Research roundup: Widows and medical spending; disparities in heart care, hospital deaths

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

National Bureau of Economic Research: Does Widowhood Explain Gender Differences in Out-of-Pocket Medical Spending Among The Elderly? -- The authors write: "We find that out-of-pocket medical spending is approximately 29 percent higher when an individual becomes widowed, a large portion of which is spending on nursing homes. Our results suggest a substantial role of living arrangements in out-of-pocket medical spending; however, our estimates combined with differences in rates of widowhood across gender suggest that marital status can explain only one third of the gender difference in total out-of-pocket medical spending, leaving a large portion unexplained. On the other hand, gender differences in widowhood more than explain the observed gender difference in out-of-pocket spending on nursing homes" (Goda, Shoven and Slavov, September 2011).

Commonwealth Fund: Variations In Amenable Mortality--Trends In 16 High-Income Nations -- This study compares 16 high-income nations that all showed an improving trend in "mortality amenable to health care." These are "deaths that are considered preventable with timely and effective health care." The U.S. had the least improvement among patients under 75 years old. Between 2006 to 2007, 24 percent of deaths in the 16 countries surveyed were due to amenable mortality, according to the research, which was based on data from the World Health Organization (Nolte and McKee, 9/23).

Robert Wood Johnson Foundation: Spillover Effects Of Community Uninsurance On Working-Age Adults And Seniors – This analysis focuses on areas with large numbers of uninsured residents and whether that condition has a "spillover," or indirect,  effect on the health care available to the privately-insured population in the area. Researchers used data from the Medical Expenditure Panel Survey (MEPS) to assess the quality of health care insured patients were receiving while in a community of uninsured. "Privately insured, working-age persons who resided in areas with a high rate of uninsurance were less likely than their peers in areas with a low uninsurance rate to have a usual source of care, an office-based visit, and any medical care expenditures." They also found that Medicare beneficiaries report "difficulty getting needed care" and prescription drugs. Both groups were less satisfied with their care (Gresenz and Escarce, September 2011).

Journal Of The American College Of Cardiology: Payment Source, Quality Of Care, And Outcomes In Patients Hospitalized With Heart Failure --  Researchers looked at more than 99,000 hospital admissions between January 2005 and September 2009 and grouped patients based on their insurance or payer status-;private, HMO, uninsured, Medicare or Medicaid. Their assessment showed that patients without insurance or on Medicaid were less likely to receive beta-blockers prescription drugs,  implantable cardioverter-defibrillators or anticoagulation medication for atrial fibrillation." They also had a longer hospital stays. The researchers also found the Medicaid and Medicare groups were offered fewer treatment options than privately-insured patients (Kapoo, et. al., 9/27). 

Archives Of Surgery: Association Between Hospitals Caring For A Disproportionately High Percentage Of Minority Trauma Patients And Increased Mortality –  By looking at 434 hospitals in the National Trauma Data Bank, researchers were able to categorize facilities as majority hospitals - serving a majority of white patients - and minority hospitals - with more black and Hispanic patients - and mixed hospitals, with a proportionately number of black, Hispanic and white patients. They concluded: "Patients treated at hospitals with higher proportions of minority trauma patients have increased odds of dying, even after adjusting for potential confounders. Differences in outcomes between trauma hospitals may partly explain racial disparities" (Haider et. al., 9/19).