Research roundup: Older consumers' spending on health care; hospital leaders' views of reporting quality

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Employer Benefit Research Institute: How Does Household Expenditure Change With Age For Older Americans?
In 2011, households with at least one member between ages 50 and 64 spent 8 percent of their total budget on health items, compared with 19 percent for those age 85 or over. Health-related expenses occupy the second-largest share of total expenditure for those ages 75 or older [behind home and home-related expenses]. ... For some, health care expenses can be heavily skewed toward the end of life .... To that extent, the difference between mean and median health care expenses for the oldest age group (85 and above) is important. For example, in 2011, while the median health care expenditure for this group was $2,814, the mean was much higher at $6,603 (Banerjee, 9/29).

Annals Of Internal Medicine: Financial Conflicts Of Interest And Conclusions About Neuraminidase Inhibitors for Influenza: An Analysis Of Systematic Reviews
Industry funding and financial conflicts of interest may contribute to bias in the synthesis and interpretation of scientific evidence. Objective: To examine the association between financial conflicts of interest and characteristics of systematic reviews of neuraminidase inhibitors [antiviral drugs used to fight influenza]. ... Reviewers with financial conflicts of interest may be more likely to present evidence about neuraminidase inhibitors in a favorable manner and recommend the use of these drugs than reviewers without financial conflicts of interest (Dunn et al., 10/7).

JAMA Internal Medicine: Attitudes Of Hospital Leaders Toward Publicly Reported Measures Of Health Care Quality
We mailed a 21-item questionnaire from January 1 through September 31, 2012, to senior hospital leaders from a stratified random sample of 630 US hospitals .... For each of the mortality, readmission, process, and patient experience measures, more than 70% of hospitals agreed with the statement that "public reporting stimulates quality improvement activity at my institution" .... A similar pattern was observed for the statement that "our hospital is able to influence performance on this measure"; ... When compared with chief executive officers and chief medical officers, respondents who identified themselves as chief quality officers or vice presidents of quality were less likely to agree that public reporting stimulates quality improvement (Lindenauer et al., 10/6).

Health Affairs: Specialty Drug Coupons Lower Out-Of-Pocket Costs And May Improve Adherence At The Risk Of Increasing Premiums
[W]e examined the prevalence of specialty drug coupons and the degree to which these reduced patients' out-of-pocket costs, focusing on 264,801 prescriptions. ... We found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. However, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs (Starner, 10/6).

CDC's Morbidity and Mortality Weekly Report: Hispanics Or Latinos Living With Diagnosed HIV: Progress Along The Continuum Of HIV Care -; United States, 2010
The results of the analysis described in this report indicate that, in 2010, among adult and adolescent Hispanics or Latinos of all age groups and both sexes who were diagnosed with HIV, 80.3% were linked to care, 54.4% were retained in care, 44.4% were prescribed ART [antiretroviral therapy], and 36.9% had achieved viral suppression. Across the HIV care continuum, Hispanics or Latinos have higher percentages of linkage to and retention in care and ART prescription compared with the national population of persons with HIV, but they have a lower percentage of viral suppression compared with the same national population. ... Hispanics or Latinos with HIV infection might not seek, receive, or adhere to HIV care or achieve viral suppression for reasons including lack of health insurance, language barriers, geographic differences, and migration patterns (Gant et al., 10/10).

Kaiser Family Foundation: Visualizing Health Policy: The 2014 Ebola Outbreak
This Visualizing Health Policy infographic provides a snapshot of the 2014 Ebola outbreak in West Africa. It includes key facts about the Ebola virus, shows how the number of Ebola cases in the current outbreak outstrips the case total from all previous Ebola outbreaks, and offers a summary of the key U.S. agencies responding to the crisis and the roles they are playing (Michaud et al., 10/8).

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

Politico Pro: Specialty Drugs Could Make Up Half Of All Pharmacy Spending By 2018
Spending on high-priced specialty drugs is growing at 15 percent per year and will require a broad range of tools to manage their cost, but they may be worth their money in the value they're delivering to patients, according to reports in a special edition of Health Affairs devoted to the trend published Monday. By 2018, specialty drugs, often defined as costing more than $600 per treatment, will account for about half of all pharmacy spending in 2018 -; or $235 billion -; a rapid escalation that the insurance industry warns could make care unaffordable for many if not brought under control (Norman, 10/6).

Modern Healthcare: Hospitals Newer To 340B Drug Discounts Found To Serve Less Needy Patients
Hospitals that joined the federal 340B drug discount program after 2004 were more likely than other participants to serve wealthier communities with higher rates of health insurance, according to a new study. ... The authors of the study, published Monday in the journal Health Affairs, ... [who] have been critical of the 340B program – matched data for 960 DSH hospitals and 3,694 affiliated clinics participating in the 340B program in 2012 against socioeconomic data about communities from the US Census Bureau (Lee, 10/6).

Related, earlier KHN story: Drug Discount Policy For Hospitals, Clinics Under Scrutiny (Carey, 6/23)

MinnPost: 'Decision Fatigue' Leads To Overprescribing Of Antibiotics, Study Finds
Doctors are much more likely to prescribe antibiotics unnecessarily to a patient with an acute respiratory illness if that patient is seen by the doctor toward the end of the doctor's morning or afternoon shift in the clinic, according to a study published Tuesday in JAMA Internal Medicine. The finding suggests, say the study's authors, that doctors are prone to "decision fatigue," a well-observed psychological phenomenon in which the very act of making repeated decisions erodes the self-confidence of the decision-maker, causing him or her to make easier and safer choices (Perry, 10/7).

San Francisco Chronicle: More Parents Turning To Online Reviews For Doctors
Americans turn to online reviews to decide which gadget to buy, which restaurant to dine in and -; increasingly -; which doctor to visit. A new study in the journal Pediatrics reveals that almost three-quarters of parents are aware of physician-rating websites, but just more than one-quarter have used the sites to choose their children's pediatrician. Researchers at the University of Michigan surveyed more than 1,600 parents nationwide and found that mothers are more likely than fathers to value physician-review sites, which include Healthgrades, Vitals.com and Angie's List. Parents under age 30 were more likely to use the sites than those 30 and older (Roethel, 10/8).

Boston Globe: 'Exceptional Responders' May Point To Personalized Cancer Therapy
Physicians have traditionally viewed the rare cancer patients who bounce back from near-certain death as inspiring anecdotes, not science. But a study published by a Boston team Wednesday in the New England Journal of Medicine highlights a radical shift in thinking: researchers are harnessing a powerful arsenal of biomedical tools to unlock the secrets of individual "exceptional responders" (Johnson, 10/8). 

The New Republic: Share Your Chocolate. It'll Make It Taste Better.
If you've ever felt like a killjoy when turning down a drink or a dessert, new research may confirm your fear. It's not just yourself you're depriving; you may actually make the experience less fun for companions who do indulge. This effect is so strong that even if the person you're with is a total stranger and you're both sitting in silence, whether or not you participating in an activity can make a meaningful difference in the amount of pleasure your companion gets out it. A team of Yale psychologists, led by graduate student Erica Boothby, demonstrate this effect in a new paper in the journal Psychological Science (Robb, 10/6).