Underinsurance among Children in the United States

This nation-wide study assesses the adequacy of insurance coverage for 91,600 American children from April 2007 through July 2008. The authors estimate that approximately 22 percent of U.S. children with continuous coverage are inadequately insured. Parents of children below the age of 18 were surveyed using random digit dialing, and adequacy was measured relative to the parents’ responses to four basic questions:

1) Does the child’s health insurance offer benefits or cover services that meet his or her needs? 2) Does the child’s health insurance allow him or her to see the health care providers he or she needs? 3) Not including health insurance premiums or costs that are covered by insurance, do you pay any money for the child’s health care? 4) If so, how often are these costs reasonable?

If a parent or guardian answered “sometimes” or “never” to any of the first three questions, the child was considered to be underinsured. The total number of underinsured children in the United States in 2007 was estimated at 14.1 million.

Aortic Dissection in Young Adults who Abuse Amphetamines

This study examined the degree to which amphetamine abuse correlates with acute aortic dissection. Researchers from the University of Texas Southwest Medical center found that the adjusted risk of aortic dissection from amphetamine abuse resembles that which victims of motor vehicle accidents encounter. The study also found that the risk of aortic dissection associate with amphetamine abuse was twice that of cocaine abuse.

Specifically, using 1995-2007 discharge data from 30 million patients aged 18-49, researchers found the risks of aortic dissection from cocaine use, amphetamine use, and traumatic motor vehicle accidents was 1.60, 3.33, and 3.57, respectively. The findings indicate that young adults presenting with acute aortic dissection should be screened for amphetamine use. In addition, public awareness campaigns should be launched to alert young adults as to the heightened risk that amphetamines pose to cardiovascular health.

FDA Approval of Mobile Diabetes Tracker May Herald Era of 'Personal Health Management'

This article addresses the implications of the FDA’s approval of WellDoc’s DiabetesManager, a mobile application that allows for the remote monitoring of patients with type 2 diabetes. The device measures blood-glucose levels and links to a mobile device that allows patients to collect, share, and track readings. The article cites health economist, Jane Sarasohn-Kahn, who views that the FDA’s approval as a tipping point for personal health management. Kahn and others feel that, as the FDA regulates mobile applications for health information technology (HIT), the devices and processes will become more refined, encouraging investors and bolstering consumer confidence. The article implies that the FDA approval may usher in a host of other mobile HIT applications, engaging patients in decisions about care and increasing awareness of personal and public health.

New Technology and Health Care Costs — The Case of Robot-Assisted Surgery

The number of robot-assisted procedures that are performed worldwide has nearly tripled since 2007. The authors of this article estimated the cost of investing in robot-assisted surgery. A review of the literature revealed that, on average, the additional variable cost of using a robot-assisted procedure was about $1,600, about 6 percent, more than the cost of the procedure in 2007. When the fixed price of the robot, itself, was included in the analysis, the cost of the procedure was $3,200 more, compared to surgery performed without the use of a robot. The authors noted slight reductions in post-operative hospital costs and gains in productivity but expressed numerous concerns. Specifically, robots have high fixed costs; physicians are more likely to substitute surgery for other treatment options when robots are available, which also increases costs; and surgeons must perform between 150 and 250 robotic surgeries before they become adept. The authors suggested the potential for substantial savings and concluded that large-scale comparative-effectiveness research was needed to determine when robot-assisted surgery is appropriate and for whom.

Defining Medical Expenses — An Early Skirmish over Insurance Reforms

One of the major provisions included in the Affordable Care Act (ACA) establishes a minimum medical loss ratio (MLR) of 80 percent for insurers. The MLR is the percentage of premium dollars devoted to direct medical care. Defining direct medical care has presented state and federal regulators with quite a challenge. This article provides an update as to the implementation process. The ACA included “activities that improve health care quality” in its definition of medical care. Recently, the National Association of Insurance Commissioners (NAIC) tightened the definition to avoid reclassifying certain types of overhead as medical expenses as activities that improve health care quality. According to the NAIC’s definition, quality-improvement expenses should be:

“capable of being objectively measured and of producing verifiable results… grounded in evidence-based medicine, widely accepted best clinical practice,” and “not designed primarily to control or contain cost,” but rather, “designed to improve health outcomes [so as to] prevent hospital readmissions; improve patient safety and reduce medical errors; lower infection and mortality rates; increase wellness and promote health activities; or enhance the use of health care data to improve quality, transparency, and outcomes.”

The definition excludes hotlines staffed by clinicians, utilization review, fraud-prevention activities, the costs of establishing or managing a provider network, and provider credentialing and accreditation fees. The NAIC’s recommendations must be certified by the Department of Health and Human Services before they take effect in January 2011.

The “Meaningful Use” Regulation for Electronic Health Records

The Health Information Technology for Economic and Clinical Health Act (HITECH) created financial incentives for providers to become “meaningful users” of electronic health records (EHRs). This article explains the Department of Health and Human Services’ (DHHS) definition of meaningful use. DHHS offered a flexible definition of meaningful use that allows providers to phase-in EHRs. The first phase, as per the definition, requires that providers meet core objectives and implement any five of ten tasks in order to be considered meaningful users between 2011 and 2012. The new definition also creates percentage rates at which objectives are to be executed. For example, one of the tasks is ensuring that 80 percent of patients have at least one entry recorded as structured data. The goal of the new flexible definition is to advance EHR adoption by establishing realistic goals that reflect emerging technologies and the evolving health care system.

Health Reform, Primary Care, and Graduate Medical Education

The article explores how Graduate Medical Education (GME) is responding to a rapidly changing health care system. The author takes a four-fold path to addressing GME: Enactment of the reform law; primary care and workforce capacity; payment of teaching hospitals; and relevant training programs. Specifically, the authors stressed that GME must respond to the Affordable Care Act’s (ACA) coverage expansion and the individual mandate. The expected influx of newly insured will likely increase the demand for health care services. Accommodating for that increased demand implies increasing capacity by investing in medical education.

The author grapples with the issues surrounding Medicare’s potential increased investment in GME. Currently, Medicare provides the most federal support for GME, but alternative funding sources and policy approaches may need to be considered as stakeholders adapt to the evolving health care system. One of the major questions this article addresses is whether or not Medicare should invest more in graduate medical education (GME) to expand the workforce and the supply of primary care providers, in particular. In the author’s opinion, it appears that the federal deficit and political climate will force states and teaching hospitals to develop innovative approaches without additional federal aid.