March 23, 2005 - Below is a summary of many of the articles appearing in the most recent issue of INQUIRY journal, being mailed this week to subscribers.
"The Managed Care Backlash: Did Consumers Vote with Their Feet?" by M. Susan Marquis, Jeannette A. Rogowski, and Josi J. Escarce - Despite predictions of managed care's demise, enrollments in health maintenance organizations (HMOs) have remained relatively constant in recent years, suggesting consumers did not react to the so-called "backlash" against managed care by leaving plans, says this new study by RAND researchers. While there was some retreat in HMO enrollments in the late 1990s - when public trust in managed care had eroded and growing criticism replaced earlier enthusiasm for HMOs - the numbers were modest. The authors posit that the backlash against managed care may have been the perceptions of the media and physicians while consumers generally were satisfied with their coverage; alternatively, to avoid losing market share, plans may have responded quickly to consumers who voiced complaints. Even in the face of the backlash, managed care expanded its market share in areas with the highest cost increases, the authors note. Growth in Medicaid HMOs also continued rapidly, indicating the possibility that low-income beneficiaries have less choice than the privately insured.
"State Payment Limitations on Medicare Cost-Sharing: Impact on Dually Eligible Beneficiaries," by Janet B. Mitchell and Susan G. Haber - Examining the effects of the Balanced Budget Act (BBA) of 1997, this analysis found that people dually eligible for Medicaid and Medicare had less access to outpatient physician visits in states that decreased how much their Medicaid programs paid to help low-income Medicare beneficiaries with out-of-pocket expenses. The BBA allowed states to limit their liability for Medicare cost-sharing, a policy that some feared would impede access to medical care by such dually eligible beneficiaries. The authors, from RTI International in Waltham, Mass., say allowing state Medicaid programs to pay variable rates "introduces substantial inequities" among this patient population. Without a policy change, they say, access to Medicare services may continue to decline for dually eligible beneficiaries.
"The Balanced Budget Act of 1997 and U.S. Hospital Operations," by Gloria J. Bazzoli, Richard C. Lindrooth, Romania Hasnain-Wynia, and Jack Needleman - This study assessed how financial pressures from the BBA - which aimed to extend the life of the Medicare Hospital Insurance Trust Fund by changing Medicare payment policy - affected the operations of nonprofit hospitals. Results show that some of the short-term changes instituted by hospitals, such as efforts to control Medicare cost growth, to expand outpatient service provision, and to contain hospital staffing, were similar to those observed in the early 1980s, when the Medicare prospective payment system (PPS) was implemented. However, there also were differences: during PPS implementation, hospitals saw declining inpatient use and rising profits; in the post-BBA period, hospitals experienced growing inpatient use, but decreasing profits.
"The Effect of Medicare's Prospective Payment System on Discharge Outcomes of Skilled Nursing Facility Residents" by Walter P. Wodchis, Brant E. Fries, and Richard A. Hirth - Implementation of PPS for Medicare patients in skilled nursing facilities delayed residents' discharge to home, but also delayed death and had no impact on hospitalizations, according to this study evaluating the effect of PPS on quality and standards of care. The authors had hypothesized that the Medicare PPS program would reduce the care provided in skilled nursing facilities and lead to deteriorating resident outcomes. They concluded, however, that the "PPS is associated with neither uniformly declining standards of care nor a large improvement in effectiveness."
"Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities: A Study of the Publication of the New York State Cardiac Surgery Reports," by Dana B. Mukamel, David L. Weimer, Jack Zwanziger, Shih-Fang Huang Gorthy, and Alvin I. Mushlin - Published reports about a surgeon's quality directly influences consumers' selection of a cardiac surgeon and diminishes the importance of experience and price as measures of quality, according to this study of the effect of the New York State Cardiac Surgery Reports. The researchers additionally found that black patients were as sensitive to the published information as white patients, suggesting that "report cards may have a very important role to play in addressing racial disparities in access to high-quality providers."
"Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program," by Thomas C. Buchmueller, Todd Gilmer, and Katherine Harris - This study, which examined reasons why Medicaid beneficiaries leave their health insurance plans, found that individuals and families who actively choose their health plans are substantially less likely to disenroll than those who are assigned to their initial plans. Finding large differences in disenrollment rates across racial and ethnic groups, the authors note that the cultural competence of providers is important in influencing patient satisfaction.
"Electronic Prescribing and HIPAA Privacy Regulation," by Michael D. Greenberg, M. Susan Ridgely, and Douglas S. Bell - Although federal privacy regulations have only a limited effect on current electronic prescribing practices, they could deter development of new e-prescribing technology and hinder future systems from realizing their potential benefits, this analysis finds. The authors suggest that policymakers revise the Health Insurance Portability and Accountability Act (HIPAA) to balance privacy protections with clinically appropriate, networked sharing of patient health information.
Abstracts and full text of the previous articles are available to reporters and INQUIRY subscribers at www.inquiryjournal.org . Individual articles are available for purchase by nonsubscribers at http://www.hartleydata.com/inquiry.
Also on the Web site are other papers from the Winter 2004/05 issue:
"The Failed Conversion of CareFirst BlueCross BlueShield to For-Profit Status: Part 2, Lessons Learned," by Bruce McPherson - This article describes the lessons gained from the failed efforts of CareFirst, a nonprofit health insurer in Maryland, to convert to for-profit status and be acquired by the for-profit company, Wellpoint Health Networks, Inc. The first part, which described the conversion attempt, appeared in INQUIRY's fall issue.
"Doing Away with Uncompensated Care of the Uninsured," by Robert M. Sigmond - This paper outlines a six-point management program designed to increase the income and decrease the expense currently associated with uncompensated care. It marks the debut of a new INQUIRY feature presenting opinions on new ideas and proposals for health policy.
"The View From Here: The Risks of an Ownership Society," by INQUIRY Editor Katherine Swartz - This editorial points out how proposals by the current administration to create an "ownership society" will reduce employers' role in health insurance and make it even more difficult for lower-income people to afford health coverage.
INQUIRY is a peer-reviewed scholarly publication. Now in its 42nd year, it is published quarterly by Excellus Health Plan, Inc. Press releases and article abstracts are available at www.inquiryjournal.org.