Research Roundup: ‘Medicare For All’; Surprise Medical Bills; And Contraception

Commonwealth Fund: The 'Medicare For All' Continuum: A New Comparison Tool For Congressional Health Bills Illustrates The Range Of Reform Ideas
Several 2020 Democratic presidential candidates have called for “Medicare for All” as a way to expand health coverage and lower U.S. health care costs. Replacing most private insurance with a Medicare-like system for everyone has instilled both hope and fear across the country depending on people’s perspective or financial stake in the current health care system. But a closer look at recent congressional bills introduced by Democrats reveals a set of far more nuanced approaches to improving the nation’s health care system than the term Medicare for All suggests. To highlight these nuances, a new Commonwealth Fund interactive tool launched today illustrates the extent to which each of these reform bills would expand the public dimensions of our health insurance system, or those aspects regulated or run by state and federal government. (Collins, 3/12)

Health Affairs: Consumers’ Responses To Surprise Medical Bills In Elective Situations
A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. We investigated consumers’ hospital choices after receipt of surprise out-of-network medical bills in an elective situation, using a large national sample of medical claims for obstetric patients with two deliveries covered by employer-sponsored health insurance in 2007–14. We found that 11 percent of mothers experienced a surprise out-of-network bill with their first delivery, and this was associated with an increase of 13 percent in the odds of switching hospitals for the second delivery, compared to mothers who did not experience a surprise bill. (Chartock, Garmon and Schutz, 3/4)

Urban Institute: Women Call For More Education, Contraceptive Choices To Prevent Unplanned Pregnancy
Although the rate of unintended pregnancies in the United States has decreased in recent years, it remains high compared with other developed countries. And though evidence shows how unplanned births affect women’s lives, less is known about what motivates women to avoid unplanned pregnancy, and what stands in their way. New Urban Institute findings are helping fill that gap in knowledge.Results from focus groups conducted by Urban with women across the country offer a window into the reasons women want to prevent unplanned pregnancy. We learned from them, too, that successfully controlling whether and when to have children can be a challenge: Many women reported that they don’t have access to quality sex education and family planning information. Nor do they have access to different contraceptive options to try, so they can decide what works best for them. (3/7)

JAMA Internal Medicine: Patient Outcomes After Hospital Discharge To Home With Home Health Care Vs To A Skilled Nursing Facility.
In a cohort study of Medicare data of more than 17 million hospitalizations using instrumental variable methods to account for confounding by indication, compared with discharging patients to skilled nursing facilities, discharging patients to home with home health care was associated with a higher 30-day rate of readmission but a significantly lower Medicare payment for initial postacute care and for the total 60-day episode of care including hospitalization, all postacute care, and subsequent readmissions. There were no significant differences in 30-day mortality rates or improved functional status. (Werner et al, 3/11)

The Henry J. Kaiser Family Foundation: Most Medicare Beneficiaries Lack Dental Coverage, And Many Go Without Needed Care
Almost two-thirds of Medicare beneficiaries (65%), or nearly 37 million people, do not have dental coverage and many go without needed care, according to a new KFF brief on dental coverage and costs for Medicare beneficiaries. Rates are even higher among black and Hispanic beneficiaries, and those with low incomes.Medicare does not cover routine preventive dental care or more expensive dental services that are often needed by older adults. Lack of dental care can lead to delayed diagnosis of serious health conditions, preventable infections and complications, chronic pain, and costly emergency room visits. (3/13)

Modern Healthcare: Home Health Saves Medicare Money Despite Higher Readmissions
Home health agencies are more likely to experience hospital readmissions compared to skilled-nursing facilities, but their lower service costs still make them a cheaper post-acute care option, according to a new analysis. The study, published this week in JAMA Internal Medicine by researchers at the University of Pennsylvania, found that Medicare patients discharged to home health had a 5.6% higher 30-day readmission rate compared with patients sent to a skilled-nursing facility, or SNF. Despite that, the authors noted home health saved Medicare $4,514 on average in the 60 days after the first hospital admission because their services cost marginally less than SNFs. (Castellucci, 3/13)