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Newsletter Article


Recent Commonwealth Fund reports and Fund-supported studies in the professional literature

Health Spending in the United States and the Rest of the Industrialized World. Gerard F. Anderson, Ph.D., Peter S. Hussey, Ph.D., Bianca K. Frogner et al. Health Affairs, July/August 2005. The U.S. spends more on health care per capita than any other country. The main reason: higher prices for services like prescription drugs, hospital stays, and doctor's visits.

Riding the Rollercoaster: The Ups and Downs in Out-of-Pocket Spending Under the Standard Medicare Drug Benefit. Bruce Stuart, Ph.D., Becky A. Briesacher, Ph.D., Dennis G. Shea, Ph.D., et al. Health Affairs, July/August 2005. Under Medicare Part D, beneficiaries will incur high average out-of-pocket costs for prescription drugs, and many will face dramatic changes in spending from quarter to quarter.

Will You Still Need Me? The Health and Financial Security of Older Americans. Sara R. Collins, Ph.D., Karen Davis, Ph.D., Cathy Schoen, M.S., Michelle M. Doty, Ph.D., Sabrina K. H. How, and Alyssa L. Holmgren. June 2005. Rising out-of-pocket health costs, sluggish wage growth, and erosion of retiree health benefits threaten older adults' ability to save for retirement.

Medicare Health Accounts: A New Policy Option to Help Adults Save for Health Care Expenses Not Covered by Medicare. Sara R. Collins, Ph.D., Karen Davis, Ph.D., Sabrina K. H. How, and Alyssa L. Holmgren. June 2005. A new Fund survey shows that older adults support savings accounts to cover health care not covered by Medicare, and other innovative strategies, to offset rising costs.

Paying More for Less: Older Adults in the Individual Insurance Market. Sara R. Collins, Ph.D., Cathy Schoen, M.S., Michelle M. Doty, Ph.D., Alyssa L. Holmgren, and Sabrina K. How. June 2005. Adults ages 50 to 64 who rely on the individual health insurance market pay much higher premiums than those with employer coverage—and have poorer access to care.

Caring for Patients with Diabetes in Safety Net Hospitals and Health Systems. Marsha Regenstein, Ph.D, Jennifer Huang, M.S., Linda Cummings, Ph.D. et al. June 2005. Safety net hospitals provide high-quality care to patients with diabetes, with outcomes on par or better than national averages. But disparities in outcomes remain, however, for minority and uninsured patients.

Insured But Not Protected: How Many Adults Are Underinsured? Cathy Schoen, M.S., Michelle M. Doty, Ph.D., and Sara R. Collins, Ph.D., and Alyssa L. Holmgren. June 2005. In addition to the 45 million uninsured U.S. adults, another 16 million were underinsured in 2003, a Fund survey finds. Inadequate coverage—much like no coverage at all—creates obstacles to care and other burdens.

A Shared Responsiblity: U.S. Employers and the Provision of Health Insurance to Employees. Sara R. Collins, Ph.D., Karen Davis, Ph.D., and Alice Ho. Inquiry, Spring 2005. Much of the health care costs of the nearly 36 million workers without job-based coverage are being picked up by other employers, by public programs, and by employees themselves.

Variations in the Impact of Health Coverage Expansion Proposals Across States, Sherry Glied, Ph.D., and Douglas Gould, Health Affairs Web Exclusive, June 7, 2005. While some states could reduce their uninsured rate by as much as 20 percent under federal policy proposals such as tax credits or public program expansions, other states might not see much change at all.

Measure, Learn, and Improve: Physicians' Involvement in Quality Improvement. Anne-Marie J. Audet, M.D., Michelle M. Doty, M.P.H., Ph.D., Jamil Shamasdin, and Stephen C. Schoenbaum, M.D., M.P.H., Health Affairs, May/June 2005. A majority of physicians are not actively engaged in quality improvement practices and are reluctant to share information about the quality of care they provide with patients or the public.

Five Years After To Err Is Human: What Have We Learned? Lucian L. Leape, M.D., Donald M. Berwick, M.D. Journal of the American Medical Association, May 18, 2005. Five years ago, the Institute of Medicine report To Err Is Human shook the health care world. While there have been incremental changes since then, achieving the key safety improvements the IOM outlined will require a national commitment to strict and well-tracked goals.

Examining Pay-for-Performance Measures and Other Trends in Employer-Sponsored Health Care. Meredith B. Rosenthal, Ph.D. May 2005. Pay-for-performance has significant potential to benefit the health care sector, Harvard professor Meredith B. Rosenthal told a congressional hearing, but payers face a number of challenges in implementing these programs.

Physicians' Views on Quality of Care: Findings from The Commonwealth Fund National Survey of Physicians and Quality of Care. Anne-Marie J. Audet, M.D., Michelle M. Doty, Ph.D., Jamil Shamasdin, and Stephen C. Schoenbaum, M.D., M.P.H. May 2005. Physicians' use of quality improvement tools, their plans to initiate quality improvement activities, and their views of potential solutions, are explored in this survey report.

The Effect of Health Savings Accounts on Health Insurance Coverage. Sherry A. Glied, Ph.D, and Dahlia K. Remler, Ph.D., M.A., D.Phil. April 2005. Fewer than 1 million of the nation's 45 million uninsured are likely to get new health coverage from health savings accounts coupled with high-deductible health plans.

How High Is Too High? Implications of High-Deductible Health Plans. Karen Davis, Ph.D., Michelle M. Doty, Ph.D., and Alice Ho. April 2005. Fund researchers say tax incentives for the purchase of high-deductible health plans will have little effect on health coverage rates, because premiums are too high for the many uninsured Americans living near the poverty level.

Early Implementation of the Health Coverage Tax Credit in Maryland, Michigan, and North Carolina: A Case Study Summary. Stan Dorn, J.D., Tanya Alteras, M.P.P., and Jack A. Meyer, Ph.D. April 2005. Despite a promising start, a federal tax credit program designed to help displaced workers buy health insurance is still experiencing disappointingly low enrollment rates more than a year after its implementation.

Quality of Health Care for Medicare Beneficiaries: A Chartbook. Sheila Leatherman and Douglas McCarthy. May 2005. Medicare has been successful in ensuring access to needed care and improving provision of preventive services to millions of beneficiaries. But like the rest of the U.S. health care system, Medicare needs to address gaps in quality and access.

States in Action: A Quarterly Look at Innovations in Health Policy. Sharon Silow-Carroll, M.B.A., M.S.W., and Tanya Alteras, M.P.P. May 2005. Despite rising insurance premiums, weak labor markets, and budget shortfalls, many states have come up with innovative strategies for stretching health care dollars and improving the quality of care. This new Fund newsletter keeps track of these efforts.

Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey. Dana Gelb Safran, Sc.D., Tricia Neuman, Sc.D., Cathy Schoen, M.S., Michelle S. Kitchman, M.H.S. et al., Health Affairs Web Exclusive, April 2005. Four of 10 seniors tell researchers they haven't taken all the drugs their doctors prescribed in the past year—either because cost was too high, they didn't think the drugs were helping, or they didn't think they needed them.

Impact of the Medicare Prescription Drug Benefit on Home- and Community-Based Services Waiver Programs. Charles J. Milligan, Jr., J.D., M.P.H. April 2005. The impending transfer of prescription drug coverage from Medicaid to Medicare might place many "dual eligibles" in jeopardy.

Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities: A Study of the Publication of the New York State Cardiac Surgery Reports. Dana B. Mukamel, Ph.D., David L. Weimer, Ph.D., Jack Zwanziger, Ph.D., et al. Inquiry, Winter 2004/2005. In addition to helping consumers make informed health care choices, quality report cards can work to level the playing field for minorities by improving their ability to see high-quality health providers.

Providing Language Services in Small Health Care Provider Settings: Examples from the Field. Mara Youdelman, J.D., and Jane Perkins, J.D. April 2005. This report shows how a number of solo practitioners, small group practices, and clinics around the country have found creative methods for meeting the needs of patients with limited English proficiency.

Creating a State Minority Health Policy Report Card. Amal N. Trivedi, M.D., M.P.H., Brian Gibbs, Ph.D., Laurie Nsiah-Jefferson, M.P.H., et al. Health Affairs, March/April 2005. In the first "report card" to evaluate all 50 states on their progress in addressing disparities in minority health care, researchers found region of the country to be a significant predictor of performance.

Cultural Competence and Health Care Disparities: Key Perspectives and Trends. Joseph R. Betancourt, M.D., M.P.H., Alexander R. Green, M.D., and J. Emilio Carrillo, M.D., Elyse R. Park, Ph.D. Health Affairs, March/April 2005. Culturally competent health care is gaining attention not only as a strategy to reduce racial and ethnic disparities but as a cost-effective means of improving health care quality.

Discount Medical Cards: Innovation or Illusion? Mila Kofman, J.D., Jennifer Libster, M.A., and Eliza Bangit, M.A. March 2005. As double-digit premium increases of the last four years have made health insurance unaffordable for many consumers, some businesses and individuals are using discount cards as a substitute for health insurance coverage.

Women at Risk: The Health of Women in New York City. New York City Department of Health and Mental Hygiene. March 2005. The health of women in New York City has improved greatly over the past decade, but many women still suffer from preventable conditions. In addition to differences in health between women and men, health disparities also exist among subgroups of women.

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