Research roundup: Closing E.R.S; Predicting future health costs; Providing rural residents with specialized care

Shefali S. Kulkarni compiled this selection of recently released health policy studies and briefs:

Journal Of The American Medical Association: Factors Associated With The Closures Of Emergency Departments In The United States -- This study looks at the community, market and medical factors that led to an increase of urban hospital-based emergency department closures. Emergency departments serve all patients regardless of insurance, but from 1990 to 2009 the number of these facilities declined despite an increase in more publicly insured and uninsured patients. The study concluded that "from 1990 to 2009, the number of hospital EDs in nonrural areas declined by 27%, with for-profit ownership, location in a competitive market, safety-net status, and low profit margin associated with increased risk of ED closure" (Hsia, Kellermann and Shen, 5/18).

PwC Health Research Institute: Behind The Numbers: Medical Cost Trends For 2012 -- This report looks at the possible fiscal trends for health care in 2012 and the factors that will influence them, projecting that "medical costs for workers are expected to increase 8.5% in 2012, up from an 8% increase in 2011." And while the study reports that health care reform will have a minimal impact on medical cost increases, "health reform is pressuring employers, providers, insurers and drugmakers, to be more cost conscious. They'll be held more accountable for costs as well as performance while coping with new tax and government payment regulations" (Barnes et al., May 2011).

Health Affairs: Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care -- This study examines an innovative model of health care called Project ECHO (Extension for Community Health Care Outcomes) in New Mexico, which "creates partnerships between primary care providers in rural and underserved areas and specialty care providers at academic medical centers that allow for the sharing of new knowledge in real time. These partnerships exponentially boost the health care system's ability to deliver specialty care to people who otherwise would lack access." This model of health care uses telehealth technology and primary care physicians and specialists at the University of New Mexico Health Sciences Center to combat patients with chronic illnesses such as hepatitis C, asthma and diabetes. (Arora et al., May, 2011).

Academic Pediatrics: A National And State Profile of Leading Health Problems And Health Care Quality For U.S. Children: Key Insurance Disparities And Across-State Variations -- This study evaluated health problems and the "special health care needs" among children in the U.S. in order to assess health care quality and coordination with insurance coverage. Of the children examined, 43 percent had at least 1 of 20 chronic conditions assessed and that "the prevalence, complexity, and severity of health problems were systematically greater" for children on public programs such as CHIP. "Findings emphasize the importance of health care insurance duration and adequacy, health care access, chronic condition management, and other quality of care goals reflected in the 2009 CHIPRA legislation and the ACA" (Bethell et al., May 2011).

Kaiser Commission on Medicaid and the Uninsured: Ensuring Access To Care In Medicaid Under Health Reform -- This issue brief focuses on the key issues raised at a recent meeting, including "opportunities to more fully realize existing capacity and to improve care through more integrated approaches to organizing and delivering services. It identified gaps in access to care in Medicaid and policies to help to close them, as well as strategies to elicit more robust provider participation in the program. Participants also identified key issues as states consider extending managed care to newly eligible Medicaid adults. Finally, the discussion revisited longstanding questions about the relative strengths and advantages for Medicaid beneficiaries of care provided by a robust safety-net system and "mainstream" care, respectively (5/18).  

The Commonwealth Fund: Realizing Health Reform's Potential: Maintaining Coverage, Affordability, And Shared Responsibility When Income and Employment Change -- This issue brief looks at how life changes, such as family income, size and employment could impact health coverage when the federal health law is fully implemented. They conclude: "Policy recommendations to reduce uncertainty, simplify coverage decisions, and minimize insurance transitions include extending coverage to the open enrollment period at the end of the year, generous treatment of income gains in correcting premium tax credits, and unifying the small-business and individual exchanges" (Farley Short et al., 5/19).