Research roundup: Workers' insurance costs vary depending on employers' size; Seniors mental health needs often unmet

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Kaiser Family Foundation: A Comparison Of The Availability And Cost Of Coverage For Workers In Small Firms And Large Firms: A View from the 2012 Employer Health Benefits Survey -- The authors of this analysis provide a detailed look at the availability of health coverage at small and large employers, as well as the variations in plan costs and cost-sharing requirements. Covered workers at small firms – those with 3-199 employees -- on average have lower annual premiums for family coverage ($15,253) than those in large firms ($15,980), yet they contribute "significantly more" for this coverage ($5,134 vs. $3,926) (Panchal, Rae, and Claxton, 12/11).

Health Affairs: Reducing Waste in Health Care -- The author of this brief writes: "[R]esearchers at the Dartmouth Institute for Health Policy and Clinical Practice have estimated that 30 percent of all Medicare clinical care spending could be avoided without worsening health outcomes. ... Efforts to extract waste from the health care system will in all likelihood continue along a range of federal government initiatives, including information technology adoption, pay-for-performance, payment and delivery reforms, comparative effectiveness research, and competitive bidding. Similar programs are also being initiated by state Medicaid agencies and by private payers. In the view of many experts, even more vigorous efforts to pursue the reduction of waste in health care are clearly warranted" (Lallemand, 12/13).

John A. Hartford Foundation: Public Poll: "Silver And Blue – The Unfinished Business Of Mental Health Care For Older Adults" – Lake Research Partners surveyed more than 1,300 adults ages 65 and older and found that many older adults "may not be receiving evidence-based standards of care, such as being informed about the side effects of treatment and receiving timely follow-up care." According to the survey, "One in five respondents (20%) reports having been diagnosed with a mental health issue. Fourteen percent have been diagnosed with depression and 11% have been told by a doctor they have anxiety." Yet the majority of those polled did not know that depression can can affect physical health and nearly half of those getting treatment said their doctors had not followed up with them to see how they were doing. The poll had a margin of error of 3.9 percentage points (12/10).

American Journal Of Public Health: Relationship Between Medical Well Baby Visits And First Dental Examinations For Young Children In Medicaid – Researchers examined the relationship between preventive well-baby visits and the time of first dental examinations among children enrolled in the Iowa Medicaid Program. After analyzing Medicaid enrollment and claims data of more than 6,000 children, the researchers found that "more well baby visits between ages 1 to 2 and 2 to 3 years were significantly associated with early first dental examinations." They add: "Few children see a dentist by age 12 months, however, which motivates efforts to identify the factors related to earlier first dental examinations" (Chi et al., 12/13).

Kaiser Family Foundation: Medicaid Eligibility, Enrollment Simplification, And Coordination Under The Affordable Care Act: A Summary Of CMS's March 23, 2012 Final Rule -- The authors write: "This brief provides a summary of the Centers for Medicare and Medicaid Services' (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the ACA. Achieving this goal will require substantial process and system changes among state Medicaid agencies and close coordination between Medicaid, the new health insurance Exchanges and other insurance affordability programs" (Artiga, Musumeci, and Rudowitz, 12/13).

Here is a selection of news coverage of other recent research:

Medscape: After-Hours Access to Clinicians Tied to Fewer ED Visits
Patients who have an easier time reaching their primary care clinician after regular office hours visit the hospital emergency department (ED) less often, according to a new study published online December 12 in Health Affairs. The study, by Ann O'Malley, MD, MPH, also reveals that patients enjoyed better after-hours access if they belonged to a practice with extended office hours. Roughly 40% of patients with a usual source of primary care reported going to a practice that was open in the evening or on weekends (Lowes, 12/13). 

Reuters: A Sick World: We Live Longer, With More Pain And Illness
The world has made huge progress fighting killer infectious diseases, but as a result we now lead longer and sicker lives, with health problems that cause us years of pain, disability and mental distress. This "devastating irony", as researchers describe it, is the main conclusion of a five-year study that forms the most comprehensive assessment of global health in the history of medicine, according to the journal publishing the research. The Global Burden of Disease study, led by the Institute for Health Metrics and Evaluation (IHME) at Washington University, finds that countries face a wave of financial and social costs from rising numbers of people living with disease and injury (Kelland, 12/13).

MedPage Today: Crowded EDs May Be Serious Health Hazard
The busiest days in Emergency Departments are linked to higher inpatient mortality risk and higher costs, a population-based study affirmed. Patients seen on days when EDs were so full they turned away ambulances had a 5% greater risk of death before discharge than those admitted at other times, Benjamin Sun, MD, MPP, of Oregon Health and Science University in Portland, and colleagues found. These patients also faced slightly but significantly longer stays and higher costs for their admission in the analysis of statewide hospital discharge and ambulance diversion data for California, reported online in the Annals of Emergency Medicine (Phend, 12/12). 

Reuters: Fewer Cancer Patients Pick CPR After Video Demo
Dying cancer patients are less likely to want aggressive end-of-life care if they watch a short video about CPR than if they simply hear about it, according to a new study. "These are huge differences. You will die very differently if you watch the video than if you don't," said Dr. Angelo Volandes, the study's lead author from Boston's Massachusetts General Hospital. ... The researchers found in a group of 150 cancer patients, who were thought to have less than a year to live, 48 percent wanted CPR after being told about it, compared to 20 percent in the group who also watched a video showing compressions on a dummy and the inserting of a breathing tube (Seaman, 12/12). 

MedPage Today: Patients' Health IT Savvy Judged Lacking
As hospitals and physicians move to wider use of electronic health records (EHRs), patients need to become more engaged and be made aware that their records are accessible, health technology experts said. And as providers work on the next stage of becoming "meaningful users" of EHRs, they must remember that higher patient engagement is related to higher quality, better outcomes, and lower costs, several speakers said at a press conference here Monday sponsored by the Bipartisan Policy Center (Pittman, 12/12).