Research roundup: Hospital care in U.S. territories lags; health spending unevenly distributed

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Archives Of Internal Medicine: Quality Care In The U.S. Territories -- This study examines the quality of hospital care in the U.S. territories -- Puerto Rico, Guam, the Northern Mariana Island, and the U.S. Virgin Islands -- and compares it to care in the states. By assessing the readmission and discharge rates of patients diagnosed with specific conditions, the authors found, "Compared with hospitals in the U.S. states, hospitals in the U.S. territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients" discharged after myocardial infarction, heart failure or pneumonia (Nunez-Smith, et. al., 6/27).

The Journal Of General Internal Medicine: The Patient-Doctor Relationship And Online Social Networks Result Of A National Survey -- This study quantifies the use of online social networks among practicing physicians, medical students and resident physicians. Slightly more than 15 percent of practicing physicians were likely to "visit the profile of a patient or a patient's family member" and more than a third of them said they had received friend requests from patients or patients' family members. However, "a majority of respondents view these online interactions as ethically problematic." Most thought doctors should not interact online with patients for social or professional reasons and many thought privacy could be a concern (Bosslet, et. al., 6/25).

National Institute For Health Care Management: Understanding U.S. Health Care Spending -- This report assesses health care spending. According to the National Health Expenditure Accounts (NHEA), U.S. spending on health care reached $2.5 trillion in 2009, with just 5 percent of the population responsible for half of that spending. The report states that the high-spenders in health care include those over 55 who rate their health as poor or fair. Several factors play a role in this increase, but "the weight of the evidence indicates that spending increases in recent years have been driven more by growth in the unit price of services than by growth in the volume of services consumed" (6/24).

Kaiser Family Foundation: Health Coverage For the Unemployed -- This brief looks at the challenge for unemployed workers to keep health insurance, especially in the current economic downturn when nearly 14 million Americans are out of work. They have several options. COBRA plans are available to those who were insured through their employer, and some people who lose jobs with coverage turn instead to insurance offered through a spouse's job. They can also buy a policy in the individual market, but the high premiums often make this a unappealing option. The authors conclude that since the economy remains weak, many consumers could be without work for extended periods of time, but by 2014, provisions of the health law will "offer new and more affordable coverage options for the unemployed through an expansion of the Medicaid program and the creation of Health Insurance Exchanges with subsidized insurance to facilitate the purchase of private coverage" (Schwartz and Streeter, 6/23).

Center on Budget and Policy Priorities and the Kaiser Family Foundation: Online Applications For Medicaid And/Or CHIP: An Overview Of Current Capabilities And Opportunities For Improvement -- This issue brief reports that 32 states offer online applications for Medicaid and the Children's Health Insurance Program (CHIP) but the way they operate varies significantly. The authors analyze how the electronic options affect consumers and what lessons can be taken as states expand their Medicaid programs under the federal health law and are required to create joint online applications for Medicaid, CHIP and new premium credits and cost-sharing subsidies for Exchange coverage." They find, "there is still a substantial amount of work ahead to develop applications that will fulfill the functions and requirements outlined under the" health law (Gonzales and Artiga, 6/23).