Medicaid Redesign, Impact of Private Insurance on Long-Term Care Use, Global Payment vs. Fee-For-Service

These and other health care topics explored in recent INQUIRY journal

ROCHESTER, NY (08/04/2011)(readMedia)-- Here's a summary of INQUIRY's recent issue:

Choice in Public Health Insurance: Evidence from West Virginia Medicaid Redesign - Tami Gurley-Calvez, Adam Pellillo, M. Paula Fitzgerald, and Michael F. Walsh – This study examined factors affecting plan choice in a redesign of West Virginia's Medicaid program, which offered a basic plan and an enhanced plan with more benefits but added requirements for adopting healthier habits. Results showed that people with patterns of higher health care use were more likely to enroll in the enhanced plan, but education level and information about the redesign also played a part in choice of plan.

The Impact of Private Long-Term Care Insurance on the Use of Long-Term Care - Yong Li and Gail A. Jensen – This study found that purchasing private long-term care insurance (LTCI) enhances access to nursing home care for the frail elderly, and allows moderately disabled older adults to avoid nursing homes and get services at their own homes instead. Although private LTCI increases use of formal services, the researchers found no evidence that it deters from informal care giving. Results suggest that if LTCI became more prevalent, older adults would be able to choose the type of long-term care arrangement best suited to their needs.

How Does Health Insurance Affect the Retirement Behavior of Women? - Kanika Kapur and Jeannette Rogowski – This analysis investigates how having employer-provided retiree health insurance affects retirement decisions for single women and women in single-earner and dual-earner couples, and compares the role of retiree health benefits for men's and women's retirement. Results show that retiree health insurance increases retirement for all groups, except single men. There is some evidence to suggest, however, that the role of retiree health insurance for women hinges on whether their husbands are still in the workforce.

A New Approach to Reducing Payments Made to Hospitals with High Complication Rates - Richard L. Fuller, Elizabeth C. McCullough, and Richard F. Averill – This article proposes reforming Medicare's inpatient prospective patient system to adjust payments to hospitals with excess complications. The authors say that Medicare hospital payment could be reduced by about 8 percent – $8.5 billion – if hospitals were held to a "best practice" standard and if payments made for excess complications were eliminated.

Also featured in INQUIRY's spring issue:

A Much Better Health Care System - Cleve Killingsworth – In this McNerney Forum piece, Cleve Killingsworth, former CEO of Blue Cross Blue Shield of Massachusetts, says global payment, based on improved clinical outcomes, is the best route to truly reforming our health care system. In this column, he discusses the benefits and hurdles to adopting global payment as a replacement for the current fee-for-service system. (Open Access article)

The View from Here: Of Private and Public Safety Nets - Alan C. Monheit – INQUIRY's editor examines the deteriorating private safety net of employment-related benefits, the implications for health and financial security and the importance of assuring funding for social programs and our public safety net. (Open Access article)

Book Reviews include:

  • The Convergence of Science and Governance: Research, Health Policy and American States, by Daniel M. Fox
  • Deadly Spin, by Wendell Potter
  • The Spirit Level: Why Greater Equality Makes Societies Stronger, by Richard Wilkinson and Kate Pickett

# # #

INQUIRY, the journal of health care organization, provision, and financing, is in its 48th year. The nonprofit Excellus Health Plan, Inc., publishes INQUIRY; the journal maintains a freelance editorial staff and is run as an independent, peer-reviewed, quarterly academic journal. Press releases and article abstracts are available on the INQUIRY website at www.inquiryjournal.org under "Current Issue Table of Contents."