The Latest Reports in Health Policy

• "Trends in Private and Public Health Insurance for Adolescents," Journal of the American Medical Association: The "modest but significant reduction" in the number of uninsured adolescents from 14.1% of the population in 1995 to 12.2% of the population in 2002 is "largely [the] result of expansions" in public health programs, according to the study by Paul Newacheck and M. Jane Park of the University of California-San Francisco and colleagues. The study notes, however, that the reduction in uninsurance among adolescents would have been even greater if not for a reduction in private health coverage for adolescents in middle- and higher-income families (Newacheck et al., JAMA, 3/10).
  

Health Affairs
The following are summaries of reports from the March/April issue of Health Affairs.

• "Are Market Forces Strong Enough To Deliver Efficient Health Care Systems? Confidence Is Waning": Based on information from the Community Tracking Study, Len Nichols, vice president of the Center for Studying Health System Change; Paul Ginsburg, HSC president and colleagues examine the pros and cons of implementing market-based reforms in communities' health systems. According to the report, private market forces would be "limited in their ability to achieve social objectives in health care services" (Nichols et al., Health Affairs, March/April 2004).
  
  
• "Market Forces and Efficient Health Care Systems": There is some evidence to suggest that certain market-based reforms would positively impact the health care system, according to the report by Alain Enthoven, a professor of public and private management at Stanford University's Graduate School of Business. A system that would implement "Medicare for all" would "not deliver efficient health care systems," the report states (Enthoven, Health Affairs, March/April 2004).
  
  
• "A Quiet Revolution: Law as an Agent of Health System Change": M. Gregg Bloche, a professor of law at Georgetown University, and David Studdert, an associate professor at the Harvard School of Public Health's Department of Health Policy and Management, examine how the law has impacted changes in the U.S. health system (Bloche/Studdert, Health Affairs, March/April 2004).
  
  
• "From Managed Care to Consumer Health Insurance: The Fall and Rise of Aetna": The report by James Robinson, a professor of health economics and policy at the University of California-Berkeley, examines how Aetna's corporate goals, products, organizational structure, information technology, premiums, cash flow, net income and share prices have transformed over the years, contributing to the insurer's "reemergence" (Robinson, Health Affairs, March/April 2004).
  
  
• "The Puzzling Popularity of the PPO": Increased enrollment in preferred provider organizations has been influenced in part by the "undesirable features of" HMOs, but the "advantages offered by PPO design are not so clear," according to the report by Robert Hurley, an associate professor at Virginia Commonwealth University's Department of Health Administration; Bradley Strunk, an HSC health research analyst; and Justin White, a research assistant at Mathematica Policy Research (Hurley et al., Health Affairs, March/April 2004).
  
  
• "Growth of Single-Specialty Medical Groups": The report by Lawrence Casalino, an assistant professor at the University of Chicago's Department of Health Studies; Hoangmai Pham, an internist and HSC senior health researcher; and Gloria Bazzoli, a professor of health administration at VCU, explores the possible impact of an increase in large single-specialty medical groups (Casalino et al., Health Affairs, March/April 2004).
  
  
• "Overlap in HMO Physician Networks": People enrolled in an HMO who would like to change health plans have a 50-50 chance of being able to retain their current provider because of an overlap in HMO physician networks, according to according to the report by Michael Chernew, an associate professor at the University of Michigan School of Public Health; Walter Wodchis, a research scientist at the Toronto Rehabilitation Institute; and colleagues. The report also notes that HMOs' restrictions on size of their physician networks could hamper members' access to care and create barriers for individuals seeking to switch health plans or jobs (Chernew et al., Health Affairs, March/April 2004).
  
  
• "Physicians' Use of Electronic Medical Records: Barriers and Solutions": Quality improvement after implementing an electronic records system in physicians' offices depends on doctors' use of the system for daily tasks, according to the report by Robert Miller, an associate professor of health economics at the University of California-San Francisco's Institute for Health and Aging, and Ida Sim, an assistant professor of medicine at UCSF's Department of Medicine. The report identifies barriers to implementing such systems and recommends ways to overcome them (Miller/Sim, Health Affairs, March/April 2004).
  
  
• "Paying for Quality: Providers' Incentives for Quality Improvement": In the report, Meredith Rosenthal, an assistant professor at the Harvard School of Public Health Department of Health Policy and Management; Rushika Fernandopulle, executive director of the Harvard Interfaculty Program for Health Systems Improvement; and colleagues examine public reports of paying health providers for quality over the last five years (Rosenthal, Health Affairs, March/April 2004).
  
  
• "Popular Medicaid Programs Do Battle With State Budget Pressures: Perspectives From 12 States": States thus far have "largely avoided" making cuts to their Medicaid and SCHIP programs that would seriously affect beneficiaries' access to care, according to the report by John Hoadley, a research professor at Georgetown University's Health Policy Institute; Peter Cunningham, an HSC senior health researcher; and Megan McHugh, a research analyst at Mathematica Policy Research. According to the report, "broad political backing" for Medicaid and SCHIP programs, along with additional federal funding, allowed states to avoid making some "devastating cuts" (Hoadley et al., Health Affairs, March/April 2004).
  
  
• "Medicaid Managed Care: The Last Bastion of the HMO?": Despite a movement away from HMOs in the private sector, many states continue to use such managed care plans to provide coverage for Medicaid beneficiaries because they offer "guaranteed access to comprehensive benefits at a predictable cost," according to the report by Debra Draper, a senior health policy researcher at Mathematica Policy Research; Robert Hurley, an associate professor at VCU's Department of Health Administration; and Ashley Short, a former HSC research analyst (Draper et al., Health Affairs, March/April 2004).
  
  
• "The Impact of the 'Aging of America' on Children": In the report, Gary Freed, a professor of pediatrics and director of the University of Michigan's Division of General Pediatrics and the Child Health Evaluation and Research Unit, and Kathryn Fant, a research associate of pediatrics at the CHEAR unit, examine how an aging population in the United States will impact the population of children in the country, which is becoming a smaller proportion overall. The increasing aging population could impact financing of health programs and other services for children, according to the report (Freed/Fant, Health Affairs, March/April 2004).