Research roundup: Recession's big impact on men's insurance coverage

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

CDC's Morbidity And Mortality Weekly Report: HIV Prevention Through Care And Treatment
Researchers examined three sets of surveillance data and found that of the estimated 1.2 million persons in the United States living with the human immunodeficiency virus, 942,000 persons were aware of their infection. More than three-quarters of those were "linked to care" and among HIV-infected adults in care, "45 percent received prevention counseling, and 89 percent were prescribed antiretroviral therapy." They concluded: "Prevalence of HIV testing and linkage to care are high but warrant continued effort. Increasing the percentages of HIV-infected persons who remain in HIV care, achieve viral suppression, and receive prevention counseling requires additional effort" (Cohen et al., 11/29).

Archives of Internal Medicine: Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention
The researchers write: "Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI)" They studied PCI hospitalizations and readmissions at one facility from 1998-2008, and found a number of factors -; including being a woman, on Medicare or having less than a high school education -; increased the risk of readmission. They conclude: "Nearly 1 in 10 patients undergoing PCI were readmitted within 30 days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality" (Khawaja et al., 11/28).

New England Journal Of Medicine: Emergency Hospitalizations For Adverse Drug Events In Older Americans
By looking at surveillance data, researchers estimated there were 99,628 emergency hospitalizations for adverse drug events for older adults from 2007-2009. "Nearly two thirds of hospitalizations were due to unintentional overdoses. These preventable errors were rarely based on commonly used medications or medicines that were considered high-risk."  They conclude: "Improved management of antithrombotic and antidiabetic drugs has the potential to reduce hospitalizations for adverse drug events in older adults"  (Budnitz et. al., 11/24). 

Summary of news coverage of this study: Drugs Seniors Use Most Often Cause 60K Hospitalizations Annually (11/26).

Kaiser Family Foundation: Medicare Advantage Plan Star Ratings And Bonus Payments In 2012
The authors write that "the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program's five-star quality rating system, or are unrated. Building on that provision, [CMS] subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their rating." According to the authors, "nationwide, Medicare Advantage plans are projected to receive $281 in bonuses per enrollee for 2012, on average" and conclude that "the bonus payments ultimately may affect market share if beneficiaries begin to shift to plans with higher ratings" (Jacobson et. al., 11/21).

National Bureau Of Economic Research: The Impact Of The Macroeconomy On Health Insurance Coverage: Evidence From The Great Recession
By looking at unemployment rates, researchers estimate that "a one percentage point increase in the state unemployment rate is associated with a 1.67 percentage point reduction in the probability that men have health insurance. ... For women and children, the unemployment rate was not significantly correlated with the probability of health insurance coverage through any source." The new health care law, according to the researchers, should help "moderate the impact of the unemployment rate on the probability of insurance coverage" (Cawley, Moriya and Simon, November 2011).

The Urban Institute/UCSF: Evaluation Of The San Mateo County Adult Coverage And Systems Redesign Initiative
This report examines the San Mateo county's initiative, launched in 2008, to increase "coverage for all uninsured adults below 200 percent of the poverty level and [also] redesigned care in county safety net clinics." The authors found that the program "substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession." They note that "[f]requent turnover in enrollment," made it difficult to provide continuous care. There were also "no reductions in average charges for care before and after systems redesign" (Howell et. al., 11/23).