Research roundup: U.S. doctors' pay exceeds foreign counterparts; Medicare Advantage prevents some hospitalizations

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

Health Affairs: Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries -- Researchers focused on primary care visits and hip replacements in the U.S., Britain, Australia, Canada, France and Germany and found that, "public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians' counterparts in other countries. ...  higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending"  (Laugesen and Glied, 9/8).

Health Affairs: A Decade Of Health Care Cost Growth Has Wiped Out Real Income Gains For An Average US Family -- Researchers examined income and health care spending from 1999 and 2009 to assess how changing health care costs affect the finances of an "average" family -- a "median-income married couple with two children and employer-sponsored health insurance."  Taking into account monthly spending increases, out-of-pocket spending and health care taxes, the researchers calculated that the difference from 1999 to 2009 and found an extra $95 left to spend on non-health care items per month. However, "had the rate of health care cost growth not exceeded general inflation, the family would have had $545 more per month instead of $95-;a difference of nearly $5,400 per year" (Auerbach and Kellermann, 9/8).

Kaiser Health News' Jordan Rau highlights the major studies in the most recent issue of Health Affairs, which is devoted to increasing health care costs.

Health Care Management Science: Medicare Managed Care And Primary Care Quality: Examining Racial/Ethnic Effects Across States -- This study compares Medicare Advantage (MA) plans to fee-for-service Medicare in three states (Florida, Massachusetts and California) across three different racial groups to see which plan provides the better quality care, "as defined by lowering the risks of preventable hospital admissions." Researchers found that "MA enrollment was associated with significantly lower odds of minority admissions than of white admissions. These results may indicate a potentially favorable role of MA plans in attenuating racial/ethnic inequalities in primary care in some states" (Basu, 9/3).

Journal Of The American Medical Association: Association Of Unconscious Race And Social Class Bias With Vignette-Based Clinical Assessments By Medical Students -- Researchers surveyed  211 medical students entering Johns Hopkins School of Medicine and included an Implicit Association Test (IAT) "to assess unconscious preferences, direct questions regarding students' explicit race and social class preferences, and 8 clinical assessment vignettes focused on pain assessment, informed consent, patient reliability, and patient trust." Results from the survey revealed a majority of students preferred white, upper class patients, though researchers concluded that "Implicit attitudes were not related to clinical assessments or decision making, in contrast to some other studies involving physicians" (Haider et. al., 9/7).

Georgetown University/Kaiser Family Foundation/NORC: Medicare Part D: The Coverage Gap -- This analysis examines "the availability of gap coverage [the so-called 'doughnut hole'] in the private Medicare Part D drug plans offered to beneficiaries in 2011, the first year of the phase-out of the gap, as required under the 2010 health reform law.  ... [As a result]  out‐of‐pocket expenses for beneficiaries who reach the coverage gap are significantly lower in 2011 than in previous years – and will continue to shrink between now and 2020. Nevertheless, some beneficiaries with high drug expenses will still face significant out‐of‐pocket costs after they reach the gap until it is completely phased out, and there is evidence from previous years that beneficiaries reduce their medication use when they reach the gap" (Hoadley et. al., 9/7).

Journal Of The American Medical Association: Lesbian, Gay, Bisexual, and Transgender-Related Content In Undergraduate Medical Education -- After surveying more than 100 medical schools in the U.S. and Canada, the study found a median of five hours are devoted to addressing health care issues for the lesbian, gay, bisexual and transgendered (LGBT) community. Some medical schools have reported that medical practitioners and students ask their patients about their sexual behaviors, but only a few schools reported teaching all 16 LGBT topic areas idenfitied by the researchers. "Only 24.2% of respondents rated their schools' overall coverage of LGBT-related curricular material as 'good' or 'very good'" (Obedin-Maliver et. al., 9/7).