Skip to main content

2012 Potpourri XL

By December 28, 2012December 29th, 2012Commentary

Research carried in the Annals of Internal Medicine discusses how to improve patient transitions from the hospital back to usual care.  This is a critical focus for improving care at this time, due to a desire to reduce hospital readmissions and to lower hospital spending.  The reviewers looked at about 36 studies of various interventions and found significant indications of reduced readmissions, better patient satisfaction and better markers of coordination of care.  Evidence for overall cost savings was not strong.   (Annals Article)

A similar theme is found in another Annals article regarding transitions from the hospital after stroke or heart attack.  This study reviewed a number of trials of various transitional care methods.  Overall the evidence for benefits from most of the interventions was weak.  It did appear that some interventions, such as hospital-initiated support, reduced length of stay for stroke patients and mortality for heart attack patients.  It was unclear exactly which features of an intervention might be most beneficial.  It is especially disappointing that there is little evidence of benefit in regard to readmissions.  (Annals Article)

A Perspective in the New England Journal of Medicine discusses lessons about insurance coverage from Massachusetts’ reform experience.  Massachusetts has near universal coverage, but some residents game the system to only pay for coverage when they need care and some seem resistant to having insurance no matter what.  While after reform Massachusetts residents averaged shorted periods of uninsurance, the proportion who were long-term uninsured remained the same as other states in the region.  Policymakers are most likely failing, as the authors of this Perspective do, to recognize that most of this is just the fundamental irresponsibility of people who likely are eligible for basically free coverage.   (NEJM Perspective)

A paper from health insurance exchange company bswift gives a good perspective on issues to consider when establishing a health plan exchange.  Insurance exchanges are a core feature of the health reform law and many employers are creating private internal exchanges to facilitate employee choice and in connection with a switch to a defined contribution approach to health benefits.  To maximize the functioning of either a public or private insurance exchange, design needs to be carefully thought out and consumers need to be given tools that help them make the best choices.  Enrolling, disenrolling and billing are complex processes and there is a need for ensuring security and privacy.  (bswift Paper)

An article in the New England Journal of Medicine discusses how to use market-based incentives to control health spending.  There has been a tug-of-war in the United States between those who think more government control and regulation is the solution to our health spending crisis and those who think creating a more market-based system will do a better job.  The authors suggest that for programs like Medicare shifting to a defined contribution model would encourage competition among health plans, who in turn should put pressure on providers.  In the private sector, changes are needed to make both employers and employees more price sensitive.   (NEJM Article)

An Annals of Internal Medicine article explores the notion that both utilization and unit price must be controlled to limit health spending growth.  Whether there is excessive utilization of health care services in the United States is a matter for debate; the fact that our unit prices for the same service are higher really is not.  Higher prices are driven by higher administrative costs, high salaries, hospital market power and lack of consumer price awareness or engagement.  To the extent that there is inappropriate utilization, it is theorized to be driven by fee-for-service reimbursement, catering to patient wishes, fear of malpractice suits and doctor practice styles.  The authors conclude both price and utilization must be addressed to limit spending growth.   (Annals Article)


Leave a comment