Recent INQUIRY Journal Highlights

ROCHESTER, NY (12/19/2011)(readMedia)-- Current topics such as health reform in Massachusetts, effects of the Breast and Cervical Cancer Prevention Act, minorities' use of hospitals, employer-based wellness programs, the accuracy of MEPS prescription drug data, health coverage for low-income teens, and individual insurance are all discussed in INQUIRY's recent issues. Here are brief summaries and hyperlinks to abstracts:

Have Working-Age People with Disabilities Shared in the Gains of Massachusetts Health Reform? by John Gettens, Monika Mitra, Alexis D. Henry, and Jay Himmelstein -- This study found that Massachusetts health reform, enacted in 2006, reduced by almost half the rate of uninsured working-age adults with disabilities--which is comparable to estimates for people without disabilities. The Massachusetts results imply that national reform has the potential to substantially improve insurance coverage for working-age people with disabilities.

Medicaid Enrollment at Early Stage of Disease: The Breast and Cervical Cancer Prevention Act in Georgia by Li-Nien Chien, E. Kathleen Adams, and Zhou Yang – Looking at data from Georgia, this analysis shows that the Breast and Cervical Cancer Prevention Act (BCCPTA)---which created a quicker path to Medicaid eligibility for low-income women with breast cancer---increased by 11 percentage points the probability of uninsured breast cancer patients enrolling in Medicaid at an early stage of disease. This is clinically significant because it can allow for more treatment options and lead to better outcomes and higher survival rates. This is the first study to look at the effect of the BCCPTA on Medicaid enrollment at early disease stage.

Do Minority Patients Use Lower Quality Hospitals? by Darrell J. Gaskin, Christine S. Spencer, Patrick Richard, Gerard Anderson, Neil R. Powe, and Thomas A. LaVeist -- It is incorrect to generalize that minorities use lower quality hospitals, according to this new study. Employing discharge data for minority patients (black, Hispanic, and Asian) from 11 states and patient safety quality indicators from the Agency for Healthcare Research and Quality, this analysis concluded that the relationship between hospital quality and minorities depends on how quality is measured and varies by race and ethnicity. The authors say "remedies should not blindly target hospitals serving high proportions of minority patients because disparities do not exist uniformly across all quality measures."

What Factors Influence Participation in an Exercise-Focused, Employer-Based Wellness Program? by Jean M. Abraham, Roger Feldman, John A. Nyman, and Nathan Barleen -- Examining an incentive-based exercise program at a large public university, this study found that prior exercise behavior, the time cost of exercise, the appeal of using a fitness center and attitudes about the benefits and barriers of exercise all influenced whether employees signed up for the program. Results showed that employees who were male, older and regular fitness center exercisers prior to the program's inception were more likely to be regular exercisers.

Implications of the Accuracy of MEPS Prescription Drug Data for Health Services Research by Steven C. Hill, Samuel H. Zuvekas, and Marc W. Zodet -- Results of this analysis suggest that the Medical Expenditure Panel Survey is a good source of data for prescription drug use and expenditures. In matching MEPS participants to Medicare Part D drug claims for 2006-2007, the study found some types of short-term and intermittently used drugs were underreported, but maintenance drugs generally were reported accurately. Respondents, however, tended to overreport the number of drug fills. Overall, the accuracy of the MEPS compares well with other surveys on medication use.

Is Fragmented Financing Bad for Your Health? by Steven D. Pizer and John A. Gardner -- This study assessed whether disruptions in clinical relationships, caused by fragmented financing through a variety of health insurers, adversely affect health outcomes. It used a large sample of low-income and disabled veterans who choose mixtures of services from private networks financed by Medicare and the public network operated by the Veterans Health Administration. Results suggest that fragmented financing increases the risk for coordination failures that result in hospitalizations for ambulatory care sensitive conditions, and thus impacts both quality and costs of care.

Why Are Low-Income Teens More Likely to Lack Health Insurance than their Younger Peers? by Lindsey Jeanne Leininger and Marguerite E. Burns – This study found, surprisingly, that socioeconomic factors, family characteristics and public health insurance eligibility do not explain why low-income teenagers are more likely to lack health insurance than younger children. To close the coverage gap, the authors say it is essential to better understand insurance enrollment dynamics specific to teens, especially in families with no younger siblings.

Geographic Market Definition: The Case of Medicare-Reimbursed Skilled Nursing Facility Care, by John R. Bowblis and Phillip North -- Most studies of the nursing home industry use geopolitical boundaries, such as the county, to define markets and analyze market share. However, this study examined patient flows for Medicare skilled nursing facilities (SNFs) and found that using the county to define the market is not appropriate for all states: in some states market share would be overestimated, in others underestimated. The authors suggest that researchers weigh methods to define the nursing home market and consider whether admission data are available.

Individual Insurance and Access to Care, by Steven C. Hill -- Anticipating changes in 2014, when the Patient Protection and Affordable Care Act (ACA) takes effect and more Americans have private individual insurance, this paper compared access to care for adults with individual insurance and those with employer-related insurance. Results showed few adults in either group reporting unmet needs for care or delays in getting medical care, prescription drugs or dental care. While individual insurance may reduce access in some areas, all effects were imprecisely estimated and none was statistically significant. Thus the average effect of the ACA on access to care for adults who currently have individual insurance is uncertain, and maybe even small.

Editorials and Dialogues:

The View from Here: Running on Empty by Alan C. Monheit -- In this column, INQUIRY's editor takes a "micro" perspective to show the devastating effects our stagnant economy is having on states and municipalities and the implications for health and education, particularly with regard to lower and middle income populations.

Dialogue: Nonprofit Health Care Market Concentration and the Public Interest - In this feature, Howard Berman, retired president and CEO of The Lifetime Healthcare Companies, Inc., of Rochester, N.Y., and publisher of Inquiry; Arthur (Art) Lerner, partner at Crowell & Mooring LLP in Washington, D.C.; Patrick Madden, retired president and CEO of the Sacred Heart Health System in Pensacola, Fla., (now residing in Nashville, Tenn.); and Lawrence (Larry) Van Horn, associate professor of health care management and executive director, health affairs, at the Owen Graduate School of Management, Vanderbilt University, discuss concerns raised about the consolidation of health care providers, especially hospitals, and the considerable market concentration that could occur with the creation of accountable care organizations. Bruce McPherson, president and CEO of the Alliance for Advancing Nonprofit Health Care in Washington, D.C., moderated the discussion.

Ryan's Hope-or Folly? by Alan C. Monheit -- In this column, INQUIRY's editor explores some of the potential implications for society's most vulnerable citizens under the radical budget proposed by Rep. Paul Ryan (R-Wis.)

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."