Houston to hire nurses as ER alternative for non-urgent care

In 2006 Harris County, which includes Houston, spent $50 million on emergency room care for patients with problems that could have been treated in a doctor’s office, according to the Houston Chronicle. The city wants to hire “tele-nurses” to work with 911 dispatchers offering first aid advice or help getting an appointment for care with a doctor or clinic for callers who do not have a true emergency. The Director of Emergency Medical Services says that many patients call 911 because they have no insurance, no transportation to the hospital or they have insurance but can’t get after hours care or cannot judge how serious a problem may be. “The whole idea is to educate people, help them get self-care when appropriate,” according to the Executive Director of the Harris County Health Alliance. “It’s just about getting these folks to connect to what we call a ‘medical home,’ a regular source of care.” Ambulance rides cost $415 each plus $7.50 per mile and ambulances responding to non-urgent problems take vital resources away from true emergencies. Richmond, VA has a similar program.
Ellen Andrews

For-profit Medicaid managed care plans provide less care according to study, Implications for return to capitation in HUSKY

A study published in Medical Care Research and Review in April found that access to health care is lower for Medicaid managed care members in for-profit HMOs than for those enrolled in nonprofit plans. The author found that members of for-profit plans were 14% less likely to have had a doctor visit in the last year (statistically significant) and 6% more likely to report an unmet need for medical care and for prescription drugs (not significant). More research needs to be done. However, this study does suggest that moving 337,181 HUSKY consumers back to capitated HMOs, including two for-profit companies, on July 1st is unwise. Another reason to delay re-contracting HUSKY.
Ellen Andrews

International study finds health inequities are about more than health coverage; editorial explores implications for US Presidential elections

A new study published today in JAMA compares health inequities across 22 European countries. Not surprisingly, rates of death and poor health are linked to lower socioeconomic status. However the scale of the disparity varied widely between countries. The authors attribute the variations in part to causes of death due to smoking, alcohol use and access to good quality health care. Interestingly, the variation between countries did not track with the generosity of welfare policies. Southern European countries tend to have less generous and less universal policies than Northern countries, but smaller health inequities, possibly due to healthier diets and lower smoking rates among women. The authors conclude that, while “a reasonable level of social security and public services may be a necessary condition for smaller inequities in health, it is not sufficient.” They suggest that improving educational opportunities, income distribution, healthy behaviors and access to quality health care may be most important. The accompanying editorial links the study to our upcoming Presidential elections. Virtually all of the 22 countries in the study have national health care policies, but wide health inequities remain. “[P]olicies related to preventive social, economic and behavioral interventions might well have a greater effect on reducing disparities than traditional medical interventions, even if as an unintended by-product.” As we’ve hard from states that are implementing “universal” health care reforms, like MA, VT and ME -- it’s not all about insurance.
Ellen Andrews

Massachusetts uninsured cut in half

The results are in. Massachusetts’ comprehensive health care reforms passed in 2006 have led the state’s rate of uninsurance to drop by almost half – from 13% in fall 2006 to 7% a year later. 355,000 more adults in Massachusetts now have affordable coverage– more than the entire uninsured population of Connecticut. The reform law, Chapter 58, included significant Medicaid expansions, subsidized private insurance offerings through an independent, trusted, and transparent resource, insurance market reforms and required individual and employer contributions. A survey published today in Health Affairs also found that under Chapter 58 the number of residents with high out of pocket costs and those reporting having trouble paying medical bills are down. The survey reported an increase in preventive care doctor visits, dental visits, a reduction in the number of adults who did not get needed care in the last year, but unfortunately no drop in ER visits. There was an increase in the number of respondents who had trouble finding a doctor or getting an appointment, but a decrease in the number who reported getting fair or poor care in the past year. 71% of state residents support the reforms. Researchers found no evidence of “crowd out” – employers dropping coverage or benefits in response to Chapter 58 requirements. Among the remaining uninsured adults, most are young and working with incomes below 300% of the federal poverty level. Only 11% have access to health benefits through work and 78% considered getting care through the new state programs. 80% reported that it would be difficult to come up with the cost of coverage, 41% had trouble paying other bills, and almost a third were not aware of the individual mandate. As for that mandate – the Dept. of Revenue reports that 86,000 tax filers paid the penalty ($219 for an individual) for remaining uninsured. Next year that penalty goes up to as much as $912.
Ellen Andrews

New from the Consumer Health Action Network

New materials for consumers from the Consumer Health Action Network:
CT Hospital Free Care and Financial Discount Programs – a compilation of financial assistance policies from CT hospitals
Two new tip sheets – Preparing for a Doctor’s Visit, Help Working with Your Doctor
Latest newsletter – Help to Lower Your Drug Costs

For more help, search our list of over two dozen tip sheets and our newsletter archives

For help accessing health care in CT, call our helpline toll-free 1-888-873-4585 or email information@cthealthpolicy.org

June web quiz

Test your knowledge of substance use in CT. Take the June CT Health Policy Web Quiz.

HealthFirst Authority update

Today the Authority tried to narrow down the options they will consider for study through the rest of the process. The Chairs began with their list of issues that everybody agrees on. It is long:
Strong prevention and health promotion component
Medical home
Electronic medical record and health information technology
Enrolling everyone who is eligible for public programs
Management of chronic illness
Incentives for healthy lifestyles and wellness
Transparency – most emphasis on data for state policymakers to make decisions (if they will) but expanded to include information for consumers in response to a question
Evidence based practices
Improving Medicaid reimbursements – recent increases were not enough
Patient safety
Employer and individual contributions
Addressing workforce shortages
Members also suggested adding Medicare cuts, universality, military health care cuts, consumer education, sustainability, adaptability, increasing federal reimbursements, and access to specialty care.
They then moved onto components that may not be unanimous. They noted that the legislation requires the Authority to consider single payer universal health care and universal primary care options. They also agreed to model the CT Health Insurance Policy Council’s proposal. Other ideas included:
· Maintaining employer and Medicare coverage
· Expanding Medicaid
· Moving SAGA into Medicaid
· Insurance pooling – including what subsidies would be needed
· Shared responsibility (employers, government and individuals) as in Healthy San Francisco, this model includes undocumented immigrants
· Incentives for quality and wellness and support for Medical Home Services
After the list was read, there was silence as most in room waited for the debate to begin. We weren’t disappointed. Perspectives and concerns were predictable. Insurers want a cost benefit study of insurance mandates and lauded Florida’s new barebones policies. There was a great deal of support for studying how a Healthy San Francisco-style model would work in CT. A suggestion to pilot it in an urban area led to concerns about two tiered care. There was no real consensus on which options to move forward. Important decisions were put off until the next meeting. At the next meeting, the members will also each get a copy of the latest Health Affairs – we’ll see if it helps. They will also discuss financing vehicles and an individual mandate – I can’t wait.
Ellen Andrews