This year was an eventful one for the U.S. health care system, marked by the opening of the Affordable Care Act’s federal and state health insurance marketplaces offering comprehensive health plans, as well as access to Medicaid, to millions of Americans. While the rollout of this enormous effort has been rocky, growth in enrollment over the past month suggests we are on the path to near-universal coverage. This year also saw the development of some consensus on ways to control health care spending though actions such as paying health care providers based on the value of the services they provide; developing new options for Medicare beneficiaries; and establishing spending targets.
We at The Commonwealth Fund offered our own analysis of how to stabilize health spending growth; reported on state health system performance for low-income Americans; conducted international comparisons; tracked insurance trends; and explained potential health system reforms. To that end, here are our five most-popular publications of 2013.
1. Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System, The Commonwealth Fund Commission on a High Performance Health System, January 2013.
This report outlined a set of policy recommendations designed to accelerate innovation in health care delivery that could also slow health spending growth by $2 trillion over 10 years. The recommendations included changing the way public and private purchasers pay for care, encouraging consumers to choose high-value care, and addressing the market forces driving up costs.
2. Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013, C. Schoen, D. C. Radley, P. Riley, J. A. Lippa, J. Berenson, C. Dermody, A. Shih, September 2013.
Health Care in the Two Americas provided the first state-by-state comparison of health care experiences for the 39 percent of Americans earning less than twice the federal poverty level ($47,000 a year for a family of four or $23,000 for an individual). The report offered a "scorecard" of states' performance on health care for low-income populations, and found that access to affordable, quality care varies greatly among the states. It also revealed striking income-related differences within states.
3. Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to 10 Other Countries, C. Schoen, R. Osborn, D. Squires, and M. M. Doty, November 2013.
This international survey found that adults in the United States are far more likely than those in 10 other high-income industrialized nations to go without health care because of cost, encounter difficulties paying medical bills, and deal with time-consuming health insurance paperwork or disputes, including claims that were unexpectedly not paid.
4.Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act, S. R. Collins, R. Robertson, T. Garber, and M. M. Doty, April 2013.
Eighty-four million people—nearly half of all working-age U.S. adults—went without health insurance for a time last year or were underinsured because of high out-of-pocket costs relative to income, according to this study based on findings from our 2012 Biennial Health Insurance Survey. This report also found that the proportion of young adults who were uninsured during the year fell from 48 percent to 41 percent between 2010 and 2012, reversing a decade-long trend for the 19-to-25 age group.
5. Primary Care: Our First Line of Defense, June 2013.
This was the first entry in our series of short, jargon-free publications, Health Reform and You. This brief explained why primary care is so fundamental to patients and to a "healthy" health system. It looked at the medical home model of primary care, payment reforms designed to ensure people get the care they need to stay healthy and productive, and ways in which the Affordable Care Act is helping to strengthen primary care.