Research roundup: Crowded emergency departments, expensive HIV drugs, high deductible insurance plans

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

RAND: Skin In The Game: How Consumer-Directed Plans Affect The Cost And Use Of Health Care -- Consumer-directed health plans, which feature lower premiums and higher deductibles than traditional plans, are designed to reduce costs by discouraging unnecessary care. This brief describes a study of more than 800,000 households that switched from a traditional employer-based plan to a consumer-based plan. Within the first year, families spent 21 percent less on care; about a third of the reduction was attributed to less spending per care episode, while two-thirds was attributed to fewer episodes total. Families also, however, sought less preventive care -- including childhood vaccinations, mammograms and blood tests. The authors caution that if "patients skimp on highly valuable services that can prevent more costly problems later, the savings [from consumer-directed plans] may be short-lived" (Haviland et al, 6/28).

Journal of the American Medical Association: Duplicate Federal Payments For Dual Enrollees In Medicare Advantage Plans And The Veterans Affairs Health Care System -- The Veterans Affairs system is allowed to bill private health plans for the care it provides to enrollees, but it is not allowed to bill privately run Medicare Advantage plans. This sets up the potential for redundant federal spending as elderly veterans enrolled in an MA plan also visit a VA facility. Researchers in this study found that, from the beginning of 2004 until the end of 2009, more than 1.2 million veterans were enrolled for at least a month in both the VA and a Medicare Advantage plan, and VA spending for the dual enrollees totaled $13 billion. The authors encourage policymakers to "monitor the use of VA services among MA-enrolled veterans and modify payments to MA plans accordingly" (Trevidi et al, 6/26).

RAND: Negotiation Strategies For Antiretroviral Drug Purchasers In The United States -- Antiretroviral drugs continue to be inaccessible and unaffordable for many low-income individuals, and despite the government's leverage through Medicaid and other programs, new strategies are needed for price negotiation with manufacturers. This report looks at several options, including improved price transparency and switching people dually eligible for Medicare Part D and Medicaid to the latter program, which pays less for these antiretroviral drugs. The authors also propose pooling individual states and groups to increase their drug purchasing power. With "greater consolidation of public programs and increased demand for drugs through universal coverage," they note, "public programs might be in a better position to negotiate drug prices" in the future (Linnemayr et al, 6/29).

Annals of Emergency Medicine: National Trends In Emergency Department Occupancy, 2001 to 2008: Effect Of Inpatient Admissions Versus Emergency Department Practice Intensity -- Emergency department crowding can lead to lower patient satisfaction and adverse outcomes. In this study, researchers used federal survey data from 2001 to 2008 and estimated that the number of ED visits increased nearly 2 percent each year, and average occupancy increased more than 3 percent each year. One of the main drivers of crowding was intensity of care, with patients receiving more imaging tests and services, which significantly extended their stays. The data also showed Medicare beneficiaries had increasingly frequent visits, which could be attributed to poor access to primary care. Overall, the authors write, "ED crowding is probably getting worse, not better" (Pitts et al, 6/22).

Here is a selection of excerpts from news coverage of other recent research:

Modern Healthcare: Researchers Find Higher Costs For Medical Homes
Healthcare payment reform is needed for the patient-centered medical-home model to be sustainable, according to a report published online by the Journal of the American Medical Association. The model leads to higher operating costs, and most of the savings generated though reduced hospital admissions and emergency-department visits benefit payers rather than providers, researchers concluded (Robeznieks, 7/2). 

Medscape: Dental Care Disparity Narrows For Black Children
Black children now receive basic dental care at nearly the same rates as white children of the same age, although other racial disparities in oral health status, such as untreated cavities, persist, a new study reports. Inyang A. Isong, MD, MPH, from Massachusetts General Hospital Center for Child and Adolescent Health Research and Policy and Harvard Medical School in Boston, and coauthors report their findings in an article published online July 2 in Pediatrics (Henderson, 7/2).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.