Research roundup: Patient's income and electronic health records; high deductible plans; raising Medicare age

Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and briefs:

American Journal of Managed Care: Healthcare Spending And Preventive Care In High-Deductible And Consumer-Directed Health Plans - Authors analyzed data from more than 800,000 families insured during 2004 and 2005 through one of 53 large employers in U.S., about half offering the high-deductible or consumer-directed plans. They write that in the first year after families enrolled in one of those options, "spending was 14% lower than that for comparable families" in a more traditional insurance plan. The families were also less likely to receive preventive services, including child immunizations as well as recommended cancer and diabetes screenings (Buntin, Haviland, McDevitt and Sood, 3/25).

Archives of Internal Medicine: The Digital Divide In Adoption And Use Of A Personal Health Record - Although personal health records (PHRs) "have great potential to improve care, … this potential will go unrealized unless patients adopt PHRs and then use them with some frequency, making evaluation of both adoption and use important," according to this study that compared the demographic characteristics of patients who registered for PHRs versus those who did not in a "large integrated delivery system in the Northeast." The authors found that "blacks and Hispanics were half as likely to adopt the PHR compared with whites," and low-income patients were less likely to adopt them than those with high incomes. "However, once patients had adopted the PHR, race/ethnicity was much less strongly associated with number of log-ins and [income] had no association, suggesting that the key target for bridging the digital divide may be at the adoption level"(Yamin et al., 3/28).

Agency for Healthcare Research and Quality: Health Literacy Interventions And Outcomes: An Updated Systematic Review - This review explores possible interventions to improve use of health care services, outcomes and costs of care. Based on analysis of 140 previously published articles (123 studies) that included data on the topic, the study authors report, "Moderate evidence about health care service use showed that lower health literacy was associated with increased hospitalization (five studies), greater emergency care use (nine studies), lower use of mammography (four studies), and lower receipt of influenza vaccine (four studies)."  However, "[e]vidence was insufficient to evaluate the relationship between differences in health literacy levels and costs" (Berkman, Sheridan et al., 3/28).

Additionally, an AHRQ summary of the report notes that federal health officials have called "for improving the jargon-filled language, dense writing, and complex explanations that often fill patient handouts, medical forms, health web sites and recommendations to the public" (3/28).

Related, earlier KHN story: Helping Patients Understand Their Medical Treatment (Boodman, 3/1) 

Government Accountability Office: Private Health Insurance Coverage: Expert Views On Approaches To Encourage Voluntary Enrollment - In this report, experts have a variety of approaches on increasing health insurance coverage: "Modify open enrollment periods and impose late enrollment penalties; Expand employers' roles in autoenrolling and facilitating employees' health insurance enrollment; Conduct a public education and outreach campaign; Provide broad access to personalized assistance for health coverage enrollment; Impose a tax to pay for uncompensated care; Allow greater variation in premium rates based on enrollee age; Condition the receipt of certain government services upon proof of health insurance coverage," among other ideas. The GAO, which did not endorse any approach, noted that the experts "emphasized that independent research is required to fully evaluate the potential effectiveness and legal or other implications associated with any approach or combination of approaches" (3/25).

Commonwealth Fund: The Essential Health Benefits Provisions Of The Affordable Care Act: Implications For People With Disabilities - The Affordable Care Act (ACA) has the potential to "transform the health insurance market for people with disabilities, enabling them to secure access to more affordable coverage. … Beyond the threshold issue of access … lies an equally important question: whether coverage will be appropriate to their health and health care needs or will leave them at risk for insufficient and ineffective care along with significant out-of-pocket financial exposure," write the authors of this issue brief (Rosenbaum, Teitelbaum and Hayes, 3/24).

Kaiser Family Foundation: Raising The Age Of Medicare Eligibility: A Fresh Look Following Implementation Of Health Reform - This report  explores the effects of raising the Medicare eligibility age to 67 in 2014, under full implementation of the health law. While federal spending would be reduced by $7.6 billion, the eligibility change would "result in an estimated net increase of $5.6 billion in out-of-pocket costs for people who would otherwise be covered by Medicare." Additionally, the authors report, "[p]remiums in the Exchange would rise for adults under age 65 by three percent (an additional $141 per enrollee in 2014), on average, due to the shift of older adults from Medicare into the pool of lives covered by the Exchange" and "Medicare Part B premiums would increase by three percent in 2014, as the deferred enrollment of relatively healthy, lower-cost beneficiaries would raise the average cost across remaining beneficiaries" (Neuman et al., 3/29).

Related KHN story: Study Finds Raising Medicare Age Would Shift Costs (Carey, 3/29)