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INQUIRY JOURNAL SPRING ISSUE RELEASED TODAY
Topics include public trust and good governance, alternative health insurance financing structures, language barriers to health care access among Medicare beneficiaries
ROCHESTER, NY, June 13, 2006 - The Spring issue of the journal INQUIRY released today includes articles on: health plan switching behavior, the use of reinsurance to finance children's health care, financial incentives and information manipulation in alcohol treatment and benefit designs for treating tobacco dependence. Summaries are below.
  • "Selection and Plan Switching Behavior," by Rusty Tchernis, Sharon-Lise T. Normand, Juliana Pakes, Peter Gaccione, and Joseph P. Newhouse - This analysis found that people with employer-sponsored health insurance who switched from a more generous to a less generous plan had lower medical spending prior to the move than the average employee in the more generous plan. Those who switched to a plan with more generous benefits, however, appeared to have anticipated higher spending, which they delayed until after changing plans. Transferring costs from a less generous to a more generous health plan increases the burden of adverse selection.
  • "The Effects of Reinsurance in Financing Children's Health Care," by David E.M. Sappington, Sema K. Aydede, Andrew Dick, Bruce Vogel, and Elizabeth Shenkman - This study shows that simple reinsurance policies can reduce substantially the variation in the financial performance of health plans that serve enrollees in the State Children's Health Insurance Program (SCHIP) and have different case mixes. This effect occurs even when plans bear the cost of reinsurance and are not fully insured against large expenditures for the most seriously ill children.
  • "Financial Incentives and Gaming in Alcohol Treatment," by Mingshan Lu and Ching-to Albert Ma - This study looked at the effect of performance-based contracting (PBC) in substance abuse treatment in Maine. Findings indicated that PBC, which allocated more resources to health care providers who achieved better outcomes for their patients, increased clinician "gaming" - the manipulation of some information for practitioners' own agendas. Results show that clinicians overstated the alcohol use of patients at the beginning of treatment episodes and understated the patients' alcohol use at the end.
  • "The Costs and Effectiveness of Different Benefit Designs for Treating Tobacco Dependence: Results from a Randomized Trial," by Helen Ann Halpin, Sara B. McMenamin, Jeffrey Rideout, and Gifford Boyce-Smith - Evidence from this smoking cessation study found no significant increases in either quitting rates or quitting attempts for people whose treatment plan covered drugs and counseling compared to those whose plan covered drug therapy only. The findings suggest that rather than raise costs by adding coverage for proactive telephone counseling to drug therapy, a more efficient use of health care dollars may be to provide insurance coverage for pharmacotherapy alone.
  • "Language Barriers to Health Care Access Among Medicare Beneficiaries," by Ninez A. Ponce, Leighton Ku, William E. Cunningham, and E. Richard Brown -- Looking at data from California, this analysis found that Medicare seniors with limited English proficiency (LEP) were less likely to have a usual source of care and to receive preventive cancer screening tests than Medicare beneficiaries who spoke only English. However, those LEP beneficiaries who were dually eligible for Medicaid seemed to fare better, possibly because federal civil rights rules require Medicaid health care providers to offer free language assistance.

  • Other papers from the Spring 2006 issue:

    The McNerney Forum: "Public Trust and Good Governance: An Essay" by Howard Berman - This essay focuses on the necessary measures that nonprofit boards must take to ensure their organizations maintain the public's confidence.
    http://www.inquiryjournalonline.org/pdfserv/i0046-9580-043-01-0006.pdf

    The View From Here: "Time to Finance Health Insurance Differently," by INQUIRY Editor Katherine Swartz -- This editorial discusses the future role of employers in contributing to the costs of health insurance and suggests potential alternative financing structures.
    http://www.inquiryjournalonline.org/pdfserv/i0046-9580-043-01-0003.pdf
INQUIRY is a peer-reviewed scholarly publication. Now in its 43rd year, it is published quarterly by Excellus Health Plan, Inc. Press releases and article abstracts are available at www.inquiryjournal.org.