Financing the U.S. Health System: Issues and Options for Change

Explores key issues of health reform and options for financing health care -- redirecting funds to more effective uses, rolling back tax cuts, modifying tax exclusions for health benefits, an employer play-or-pay model, and a value-added tax

Covering the Uninsured: What is the Problem, Why Care?

Presentation for Covering the Uninsured Week event sponsored by GW\u27s Health Advocacy Initiative and the Department of Health Policy

Medicare Prescription Drug Legislation: What It Means for Rural Beneficiaries

Executive Summary: Congress is currently debating legislation that would not only add a prescription drug benefit to Medicare but create an unprecedented role for private health insurers in delivering all Medicare services. Such changes would have profound effects on the 41 million people covered by Medicare -- particularly the one in four who lives in rural America. Previous studies have shown that rural beneficiaries have different health care needs and delivery systems than their urban counterparts. Indeed, the bills that passed the House and Senate address payments to rural hospitals and other providers. However, less attention has been paid to the rural beneficiary implications of the prescription drug benefit and private plan reforms included in the Medicare legislation. This study does so, through new data analysis and synthesis of existing information. The results of this study underscore the unique challenges that face Medicare’s 9 million rural beneficiaries today and under the Medicare proposals under consideration. New analysis shows that rural beneficiaries are, relative to urban beneficiaries, older, sicker, and poorer and have a greater need for a Medicare drug benefit. They are nearly twice as likely to lack any type of insurance coverage for prescription drugs. However, the design of a Medicare prescription drug benefit is critical to ensuring that the unique needs of Medicare’s rural beneficiaries are met. Rural beneficiaries would be disadvantaged by a Medicare prescription drug benefit that has weak protections for low-income beneficiaries – or excludes them altogether. Their higher incidence of chronic illnesses like arthritis and heart disease would leave them vulnerable to higher prescription drug cost sharing and premiums if private insurers rather than Medicare were to define the benefit. In addition, a prescription drug benefit that relies exclusively on private insurers could create serious access problems for rural beneficiaries. This study shows that private insurers have proven unreliable in rural areas: they are less likely to serve rural areas, and when they do, they are less likely to maintain service over a sustained period of time. Finally, reforms outside the addition of a prescription drug benefit could exacerbate the current inequities caused by Medicare funding of supplemental health benefits only through private plans. Not only do rural beneficiaries have less access to subsidized benefits through private plans, but they would fund these benefits through higher Medicare premiums. The report concludes by recommending that stronger protections for low-income and sicker beneficiaries, a more stable prescription drug delivery system, and a more equitable allocation of Medicare subsidies for supplemental benefits – rather than concentrating them in private plans -- would make the ultimate Medicare legislation more responsive to rural beneficiaries’ circumstances

Health Coverage in Massachusetts: Far to Go, Farther to Fall

This analysis has been prepared to highlight the state\u27s experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation\u27s health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus on shorter term reforms that can be achieved both politically and financially, which would offer important protections to the residents who most need the help

Capacity of Thailand to Contain an Emerging Influenza Pandemic

Gaps exist in infrastructure, personnel and materials, and surveillance capacity to meet needs of various pandemic scenarios

Can Broader Diffusion of Value-Based Insurance Design Increase Benefits from US Health Care without Increasing Costs? Evidence from a Computer Simulation Model

Using a computer simulation based on US data, R. Scott Braithwaite and colleagues calculate the benefits of value-based insurance design, in which patients pay less for highly cost-effective services

Length of patient-physician relationship and patients' satisfaction and preventive service use in the rural south: a cross-sectional telephone study

BACKGROUND: Physicians and patients highly value continuity in health care. Continuity can be measured in several ways but few studies have examined the specific association between the duration of the patient-doctor relationship and patient outcomes. This study (1) examines characteristics of rural adults who have had longer relationships with their physicians and (2) assesses if the length of relationship is associated with patients' satisfaction and likelihood of receiving recommended preventive services. METHODS: Cross-sectional telephone survey of health care access indicators of adults in selected non-metropolitan counties of eight U.S. predominantly southern states. Analyses were restricted to adults who see a particular physician for their care and weighted for demographics and county sampling probabilities. RESULTS: Of 3176 eligible respondents, 10.8% saw the same physician for the past 12 months, 11.8% for the previous 13–24 months, 20.7% for the past 25–60 months and 56.7% for more than 60 months. Compared to persons with one year or less continuity with the same physician, respondents with over five years continuity more often were Caucasian, insured, a high school graduate, and more often reported good to excellent health and an income above $25,000. Compared to those with more than five years of continuity, participants with either less than one year or one to two years of continuity with the same physician were more often not satisfied with their overall health care (OR 2.34; OR 1.78), participants with less than one year continuity were more often not satisfied with the concern shown them by their physician (O.R. 1.90) and having their health questions answered, and those with one to two years continuity were more often not satisfied with the quality of their care (OR 2.37). No significant associations were found between physician continuity and use rates of any of the queried preventive services. CONCLUSION: Over half of this rural population has seen the same physician for more than five years. Longer continuity of care was associated with greater patient satisfaction and confidence in one's physician, but not with a greater likelihood of receiving recommended preventive services