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Summer 2004 Commonwealth Fund Quarterly: A Digest of Current Work in Health Policy and Practice




Keep in mind:

Prices for a group of key prescription medicines are 34 to 59 percent lower in Canada, France, and the United Kingdom than in the U.S. If Medicare could match these prices through negotiation, drug formularies, or some other mechanism, the "doughnut hole" in drug coverage could be eliminated.
—From "Doughnut Holes and Price Controls," Health Affairs Web Exclusive, July 21, 2004



Eliminating the "Doughnut Hole"
Could senior citizens and the disabled have full prescription drug coverage as well as fewer out-of-pocket costs, without causing any increase in total Medicare spending? According to researchers they could—if prescription drug prices in the United States were typical of the prices found in other industrialized countries. In a Fund-supported study led by Johns Hopkins University's Gerard F. Anderson (see "Doughnut Holes and Price Controls," Health Affairs Web Exclusive, July 21, 2004), prices for a group of key prescription medicines were shown to be 34 to 59 percent lower in Canada, France, and the United Kingdom than in the U.S. Read More>>

Grantee Spotlight: Paul Dworkin, M.D.
Run by the Connecticut Children's Trust Fund in collaboration with community-based agencies, Help Me Grow connects at-risk children under age 5 with needed services through a toll-free telephone hotline. A Fund-supported project led by Paul Dworkin, M.D., physician-in-chief for Connecticut Children's Medical Center, is now seeking to strengthen Help Me Grow by training physicians to improve recognition and referral of at-risk children. Read More>>

Code Red: Patient Debt Hospital Collection Practices Point to Ailing Health System
Recent reports of hospitals billing uninsured patients at higher rates than insured patients and using aggressive collection practices are symptoms of two underlying trends in the U.S. health care system: growing instability in insurance coverage and rapid growth in the costs of care, according to testimony given before two congressional subcommittees in June. Pricing practices at selected hospitals "are placing vulnerable patients at financial risk," Fund President Karen Davis said in invited testimony June 22 before the House Ways and Means Committee's Subcommittee on Oversight. Read More>>

High-Performing Hospitals Share Their Secrets
Talk of quality improvement has become increasingly prevalent in the hospital industry. In fact, most hospitals are involved in some kind of quality improvement project—be it benchmarking, collecting data, or forming monitoring committees. So what differentiates these hospitals from the top-tier, high-performing hospitals that consistently provide high quality at low cost? According to Jack A. Meyer, Ph.D., founder and president of the Washington, D.C.-based Economic and Social Research Institute (ESRI), the high-performers make quality a continuous, living process of drilling down into data, feeding information back, tracking progress, and making needed changes. Read More>>

With Help, NYC Clinics Improve Primary Care
Community health centers deliver primary health care to much of New York City's low-income population. But the design and delivery of services at these clinics can be flawed. There often are delays in access to care, making it difficult to get an appointment. In the past several years, however, dozens of New York clinics have cut their waiting times, become more patient-friendly, and improved their finances. What's their secret? Collaborative learning and an ongoing commitment to sustaining change, according to a new Commonwealth Fund report, Achieving a New Standard in Primary Care for Low-Income Populations. Read More>>

Lost in Translation? Not These Innovations
In today's cost-conscious health care environment, translating evidence-based quality innovations into clinical practice is a tall challenge. Limited resources mean providers and health systems must follow proven methods for diffusing and adopting effective interventions. A new Commonwealth Fund issue brief, Translating Research into Practice: Speeding the Adoption of Innovative Health Care Programs, offers lessons for successfully implementing and spreading quality improvement initiatives. Read More>>

NYC's Poor at Greater Risk for Chronic Diseases
Black and Hispanic New Yorkers, as well as poor city residents regardless of race or ethnicity, are more likely than whites to have diabetes, HIV, and other diseases—and more likely to die prematurely, according to a report released by the New York City Department of Health and Mental Hygiene. Read More>>

States Tackling Disparities from Multiple Angles
In 1998, racial and ethnic disparities in health care emerged as a major issue when President Bill Clinton and Surgeon General David Satcher, M.D., announced a goal of eliminating disparities by 2010 in six health categories. No real progress has been made, however, since the announcement of that lofty goal. But while momentum has stalled at the national level, a range of activities now under way at the state and local levels provide reason for hope. A new Fund report illustrates how states can play important roles in eliminating disparities and informing federal policy. Read More>>

Well-Child Care Needs Overhaul, Fund Expert Says
Pediatric preventive care in the U.S. needs "major" revisions if chronic health problems and unmet behavioral and developmental needs are to be addressed, according to a leading child health expert writing in the journal Pediatrics (special article, July 2004). Read More>>

Maine Further Along in Plan to Cover Uninsured
The state of Maine faces considerable health care challenges. Approximately 14 percent of its residents lack even basic health coverage. It has the highest incidence of chronic disease and illness in New England, as well as the region's highest hospital utilization rates. Maine's small businesses, meanwhile, saw their health insurance premiums rise 58 percent between 1996 and 2001. According to state officials, however, hope is now well on the way. Read More>>

Yun Joins Fund's Board
William Y. Yun, president of the Fiduciary Trust, a unit of Franklin Templeton Investments, was elected to The Commonwealth Fund's board of directors in July. Read More>>

Recent and Forthcoming Commonwealth Fund Publications, Summer 2004

Fund Reports
B. Biles, L. H. Nicholas, and B. S. Cooper, The Cost of Privatization: Extra Payments to Medicare Advantage Plans, May 2004

D. Blumenthal, C. Vogeli, L. Alexander et al., A Five-Nation Hospital Survey: Commonalities, Differences, and Discontinuities, May 2004

E. H. Bradley, T. R. Webster, D. Baker et al., Translating Research into Practice: Speeding the Adoption of Innovative Health Care Programs, July 2004

S. R. Collins, Health Care Costs and Instability of Insurance: Impact on Patients' Experiences with Care and Medical Bills, Congressional testimony, June 24, 2004

The Commonwealth Fund, First Report and Recommendations of The Commonwealth Fund's International Working Group on Quality Indicators, June 2004

L. A. Cooper and N. R. Powe, Disparities in Patient Experiences, Health Care Processes, and Outcomes: The Role of Patient–Provider Racial, Ethnic, and Language Concordance, July 2004

K. Davis, Will Consumer-Directed Health Care Improve System Performance? August 2004

K. Davis, Hospital Pricing Behavior and Patient Financial Risk, Congressional testimony, June 2, 2004

J. N. Edwards, S. How, H. Whitmore et al., Employer-Sponsored Health Insurance in New York—Findings from the 2003 Commonwealth Fund/HRET Survey, May 2004

J. R. Gabel and J. D. Pickreign, Risky Business: When Mom and Pop Buy Health Insurance for Their Employees, April 2004

P. Gordon and M. Chin, Achieving a New Standard in Primary Care for Low-Income Populations: Case Studies of Redesign and Change Through a Learning Collaborative, August 2004

R. Hasnain-Wynia, D. Pierce, and M. A. Pittman, Who, When, and How: The Current State of Race, Ethnicity, and Primary Language Data Collection in Hospitals, May 2004

E. LeCouteur, New York's Disaster Relief Medicaid: What Happened When It Ended?, July 2004

J. E. McDonough, B. K. Gibbs, J. L. Scott-Harris et al., A State Policy Agenda to Eliminate Racial and Ethnic Health Disparities, June 2004

J. A. Meyer, S. Silow-Carroll, T. Kutyla, L. S. Stepnick, and L. S. Rybowski, Hospital Quality: Ingredients for Success, July 2004

M. Moon, How Beneficiaries Fare Under the New Medicare Drug Bill, June 2004

C. Pryor and R. Seifert, Unintended Consequences: An Update on Consumer Medical Debt, June 2004

L. Shelton, L. Aiuppa, and P. Torda, Recommendations for Improving the Quality of Physician Directory Information on the Internet, August 2004

S.-C. Sim and C. Peng, Lessons Learned from a Program to Sustain Health Coverage After September 11 in New York City's Chinatown, July 2004

L. Summer and L. Thompson, How Asset Tests Block Low-Income Medicare Beneficiaries from Needed Benefits, May 2004

T. Trail, K. Fox, J. Cantor et al., State Pharmacy Assistance Programs: A Chartbook, August 2004

Journal Articles and Other Publications
G. F. Anderson, D. G. Shea, P. S. Hussey et al., "Doughnut Holes and Price Controls," Health Affairs Web Exclusive (July 21, 2004): W4-396–W4-404

G. Flores, M. Abreu, D. Sun et al., "Urban Parents' Knowledge and Practices Regarding Managed Care," Medical Care 42 (April 2004): 336–45

C. Homer, D. Iles, D. Dougherty et al., "Exploring the Business Case for Improving the Quality of Health Care for Children," Health Affairs 23 (July/August 2004):159–66

I. B. Horn and A. C. Beal, "Child Health Disparities: Framing a Research Agenda," Ambulatory Pediatrics 4 (July/August 2004): 269–75

NYC Department of Health and Mental Hygiene, Health Disparities in New York City, July 2004

E. G. Poon, D. Blumenthal, T. Jaggi et al., "Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals," Health Affairs 23 (July/August 2004):184–90

J. Rosenthal and C. Pernice, Dirigo Health Reform Act: Addressing Health Care Costs, Quality, and Access in Maine, June 2004

B. M. Rothenberg, T. Pearson, J. Zwanziger et al., "Explaining Disparities in Access to High Quality Cardiac Surgeons," Annals of Thoracic Surgery 78 (July 2004): 18–24

C. Schoen and M. M. Doty, "Inequities in Access to Medical Care in Five Countries," Health Policy 67 (March 2004): 309–22

E. Schor, "Rethinking Well Child Care," Pediatrics 114 (July 2004): 210–16


Publication Details



Summer 2004 Commonwealth Fund Quarterly: A Digest of Current Work in Health Policy and Practice, September 2004