Research Roundup: Medicare Part D’s Effect; Attitudes On Indoor Tanning; Premium Changes

Annals of Internal Medicine: Did Medicare Part D Affect National Trends In Health Outcomes Or Hospitalizations?
Medicare Part D increased economic access to medications, but its effect on ... health outcomes and use of other medical services remains unclear. ... [Researchers analyzed a] nationally representative sample of Medicare beneficiaries ... from 2000 to 2010 [to see] changes in self-reported health status, limitations in activities of daily living (ADLs) ..., emergency department visits and hospital admissions (prevalence, counts, and spending), and mortality. Medicare claims data were used for confirmatory analyses. ... Five years after Part D implementation, no clinically or statistically significant reductions in the prevalence of fair or poor health status or limitations in ADLs ... were detected. Compared with trends before Part D, no changes in emergency department visits, hospital admissions or days, inpatient costs, or mortality after Part D were seen. (Briesacher et al., 6/16)

Health Affairs: Despite High Cost, Improved Pneumococcal Vaccine Expected To Return 10-Year Net Savings Of $12 Billion
In 2010 the US Advisory Committee on Immunization Practices recommended that the seven-valent pneumococcal conjugate vaccine (PCV7) be replaced by the thirteen-valent version (PCV13), which provides protection against six additional serotypes of the bacterium Streptococcus pneumoniae. The higher price ... may be a concern for funding agencies and payers .... This study estimated the budgetary impact ... from 2010 to 2019. Implementing the PCV13 vaccine is projected to cost public and private payers $3.5 billion and $2.6 billion, respectively, more than PCV7. However, PCV13 is expected to provide net cost savings of $6.1 billion and $4.2 billion, respectively, to those payers during the ten-year period by preventing pneumococcal disease and its associated costs. An additional $1.7 billion in cost savings would be realized for uninsured patients. (Kohli et al., 7/1)

JAMA Dermatology: Recent Changes In The Prevalence Of And Factors Associated With Frequency Of Indoor Tanning Among US Adults
We examined changes in the ... frequency of indoor tanning among US adults [using] ... the 2010 and 2013 National Health Interview Survey .... We observed significant reductions in indoor tanning from 2010 to 2013: from 5.5% to 4.2% ... among all adults, from 8.6% to 6.5% ... among women, and from 2.2% to 1.7% ... among men .... The decrease in indoor tanning may be partly attributable to the increased awareness of its harms. Indoor tanning devices have been classified as carcinogenic to humans, their use has consistently been shown to increase skin cancer risk, and laws restricting access among minors may have changed public perceptions of their safety. In addition, a 10% excise tax on indoor tanning was implemented in 2010, which may have contributed to the decrease in indoor tanning. (Guy, Berkowitz, Holman and Hartman, 7/1)

AMA Journal of Ethics/Urban Institute: Consumer Satisfaction With Health Insurance Coverage In Massachusetts
This paper examines Massachusetts residents’ satisfaction with their health insurance coverage using the 2013 Massachusetts Health Reform Survey (MHRS). We find that nonelderly adults in Massachusetts are generally quite satisfied with their coverage, their network of health care practitioners, and the quality of care available with their plans. However, they are less satisfied with the financial protections afforded by their health insurance coverage and often report financial barriers to care and problems paying medical bills. Health care affordability continues to be a challenge for Massachusetts residents, despite near-universal coverage. (Long and Dimmock, 7/1)

Urban Institute: Marketplace Price Competition In 2014 And 2015: Does Insurer Type Matter In Early Performance?
We analyze how price competition in the ACA’s nongroup insurance marketplaces varies by insurer type: national, regional, Blue Cross Blue Shield, previously Medicaid-only, provider-sponsored, and co-ops. National insurers are expanding their presence, but are not yet pricing aggressively. Regional insurers have increased participation but seem to be losing price competitive ground. Blue Cross Blue Shield insurers have widespread participation but pursue very different pricing strategies. Previously Medicaid-Only insurers are a growing presence that is getting increasingly price competitive. Provider-sponsored insurers have a limited presence and an inconsistent competitive footing. Finally, co-ops are expanding and improving their competitive pricing position. (Blumberg, Holahan and Wengle, 6/25)

The Kaiser Family Foundation: Analysis Of 2016 Premium Changes And Insurer Participation In The Affordable Care Act’s Health Insurance Marketplaces
This brief presents an early analysis of changes in the premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 10 states plus the District of Columbia, where we were able to find complete data on rates for all insurers. ... In most of these 11 major cities, we find that the costs for the lowest and second-lowest cost silver plans – where the bulk of enrollees tend to migrate – are changing relatively modestly in 2016, although increases are generally bigger than in 2015. The cost of a benchmark silver plan in these cities is on average 4.4% higher in 2016 than in 2015. These premiums are still preliminary in some cases and could be raised or lowered through these states’ rate review processes .... We also find that the number of insurers participating has stayed the same or increased in 9 states. (Cox, Ma, Claxton and Levitt, 6/24)

The Kaiser Family Foundation: Year Two Of The ACA Coverage Expansions: On-The-Ground Experiences From Five States
This brief provides insight into ... questions [about the Affordable Care Act enrollment] through an on-the-ground view of ACA implementation in five states. ... Key findings from stakeholders ... show that, as of the second year, most major enrollment systems issues had been resolved. The states that expanded Medicaid continued to experience enrollment growth, and Marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a key enrollment challenge. ... Per enrollee costs of care for expansion enrollees have been lower than anticipated in the three states that expanded Medicaid. Expansion enrollees generally are able to access needed care, although there are access challenges for some services. (Artiga, Tolbert and Rudowitz, 6/22)

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

MedPage Today: Report: Most Hospitals Stand Aloof In Their Neighborhoods
Outside of direct patient care, hospitals spend relatively little to foster health in their communities, a new study found. A report published online Thursday by Health Affairs revealed that for the $62 billion that not-for-profit hospitals allocated in 2011 for "charity care and community benefit," only $4 billion -- less than 1% of hospital spending across the board -- went toward improving health in surrounding geographic areas. ... One effect of this trend is a big spike in the value of the tax exemptions that not-for-profit hospitals receive. From 2002 to 2011, that value rose from $12.6 billion to $24.6 billion, according to the study, which based its findings on Internal Revenue Service data. (Harris, 6/26)

Reuters: For Post-Op Complications, Go Back To The Same Hospital: Study
Patients who need to be rehospitalized within a month after major surgery have a lower risk of death over the next two months if they return to the hospital where they had the surgery rather than going to a different facility, according to a new study. “Most clinicians or surgeons feel like if you take the time to do a big operation on someone, you know the area operated on, how the operations went, if there were complications,” lead author Dr. Benjamin S. Brooke of the University of Utah School of Medicine in Salt Lake City told Reuters Health by phone. Doctors who did not perform the surgery won’t have that context, which may explain part of the survival benefit of returning to the original hospital, he said. (Doyle, 6/29)

The Associated Press: Report Urges Major Steps To Help Victims Of Cardiac Arrest
Every year, about 395,000 people suffer cardiac arrest in their homes or other non-hospital settings — and less than 6 percent of them survive, the Institute of Medicine estimated Tuesday. ... An additional 200,000 cardiac arrests occur in hospitals every year, and even there only a quarter of patients survive, the report found. ... the IOM committee said fear, not understanding what cardiac arrest is, lack of first-aid training and concern about legal liability can hamper response and cost precious time. ... Moreover, there are wide disparities in outcomes: One study found that survival ranged from about 8 percent to 40 percent across 10 different communities. On Tuesday, the IOM called for a major public education effort to teach people how to recognize and react to cardiac arrest. (Neergaard, 6/30)

Reuters: Nearly Four Of 10 U.S. Kids Exposed To Violence
Phone-based surveys show that nearly four of every 10 kids and teens in the U.S. were exposed to violence or abuse over the previous year, researchers have found. “Children are the most victimized segment of the population,” said study leader David Finkelhor of the Crimes Against Children Research Center at the University of New Hampshire in Durham. ... Compared to 2011, the violence rates appear to be stable, and certain kinds of violence exposure may be decreasing, he said. While the rates are not going up, “the problem is that there is still way too much,” he said. (Doyle, 6/29)

Reuters: Elder Abuse May Be More Common Than People Think
Elder abuse may be more common than is recognized, particularly among adults with dementia or other cognitive impairments, a research review suggests. In North and South America, elder abuse prevalence ranges from 10 percent of lucid older adults to almost half of those with dementia, the review of previous studies found. In Europe, prevalence ranges from about 2 percent in Ireland to about 61 percent in Croatia and in Asia, exposure to elder abuse ranges from 14 percent in India to 36 percent in China. (Rapaport, 6/25)

Reuters: Few People Heading Toward Diabetes Know It
Only about one in eight people with so-called pre-diabetes, often a precursor to full-blown disease, know they have a problem, a U.S. study found. Lacking awareness, people with the elevated blood sugar levels were also less likely to make lifestyle changes such as getting more exercise or eating less sugary food that might prevent them from ultimately becoming diabetic. (Rapaport, 6/29)