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Getting to the Real Issues in Health Care Reform

If current congressional health care reform proposals become law it would be only the start of the reform process, according to a policy perspective by HSC President Paul B. Ginsburg, Ph.D., published online on Nov. 12 by the New England Journal of Medicine.

Despite Transparency, New Hampshire Health Care Price Variation Remains

Price variation for certain outpatient medical procedures has not decreased in New Hampshire since the state launched the HealthCost price transparency program in early 2007, according to a study released today by HSC and funded by the California HealthCare Foundation.

Health Insurers Pursue Growth Potential of Individual Market

Insurers are pursuing strategies to tap the growth potential of the individual health insurance market, including entering less-regulated markets and developing lower-cost, less-comprehensive products targeting younger, healthy consumers, according to a study released today by HSC.

Hospital Strategies to Engage Physicians in Quality Improvement

While physicians are essential to hospital quality improvement efforts, competing time and financial pressures pose hurdles to physician participation, according to a study released today by HSC.

University of California Physician Joins HSC as Visiting Senior Fellow

Patrick S. Romano, M.D., M.P.H., has joined the Center for Studying Health System Change (HSC) as a visiting senior fellow while on sabbatical as a professor of medicine and pediatrics at the University of California, Davis School of Medicine.

Policy Perspective: Affordable Health Coverage for Near-Elderly Americans

Among the policy options to expand health coverage for Americans aged 55 to 64—the near elderly—comprehensive reform of the individual insurance market, coupled with a Medicaid expansion for those with very low incomes, would be the most effective and far-reaching approach, according to a new Policy Perspective from HSC.

Two HSC Articles Appear in September/October Health Affairs

Two September/October Health Affairs articles from HSC researchers explore whether U.S. health care spending is excessive and the role of Medicare governance in provider payment policy.

A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey

Almost 75 percent of physicians were accepting all or most new Medicare patients, the vast majority of physicians contracted with managed care plans, and slightly fewer than six in 10 physicians provided charity care in 2008, according to findings released today from the nationally representative HSC 2008 Health Tracking Physician Survey.

Does Telemonitoring of Patients—the eICU—Improve Intensive Care?

While nearly 10 percent of U.S. hospital intensive care unit (ICU) beds use advanced telemonitoring—known as eICUs—there has never been a systematic evaluation of how the innovative approach to caring for critically ill patients affects quality and costs, according to a study by HSC published today as a Web exclusive in the journal Health Affairs.

Suburban Poverty and the Health Care Safety Net

As suburban poverty increases, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace, according to a new study by HSC of five communities—Boston, Cleveland, Indianapolis, Miami and Seattle.

Exploring Six California Health Economies

California is large and diverse, and health care is organized, delivered and financed differently across the state. To help inform local leaders, policymakers, the public and the media about regional differences in health care affordability, access and quality, the California HealthCare Foundation funded HSC to conduct in-depth site visits in six California regions. Regional reports were published today.

Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans

Over a two-year period, 20 percent of nonelderly adults who had a chronic health condition spent more than 5 percent of their income on out-of-pocket expenses and health insurance premiums, according to a study released today by The Commonwealth Fund and conducted by Peter J. Cunningham, Ph.D., a senior fellow at HSC. Among people with three or more chronic conditions, the proportion spending 5 percent of income—39 percent—was nearly double.

Health Care Quality Transparency Initiatives

Until consumers are motivated to investigate differences in hospital and physician quality, the main value of public quality reporting will likely be to spur providers to improve their performance, according to a Commentary published today by HSC. In a separate Issue Brief released today, HSC researchers highlight two quality transparency initiatives: CalHospitalCompare, a report card for hospitals, and Massachusetts Health Quality Partners, a report card for primary care physician groups.

Emergency Physician Joins HSC as Senior Researcher

Emily Carrier, M.D., M.S.C.I., an emergency physician, has joined the Center for Studying Health System Change (HSC) as a senior health researcher.

Pham Receives AcademyHealth New Investigator Award

HSC Senior Researcher Hoangmai H. Pham, M.D., M.P.H., has received AcademyHealth’s 2009 Alice S. Hersh New Investigator Award, which recognizes the contribution of new scholars to the field of health services research. Pham was recognized for her body of work, which focuses on the organization of care delivery, how providers respond to incentives, quality of care, health care disparities and how each of these areas intersects with payment policy.

How Does Health Coverage and Access to Care for Immigrants Vary by Length of Time in the U.S.?

While, overall, immigrants have a high uninsured rate and face greater access barriers relative to U.S.-born residents, many immigrants eventually gain health insurance and improved access to health care as they acquire language and job skills, improve their economic standing and become more familiar with the U.S. health care system, according to a study released today by the Kaiser Family Foundation (KFF). The research, conducted by HSC Senior Fellow Peter J. Cunningham, Ph.D., and KFF Senior Policy Analyst Samantha Artiga, examines how health coverage and access to care for nonelderly adults vary based on immigrants' length of time in the U.S.

Physician Performance Measurement

Physicians wield significant influence—directly and indirectly—over the quality and cost of health care, but early efforts to measure physician performance may prove a lost opportunity to improve the nation's health care system if methodological and other shortcomings are not addressed, according to a commentary published today by HSC.

Efficiency and Quality: The Role of Controlling Health Care Cost Growth in Health Care Reform

Expanding health insurance coverage to the more than 45 million uninsured Americans is a key U.S. policy goal, but expanding coverage without steps to contain rapidly rising health care costs is a recipe for failure. This Center for American Progress paper by HSC President Paul B. Ginsburg, Ph.D., focuses on steps that can be taken as part of health reform to slow the trend of health spending, including steps that Congress can take now, as well as direction for developing and implementing longer-term policies.

HSC Study Underscores Need for Quality Metrics to Measure Overuse of Care

Although rapid X-rays or other imaging for uncomplicated low-back pain are rarely indicated, almost 1 in 3 elderly Medicare patients received imaging services within a month of low-back pain diagnosis, according to a study by researchers at HSC in the May 25 Archives of Internal Medicine.

Coordination of Care by Primary Care Practices

Despite wide recognition that the fragmented U.S. health care system does a poor job of coordinating patients' care, little information is available about how physicians can improve care coordination, both within and across practices and care settings, according to a study released today by HSC.

General Hospitals, Specialty Hospitals and Financially Vulnerable Patients

Despite initial challenges recruiting staff and maintaining service volume and patient referrals, general hospitals were generally able to respond to the initial entry of specialty hospitals with few, if any, changes in the provision of care for financially vulnerable patients, according to a study by HSC of three markets with established specialty hospitals—Indianapolis, Phoenix and Little Rock, Ark.

Two-Thirds of Primary Care Physicians Can't Get Mental Health Services for Patients

About two-thirds of U.S. primary care physicians reported in 2004-05 that they couldn’t get outpatient mental health services for their patients—a rate that was at least twice as high as for other services, according to a national study published today as a Web Exclusive in the journal Health Affairs.

Financial and Health Burdens of Chronic Disease Grow

Almost three in 10 working-age Americans with diabetes, asthma, depression or other chronic conditions lived in families with problems paying medical bills in 2007—a significant increase from two in 10 in 2003, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation.

Ginsburg Testifies at House Energy and Commmerce Health Panel on Transparency

Despite well-intentioned efforts in recent years by government, employers, health plans and others to foster health care price and quality transparency, most Americans still choose doctors and hospitals the old-fashioned way—they rely on recommendations from friends and families and physicians, economist Paul Ginsburg, Ph.D., president of HSC, told Congress today.

Preventing and Managing Chronic Conditions: What’s Working in the Real World?

Innovative approaches to promote wellness and manage chronic conditions will be the focus of a Center for Studying Health System Change (HSC) conference on April 8—the second of four HSC conferences on significant health policy topics sponsored by the Pharmaceutical Research and Manufacturers of America (PhRMA), DMAA: The Care Continuum Alliance and the American College of Preventive Medicine.

Insurer Personal Health Records: Can They Bridge the Information Gap?

While many major health insurers have created personal health records (PHRs) to allow enrollees to electronically store and organize their health care information, whether patients and physicians will embrace the new electronic tool remains an open question, according to an HSC study published today in the journal Health Affairs.

Access to Prescription Drugs for Medicare Beneficiaries

The introduction of the outpatient Medicare drug benefit in 2006 did little to close longstanding prescription drug access gaps between white and African-American seniors, healthier and sicker beneficiaries, and lower-income and higher-income beneficiaries, according to a national study released today HSC.

Care Coordination Daunting for Physicians

Illustrating the formidable task of coordinating care, a typical primary care physician who treats elderly Medicare patients must coordinate care with 229 other physicians working in 117 different practices, according to a study by researchers at HSC, Memorial Sloan-Kettering Cancer Center and the Dana-Farber Cancer Institute in the Feb. 17 Annals of Internal Medicine. A related editorial is also available.

Consumer-Directed Health Care: Promise and Performance

The performance of consumer-driven health care has fallen short of both the aspirations of its proponents and the fears of its critics, according to a study released today as a Web exclusive in the journal Health Affairs. Growth of the organizational forms favored by advocates of consumer-driven health care, such as high-deductible health plans and individually purchased insurance, has been anemic.

Access to Prescription Drugs Declines Among Nonelderly Americans

The proportion of children and working-age Americans who went without a prescription drug because of cost jumped to one in seven in 2007, up from one in 10 in 2003, according to a national study released today be HSC and funded by the Robert Wood Johnson Foundation.

Studies Examine Patient Trust in Physicians and Patient Views of Care Coordination

Patients with high medical costs are less likely to trust that their physician will put their interests first, while less than half of patients reported that their primary care physician always seemed informed about specialist care received, according to two studies by the Center for Studying Health System Change (HSC) published online in The Journal of General Internal Medicine.

Living on the Edge: Health Care Expenses Strain Family Budgets

Financial pressures on families from medical bills increase sharply when out-of-pocket spending for medical care exceeds 2.5 percent of family income, according to a new national study by HSC.

American Families' Use of Retail-Based Health Clinics Remains Modest

Despite rapid growth of retail clinics, only a tiny fraction of American families in 2007 had ever used the in-store clinics, typically located in pharmacies, supermarkets and big-box retailers, according to a national study released today by the Commonwealth Fund and conducted by HSC.

Making Medical Homes Work: Moving from Concept to Practice

Key operational issues facing medical home initiatives include how to qualify physician practices as medical homes; how to match patients to their medical homes; how to engage patients and other providers to work with medical homes in care coordination; and how to pay practices that serve as medical homes, according to a new Policy Perspective from researchers at the Center for Studying Health System Change (HSC) and Mathematica Policy Research (MPR).

Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

Despite myriad initiatives to encourage people to use health care price and quality information, most Americans still rely on word-of-mouth and physician recommendations to choose health providers, according to a new HSC study funded by the California HealthCare Foundation.

The Fraying Link Between Work and Health Insurance

Most nonelderly Americans still obtain health insurance coverage through an employer, but the percentage of nonelderly persons with employer-sponsored insurance coverage has declined steadily since 2000, according to a study released today by the Kaiser Family Foundation (KFF). The research, conducted by HSC Senior Fellow Peter J. Cunningham, Ph.D., and KFF Senior Policy Analysts Samantha Artiga and Karyn Schwartz, examines the factors driving the decrease in employer-sponsored insurance since 2000.

Medicaid Payment Delays Deter Physician Participation

Although low fees discourage physicians from treating Medicaid patients, payment delays also play an important role in physician decisions to avoid Medicaid patients, according to an HSC study published as a Web exclusive in the journal Health Affairs.

Massachusetts Health Reform: High Costs and Expanding Expectations May Weaken Employer Support

While employer support was key to enacting Massachusetts' landmark law to gain near-universal health coverage, high costs and expanding expectations may dampen employer support as the reform plays out, according to a new study by HSC.

How Engaged Are American Consumers in Their Health and Health Care?

The level of patient activation—a person's ability to manage their health and health care—varies considerably in the U.S. population, with less than half of adults (41.4%) at the highest level, according to a new national study by HSC.

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