On June 24, the non-profit National Institute for Health Care Management (NIHCM) Foundation released a data brief, Understanding U.S. Health Care Spending, analyzing total U.S. health care spending.  Examining data from the National Health Expenditure Accounts (NHEAs) and the Medical Expenditure Panel Survey (MEPS), the brief notes that annual health care spending reached $2.5 trillion in 2009, or 17.6 percent of the Gross Domestic Product (GDP).  The brief also notes that spending increased 29 percent between 2005 and 2009, averaging $8,100 per person in 2009.  The Foundation found that costs are highly concentrated among a small number of high-cost patients, with approximately 5 percent of the population accounting for 47.5 percent of all spending, while 50 percent of the population accounts for only 3 percent of spending.  The brief also notes that rising prices have played a larger role than increased utilization rates in driving recent cost growth.

From the report:

On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

Health Affairs has released a study finding that hospitals in areas with robust hospital competition tend to address shortfalls between Medicare payments and projected costs primarily by reducing hospital costs.  Conversely, the authors found that hospitals in areas where hospital care is concentrated among a limited number of providers respond by raising the prices they charge private insurers, in a practice known as “cost shifting”.  The authors argue that their findings necessitate a policy discussion about whether increased provider integration will interfere with the national health care reform law’s goal of reducing Medicare spending, as increased integration could reduce market competition and, in turn, increase the use of cost shifting.

Robinson, James. (2011). Hospitals respond to Medicare payment shortfalls by both shifting costs and cutting them, based on market concentration. Health Affairs, 30 (7): 1265-1271. doi: 10.1377/hlthaff.2011.0220. http://content.healthaffairs.org/content/30/7/1265.abstract

Author: James Robinson.

On July 7, the National Bureau of Economic Research (NBER) published a study examining the impact of providing health coverage to uninsured low-income individuals.  Focusing on the impact on health service utilization, health outcomes, and financial burden, the study examined the effects of a 2008 Oregon Medicaid expansion that used a lottery system to select 10,000 participants to enroll in Medicaid out of a pool of approximately 90,000 applicants.  NBER found that beneficiaries had statistically significantly higher health service utilization and better self reported physical and mental health than the control group, which was comprised of individuals not selected for Medicaid coverage in the lottery.  Additionally, the authors found statistically significantly lower out-of-pocket (OOP) medical spending and medical debt among beneficiaries when compared to the control group.  The study has implications for the impact of the national health care reform law’s Medicaid expansion on uninsured individuals.

Finkelstein, Amy et. al. (2011). The Oregon health insurance experiment: evidence from the first year. National Bureau of Economic Research, (17190). http://www.nber.org/papers/w17190

Authors: Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, and Katherine Baicker.

Mathematica Policy Research has released a brief examining managed long-term care.  Focusing on options for New York State, the brief also offers general options available to all states.  The authors also offer options for improving dual eligibles' care.

From the report:

The Federal Coordinated Health Care Office (renamed the Medicare-Medicaid Coordination Office) and the Center for Medicare and Medicaid Innovation are partnering to help states develop integrated care programs for dual eligibles.  CMS selected 15 states on April 14, 2011 to receive contracts of up to $1 million each to help them plan dual eligible demonstration projects.  States selected were CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, and WI.  Planning contracts will be for 18 months, and demonstrations will start in 2012.

Full report: Managed Long Term Care: Options for New York and Examples From Other States (PDF | 197.47 KB)

Mathematica Policy Research.  (2011).  Managed long term care: options for New York and examples from other states.  Verdier, J.

On June 23, the Kaiser Family Foundation (KFF) released a brief examining health coverage challenges facing unemployed individuals and outlining their options for maintaining coverage.  The brief notes that 13.9 million individuals were unemployed in May 2011, of whom 6.2 million had been uninsured for at least six months.  The authors suggest that individuals’ options to maintain health coverage diminish as they remain unemployed for six months or more, highlighting COBRA, public health coverage, and the individual insurance market as options for unemployed individuals to obtain health coverage.  The authors assert that implementation of the national health care reform law will result in a wider range of affordable coverage options for the unemployed.

From the report: