. Forty-four percent of caregivers lived in households with incomes under twice the federal poverty level, compared with one-third of non-caregivers.

Caregivers More Likely to Have Health Conditions; Have Trouble Paying for Care
Caregivers are more likely than non-caregivers to have health problems of their own. Three-fifths of caregivers reported that they were in fair or poor health, or had one or more chronic conditions or a disability, compared with one-third of non-caregivers. In fact, caregivers reported chronic conditions at nearly twice the rate of non-caregivers, 45 percent vs. 24 percent.

Lack of insurance coverage, low income, and the financial burden of providing care can make it difficult for caregivers to afford health care, according to the study authors. Caregivers reported disproportionately high rates of medical bill problems. Among the findings:

* 60 percent of caregivers reported medical bill problems or medical debt compared with 39 percent of non-caregivers
* 34 percent of caregivers were uninsured for at least some period during the year, compared with 26 percent of non-caregivers
* Half of caregivers reported that they had problems accessing the health care system because of cost, compared with 35 percent of non-caregivers. Cost-related access problems included not filling a prescription; failing to see a specialist when a doctor thought it was needed; skipping a recommended medical test, treatment or follow-up; or having a medical problem but not visiting a doctor or clinic

"While caregivers provide a critical, vital function in society, they pay a price in terms of their financial security and overall well-being," said Sara Collins, senior program officer at The Commonwealth Fund and co-author of the study. "Modest policy proposals such as expanding Medicaid and Children's Health Insurance Program coverage to caregivers, allowing Medicare buy-in for caregivers of Medicare beneficiaries, or tax credits for caregivers' medical expenses could ease their financial burden."

Posted by: Duncan Kinder on Aug 25, 05 | 1:20 pm | Profile

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Wed Aug 24, 2005

Study: Physicians, Hospitals Compete for Highly Profitable Specialty Services While Shirking Less-Profitable Basic Healthcare

Fierce competition among hospitals and physicians for profitable specialty services is driving costly inpatient and outpatient expansions, especially in more affluent areas with well-insured populations, according to initial findings from the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities, according to a news release.

"As hospitals and physicians compete more broadly for profitable services, more and more diagnostic and surgical services are shifting from hospitals to physician offices and physician-owned ambulatory centers," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded primarily by The Robert Wood Johnson Foundation.

Competition among hospitals�and between hospitals and physicians�has focused on key, profitable service lines, including cardiac, orthopedic and cancer care, researchers found. Facing stagnant growth in professional fees and pressure from growing malpractice premiums and other practice expenses, physicians increasingly view facility fees as an important new revenue source, according to the study.

The medical building boom and intensified service-line competition identified in the fifth round of HSC site visits potentially have consequences for local health care markets. Whether meeting or creating new demand, the capacity expansions are destined to lead to higher rates of care use and costs.

The intense competition for profitable services also may influence the availability of health care services and patients' access to care. For example, many hospitals are struggling to get physician specialists to provide on-call emergency department coverage. Increasingly, hospitals are paying physicians to provide on-call coverage�historically part of physicians' obligation in return for hospital privileges. As specialists provide more services in their practices or in other facilities they have a financial interest in, they become less dependent on having privileges at general hospitals, potentially diminishing access to specialty care for some patients.

"All the signs in the 12 communities are pointing toward higher costs and growing gaps in access to care by income and geographic location," Ginsburg said. "Continuing high cost trends threaten the affordability of health insurance, especially for low-wage workers and small firms, increasing the likelihood that the number of uninsured Americans will continue to rise."

The movement of profitable services out of hospitals and into physician practices and physician-owned facilities poses a threat to some hospitals' ability to subsidize care for less profitable services and for low-income patients. And, as hospitals expand lucrative services, some are cutting back on less profitable ones such as inpatient psychiatric care.

The study's findings are detailed in a new HSC Issue Brief�Initial Findings from HSC's 2005 Site Visits: Stage Set for Growing Health Care Cost and Access Problems�by Cara S. Lesser, M.P.P., HSC director of site visits; Ginsburg and Laurie Felland, M.S. an HSC health researcher. The Issue Brief and five new Community Reports describing market changes in Indianapolis; Cleveland; Little Rock, Ark.; northern New Jersey; and Orange County, Calif.; are available online at

Every two years, HSC researchers visit 12 nationally representative communities across the country, conducting intensive interviews with local health care leaders, including health plans, providers, policy makers, employers and consumer advocates. In addition to the five community reports released recently, HSC will issue reports in the coming months covering Lansing, Mich.; Greenville, S.C.; Syracuse, N.Y.; Boston; Miami; Phoenix; and Seattle.

Other key initial findings from the fifth round of HSC site visits include:

* Employers and Health Plans Fall Back on Patient Cost Sharing. Employers and health plans have launched few initiatives to control rising costs beyond increasing patient cost sharing. Since traditional managed care tools, such as administrative utilization controls, have fallen into disfavor as a result of the managed care backlash, health plans largely have focused on new product designs aimed at engaging consumers to make more cost-conscious decisions about service use and choice of providers. Plans across the 12 markets quickly developed consumer-driven products-high-deductible coverage linked to spending accounts, including health savings accounts (HSAs) and health reimbursement accounts (HRAs), but enrollment to date is limited.
* Safety Net Strained as Demands Increase. While health care costs continue to rise and health insurance becomes less affordable, the public sector has fewer resources to respond to growing needs for coverage or subsidized care. The combination of ongoing state budget constraints, unwillingness to raise taxes and federal budget pressures have left state and local governments hard pressed to keep up with growing needs. Many community health centers and safety net hospitals report that funding support has not kept pace with the increasing numbers of uninsured patients they treat.
* Quality Improvement. Hospitals have increased attention to quality improvement over the past two years. Some hospitals, especially those that lagged in adopting quality improvement initiatives, pointed to Medicare's linking a portion of the hospital inpatient payment update to public reporting of data on the quality of care as an important catalyst. This initiative has helped focus hospital quality improvement efforts. Indeed, many hospitals expect payer demand for demonstrated quality to increase and, therefore, view these activities as important investments to be able to compete in the future.
* Information Technology Investment. While information technology (IT) investment has increased, the scope is more limited than some policy makers and industry proponents would suggest. Hospitals and a handful of large physician groups are at the forefront of significant IT investment.
* No Silver Bullet. Overall, the promise of quality improvement initiatives and IT investments pales in comparison to the scope of the cost and access problems confronting the health care system today. If current trends continue unabated, communities are likely to face growing numbers of uninsured people and increasing disparities in access to care by income and geographic location.

Stakeholder Comments on the HSC Study

Carmela Coyle, senior vice president for policy, American Hospital Association,

"Society faces a balancing act as we weigh the benefits of improved care and longer lives with the growing cost of health care. Advances in medicine can dramatically improve the quality of life for patients. This comes with higher costs, but these investments can make a difference in the health of Americans. With demand for care increasing and the cost of providing that care on the rise, we need
to look at ways to improve care through better management of chronic illness and coordination among providers. The trend toward physician-owned, limited-service hospitals hinders rather than helps this coordination."

Donald W. Fisher, Ph.D., C.A.E., president and CEO, American Medical Group Association,

"The Center's findings underscore the fact that market forces are becoming the primary drivers of the business of medicine today. While this is understandable, given the economics of the times, it is imperative that we remain vigilant in upholding the highest standards of quality and outcomes and, in the process, change our payment system to one that assures the financial recognition of this value in medical
care. The American Medical Group Association has begun its Result-Based Payment System Initiative to look for useful ways to link medical reimbursement to outcomes and not processes. AMGA's multi-year study seeks to develop a system that rewards providers and facilities who achieve or improve health care delivery with regard to efficiency, timeliness, quality, appropriateness of care, patient-centricity and other factors of health care traditionally absent from the fee for service or pay for transactions structure."

Karen Ignagni, president and CEO, America's Health Insurance Plans,

"Health insurance plans have developed a new generation of cost containment tools and techniques that are providing results. For example, the upward trend in spending on prescription drug benefits has been cut dramatically over the past three years as these tools and techniques have been more widely used. The new HSC study looks at emerging patterns in the use of new technologies that may make it more difficult to bring down cost trends and provide coverage for more Americans. This points to a key role for government in overall planning and in evaluating the efficacy of new technologies and their diffusion into practice."

Posted by: Duncan Kinder on Aug 24, 05 | 2:41 pm | Profile

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Survey: Med School Students Are Dissatisfied with Their Curricula

According to survey results, released today, physicians-in-training are receiving traditional education, but are not being offered curricula that keeps pace with the advances in the healthcare industry. As summer vacation ends and schools re-open, medical students wonder, am I receiving an education that will make me a competent physician? Results show that only 17 percent of students are very satisfied with their curricula, according to a press release.

The survey, conducted by the American Medical Student Association (AMSA), the nation�s largest, independent medical student organization, also shows that over 35 percent of students are not required to study medical ethics. Over half of respondents (57.5 percent) are not offered courses or are not sure of their options in bioterrorism or disaster preparedness.

�Medical education should provide students with the information and skills they need to enter medicine as physicians worthy of the public trust,� says Leana S. Wen, AMSA national president. �It is a constant challenge for medical schools to teach the traditional medical curriculum while also incorporating new, timely topics. However, it is absolutely necessary that medical schools recognize this challenge and strive to develop physicians who can effectively provide care in this modern healthcare environment.�

Highlights of the survey include:

�Medical education has not evolved at the same pace as the health care delivery system. We are being trained to practice in an environment that no longer exists,� says an anonymous respondent. Another reports the experience as, �very traditional. Disappointingly so.�

�To ensure that future physicians are properly prepared and curricula is all-encompassing, students and educators must collaborate and continue to refine medical education,� continues Wen. �AMSA continues to work with educators to develop the best curriculum possible that not only reflects the clinical skills future doctors need, but also the other aspects of being a socially responsible physician in our modern and diverse society.�

This survey was conducted to gather a general assessment on medical students� attitudes on medical school curricula. AMSA designed and widely solicited this online survey to AMSA members�322 students responded. For more information, please visit:

Posted by: Duncan Kinder on Aug 24, 05 | 2:27 pm | Profile

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Mon Aug 22, 2005

U C Davis Cancer Center Spurs Investor Interest

Yet another cancer center apparently has economic development potential for its host community, as Sacramento reportedly stands to benefit from research conducted at the U C Davis Cancer Center, MSNBC reports.

Posted by: Duncan Kinder on Aug 22, 05 | 9:00 pm | Profile

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Veteran's Administration is Now a Model for What All Healthcare Might Be Like

After years of being a target of criticism, the Veterans Administration health system now stands as a model of high quality, low cost healthcare, according to the Washington Post. Reportedly, the VA's extensive use of electronic medical records contributes to its achievement.

Posted by: Duncan Kinder on Aug 22, 05 | 2:50 pm | Profile

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California Latinos Seek Medical Care South of the Border

California's Latinos increasingly are seeking medical care in Mexico, where medicine is less expensive but the quality is uneven, according to the Los Angeles Times.

Posted by: Duncan Kinder on Aug 22, 05 | 1:22 am | Profile

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Sat Aug 20, 2005

Insurers Begin to Require Pre-Certification for High Tech Imaging

Citing high costs and overuse, insurers are beginning to require pre-certification for high tech medical imaging such as CT scans, MRIs, and PET scans, according to the Philadelphia Inquirer.

Posted by: Duncan Kinder on Aug 20, 05 | 12:10 am | Profile

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Thu Aug 18, 2005

What Might A Nationwide IT Infrastructure Actually Look Like?

Although information technology (IT) holds potential for transforming health care delivery in important ways, little is known about what a nationwide IT infrastructure might look like. A new issue brief from Mathematica Policy Research, Inc., summarizes recent federal policy efforts to expedite the adoption of electronic health records (EHRs), which are envisioned as the main component of a strategy for improving quality of care, reducing medical errors, and lowering administrative costs.

EHRs consist of clinical information systems that allow physicians and other health care professionals to monitor the health status of their patients with electronic medical charts; expedite referrals and other care decisions; support care decisions with evidence-based guidelines; computerize their ordering of prescription drugs, lab tests, and images; and store and retrieve medical records from different locations.

The brief is based on Mathematica's ongoing literature review of health care providers' use of EHRs, incentives to increase the number of providers that adopt them, and recent legislation aimed at expanding their use. In addition, the publication discusses the implications that use of this technology may have on the development of quality-based purchasing.

�Our review suggests that use of EHRs by physician practices is still modest among solo or small-group practices,� said Lorenzo Moreno, author of the issue brief and a senior health researcher at Mathematica. �Current policies and recent legislative initiatives are likely to expedite the adoption of this technology, however. Providing appropriate financial incentives to providers, fostering the development of standards and networks for allowing EHR systems to communicate nationwide, and addressing legal barriers to the secure exchange of data will move this process forward.�

The brief, �Electronic Health Records: Synthesizing Recent Evidence and Current Policy,� is on the web at Printed copies are available from Publications, (609) 275-2350.

Mathematica, a nonpartisan firm, conducts policy research and surveys for federal and state governments, foundations, and private-sector clients. The employee-owned company, with offices in Princeton, N.J., Washington, D.C., and Cambridge, Mass., has conducted studies of health care, disability, early childhood policies, welfare, education, employment, and nutrition programs in the U.S.

Posted by: Duncan Kinder on Aug 18, 05 | 2:29 pm | Profile

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Wed Aug 17, 2005

As Hospital Building Boom Roars in Wealthy Suburbs, Public Hospitals in Inner City Decline

A new report, Hospital Care in the 100 Largest Cities and Their Suburbs, 1996-2002: Implications for the Future of the Hospital Safety Net in Metropolitan America, released today from State University of New York (SUNY) Downstate Medical Center, sheds new light on the struggle to meet the health care needs of all communities across the nation.

More public hospitals were lost between 1996 and 2002 (16 percent in cities and 27 percent in the suburbs) than for-profit (11 percent in cities and 11 percent in suburbs) and non-profit hospitals (11 percent in cities and 2 percent in the suburbs), a stark contrast to the relatively moderate decline in the number of hospitals nationwide. Public hospitals typically serve the most vulnerable populations, and those that face major challenges in accessing private health care services.

However, as previously reported, a hospital building boom is going on in wealthy suburbs, as hospitals seek well-insured, high paying customers living there or for a few specialties. As noted below, according to this report, poorer suburbs are doing poorly.

�Public hospitals may become an endangered species,� said Dennis Andrulis, Ph.D., lead study author, formerly of SUNY Downstate Medical Center, and now with Drexel University School of Public Health. �Not only are public hospitals disappearing from inner cities across the country; they are disappearing from the suburbs as well.�

The report funded by the Robert Wood Johnson Foundation shows that urban public hospitals provided less inpatient and emergency care in 2002 than in 1996, with for-profit hospitals now surpassing public hospitals in total admissions for the 100 largest cities. Yet, public hospitals continue to care for more seriously ill patients, as measured by the average length of a hospital stay.

In this fifth installment of the series The Social and Health Landscape of Urban and Suburban America, the focus is on key factors of hospital use and availability. The data, provided by the American Hospital Association, were analyzed by ownership type (for-profit, non-profit and public) and by levels of poverty (low, medium and high). The review covers the volume of inpatient and outpatient care, including emergency department visits; number of beds, average length of stay (ALOS) and occupancy rate; three types of specialty care: level 1 and level 2 trauma centers, neonatal intensive care beds, and positron emission tomography (PET) scanners; and hospital revenues and margins.

Perhaps the most unexpected and potentially troubling finding was that high-poverty suburbs appear to be relatively underserved by hospitals, compared to low-poverty suburbs, which appear to have an abundance of hospital resources. Among the metropolitan areas of the 100 largest cities, high-poverty suburbs made up 44 percent of the total suburban population in 2000, but accounted for only 20 percent of total admissions, inpatient days, and outpatient and emergency visits in 2002. For the same years, low-poverty suburbs comprised only 26 percent of the total suburban population, yet had more than more than 40 percent of all suburban hospital admissions, outpatient visits and emergency department visits.

�While we all may read more about the impact of public hospital closures on inner cities, the fact is we are also seeing the potential for an impending access crisis in suburbs with high-poverty populations,� said Andrulis. �These high-poverty suburbs exist disproportionately in California, Texas and other areas in the south.�

The report finds that on average high poverty suburbs have five times the percentage of Latino residents as low-poverty suburbs (26.4 percent versus 5.3 percent) and twice the percentage of population that is foreign-born.

Prior surveys have documented these groups as having the highest uninsured rates in the country. Lack of health coverage for a significant share of population may be a contributing factor in the much lower levels of use and availability of hospital care in high-poverty suburbs. Conversely, residents of low poverty suburbs, on average, are the most affluent residents of metropolitan America, and are likely the best insured.

�A major question the study raises is how the hospital safety net will adapt to meet the health care needs of the poorest and sickest residents of our nation,� said Andrulis. �As the number of public hospitals continues to decline, the concern remains to what extent non-profit and for-profit hospitals are taking or will take on greater responsibilities as safety net providers, and to what degree their focus is on attracting the healthiest of Medicaid patients, leaving the sickest and costliest patients to the care of the remaining public or major safety net hospitals.�

For a link to the report, go to The report will be posted by 12:01 a.m. ET on Wednesday, Aug. 17. Or you may contact Dennis Andrulis via email at [email protected] or by phone at (215) 762-6957.

Posted by: Duncan Kinder on Aug 17, 05 | 2:31 pm | Profile

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Tue Aug 16, 2005

UCLA Report: California Jobs-Based Health Insurance Coverage Is Declining

A new report from the UCLA Center for Health Policy Research shows that job-based health insurance coverage - the backbone of the state's system of health insurance - is declining. While job-based family coverage plummets, children's coverage is protected by public insurance programs, such as Medi-Cal and Healthy Families.

"We are seeing a shift to government programs, like Medi-Cal and Healthy Families, as employers fail to provide affordable health insurance for working families," said author E. Richard Brown, Ph.D., director of the UCLA Center for Health Policy Research and professor in the School of Public Health. "The data show that California's health insurance system is increasingly unstable and unable to provide for the basic medical needs of millions of residents."

While a majority of Californians are still insured through their jobs or those of relatives, those numbers are declining, specifically among dependents. Pushed by a dramatic 79.1 percent increase in the cost of job-based family coverage for the average worker, enrollment of dependents dropped 4 percentage points for children and 2 percentage points for adults from 2001 to 2003. All income groups and all racial and ethnic groups had significant decreases in job-based insurance.

Among children, however, these losses were balanced by a 5 percentage point increase in children's enrollment in Medi-Cal and Healthy Families, leading to an actual increase in children's insurance overall. Many adults shifted to privately purchased heath plans, and many of those bought high-deductible health plans, potentially risking bankruptcy and/or significant financial losses due to high medical bills. Approximately 50 percent of all personal bankruptcies in the U.S. are due to medical debt, according to a recent report by Harvard researchers.

The shrinking of job-based health insurance is just one of many trends identified in "The State of Health Insurance in California: Findings from the 2003 California Health Interview Survey." Other findings from the report include:

* More than 6.6 million Californians under age 65 (more than one in five nonelderly residents) went without insurance for at least part of 2003.
* More than 3.7 million lacked health coverage for the entire year.
* Nonelderly Latinos and American Indian/Alaska Natives report highest rates of uninsurance.
* Three out of four uninsured are in working families. Two-thirds of children in Medi-Cal or Healthy Families had at least one parent who was employed.
* Main reason the uninsured give for not having coverage is "I can't afford it."
* Those without health insurance were much less likely to have seen a doctor, gotten vital preventive screenings for cancer, or taken medication for high blood pressure.

The report was funded by grants from The California Endowment and The California Wellness Foundation. Findings are based on data collected in the 2003 California Health Interview Survey.

"We see more and more middle- and low-income workers priced out of job-based health coverage each year because they can't afford their share of the cost," said Robert K. Ross, M.D., president and CEO of The California Endowment. "Our state and national leaders on both sides of the aisle must work together to reform the system before all but the highest wage workers are priced out of health coverage."

"These numbers represent millions of people - our fellow Californians - whose lives can be devastated by illness or injury because they don't have the access to medical care that health insurance provides," said Gary L. Yates, president and CEO of the California Wellness Foundation.

The 2003 survey interviewed more than 42,000 households throughout the state. Since it was first conducted in 2001, the California Health Interview Survey has been an essential tool for policy makers, researchers and health advocates at every level needing a detailed snapshot of the complex health needs of California's diverse population. The survey is a collaborative project of the UCLA Center for Health Policy Research, the California Department of Health Services, and the Public Health Institute.

The UCLA Center for Health Policy Research was established in 1994 and is one of the nation's leading health policy research centers. It is also the premier source of key health policy information for California. The Center is based in the UCLA School of Public Health and is affiliated with the UCLA School of Public Affairs.

Posted by: Duncan Kinder on Aug 16, 05 | 2:53 pm | Profile

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Report: States, to Solve Medicaid Costs, Use Short Term Solutions that Create Long Term Costs

State governments have relied on �short-term solutions� to address the budgetary squeeze posed by increasing Medicaid and SCHIP expenses and lagging tax revenues during the recent economic turmoil, which �pushed their fiscal problems into the future,� according to a new article published June 16 on the Health Affairs Web site.

States were generally reluctant to raise taxes or reduce either benefits or program rolls, and they frequently relied on one-time actions such as depleting rainy-day funds, shifting money from surplus accounts into general funds, changing accounting rules, or delaying payments from one fiscal year into the next, according to a review of actions in eight states related to Medicaid and the State Children�s Health Insurance Programs (SCHIP) in 2003-2005.

Among the strategies was selling bonds backed by the expected revenue stream from the national tobacco settlement. California, meanwhile, got voter approval to sell $15 billion in deficit financing bonds to close budget gaps over the next several years.

�States did not fundamentally reassess the basic structure or rules related to their major budget items, and few questioned their tax structures and policies,� wrote the authors, Teresa Coughlin and Stephen Zuckerman, both principal research associates at the Urban Institute�s Health Policy Center.

�Instead, this review of eight states shows that states relied on a range of short-term solutions that, in some cases, pushed fiscal problems into the future,� the authors wrote. �By taking this approach, however, some states have created structural deficits that will profoundly influence state policy making for many years to come.�

The authors� research was supported by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute�s Assessing the New Federalism project, which is funded by a consortium of foundations that includes the Robert Wood Johnson Foundation.

The eight states reviewed were Alabama, California, Colorado, Massachusetts, Michigan, New York, Texas, and Washington.

The states had little political support for tax increases in 2003 but were more likely to increase taxes and fees or close loopholes in 2004. Only two states increased broad-based taxes: New York enacted a temporary three-year increase in personal income taxes along with sales taxes, and Michigan increased its sales tax.

States frequently borrowed from dedicated accounts, such as education, transportation, or human service funds, to help finance Medicaid. California, Colorado, and Michigan delayed paying bills to shift spending from one fiscal year to the next. Several states imposed provider taxes to raise Medicaid payment rates, which states use to increase the federal government�s contribution to state Medicaid accounts without expenditures from the state general fund. Other similar Medicaid maximization strategies also were employed.

To reduce spending, states were more likely to change administrative rules to reduce the number of Medicaid or SCHIP enrollees than they were to enact broad-based benefit cutbacks. The states also imposed copayments for some Medicaid and SCHIP beneficiaries, strengthened asset collection activities, and cut or froze provider payment rates.

While tax revenues have begun to recover, the authors write that the decisions made in their review period will need to be addressed in the near future.

�After the difficult fiscal period that states have just weathered, getting back on track will undoubtedly be a challenge,� they write. �Because of the tax cuts many states adopted in the late 1990s, states have a much lower tax base to pay their bills.

�To compound the problem, many states borrowed or pushed current obligations into the future. Although these obligations could be dealt with through new revenue sources, the reluctance to raise taxes makes that quite unlikely. However, if these structural deficits cannot persist indefinitely, states will be forced to confront the choice between cutting spending drastically and bucking the antitax sentiment.�

Posted by: Duncan Kinder on Aug 16, 05 | 12:43 pm | Profile

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Mon Aug 15, 2005

Diagnostic Imaging Companies: Benefits are Worth the Costs

Responding to criticisms that diagnostic imaging costs are out of control, imaging companies are now asserting that their technologies deliver high value,according to the Boston Globe.

As previously reported, diagnostic imaging is the fastest growing element in the U.S. health care budget.

The Globe's article does not discuss teleradiology, the use of long-distance communication by which low cost radiologists from India help keep diagnostic imaging costs under control.

Posted by: Duncan Kinder on Aug 15, 05 | 8:04 pm | Profile

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"Not for Profit" BlueCross BlueShield of Tennessee Racks Up $1 Billion

Despite its nonprofit status, BlueCross BlueShield of Tennessee has earned profits for the past four years and accrued $1 billion in reserves, twice the amount required by law, according to The Tennessean.

Posted by: Duncan Kinder on Aug 15, 05 | 10:14 am | Profile

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Thu Aug 11, 2005

Report Compares Minnesota Health Plan Quality

A report comparing the quality and efficiency of Minnesota's major health plans was released today by the Buyers Health Care Action Group (BHCAG), a Twin Cities-based employer health care purchasing coalition. Intended to guide employer purchasing and consumer health plan selection, this first-of-its-kind study is based on health plan performance data collected through eValue8, a nationally recognized survey that asks health plans to submit information about their clinical quality and administrative efficiency. Seven health plans doing business in Minnesota participated in the survey including Blue Cross Blue Shield of Minnesota, HealthPartners HMO, HealthPartners PPO, Patient Choice, Medica HMO, CIGNA PPO and Sioux Falls-based Sioux Valley HMO. BHCAG conducted individual meetings with each participating plan to share the results and to identify areas for improvement and collaboration.

�The eValue8 tool measures the steps Minnesota�s health plans are taking to adopt electronic medical records, manage chronic diseases, help consumers chose high-performing providers and reward providers who provide high-quality care,� explained BHCAG CEO Carolyn Pare. �eValue8 shifts our current health care system�s fee-for-service focus to a pay-for-performance system where doctors and hospitals have strong incentives to improve care, consumers have comparative information to choose high quality doctors and employers voice common expectations to the health care marketplace.�

By using eValue8, Pare says employers are able to influence the health care marketplace both locally and nationally by placing a common "purchase order" for clinical specifications that have been proven to stabilize costs and keep quality high. eValue8 is a national initiative supported by the Washington, DC-based National Business Coalition on Health. More than 250 health plans in the nation now participate in the survey process and it has been used successfully by ten employer purchasing coalitions as well as companies like General Motors and Pitney Bowes to negotiate pricing, determine employee premiums and collaborate on programs to improve treatment of costly chronic health conditions such as diabetes, asthma and cardiovascular disease. The Minnesota report can be obtained at

How eValue8 Works

Hundreds of benchmarks are gathered through a rigorous survey that measures a health plan�s effectiveness in such areas as information technology, member communication, disease management, measuring provider performance, behavioral health treatment and management of pharmacy costs and safety. For information technology, health plans are asked if the physicians and nurse practitioners within their network have access to portable handheld devices and computer software to order patient prescriptions and prevent drug conflicts. Plans must also disclose the sophistication of the information systems they use to process claims and how they communicate claim costs to employers. In the consumer engagement section, health plans submit information on the extent of their member outreach activities such as 24 hour/ seven day a week nurse advice lines, the type of provider qualifications and performance criteria they list in their consumer catalogs and whether or not they use �push� email technology to educate members about their specific health conditions and the disease management programs offered to help members control their disease. Pharmacy management is another important category where plans report on the steps they take to ensure pharmacy safety at the prescribing and patient level, their relationships with pharmacy benefit management firms, how they manage costs through generic equivalent prescriptions and whether or not they have programs to address the fast-growing category of specialty pharmaceuticals that are used in chemotherapy and to treat diseases such as Hepatitis C.

Other Key Survey Areas

Provider quality incentives, healthy lifestyle promotion, and behavioral health treatment are also part of the eValue8 survey. For example, plans are asked what they do to track and compare performance for both doctors and hospitals and if they partner with other health plans in the community on patient safety programs. The survey also requires plans to document the extent of their involvement in community health prevention programs on cancer, immunizations, tobacco cessation, weight management, and worksite health promotion. For behavioral health, plans are rated high if they demonstrate a commitment to promote established clinical guidelines and best practices for treating depression and alcohol disorders. eValue8 pays close attention to whether plans measure individual provider performance results in behavioral health and the extent of their patient support and education programs.

Minnesota Results

Minnesota plans compared favorably to the best performing national plan in most of the quality categories. HealthPartners HMO, HealthPartners PPO, Medica and Patient Choice received special national recognition for their performance in three survey categories. HealthPartners HMO and Medica were selected for their success in adopting health information technology while Patient Choice was recognized for its efforts in measuring and publicly reporting individual provider performance. HealthPartners PPO was also honored for its effectiveness in offering preferred provider plans for specific employer needs. These Minnesota health plans recently shared their strategies at a recent eValue8 best practices national conference held in Chicago, Illinois. One of the first Minnesota employers to include the eValue8 results in their health care purchasing decision-making is the University of Minnesota. �The eValue8 results allowed us to create a special quality-ranking matrix that we used in our health plan selection process,� explained Dann Chapman, Director of the University�s Employee Benefits. �We are now able to set performance and accountability standards with our health plan vendors that have both a financial and quality improvement focus.�

Cornerstone of a Comprehensive Value-Based Purchasing Strategy

The eValue8 survey tool is one of the major components of the Smart Buy Alliance � representing more than three-fifths of all Minnesota consumers - that was formed late last year by private sector employers, unions and the State of Minnesota. Pare said eValue8 allows employers of all sizes to make health care purchasing decisions using their own criteria. �Some employers use the eValue8 information to negotiate pricing with health plans. Some employers use the information to set employee premiums, with higher quality health plans costing employees less,� Pare explained. �Equally important to pricing - employers working with coalitions like BHCAG use the information to promote market wide improvements in health care quality through partnerships with the health plans.� "We are very pleased with the growing acceptance of a common tool such as eValue8 to measure health plan performance," said Kevin Goodno, Commissioner of the Department of Human Services and member of Governor Pawlenty's Health Cabinet. "This will lead to the recognition and rewarding of positive outcomes, which is a critical part of the Governor's agenda to reform the health care system." Survey Triggers Community-Wide Health Improvement Programs

�The ultimate goal is for all health care purchasers to use eValue8 so it can become a true, community-wide tool for health care quality improvement,� Pare stated. BHCAG will use the eValue8 results to develop community-wide programs between employers, providers and heath plans. Program areas identified by the Minnesota results include an effort to promote the use of established clinical guidelines for depression and alcoholism treatment, enhancing pay-for-performance through cash rewards to providers, the continuation of developing portable electronic personal health records and the promotion of RxHub, a common communications framework that links doctors, pharmacies, pharmaceutical benefit management companies and health plans for the purpose of sharing prescription benefit information. Health Plans Endorse the Process

�The eValue8 tool gives purchasers a comprehensive way to examine health plan capabilities and highlights those health plans who have made quality and performance measurement a priority. It provides a solid reinforcement for health plans and providers, and keeps us focused on continued improvements,� said Andrea Walsh, Executive Vice President and Chief Marketing Officer at HealthPartners. "The eValue8 process provides Blue Cross a useful way to hear from a segment of our customers. While scorecards always have limitations, this kind of dialogue is helpful in guiding our work," explained Richard Neuner, senior vice president and chief marketing officer.

About The Buyers Health Care Action Group

Formed in 1988, the Buyers Health Care Action Group (BHCAG) is a coalition of public and private employers working to recreate the health care system so consumers will get the care they need in the right place, at the right time and at the right price. BHCAG is a founding member of eValue8 that was created by leading U.S. employers and coalitions as a way for health care purchasers to buy and evaluate health plans based on their performance and value instead of solely on price.

Posted by: Duncan Kinder on Aug 11, 05 | 11:50 pm | Profile

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Wed Aug 10, 2005

Commonwealth Fund: 77 Million Americans Struggle With Medical Bills

Both the high cost of health care and inadequate health insurance coverage are undermining the financial security of millions of Americans, according to a new Fund analysis. Based on results from the Commonwealth Fund Biennial Health Insurance Survey, an estimated 77 million Americans struggle with medical bills, have recent or accrued medical debt, or both.

In Seeing Red: Americans Driven into Debt by Medical Bills, Fund researchers Michelle M. Doty, Ph.D., Jennifer N. Edwards, Dr.P.H, and Alyssa L. Holmgren report that while medical bill problems and debt are experienced most often by the uninsured, even many working-age adults who are continually insured have problems paying their medical bills and have medical debt. The study also found that working-age adults incur significantly higher rates of medical bills and debt than adults 65 and older.

These financial burdens ultimately affect the likelihood that people will get the care they need. About 63 percent of those reporting medical bill problems or medical debt went without needed care because of the cost, compared with 19 percent of adults without any medical bill problems or debt.

Posted by: Duncan Kinder on Aug 10, 05 | 1:36 pm | Profile

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JAMA: Current Clinical Practice Guidelines are not Written with Older Adults With Multiple Illnesses in Mind

Current clinical practice guidelines are not written with older adults with multiple illnesses in mind, according to a study in the August 10 issue of JAMA. The use of CPGs as the basis for pay-for-performance initiatives that focus on specific treatments for single diseases may be particularly unsuited to the care of older individuals with multiple chronic diseases.

The aging of the population and the increasing prevalence of chronic diseases pose challenges to the development and application of clinical practice guidelines (CPGs), according to background information in the article. In 1999, 48 percent of Medicare beneficiaries aged 65 years or older had at least 3 chronic medical conditions and 21 percent had 5 or more.

Clinical practice guidelines are based on clinical evidence and expert consensus to help decision making about treating specific diseases. Most CPGs address single diseases in accordance with modern medicine's focus on disease and pathophysiology. However, physicians who care for older adults with multiple diseases must strike a balance between following CPGs and adjusting recommendations for individual patients' circumstances. Difficulties escalate with the number of diseases the patient has. The limitations of current single-disease CPGs may be highlighted by the growth of pay-for-performance initiatives, which reward practitioners for providing specific elements of care. Because the specific elements of care may be based on single-disease CPGs, pay-for-performance may create incentives for ignoring the complexity of multiple comorbid (related illnesses) chronic diseases and dissuade clinicians from providing optimal care for individuals with multiple comorbid diseases.

Cynthia M. Boyd, M.D., M.P.H., from the Center on Aging and Health, Johns Hopkins University, Baltimore, and colleagues examined how CPGs address comorbidity in older patients and explored what happens when multiple single-disease CPGs are applied to a hypothetical 79-year-old woman with 5 common chronic diseases. Selection of these diseases were based on data from the National Health Interview Survey and a nationally representative sample of Medicare beneficiaries (to identify the most prevalent chronic diseases in this population). The National Guideline Clearinghouse was used to locate evidence-based CPGs for each chronic disease. Of the 15 most common chronic diseases, the researchers focused on CPGs for hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis.

Two investigators independently assessed whether each CPG addressed older patients with comorbidities, goals of treatment, interactions between recommendations, burden to patients and caregivers, patient preferences, life expectancy, and quality of life. For a hypothetical 79-year-old woman with chronic obstructive pulmonary disease, type 2 diabetes, osteoporosis, hypertension, and osteoarthritis, the authors aggregated the recommendations from the relevant CPGs.

The researchers found that most CPGs did not modify or discuss the applicability of their recommendations for older patients with multiple comorbidities. Most also did not comment on burden, short- and long-term goals, and the quality of the underlying scientific evidence, nor give guidance for incorporating patient preferences into treatment plans. If the relevant CPGs were followed, the hypothetical patient would be prescribed 12 medications (costing her $406 per month) and a complicated nonpharmacological regimen. Adverse interactions between drugs and diseases could result.

"For the present, widely used CPGs offer little guidance to clinicians caring for older patients with several chronic diseases. The use of CPGs as the basis for pay-for-performance initiatives that focus on specific treatments for single diseases may be particularly unsuited to the care of older individuals with multiple chronic diseases. Quality improvement and pay-for-performance initiatives within the Medicare system should be designed to improve the quality of care for older patients with multiple chronic diseases; a critical first step is research to define measures of the quality of care needed by this population, including care coordination, education, empowerment for self-management, and shared decision making based on the individual circumstances of older patients," the authors conclude.

Posted by: Duncan Kinder on Aug 10, 05 | 12:44 am | Profile

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Survey: Many Hispanics are Uninsured

Hispanics make up 15 percent of the U.S. population and almost 29 percent of the uninsured. More than one in three Hispanics is uninsured, and 25 percent has only public health insurance, according to the government's leading health expenditure survey. In addition, Hispanics constitute 36 percent of all uninsured children under 18.

The 2004 Medical Expenditure Panel Survey (MEPS) findings released today by the Agency for Healthcare Research and Quality provide data on the uninsured, including detailed breakdowns by subpopulation groups. These breakdowns are intended to help policymakers and others understand health insurance status in detail.

According to the 2004 survey, for adults under age 65:

* White non-Hispanics made up 65 percent of the U.S. population and almost 50 percent of the uninsured. About one in seven whites was uninsured, and 10 percent had only public insurance.
* Black non-Hispanics made up almost 13 percent of the population and almost 15 percent of the uninsured. About one in five blacks was uninsured, and 28 percent had only public insurance.

"These results confirm the urgency of identifying effective policies to expand access to care for all Americans, particularly Hispanics," said AHRQ Director Carolyn M. Clancy, M.D. "The MEPS is a unique resource for evaluating the impact of proposed solutions for different populations."

Findings on uninsured Americans in a given year are often presented in three ways: people uninsured for a full year, those ever uninsured during a year, and those uninsured for a specific point in time. The MEPS provides data for all three categories and also covers a 2-year period. The data provided in this most recent MEPS release reflect insurance status for a specific point in time�the first part of 2004.

Additional MEPS data from the first part of 2004 show:

* For the population under age 65, 19 percent (48 million) were estimated to be without health insurance.
* For children under age 18, nearly 12 percent (8.5 million) were uninsured. These most recent estimates of children without health insurance were significantly lower than estimates from the previous decade, mostly due to public insurance expansions aimed at children, including Medicaid and the State Children's Health Insurance Program.
* Young adults aged 19-24 were at greatest risk of being uninsured, with 35 percent having no insurance coverage for the first part of 2004. Furthermore, this lack of coverage was worst for young Hispanic adults, with 56 percent uninsured.

Details about the uninsured are in several statistical briefs just released by AHRQ, including The Uninsured in America, 2004: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65; The Uninsured in America, 1996-2004: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65; and Health Insurance Status of Children in America, 1996-2004: Estimates for the U.S. Civilian Noninstitutionalized Population under Age 18. Furthermore, a set of charts illustrating more detailed summaries of the data mentioned in this release exists.

About MEPS: AHRQ's expenditure survey collects information each year from a nationally representative sample of U.S. households about health care use, expenses, access, health insurance coverage, health status and quality. It is unique in its degree of detail and in its ability to link data on health spending and health insurance to various characteristics of individuals and families. People surveyed by MEPS are followed for 2 consecutive years, providing additional depth and value to its data, especially in differentiating between short-term lack of insurance and persistent lack of insurance.

MEPS data are publicly available for use by researchers, policymakers and others at Analytical tools to enhance the usability of the survey also are provided on the MEPS Web site. These include MEPSnet, a menu-driven analytic tool that allows customized tabulations to be produced in real time in a non-programming environment , and the MEPS Household Compendia of Tables which present detailed national estimates from the MEPS Household Component in tabular form.

About federal health insurance surveys: Information about health insurance status is collected as a part of several different federal surveys. As part of broader surveys, these efforts examine different aspects of the problem, while also providing the benefit of validation for one another's findings. The data provided today reflect insurance status for a specific period of time. By comparison, the often-cited health insurance data provided as part of the Census Bureau's annual Current Population Survey are estimates for full-year lack of insurance.

Posted by: Duncan Kinder on Aug 10, 05 | 12:27 am | Profile

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Report: Rich New Jersey Hospitals Grow Richer While Poor Grow Poorer

Hospitals and physicians are aggressively expanding capacity to deliver profitable specialty services in suburban areas of northern New Jersey, fueling concerns about health care costs, according to a new community report released today by the Center for Studying Health System Change (HSC).

The improving financial performance among suburban hospitals has fueled expansion and modernization efforts, while the smaller community hospitals in the urban communities surrounding the city of Newark are confronting declining admissions, growing charity care burdens and deteriorating financial performance. At the same time, safety net hospitals in Newark have financial and institutional protections that-for the time being-protect them from the economic decline experienced by smaller hospitals in surrounding urban communities.

"These developments raise the prospect of widening disparities in care among the three groups of hospitals and the patients they serve," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

Other key findings of the report, Urban-Suburban Hospital Disparities Grow in Northern New Jersey, include:

* Growing numbers of specialist physicians are terminating contracts with health plans�or threatening to do so�in an effort to obtain higher payments.
* Employers are shifting health costs to workers, but most are holding off on adopting consumer-driven health plan designs.
* Recent increases in the state's charity care funding pool have helped hospitals, but access to ambulatory care remains limited for uninsured people.

Northern New Jersey is one of 12 communities across the country tracked intensively by HSC researchers through site visits. The new report is based on a March 2005 site visit and interviews with more than 75 Northern New Jersey health care leaders, representing health plans, employers, hospitals, physicians and policy makers.

Posted by: Duncan Kinder on Aug 10, 05 | 12:12 am | Profile

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Tue Aug 09, 2005

Regulation, Payment Driving Heated Health Care Competition

Provider reimbursement and competition are the subjects of a series of articles published today on the Health Affairs Web site.

In the first article, Sujit Choudry, an associate professor at the University of Toronto, and two colleagues address the legal implications of trying to combat the migration of highly profitable cases and well-insured patients from general hospitals to ambulatory surgical centers and specialty hospitals.

In a brief response to the paper by Choudhry and colleagues, Clark C. Havighurst, professor emeritus at Duke University School of Law, argues against any legal protections for general hospitals that might lead to monopolies.

Finally, Paul Ginsburg and Joy Grossman of the Center for Studying Health System Change examine the ways in which inaccurate and out-of-date cost data drive the heated competition for highly profitable health care cases.

This paper is being published on the Health Affairs Web site with support from the California HealthCare Foundation.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Additional peer-reviewed papers are published weekly online as Health Affairs Web Exclusives at Health Affairs Web Exclusives are supported in part by a grant from the Commonwealth Fund.

Posted by: Duncan Kinder on Aug 09, 05 | 5:29 pm | Profile

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Outsourcing Patholicial Samples: India Moves Up

As another medical cost-cutting measure, low cost Indian firms are now analyzing pathological samples, according to the Times of India.

Posted by: Duncan Kinder on Aug 09, 05 | 3:24 pm | Profile

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When The Price Isn�t Right: How Inaccurate Payments Drive Expensive Medical Care

Unintentionally inflated prices for certain medical services are spurring intense competition among physicians and hospitals to expand cardiac, orthopedic and high-end imaging services, potentially sparking a powerful new health care cost driver, according to a study by the Center for Studying Health System Change (HSC) published today as a Web Exclusive article in the journal Health Affairs.

�In many communities, hospitals and physicians are racing to expand profitable cardiac and orthopedic care, signaling that we�re inadvertently paying too much for these services,� said Paul B. Ginsburg, Ph.D., lead author of the study funded by the California HealthCare Foundation. Ginsburg is an economist and president of HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

[Note:] Low cost specialty care in precisely fields such as this is what is driving the push to medical tourism in South Asia.]

�This research provides further evidence that some aspects of the health care system have evolved in a direction that is both costly and inefficient,� said Jill Yegian, director of the Health Insurance Program at the California HealthCare Foundation. �Intentional or unintentional, these perverse incentives make the already difficult job of reining in health care spending that much harder.�

Current payment systems often rely on provider charges for services rather than the actual costs of providing care, leading to large differences in profitability when charges and costs diverge, the study finds.

Over time, changes in productivity and costs lead to inadvertent variation in profitability across different services, with many newer, more technologically advanced services likely becoming relatively more profitable. While variation in profitability probably isn�t a new phenomenon, growing financial pressures on physicians and hospitals are leading to increased competition for the more lucrative services.

Faced with stagnant payment rates for professional services, many physicians are growing more entrepreneurial, either by adding capacity for more profitable services in their practices or by investing in freestanding facilities. Advances in technology also have made it possible to offer more services in physician practices and physician-owned facilities.

Hospitals often cite the ability to cross-subsidize less profitable services as a motivation for expansion of profitable services, according to the study. And, in some cases, hospitals are responding to perceived competitive threats from physician-owned facilities.

Congress has focused attention on threats to general hospitals from the growth of physician-owned specialty hospitals, but the competition between physicians and hospitals for profitable services and the threat to hospitals is much broader, according to the study, which is based on findings from HSC�s site visits to twelve nationally representative communities and additional interviews with government officials, industry experts and private insurers. For example, such services as magnetic resonance imaging (MRI), radiation therapy and outpatient cancer care increasingly are being provided in physician practices, where physician self-referral restrictions don�t apply.

The study encourages policymakers to consider options to improve the accuracy of Medicare payment systems, such as subsidizing a sample of providers to provide systematic cost accounting data to the Medicare program or assuming higher rates of capacity utilization for equipment in setting payment rates. The study cautions, however, that policymakers must be willing to spend money to save money.

�Although the amounts are likely to be minuscule in relation to the potential reduction in outlays for benefits, funds for administering Medicare have always been tight,� the article states. �If experience prevails, resources will become available only when a major stakeholder decides this investment is important and effectively advocates for it.�

Posted by: Duncan Kinder on Aug 09, 05 | 1:31 pm | Profile

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Report: Medicaid Cuts Impact Health Centers

As the nation celebrates "National Health Center Week 2005" (August 7-13) and the 40th anniversary of health centers, the National Association of Community Health Centers (NACHC) has released a new report that reveals the challenges health centers face in providing affordable health care to medically underserved communities. The report, entitled, �The Safety Net on the Edge,� chronicles the financial realities health centers face due to Medicaid cutbacks, the rising number of uninsured Americans, and the increasing cost of delivering care. Consequently, patient demand for services is rising at an unprecedented rate and cost at a time when Medicaid cuts are being debated in Congress.

�Health centers are the medical home to more than 15 million patients in rural and urban areas around the country, but as this report finds, that �safety net� is in danger,� said Dan Hawkins, Vice President for Federal State and Public Affairs at NACHC. �Over the last six years, we�ve seen the total number of health centers patients treated increase by more than 45 percent, with large spikes in the low income and uninsured patient categories. At the same time, many states are restructuring Medicaid in an effort to cut costs, resulting ultimately in more uninsured Americans. Our nation�s health centers continue to provide the best care for this rising section of the population, but the long term sustainability of this quality care is threatened if support continues to wane.�

One example of Medicaid restructuring that has impacted coverage is Tennessee�s recent overhauls. The changes have resulted in 2,000 people a day losing their TennCare coverage. On August 1st, 200,000 TennCare beneficiaries lost all prescription coverage, and the coverage of another 97,000 TennCare enrollees who are the sickest may hang in balance. �I know first hand the challenges associated with these cuts on our health center in providing quality patient care,� said Mary Bufwack, Ph.D., Chief Executive Officer of United Neighborhood Health Services of Nashville, Tennessee. �These cutbacks simply cannot be measured by dollar figures and only shift the financial burden onto our health center. The changes resulted in higher numbers of uninsured patients seen at United Neighborhood Health Services.� Bufwack also notes that on the first day that 200,000 TennCare beneficiaries lost their coverage, 50 newly uninsured people signed up for an appointment at United Neighborhood Health Services.

At many health centers, patients have access to dental, mental health, substance abuse, vision, hearing and pharmacy services. In addition to the financial challenges associated with Medicaid cutbacks, health centers have also experienced a reduction in the federal funding available per patient served-- despite increased funding for the program. Also, 17 states slashed direct funding for health centers during fiscal year 2004, and seven states did so during the current fiscal year. The losses amount to $40 million last year and $14 million in 2005. Nevertheless, health centers still provide quality health care to anyone, regardless of their insurances status or ability to pay.

�My family could very easily be among the many Americans you hear about who go without health care because they have run out of affordable options. But we are not-- and the reason is I have a health center to go to at North Hudson Community Action Corporation,� said Adela Santigao, a patient at NHCAC, a health center network in New Jersey. �At North Hudson, my two sons get first class treatment for their allergies and asthma. I get the best OB/GYN services, regular check ups and prescriptions when I need them-- and I have Medicaid to help me with paying my bills."

�This year�s National Health Center Week, along with the 40th Anniversary of health centers, provide a tremendous opportunity to educate the public as to the important role health centers play in their communities and the financial dangers they are facing due to cutbacks and restructuring,� said Hawkins. �This report provides a glimpse into the future financial dangers that community health centers could face, and the continued need to fully fund health centers.�

For more information about health centers, the new report and National Health Center Week 2005, visit

Posted by: Duncan Kinder on Aug 09, 05 | 12:17 am | Profile

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Mon Aug 08, 2005

Luxury Hospitals

While 43 million Americans do without health insurance and cost cutting employers cut company health benefits, luxury hospitals compete for high paying customers by providing art filled waiting rooms and other perks, according to the Detroit News.

On the other hand, the Milwaukee Journal Sentinel describes how a newly designed hospital has been designed to promote health.

Posted by: Duncan Kinder on Aug 08, 05 | 8:59 pm | Profile

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Hospital Finances: The Devil is In the Details

MSNBC, using North Carolina lawsuits that challenge the common hospital practice of failing to disclose hospital charges ahead of time and then charging the uninsured top rates, detail the ins and outs of hospital finances - that make sense to hospital administrators if not to anyone else.

Posted by: Duncan Kinder on Aug 08, 05 | 8:52 pm | Profile

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National Quality Forum Endorses Voluntary Consensus Standard for Patient Safety

The National Quality Forum (NQF) on August 3 announced the endorsement of a National Voluntary Consensus Standard for a patient safety taxonomy. The voluntary consensus standard�representing the consensus of more than 260 healthcare providers, consumer groups, professional associations, purchasers, federal agencies, and research and quality improvement organizations�establishes the nation�s first standardized integrative classification system for healthcare errors and other patient safety problems.

To make healthcare safer, institutions must be able to identify, catalog, and analyze errors and other patient safety concerns. This requires better data on how and when these problems occur. Many healthcare providers, professional organizations, and some states and agencies of the federal government have implemented patient safety reporting systems; unfortunately, the ability to learn from these systems is limited because they do not �talk� to each other.

The NQF project addresses this by endorsing a specific classification system (i.e., taxonomy)�the Patient Safety Event Taxonomy (PSET)�that will enable interoperability of reporting systems and comparability of information across systems and over time. The Joint Commission on Accreditation of Healthcare Organizations developed PSET with the assistance of a work group comprising representatives of provider and health professional organizations and the federal government. To add to overall clarity and to support full implementation of the taxonomy, NQF also endorses definitions of key patient safety terms, standard reporting elements for patient safety reporting systems, and additional recommendations in two areas related to the taxonomy: guiding principles to improve it and the role of the taxonomy in the healthcare information technology infrastructure.

The taxonomy can be used to classify data collected through the various reporting systems used by different healthcare providers, allowing information about patient safety events to be organized, combined, and analyzed. It is not intended to replace existing reporting systems already in use; instead, existing systems should be mapped to this taxonomy and should evolve to align with it.

NQF is a voluntary consensus standard-setting organization. Any party may request reconsideration of the recommendations, in whole or part, by notifying NQF in writing no later than September 2, 2005 (601 13th Street, NW, Suite 500 North, Washington, DC 20005; fax 202.783.3434). For an appeal to be considered, the notification letter must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

NQF is a private, not-for-profit, public benefit corporation established in 1999 to standardize healthcare quality measurement and reporting. Established as a unique public-private partnership, NQF has broad participation from all sectors of the healthcare industry. Visit NQF on the web at

Posted by: Duncan Kinder on Aug 08, 05 | 3:15 pm | Profile

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Sun Aug 07, 2005

California Proposition 79: Drug Companies and Consumers Square Off

Big money is being spent on two competing propositions on the California ballot. Proposition 79, favored by consumer groups, would establish discounts, discourage drug companies that refuse discounts from participating in the state's Medicaid program, and allow consumers to sue drug companies for profiteering. Its rival, Proposition 78, favored by the drug companies, would allow drug companies voluntarily to participate in a discount plan. details the California struggle.

Posted by: Duncan Kinder on Aug 07, 05 | 5:55 pm | Profile

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Sat Aug 06, 2005

LA Times: Retiree Health Benefits Challenge California State and Local Governments

According to the Los Angeles Times, new accounting rules are forcing California's state and local governments to face up to mounting obligations to fund their retired employees' health care.

Posted by: Duncan Kinder on Aug 06, 05 | 1:09 am | Profile

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Thu Aug 04, 2005

Report: British NHS Needs to Broaden Objectives

The British government now needs to broaden its focus from driving down waiting times to ensuring that the British National Health Service (NHS) delivers equal treatment for patients in equal need of it, according to a new report from the King's Fund.

The report, " War on Waiting for Hospital Treatment: What has Labour achieved and what challenges remain?", by Anthony Harrison and John Appleby, is available priced �15 from King�s Fund publications on 020 7307 2591 or by visiting

The report argues the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008, although it warns there are many constraints that could still mean the target is missed. It also suggests the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice.

However, it says that even if the 18-week target is met, it will not be the 'end of waiting' that Ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further, it says, and develop policies to remove variations in access to services and unacceptable differences in the quality of clinical practices.

Report author Anthony Harrison said: "The government is moving in the right direction on waiting times but should use the next two to three years to prepare to go further. Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time.

"Yet we know that access to some non-emergency surgical treatments is lower for people from poorer communities compared to those who are better off, and that the clinical criteria by which patients are treated vary from area to area and even doctor to doctor. More work is needed to determine the scale of the current variations, the reasons for them and the policies likely to be effective in tackling them. But as the 18-week target is approached, the government should put much more emphasis on doing just that."

The government inherited a waiting list of 1.3 million people and a maximum waiting time of 18 months when it came to power in 1997. The War on Waiting for Hospital Treatment , by Anthony Harrison and John Appleby, analyses how the government has reduced this by waging a three-phase campaign against waiting lists and times, and says its policies have become more important and effective at each stage:

* First phase - lasting from 1997 to 2000, the government focused on reducing the number of people waiting through a combination of funds for specific initiatives and advice for NHS trusts
* Second phase - lasting from 2000 to 2004, Ministers set targets in terms of maximum waiting times and introduced a much wider range of policies designed to increase the supply of elective care
* Third phase - starting in 2005, the government set an 18 week 'total' waiting target, including waiting for diagnostic tests, to be met by 2008. Ministers argue that if this is met, waiting for elective treatment will cease to be a major concern for the NHS, and it will be able to turn its attention to other priorities.

King's Fund chief executive Niall Dickson said: "The government has waged a war on hospital waiting that has achieved a degree of success few believed was possible at the start. While they may not be perfect, targets can deliver real improvements and Ministers may well feel confident they will meet the ambitious 18-week target. Waiting lists continue to fall and extra capacity purchased from the private sector is starting to come on stream. But nothing should be taken for granted. The sheer number of patients to treat, the worsening financial climate, the uncertain impact of payment by results and choice, and shortages of staff in key areas all present real challenges for the government and the NHS."

Finally, the report argues that government will need to manage both supply and demand to secure its gains. On the supply side, choice and payment by results could shift work between hospitals and between elective and emergency services, without increasing overall NHS capacity. The government will need to monitor their impact. On the demand side, shorter waiting times could encourage doctors and patients to refer more people into the system. The report says the government needs to look carefully at treatment 'thresholds' to stop this happening and to ensure treatment is clinically appropriate.

Posted by: Duncan Kinder on Aug 04, 05 | 1:59 pm | Profile

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Communication Workers of America Launch Healthcare Website

A new website provides access to the latest information on the state of the health care system and gives working families the opportunity to directly tell their stories.

The site,, is a project of the Communications Workers of America. It's a vehicle for workers to speak out about the health care crisis and to tell members of Congress, policy makers, the media and others that despite skyrocketing costs and expenses, the nation's health care system isn't working.

It also serves as a clearinghouse for the latest news and analysis on health care issues, with reports and findings from the National Coalition on Health Care, Families USA, and other organizations working to find a solution to the country's health care crisis.

"CWA is encouraging working families to share their experiences � the hardships they face and the choices they must make to keep health care coverage. Working families deserve a real solution to this crisis, not empty promises and greater cost shifting," said CWA President Morton Bahr.

CWA has endorsed five key principles for national health care reform: universal coverage, comprehensive benefits, affordability, fair financing, and quality care delivery, and has worked to achieve this reform at the bargaining table, in legislative arenas and in communities.

"Our country's health care crisis can't be fixed solely at the bargaining table," said CWA Executive Vice President Larry Cohen. "Our elected officials must face up to the crisis. CWA will continue to work with coalition partners, including some of our employers, to push for just such a solution. CWA remains committed to the goal of maintaining quality, affordable healthcare for our members."

On the website, workers can submit their stories and health care horror stories, search through the latest surveys and other research from organizations fighting for fair health care reform and can donate to CWA-COPE, with funds distributed to candidates for public office who have committed to working for working families, on health care reform and other important issues.

Posted by: Duncan Kinder on Aug 04, 05 | 12:11 am | Profile

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Wed Aug 03, 2005

California Insurance Commissioner: Californians Pay far too Much for far too Little in a Rapidly Deteriorating System. Reform is Needed Immediately Before System "Collapses"

Warning that California�s health care system is in a �death spiral,� Insurance Commissioner John Garamendi on Wednesday unveiled a comprehensive report outlining his plan to begin reforming the system and bring universal access to health care, according to a press release.

The report, �Priced Out,� details serious problems facing Californians as rising costs burden the entire health system and fray the safety net. Its findings will be used to provide the framework for the concerted effort by Commissioner Garamendi to begin reform of the system and to lay the groundwork for universal access to health care.

During a news conference at Joe�s Pharmacy in San Francisco�s Richmond district, the Commissioner announced that he will hold a hearing in San Francisco this September to address the issues of large deductibles, health savings accounts, and what he calls �skeletal� policies. These policies offer a reduced level of coverage for people priced out of the system, but often at a cost to their long-term health and the overall stability of the health care system.

�There is no more glaring example today of what ails our society than the broken and deteriorating health care system,� Commissioner Garamendi said. �It is being choked by rising costs that have little relation to the ability of employers and patients to pay. This system is well on its way to collapse, and we are all bearing the brunt of its failure.�

Garamendi was joined at the pharmacy by Tony Bastian, owner of the business, whose health care premium for his family and one employee costs $1,100 per month.

Beth Capell, the legislative advocate for �Health Access,� California�s consumer coalition on health care, also attended, as did three consumers who are �priced out� of the health insurance market.

Barbara Brinkerhoff, a 54-year-old San Francisco consumer, shared her nightmare of $36,000 in unpaid bills for surgeries and medicine that she now faces after two years of being unemployed, prior to finding work this April. �My medical bills are so horrendous I don�t know how I�m going to be able to pay them off without possibly filing for bankruptcy,� she said.

The report�s information will help shape the reform effort. Much of the report was generated from a series of high-level health care forums with industry and medical experts from around the state and nation. They included labor and consumer groups, legislators, principals from major health care trade associations, CEOs of health plans, and representatives from pharmaceutical companies.

The report shows that 6.6 million Californians currently have no health insurance at all; premiums for private coverage have soared 60% in the past four years; and families and individuals with coverage are struggling as employers are forced to transfer more of the cost of insurance to their employees.

It also shows that the distribution of the health care dollar is a significant factor in the dysfunction of the system. Nationally, administrative costs account for 31 cents of every dollar spent on health care.

�It is unconscionable that administrative costs are sapping this system of nearly one-third of every dollar, severely limiting resources that could go to patient care,� the Commissioner said. �Some 2,500 people in this state die each year because they have no health insurance, while the crushing financial burden on employers is dampening our economy. We simply must act now.�

He noted that federal and state budget crises leave virtually no new public money to address these problems. �Unless we right this ship,� he said, �we will see a future in which insurers offer inadequate policies that cover fewer services to an ever-shrinking pool of people who can afford them.�

The report contains not only an extensive analysis of the system and its problems, but a series of specific recommendations and action points designed to change fundamentally how health care is delivered. It advocates the creation of a universal health care system, a health program that covers everyone regardless of income, zip code or racial and ethnic characteristics.

In September, the Commissioner will convene a public hearing in San Francisco to address the proliferation of reduced benefit, or �skeletal� health policies. While such policies do provide a measure of coverage for some who would otherwise go without, they do not provide the basic, comprehensive medical care that is essential to building a sustainable health care system.

A second hearing in Los Angeles, later in the year, will focus on how much of each premium dollar goes to providing care for individuals. �It is clear from my report that health insurance companies keep too much of the premium dollar, fattening their executives� wallets and Wall Street purses at the expense of patients and doctors,� said Commissioner Garamendi.

�The structure of compensation for health insurance companies, as well as for the executives who run them, is a major factor in the dysfunction of this current system. We must find a way to determine how much compensation is appropriate and rationally required to provide essential services,� the Commissioner said.

Through education, legislation and regulation, the Commissioner�s effort to reform the system will take focused steps to address immediate concerns, while building toward the long term goal of universal access to care. It will do so through a framework of the following guiding principles:

A copy of the Commissioner�s report, �Priced Out�, is available on the California Department of Insurance web site.

Posted by: Duncan Kinder on Aug 03, 05 | 11:57 pm | Profile

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Nebraska Joins Michigan in Using Accelerated Programs to Fight Nursing Shortage

The University of Nebraska Medical Center has begun an accelerated nursing program that compresses two and one-half years of instruction into one year, according to Omaha

The nation faces not only a nursing shortage but a nursing school instructor shortage, which means that training large number of new nurses is no easy trick. Accelerating nursing programs is intended to boost the productivity of those instructors that do exist.

As previously reported, Grand Rapids is also accelerating its nursing instruction program.

Posted by: Duncan Kinder on Aug 03, 05 | 11:42 pm | Profile

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Tue Aug 02, 2005

Electronic Health Records will Cost $156 Billion to Build and $48 Billion Annually to Operating costs

A study by the Annals of Internal Medicine states that a a national health information network would cost $156 in capital costs and an additional $48 billion annually in operating costs

Posted by: Duncan Kinder on Aug 02, 05 | 11:49 am | Profile

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Mon Aug 01, 2005

(Relatively) Low Medicaid Payments Afflict Vermonts Doctors

Doctors in Vermont find it hard to make ends meet when treating Medicaid patients, according to the Rutland Herald.

According to the article, fifty percent of a doctor's gross goes to overhead, while Medicaid pays approximately fifty percent of what private insurers pay.

Note:The article appears to presume that the solution to the problem is to boost Medicaid payments and not to cut doctor's overhead. It also does not consider whether doctors may be over compensated, have exaggerated financial expectations, and therefore may have a distorted perspective on what may or may not constitute a financial hardship.

Posted by: Duncan Kinder on Aug 01, 05 | 11:15 am | Profile

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