Research roundup: Medicaid vs. private pay ER use; Doctors treat black, white patients differently; Caregiver stress

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

Annals of Emergency Medicine: National Study Of Barriers To Timely Primary Care And Emergency Department Utilization Among Medicaid Beneficiaries -- By looking at National Health Interview Survey data of more than 230,000 patients from 1999-2009, researchers were able to compare Medicaid with privately insured patients. More than 39 percent of those enrolled in Medicaid in the sample used the ER versus 17.7 percent of privately insured patients. Medicaid patients wer much more likely to have "specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician's office, limited clinic hours, lack of transportation.)"  The authors note that "expansion of Medicaid eligibility alone (in the federal health law) may not be sufficient to improve health care access" (Cheung et. al., 3/14).

National Bureau of Economic Research: Does Universal Coverage Improve Health? The Massachusetts Experience -- The authors write: "Using individual-level data from the Behavioral Risk Factor Surveillance System, we provide evidence that health care reform in Massachusetts led to better overall self-assessed health. ... We also document improvements in several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity. The health effects were strongest among women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law's subsidies" (Courtemanche and Zapata, March 2012).

Urban Institute/Robert Wood Johnson Foundation: Will The Affordable Care Act Move Patient-Centeredness To Center State? -- This paper examines the "patient's changing role" in the health care system in light of the federal health law. The authors examine "patient engagement, patient experience of care, and overall patient centeredness within the context of the ACA and its mandates." It outlines "the growing evidence of benefits from better communication between providers and patients, and involving patients more closely in their care, including greater adherence to medical advice, fewer complaints, fewer malpractice claims and improvement in patient health" (Millenson and Macri, March 2012).

Institute of Medicine: Monitoring HIV Care In The United States: Indicators And Data Systems -- In order to effectively measure the success of the White House's National HIV/AIDS Strategy, the Office of National AIDS Policy commissioned the Institute of Medicine (IOM) to identify what indicators and data systems should be used to measure HIV patients' care and access to support services, especially in light of the health reform law. The report notes that the core indicators "include measures of clinical HIV care, access to treatment for substance abuse and mental health disorders, and access to supportive services, such as housing, transportation, and food assistance, all of which have been shown to influence the overall health of people with HIV" (Volberding et. al., 3/15).

KHN's Capsules blog included coverage of the report: New Report Identifies Barriers To HIV Care In U.S. (Kulkarni, 3/15)

American Journal of Public Health: The Associations Of Clinicians' Implicit Attitudes About Race With Medical Visit Communication And Patient Ratings Of Interpersonal Care -- Researchers used two "implicit association" tests -- online cognitive tests that measure racial attitudes and stereotypes -- and analyzed audio recording of clinician/patient interactions. They found that "clinician implicit race bias and race and compliance stereotyping are associated with markers of poor visit communication and poor ratings of care, particularly among Black patients." For white patients the effect of implicit racial attitudes is largely positive: "White patients report being more respected and liked" (Cooper et al., 3/15).

The National Alliance for Caregiving: Multiple Sclerosis Caregivers 2012 -- Authors surveyed 421 caregivers of Multiple Sclerosis patients. There is great variation among MS patients in disease severity, degree of incapacitation and longevity, and also of what caregivers are providing: "On average, respondents spend 24 hours each week providing care to their care recipient with MS. The range is quite substantial, from just one hour up to 24 hours, 7 days a week." The alliance points out that the survey also found that "86% of family caregivers of people with MS indicated needing assistance in funding to pay for in-home care to help keep their loved one home and out of a long-term care facility" (3/8).

KHN also summarized news coverage of other studies this this week:

JAMA Study: Higher Spending = Better Quality In Canadian Hospitals

Guidelines For Cervical Cancer Screening Revised 

Quality, Access and Cost: It's About Location, Location, Location, A Study Finds