Issue brief (Center for Studying Health System Change)最新文献

Although health care spending trends have slowed slightly, employers and consumers can expect another round of double-digit health insurance premium increases in 2004, according to a panel of market and health policy experts at the Center for Studying Health System Change's (HSC) eighth annual Wall Street roundtable. Firms will continue to shift costs to workers but are skeptical of new insurance products, including consumer-driven health plans and tiered provider networks. Most health plans are thriving as they continue to price products ahead of cost trends and gain administrative efficiencies. Many hospitals, facing revenue pressures from increasing competition from physician-owned specialty facilities, are continuing aggressive building campaigns, raising concerns about increased costs if they overshoot and add too much capacity. Efforts to revive the ailing Medicare managed care program face an uphill climb as Congress debates reforms as part of prescription drug legislation.

The nation's health care safety net--heavily reliant on external funding and support--is uniquely vulnerable to shifting and often adverse market and policy conditions. While adequate funding is essential to ensuring safety net providers can care for low-income people, the Center for Studying Health System Change (HSC) has identified a number of other factors key to building and maintaining viable community safety nets. Throughout the four rounds of HSC's Community Tracking Study (CTS) site visits, researchers have found that strong political and organizational leadership, community support, collaboration and business acumen have helped safety net providers build capacity and improve care coordination for low-income and uninsured people. These characteristics and business strategies have strengthened many community safety nets, better preparing them to weather current economic problems and providing a road map for the potentially tougher times ahead.

In anticipation of future terrorist attacks, the nation has been focused on emergency preparedness, including threats to public health and the ability of communities to respond to them. The Center for Studying Health System Change's (HSC) recent site visits to 12 nationally representative communities found early benefits to public health due to heightened attention to bioterrorism preparedness: more visibility and credibility for public health, stronger public health infrastructure and improved communication and coordination across sectors. Modest negative effects included staff diversions and delays in some program implementation. As the site visits continued from fall 2002 into 2003, concerns grew that the federal smallpox vaccination program was diverting resources from such traditional public health activities as routine immunizations, health promotion and screening.

Continued high-cost trends are threatening the affordability of health insurance and many consumers' access to care. Early findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities show the retreat from tightly managed care continues to shape local health care markets. Employers are aggressively shifting higher health costs to workers, and absent tight managed care controls to limit the use of care and slow payment rate increases, hospitals and physicians in many markets are competing fiercely for profitable specialty services. These developments have sparked growing skepticism about the potential for market-led solutions to the cost, quality and access problems facing the health care system today.

Hospitals specializing in cardiovascular and orthopedic procedures are developing rapidly throughout the country, raising challenging questions for communities and policy makers. Proponents argue that specialty hospitals could improve quality and reduce costs, yet skeptics note that specialty hospitals might reduce quality, increase costs and decrease access to basic services. The Center for Studying Health System Change (HSC) site visit findings suggest that the relatively high profit margins of these select procedures and specialists' desire to increase control over the care environment and increase their income are among the key reasons for this specialty hospital building boom. Policy makers are exploring a range of responses with the goal of allowing specialty hospitals to compete and innovate while minimizing the potential for quality, cost and access problems.

Contrary to popular belief that Americans avidly seek health information--especially on the Internet--a majority of Americans in 2001 sought no information about a health concern, according to a Center for Studying Health Systems Change (HSC) study. And, instead of surfing the Internet, the 38 percent of Americans who did obtain health information relied more often on traditional sources such as books or magazines. People living with chronic conditions were more likely to seek information, yet more than half did not. Education is key to explaining differences among people. Those with a college degree are twice as likely to seek health information as people without a high school diploma. As consumers are confronted with more responsibility for making trade-offs among the cost, quality and accessibility of care, credible and understandable information will be critical to empowering consumers to take active roles in managing their care.

Physicians' acceptance of care management tools--practice guidelines, patient satisfaction surveys and practice profiling--is an important indication of whether these efforts to improve quality and control health costs will succeed. According to a new study by the Center for Studying Health System Change (HSC), a majority of physicians affected by these tools believe the overall effect of each on the quality and efficiency of care they provide has been positive. Physicians affected by related financial incentives are more likely to view care management techniques positively if they are risk adjusted to reflect the greater need for services by people with health problems.

Recent expansions of the State Children's Health Insurance Program (SCHIP) and Medicaid have led to significant shifts in insurance coverage for children. New findings from the Center for Studying Health System Change (HSC) show that the proportion of low-income children who were uninsured dropped from 20.1 percent in 1997 to 16.1 percent in 2001, a result of significant increases in public program coverage. The net effect of these gains in coverage was limited, however, by a decline in private insurance coverage (from 47% in 1997 to 42.3% in 2001). The drop in private insurance was due, in part, to substitution of public for private insurance coverage.

As policy makers in Washington consider the use of tax credits to encourage uninsured Americans to buy health insurance, researchers and policy experts debated the merits of the individual health insurance market at a conference sponsored by the Center for Studying Health System Change (HSC) and Health Affairs. One presenter estimated that the individual market "works acceptably well for about 80 percent of potential buyers" but is unlikely to help the remaining 20 percent, who suffer from the worst health. Another presenter argued that the individual market "is not a good place to target substantial new resources aimed at lowering the number of uninsured persons." A proposal that intrigued many conference attendees is to have the federal government serve as a reinsurer of the individual market "by assuming responsibility for most of the costs of people in the highest 2 percent to 3 percent of the national spending distribution."