Findings Brief

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findings1003no5.pdf

The already large numbers of Americans without health insurance continue to grow as more and more employers respond to high health care costs and a weak economy by cutting back on the coverage they offer their employees. Reformers have focused efforts to reduce their numbers on working people since most of the uninsured are employed.

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HCFO Brief May 2011 FINAL.pdf

Medicare payment policy remains an important issue as the Patient Protection and Affordable Care Act (ACA) calls for reduced Medicare payments to health care providers, including hospitals. In the past, certain stakeholders have argued that lower payments to hospitals by Medicare and Medicaid can lead to cost-shifting, charging private payers more to compensate for shortfalls in payments from public programs. Austin Frakt, Ph.D., of Boston University undertook the first systematic review of the literature on cost-shifting since the 1990s.

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findings1199.pdf

Researchers at the Urban Institute in Washington, D.C., recently completed a study examining how the availability and cost of health insurance affect older workers’ decisions to retire. The first phase of the project, led by Sheila Zedlewski, Ph.D., and Pamela Loprest, Ph.D., described the work and health insurance transitions of older persons, while the second phase of the project, led by Richard Johnson, Ph.D., and Amy Davidoff, estimated how changes in premium costs due to COBRA availability or Medicare reforms affect older workers’ decisions to retire before age 65.

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findings0102.pdf

Many uninsured individuals in the United States today do not enjoy the benefits of employer-sponsored insurance because their employers do not offer it. Others are offered a plan, but cannot afford to pay their share of the premiums. Given evidence that people without insurance get less needed care, the uninsured will continue to suffer both economically and physically. Unfortunately, low-income racial and ethnic minorities are particularly disadvantaged because they are disproportionately represented among the uninsured.

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findings0303.pdf

Medical directors consult a number of sources to define coverage limits for new and standard medical interventions, including technology assessment reports, the results ofrandomized trials, and professional guidelines,according to the findings of a research project funded by The Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) initiative. The vast majority of medical directors reported that cost considerations also entered into their decision-making process.

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findings0204.pdf

Some researchers and policy analysts have speculated that employers tend to self-insure their firms in an effort to circumvent compliance with evolving state mandates on coverage, which may require them to provide generous benefit packages. However, new research by Gail Jensen, Ph.D., at Wayne State University suggests otherwise.

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findings498.pdf

Proponents of hospital mergers in local markets claim that mergers will have many desirable results—among them, reducing excess capacity and improving efficiency, thereby lowering costs. But a recent study of the early effects of hospital mergers in St. Louis and Philadelphia by researchers at the Economic and Social Research Institute (ESRI) in Washington, D.C., suggests that policymakers should not rely on mergers to reduce excess capacity and produce efficiency in the short term.

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findings0405.pdf

Hospital networks raise potential antitrust issues because they sometimes bring together providers that are otherwise competitors in a given market. Specifically, the concern is that the participating hospitals will use the network to coordinate prices and market strategies in ways that are anti-competitive, which drives up costs and ultimately hurts the consumer/patient by reducing access to care.

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findings0101.pdf

The New York Health Care Reform Act (HCRA) of 1996 sent a shock wave through New York’s hospital and provider community by terminating the hospital reimbursement rate system put in place 14 years earlier by the New York Prospective Hospital Reimbursement Methodology. By eliminating the relatively noncompetitive marketplace experienced by the states’ providers, HCRA’s passage heralded a growing wave of managed care market penetration. It challenged providers to work within the context of new market forces to decrease costs and increase efficiency and quality.

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findings0806.pdf

Researchers at the University of California, Berkeley examined how a forty-hospital, non-profit system, Catholic Healthcare West (CHW), that was experiencing major financial losses in 2000 was able to reorganize and reverse those losses, while still preserving its charitable mission. Lessons from this experience provide important insights and considerations for non-profit hospitals attempting to reverse financial losses and demonstrate tangible community benefits.