The White House's "Health Care Summit" on February 25 identified many areas of common cause between President Obama and members of Congress. They agreed broadly on the goals for reform and on many specifics, but a fundamental divide remains over how to make coverage affordable for every American and find a way to pay for it.
In a new blog post, Commonwealth Fund president Karen Davis says that the President's proposed approach, as well as the comprehensive reform proposals passed by the House of Representatives and Senate, would provide affordable coverage for those who are uninsured and ensure that premiums and medical bills do not exceed an affordable share of income for those with coverage. By contrast, Republican leaders offer several small steps that would assist certain groups—including tax credits for small businesses, tax incentives for health savings accounts, and state high-risk pools—but fail to make a substantial change in the numbers of uninsured and those experiencing difficulties paying premiums and medical bills.
A study in the Archives of Internal Medicine found that Medicare beneficiaries admitted to U.S. hospitals with heart failure or pneumonia showed no definitive connection between the cost and quality of care, or between cost and death rates. Some experts are concerned about the tradeoffs between hospitals' efforts to lower costs and at the same time improve quality. This study shows little evidence to support the "penny-wise and pound-foolish" hypothesis: that low-cost hospitals discharge patients earlier but have higher readmission rates and greater inpatient costs downstream.
This case study spotlights the Massachusetts Child Psychiatry Access Project, in which primary care providers are given assistance in caring for children with mental health problems. On the basis of an initial phone consultation, the program may provide an in-person psychiatric or clinical assessment, transitional therapy, and/or facilitated linkage to community resources. Most of the state's primary care practices are enrolled, and providers report greater confidence in their ability to serve children with mental health problems as a result of their participation.
This study in Pediatrics reports on the results of an experimental program in Milwaukee that uses trained parent mentors to help other parents care for their young child's asthma. This led to a reduction in wheezing, asthma exacerbations, emergency room visits, and missed work days, while improving parents' competence in recognizing breathing problems that are controllable at home, all at a reasonable cost.
Medicare savings programs are designed to provide financial assistance to beneficiaries whose income and assets are too high to allow them to qualify for full Medicaid coverage. In examining policy changes that would expand eligibility for the programs, the authors of this study published in Inquiry find a trade-off between making more beneficiaries eligible and targeting a smaller group of individuals with greater health care needs.
As the rapid rise of health insurance premiums becomes a focus of the health care reform debate, we have put together a resource page of Commonwealth Fund research to provide background on this topic. Resources include: a report showing that nationally family premiums for employer-sponsored health insurance increased 119 percent between 1999 and 2008, and could increase another 94 percent by 2020, to an average $23,842 per family; a blog post by Commonwealth Fund President Karen Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums; and a study analyzing high out-of-pocket expenses and premiums for working-age adults with chronic conditions.
Join the Health Research and Educational Trust (HRET) for a webinar on March 29, 2010, from 1:00 p.m. to 2:30 p.m. EDT, to discuss best practices of high-performing health systems, based on the findings of Commonwealth Fund–supported research. Three health systems will present their experiences in improving care, including system-wide strategic planning, aligning system goals, standardizing and spreading best practices, and leveraging data and measurement for performance improvement. To register for the free webinar, click here. For more information, contact Julie Yonek at firstname.lastname@example.org.
On March 18, the New York Academy of Medicine's Section on Health Care Delivery will present "Health Care Reform and Access to Care," the second lecture in its series on health care reform and New York State. Representatives from different delivery systems will share their perspective on the ways in which organizations and their patients might be affected by federal health care reform. For more information or to register, visit the NYAM Web site. The next two lectures will take place on April 15 ("Models of Accountable Care Organizations in New York—Issues of Quality and Cost") and May 12 ("Health Care Reform and Access to Coverage").
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The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.