New on the Web 26: October 2004
We've collected information on several new reports and other resources available on the Web that we hope you'll find interesting and useful. Descriptions and links appear below.
Center for Studying Health System Change: "Rising Health Costs, Medical Debt and Chronic Conditions"
Center on Budget and Policy Priorities: "A Brief Update on State Fiscal Conditions and the Effects of Federal Policies on State Budgets," "Initial Data on Individual Market Enrollment Fail to Dispel Concerns about Health Savings Accounts"
Commonwealth Fund: "Policies to Reduce Racial and Ethnic Disparities in Child Health and Health Care," "A Review of the Quality of Health Care for American Indians and Alaska Natives," "State Pharmacy Assistance Programs: A Chartbook," "Will Consumer-Directed Health Care Improve System Performance?" Economic Policy Institute: "The Chronic Problem of Declining Health Coverage: Employer-Provided Health Insurance Falls for Third Consecutive Year"
Health Affairs: "Managed Care Rebound? Recent Changes in Health Plans' Cost Containment Strategies"
The Journal of Family Practice: "R-E-S-P-E-C-T: Patient Reports of Disrespect in the Health Care Setting and Its Impact on Care"
Kaiser Family Foundation: "The Public, Managed Care, and Consumer Protections," State Health Facts Online adds prescription drug data, "Views of the New Medicare Drug Law: A Survey of People on Medicare"
Kaiser Family Foundation and eHealthInsurance: "Update on Individual Health Insurance"
Kaiser Family Foundation and Health Research and Educational Trust (HRET): "Employer Health Benefits 2004 Annual Survey"
Kaiser Network: Ask the Experts: American Indian/Alaska Native Health webcast
KaiserEDU: Tutorial on the role of race and ethnicity in the U.S. health care system
Mathematica: "Monitoring Medicare+Choice: What Have We Learned? Findings and Operational Lessons for Medicare Advantage"
National Council of La Raza: "The Health of Latino Communities in the South: Challenges and Opportunities"
Urban Institute: "Access to Children's Mental Health Services under Medicaid and SCHIP," "A Health-Conscious Safety Net? Health Problems and Program Use among Low-Incomes Adults with Disabilities"
From the Center for Studying Health System Change
About 57 million working-age Americans (18-64 years old) live with chronic conditions such as diabetes or depression. Rising Health Costs, Medical Debt and Chronic Conditions reports that, in 2003, more than one in five—12.3 million people with chronic conditions—lived in families that had problems paying their medical bills. Rising health costs have hit low-income, privately insured people with chronic conditions particularly hard: Between 2001 and 2003, the proportion of such people who spent more than 5 percent of their income on out-of-pocket health care costs grew from 28 percent to 42 percent. (September 2004)
From the Center on Budget and Policy Priorities
Although state tax revenues have begun to rise again, the severe fiscal problems of the past several years continue to dominate the budget landscape. A Brief Update on State Fiscal Conditions and the Effects of Federal Policies on State Budgets discusses key aspects of the fiscal crisis and the outlook for 2005 and beyond. More detailed information is also available. (September 13, 2004)
Debate continues over Health Savings Accounts (HSAs), though many leading health care analysts and economists have warned that HSAs pose a high risk of causing "adverse selection." Adverse selection occurs when healthy people and less-healthy people separate into different insurance arrangements, which drives up the cost of insurance for less-healthy enrollees. Initial Data on Individual Market Enrollment Fail to Dispel Concerns about Health Savings Accounts considers new data, which the authors conclude do not support the claims of HSA proponents. (September 13, 2004)
From the Commonwealth Fund
The medical care that minority children receive is often inferior to the health care services that other children receive. Current research on racial and ethnic disparities documents widespread failings in both access to care and the quality of care for millions of minority children. Policies to Reduce Racial and Ethnic Disparities in Child Health and Health Care describes an arsenal of weapons available for reducing racial disparities in health care. (September/October 2004)
A Review of the Quality of Health Care for American Indians and Alaska Natives reports on progress made in the last five years to reduce or eliminate gaps in care for this population. It concludes that American Indians and Alaska Natives (AIANs) continue to suffer significant disparities in their health status and care despite the efforts of the Indian health system to improve the quality of care in AIAN communities. The author offers 10 conclusions/recommendations with respect to disparities between medical care for AIANs and the general population. (September 2004)
Before the Medicare drug law was enacted, many states already had programs in place to provide prescription drug coverage to some residents who did not qualify for Medicaid drug coverage. Now, states are trying to figure out whether and how to "wrap around" the new federal benefit in order to fill in coverage gaps. State Pharmacy Assistance Programs: A Chartbook offers policy makers and others comprehensive information on the 38 pharmacy assistance programs now in place, including how these efforts generally compare with the new Medicare drug benefit. (August 2004)
Consumer-directed health care plans have attracted attention as a method for managing rising health care spending by "giving consumers greater financial control over their health care." Increased cost-sharing is the principal tool used by these plans to achieve lower spending. Will Consumer-Directed Health Care Improve System Performance? argues that this and other measures may also cause patients to consume less care, even when that care is essential, potentially costing the health care system more in the long run. (August 2004)
From the Economic Policy Institute
The persistently weak labor market, together with sharply increasing health care costs, have led to a related problem for working families: the loss of employer-provided health coverage. The Chronic Problem of Declining Health Coverage: Employer-Provided Health Insurance Falls for Third Consecutive Year examines the erosion of employer-based coverage since 2000, with an emphasis on the characteristics—gender, race, education, and wage and income levels—of those who have lost coverage. (September 16, 2004)
From Health Affairs
Large increases in health care costs combined with an economic slowdown have created pressures for health plans and employers to reconsider cost containment strategies that were scaled back after the managed care backlash. Managed Care Rebound? Recent Changes in Health Plans' Cost Containment Strategies examines how plans' approaches to cost containment and care management have evolved since 2001. (August 11, 2004)
From The Journal of Family Practice
Perceptions of disrespect and of being treated unfairly within patient/provider relationships affect whether patients heed doctors' advice or return for treatment. In "R-E-S-P-E-C-T: Patient Reports of Disrespect in the Health Care Setting and Its Impact on Care," in the September 2004 issue of the Journal of Family Practice, researchers found that minorities are significantly more likely than whites to report being treated with disrespect or being looked down upon in patientprovider relationships. These patients were also more likely to put off needed care, less likely to follow doctors' advice, and less likely to receive optimal care for chronic diseases. (September 2004)
From the Kaiser Family Foundation
State Health Facts Online, a rich resource of state-specific numbers, has added prescription drug data to their database. These data include statistics on prescription drug use and spending for all 50 states and the U.S. This information is available by age group (seniors, adults, and children) and gender and displayed in ranked tables and color-coded maps. (September 2004)
Knowledge of the new Medicare prescription drug law remains sketchy, but 15 months from the date when the benefit is set to kick in, many more people on Medicare have an unfavorable than a favorable impression of the new law. Views of the New Medicare Drug Law: A Survey of People on Medicare assesses beneficiary attitudes toward the new Medicare drug law. It provides detailed insight in their perceptions and opinions about the law, the Medicare-approved drug-discount card program, and the new Medicare drug benefit. (August 2004)
The Public, Managed Care, and Consumer Protections, a Kaiser Health Poll Report examines the public's attitudes towards, and experiences with, their health plans, with a specific focus on managed care. The report uses current and historical public opinion data from the Kaiser Family Foundation and other polling organizations. It also looks at current and historical support for legislative action with regards to patients' rights. (July/August 2004)
From the Kaiser Family Foundation and eHealthInsurance
Many people are unfamiliar with the individual health insurance market because most Americans get their health coverage through their jobs or from a public program. Update on Individual Health Insurance provides information about the individual health insurance market, including information on insurance purchasers, premiums, retention rates, and cost-sharing. Future reports will provide trend information in such areas as premiums and cost-sharing and data on other topics such as Health Savings Accounts and small business health insurance trends. (August 2004)
From the Kaiser Family Foundation and Health Research and Educational Trust (HRET)
Employer Health Benefits 2004 Annual Survey is part of an annual series of studies documenting changes in employer-sponsored health insurance, including trends in premium rates and cost-sharing mechanisms. Among its findings, the survey reports that 61 percent of all workers receive health coverage from their employer, down significantly from its peak in 2001, meaning there are at least 5 million fewer jobs that provide health insurance in 2004 than there were in 2001. (September 2004)
From the Kaiser Network
Ask the Experts: American Indian/Alaska Native Health, a webcast, examined the state of health and health care in the American Indian/Alaska Native (AI/AN) population. The discussion addressed issues that included the adequacy of funding for AI/AN health care programs; efforts to improve AI/AN health and facilitate access to other health care resources; how to meet the unique needs of both rural and urban populations; and viewer questions. (September 27, 2004)
From KaiserEDU
This tutorial on the role of race and ethnicity in the U.S. health care system discusses how a person's race and ethnicity relate to their health status, health insurance coverage, health care access, and the quality of the care they receive. (July 2004)
From Mathematica
The role of private health plans in Medicare expanded substantially in 2004 under the new Medicare Modernization Act. Monitoring Medicare+Choice: What Have We Learned? Findings and Operational Lessons for Medicare Advantage notes that the program, now known as Medicare Advantage, is widely viewed as a failure. As private plans continue to be a focal point for changing Medicare in the future, policy makers need a better understanding of the dynamics of the system to facilitate a successful transition in this latest effort. (August 2004)
From the National Council of La Raza
The Health of Latino Communities in the South: Challenges and Opportunities provides a first-ever look at the health care needs, challenges, and realities of newly emerging Latino communities in the southern U.S. The study also includes a literature review and highlights of a regional meeting with key stakeholders from throughout the South. Findings show that Latinos in the South are reluctant to use public health care programs and facilities due to barriers such as lack of information about available services; lack of insurance; insufficient numbers of bilingual, bicultural personnel; and disparate treatment. (September 2004)
From the Urban Institute
Many low-income adults have a health problem or impairment that limits their ability to participate in social activities, including work. A Health-Conscious Safety Net? Health Problems and Program Use among Low-Income Adults with Disabilities examines the employment and program participation patterns of low-income adults with disabilities and how well the current safety net meets their needs. It also compares low-income adults with and without disabilities across employment, program participation, and income status. (September 2004)
At least 10 percent of low-income children have serious emotional and behavioral problems. States have adopted widely different ways of financing and delivering children's mental health services. Access to Children's Mental Health Services under Medicaid and SCHIP provides new information on Medicaid and SCHIP coverage of mental health services and on the prevalence of mental health problems among children according to income and health insurance coverage. (August 2004)
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