Health Care Access, Quality Focus of Special JAMA Issue
The Journal of the American Medical Association on Wednesday featured several studies and articles on health care access and quality. Summaries appear below.
Patients without health insurance are less likely to receive treatment after injuries or diagnoses of chronic diseases, according to a study led by Jack Hadley of the Urban Institute, Bloomberg/Boston Globe reports.
The study, which tracked 31,000 patients nationwide, found that 89% of participants with health insurance sought treatment from a physician after injuries, compared with 79% of those without coverage. In addition, the study found that 9% of participants with health insurance who sought treatment from a physician after injuries failed to receive necessary follow-up care, compared with 19% of those without coverage.
Among participants with chronic diseases, 92% of those with health insurance sought initial treatment from a physician, compared with 82% of those without coverage, and 4.4% of those with health insurance failed to receive necessary follow-up care, compared with 9.4% of those without coverage, according to the study.
Hadley said, "Health insurance coverage is becoming a major political issue, and we know that expanding coverage is going to cost a lot," adding, "This study shows there is a real health benefit."
Patients in many cases do not receive necessary follow-up care, regardless of whether they have health insurance, according to a study led by Harlan Krumholz of Yale University School of Medicine, Bloomberg/Globe reports.
The study surveyed 2,498 patients who experienced heart attacks.
According to the study, one in five participants said they could not afford necessary follow-up care, and one in eight did not purchase prescribed medications because of the cost. Among participants concerned about the cost of necessary follow-up care or medications, more than two-thirds had health insurance, the study found.
In addition, the study found that participants who did not follow physician recommendations for follow-up care because of "financial barriers" were 30% more likely to require repeat hospitalization and that those who could not afford prescribed medications were 50% more likely to require repeat hospitalization.
Krumholz said, "We often talk about health insurance as a yes-or-no thing. But just to get health insurance without looking at the type of coverage it entails is often not enough" (Marcus, Bloomberg/Boston Globe, 3/14).
Physicians should work in teams and measure the quality of care provided to patients to help reduce costs and address other problems in the U.S. health care system, according to an article written by Michael Porter of Harvard Business School and Elizabeth Olmsted Teisberg of the University of Virginia, the Boston Globe reports.
At a briefing on Tuesday, Porter said that physicians must lead an effort to establish "a system where everyone is rewarded for value." For example, physicians should coordinate their schedules to allow a cancer patient to visit several specialists in one day, rather than multiple visits on multiple days, he said.
In addition, Porter said that physicians should work with hospitals to track measures such as survival rates, recovery times and patient satisfaction. He said, "As important as insurance coverage is, insurance is just the beginning. If we just fix insurance, but don't fix the delivery of health care, we might have a greater crisis than we have today" (Donnelly, Boston Globe, 3/14).
Spending on emergency care for recent documented and undocumented immigrants accounted for less than 1% of the North Carolina Medicaid budget annually between 2001 and 2004, according to a study of 317,090 paid claims in the state, the AP/Winston-Salem Journal reports.
According to the study, conducted by Annette DuBard of the University of North Carolina-Chapel Hill and Mark Massing of the Carolinas Center for Medical Excellence, 99% of the 48,391 individuals who received emergency care through Medicaid were undocumented immigrants; 95% were female; and 93% were Hispanic. More than 80% of those individuals received care for conditions related to childbirth or pregnancy complications, the study found (AP/Winston-Salem Journal, 3/14).
The study found that spending on emergency care under Medicaid increased from $41.3 million in 2001 to $52.9 million in 2004 (Fisher, Raleigh News & Observer, 3/14).
However, the increase accounted for less than 35% of the overall increase in Medicaid spending between 2001 and 2004 (AP/Winston-Salem Journal, 3/14).