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(From the Public Policy section)
December 16, 2011
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Updated! Even as the U.S. Supreme Court considers constitutional challenges to the Patient Protection and Affordable Care Act (ACA), efforts continue at the state and federal levels to prepare for implementation of key provisions of the Act scheduled to take effect in 2014. This flow chart provides a high-level picture of the ways that people will obtain health coverage in 2014, assuming the Act is implemented as it exists today, reflecting the complexity of the public/private hybrid of U.S. healthcare coverage retained by the Act.
August 31, 2011
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The most critical health care decisions facing patients and families are often made under the most difficult of circumstances—in emergencies, or when patients are not able to speak for themselves. Advance directives offer a solution but in order for them to be effective, health care providers need to know they exist and have ready access to them. One way to accomplish this is through statewide electronic registries of advance directives.This paper discusses advance directives available under Michigan law, models for state and regional advance directive registries, and approaches for encouraging their use.
August 24, 2011
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Electronic prescribing (also known as e-prescribing) is a system that enables providers in health care settings—e.g. doctors’ offices, hospitals, and long-term care facilities—to electronically write and store prescription information and send it directly to pharmacies. Advanced features of some e-prescribing systems have the potential to enhance physicians’ decision-making capabilities and increase their use of e-prescribing. Although the use of e-prescribing is increasing, providers continue to encounter significant barriers to the implementation and effective use of e-prescribing systems. It is important to understand these challenges in order to ensure the widespread adoption and effective use of e-prescribing.
June 28, 2011
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We can be certain that Medicaid eligibility will expand greatly in 2014, but actual Medicaid enrollment numbers will depend on the outreach and enrollment processes used by individual states. Michigan can learn from states that have successfully expanded eligibility in public insurance programs as it develops a comprehensive strategy for reaching and enrolling those who are currently eligible and the newly eligible population in 2014. This paper examines the structure of the Medicaid program today, describes enrollment and outreach strategies used by other states, and identifies opportunities to increase Medicaid enrollment in Michigan.
(From the Public Policy section)
October 17, 2011
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The Patient Protection and Affordable Care Act (ACA) includes a number of provisions designed to increase the number of individuals with health insurance coverage. This policy brief focuses on midsize and large employers, to help illuminate provisions in the ACA most likely to affect them and suggest issues or questions for consideration as ACA implementation progresses.
April 28, 2011
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The Patient Protection and Affordable Care Act of 2010 (ACA) requires the establishment of significant new state-level structures by the year 2014. This policy brief summarizes major requirements and policy choices for states between now and 2014, and describes other components of the ACA that do not involve state implementation but have state budgetary impacts.
May 24, 2010
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While health care reform has its foundation and framework at the federal level, many key elements will be carried out at the state and local level. Rather than addressing changes that apply to private sector health insurance, this policy brief summarizes some of the most salient state requirements and state and local opportunities with regard to coverage and health care delivery.
June 21, 2010
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Cover Michigan 2010 is CHRT's annual report of health care coverage in the U.S. and Michigan, including data on the uninsured, publicly and privately insured, premiums and cost-sharing, the health care safety net and, new for this year, health reform (also available separately in the CHRT Issue Brief, Impact of Health Reform on Coverage in Michigan).
Cover Michigan 2010 presents the most recent comparative data available for the U.S. and Michigan: 2008 data for the U.S. and 2007/2008 two-year pooled data for Michigan. Michigan data are pooled to ensure an adequate sample size; some demographic data are reported as three-year pooled averages. Where possible, more recent data are included.
The Cover Michigan 2010 report and the Cover Michigan Survey 2010 (released in March 2010) both reveal continued upward trends in areas of concern from our 2009 report: more people lacking insurance, more employers dropping coverage, higher costs for those who have insurance, and a growing strain on the health care safety net.
June 20, 2011
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In 2009, CHRT commissioned the first Cover Michigan Survey, to gain insight into the issue of health care access in Michigan. The report was released in March 2010. One of the most important conclusions of the Cover Michigan Survey was this: having health coverage is not synonymous with having access to health care. Many respondents—even those with health coverage—reported significant barriers to obtaining affordable care. This report presents the findings of the Cover Michigan Survey conducted in 2010, which was designed to delve deeper into key questions raised by the previous report
June 21, 2010
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The Patient Protection and Affordable Care Act (PPACA, or the Act) will affect the picture of coverage in Michigan in many different ways. In this issue brief (drawn from the final chapter of CHRT's Cover Michigan 2010 report), we try to give a picture of the impact of the PPACA, had it been fully implemented and in effect in 2007/2008 (the period for which we have the most recent, comprehensive data on health coverage in the state).
March 8, 2010
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In January of 2009, CHRT released the first edition of Cover Michigan, a report designed to provide a comprehensive picture of health care coverage in the U.S. and Michigan. In August 2009, to better understand the impact of coverage trends on the people behind the statistics, CHRT commissioned a survey of 1,022 Michigan adults about their sources of coverage, perceived health status, ability to pay for insurance and care, and decisions about seeking—or not seeking—needed health care services.
January 26, 2009
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The 2009 edition of the complete Cover Michigan report.
The Price of Care series of issue briefs and reports presents a picture of medical care spending in the U.S. and Michigan. Price of Care reports are intended to provide policy makers, payers, providers, and consumers alike with a better understanding of the price and distribution of health care, and shed light on potential opportunities for changes in health policy, medical practice — even personal health choices — that could lead to reductions in overall health care spending.
February 28, 2011
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The Institute of Medicine and the Centers for Disease Control and Prevention (CDC) have identified antibiotic resistance as a major public health problem in our country. One of the biggest contributors to antibiotic resistance is the inappropriate use of antibiotics. Of particular concern is the prescribing of antibiotics for infections that are usually viral in nature—colds, sore throats, and most upper respiratory infections. These illnesses do not respond to antibiotics and nearly always get better on their own. Since 1995 the CDC has run an outreach campaign to encourage appropriate use of antibiotics, and the overall rate of antibiotic prescribing decreased 23 percent from 1992 to 2000. Nevertheless, a high rate of inappropriate antibiotic use—a rate that continues to put population health at risk—persists. This issue brief examines antibiotic prescribing trends in Michigan in recent years.
November 16, 2010
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One in eight babies are born prematurely in the United States and Michigan, with serious consequences for infant morbidity and mortality. Premature babies experience a variety of medical problems, resulting in more doctor visits and hospitalizations. Having a premature baby takes an enormous emotional toll on a family. Medical care for premature infants can cost over $100,000, and preterm births have been estimated to cost the U.S. more than $26 billion annually. While significant medical and technological advances in the treatment of preterm babies have allowed more babies to survive, preterm birth is still the leading cause of infant death. Preterm birth disproportionately affects blacks and contributes to the disparity between blacks and other races in infant mortality.
October 4, 2010
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For more than 20 years, researchers at Dartmouth Institute for Health Policy and Clinical Practice have been sharing data on regional variation in the use of health care services: variation that does not seem to be explained by health status or other relevant differences among the populations studied. Most of work done on geographic variation has been done on the Medicare population, and some could argue that the phenomenon of variation is unique to a senior population or some specific attribute of the Medicare structure. However, just over 10 years ago, we in Michigan were fortunate to have the opportunity to collaborate with our colleagues at Dartmouth to look at this same kind of data in the commercial Blue Cross and Blue Shield of Michigan (BCBSM) population. Our findings then showed that patterns of geographic variation in the commercial population were similar to those found in the Medicare population.
In this report, we are again comparing the commercial BCBSM population to the Medicare population, but we are also looking at changes within the commercial population in overall use and geographic variation over the past 10 years.
August 3, 2010
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In our January 2010 issue brief, The Cost Burden of Disease, we presented the most common reasons for hospitalizations, the most expensive conditions, and gender differences between men and women with respect to the top ten diagnoses. In this issue brief, we focus on costs and risk factors relating to selected chronic conditions, comorbidities, and health risk factors of cigarette smoking and overweight/obesity.
January 25, 2010
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There may be no broad consensus on the impact of recent health reform proposals on the growth of health care costs in the U.S., but few would dispute that rising health care costs are a threat to the U.S. economy, the health system, and the health and financial well-being of families and individuals in the United States. As we collectively seek ways to address the crisis of rising costs—as part of overall health reform or through regional, state, or local approaches—we must understand the factors that drive health care costs and where opportunities exist to affect those drivers.
December 14, 2009
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To enact reforms that have a positive impact on health care costs, we must first understand how and where we are spending our health care dollars today. This issue brief provides an overview of health care spending in the U.S., comparing U.S. spending to the rest of the world, Michigan spending to other U.S. states, and spending by payer (Medicare, Medicaid, and commercial).
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