ROCHESTER, N.Y. - With its fall issue, INQUIRY continues to examine topics relevant to health care reform, such as access to health insurance at small businesses, Medicaid physician fees and the controversy surrounding the recent reform debate. Highlights include:

"Access to Health Insurance at Small Establishments: What Can We Learn from Analyzing Other Fringe Benefits?" by Jean Marie Abraham, Thomas DeLeire, and Anne Beeson Royalty - This study examined the relationship between health insurance and other non-pecuniary components of workers' compensation. It found that workers in larger establishments are not only more likely to be offered health insurance by their employers, but also are more likely to be offered retirement and paid vacation benefits. Results suggest that the administrative costs associated with running a health plan could be an obstacle to offering health insurance, and thus lowering these costs might increase the rate of health insurance offers at small establishments.

"Changes in Medicaid Physician Fees and Patterns of Ambulatory Care," by Sandra L. Decker - According to this study, cuts in Medicaid fees to physicians lead to a decrease in the number of times Medicaid enrollees see a physician, compared to physician visits made by privately insured people. The reduced physician fees also shift Medicaid patients away from visiting physician offices and toward hospital emergency departments and especially outpatient departments. The changes in site of care are most pronounced for Medicaid enrollees whose primary diagnoses include hypertension, asthma, urinary tract infection and diabetes.

"The View from Here: Speaking Truth to Power," by Alan C. Monheit - In this column, INQUIRY's editor sorts out fact from fiction in the ongoing debate about health reform, concluding that true reform will require sacrifices by all Americans. (open access article available at www.inquiryjournalonline.org/inqronline/?request=get-document&issn=0046-9580&volume=046&issue=03&page=0247 )

Other research papers in INQUIRY's fall issue:

"Private Long-Term Care Insurance and State Tax Incentives," by David G. Stevenson, Richard G. Frank, and Jocelyn Tau - Looking at national data, this study found that purchase of long-term care insurance has grown steadily over the last decade, but state tax incentives were responsible for only a small portion of the market take-up. The modest ability of state tax incentives to lower premiums limits their potential to attract new buyers and implies that they should be considered a "small piece" of the long-term care financing puzzle, the authors say.

"The Relationship between Medicare's Process of Care Quality Measures and Mortality" by Andrew M. Ryan, James F. Burgess, Jr., Christopher P. Tompkins, and Stanley S. Wallack - Using data from Hospital Compare---Medicare's public quality reporting program---this paper assessed the association between process of care measures and 30-day mortality rates, a commonly used measure of patient outcomes. Results showed that the Hospital Compare process measures for acute myocardial infarction, heart failure and pneumonia are not causally related to mortality for these diagnoses. The finding "casts serious doubt on the validity of current process performance measures as a metric of hospital quality improvement," the authors say.

"Racial and Ethnic Disparities in the Use of High-Volume Hospitals," by Bradford H. Gray, Mark Schlesinger, Shannon Mitchell Siegfried, and Emily Horowitz - Focusing on the New York City metropolitan area---where high-volume hospitals are relatively accessible to the entire population---this analysis found that minority patients were significantly less likely than whites to be treated at high-volume hospitals for services for which "high volume" is associated with better outcomes. Disparities were greatest between blacks and whites for cancer surgeries and cardiovascular procedures. The authors note that the disparities cannot be attributed to differences in socioeconomic status, insurance coverage, or neighborhood of residence; thus the findings raise questions about how racial and ethnic groups gain access to medical care.

"Line Authority for Nurse Staffing and Costs for Acute Inpatient Care," by Chuan-Fen Liu, Nancy D. Sharp, Anne E. Sales, Elliott Lowy, Matthew L. Maciejewski, Jack Needleman, and Yu-Fang Li - This study found that nurse executives' direct line authority for nurse staffing in acute inpatient settings was associated with lower nursing costs per admission. The analysis, which used data from 124 Department of Veterans Affairs medical centers, suggests that reducing nursing line authority may adversely impact nursing costs.