Research roundup: Restricting Medigap coverage; Hospital-acquired infections

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Archives Of Surgery: Increases In Mortality, Length Of Stay, And Cost Associated With Hospital-Acquired Infections In Trauma Patients -- This study explores the clinical and economic burden of hospital-acquired infections, the most common complication in hospitalized patients, for trauma patients. The authors write, "In light of the preventability of many HAIs, obtaining a better understanding of the clinical impact of HAI on outcomes in trauma patients may provide the impetus for the implementation of best practices for infection control in injured patients." Looking at a nationwide hospital patient sample from 2005 and 2006 the study found trauma patients who contract an infection in the hospital "are at increased risk for mortality, have longer lengths of stay, and incur higher inpatient costs" (Glance, et al., 7/1).

Health Affairs: Contradicting Fears, California's Nurse-To-Patient Mandate Did Not Reduce The Skill Level Of The Nursing Workforce In Hospitals -- The study looks at the result of a 1999 law passed in California that mandated a minimum nurse-to-patient staffing ratio in hospitals. The authors compared California hospital staffing to other hospitals of similar size across the country from 1997 to 2008. Their research shows that "that California's mandate did not reduce the nurse workforce skill level as feared. Instead, California hospitals on average followed the trend of hospitals nationally by increasing their nursing skill mix, and they primarily used more highly skilled registered nurses to meet the staffing mandate" (McHugh, et al., 7/15).

Health Affairs: Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths -- This study analyzed whether changes in spending at the 3,000 local public health agencies over 13 years had an effect on mortality from preventable causes of death, "including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending." But the researchers noted that money alone could not sustain these improvements: "higher levels of spending may contribute to improved population health if resources are allocated to activities that are effective in reducing health risks, and if these activities are targeted successfully to population groups at risk" (Mays and Smith, 7/21).

Annals Of Internal Medicine: Low Health Literacy And Health Outcomes: An Updated Systematic Review -- This study is an update of a 2004 "systematic review" of studies that concern the approximately 80 million Americans with "low health literacy." The authors found that "low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes (Berkman et al., 7/19).

Kaiser Family Foundation: Medigap Reforms: Potential Effects Of Benefit Restrictions On Medicare Spending And Beneficiary Costs -- This report details three options for changes in Medigap. The first -- a plan with a relatively high deductible for Medicare Part A and B and a out-of-pocket spending limit -- would reduce federal Medicare spending by $4.6 billion a year. The second, which would save about half as much, has a lower annual deductible and a lower out-of-pocket limit. The third would have a cost-sharing requirement for physician and emergency room visits and would save the program about $1.5 billion. The report also finds: "Under each of the options, enrollees would see an increase in average out-of-pocket spending for Medicare-covered services, as their Medigap policies become less generous. As a result of higher cost-sharing requirements, beneficiaries with Medigap could be expected to use fewer Medicare-covered services, leading to a decrease in average Medigap premiums" (Merlis, 7/20).

Related, from KHN: FAQ: Seniors May See Changes in Medigap Policies (Appleby, 7/15).