Research Roundup: International Travel Risks; Telehealth; Freestanding ERs; Methadone Use
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The New England Journal of Medicine:
Medical Considerations Before International Travel
In 2015, international tourist arrivals in all countries exceeded 1.2 billion persons. In 2014, the total number of arrivals in countries with emerging markets nearly surpassed the number in developed countries. Depending on the destination, 22 to 64% of travelers report some illness; most of these illnesses are mild and self-limited, such as diarrhea, respiratory infections, and skin disorders. Some travelers return to their own countries with preventable life-threatening infections. ... Yet 20 to 80% of travelers do not seek pretravel health consultation. ... Persons who are planning to travel to other countries often ask their health care providers for information about preventive interventions. Nonspecialists can provide information and care to healthy adults traveling to common destinations by following protocols such as those offered in this review. (Longo, 7/21)
The New England Journal of Medicine:
State Of Telehealth
Telehealth is the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without a video connection. Telehealth is growing rapidly and has the potential to transform the delivery of health care for millions of persons. Although several reviews have examined the historical use and effects of telehealth, few articles have characterized its current status. Here we examine the trends of telehealth, its limitations, and the possibilities for future adoption. (Dorsey and Topol, 7/14)
Annals of Emergency Medicine:
Where Do Freestanding Emergency Departments Choose To Locate? A National Inventory And Geographic Analysis In Three States
We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics ... and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. (Schuur et al., 7/12)
JAMA/Kaiser Family Foundation:
HIV Awareness And Testing, 2013 And 2014
This Visualizing Health Policy infographic provides a snapshot of HIV-related awareness and experiences among adults in the United States and 2 demographic groups that make up a disproportionate share of people with HIV: black adults and gay and bisexual men. In 2014, 4 in 10 black adults, and more than half of gay and bisexual men said they personally knew someone who is HIV-positive (HIV+) or who has died of HIV/AIDS, compared with only 28% of adults in the United States overall. Only 21% of US adults were aware that consistent antiretroviral treatment can significantly reduce the risk of HIV transmission, and only 14% had heard of a new prevention strategy, preexposure prophylaxis. Awareness was only slightly higher among black adults and gay and bisexual men. (Firth et al., 7/12)
Morbidity and Mortality Weekly (CDC):
Trends In Methadone Distribution For Pain Treatment, Methadone Diversion, And Overdose Deaths — United States, 2002–2014
Use of the prescription opioid methadone for treatment of pain, rather than for treatment of opioid use disorder, has been identified as an important contributor to the rise in opioid-related overdose deaths. In recent years, a number of actions to reduce the use of methadone for pain treatment have been taken. ... During 2002–2006, the national distribution rate of methadone increased, on average, 25.1% per year, methadone-involved drug overdose deaths increased 22.1% per year, and methadone diversion increased 24.3% per year. After 2006, methadone distribution declined 3.2% per year, and methadone-involved overdose deaths declined 6.5% per year. Rates of methadone diversion continued to increase during 2006–2009, but substantially more slowly, and then declined an average of 12.8% per year beginning in 2010. (Jones et al., 7/8)
Morbidity and Mortality Weekly (CDC):
Vital Signs: Motor Vehicle Injury Prevention — United States And 19 Comparison Countries
CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries .... In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3) ... and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use. (Sauber-Schatz et al., 7/6)
The National Bureau of Economic Research:
Strategic Formulary Design In Medicare Part D Plans
The design of Medicare Part D causes most Medicare beneficiaries to receive fragmented health insurance, whereby prescription drugs and other medical care are covered by separate insurance plans. Fragmentation of insurance plans is potentially inefficient since separate insurers maximize profits over only one component of healthcare spending ... Relative to fragmented plans, integrated plans systematically design their drug formularies to encourage enrollment by beneficiaries with medical conditions that are profitable under Parts A & B. However, integrated plans also more generously cover drugs that have the potential to causally reduce medical costs. These large differences in incentives and plan design between integrated and fragmented plans are likely the precursors of substantial differential selection of enrollees, and the basic design of Medicare Part D abets this covert selection. (Lavetti and Simon, 6/24)
The Urban Institute/Kaiser Family Foundation:
A Look At Rural Hospital Closures And Implications For Access To Care: Three Case Studies
[T]he examination of rural hospital closures in three communities as well as interviews with national experts show that a number of factors contribute to rural hospital closures, including demographics (aging, poor, and declining populations), hospital finances (high uninsured rates and high shares of public paying patients), and overall changes in how care is delivered. ... the hospital closures reduced local residents’ access to care (especially emergency care), led to an outmigration of health care professionals, and worsened pre-existing challenges in obtaining access to specialty care. ... The experience of study hospitals, stakeholder interviews, and other research show that a state’s decision about the Medicaid expansion has an important impact on hospital revenues and access to care, but the sustainability of rural hospitals depends on a broader set of factors. (Wishner and Rudowitz et al., 7/7)
Employee Benefit Research Institute:
Views On The Value Of Voluntary Workplace Benefits: Findings From The 2015 Health And Voluntary Workplace Benefits Survey
The benefits package that an employer offers prospective workers is an important factor in their decision to accept or reject a job. More than one-third (36 percent) of workers say the benefits package is extremely important, while 41 percent say it is very important. ... Workers overwhelmingly consider health insurance to be the most important workplace benefit. Nearly two-thirds (64 percent) say this benefit is extremely important, while an additional 24 percent consider it to be very important. Indeed, having access to health insurance through their employer is considered so important that 6 in 10 (60 percent) report they are planning to work longer than they would like in order to continue receiving health insurance through their employer. (Fronstin and Hellman, 7/5)
Here is a selection of news coverage of other recent research:
Morning Consult:
Report: ACA Enrollees Are Less Healthy, Uninsured Are Healthier
During the first year of Obamacare’s implementation, the individual insurance market became less healthy while the uninsured and Medicaid populations became healthier, according to a new analysis. A Health Affairs data analysis ... underscores the often stated observation that the Affordable Care Act has brought sicker, more expensive enrollees into the individual marketplace while healthier people have tended to resist enrollment. (Owens, 7/6)
WTOP (Washington, DC):
Study: Knee-Friendly Shoes No More Effective Than Sneakers
The box might say those ugly, thick-soled shoes will ease knee strain. But do they really work? A new study suggests they are no better than a good pair of sneakers. (Wolfson, 7/12)
Houston Chronicle:
Wealthy Get More Health Care Than Other Americans
There is little debate that health care costs are growing too fast, and the United States needs to discourage over-utilization. Co-pays and deductibles can achieve those goals, but this study shows that people with higher incomes are not as deterred as lower-income Americans. (Tomlinson, 7/12)