Research roundup: Insurance coverage and access to care in Massachusetts

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

Health Affairs: Survey Finds Public Support For Legal Interventions Directed At Health Behavior To Fight Noncommunicable Disease – With increasing interest in public health problems such as obesity and alcohol and tobacco use, lawmakers are increasingly considering using policy to modify behavior. According to the authors, little is currently known about the public's willingness to accept such policies.  The researchers surveyed more than 1,800 adults to assess their attitudes toward government interventions aimed at these issues. They found that strong support, especially among African Americans and Hispanics. "There was much support for strategies that enable people to exercise healthful choices-;for example, menu labeling and improving access to nicotine patches-;but considerably less for more coercive measures, such as insurance premium surcharges," the authors write. Policy makers "should involve the public in priority-setting activities in public health" and "seek to understand the values held by different segments of the population and incorporate those values in to policy decisions," the authors suggest (Morain and Mello, 3/2013).

Health Affairs: Insurance Expansion In Massachusetts Did Not Reduce Access Among Previously Insured Medicare Patients – In 2006 Massachusetts passed health overhaul legislation that sought to get universal coverage in the state. Opponents suggested it could have a negative impact on people who already had insurance. They said that the sudden increase in the number of people with insurance might overwhelm doctors and other health care providers, creating shortages and poor health care for some people who were already in the system, especially Medicare beneficiaries who are older and often need more medical care. In this study, researchers analyzed Medicare data from 2004 to 2009 to determine how insurance expansion under the Massachusetts' health reform law affected beneficiaries. "We found no evidence that Massachusetts' health care reform, with its resulting insurance expansion and consequent threat of negative spillover on the previously insured, led to an increase in preventable hospitalization among Medicare patients," the authors write. Their study found that preventable hospitalizations among beneficiaries in Massachusetts dropped slightly more than rates in comparison New England states (Joynt, Chan, Orav, and Jha, 3/2013).  

The Kaiser Family Foundation/The Urban Institute: Reversing The Trend? Understanding The Recent Increase In Health Insurance Coverage Among The Nonelderly Population -- According to the authors of this brief, the number of uninsured people in the U.S. decreased by 1.2 million in 2011. They suggest that this decrease was the result of an increase in coverage through public programs such as Medicaid and the Children's Health Insurance Program. "Most of the growth in public coverage, and the attendant reduction in the nonelderly uninsured, was concentrated among adults, while the number of uninsured children was largely unchanged between 2010 and 2011," the synopsis of the study notes. This brief includes discussions of trends in coverage by work status, race and ethnicity and region, and of the impact of the Affordable Care Act (Holahan and McGrath, 3/1).

Journal Of General Internal Medicine: Access, Interest, and Attitudes Toward Electronic Communication For Health Care Among Patients In The Medical Safety Net – According to the authors, e-mail communication between patients and clinicians "is a promising application of health information technology." There are disparities, however, in adoption of the tool. The researchers surveyed a group of patients from a large urban safety net clinic network to assess their level of access to and attitudes toward using e-mails to communicate with their doctors. "In our study of ethnically diverse, low-income patients, we found that the majority use email; nearly three out of every four patients were interested in using email for health communication with their medical providers," the authors write, although less than 20 percent of patients had used e-mail to communicate with their providers. "This demonstrates and unmet interest in health-related electronic communication among patients in the safety net," the researchers said (Schickedanz et al., 2/20).

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

Reuters: Study Results Take Almost Two Years To Be Released
Results from the average clinical trial take almost two years to be published, according to a new study, despite U.S. regulations calling for a 12-month maximum lag time on the release of most research findings. That's concerning, researchers said, because publication delays hinder doctors' ability to make the most well-informed treatment choices with their patients and slow progress within the scientific community (Pittman, 3/6). 

Reuters: Doctors Don't Often Tell Patients Of CT Scan Risks
Only about a third of patients surveyed at one U.S. medical center said their doctors told them about the possible risks of a CT scan, such as radiation exposure, a new study finds. Researchers, who published their findings in JAMA Internal Medicine on Monday, also found that most patients thought their doctors made the final decision to have the scans (Seaman, 3/4).

Reuters: Is Enrolling In A Clinical Trial Tied To Survival?
People with certain cancers enrolled in clinical trials survive longer, not necessarily from the treatment itself but potentially because those enrolled are better off to begin with, according to new research. "The survival benefits for an individual to be on a cancer trial are not necessarily to be on a trial itself. Cancer trials select patients who are healthier and are able to tolerate treatments," said senior study author Dr. Waddah Al-Refaie, chief of surgical oncology at MedStar Georgetown University Hospital in Washington, D.C. (Stokes, 2/28).

MedPage Today: Dissatisfaction With EHRs Rising, Survey Finds
Physician satisfaction and usability ratings for certified electronic health records (EHRs) have fallen since 2010, a survey of more than 4,200 doctors found. The number of physicians who said they would not recommend their EHR to a colleague rose to 39% in 2012 from 24 percent 3 years ago, the survey found. It was released Tuesday by the American College of Physicians (ACP) and AmericanEHR Partners, the web-based resource arm that ACP helped create. Much of the physicians' dissatisfaction was due to EHRs' failure to increase productivity (Pittman, 3/7).