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Health Care Costs
HSC researchers are tracking the drivers of health care cost trends. Below are HSC research products related to this topic.
Contrary to Conventional Cost-Shifting Wisdom, Lower Medicare Hospital Payment Rates Lead to Lower Rates for Private Payers
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
Scaling Up Payment Reform Pilots Key to Health Care Cost Containment
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
Few Americans Switch Employer Health Plans for Better Quality, Lower Costs
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
Despite Recession, Share of Americans with High Medical Costs Mostly Unchanged
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.)
Adapting Tools from Other Nations to Slow U.S. Prescription Drug Spending
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).
The Growing Power of Some Providers to Win Steep Payment Increases from Insurers Suggests Policy Remedies May be Needed
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.
Hospitals' Geographic Expansion in Quest of Well-Insured Patients: Will the Outcome be Better Care, More Cost, or Both?
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.
Limited Options to Manage Specialty Drug Spending
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).
Great Recession Accelerated Long-Term Decline of Employer Health Coverage
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).
Slower Growth in Medicare Spending—Is This the New Normal?
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.
Health Status and Hospital Prices Key to Regional Variation in Private Spending
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).
1 in 5 Americans in Families with Problems Paying Medical Bills in 2010
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).
Physician Visits After Hospital Discharge: Implications for Reducing Readmissions
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).
Employer-Sponsored Health Insurance: Down but Not Out
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.
Health Care's Role in Deficit Reduction—Guiding Principles
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.
Reforming Provider Payment—The Price Side of the Equation
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.
Rising Hospital Employment of Physicians: Better Quality, Higher Costs?
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.
Primary Care Physician Willingness and Capacity to Treat More Medicaid Patients
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.
Follow the Money: Why are High-Cost Medicare Beneficiaries So Costly?
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.
Wide Variation in Private Insurer Payment Rates Evidence of Hospital Market Power
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.
Comparative Effectiveness Research and Medical Innovation
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).
Affordability of Medical Care a Moving Target for Families
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.
Damage Caps No Cure for Physician Fear of Malpractice Suits
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.
Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World?
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.
The Growing Financial Burden of Health Care: National and State Trends, 2001-2006
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.
Consumer-Driven Health Care
Consumer-Driven 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.
Checking Up on Retail-Based Health Clinics: Is the Boom Ending?
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.
The Transition from Managed Care to Consumerism: A Community-Level Status
This paper assesses the evolving "facilitated consumerism" model of health care at the community level, finding that in a relatively short time large employers and health plans have made notable progress in putting the building blocks in place to support their vision of consumerism. However, developments in the 12 communities suggest that the consumerism strategy evolving in local markets is more nuanced than implied by some descriptions of health care consumerism.
Consumer-Directed Health Plans: Mixed Employer Signals, Complex Market Dynamics
While adoption of high-deductible health plans coupled with spending accounts remains modest, supporters believe consumer-directed health plans (CDHPs) will take hold as part of a larger employer strategy to confer more responsibility on workers for health care costs, lifestyle choices and treatment decisions.
Benefit Design Innovations: Implications for Consumer-Directed Health Care
Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool
Health Benefits In 2006: Premium Increases Moderate, Enrollment In Consumer-Directed
Health Plans Remains Modest
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including changes in premiums, employee contributions, cost-sharing policies, and other relevant information. This year the survey also documented the prevalence of high-deductible health plans associated with a savings option, including the percentage of employers offering these plan types and the percentage of workers covered by them. The 2006 survey included 3,159 randomly selected public and private firms with three or more employees (2,122 of which responded to the full survey and 1,037 of which responded to an additional question about offering coverage). Researchers at the Kaiser Family Foundation, the Center for Studying Health System Change and Health Research and Educational Trust designed and analyzed the survey.
Consumer-Directed Health Insurance Products: Local-Market Perspectives
During the past few years, health plans have focused product development on consumer-driven health plans. This paper examines how these products are faring in twelve Community Tracking Study (CTS) communities. Although there has been a proliferation in the number and variety of consumer-directed plan options available, employers have taken a cautious approach. Given the increased financial stake and decision-making responsibility consumers hold when enrolled in these plans, respondents expressed frustration that the availability of information support has lagged behind the demands placed on consumers.
What High-Deductible Plans Look Like: Findings from a National Survey of Employers, 2005
This Health Affairs article documents the availability, enrollment, premiums, and cost sharing for high-deductible health plans that are offered with a health reimbursement arrangement (HRA) or are health savings account (HSA)-qualified plans. Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging $1,870 for single coverage and $3,686 for family coverage in high-deductible health plans with an HRA and $1,901 for single coverage and $4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers.
Free access to this Health Affairs article is available at the Kaiser Family Foundation Web site.
HSC Conference Examines Promises and Pitfalls of Patient Cost Sharing
The Center for Studying Health System Change (HSC) conducted a conference Dec. 3, titled "Patient Cost Sharing: Promises and Pitfalls." A transcript and webcast of the conference are now available.Issue Brief No. 72
Patient Cost-Sharing Innovations: Promises and Pitfalls
HSC's Patient Cost Sharing: Promises and Pitfalls conference on Dec. 3, 2003, featured presentations and a panel discussion on cost-sharing trends and the implications for consumers. An Issue Brief describing the conference discussion is now available.
Health Information Technology
Transmitting and Processing Electronic Prescriptions: Experiences of Physician Practices and Pharmacies
The study focuses on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies. It explores facilitators of and barriers to the electronic transmission of new prescriptions and renewals and pharmacy e-prescription processing.Journal Article - (Free access.)
E-Prescribing and Information to Improve Physician Prescribing Decisions
While many e-prescribing systems have features to provide access to important external patient informationdrugs prescribed by physicians in other practices and patient formularies, for examplephysician practices face challenges using these tools effectively, according to a study released by HSC.HSC Research Brief No. 20
Achieving Health Information Technology's Potential to Improve Care is Daunting Task
While health information technology (HIT) holds great promise in helping clinicians improve patient care, realizing that potential will require progress on multiple fronts, according to a perspective by Ann S. O’Malley, M.D., M.P.H., a senior researcher at HSC, published in the New England Journal of Medicine.Journal Article Abstract
Physician E-mail with Patients Uncommon
Despite indications that many patients want to communicate with their physicians via e-mail, physicians’ use of e-mail with patients is the exception rather than the rule, according to a national study released by HSC.
Overall, only 6.7 percent of all office-based physicians nationally routinely e-mailed patients about clinical issues in 2008, according to the study funded by the Robert Wood Johnson Foundation (RWJF). About one-third of office-based physicians in 2008 reported that information technology for communicating with patients about clinical issues via e-mail was available in their practice. Of the physicians with access to e-mail, about one in five (19.5%) routinely e-mailed patients.Issue Brief No. 134
Even When Physicians Adopt E-Prescribing, Use of Advanced Features Lags
Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by HSC.
Slightly more than two in five office-based physicians reported that information technology was available in their practice to write prescriptions in 2008, the year before implementation of federal incentives. And, among physicians with e-prescribing capabilities, about a quarter used the technology only occasionally or not at all.Issue Brief No. 133
Electronic Medical Records Help and Hinder Communication with Patients and
Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communicationreal-time, face-to-face or phone conversationswith patients and other clinicians, according to a new HSC study released today.Issue Brief No. 131
Gap Exists Between Vision for Electronic Medical Records and Clinicians'
A gap exists between policy makers' expectations that current commercial electronic medical records (EMRs) can improve coordination of patient care and clinicians' real-world experiences with EMRs, according to a study by HSC published online in The Journal of General Internal Medicine.
Does Telemonitoring of Patients�the eICU�Improve Intensive Care?
While nearly 10 percent of U.S. hospital intensive care unit (ICU) beds use advanced telemonitoringknown as eICUsthere 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 as a Web exclusive in the journal Health Affairs.
Information Gap: Can Health Insurer Personal Health Records Meet Patients'
and Physicians' Needs?
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 in the journal Health Affairs.
Despite Regulatory Changes, Hospitals Cautious in Helping Physicians Purchase Electronic Medical Records
Despite regulatory changes allowing hospitals to help physicians purchase electronic medical records (EMRs), hospitals are proceeding cautiously, according to a study released today by HSC.Issue Brief No. 123
Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome?
Feb. 25, 2008
Barriers to sharing patient clinical data electronically among rival hospitals, doctors and health plans remain high as concerns about loss of competitive advantage and data misuse hamper participation in local health information exchanges, according to a new study released by HSC and the National Institute for Health Care Management Foundation.
Clinical Information Technology Adoption Varies Across Physician Specialties
Sept. 20, 2007
While practice setting and size are the strongest predictors of physicians' access to clinical information technology (IT) in their practices, significant variation in IT adoption exists across specialties, according to a national study released by HSC.
Physicians' Experience Using Commercial E-Prescibing Systems
April 3, 2007
While physicians who have embraced e-prescribing wouldn't go back to paper prescriptions, they report major barriers to using advanced e-prescribing features that many advocates believe offer the greatest potential to improve the safety and quality of health care, according to a study by HSC researchers published today as a Web exclusive in the journal Health Affairs.
The Role of Competition in Driving Clinical Data Exchange
Nov. 14, 2006
Recent policy efforts to encourage the use of health information technology are emphasizing development of communitywide health information exchanges to share clinical data across patient care settings. The study found that most large hospitals have or are developing physician portals to provide admitting physicians with remote access to patient records, but there is little data sharing among unaffiliated organizations. Competition among hospitals for physicians is a key factor driving adoption of these proprietary systems. In contrast, provider and health plan competition and adversarial relationships between providers and plans are viewed as major barriers to communitywide clinical data sharing.
Clinical IT Gaps Persist Between Small and Large Physician Practices
Nov. 9, 2006
Physicians in smaller practices continue to lag well behind physicians in larger practices in reporting the availability of clinical information technology (IT) in their offices. The proportion of physicians reporting access to IT for each of five clinical activities increased across all practice settings between 2000-01 and 2004-05. However, adoption gaps between small and large practices persisted for two of the clinical activitiesobtaining treatment guidelines and exchanging clinical data with other physiciansand widened for the other threeaccessing patient notes, generating preventive care reminders and writing prescriptions.
Physicians Slow to Adopt Patient E-mail
Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01.
Physician Access to Clinical Information Technology Grows
Physician access to practice-based clinical information technology (IT) grew significantly between 2000-01 and 2004-05. The study examined whether physician practices used information technology for the following five clinical activities: obtaining information about treatment alternatives or recommended guidelines; exchanging clinical data and images with other physicians; accessing patient notes, medication lists or problem lists; generating preventive treatment reminders for the physician's use; and writing prescriptions.
Most Medicare Outpatient Visits to Physicians with Limited Clinical IT
A majority of Medicare fee-for-service outpatient visits in 2001 were to physicians without significant information technology (IT) support for patient care. Through a linkage of Medicare claims data to HSC's nationally representative physician survey, HSC researchers found that more than half of Medicare outpatient visits (57%) were to physicians in practices that used IT for no more than one of the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating preventive treatment reminders for the physician's use, and writing prescriptions.Data Bulletin No. 30
Limited Information Technology for Patient Care in Physician Offices
While there's wide enthusiasm for harnessing the power of information technology (IT) to improve U.S. medical care, fewer than a quarter of physicians in 2001 could generate electronic treatment reminders for use during patient visits and only about 10 percent could write electronic prescriptions.
Providing the first nationally representative snapshot of the availability of information technology to support patient care in physician offices across specialties, practice settings and geographic areas, the study found wide variation in IT adoption across physician practices. The study examined whether physician practices used computers or other information technology for the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating treatment reminders for the physician's use and writing prescriptions.
Emerging Market Trends
Since 1996, researchers have visited the 12 communities approximately every two to three years to conduct in-depth interviews with leaders of the local health system. HSC explores how the organization, financing and delivery of health care have been changing and the impact of these changes on people. Researchers interview representatives of local hospitals, health plans, physician organizations, safety net providers, employers, key government agencies, policy makers and consumer groups.
HSC has completed its seventh round of site visits and has published Community Reports from each site. In addition, HSC is in the process of publishing cross-site analyses on trends uncovered through the visits. The cross-site analyses are being published as HSC Issue Briefs, Research Briefs and peer-reviewed journal articles. Click here for more information on the site visits.
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.
2010 CTS Site Visit Products
Issue Brief No. 138 - Small Employers and Self Insured Health Benefits: Too Small to Succeed?
Research Brief No. 25 - Local Public Hospitals: Changing with the Times
Journal Article - Health Plan-Provider Price Negotiations: Passing the Buck to Employers
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