June 6, 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.
"How Much Can Really Be Saved by Rolling Back SCHIP? The Net Cost of Public Health Insurance for Children," by Thomas M. Selden and Julie L. Hudson. This analysis finds that the true cost of the State Children's Health Insurance Program (SCHIP) - both to states and the federal government - is substantially less than average spending per enrollee would suggest, bolstering arguments against SCHIP cutbacks.
"Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?" by John C. Fortney, Matthew L. Maciejewski, James J. Warren, and James F. Burgess, Jr. This study shows that community-based outpatient clinics (CBOCs) established across the country by the Department of Veterans Affairs improved veterans' access to health care, but had little impact on overall patterns of use and cost of primary care services.
"Home and Community-Based Waivers for Disabled Adults: Program versus Selection Effects," by Courtney Harold Van Houtven and Marisa Elena Domino. Examining North Carolina Medicaid claims data, this study found no savings in total costs for disabled adults who participated in Medicaid home and community-based waiver programs, but did find significant reductions in spending for nursing home and hospital care. The results indicate the programs met their goal of providing cost-neutral care in the community.
"Hospital Finances and Patient Safety Outcomes," by William E. Encinosa and Didem M. Bernard. Evidence from this study indicates that a decline in a hospital's profit margins increases the probability of medical errors for both nursing and surgical events. The findings suggest that financial pressures limit a hospital's ability to make costly investments in patient safety improvements and that any cost-cutting efforts be carefully managed and designed.
"Has Competition Lowered Hospital Prices?" by Jack Zwanziger and Cathleen Mooney. Looking at data from New York, this analysis indicates that the 1997 deregulation of hospital prices was successful - at least in the short run - in using price competition to reduce payments for hospital services. However, the increase in hospital concentration occurring through mergers may counteract that effect in the longer term.
"Spillover Effects of Benefit Expansions and Carve-outs on Psychotropic Medication Use and Costs," by Samuel H. Zuvekas, Agnes E. Rupp, and Grayson S. Norquist. This study found that expanding benefits and adding a "carve-out" to a managed behavioral health care organization (MBHO) increased spending for prescription medication, offsetting large declines in expenditures for mental health/substance abuse inpatient specialty care. However, there is evidence that spending for psychotropic medication rose at markedly slower rates under the expanded MBHO.
Abstracts and text of previous articles available to reporters and INQUIRY subscribers at www.inquiryjournalonline.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 Spring 2005 issue:
"A Shared Responsibility: U.S. Employers and the Provision of Health Insurance to Employees," by Sara R. Collins, Karen Davis and Alice Ho. This "Opinion" paper makes the case for shoring up employer coverage both to curb its recent erosion and to build a more comprehensive system of health insurance.
"The View From Here: Informed Consumer - Caveat Emptor," by INQUIRY Editor Katherine Swartz. This editorial points out some of the shortcomings and potential problems with consumer-driven health care.
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.