Research Roundup: Mental Health Challenges; Telehealth Parity; Long-Term Care Insurance
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The New England Journal of Medicine:
Mental Health And Substance-Use Reforms — Milestones Reached, Challenges Ahead
More than half of all Americans will have symptoms of a mental disorder at some point in their lives. Yet, persons with these conditions have historically faced limits on health insurance coverage that have restricted their access to treatment, along with shortages of mental health specialists (particularly those who accept insurance) and a treatment system plagued by fragmentation in care delivery. Such fragmentation stems from the historical separation of mental health providers from the rest of the health care system. ... In this report, we will cover issues that surround treatment for mental disorders, including the prevalence of mental disorders, spending trends, the shortage of practicing mental health specialists, efforts to break down the separation between mental health providers and the rest of the health care system. (Haiden A. Huskamp and John K. Iglehart, 8/18)
JAMA Internal Medicine:
Changes In Utilization And Health Among Low-Income Adults After Medicaid Expansion Or Expanded Private Insurance
[Researchers sought to] assess changes in access to care, utilization, and self-reported health among low-income adults [looking at] ... Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas. ... In the second year of expansion, Kentucky’s Medicaid program and Arkansas’s private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion. (Sommers et al., 8/8)
CDC/Morbidity and Mortality Weekly Report:
Evaluating The Impact Of National Public Health Department Accreditation ― United States, 2016
In 2011, the Public Health Accreditation Board launched the national, voluntary public health accreditation program as a strategy to advance the quality and performance of governmental public health departments. As of May 2016, 134 state and local health departments have been accredited. In addition, Florida, in which employees of all 67 local health departments are employees of the state, achieved accreditation for the entire integrated local public health department system in the state. ... A survey of health departments that had been accredited for one year indicates that >90% report experiencing benefits such as stimulation of quality improvement and performance improvement opportunities; increased accountability and transparency; and improved management processes. (Kronstadt et al., 8/12)
Health Affairs Policy Briefs:
Telehealth Parity Laws
Many believe that the answer to issues of cost and access in the US health system lies in telehealth, which increases access to care, alleviates travel costs and burdens, and allows more convenient treatment and chronic condition monitoring. ... The ACA ... implemented telehealth at the federal level through Medicare, in selected circumstances .... telehealth implementation varies from state to state in terms of what services providers will be reimbursed for delivering .... telehealth faces significant obstacles in becoming an accepted and used health care option for individuals, and states and the nation as a whole cannot fully realize the cost savings of telehealth. ... Congress is now considering a nationwide telehealth parity act. The Medicare Telehealth Parity Act is intended to modernize the way Medicare reimburses telehealth services and to expand coverage for Medicare beneficiaries. (Yang, 8/15)
The Cost To States Of Not Expanding Medicaid
We analyze the 19 states that have not expanded Medicaid. From 2017 to 2026, expansion in these states would increase nominal state costs by less than $60 billion while increasing federal funding by more than $400 billion. Each new state dollar would draw down between $7 and $8 in additional federal dollars. We were not able to estimate offsetting state revenue gains and full state cost savings. Every broad fiscal review conducted in expansion states finds that such offsets are exceeding state cost increases, so expansion is helping overall state budgets. (Dorn and Buettgens, 8/9)
The Kaiser Family Foundation/Peterson Center on Healthcare:
What Do We Know About Cardiovascular Disease Spending And Outcomes In The United States?
The U.S. and other countries have made dramatic progress in lowering mortality from cardiovascular diseases, which include heart disease and stroke. In the U.S., the mortality rate has fallen from 590 deaths per 100,000 people in 1983 to 253 in 2013. Recently, this has been due in large part to improvements in emergency response for heart attack patients, in addition to medical advances, reduced smoking rates, and improvements in controlling cholesterol and blood pressure. This chart collection explores prevalence, spending, and health outcomes for cardiovascular disease and related conditions. (8/3)
Who Is Covered by Private Long-Term Care Insurance?
Many Americans will develop health problems as they age and need assistance with everyday activities. Private long-term care insurance could protect them from high out-of-pocket costs if they need paid assistance at home or in nursing or assisted-living facilities. Yet, only 11 percent of adults ages 65 and older had coverage in 2014, including only 25 percent of those worth at least $1 million and who would benefit most from coverage. Various policy reforms could promote long-term care insurance, such as ones that create new incentives for employers to offer coverage through workplace retirement plans on an opt-out basis. (Johnson, 8/2)
The Kaiser Family Foundation:
Emergency contraception (EC), sometimes referred to as “the morning-after pill,” is a form of backup birth control that can be taken up to several days after unprotected intercourse or contraceptive failure and still prevent a pregnancy. In 1999, Plan B® was the first oral product approved for use in the U.S. as an EC by the Food and Drug Administration (FDA). Since then, more EC products have been approved, and there has been debate over access to EC, particularly over-the-counter availability for teenagers. Many have confused EC with the “abortion pill,” but EC does not cause abortion, since it works by delaying or inhibiting ovulation and will not work if the woman is already pregnant. This fact sheet reviews the methods of EC, known mechanisms of action, women’s awareness of EC, and current national and state policies affecting EC access. (7/25)