Improving Health Care Access for Older Alaskans: What Are the Options?

This report focuses on the problem older Alaskans who rely on Medicare face getting access to primary care, and discusses some of the options policymakers are considering to resolve the problem. But older Americans across the country also report difficulty getting the primary care they need. The discussion here sheds light on the problem and potential solutions nationwide. Most Americans 65 and older use Medicare as their primary health insurance. Medicare is federal health insurance for people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease—but this report looks only at access issues for Medicare beneficiaries 65 and older. Doctors don’t have to participate in the Medicare program. But those who do participate have to accept, as full payment, what Medicare pays for specific services. Many primary-care doctors say Medicare doesn’t pay them enough to cover their costs—so growing numbers are declining to see new Medicare patients. Among primary-care doctors nationwide, 61% accept new Medicare patients.1 National surveys sponsored by the Medicare Payment Advisory Commission have found that 17% of Medicare patients in the U.S. had “a big problem” finding family doctors in 2007—up from 13% in 2005.2 In Alaska, a 2008 survey by the Institute of Social and Economic Research (ISER) found that just over half of Alaska’s primary-care doctors were willing to treat new Medicare patients.3 The situation was worse in Anchorage, where 40% of all older Alaskans live. Only 17% of primary-care doctors in Anchorage were willing to treat new Medicare patients as of 2008 (Figure 1).4The Harold E. Pomeroy Public Policy Research EndowmentIntroduction / How Medicare Works / Closed Doors / Older Anchorage Residents and Primary Care / Options for Changing Access to Primary Care: What is Alaska Considering? / Conclusions / Appendi

UA Research Summary No. 14

In the past few years, Alaskans have been hearing reports that some primary-care doctors won’t see new Medicare patients. Medicare pays these doctors only about two-thirds of what private insurance pays—and that’s after a sizable increase in 2009. But most Americans 65 or older have to use Medicare as their main insurance, even if they also have private insurance. Just how widespread is the problem of Alaska’s primary-care doctors turning away Medicare patients? ISER surveyed hundreds of doctors to find out—and learned that so far there’s a major problem in Anchorage, a noticeable problem in the Mat-Su Borough and Fairbanks, and almost no problem in other areas.University of Alaska Foundation

UA Research Summary No. 18

Health-care spending for Alaskans reached about $7.5 billion in 2010. For comparison, that’s close to half the wellhead value of all the oil produced in Alaska that year. It’s also roughly equal to half the wages Alaskans collected in 2010. The state’s health-care spending has been rising fast, tripling since 1990 and jumping 402010—and at current trends it could double by 2020, reaching more than$14 billion. Here we report on who’s paying the bills, what we’re buying, what’s contributing to the growth, and other aspects of health-care spending. We conclude with a discussion of how Alaska could get better value for its health-care dollars

Fighting Neurelitism

The author discusses prejudices against alternative perceptions of reality

High-Performance Silicon-Based Multiple Wavelength Source

We demonstrate a stable CMOS-compatible on-chip multiple-wavelength source by filtering and modulating individual lines from a frequency comb generated by a microring resonator optical parametric oscillator.. We show comb operation in a low-noise state that is stable and usable for many hours. Bit-error rate measurements demonstrate negligible power penalty from six independent frequencies when compared to a tunable diode laser baseline. Open eye diagrams confirm the fidelity of the 10 Gb/s data transmitted at the comb frequencies and the suitability of this device for use as a fully integrated silicon-based WDM source.Comment: 3 pages, 3 figure

Shorter Migration Distances Associated with Higher Winter Temperatures Suggest a Mechanism for Advancing Nesting Phenology of American Kestrels \u3cem\u3eFalco sparverius\u3c/em\u3e

Global climate change has affected avian migration patterns and nesting phenology. Changes in one phase of a bird\u27s cycle will most likely affect other stages, but few studies focus simultaneously on multiple life-history events. We used western North American ringing records and Christmas Bird Counts to examine whether changes in migration patterns were concordant with advancing American kestrel Falco sparverius nesting phenology. Consistent with previous findings, male kestrels migrated shorter distances than female kestrels, and kestrels nesting in southern latitudes migrated shorter distances than kestrels nesting in more northern areas. In addition, kestrel migration distance decreased significantly from 1960 to 2009 and was negatively associated with winter minimum temperatures. Christmas Birds Counts from the same time period showed increasing indices of overwintering kestrel abundance in northern states (Washington, Idaho, and Utah), where winter minimum temperatures have increased significantly, and concomitant decreases in southern states (California and Arizona). Finally, changes in nesting phenology of kestrels in southwestern Idaho were best explained by warmer winters, not springs. Warmer winters may decrease energetic demands on migrants by allowing for shorter migration distances, decreasing thermoregulatory costs, or both. Decreased energy demands during winter may allow birds to gain resources necessary for reproduction earlier in the nesting season. Higher winter temperatures that decrease (former) constraints on early nesting may be a particularly important mechanism leading to advancing nesting phenology for species with strong seasonal declines in fecundity or intense early season competition for high-quality nesting areas

Speciation and Mobilization of Toxic Heavy Metal Ions by Methanogenic Bacteria

HWRIC Project HWR 92-09