Uninsured Americans with Chronic Health Conditions: Key Findings from the National Health Interview Survey

The Robert Wood Johnson Foundation (RWJF) commissioned researchers Amy Davidoff of the Department of Public Policy of the University of Maryland, Baltimore County and Genevieve Kenney, of the Health Policy Center at The Urban Institute, to document the prevalence and impact of selected chronic health conditions among the uninsured.1 Using the most recent data from the National Center for Health Statistics' National Health Interview Survey (NHIS), the researchers quantified the number of uninsured adults with chronic conditions, overall and by race and ethnicity, and examined whether they experience gaps in their access to care. Researchers further examined access problems faced by uninsured adults with different chronic health problems. The results are startling

The Effect of Supplemental Medical and Prescription Drug Coverage on Health Care Spending for Medicare Beneficiaries with Cancer

AbstractObjectivesTo examine whether patients with newly diagnosed cancer respond differently to supplemental coverage than the general Medicare population.MethodsA cohort of newly diagnosed cancer patients (n = 1,799) from the 1997-2007 Medicare Current Beneficiary Survey and a noncancer cohort (n = 9,726) were identified and matched by panel year. Two-year total medical care spending was estimated by using generalized linear models with gamma distribution and log link—including endogeneity-corrected models. Interactions between cancer and type of insurance allowed testing for differential effects of a cancer diagnosis.ResultsThe cancer cohort spent an adjusted $15,605 more over 2 years than did the noncancer comparison group. Relative to those without supplemental coverage, beneficiaries with employer-sponsored insurance, other private with prescription drug coverage, and public coverage had significantly higher total spending ($3,510, $2,823, and$4,065, respectively, for main models). For beneficiaries with cancer, supplemental insurance effects were similar in magnitude yet negative, suggesting little net effect of supplemental insurance for cancer patients. The endogeneity-corrected models produced implausibly large main effects of supplemental insurance, but the Cancer × Insurance interactions were similar in both models.ConclusionsMedicare beneficiaries with cancer are less responsive to the presence and type of supplemental insurance than are beneficiaries without cancer. Proposed restrictions on the availability of supplemental insurance intended to reduce Medicare spending would be unlikely to limit expenditures by beneficiaries with cancer, but would shift the financial burden to those beneficiaries. Policymakers should consider welfare effects associated with coverage restrictions

Prevalence of Potentially Inappropriate Medication Use in Older Adults Using the 2012 Beers Criteria

The Beers list of potentially inappropriate medications (PIMs) provides a key indicator of medication prescribing quality. The criteria were updated in 2012, adding new drugs and assessing evidence strength

Fructose Modulates Cardiomyocyte Excitation-Contraction Coupling and Ca2+ Handling In Vitro

BACKGROUND: High dietary fructose has structural and metabolic cardiac impact, but the potential for fructose to exert direct myocardial action is uncertain. Cardiomyocyte functional responsiveness to fructose, and capacity to transport fructose has not been previously demonstrated. OBJECTIVE: The aim of the present study was to seek evidence of fructose-induced modulation of cardiomyocyte excitation-contraction coupling in an acute, in vitro setting. METHODS AND RESULTS: The functional effects of fructose on isolated adult rat cardiomyocyte contractility and Ca²⁺ handling were evaluated under physiological conditions (37°C, 2 mM Ca²⁺, HEPES buffer, 4 Hz stimulation) using video edge detection and microfluorimetry (Fura2) methods. Compared with control glucose (11 mM) superfusate, 2-deoxyglucose (2 DG, 11 mM) substitution prolonged both the contraction and relaxation phases of the twitch (by 16 and 36% respectively, p<0.05) and this effect was completely abrogated with fructose supplementation (11 mM). Similarly, fructose prevented the Ca²⁺ transient delay induced by exposure to 2 DG (time to peak Ca²⁺ transient: 2 DG: 29.0±2.1 ms vs. glucose: 23.6±1.1 ms vs. fructose +2 DG: 23.7±1.0 ms; p<0.05). The presence of the fructose transporter, GLUT5 (Slc2a5) was demonstrated in ventricular cardiomyocytes using real time RT-PCR and this was confirmed by conventional RT-PCR. CONCLUSION: This is the first demonstration of an acute influence of fructose on cardiomyocyte excitation-contraction coupling. The findings indicate cardiomyocyte capacity to transport and functionally utilize exogenously supplied fructose. This study provides the impetus for future research directed towards characterizing myocardial fructose metabolism and understanding how long term high fructose intake may contribute to modulating cardiac function

WHAT GOOD IS WEALTH WITHOUT HEALTH? THE EFFECT OF HEALTH ON THE MARGINAL UTILITY OF CONSUMPTION

We estimate how the marginal utility of consumption varies with health. To do so, we develop a simple model in which the impact of health on the marginal utility of consumption can be estimated from data on permanent income, health, and utility proxies. We estimate the model using the Health and Retirement Study's panel data on the elderly and near-elderly, and proxy for utility with measures of subjective well-being. Across a wide range of alternative specifications and assumptions, we find that the marginal utility of consumption declines as health deteriorates, and we are able to clearly reject the null of no state dependence. Our point estimates indicate that a one-standard-deviation increase in the number of chronic diseases is associated with a 10%–25% decline in the marginal utility of consumption relative to this marginal utility when the individual has no chronic diseases. We present some simple, illustrative calibration results that suggest that state dependence of the magnitude we estimate can have a substantial effect on important economic problems such as the optimal level of health insurance benefits and the optimal level of life-cycle savings.United States. Social Security Administration (National Bureau of Economic Research Grant 10-P-98363-1-05)National Institute on Aging (Grant T32-AG000186

Health Insurance Costs and Early Retirement Decisions

The loss of health insurance may be an important component of the cost of retirement, especially for workers without retiree health insurance coverage. The authors find that insurance costs significantly reduce retirement rates for full-time wage and salary workers ages 51 to 61. Simulations suggest that a $1,000 increase in the net present value of health insurance premium costs reduces the probability of early retirement by 0.17 percentage points for men and by 0.24 percentage points for women, corresponding to elasticities of –0.22 and –0.24, respectively. The authors’ models predict that expanding the Medicare program to cover those aged 62–64 would increase retirement rates for workers with employer-sponsored coverage who lack retiree benefits, if the government subsidizes their coverage. However, the impact would be small, increasing overall retirement rates by only 7%

Does medication adherence lower Medicare spending among beneficiaries with diabetes?

OBJECTIVE: To measure 3-year medication possession ratios (MPRs) for renin–angiotensin–aldosterone system (RAAS) inhibitors and statins for Medicare beneficiaries with diabetes, and to assess whether better adherence is associated with lower spending on traditional Medicare services controlling for biases common to previous adherence studies. DATA SOURCE: Medicare Current Beneficiary Survey data from 1997 to 2005. STUDY DESIGN: Longitudinal study of RAAS-inhibitor and statin utilization over 3 years. DATA COLLECTION: The relationship between MPR and Medicare costs was tested in multivariate models with extensive behavioral variables to control for indication bias and healthy adherer bias. PRINCIPAL FINDINGS: Over 3 years, median MPR values were 0.88 for RAAS-I users and 0.77 for statin users. Higher adherence was strongly associated with lower Medicare spending in the multivariate analysis. A 10 percentage point increase in statin MPR was associated with U.S.$832 lower Medicare spending (SE=219; p<.01). A 10 percentage point increase in MPR for RAAS-Is was associated with U.S.$285 lower Medicare costs (SE=114; p<.05). CONCLUSIONS: Higher adherence with RAAS-Is and statins by Medicare beneficiaries with diabetes results in lower cumulative Medicare spending over 3 years. At the margin, Medicare savings exceed the cost of the drugs