Research roundup: Colonscopy in the countryside; retiree health benefits; what should hip surgery cost?

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

JAMA Surgery: Rural-Urban Differences In Access To Specialist Providers Of Colorectal Cancer Care In The United States
Rural residents who commonly seek treatment for advanced stages of colorectal cancer have been thought to lack access to cancer screening and adjuvant therapy. ... Several theories have been postulated to explain these findings, some of which include low socioeconomic status, lower educational attainment, lack of insurance coverage, underinsurance, and travel distance to health care facilities. ... Colonoscopy is the most sensitive and specific test to screen for colorectal cancer in individuals older than 50 years. ... A rural-urban disparity exists in the density of gastroenterologists, general surgeons, and radiation oncologists who traditionally provide colorectal cancer screening services and treatment. This might affect access to these services and may negatively influence outcomes for colorectal cancer in rural areas (Aboagye, Kaiser and Hayanga, 4/16).

JAMA Dermatology: Characterizing The Relationship Between Free Drug Samples And Prescription Patterns For Acne Vulgaris And Rosacea
On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples) (Hurley, Stafford and Lane, 4/16).

Employee Benefit Research Institute: Reference Pricing For Health Care Services: A New Twist On The Defined Contribution Concept In Employment-Based Health Benefits
This analysis examines reference pricing, a form of defined contribution health benefits, where plan sponsors pay a fixed amount or limit their contributions toward the cost of a specific health care service, and health plan members must pay the difference in price if a more costly health care provider or service is selected. Reference pricing for hip and knee replacement, colonoscopy, magnetic resonance imaging (MRI) of the spine, computerized tomography (CT) scan of the head or brain, nuclear stress test of the heart, and echocardiogram were examined because these services have fairly uniform protocols .... Potential aggregate savings could reach $9.4 billion if all employers adopted reference pricing for the health care services examined in this paper (Fronstin and Roebuck, 4/15).

Georgetown University Health Policy Institute/The Commonwealth Fund: The Role Of Medicaid Managed Care In Health Delivery System Innovation
States are increasingly turning to Medicaid managed care as a key strategy to manage costs and encourage innovation in health care delivery. This report examines health care providers' perspectives on the role of managed care in improving health services for low-income adults in four communities: Milwaukee, Wisconsin; Oakland, California; Seattle, Washington; and Washington, D.C. It finds that providers do not generally perceive Medicaid managed care as a catalyst for delivery system reform. Fragmented delivery systems, limits on the types of services for which managed care organizations are at risk, and the volatility in managed care markets all present challenges to improving care delivery (Summer and Hoadley, 4/14).

The Kaiser Family Foundation: Retiree Health Benefits At The Crossroads
A marked and growing interest in shifting to a defined contribution approach for both pre-65 and post-65 retiree coverage is fueled by the employers desire to manage future costs. Increasing interest in moving from group coverage to non-group coverage is a trend that is particularly strong with respect to Medicare-eligible retirees for whom employers can facilitate access to non-group coverage through private exchanges. ... the new federal/state marketplaces are gaining at least the consideration by employers as a possible pathway through which the employer's pre-65 retiree population might gain access to non-group coverage (McArdle, Neuman and Huang, 4/14).

Mathematica/California Healthcare Foundation/RWJF: Moving Markets: Lessons From New Hampshire's Health Care Price Transparency Experiment
Over the last decade, New Hampshire has pioneered health care price transparency to support cost-conscious consumer behavior and, ultimately, to spur competition and increase efficiency among health care providers. In 2003, the state mandated one of the nation's first all-payer claims databases .... Based on interviews with a broad range of health care stakeholders and experts, ... the analysis [shows] that consumer use of NHHealthCost.org has been modest and that the program did not fulfill a primary goal of directly encouraging consumer price-shopping (Tu and Gourevitch, April 2014).

American Economic Journal: Human Capital And Productivity In A Team Environment: Evidence From The Healthcare Sector
Using panel data from a large hospital system, this paper presents estimates of the productivity effects of human capital in a team production environment. Proxying nurses' general human capital by education and their unit-specific human capital by experience on the nursing unit, we find that greater amounts of both types of human capital significantly improve patient outcomes. Disruptions to team functioning attributable to the departure of experienced nurses, the absorption of new hires, and the inclusion of temporary contract nurses are associated with significant decreases in productivity beyond those attributable to changes in nurses' skill and experience (Bartel et al., April 2014).

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

The New York Times: For Diabetics, Health Risks Fall Sharply
Federal researchers on Wednesday reported the first broad national picture of progress against some of the most devastating complications of diabetes, which affects millions of Americans, finding that rates of heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades (Tavernise and Grady, 4/16).

Minnesota Public Radio: New Alzheimer's Studies Point To New Care Options
The number of people with the memory-stealing diseases like Alzheimer's is expected to skyrocket as the baby boom generation gets older. The way we care for people with dementia is the subject of some new reports published this week by Minnesota-based researchers. One report from the University of Minnesota suggests nursing homes need to undergo a culture shift in the way they assess and care for Alzheimer's patients. It recommends government policy changes that could encourage that kind of shift. Alongside that report this week, is separate research showing family caregivers can help keep Alzheimer's patients at home longer if they receive specific targeted support (Wurzer, 4/11).

The Boston Globe: 1 In 20 Adult Outpatients Misdiagnosed, Study Reports
At least 1 in 20 adult outpatients receives an incorrect diagnosis from their doctor, according to a new study. Sometimes the consequences are minor -- calling something an "allergy" when it's really a cold, for instance. But in more than 6 million patients a year in the United States, such misdiagnosis could have major consequences, such as a dangerous delay in cancer treatment. "The question is, can we eliminate human error, and the answer is no," said Hardeep Singh, lead author of the paper, which appeared in the journal BMJ Quality & Safety (Weintraub, 4/16).