Research roundup: 'No individual mandate' scenarios; Breaking down health care expenditures

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

Urban Institute / Robert Wood Johnson Foundation - Eliminating The Individual Mandate: Effects On Premiums, Coverage, and Uncompensated Care – This paper expands 2011 research examining whether the health law's controversial individual mandate – which requires most people to have health insurance -- will be effective. Using sophisticated models, the authors examined the effects of the mandate and three possible scenarios if the mandate were dropped from the law. Those alternatives had decreasing levels of participation in the health insurance exchanges to purchase coverage. The researchers report that without the mandate, the number of uninsured would fall to about 40 million people instead of the 26 million with it, private plans would cover 4 million fewer people than they would under the mandate, uncompensated care spending would be higher and premiums for individual policies in the exchanges would increase  (Buettgens and Carroll, January 2012). 

New England Journal Of Medicine: Bone Density Testing Interval And Transition To Osteoporosis In Older Women -- Researchers studied the test results of more than 4,900 women over the course of 15 years to find the best time interval between bone mineral density (BMD) tests. "Recent controversy over the harms of excessive screening for other chronic diseases reinforces the importance of developing a rational screening program for osteoporosis that is based on the best available evidence rather than on health care marketing, advocacy, and public beliefs that have encouraged overtesting and overtreatment in the United States." The researchers found that the disease developed more slowly than anticipated and suggested that safe screning intervals could be: "approximately 15 years for women with normal bone density or mild osteopenia at the initial assessment, 5 years for women with moderate osteopenia, and 1 year for women with advanced osteopenia" (Gourlay et. al., 1/19).

KHN summarized news coverage of this study: Study Finds Older Women Can Wait Up To 15 Years To Repeat Bone Scans (8/19) 

Journal Of General Internal Medicine: How Much Time Do Low-Income Patients And Primary Care Physicians Actually Spend Discussing Pain? A Direct Observation Study -- Researchers videotaped 133 patients who saw family medicine residents in a Detroit clinic "serving predominantly low-income, black patients because this population experiences more frequent and more severe pain than the general population." They reported that 69 percent of the visits included a discussion about pain. Since talking about pain comprise a substantial portion of the primary care visits, the researchers suggested that future investigations examine the link between time spent talking about pain and the quality of the pain management (Henry and Eggly, 1/10).

Kaiser Family Foundation: Medicaid's Role For Women Across The Lifespan: Current Issues And The Impact Of The Affordable Care Act – "Because women are more likely than men to fall into one of the eligibility categories for Medicaid and are more likely than men to be poor, women comprise over two-thirds of beneficiaries," according to this brief that "explores Medicaid's role for women across their lifespans including reproductive health services, care for chronic conditions and disabilities, and long-term care services." The authors conclude that while "the many fiscal constraints the Medicaid program already faces at the federal and state levels will persist," under the 2010 federal health law it "offers a number of opportunities" to improve health care for low-income women (Salganicoff and Ranji, 1/6).

Agency For Health Care Research And Quality (AHRQ): The Concentration and Persistence In the Level of Health Expenditures Over Time: Estimates For the U.S. Population, 2008-2009 – Using AHRQ's Medical Expenditure Panel Survey data from 2008, the authors found that 1 percent of the population accounted for 20.2 percent of the total health care expenditures. In 2009, that percentage increased to 21.8. "In both 2008 and 2009, the top 5 percent of the population accounted for nearly 50 percent of the health care expenditures."  The authors concluded that those in the top 10 percent of spending "were more likely to be in fair or poor health, elderly, female, non-Hispanic whites and those with public-only coverage. Those who remained in the bottom half of spenders were more likely to be in excellent health, children and young adults, men, Hispanics, and the uninsured" (Cohen and Yu, January 2012).