Archive
Essential Health Benefits: States will determine the minimum set of benefits to be included in individual and small group insurance plans. What lies ahead?
What’s the issue?
The Affordable Care Act of 2010 requires that health insurance plans sold to individuals and small businesses provide a minimum package of services in 10 categories called “essential health benefits.” These include hospitalization, maternity and newborn care, ambulatory care, and prescription drugs.
But rather than establishing a national standard for these benefits, the Department of Health and Human Services (HHS) has decided to allow each state to choose from a set of plans to serve as the benchmark plan in their state. Whatever benefits that plan covers in the 10 categories will be deemed the essential benefits for plans in the state.
This approach has drawn criticism from health care providers, consumer groups, and patient advocates, who would prefer a national standard. But it has been more welcomed by states and the business community, who appreciate the flexibility the arrangement will afford states to tailor benefits to local circumstances. This policy brief explores the background of the debate and the policy implications surrounding essential health benefits.
New From the GAO
New GAO Reports and TestimonySource: Government Accountability Office
+ Reports
1. Defense Management: Actions Needed to Evaluate the Impact of Efforts to Estimate Costs of Reports and Studies. GAO-12-480R, May 10.
http://www.gao.gov/products/GAO-12-480R
2. Patient-Centered Outcomes Research Institute: Review of the Audit of the Financial Statements for 2011 and 2010. GAO-12-663R, May 10.
http://www.gao.gov/products/GAO-12-663R
3. Security Force Assistance: Additional Actions Needed to Guide Geographic Combatant Command and Service Efforts. GAO-12-556, May 10.
http://www.gao.gov/products/GAO-12-556
Highlights – http://www.gao.gov/assets/600/590769.pdf
4. Homelessness: Fragmentation and Overlap in Programs Highlight the Need to Identify, Assess, and Reduce Inefficiencies. GAO-12-491, May 10.
http://www.gao.gov/products/GAO-12-491
Highlights – http://www.gao.gov/assets/600/590781.pdf
+ Testimony
1. Unconventional Oil and Gas Production: Opportunities and Challenges of Oil Shale Development, by Anu K. Mittal, director, natural resources and environment, before the Subcommittee on Energy and Environment, House Committee on Science, Space, and Technology. GAO-12-740T, May 10.
http://www.gao.gov/products/GAO-12-740T
Highlights – http://www.gao.gov/assets/600/590763.pdf
Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results
Consumers’ And Providers’ Responses To Public Cost Reports, And How To Raise The Likelihood Of Achieving Desired Results
Source: Health Affairs
There is tremendous interest in different approaches to slowing the rise in US per capita health spending. One approach is to publicly report on a provider’s costs—also called efficiency, resource use, or value measures—with the hope that consumers will select lower-cost providers and providers will be encouraged to decrease spending. In this paper we explain why we believe that many current cost-profiling efforts are unlikely to have this intended effect. One of the reasons is that many consumers believe that more care is better and that higher-cost providers are higher-quality providers, so giving them information that some providers are lower cost may have the perverse effect of deterring them from accessing these providers. We suggest changes that can be made to content and design of public cost reports to increase the intended consumer and provider response.
Red Meat Consumption and Mortality
Red Meat Consumption and Mortality
Source: Archives of Internal Medicine
Background
Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain.Methods
We prospectively observed 37 698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses’ Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years.Results
We documented 23 926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow-up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13-1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat.Conclusions
Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is associated with a lower mortality risk.
New From the GAO
New GAO Reports and TestimonySource: Government Accountability Office
+ Reports
1. Chemical, Biological, Radiological, and Nuclear Risk Assessments: DHS Should Establish More Specific Guidance for Their Use. GAO-12-272, January 25.
http://www.gao.gov/products/GAO-12-272
http://www.gao.gov/assets/590/587673.pdf
2. Capitol Police: Retirement Benefits, Pay, Duties, and Attrition Compared to Other Federal Police Forces. GAO-12-58, January 24.
http://www.gao.gov/products/GAO-12-58
http://www.gao.gov/assets/590/587910.pdf
3. Defense Health: Coordinating Authority Needed for Psychological Health and Traumatic Brain Injury Activities. GAO-12-154, January 25.
http://www.gao.gov/products/GAO-12-154
http://www.gao.gov/assets/590/587920.pdf
4. Federal Employees’ Compensation Act: Preliminary Observations on Fraud-Prevention Controls. GAO-12-402, January 25.
http://www.gao.gov/products/GAO-12-402
+ Testimony
1. Arlington National Cemetery: Actions Taken and Steps Remaining to Address Contracting and Management Challenges, by Brian J. Lepore, director, defense capabilities and management, and Belva M. Martin, director, acquisition and sourcing management, before the Ad Hoc Subcommittee on Contracting Oversight, Senate Committee on Homeland Security and Governmental Affairs, GAO-12-374T, January 25.
http://www.gao.gov/products/GAO-12-374T
http://www.gao.gov/assets/590/587928.pdf
Achieving Equity in Health
Achieving Equity in Health (PDF)
Source: Health Affairs
America’s racial and ethnic minorities have worse health than whites do, and they often receive a lesser standard of health care. People who have limited education or income or who live in poor neighborhoods have worse health and health care compared to those who are better educated or financially better off. People with disabilities are also in worse health, and receive worse health care, compared to people without disabilities.
Narrowing these disparities in health and health care has been the goal of many public and private efforts since the early 1990s. Although some progress has been made—particularly in closing the quality gap in the care that minorities and whites receive—much more remains to be done.
The multiple causes of health and health care disparities are complex, and some are only beginning to be explored deeply. This policy brief summarizes what is known about health and health care disparities, discusses recent efforts to close the gaps, and enumerates some policy recommendations for making further progress.
U.S. Physician Practices Spend Nearly Four Times as Much Money Interacting with Health Plans and Payers Than Do Their Canadian Counterparts
U.S. Physician Practices Spend Nearly Four Times as Much Money Interacting with Health Plans and Payers Than Do Their Canadian Counterparts
Source: Health Affairs (via Commonwealth Fund)
Synopsis
Survey research reveals that physician practices in the United States incur nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts. The U.S. could save almost $27.6 billion in annual health spending if administrative costs were similar to those in Canada.The Issue
Per capita health spending in the United States is 87 percent higher than in Canada—$7,290 versus $3,895 annually. Many factors contribute to the high cost of health care in the U.S., but there is broad consensus that administrative costs stemming from interactions between physician offices and health insurance plans are a leading culprit. In contrast to physicians in Canada, which has a single-payer, predominantly public health insurance system, most U.S. practices must interact with many health plans, each with its own insurance products and rules regarding formularies, prior authorization, billing, and claims submission. For this Commonwealth Fund–supported study published in Health Affairs, researchers surveyed physicians and administrators in Ontario, Canada, about the time they spend interacting with payers. Results were compared with a national companion survey in the United States.Key Findings
- Physician practices in the United States spent $82,975 per physician per year interacting with payers, compared with $22,205 in Ontario.
- If U.S. physicians had administrative costs similar to those of Ontario physicians, their total savings would be approximately $27.6 billion per year.
- In the U.S., nurses and medical assistants spent 20.6 hours per physician per week on administrative tasks related to health plans, nearly 10 times the 2.5 hours spent by Canadian nursing staff. U.S. nursing staff spent more time in every category of interactions, most notably obtaining prior authorizations, which accounted for 13.1 hours per physician per week.
- Very little time was spent submitting quality data in either the United States or Ontario.
+ Full Paper (PDF)
Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths
Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths
Source: Health Affairs
Public health encompasses a broad array of programs designed to prevent the occurrence of disease and injury within communities. But policy makers have little evidence to draw on when determining the value of investments in these program activities, which currently account for less than 5 percent of US health spending. We examine whether changes in spending by local public health agencies over a thirteen-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes, and cancer. We found that mortality rates fell between 1.1 percent and 6.9 percent for each 10 percent increase in local public health spending. These results suggest that increased public health investments can produce measurable improvements in health, especially in low-resource communities. However, more money by itself is unlikely to generate significant and sustainable health gains; improvements in public health practices are needed as well.
Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008
Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008
Source: Health Affairs
A 2002 analysis documented $54.9 billion in annual costs of environmentally mediated diseases in US children. However, few important changes in federal policy have been implemented to prevent exposures to toxic chemicals. We therefore updated and expanded the previous analysis and found that the costs of lead poisoning, prenatal methylmercury exposure, childhood cancer, asthma, intellectual disability, autism, and attention deficit hyperactivity disorder were $76.6 billion in 2008. To prevent further increases in these costs, efforts are needed to institute premarket testing of new chemicals; conduct toxicity testing on chemicals already in use; reduce lead-based paint hazards; and curb mercury emissions from coal-fired power plants.
