2012 Potpourri XXVIII

Caring for traumatic conditions is one of the highest cost spending categories.  A study in The Journal of Trauma and Acute Care Surgery finds that there is significant geographic variation in such spending across the United States, but the higher spending is not linked with better survival rates.  The researchers looked at the five most costly traumatic conditions over a three year period, based on the HCUP Nationwide Inpatient Sample, and adjusted the data for severity, presence of chronic illness and regional price variations.  Trauma care cost was lowest in Northeast, at $14,022 per case, and was 18% higher in the Southern US, 22% more expensive in the Midwest and 33% more expensive in the Western US.  The researchers did not identify why the cost varied from region to region.   (Trauma Article)

Small businesses account for much of the job growth in the United States and are the primary source of entrepreneurial innovation.  The National Federation of Independent Business does periodic surveys of members to understand the concerns affecting their business.  In 2012, as it has been for the last 5 years, health care costs are the number one concern, ranked as critical by 52% of members.   Health insurance costs have risen over 100% in a decade for small businesses.  Uncertainty in economic conditions, at 38%, and uncertainty over government actions, at 35%, and unreasonable government regulations, at 34%, are other primary concerns.  Health care undoubtedly accounts for much of the concern over government actions and the unreasonableness of regulations.  (NFIB Survey)

Researchers reporting in the journal Diabetes Care find that providing genetic counseling about diabetes risk doesn’t change the behavior of people who might develop the disease, contrary to a hypothesis that if people understood they were at greater risk, they would take actions to avoid actually getting diabetes.  Another possibility is that patients who are at low risk may not continue to engage in healthy behaviors.  The authors identified 42 people with the highest genetic risk for diabetes and 32 with the lowest and sent each group to a counseling session, then put each on a group diet and exercise program, along with 34 patients who had not been tested.  Across all groups, an average of 8.5 pounds was lost but there was no difference in weight loss across the groups nor to how dedicated they were in following the program.   (Diabetes Care Article)

A study involving wellness programs from Interactive Health Solutions suggests that its offerings lead to substantial cost savings.  The study, conducted by Zoe Consulting, compared members in clients that used Interactive versus companies that did not, over a four year period.  There is not indication, however, that the comparison was adequately controlled for confounding factors such as demographics or health status.  In any event the study indicated that the programs were associated with a 6% average annual medical cost trend reduction and with 85% of members maintaing or reducing their health risk level.  Participants were also said to return to work up to nine days sooner on workers’ compensation leaves and 17 days sooner on disability ones.     (IHS Study)

Most states have struggled with creating an individual health insurance market with attractive rates to people of all ages and health conditions.  If too strict rules on underwriting are adopted, rates will tend to be universally high and fewer people will have coverage.  Allowing unlimited underwriting may mean that rates are completely unaffordable for older, less healthy persons.  Maine had very strict rules, but much higher rates than most states.  It relaxed its underwriting rules to give insurers more flexibility to charge older people more.  The change has had a limited impact in six months, which might be expected, but it has resulted in lower rates for persons under 40 and higher rates for people over 55.  About half of people saw rate increases but only an average of 1.7%.  (KHN Story)