Health policy research roundup

Robert Wood Johnson Foundation: A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey - This brief reviews findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a national survey including the responses of more than 4,700 U.S. physicians who provide "at least 20 hours per week of direct patient care." Among other things, the survey found nearly half of physicians' practice revenue was derived from public sources, with about 31 percent from Medicare and 17 percent from Medicaid. Nearly 60 percent of physicians surveyed reported "providing charity care - defined as free or reduced-cost care - to patients in financial need," according to the study (Boukus et al., Sept. 2009).

Health Affairs: Reducing Racial Disparities In Coronary Angiography - "Despite a great depth of evidence documenting racial disparities in access to cardiac diagnostic and treatment services, few studies have evaluated public policy strategies to reduce these gaps," write the authors of a paper study that examines how hospital regulatory reform by the New Jersey Department of Health and Senior Services in 1996 reduced the racial gap in coronary angiography utilization rates. The authors include comments on the lessons learned from the certificate-of-need reform in New Jersey that may help policymakers in the future (Cantor et al., Sept./Oct. 2009).

University of North Carolina School of Medicine: The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication - "Black patients with high blood pressure experience poorer communication with their doctors than white patients do," finds a recent study (Cene) appearing in the Journal of General Internal Medicine, according to a UNC School of Medicine description of the study. Analysis of audio recordings from patient visits with their primary care provider, including 226 high blood pressure patients and 39 physicians from 15 practices in Baltimore found "black patients had shorter office visits, less biomedical and psychosocial exchange and less rapport building with their doctors than white patients" (9/1).

Commonwealth Fund: Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance, and How Health Care Reform Can Help - "Although an estimated 162 million Americans have health insurance coverage through employers, many workers in small firms—particularly low-wage workers—are left out," write the authors of this issue brief that compares the health insurance experiences of the workers of small businesses (with fewer than 50 people) to the employees of larger businesses, as captured in the Commonwealth Fund 2007 Biennial Health Insurance Survey. Some of the findings include: "in 2007, only 25 percent of employees in small businesses had coverage through their own employers, compared with 74 percent of workers in large firms" and "between 2003 and 2007, the share of workers in small companies who were offered health benefits and also eligible for those benefits declined from 45 percent to 36 percent" while "[w]orkers in large firms experienced no change over the same period," according to the brief. The brief also examines how small businesses would be affected by current health reform proposals (Doty et al., 9/9).

Kaiser Family Foundation: Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage - "This issue brief examines the health care needs and health costs of individuals with special health challenges, focusing on those with low-to-moderate incomes. It finds that even under a benefit package more generous than most offered in the private insurance market, individuals and families can face significant gaps in coverage and large out-of-pocket costs, especially if they have serious health conditions" (Pollitz, Lipster, O'Malley Watts, 9/2009).

Health Affairs: Is Health Spending Excessive? If So, What Can We Do About It? - This paper examines the factors contributing to the U.S.'s high rate of spending on health care and proposals to drive costs down without sacrificing "net welfare." The authors conclude: To lower spending without lowering net welfare, it is necessary to organize the delivery of care to promote efficient cooperation among the many providers and practitioners involved in delivering modern treatment, to conduct costly research over many years to identify which procedures are effective at reasonable cost, to develop protocols that enable providers to identify in advance patients in whom expected benefits of treatment are lower than costs, to design incentives that encourage providers to act on those protocols, and to educate patients on why such protocols should be sustained" (Aaron and Ginsburg, Sept./Oct. 2009).

Group Health Research Institute: Patient-Centered Medical Home Demonstration: A Prospective, Quasi-Experimental, Before and After Evaluation - This study examines the differences in patient and staff experience for those enrolled in a "patient-centered medical home" (PCMH) at Group Health Cooperative in Seattle after one year. Patients in medical homes rated their patient experience higher than those in a control group and had 29 percent fewer emergency room visits and there was less burnout among PCMH staff. After 12 months the study also found there were no significant differences in overall costs between PCMH and control clinics (Reid, Fishman, Yu, Ross, Tufano, Soman and Larson, 9/1).

Health Affairs: Medicare Governance And Provider Payment Policy - "Debates on health reform provide an opportunity to reexamine the underlying structures for decision making that, if uncorrected, could undermine even well-designed policy changes," write the authors of a paper that examines "how governance issues may undermine reform efforts in Medicare, by impairing decision making on provider payment." The paper includes a "framework for analyzing options for reformed decision-making structures," as well as two models for new Medicare decision-making structures (Pham, Ginsburg and Verdier, Sept./Oct. 2009).

Kaiser Famiy Foundation/Lake Research Partners: Oral Histories: Report From a Dental Fair for Uninsured Adults - "This report profiles patients attending a dental fair in rural Virginia to highlight the impact of lack of coverage for oral health services on adults. Uninsured adults have vast oral care needs, and untreated dental problems can have serious health, employment and social consequences, highlighting the relationship between inadequate benefits and unmet health needs." (Perry, Lewis and Paradise, 9/2009). The report includes a video (Judd).