What Do People Buy When They Don't Buy Health Insurance and What Does that Say about Why They Are Uninsured

Using data from the Consumer Expenditure Survey, this study compares household spending on different goods by insured versus uninsured households, controlling for total spending and demographic characteristics. The analysis shows that uninsured households, on average, spend more on housing, food, alcohol, and tobacco compared to insured households. These results suggest that both prices and preferences, in addition to income, help explain why some households do not buy coverage; the findings also raise the possibility that the uninsured may lack coverage in part because they face higher prices for basic needs like housing and food.

A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

In this study of employees of one large company, financial incentives for smoking cessation significantly increased the rates of smoking cessation. Researchers randomly assigned 878 employees to receive information about smoking-cessation programs or to receive information about programs plus financial incentives. The incentive group had significantly higher rates of smoking cessation than the information-only group 9 or 12 months after enrollment. Incentive-group participants also had higher rates of enrollment in smoking-cessation programs, completion of smoking-cessation programs, and smoking cessation within the first six months after enrollment. Given that up to 40 percent of premature deaths in the United States are due to unhealthy behaviors such as smoking, the authors suggest that incentives directed toward patients rather than providers may have greater potential for changing health behaviors.

Slowing the Growth of Health Care Costs – Lessons from Regional Variation

Medicare spending continues to vary widely across the country, with some cities like Miami and Dallas experiencing much faster growth in costs than places like San Francisco and Pittsburgh, according to this analysis by Dartmouth researchers. The authors advocate a new payment method that would reward doctors for providing better care and would share with them any savings they generated by keeping patients out of the hospital or choosing not to order another test. The Dartmouth researchers estimate that if the federal government could find a way to make sure the national health care bill increased no more quickly than that of a city like San Francisco, it could eventually save tens of billions of dollars.

The Dartmouth Atlas website provides spending, hospital, and workforce data for each U.S. hospital-referral region.

The Elusive Quest for Quality and Cost Savings in the Medicare Program

In 2002, 15 programs were independently funded by the Centers for Medicare & Medicaid Services (CMS) to participate in the Medicare Coordinated Care Demonstration. The goals of the project were to determine whether enhanced care coordination could improve the quality of care or reduce Medicare expenditures for patients with serious chronic health conditions. The authors conclude that although these demonstration projects are essential to understanding how services can be improved, they will not achieve sufficient cost savings to solve Medicare's fiscal problems in the next decade. Balancing the Medicare budget will require difficult political decisions among less appealing choices: raising payroll taxes, increasing beneficiary cost-sharing, reducing benefits, or cutting payments to physicians, hospitals, and health plans, particularly for services that are not clearly beneficial.

Primary Care Physicians' Links to Other Physicians Through Medicare Patients: The Scope of Care Coordination

According to a study by researchers at HSC, Memorial Sloan-Kettering Cancer Center, and the Dana-Farber Cancer Institute a typical primary care physician who treats elderly Medicare patients must coordinate care with 229 other physicians working in 117 different practices.  Care coordination may improve health outcomes and reduce costs, but coordination may be particularly challenging in the fee-for-service Medicare program, which lacks defined provider networks, providers designated to guide referrals, systems to track referrals, and explicit incentives to coordinate care. As Medicare and private health plans experiment with extra payments to primary care physicians to coordinate care — for example, through medical homes — the study findings suggest that substantial delivery system reforms may be needed to make such models work.

Surgeons send 'tweets' from operating room

In early February, for the second known time, surgeons "Twittered" during a surgery to give short real-time updates about the procedure. Following the February 9, 2009 operation online were other doctors, medical students and the merely curious. Observers say there is no question that more and more doctors — and patients — will be sharing the blow-by-blow of medical procedures on sites like Twitter and Facebook. Dr. Craig Rogers, the lead surgeon in the Henry Ford surgery, said the impetus for his Twittering was to let people know that a tumor can be removed without taking the entire kidney. He noted that, "doing this removes a real communication barrier. It helps make something scary much more comprehendable," As the younger generation moves into medicine, there may be more sharing online of private medical procedures — including photos and videos, as well as real time "tweets".

Imaging strategies for low-back pain: systematic review and meta-analysis

This study investigated the effects of routine, immediate lumbar imaging versus usual clinical care without immediate imaging on clinical outcomes in patients with low-back pain and no indication of serious underlying conditions. The trials reported pain or function (primary outcomes), quality of life, mental health, overall patient-reported improvement (based on various scales), and patient satisfaction in care received. The results did not indicate significant differences between immediate lumbar imaging and usual care without immediate imaging for primary outcomes at either short-term (up to 3 months), or long-term (6–12 months) follow-up. Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. 

Health Insurers and Medical-Imaging Policy – A Work in Progress

This report updates a study published in 2006 regarding new policies enacted by Congress that have unsettled physicians who perform imaging studies and other interests involved in the manufacture, leasing, and sale of imaging equipment. From 2000 through 2006, Medicare expenditures for such services rose from $3.6 billion to $7.6 billion (17% a year on average). This rate of growth was more rapid than that of any other service for which physicians billed Medicare during this period. Some of the highlights of the article include: a review of the rapid growth of imaging-related capacity, pushback from the imaging industry, controls on imaging by private health plans, and an example of a physician-driven alternative to prior authorization for imaging. The authors conclude that the fee-for-service payment must be restructured or replaced by an approach that promotes a more efficient delivery system.