Health Affairs Issue Highlights Health Care Workforce Issues

The September/October issue of the journal Health Affairs focuses on policies governing the health care workforce. The following is a summary of several studies and articles included in the issue:

• "Dreaming the American Dream: Once More Around on Physician Workforce Policy": While it is possible to imagine a system in which the government controls the number of physicians in various specialties, the "great uncertainty" in such a scheme could result in "huge forecasting errors" that could lead to "imbalances" between the number of available doctors and the number of doctors demanded by advances in technology, Uwe Reinhardt, a professor of political economy at Princeton University, writes. Reinhardt instead promotes a "retail market for physician labor" in which market forces between patients' demand for services and the availability of doctors creates the appropriate number of health care providers.
  
• "The Growing Challenge of Providing Oral Health Care Services to All Americans": While oral health care has improved for many parts of the population, there is "abundant evidence that a sizable segment of the population does not have access" to private dental care and that the dental safety net is "poorly defined and underdeveloped," a study by Elizabeth Mertz, a project director at the University of California-San Francisco's Center for the Health Professions, and Edward O'Neill, a national authority on workforce issues, finds. The study surmises that "[r]adical steps" need to be taken to correct the "growing disconnect between the dominant pattern of practice ... and the oral health needs of the nation."
  
• "The Case for Diversity in the Health Care Workforce": "[F]undamental reforms" of the U.S. precollege system are necessary to increase the racial and ethnic diversity of health care workers, which would lead to "culturally competent care [for] our nation's burgeoning minority communities," an article by Jordan Cohen, president of the Association of American Medical Colleges, and colleagues states. A diverse health care workforce would expand health care access to underserved populations, jumpstart research in "neglected areas of societal need" and increase the number of managers and policy makers concerned with meeting minority health care needs.
  
• "Job-Based Health Benefits in 2002: Some Important Trends": The cost of employer-sponsored health insurance increased 12.7% from spring 2001 to spring 2002 in large part because of increasing claims expenses, a study by researchers at Health Research and Educational Trust and Kaiser Family Foundation finds. Employee contributions toward health plans increased during the period, as did deductibles and copayments.
  A HealthCast of the briefing to release this report will available online.
  
• "Trends in the Physician Workforce, 1980-2000": Despite a past concern about a possible U.S. surplus of physicians by the year 2000, such a surplus has not materialized and the number of doctors might have reached a plateau, a study by Edward Salsberg, executive director of the Center for Health Workforce Studies at the State University of New York-Albany, and Gaetano Forte, a center research associate, finds.
  
• "Trends in the Supply of Physician Assistants and Nurse Practitioners in the United States": The annual number of nurse practitioner graduates, who work predominantly in primary care, is declining, while the annual number of physician assistant graduates, who work in both primary and specialty care, is increasing, a study by Roderick Hooker, associate professor and chief of the Division of Health Services Research at the University of Texas Southwestern Medical Center in Dallas, and Linda Berlin, associate director of research and data services at the American Association of Colleges of Nursing, finds.
  
• "Obstacles to Employers' Pursuit of Health Care Quality": Large employers are "shifting away from value-based purchasing" of employee health coverage and are turning toward "direct efforts to improve health care delivery within local markets," a study by J. Lee Hargraves and Sally Trude, senior health researchers at the Center for Studying Health System Change, finds. "[I]nadequate information" on the quality of health plans has "frustrated employers and limited their ability to make choices" based on quality, the study states.
  
• "The Benefits Divide: Health Care Purchasing in Retail Versus Other Sectors": Because retail companies are more price-oriented than other Fortune 500 firms when it comes to purchasing health insurance, that sector has the largest number of uninsured workers in the U.S. economy, a study by James Maxwell, director of health policy at John Snow Research and Training Institute, and colleagues finds. The study suggests increasing efforts to decrease the number of uninsured to include workers in large companies and not just small-business employees.
  
• "Access to Postacute Nursing Home Care Before and After the BBA": Following the Balanced Budget Act of 1997, which created incentives for nursing homes to limit the admission of "potentially costly patients," there was only a "small decrease" in the proportion of the costliest patients who were discharged from hospitals into nursing homes, a study by Joseph Angelelli, an assistant professor at Brown University's Center for Gerontology and Health Care Research, and colleagues finds. However, reduced rates of admission for the costliest patients were concentrated at particular types of nursing homes, necessitating the need to "closely monitor" the effect of post-BBA policy updates.
  
• "Monitoring Local Safety-Net Providers: Do They Have Adequate Capacity?": The capacity to provide primary care to uninsured people at safety-net hospitals in five cities is "often adequate," a study by Suzanne Felt-Lisk, a senior researcher at Mathematica Policy Research, and colleagues finds. However, the capacity of those hospitals to provide specialty services and pharmaceuticals was "difficult" the study states.
  
• "Promising Practices: How Leading Safety-Net Plans are Managing the Care of Medicaid Clients": Safety-net health plans for Medicaid patients that emphasize a partnership with health providers are better than plans that rely on "coercive, command-style tools of managed care," a study by Michael Sparer, an associate professor at Columbia University's Mailman School of Public Health, and colleagues finds. Aspects of the partnership include sharing data about practice patterns, giving providers financial bonuses to encourage particular practices and developing disease management programs that encourage patient compliance with treatment decisions.