Twice each month, theWeekly highlights recent research on health care finance, access to care and other topics. This edition of the Health Policy Update includes research on:
- Geographic variation in Medicare spending;
- The effect of a cardiovascular disease educational program on medical visits and costs;
- Enrollment patterns in the Medicare prescription drug benefit program; and
- Physician assessment of appropriate health care level among nonurgent patients.
Medicare
Medicare beneficiaries' health status and personal characteristics, as well as certain geographic factors, contribute to regional differences in Medicare spending, researchers report in the New England Journal of Medicine.
The study found that unadjusted Medicare spending per beneficiary was 52% higher in the geographic regions that made up the highest Medicare spending group, compared with regions in the lowest spending group. Researchers also found that differences in patients' health status and demographic characteristics accounted for a major portion of the geographic differences in Medicare spending.
Researchers suggest that policymakers need access to better information about the specific sources of geographic differences in Medicare spending. They add that policymakers should account for underlying differences in beneficiaries' health characteristics when developing methods to regulate spending levels (Zuckerman et al., New England Journal of Medicine, 5/12).
Chronic Disease Care
A one-year screening and educational intervention for cardiovascular disease patients and their families resulted in significantly fewer visits to health care providers, as well as an insignificant decline in emergency department visits, according to a study published in the American Journal of Managed Care.
Researchers found that patients who enrolled in the intervention program had an average of 2.81 visits to health care providers, compared with an average of 3.92 visits among patients in the control group. Patients who enrolled in the intervention program had an average of 0.16 ED visits, compared with an average of 0.18 ED visits among patients in the control group. The study also found that patients in the intervention program had lower health care costs than patients in the control group.
Researchers suggest that an educational program on cardiovascular disease could offer a low-cost strategy to improve patient health. They add that more research would be necessary to determine the long-term effects and costs of such programs (Nawathe et al., American Journal of Managed Care, May 2010).
Medicare Drug Benefit
Millions of low-income Medicare beneficiaries did not enroll in a subsidy program designed to help such residents afford coverage under the Medicare prescription drug benefit, according to a study published in the journal Health Affairs.
Researchers found that 63% of all eligible U.S. seniors and 69% of low-income Medicare beneficiaries were enrolled in Medicare Part D in 2006. However, the study found that only 29% of low-income beneficiaries were enrolled in the Part D subsidy program that year.
Eligible beneficiaries reported that they did not enroll in Part D because:
- Premiums were too costly;
- Enrollment was burdensome;
- Information about enrollment was difficult to obtain; or
- They did not use enough prescription drugs to benefit from the program.
Researchers note that the federal health reform law could further reduce enrollment in Part D because the program is likely to raise premiums to offset the cost of expanded drug benefits. The authors recommend expanding program eligibility and adjusting policies to promote greater Part D enrollment (Davidoff et al., Health Affairs, June 2010).
Doctors and Nurses
Physicians in primary care settings are more likely than emergency department physicians to report that nonurgent patients are seeking an appropriate level of care, according to a study published in the American Journal of Managed Care.
Researchers found that nonurgent patients who seek ED care for conditions considered inappropriate for the setting typically have limited previous experience with regular health care use.
The study also found that ED physicians tend to be younger and less experienced than their primary care counterparts. More experienced ED physicians were less likely to report that nonurgent patients were seeking an inappropriate level of care.
The authors suggest that further research could help determine the best strategies for disseminating information about appropriate settings for care (Backman et al., American Journal of Managed Care, May 2010).