The Latest Reports in Health Policy

• "Consumer-Driven Health Plans: Are They More Than Talk Now?," Health Affairs: Although "consumer-driven" health insurance plans have become "central" to many insurers' business plans, it is still too early to determine if such plans will "appeal broadly to employees" and experience an enrollment increase, Jon Gabel, vice president for health systems studies at the Health Research and Educational Trust, Anthony Lo Sasso, research associate professor at Northwestern University's Institute for Health Services Research and Policy Studies, and Thomas Rice, a professor in the University of California-Los Angeles School of Public Health write in a study published Nov. 20. The study's findings are based on interviews with 37 insurance experts, including brokers, health plan executives, policymakers and employee group leaders. According to the authors, more research is needed on consumer-driven plans to determine if they "split up risk pools and shift costs to sicker enrollees (Health Affairs release, 11/20).
  
• "Specialty of Ambulatory Care Physicians and Mortality among Elderly Patients after Myocardial Infarction," New England Journal of Medicine: Heart attack survivors who are treated by a cardiologist after being released from the hospital receive more rehabilitative care and have lower mortality rates than heart attack patients who are cared for by internists or family practitioners, John Ayanian of Brigham and Women's hospital, Mary Beth Landru of Harvard Medical School's Department of Health Care Policy and colleagues write in the study. Two years following hospitalization, 18.3% of patients who were being treated solely by a primary care doctor died, compared to 14.6% of patients under the care of a cardiologist only. The patients who did not see a cardiologist following hospitalization were more likely to be African-American, female or "very elderly" and were more likely than other patients to have other major chronic illnesses such as congestive heart failure, diabetes or lung disease (Ayanian et al., NEJM, 11/21).
  
• "Health Disparities and the Quality of Ambulatory Care," New England Journal of Medicine: In an editorial, RAND researchers Dr. Nicole Lurie and Melinda Beeuwkes Buntin write that based on the findings of an Institute of Medicine report, "systemwide coordination of care is an essential requirement for improving the quality of care" (Lurie/Beeuwkes Buntin, New England Journal of Medicine, 11/21). The IOM report, "Crossing the Quality Chasm: A New Health System for the 21st Century," found that a "major overhaul" of the nation's health system is needed because the current system is "a tangled, highly fragmented web that often wastes resources by providing unnecessary services and duplicating efforts" (Kaiser Daily Health Policy Report, 3/2/01). Racial health disparities "largely reflect deficiencies in the quality of care," Lurie and Buntin write, concluding that quality initiatives that focus on increasing collaboration in the health system should be directed toward women, minorities and low-income people -- groups that are less likely to have access to health services (New England Journal of Medicine, 11/21).