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Health Problems Cost Billions in Lost Productivity
Health problems among working-age Americans and their families carry an estimated price tag of $260 billion in lost productivity each year, Fund researchers say. As reported in Health and Productivity Among U.S. Workers, 18 million adults ages 19 to 64 were not working and had a disability or chronic disease, or were not working because of health reasons. Providing workers with the means to maintain their health—such as affordable and comprehensive health insurance coverage and paid sick leave—could yield economic pay-offs for the entire economy.

Oregon Medicaid Policies Cut Deeply
Like many other cash-strapped states, Oregon has enacted major changes to its Medicaid program in a bid to save money. In 2003, the state raised premiums, required copays for the first time, and imposed a six-month lockout for individuals missing premium payments—and then rolled back some of these policies the following year. But Oregon's changes came at a steep price to many low-income residents, according to the Commonwealth Fund report, Impact of Changes to Premiums, Cost-Sharing, and Benefits on Adult Medicaid Beneficiaries: Results from an Ongoing Study of the Oregon Health Plan. Lead author Bill J. Wright, Ph.D., and colleagues say nearly two-thirds of surveyed individuals lost their coverage after the initial premium and cost-sharing increases, many directly resulting from increased costs. Those who left because of higher premiums and cost-sharing reported worse access to care, reduced primary care utilization, and greater financial hardships than those who remained enrolled or left the Oregon Health Plan for other reasons.

Antipsychotics Overprescribed in Nursing Homes
After a period of marked decreases, antipsychotic drug prescribing in nursing homes may be on the rise. Fund-supported research published in the Archives of Internal Medicine indicates 28 percent of Medicare beneficiaries in nursing homes received antipsychotic drugs in 2000—the highest reported rate in nearly a decade. In The Quality of Antipsychotic Drug Prescribing in Nursing Homes, a research team led by Becky Briesacher, Ph.D., reports that more than half of nursing home residents receiving antipsychotics were given doses that exceeded recommended maximum levels, received duplicative therapy, or had conditions, like memory problems or depression, for which such drugs are considered inappropriate.

Caring for Caregivers
In 2003, nearly one of 10 working-age adults was caring for a sick or disabled family member. Yet more than half of the nation's 16 million informal caregivers have health problems of their own, and many cope with severe financial stress. In A Look at Working-Age Caregivers' Roles, Health Concerns, and Need for Support, Fund researchers say caregivers ages 19 to 64 are more likely to not be working, to miss days of work if they are employed, and to lack health insurance coverage than non-caregivers. As a result, many are financially vulnerable and struggle to obtain needed care.

How States Can Upgrade Kids' Care
As administrators of public insurance and health care programs, states are in a unique position to improve health care for young children. But a Fund-supported study finds that state quality improvement initiatives are hampered by lack of program coordination, inadequate data and information technology, and a focus on short-term projects. According to Vernon K. Smith, Ph.D., author of The Role of States in Improving Health and Health Care for Young Children, "State officials are more likely to realize improvements in child health care when they work across departmental lines collaboratively, with a focus on the health of the child rather than any individual program."

Two Takes on Tackling Disparities
Two Fund reports offer strategies to eliminate racial and ethnic disparities in health care. Taking lessons from the civil rights movement, David Barton Smith, Ph.D., argues that progress can best be achieved by making the reduction of segregation in health care a measurable goal, reinvigorating regional planning, taking a more critical view of "consumer-driven" choice, and transforming health reform into a civil rights issue. Meanwhile, Sidney D. Watson, J.D, calls for a "systems reform" approach that includes the collection and reporting of performance data by patient race and ethnicity, which neither government agencies nor private accreditation bodies currently require.

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