August 5, 2014
Health-information exchanges — not to be confused with health-insurance exchanges for purchasing coverage — are networks that allow patients’ records to be shared digitally among the providers caring for them. Through an HIE, emergency physicians could quickly access the medical history of a comatose accident victim, for example, or a specialist could review past test results and avoid ordering duplicates.
In 2009, the federal government allocated nearly $550 million in fiscal-stimulus funds to spur the development of HIEs in every state. More than 300 are in operation, including some run by state governments, some formed by hospital systems that share data only among their own affiliates and some public-private hybrids.
But dozens of HIEs have closed or consolidated amid funding and logistical woes, and experts say many more could struggle when federal funding ends this year. Previous efforts to create a statewide health-data network for California have foundered, though the state has some regional and local exchanges.
via Health Insurers Map Patient Database | Industries News Press.
July 2, 2014
This paper explores the effects of public health insurance expansions on hospitals’ decisions to adopt medical technology. Specifically, we test whether the expansion of Medicaid eligibility for pregnant women during the 1980s and 1990s affects hospitals’ decisions to adopt neonatal intensive care units NICUs. While the Medicaid expansion provided new insurance to a substantial number of pregnant women, prior literature also finds that some newly insured women would otherwise have been covered by more generously reimbursed private sources. This leads to a theoretically ambiguous net effect of Medicaid expansion on a hospital’s incentive to invest in technology. Using American Hospital Association data, we find that on average, Medicaid expansion has no statistically significant effect on NICU adoption. However, we find that in geographic areas where more of the newly Medicaid-insured may have come from the privately insured population, Medicaid expansion slows NICU adoption. This holds true particularly when Medicaid payment rates are very low relative to private payment rates. This finding is consistent with prior evidence on reduced NICU adoption from increased managed-care penetration. We conclude by providing suggestive evidence on the health impacts of this deceleration of NICU diffusion, and by discussing the policy implications of our work for insurance expansions associated with the Affordable Care Act.
via Public Health Insurance Expansions and Hospital Technology Adoption.
May 13, 2014
We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly initial age 50-61 over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies.
via The Effect of Health Insurance on Near-Elderly Health and Mortality by Bernard S. Black, José-Antonio Espín-Sánchez, Eric French, Kate Litvak :: SSRN.
May 7, 2014
The Annals of Internal Medicine study, using a rigorous methodology, tells us something that actually isn’t very surprising: that expanding coverage using private-sector health insurance improves health outcomes. The very same medical literature that overwhelmingly highlights Medicaid’s poor outcomes also highlights the substantial benefits of private health insurance.
via Romneycare Improved Health Outcomes, Thanks To Private-Sector Coverage.
March 25, 2014
This is cause for serious concern. Not only does the change lend credence to a discredited approach to fighting obesity, but it in effect allows companies to punish their employees for pre-existing conditions, something that Obamacare was designed to avoid.
Worse that being simply ineffective, financial penalties for obesity have significant negative effects. They erode trust between employers and employees, prompting some workers to quit or suffer the genuine fear that the release of private health data will endanger their future employability.
These penalties also discriminate against the poor — many of whom live in neighborhoods with limited access to nutritional foods but plenty of cheap junk food available – and against people with mobility problems who are more likely to be obese. Large controlled studies show that increasing health care charges actually steers people away from essential medical care, exacerbating high blood pressure, worsening vision, and increasing mortality by 10% among low income people with chronic diseases.
via An Obamacare Fine on Overweight Americans: Discriminatory and Ineffective | The Health Care Blog.
March 21, 2014
Michael Hiltzik is a business columnist for the Los Angeles Times who has spent a good deal of the last few months blogging about ObamaCare. I noticed that he recently used the discredited statistic that “45,000 Americans die annually because they lack insurance.”
That statistic came from this study entitled “Health Insurance and Mortality in US Adults”—henceforth the “Wilper-2009 study” after the lead author. The Wilper-2009 study examined the insurance status of a group of people in 1993 and then checked their mortality in 2001. The researchers found a higher death rate among those who where uninsured in 1993 and from that computed that 45,000 statistic.
The big flaw, as I pointed out, is “the authors had no idea how many people uninsured in 1993 subsequently acquired health insurance. Someone who was uninsured in 1993, got insurance in, say, 1996, and then died in 2000—well, it would be pretty hard to attribute his death to being uninsured, wouldn’t it? “
via 45,000 People Die From Lack Of Insurance Because Michael Hiltzik Of The L.A. Times Says So – Amy Ridenour’s National Center Blog – A Conservative Blog.
March 6, 2014
The growing bureaucratization of medicine presents a serious threat to physicians’ ability to provide quality patient care. Whether through big government or mega hospital systems, innovation and detailed attention to the needs of individual patients will suffer.
The pain will be especially acute for independent practices specializing in primary care. They operate with the narrowest margins and have the fewest resources to adjust to the mountain of new regulatory demands being imposed on them.
via Governmen Bureaucracy Will Stifle Hospital and Smal Practitioners – NYTimes.com.