Research Roundup: Other Nations Surpass U.S. Health Care
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs/The Commonwealth Fund: Access, Affordability, And Insurance Complexity Are Often Worse In The United States Compared To Ten Other Countries
Our 2013 survey of the general population in eleven countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—found that US adults were significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. Signaling the lack of timely access to primary care, adults in the United States and Canada reported long waits to be seen in primary care and high use of hospital emergency departments, compared to other countries (Schoen, Osborn, Squires and Doty, 11/14).
Journal of the American Medical Association (JAMA): Hospitals, Market Share, And Consolidation
What was once a set of independent hospitals having arms-length relationships with physicians and clinicians who provide ambulatory care is becoming a small number of locally integrated health systems, generally built around large, prestigious academic medical centers. The typical region in the United States has 3 to 5 consolidated health systems, spanning a wide range of care settings, and a smaller fringe of health care centers outside those systems. Consolidated health systems have advantages and drawbacks (Cutler and Morgan, 11/12).
JAMA: Increasing Demands For Quality Measurement
The proliferation of quality measures at the clinician, hospital, and insurer level has created challenges and logistical problems. Recommendations include raising the bar for quality measurements to achieve transformational rather than incremental change in the US quality measurement system, promoting a logical set of measures for the various levels of the health system, ... reducing attention to proprietary report cards, prompt but careful transition to measures from electronic health records, and allocation of sufficient resources to accomplish the goals of an efficient, properly focused measurement system (Panzer et al., 11/12).
JAMA Surgery: Increasing Organ Donation In Hispanic Americans
Although the number of Hispanic Americans on the national organ waiting list has increased dramatically, the Hispanic American population is still 60% less likely to donate organs compared with the non-Hispanic white population. A national organ shortage at crisis proportion requires attention to this gap to increase the number of registered donors. A large presence on the waiting list matched with a historic lack of intent to donate makes the Hispanic American community a prime population on whom to focus resources and educational efforts to increase the number of registered donors. The purpose of this study was to determine whether the respondents would change their intent to donate after multiple interventions. We observed a 55% increase in the intent to donate organs in wave 3 compared with wave 1. We attribute this increase to the combination of the media and educational interventions implemented as part of our ongoing effort (Salim et al., 11/13).
AARP Public Policy Institute: Rapid Growth In Medicare Hospital Observation Services: What’s Going On?
This report summarizes the results of our analysis of growth in the frequency and duration of hospital observation services (OS) by Medicare beneficiaries between 2001 and 2009. Our study found far greater increases in both the frequency and duration of OS use than previous studies that covered shorter periods. Although only about 3.5 percent of Medicare beneficiaries used OS in 2009 during the study period, Medicare claims for OS grew by more than 100 percent, with the greatest increase occurring in cases not leading to an inpatient admission. The duration of OS visits has also increased dramatically (Zhao et al., 11/14).
Here is a selection of news coverage of other recent research:
Modern Healthcare: Analysis Finds Slow Progress Improving Outcomes, Big Jumps In Chronic Disease Since 1980
A sweeping analysis of U.S. healthcare trends over the past three decades points to slow progress on health outcomes, such as life expectancy; increased consolidation; jumps in cost-driving rates of chronic illness; and a growing focus on consumer-oriented care. The paper, published in the Nov. 13 issue of the Journal of the American Medical Association, ... highlighted a number of surprises, including a steady decline in personal out-of-pocket healthcare spending since 1980, said Dr. Hamilton Moses, a neurologist, head of the North Garden, Va.-based Alerion Institute, and the article's lead author (McKinney, 11/12).
McKnight's: Price Increases, Not A Larger Senior Population, Are Responsible For Exploding Healthcare Costs: Analysts
Escalating healthcare costs in the United States cannot be pinned on an aging population demanding more services for chronic conditions. Instead, higher costs are primarily the result of price increases, according to a new analysis in the Journal of the American Medical Association. ... The huge number of aging baby boomers is putting increased demand on the healthcare system, driving up overall costs (Mullaney, 11/13).
Medscape: Clinic Staff Relationships Affect Patient Satisfaction
The relationships between clinicians and staff play an important role in patients' perception of quality care. A new scale, known as the Work Relationship Scale (WRS), can be used to measure these relationships and may help optimize care delivery in the primary setting. Erin P. Finley, PhD, MPH, from South Texas Veterans Health Care System in San Antonio, Texas, and colleagues published the results of their study in the November/December issue of the Annals of Family Medicine. The article describes the WRS and the association between WRS scores and patient experiences of care, as determined by VA Survey of Healthcare Experiences of Patients data (Pullen, 11/14).
Medscape: Demand For Specialists Will Outpace Primary Care By 2025
The demand for adult primary care services will grow by 14% in the next 12 years, according to a study published online November 4 in Health Affairs. However, with an aging population and expanded medical coverage, demand will grow even more markedly for specialized services. Timothy M. Dall, managing director for healthcare and pharma at IHS Inc in Washington, DC, and colleagues estimate demand for vascular surgery will rise 31% by 2025, cardiology will rise 20%, and neurosurgery, radiology, and general surgery will rise by 18% each (Frellick, 11/8).
Medscape: Emerging Care Models May Ease Primary Care Doc Shortage
Forecasts that predict dire shortages of primary care physicians have not generally factored in projected changes in the way healthcare is delivered. David I. Auerbach, a policy researcher with RAND Corporation in Boston, Massachusetts, and colleagues analyzed what the picture might look like with more primary care delivered using 2 emerging models: patient-centered medical homes and nurse-managed health centers. Both models use more nurse practitioners (NPs) and physician assistants (PAs) than traditional models (Frellick, 11/8).
Reuters: ER Visits Fell After Warnings Put On Kids Cough Drugs
Fewer kids went to U.S. emergency departments for reactions related to over-the-counter cough and cold medicine after manufacturers printed new warnings on medicine bottles, says a new government study. But the researchers from the U.S. Centers for Disease Control and Prevention (CDC) say more can be done to prevent kids from accidentally taking cough and cold medicine (Seaman, 11/11).
Reuters: Don't Neglect Oral Healthcare In Frail, Elderly: Study
Advancements in dentistry make it more likely that older adults will keep their teeth longer, which means ongoing oral healthcare is essential, a new study says. Unfortunately, it's not unusual for the frail and elderly to have poor oral hygiene. "Although during recent years increasing attention has been given to improving oral health care for frail old people, there is ample evidence showing that the oral health of elderly people, in particular of care home residents is (still) poor," researchers wrote in the journal European Geriatric Medicine (Jegtvig, 11/8).