Research Roundup: Handling Health Care Consolidation; Surprising Take On Obesity

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Seeking Lower Prices Where Providers Are Consolidated: An Examination Of Market And Policy Strategies
The ongoing consolidation between and among hospitals and physicians tends to raise prices for health care services, which poses increasing challenges for private purchasers and payers. This article examines strategies that these purchasers and payers can pursue to combat provider leverage to increase prices. ... How effective market-oriented approaches will be at mitigating provider price increases is uncertain. Their effectiveness will undoubtedly vary because of market structure, degree of plan and provider concentration, the nature of state regulation, and their acceptance by employers and consumers. ... Many analysts doubt that market approaches will manage to constrain spending sufficiently. Should these approaches fail to mitigate the effects of provider consolidation, more overt forms of government intervention, including rate setting or direct provision of coverage, will be likely (Paul B. Ginsburg and L. Gregory Pawlson, 5/19).

Health Affairs: Getting The Product Right: How Competition Policy Can Improve Health Care Markets
As hospital, physician, and health insurance markets consolidate and change in response to health care reform, some commentators have called for vigorous enforcement of the federal antitrust laws to prevent the acquisition and exercise of market power. In health care, however, stricter antitrust enforcement will benefit consumers only if it accounts for the competitive distortions caused by the sector's long history of government regulation. ... The greatest obstacle to effective competition in health care is failure to understand the product. A product is more than a series of process steps that can be billed for. Instead of perpetuating stylized negotiations between private insurers and providers that seldom make assembled, warranted products available to consumers, competition policy makers should force the health care industry to define and market such products (William M. Sage, 5/19).

Health Affairs also offers two alternative perspectives on these proposals.

JAMA Surgery: Costs Associated With Surgical Site Infections In Veterans Affairs Hospitals
Surgical site infections (SSIs) are potentially preventable complications that are associated with excess morbidity and mortality. [The study sought to] determine the excess costs associated with total, deep, and superficial SSIs among all operations and for high-volume surgical specialties. ... Among 54 233 VA patients who underwent surgery, 1756 (3.2%) experienced an SSI. ... The mean unadjusted costs were $31 580 and $52 620 for patients without and with an SSI, respectively. ... The costs of SSIs have been under scrutiny ever since the Centers for Medicare and Medicaid have stopped paying for the increased costs associated with SSIs after some surgical procedures because it was determined that these types of infections are potentially preventable. Thus, knowledge of the risk-adjusted costs of SSIs can inform policy makers and create a business case for implementing specific interventions to reduce the number of SSIs (Schweitzer et al., 5/21).

CA Cancer: Obesity And Economic Environments
Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). ... Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption (Sturm and An, 5/22).

Employee Benefits Research Institute: Trends In Health Coverage For Part-Time Workers, 1999–2012
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires that employers with 50 or more fulltime workers pay a penalty if they fail to provide health coverage to full-time workers in 2014. ... [That] has raised concern that employers may respond by cutting back on health coverage for part-time workers or by increasing the proportion of part-time workers .... Among those employed fewer than 30 hours per week, 2.6 million (12.8 percent) had employment-based coverage from their own job. And among those employed between 30–39 hours per week, 6.3 million (33.6 percent) had employment-based coverage from their own job. ... Recently, the percentage of employers with 200 or more workers offering health benefits to part-time workers has been increasing ... from 39 percent in 2010 to 47 percent in 2013. ... [S]ince 2010 the percentage of workers employed less than 40 hours per week has declined slightly. At the same time, while both fulltime and part-time workers have experienced drops in coverage, part-time workers have been affected disproportionately. While PPACA may affect whether part-time workers get coverage through their job, ... the strength of the economy may play a larger role on workforce patterns (Fronstin, 5/22). 

Kaiser Family Foundation: Visualizing Health Policy: Public Opinion At The End of the First Open Enrollment Period
This Visualizing Health Policy infographic takes a look at public opinion of the Affordable Care Act at the end of the first enrollment period, including the persistent deep partisan divisions, the sources of people's impressions, and the favorable views towards many of the ACA's least well-known provisions. Further, more people want Congress to improve the ACA than to repeal it (Hamel et al., 5/20). 

National Girls Health Justice Institute/Kaiser Family Foundation: Health Coverage and Care For Youth In The Juvenile Justice System: The Role Of Medicaid And CHIP
Girls and boys in the juvenile justice system are a diverse group of young people with often complex health needs. Many are from low-income families of color, have suffered abuse, were involved in the foster care system, and may require comprehensive and ongoing physical, reproductive, mental, and behavioral health services upon discharge from juvenile justice residential facilities. ... This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid in addressing those needs. It focuses on the circumstances of those girls and boys who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by the Affordable Care Act (Acoca, Stephens and Van Vleet, 5/19).

Here is a selection of news coverage of other recent research:

Bloomberg: Most Doctors Prescribe Antibiotics That Don't Work
Medical researchers concluded years ago that antibiotics don't cure acute bronchitis. The drugs might reduce your coughing symptoms slightly, but the antibiotics also increase your risk of side effects such as diarrhea and nausea. And overuse of antibiotics breeds bacteria resistant to the current cures. Yet patients who show up to clinics or emergency rooms with bronchitis still receive antibiotics about 70 percent of the time, according to a new review of prescribing data published in JAMA: The Journal of the American Medical Association. And the rate even increased slightly between 1996 and 2010 despite efforts to educate doctors and establish guidelines against antibiotics (Tozzi, 5/20).

Reuters: School Nurses Save Money: Study
A Massachusetts program that put full-time registered nurses in schools more than paid for itself by averting medical costs and lost work for parents and teachers, according to a new study. Many school districts have cut or reduced the hours of school nurses in recent years, and nationwide less than half of public schools have a full-time nurse, the authors of the report note. They say their results warrant "careful consideration" from districts that are thinking of making such cuts in an effort to save money (Pittman, 5/19).

The New York Times: Drug Found To Aid Breathing In A Fatal Lung Disease
For the first time, researchers have found drugs that can slow the decline of people with a fatal lung disease, idiopathic pulmonary fibrosis. Studies of two experimental drugs were published in The New England Journal of Medicine and presented on Sunday in San Diego at a meeting of the American Thoracic Society. ... InterMune announced on Friday that it would make pirfenidone available for free to some patients in the United States through an "expanded access program," designed to help patients obtain experimental drugs that have not yet been approved (Grady, 5/18).

MinnPost:  Time To Ban Handshakes From Medical Settings?
Should our hospitals and medical clinics become "handshake-free zones"? The issue should at least be studied and discussed, according to two University of California, Los Angeles (UCLA) pediatricians and a medical student in a commentary published last week in the Journal of the American Medical Association (Perry, 5/19). 

news@JAMA:  Study Links Sleep Deprivation With Obesity In Children
Children who get less sleep in infancy and early childhood may be at greater risk of being overweight or obese during mid-childhood, according to a study published today in the journal Pediatrics. Over the past 20 years, studies have documented that the amount of daily time spent sleeping has declined for infants, children, and adolescents. Cultural changes have likely contributed to this trend, including more 2-parent working families and longer work hours. There is some evidence that reduced duration of sleep can to contribute to negative health outcomes, such as increased risk factors for cardiovascular disease (Kuehn, 5/19).

Reuters:  Texting Improves Link Between Sick Teens And Docs
Adolescents with chronic diseases who were allowed to text their doctors were better equipped to manage their own healthcare and more likely to request help at the first sign of problems, a new study found. "Give them a voice, and they will talk," lead author Dr. Jeannie Huang told Reuters Health. "And that's really what we want them to do." Huang, from the University of California, San Diego, said her study shows that using the Internet and cellphones to communicate with youths has the potential to get them earlier care and improve outcomes (Cohen, 5/20).

Reuters:  Elderly May Have Trouble Accessing Online Health Records
Electronic medical records will let patients access their health information over the Internet, but a new study suggests some of the most vulnerable older Americans may be left behind. While Internet use doubled among seniors in general over the past decade, researchers found, there was little growth among people with physical impairments -- suggesting a new digital divide could be forming. Functional impairments, including physical disabilities such as the loss of a sense or the ability to walk, make it difficult for people to live in their community, take care of personal finances and coordinate transportation (Seaman, 5/21).

WBUR: Know Your Mental Health Coverage Rights? Probably Not, Study Finds
No one could ever blame for you failing to grasp all the Byzantine ins and outs of your health insurance plan. But here's a simple concept that everyone should know, and that most of us don't: Under federal and state law, your health insurer must treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care. How do I know that most of us don’t know this? From a survey of more than 1,000 adults just released by the American Psychological Association (which, yes, may have a vested interest in spreading the word that therapy should often be covered.) It found that only 4 percent knew about the 2008 law that guarantees mental health coverage "parity" with physical health, no higher than in 2010 (Goldberg, 5/21).