Research roundup: Unraveling why elderly men are tested for prostate cancer; Difficulty paying medical bills

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

Journal Of General Internal Medicine: Medical Center Characteristics Associated With PSA Screenings In Elderly Veterans With Limited Life Expectancy --  Medical guidelines recommend against prostate-specific antigen (PSA) screenings for prostate cancer in men with limited life expectancy, but studies have shown that many elderly men still get the test. This study examined Department of Veterans Affairs (VA) centers to look for medical center characteristics correlated with unnecessary testing. They reported that about a third of the medical centers screened elderly men with limited life expectancy. The study found that geographic location (centers in the South were more prone to testing), a lack of academic affiliation and a high ratio of nurse practitioners and physician assistants to physicians in primary care were associated with the higher screenings (So, Kirby, Mehta et. al., 12/17). 

Center For Studying Health System Change/Robert Wood Johnson Foundation: Medical Bill Problems Steady For U.S. Families, 2007-2010 -- This report, based on 2007 and 2010 household surveys, finds that the share of American families having difficulty paying their medical bills remained fairly stable during that time, despite the economic downturn. The researchers report that more than one in five people were in families that had difficulty meeting those obligations. They suggest that rate may not have increased during the recession because many people concerned about money declined to use health care services. Still, the proportion with medical bill-paying difficulty in 2010 was more than one-third higher than in a similar survey in 2003. The share of nonelderly respondents with medical billing problems "significantly" increased from 16.2 percent in 2003 to 22.4 percent in 2010. Despite federal entitlements like Medicare, the elderly (those 65 and older) faced "higher out-of-pocket spending" and those experiencing billing problems rose from 6.9 percent in 2003 to 10.3 percent in 2010 (Sommers and Cunningham, 12/23).

National Bureau of Economic Research: Take-Up Of Public Insurance And Crowd-Out Of Private Insurance Under Recent CHIP Expansions To Higher Income Children --This report is about the effects of the expansion of the Children's Health Insurance Program (CHIP) between 2000 and 2009 to families with incomes that were higher than historic eligibility thresholds. The researchers explored whether the CHIP expansions created a "crowd out" of private insurance, meaning that families switched their children from their private insurance to the public CHIP programs. They found a "very limited take-up of public insurance among children in families with incomes between 2 and 4 times" the federal poverty level, "with 4 children enrolling for every 100 who become newly eligible." The study also found that the expansion produced only a 2 percentage point reduction in the uninsurance rate among children in those families. "Not surprisingly, given the low uptake of public coverage, crowd-out was limited as well," the study concludes (Gresenz, Edgington, Laugesen, et. al., December 2011).

Inquiry: Do Minority Patients Use Lower Quality Hospitals? -- This study compiled patient discharge data and patient safety quality indicators from 11 states over three years to determine if minority patients are more likely to seek care at low-quality hospitals. In order to determine a hospital's quality, the researchers used patient safety and inpatient quality indicators from the Agency for Healthcare and Research Quality (AHRQ). By focusing on these indicators -- some of which homed in on specific procedures, and medical conditions -- it was incorrect to say that Asians, Hispanics and blacks generally use lower quality hospitals. "We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics  performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis" (Gaskin, Spencer, Richard, et. al., 12/19).