Center for Studying Health System Change

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Hot Issues

Health Care Costs

HSC researchers are tracking the drivers of health care cost trends. Below are HSC research products related to this topic.

When Medicare Squeezes Payments, Hospitals Cut Costs Instead of Shifting Costs
Oct. 8, 2013

Contrary to the popular belief that hospitals shift costs to private payers when Medicare squeezes payments, hospitals instead cut operating costs to adjust to reduced revenues, according to a study by the Center for Studying Health System Change (HSC) published online in the journal Health Services Research.

Journal Article -- (Free access)
Media Advisory

Affordable Health Coverage Key to Attracting Uninsured ‘Young Invincibles’
September 2013

Most uninsured nonelderly adults—even the so-called young invincibles—believe they need health insurance, but fewer believe coverage is now affordable, according to a new national study by the Center for Studying Health System Change (HSC).

Research Brief No. 28
News Release

Wide Price Variation for Privately Insured Underscores Hospital Market Power
September 2013

Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients—especially for outpatient care—are much higher than Medicare and vary widely within and across communities, according to a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Research Brief No. 27
News Release

Urgent Care Centers: Emergency Department Alternative or Costly Convenience?
July 2013

Consumer demand for more convenient and timely access to care for illnesses and injuries is a major driver of the rapid growth of urgent care centers across the country, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Research Brief No. 26
Media Advisory

Ginsburg Testifies at Senate Finance Panel on Health Care Price Transparency
June 18, 2013

Most health care price transparency initiatives, including the recent government release of hospital charges, miss the mark because they fail to give patients useful information to identify hospitals and physicians providing high-quality care efficiently, economist Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change (HSC), told Congress today.

Senate Testimony
Media Advisory

Contrary to Conventional Cost-Shifting Wisdom, Lower Medicare Hospital Payment Rates Lead to Lower Rates for Private Payers
May 2013

Contrary to the notion that hospitals charge private payers higher payment rates to offset lower Medicare rates, it turns out the opposite is true—lower Medicare payment rates lead to lower private rates for inpatient care, according to a study by the Center for Studying Health System Change (HSC) published in the May Health Affairs.

Journal Article
News Release

Scaling Up Payment Reform Pilots Key to Health Care Cost Containment
May 2013

Scaling up health care payment reform to control costs and improve quality will require both sticks to prod providers from the sidelines and carrots to guide patients to more-efficient, higher-quality doctors and hospitals, according to an article by Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change (HSC), in the May Health Affairs.

Journal Article
News Release

Few Americans Switch Employer Health Plans for Better Quality, Lower Costs
Jan. 31, 2013

Less than 2.5 percent of nonelderly Americans in 2010 with employer coverage—about the same proportion as in 2003—initiated a change in health plans to reduce their health insurance costs or get a better quality plan, accordingto a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

NIHCR Research Brief No. 12
News Release

Despite Recession, Share of Americans with High Medical Costs Mostly Unchanged
Oct. 24, 2012

Almost one in five Americans younger than 65—18.8 percent—lived in families with high medical costs in 2009, roughly the same as 2006 despite widespread job losses, more uninsured and declining incomes during the Great Recession, according to a study by the Center for Studying Health System Change (HSC) published today as a Web First by Health Affairs.

Journal Article - (Free access.)
News Release

Adapting Tools from Other Nations to Slow U.S. Prescription Drug Spending
August 2012

Tools commonly used in other developed nations to help slow prescription drug spending growth offer potential lessons for the U.S. health system, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

NIHCR Policy Analysis No. 10
Media Advisory


The Growing Power of Some Providers to Win Steep Payment Increases from Insurers Suggests Policy Remedies May be Needed
May 2012

Given the negotiating clout of so-called must-have hospitals and physician groups, even dominant health plans are wary of disrupting the status quo by trying to constrain prices, perhaps because insurers can simply pass along higher costs to employers and their workers, according to a study by the Center for Studying Health System Change (HSC) published in the May edition of Health Affairs.

Journal Article
Media Advisory


Hospitals' Geographic Expansion in Quest of Well-Insured Patients: Will the Outcome be Better Care, More Cost, or Both?
April 2012

Hospitals’ longstanding competitive focus on cutting-edge technology, niche specialty services and amenities to attract physicians and patients has set the stage for the next chapter in hospital competition—targeted geographic expansion into new markets with well-insured people, according to a study by the Center for Studying Health System Change (HSC) published in the April edition of Health Affairs.

Journal Article
Media Advisory


Limited Options to Manage Specialty Drug Spending
April 2012

Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change (HSC).

HSC Research Brief No. 22
News Release


Great Recession Accelerated Long-Term Decline of Employer Health Coverage
March 2012

Between 2007 and 2010, the share of U.S. children and working-age adults with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a national study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

NIHCR Research Brief No.8
News Release


Slower Growth in Medicare Spending—Is This the New Normal?
March 7, 2012

While the economic downturn and other temporary factors likely have a role in slowing Medicare spending growth, past cost-control efforts and the looming specter of broader provider payment reform may signal a longer-term slowdown in Medicare spending growth, according to a perspective by researchers at the Center for Studying Health System Change (HSC), published online today in the New England Journal of Medicine.

Journal Article -- (Free access.)
Media Advisory


Health Status and Hospital Prices Key to Regional Variation in Private Spending
February 2012

Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices—especially for hospital care—also play a key role, accordingto a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

NIHCR Research Brief No. 7
News Release


1 in 5 Americans in Families with Problems Paying Medical Bills in 2010
December 2011

More than one in five Americans were in families with problems paying medical bills in 2010—about the same proportion as in 2007, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation (RWJF).

Tracking Report No. 28
News Release


Physician Visits After Hospital Discharge: Implications for Reducing Readmissions
December 2011

One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge,accordingto a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

NIHCR Research Brief No. 6
News Release


Employer-Sponsored Health Insurance: Down but Not Out
October 2011

Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to a study released today by HSC.

Issue Brief No. 137
News Release


Health Care's Role in Deficit Reduction—Guiding Principles
Oct. 27, 2011

Cutting federal health care spending over the next 10 years will be particularly challenging for the congressional super committee charged with proposing $1.2 trillion in additional deficit reduction by Thanksgiving, according to a perspective by researchers at the Center for Studying Health System Change (HSC) published online in the New England Journal of Medicine.

Journal Article -- Free Access
Media Advisory


Reforming Provider Payment—The Price Side of the Equation
Oct. 6, 2011

Unless public and private health care payers send consistent signals to providers through payment reform about controlling both the price and quantity of care, they risk working at cross purposes, according to a perspective by Paul B. Ginsburg, president of the Center for Studying Health System Change (HSC), published online in the New England Journal of Medicine.

Journal Article -- Free Access
Media Advisory


Rising Hospital Employment of Physicians: Better Quality, Higher Costs?
August 2011

While not new, the pace of hospital employment of physicians has quickened in many communities, driven largely by hospitals’ quest to increase market share and revenue, according to a study released by HSC.

Issue Brief No. 136
News Release


Primary Care Physician Willingness and Capacity to Treat More Medicaid Patients
April 27, 2011

Supporting increased capacity among primary care physicians already treating many Medicaid patients may be the best way to help ensure adequate capacity for people gaining Medicaid coverage under health reform coverage expansions starting in 2014, according to a national study by researchers at HSC and the Kaiser Family Foundation.

Kaiser Family Foundation Report
News Release


Follow the Money: Why are High-Cost Medicare Beneficiaries So Costly?
Feb. 11, 2011

In the quest to unravel the role of supply and demand in health care costs, policy makers may need to reconsider a commonly held premise that the supply of physicians, hospital beds and other health care resources is a major factor driving high Medicare costs, according to a study by HSC published online in the journal Health Services Research.

Journal Article Abstract
News Release


Wide Variation in Private Insurer Payment Rates Evidence of Hospital Market Power
Nov. 18, 2010

Wide variation in private insurer payment rates to hospitals across and within local markets suggests that some hospitals have significant market power to negotiate higher-than-competitive prices, according to a study released today by HSC commissioned by Catalyst for Payment Reform.

Research Brief No. 16
News Release


Comparative Effectiveness Research and Medical Innovation
Oct. 5, 2010

Determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research—can help foster beneficial medical innovation, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Policy Analysis No. 3
News Release


Affordability of Medical Care a Moving Target for Families
Sept. 16, 2010

While more Americans under 65 with employer health coverage faced problems paying medical bills between 2003 and 2007, increased out-of-pocket spending on health services played only a small part in the rising financial stress for families, according to an HSC study published online in the journal Medical Care Research and Review.

Journal Article Abstract
News Release


Damage Caps No Cure for Physician Fear of Malpractice Suits
Sept. 7, 2010

Even in states with economic damage caps in malpractice suits, physicians remain highly concerned about being sued, suggesting that many popular tort reform proposals may do little to deter the practice of defensive medicine that contributes to unnecessary health spending, according to a study by researchers at HSC in the September Health Affairs.

Journal Article Abstract
News Release


Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World?
June 22, 2010

Wellness and prevention strategies are fast becoming a standard feature of employer-based health benefits in hopes of countering rapidly rising health care costs that drive higher insurance premiums. Panelists at an HSC conference titled Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World? explored how effective employer-sponsored wellness and prevention initiatives focus on health improvement as a business strategy that foster work and community environments that help people lower risk factors.

Issue Brief No. 132


The Growing Financial Burden of Health Care: National and State Trends, 2001-2006
March 25, 2010

Almost one in five Americans—or 19.1 percent of the nonelderly population—lived in families spending more than 10 percent of before-tax income on health care in 2006, up from one in seven Americans (14.4%) in 2001, according to a Center for Studying Health System Change (HSC) study published online by Health Affairs.

Journal Article Abstract
News Release



Research Brief No. 10 - Living on the Edge: Health Care Expenses Strain Family Budgets
Journal Article - High Medical Cost Burdens, Patient Trust and Perceived Quality of Care
RWJF Synthesis Project Report - High and Rising Health Care Costs: Demystifying U.S. Health Care Spending
Tracking Report No. 21 - Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007
Congressional Testimony - Senate Finance Committee, hearing on "Rising Costs, Low Quality in Health Care: The Necessity for Reform"
Journal Article - Don't Break out the Champagne: Continued Slowing of Health Care Spending Growth Unlikely to Last
Journal Article - Tracking Health Care Costs: Continued Stability But at High Rates in 2005
Data Bulletin No. 33 - Tracking Health Care Costs: Spending Growth Remains Stable at High Rate in 2005
Journal Article - When the Price Isn't Right: How Inadvertent Payment Incentives Drive Medical Care
Journal Article - Tracking Health Care Costs: Declining Growth Trend Pauses in 2004
Data Bulletin No. 29 - Tracking Health Care Costs: Spending Growth Stabilizes at High Rate in 2004
Issue Brief No. 91 - Tracking Health Care Costs: Spending Growth Slowdown Stalls in First Half of 2004
Issue Brief No. 88 - Rising Health Costs, Medical Debt and Chronic Conditions
Issue Brief No. 85 - Tough Trade-offs: Medical Bills, Family Finances and Access to Care
Data Bulletin No. 27 - Tracking Health Care Costs: Trends Turn Downward in 2003
Journal Article - Tracking Health Care Costs: Trends Turn Downward in 2003
Issue Brief No. 75 - Patient Cost-Sharing Innovations: Promises and Pitfalls
Data Bulletin No. 26 - Tracking Health Care Costs: Trends Slow in First Half of 2003
Issue Brief No. 72 - Patient Cost Sharing: How Much is Too Much?


Emerging Market Trends

RWJF State Health Reform Assistance Network Initiative

As part of the Robert Wood Johnson Foundation’s (RWJF) State Health Reform Assistance Network initiative, HSC examined commercial and Medicaid health insurance markets in eight U.S. metropolitan areas: Baltimore; Portland, Ore.; Denver; Long Island, N.Y.; Minneapolis/St. Paul; Birmingham, Ala.; Richmond, Va.; and Albuquerque, N.M. The study examined both how these markets function currently and are changing over time, especially in preparation for national health reform as outlined under the Patient Protection and Affordable Care Act of 2010. The site visits took place in 2012-13. HSC will publish Community Reports for each community and two cross-site analyses based on findings from the site studies. More information can be found here.

2013 RWJF Reform Community Reports

Richmond Community Report - Federal Exchange Option and Indecision on Medicaid Expansion Create Uncertainty for Richmond, Va., Market
Long Island Community Report - Long Island Follows Bumpy New York Road to National Health Reform
Minneapolis Community Report - Minneapolis-St. Paul: Health Care Market Overcomes Early State Resistance to National Reform
Portland Community Report - Portland, Oregon: Health Insurance Market Geared Up for National Health Reform
Denver Community Report - Competitive Insurance Market Awaits National Health Reform
Baltimore Community Report - Health Insurance Market Primed for National Health Reform

Community Tracking Study (CTS) Site Visits

As part of the CTS, HSC studies how local health systems are changing through site visits to 12 randomly selected U.S. communities. Since 1996, researchers have visited the 12 communities approximately every two-three years to conduct in-depth interviews with leaders of the local health system. In 2010, HSC completed its seventh round of site visits and has published Community Reports from each site. More information can be found here.

2010 CTS Site Visit Products

Cross-Site Analyses

Issue Brief No. 138 - Small Employers and Self Insured Health Benefits: Too Small to Succeed?
Issue Brief No. 137 - Employer-Sponsored Health Insurance: Down but Not Out
Issue Brief No. 136 - Rising Hospital Employment of Physicians: Better Quality, Higher Costs?
Issue Brief No. 135 - Key Findings from HSC's 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

Research Brief No. 25 - Local Public Hospitals: Changing with the Times
Research Brief No. 21 - A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under Reform

Journal Article - Health Plan-Provider Price Negotiations: Passing the Buck to Employers
Journal Article - Hospitals' Geographic Expansion in Quest of Well-Insured Patients: Will the Outcome be Better Care, More Cost, or Both?

Community Reports

Boston Community Report - State Reform Dominates Boston Health Care Market Dynamics
Cleveland Community Report - Cleveland Hospital Systems Expand Despite Weak Economy
Greenville Community Report - Greenville & Spartanburg: Surging Hospital Employment of Physicians Poses Opportunities and Challenges
Indianapolis Community Report - Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients
Lansing Community Report - Lansing's Dominant Hospital, Health Plan Strengthen Market Positions
Little Rock Community Report - Little Rock Health Care Safety Net Stretched by Economic Downturn
Miami Community Report - Economic Downturn Strains Miami Health Care System
Northern New Jersey Community Report - Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts
Orange County Community Report - Physicians Key to Health Maintenance Organization Popularity in Orange County
Phoenix Community Report - Economic Downturn Slows Phoenix's Once-Booming Health Care Market
Seattle Community Report - Seattle Hospital Competition Heats Up, Raising Cost Concerns
Syacuse Community Report - Syracuse Health Care Market Works to Right-Size Hospital Capacity

 

California Site Studies

As part of the California Health Care Almanac project, the California HealthCare Foundation (CHCF) funded HSC to conduct interviews in six California communities in 2011-12 to assess how the organization, financing and delivery of health care are changing, including preparations for health reform. CHCF will publish regional market reports for each community and two cross-site analyses based on findings from the site studies. A previous round of California site studies was conducted by HSC researchers in 2008. More information can be found here.



 

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