Research Roundup: Soda taxes, health reform timeline, children's health disparities, best hospital practices

Health Affairs: Soda Taxes, Soft Drink Consumption, And Children's Body Mass Index - "Using data on state sales taxes for soda and individual-level data on children," the authors report existing taxes on soda fail to "substantially affect overall levels of soda consumption or obesity rates." However, the authors also found "statistically significant and substantively larger effects of differential soda sales taxes among children who are heavier, have lower family income, are African American, or watch a great deal of TV. This was particularly pronounced for children for whom sugar-sweetened beverages are available at school."

"We can expect that many localities will implement taxes on a variety of foods deemed 'junk' foods, most likely starting with sugar-sweetened beverages, in the near future," the authors conclude. "To have a measurable effect on consumption, taxes need to be tied to consumption, and they need to be larger than the existing state variation in sales taxes" (Sturm et al., 4/1).

A related Health Affairs study examines the effectiveness of policies aimed at reducing childhood obesity by taxing soft drinks and outlines "changes that may increase their effectiveness, such as implementing comprehensive restrictions on access to soft drinks in schools and imposing higher tax rates than are currently in place in many jurisdictions" (Fletcher, Frisvold and Tefft, 4/1).

Pediatrics: Technical Report -- Racial And Ethnic Disparities In Health And Health Care Of Children - The authors review 111 studies and find that "racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care. Methodologic flaws were identified in how such disparities are sometimes documented and analyzed."

"Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. ... Without recognition of child health disparities as pervasive problems, sound methodologies to assess the magnitude of disparities, and rigorous evaluation of disparities interventions, the pediatric community will not be able to realize the vision of the [American Academy of Pediatrics] to attain optimal physical, mental, and social health and well-being of all infants, children, adolescents, and young adults" (Flores et al., 3/29).

Kaiser Family Foundation: Summary Of New Health Reform Law - This summary (.pdf) describes the main provisions of the Patient Protection and Affordability Act, including "provisions to expand coverage, control health care costs, and improve the health care delivery system," according to a Kaiser Family Foundation description of the document (3/29). The foundation also provides a timeline (.pdf) to track the implementation of the comprehensive health reform legislation, beginning in 2010, "including the creation of a national high-risk pool for people with pre-existing conditions that can't buy insurance on their own ... and continues through 2014, when the major reforms to expand access to health coverage are fully implemented" (3/31).

New England Journal of Medicine: Advance Directives And Outcomes Of Surrogate Decision Making Before Death - More than one in four elderly Americans lacked the ability to make a decision about their medical care at the end of life. Drawing from the Health and Retirement Study data and interviews following the patient's death with a family member or someone knowledgeable about the case, the authors found, "Incapacitated subjects who had prepared a living will (regardless of preferences) were less likely to receive all treatment possible … and more likely to receive limited treatment than subjects without a living will. … Living wills were associated with increased odds of receiving comfort care." In comparison, "Subjects who had appointed a durable power of attorney for health care were less likely to die in a hospital … or receive all care possible … than those who had not appointed a durable power of attorney."

"[A]dvance directives are important tools for providing care in keeping with patients' wishes. ... the health care system should ensure that providers have the time, space, and reimbursement to conduct the time-consuming discussions necessary to plan appropriately for the end of life" (Silveira, Kim and Langa, 4/1).

KHN summarized news coverage of the NEJM study (4/1)

Health Research & Educational Trust/American Hospital Association/Commonwealth Fund: A Guide To Achieving High Performance In Multi-Hospital Health Systems - This report outlines several best practices associated with high performing health systems. "Through the use of publicly available quality data, interviews with leaders of 45 multi-hospital health systems, and analysis," the authors identified "three major themes, four major best practice categories and seventeen specific best practices that are associated with high performance."

The themes are: "No one system type was most associated with high performance ... No one factor was clearly associated with high performance ... Creating a culture of performance excellence, accountability for results, and leadership execution are the keys to success" (Yonek, Hines and Joshi, 3/29).

Commonwealth Fund: Primary Care And Prescription Drugs: Coverage, Cost-Sharing, And Financial Protection In Six European Countries - This issue brief examines coverage, cost-sharing and financial protection for primary care and prescription drugs in Denmark, England, France, Germany, the Netherlands and Sweden - countries that "spend significantly less per person on health care than the U.S.," but possess health system outcomes "generally similar to or often better than those in the U.S."

"The European countries generally provide the most financial protection to those with the greatest health needs—people with chronic conditions, poorer households, and children—rather than allowing those individuals to experience the highest costs. This is achieved in a variety of ways, including exemptions and caps on out-of-pocket spending. ... countries should avoid relying on Medigap-style private insurance to protect poorer households from cost-sharing because differences in access to and quality of private insurance can exacerbate inequalities in access to health care." (Thomson et al., March 2010).