New from Health Affairs –6.9 million more uninsured Americans by 2010, MA reform benefits continue, and cost does not equal quality in health care

Study predicts US uninsured to grow to 52 million by the end of next year

A study published today predicts that due to rising health care costs, by the end of 2010 another 6.9 million Americans will be uninsured, bringing the rate to 19.2%. For every 1% increase in health costs relative to income, another 314,000 Americans lose coverage. This model does not include the impact of unemployment, which is rising sharply, so the picture may be much worse. The authors note that previous estimates using this model of increases in the number of uninsured have, unfortunately, been largely accurate.

Study finds MA continues to enjoy benefits of health reform but challenges of costs and workforce remain

Another study published today finds that after health reforms implemented two years ago, MA consumers are getting more access to medical and dental care, preventive services and medications, particularly low income residents. However, emergency room visits have not declined, including those for non-emergencies. Just over 20% of adults reported difficulty getting care because a provider was not taking new patients (or patients with their condition); that rate was about much higher for low-income and patients with public coverage. Problems accessing care were worst in Western Mass. Initial gains in the affordability of coverage from reforms have eroded somewhat. The authors note that these changes occurred before the full impact of penalties in MA’s individual mandate occurred. The authors cite new measures enacted by MA to address cost control and workforce shortages.

Study finds health care quality and cost not linked, even divergent in some cases

A new study by Dartmouth researchers found that spending on health care does not guarantee quality at the level of individual hospitals, and could even be negatively correlated. The study looked at chronically ill Medicare patients’ care in the last two weeks of life across the US. Hospital averages for spending per end-of-life patient varied from $13,840 to $37,010. Earlier studies found that higher spending produces more care but not better care. This study confirmed that higher spending is associated with higher utilization – more hospital visits, longer stays, more specialists, and more tests -- but worse process-of-care performance. Prior research has found a similar lack of connection between spending and quality by region, but this is the first to show that there is no relationship at the hospital level and that there is wide variation within regions. The study has some important limitations – they only studied processes of care (i.e. appropriate antibiotics given for pneumonia), not outcomes (i.e. adult pneumonia death rates). They did not adjust for patient risk (i.e. some hospitals may treat sicker patients), but they chose process measures that should be done for every patient. By focusing on end of life, the study misses hospital successes – very sick patients who are treated and survive. However, the study does provide strong evidence that there are costs that can be wrung out of the health care system without endangering quality, possibly even improving it. The authors argue for better cost and quality reporting.
Ellen Andrews