Recent health policy studies and analyses

The Urban Institute: Age Rating Under Comprehensive Health Care Reform: Implications for Coverage, Costs, and Household Financial Burdens - The authors of this study brief compare the "financial implications of the premium rating policy," as outlined in the House Tri-Committee proposal (H.R. 3200), across households of different ages, incomes, and sizes. "While subsidies provided by the federal government to those with incomes below 400 percent of the federal poverty level ameliorate the lion's share of premium differences due to the choice of rating, rating differences will significantly alter health care financing burdens for the youngest and oldest adults and families with higher incomes," according to the authors. "In order to make combined premium and out-of-pocket health care burdens affordable by conventional standards for this older middle income population, premium subsidies could be extended to higher incomes than are currently being considered or the variance in age-rating bands could be limited to a maximum of 2:1, perhaps with a plan to phase down further over time" (Blumberg, Buettgens and Garrett, Oct. 2009).

Commonwealth Fund: Supporting Culture Change: Working Toward Smarter State Nursing Home Regulation - This brief examines the growing interest at the state and federal levels to transition away from a traditional regulatory model of nursing homes. The authors of the brief discuss the importance of a model that "strike[s] a balance between the traditional regulatory approach to weed out substandard facilities and a partnership model aimed at promoting high performance" as well as the need to train health providers and regulatory staff in preparation for such changes, according to a Commonwealth Fund description of the brief (Stone, Bryant and Barbarotta, Oct. 2009). An accompanying podcast examines the changing culture of nursing home regulation (Housman, 10/8).

Robert Wood Johnson Foundation: The Effect Of Reimbursement On Medical Decision Making: Do Physicians Alter Treatment In Response To A Managed Care Incentive? - An analysis of survey data from the National Ambulatory Medical Care Survey (NAMCS) finds physicians spend less time with capitated patients, or those for whom a physician "receive[s] a set fee … that is meant to reflect the actuarial cost of care the patient is expected to require," compared to noncapitated patients. The article, published in the Journal of Health Economics, reveals the effects of capitation on medical practice (Melichar, Oct. 2009).

Kaiser Family Foundation: The Uninsured: A Primer - "This primer, updated with 2008 data, reviews the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, key issues in increasing coverage and basic statistics on the uninsured," according to a Kaiser Family Foundation description of the report (Kaiser Commission on Medicaid and the Uninsured, 10/13).

Commonwealth Fund: Incremental Cost Estimates For The Patient-Centered Medical Home - "Despite wide and growing interest in the medical home approach, little is known about the costs it entails," write the authors of this paper, which analyzes data from 35 practices to determine "the relationship, if any, between costs and medical home activities." The authors report they "do not find evidence of additional costs associated with higher levels of 'medical homeness,' with the exception of information technology costs, which show a modest but statistically significant increase with medical home intensity" (Zuckerman et al., Oct. 2009).

UCLA Center for Health Policy Research: African Americans In Commercial HMOs More Likely To Delay Prescription Drugs And Use The Emergency Room - An analysis of data from the 2007 California Health Interview Survey (CHIS) finds that African Americans enrolled in commercial HMOs in California are more likely to use the emergency room and delay obtaining medications than other racial/ethnic groups in comparable HMO plans. "In light of the existence of potential barriers to accessing appropriate medical care for African Americans with HMO coverage, greater effort is needed to identify ways to encourage African Americans to obtain needed prescription drugs in a timely manner and avoid ER use if adequate primary or specialty care is available in their community at a reasonable cost," the authors write (Roby, Nicholson and Kominski, Oct. 2009).

RAND Health: Health and Health Care Among District of Columbia Youth - A study of 100,000 youth living in Washington, D.C., finds that "[d]espite high rates of health insurance coverage among children … [their] access to health care is inadequate and poses a significant health problem for the city's young residents, particularly those who are publicly insured," according to a RAND description of the report. Among other things, the researchers recommend the development of strategies to increase children's access to primary and specialty care, interventions for children with particular health needs and increased efforts to continuously and comprehensively monitor children's health (Chandra et.al, 10/8).

UCLA Center for Health Policy Research: Migration & Health: The Children Of Mexican Immigrants In The United States - This report examines the barriers the more than 6 million children of Mexican immigrants face in accessing health care in the U.S., compared to native born white children, African American children, and the children of immigrants from other countries. Although most of the children born to Mexican immigrants are U.S. citizens because they were born in the U.S., the study found, among other things, "[t]hey are about three times more likely than other children in the U.S. to be uninsured (19.4 percent vs. 6.8 percent)" and "three times more likely than children of U.S. born whites to have no usual place to obtain regular medical care (13.8 percent versus 3.9 percent)," according to a UCLA Center for Health Policy Research description of the study (Wallace, Leite, Castaneda and Schenken, 10/5).