Health Policy Research Roundup: New Orleans clinic experiences, health reform and lagging biomedical research funds

Journal of the American Medical Association: Funding of US Biomedical Research, 2003-2008 - After doubling in a decade, the rate of increase in biomedical research in the U.S. has slowed since 2005, and the level of funding from the National Institutes of Health and industry appears to have decreased by 2 percent in 2008, after adjusting for inflation, the authors of this study report. The researchers note "industry remained the largest contributor to biomedical research, accounting for 58% of all expenditures in 2007," followed by NIH, accounting for 27 percent of all expenditures. According to the researchers, "The cost of care in the current era will be an even greater influence on research investment than it has been in the era just concluded. The United States and other developed countries have aging populations, greater burdens of chronic diseases, an increased sense of obligation toward disease in the developing world, and new or refractory infections (eg, 2009 influenza A[H1N1]) of public health import. Economic limitations are also palpable as the United States considers alternatives to private insurance, limits to public funding, and more realistic actuarial assumptions" (Dorsey et al., 1/13).

Kaiser Family Foundation/Georgetown University Health Policy Institute: Issues for Structuring Interim High-Risk Pools - "One of the first provisions that would be implemented under federal health reform bills in the House and the Senate would establish a national high-risk pool program to offer coverage to otherwise uninsurable individuals during the interim period between enactment and implementation of broader health care reform," writes the author of this paper (.pdf) which "examines the role of high-risk pools as a coverage safety net today and reviews key issues involved in implementing a national high-risk pool" (Pollitz, 1/7).

Commonwealth Fund: The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs - This report provides an overview of the provisions in The Affordable Health Care for America Act (H.R. 3962) and The Patient Protection and Affordable Care Act (H.R. 3590) that aim to expand and improve health insurance coverage in the U.S. The report highlights differences between the bills, including information on the number of people who would likely gain coverage under the two bills, estimates premium and out-of-pocket costs for families and new national insurance regulations (Collins et al, Jan. 2010).

Urban Institute: Reconciling House and Senate Health Reform Proposals: Eligibility, Enrollment, and Retention Policies That Will Maximize Health Coverage Among the Low-Income Uninsured - "If policymakers want health reform legislation to maximize health coverage among low-income, uninsured Americans who qualify for help, eligibility rules for all subsidies—Medicaid, the Children's Health Insurance Program (CHIP), and premium and cost-sharing assistance in the exchange—need to make enrollment and retention simple, seamless, and as automatic as possible for consumers." The author of this paper (.pdf) proposes the use of a single application form and eligibility system for all subsidies under the health overhaul (Medicaid, CHIP, subsidies in the exchange) and base eligibility on government data, when possible; a procedure for Medicaid eligibility similar to those planned for the exchanges and a "compromise between annual eligibility periods in Senate and 'real time' eligibility updates in the House bill" (Dorn, 1/13).

New England Journal of Medicine: Public Reporting of Discharge Planning and Rates of Readmissions - "Despite the interest in ensuring effective discharge planning (in part because of its presumed impact on decreasing unnecessary readmissions), there are few empirical data to support this approach or guide policymakers," write the authors of this study that explores the association between readmission in U.S. hospitals and performance on two discharge planning measures (chart-based and patient reported). Though the study authors found "large variations in readmission rates across health care markets," their analysis revealed "no association between performance on the chart-based measure and readmission rates among patients with congestive heart failure … and only a very modest association between performance on the patient-reported measure and readmission rates for congestive heart failure … and pneumonia." The authors conclude: "Our findings indicate that improvements in performance on current measures of discharge planning are unlikely to have a meaningful effect. The large variation in readmission rates across health care markets suggests ample opportunity for improvement, but to substantially reduce readmission rates, we will probably need new strategies to improve transitional care in the ambulatory sector" (Jha, Orav and Epstein, 12/31).

Kaiser Family Foundation: Access to Abortion Coverage and Health Reform - This issue brief (.pdf) explores the ongoing debate in the House and Senate regarding abortion coverage under health reform. The brief examines current law regarding federal and state policies that address abortion coverage and the impact future legislation may have on such services (Ranji and Salganicoff, 1/7).

Commonwealth Fund/Urban Institute: COBRA Subsidies for Laid-Off Workers: An Initial Report Card - This issue brief examines the early outcomes of the subsidies extended to workers through the American Recovery and Reinvestment Act of 2009 (ARRA) to cover the majority of their COBRA costs. "COBRA is very valuable for those who can use it but targets only one segment of the nation's uninsured. ... Laid-off workers with low incomes are disproportionately left behind, as they are more likely to have lacked employer health benefits before they were terminated—and thus are ineligible for COBRA and the subsidy," the study authors write. The brief also highlights lessons learned from the ARRA experience that could applied to a comprehensive reform (Bovbjerg, Dorn, Macri and Meyer, Dec. 2009). 

Commonwealth Fund: Coming Out of Crisis: Patient Experiences in Primary Care in Four Years Post-Katrina - Despite being disproportionately low-income and uninsured, safety-net clinic patients in New Orleans are less likely to forgo medical care due to costs compared to most U.S. adults (41 percent vs. 27 percent). The survey of more than 1,200 adults, ages 18 to 64, who attend 27 primary care and pediatric clinics in New Orleans that received funding from the Primary Care Access and Stabilization Grant (PCASG), also found clinic patients were less likely to report inefficiencies in their care than the general population (4 percent vs. 34 percent). Clinic patients also experience greater accessibility to same-, next-day, or after-hours medical care compared to the general population of New Orleans (80 percent vs. 54 percent). "The early experience from the PCASG clinics in Louisiana shows that a comprehensive approach that is carefully planned and locally implemented—with shared resources and ample support for community clinics—has the potential to provide better-quality care for our nation's most vulnerable populations," the authors conclude (Doty et al., 1/15).

Journal of General Internal Medicine/American College of Physicians: Family Caregivers, Patients and Physicians: Ethical Guidance to Optimize Relationships - This paper (originally approved by the American College of Physicians Board of Regents on July 13, 2008) outlines four primary principles to help guide physicians in developing mutually supportive patient-physician-caregiver relationships: "Respect for the patient's dignity, rights, and values should guide all patient-physician-caregiver interactions; Effective communication and physician accessibility are fundamental to supporting the patient and family caregiver; The physician should recognize the value of family caregivers as a source of continuity regarding the patient's medical and psychosocial history and facilitate the intellectual and emotional transition to the end stage of serious chronic illness; When the caregiver is a health care professional, the physician should draw appropriate boundaries to ensure that the caregiver is not expected to function in a professional capacity in relation to the patient and that the caregiver receives appropriate support, referrals, and services" (Mitnick, Leffler, and Hood, 1/12).