Research Roundup: Antibiotics; End-Of Life Care; And The Individual Marketplace
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA Internal Medicine:
Comparison Of Antibiotic Prescribing In Retail Clinics, Urgent Care Centers, Emergency Departments, And Traditional Ambulatory Care Settings In The United States
Antibiotic use contributes to antibiotic resistance and is associated with adverse events, including Clostridium difficile infections. Antibiotic overuse, especially for viral respiratory infections, is common. Only 60% of outpatient antibiotic prescriptions dispensed in the United States are written in traditional ambulatory care settings (hereinafter “medical offices”) and emergency departments (EDs). Growing markets, including urgent care centers and retail clinics, may contribute to the remaining 40%. Our objective was to compare antibiotic prescribing among urgent care centers, retail clinics, EDs, and medical offices. (Palms et al, 7/16)
Health Affairs:
Factors Contributing To Geographic Variation In End-Of-Life Expenditures For Cancer Patients
Health care spending in the months before death varies across geographic areas but is not associated with outcomes. Using data from the prospective multiregional Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, we assessed the extent to which such variation is explained by differences in patients’ sociodemographic factors, clinical factors, and beliefs; physicians’ beliefs; and the availability of services. Among 1,132 patients ages sixty-five and older who were diagnosed with lung or colorectal cancer in 2003–05, had advanced-stage cancer, died before 2013, and were enrolled in fee-for-service Medicare, mean expenditures in the last month of life were $13,663. (Keating et al, 7/9)
Commonwealth Fund:
To Understand How Consumers Are Faring In The Individual Health Insurance Markets, Watch The States
Since passage of the Affordable Care Act (ACA), millions of Americans have gained access to comprehensive health coverage, driving the uninsured rate to historic lows. Many people continue to face difficulty affording coverage, however, including those with moderate incomes who nevertheless earn too much to qualify for federal premium subsidies. Though recent developments in Congress and actions by the Trump administration are likely to make it harder for individuals — particularly those who aren’t in perfect health — to afford adequate coverage, some states are taking action to safeguard their residents. (Giovannelli, Lucia and Corlette, 7/18)
The Henry J. Kaiser Family Foundation:
Tracking Section 1332 State Innovation Waivers
Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. As states explore ways to address access and affordability issues in their individual and small group markets, they are increasingly turning to 1332 waivers. (4/16)
JAMA Internal Medicine:
Associations Between The Patient Protection And Affordable Care Act Medicaid Primary Care Payment Increase And Physician Participation In Medicaid
The limited duration and design of the payment increase may have dampened its effectiveness. Future efforts to improve access through payment changes or other means can benefit from better understanding of the outcomes of this policy. (Mulcahy, Gracner and Finegold, 7/16)
