Center for Studying Health System Change

Using Science to Shape Medicare Physician Payment

After years of inattention, ensuring a more rigorous approach to updating the Medicare physician fee schedule should help address the serious threat to the viability of primary care, according to an invited commentary by HSC President Paul B. Ginsburg published in JAMA Internal Medicine.

Physicians’ Fear of Malpractice Suits Linked to More Diagnostic Testing

Medicare patients receive more diagnostic tests and ED referrals when treated by physicians who worry more about malpractice liability, regardless of whether states have adopted common malpractice tort reforms, according to a study by researchers at the Center for Studying Health System Change (HSC) in the August Health Affairs.

Urgent Care Centers: Emergency Department Alternative or Costly Convenience?

Consumer demand for more convenient and timely access to care for illnesses and injuries is a major driver of the rapid growth of urgent care centers across the country, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Treatment Costs for Specific Conditions Vary Within and Across Communities

Across treatment of different medical conditions among Medicare beneficiaries, there is little consistency in geographic cost variations, with some communities high cost for certain conditions but not others, according to a study by a Center for Studying Health System Change (HSC) researcher published online in the journal Health Services Research.

Competitive Denver Insurance Market Awaits National Health Reform

Despite waiting until nearly the 11th hour to approve a Medicaid expansion, Colorado is at the forefront of preparing for national health reform relative to many other states, according to a new Community Report released today by Center for Studying Health System Change (HSC).

Ready or Not: Are Health Care Safety-Net Systems Prepared for Reform?

Even with new federal resources to help, communities with weaker safety-net systems are lagging in preparations for health reform, according to a new study by the Center for Studying Health System Change (HSC) for the California HealthCare Foundation (CHCF).

Overcoming Obstacles to Specialty Care for Medicaid Patients

Across the country, several innovative approaches to expanding Medicaid patients’ access to specialty care are showing early promise, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the Commonwealth Fund.

Health Differences Explain Most Geographic Variation in Medicare Costs

Wide geographic variation in Medicare costs is largely explained by health differences across communities rather than inefficient care delivery, according to a Center for Studying Health System Change (HSC) study published online today in the SAGE journal Medical Care Research and Review.

Baltimore Health Insurance Market Primed for National Health Reform

With a history of aggressive state oversight of health care and Medicaid coverage expansions, the Baltimore metropolitan area likely faces a smoother transition to national health reform than many other markets across the country, according to a new Community Report released today by the Center for Studying Health System Change (HSC).

Lower Medicare Hospital Payment Rates Lead to Lower Rates for Private Payers

Contrary to the notion that hospitals charge private payers higher payment rates to offset lower Medicare rates, it turns out the opposite is true—lower Medicare payment rates lead to lower private rates for inpatient care, according to a study by the Center for Studying Health System Change (HSC) published in the May Health Affairs.

Scaling Up Payment Reform Pilots Key to Health Care Cost Containment

Scaling up health care payment reform to control costs and improve quality will require both sticks to prod providers from the sidelines and carrots to guide patients to more-efficient, higher-quality doctors and hospitals, according to an article by Paul B. Ginsburg, Ph.D., president of the Center for Studying Health System Change (HSC), in the May Health Affairs.

Hospital Quality Reporting: Separating the Signal from the Noise

Amid the proliferation of quality measures, reporting requirements and transparency efforts, purchasers often find it difficult to separate the signal from the noise when determining what hospital quality measures are important, how to interpret and use quality information in a meaningful way, and how to present useful and actionable information to consumers, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Medicare Spending Limits: Issues and Implications

Several major deficit-reduction plans include provisions that would impose an explicit limit on the growth in Medicare spending. A new Kaiser Family Foundation report written by Chapin White, Ph.D., HSC senior health researcher, describes and analyzes various approaches to setting and enforcing limits on Medicare spending.

Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies

While state scope-of practice laws don’t typically restrict what primary care services nurse practitioners (NPs) can provide to patients, the laws do affect practice opportunities for NPs and appear to influence payer policies, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Few Americans Switch Employer Health Plans for Better Quality, Lower Costs

Less than 2.5 percent of nonelderly Americans in 2010 with employer coverage—about the same proportion as in 2003—initiated a change in health plans to reduce their health insurance costs or get a better quality plan, according to a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Los Angeles and San Diego Regional Market Studies

New market studies of the Los Angeles and San Diego areas conducted by the Center for Studying Health System Change (HSC) offer a look at emerging trends, including preparations for health reform.

17th Annual Wall Street Comes to Washington Conference

HSC's 17th Annual Wall Street Comes to Washington conference was held on Wednesday, Dec. 19, 2012, in Washington, D.C. A transcript and audio podcast of the conference are now available.

Employer-Sponsored Insurance and Health Reform: Doing the Math

Amid concerns that health reform might hasten the ongoing decline of employer health coverage, the calculus of offering coverage will continue to make economic sense for businesses employing most workers (81%) now offered insurance, according to a new national study for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Easier Access to After-Hours Care Linked to Less Emergency Department Use

Patients with problems reaching their primary care practice after hours are more likely to report ending up in the emergency department and going without needed medical care, according to a study by the Center for Studying Health System Change (HSC) published today as a Web First by Health Affairs.

San Francisco and Fresno Regional Market Studies

New market studies of the San Francisco and Fresno areas conducted by the Center for Studying Health System Change (HSC) offer a stark contrast—particularly in preparations for health reform—between one of the most affluent and poorest regions of the state.

Local Public Hospitals: Changing with the Times

In recent years, local public hospitals have stayed afloat financially without abandoning their mission to care for low-income people by expanding access to primary care, attracting privately insured patients and paying closer attention to collection of patient revenues, among other strategies, according to a qualitative study released today by the Center for Studying Health System Change (HSC).

Care Coordination Agreements: Lessons Learned

To improve the quality and coordination of care, some physicians have developed written care coordination agreements that spell out the respective responsibilities of two or more physicians for coordination of patient care. Changes in payment policies likely could encourage further development of these kinds of agreements, according to a study by the Center for Studying Health System Change (HSC) published as a Web Exclusive by the American Journal of Managed Care.

Emergency Preparedness and Community Coalitions: Opportunities and Challenges

While hospitals and first responders consistently work together to prepare for natural disasters, infectious disease outbreaks and other emergencies likely to result in many injured or ill people, other important groups—primary care clinicians and nursing homes, for example—typically do not participate in local emergency-preparedness coalitions, according to a new qualitative study of 10 U.S. communities by the Center for Studying Health System Change (HSC).

Despite Employer Interest, Americans' Use of Workplace Clinics Remains Low

Despite heightened employer interest in workplace clinics as a cost-containment tool, only 4 percent of American families in 2010 reported visiting a workplace clinic in the previous year—the same proportion as in 2007, according to a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Despite Recession, Share of Americans with High Medical Costs Mostly Unchanged

Almost one in five Americans younger than 65—18.8 percent—lived in families with high medical costs in 2009, roughly the same as 2006 despite widespread job losses, more uninsured and declining incomes during the Great Recession, according to a study by the Center for Studying Health System Change (HSC) published today as a Web First by Health Affairs.

High-Intensity Primary Care: Lessons for Physician and Patient Engagement

If fledgling efforts to improve quality and lower costs by focusing extra primary care attention on patients with complex conditions are to succeed, ensuring physicians and patients are on board will be key, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Sacramento and Riverside/San Bernardino Regional Market Studies

Increased pressure on hospitals to contain costs, growing concerns about physician shortages and strained safety nets are among the trends identified in new market studies of the Sacramento and Riverside/San Bernardino regions conducted by the Center for Studying Health System Change (HSC).

Accuracy of Medicare Physician Fee Schedule Key to Broader Reform

Despite growing interest in replacing fee-for-service payments to health care providers, fee for service is likely to remain the core way of paying physicians, so ensuring the accuracy of these payments will be important to the success of broader payment reforms, according to an article by Paul B. Ginsburg, Ph.D., HSC president, published in the September edition of Health Affairs.

Adapting Tools from Other Nations to Slow U.S. Prescription Drug Spending

Tools commonly used in other developed nations to help slow prescription drug spending growth offer potential lessons for the U.S. health system, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Health Care Safety Net Coordination Grows in Some Communities

Safety net clinics, hospitals and other providers that care for uninsured and low-income people increasingly are seeking ways to coordinate services to increase access, improve quality and reduce costs, according to a study by HSC published in the August edition of Health Affairs.

Small Employers and Self-Insured Health Benefits: Too Small to Succeed?

While large firms often assume financial risk for enrollees’ medical care through self-insurance, small firms’ growing interest in the practice may pose challenges for policy makers, according to a new qualitative study by the Center for Studying Health System Change (HSC).

Majority of Medicaid ED Visits for Urgent or More Serious Symptoms

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a national study released today by the Center for Studying Health System Change (HSC).

Lessons in Linking After-Hours Care to Primary Care

From solo physicians sharing on-call coverage to large practices contracting with urgent care centers, financial backing from payers and electronic health records can help support coordination of after-hours care with patients’ primary care practices, according to a study by the Center for Studying Health System Change (HSC) published online in The Journal of General Internal Medicine.

Challenges Uninsured Near Elderly Face Accessing and Affording Health Care

Four in 10 uninsured Americans aged 55-64 reported having unmet health care needs or delaying treatment in 2010, while three in 10 uninsured near elderly people lived in families with problems paying their medical bills largely due to the cost, according to a Kaiser Family Foundation (KFF) report by researchers at the Center for Studying Health System Change (HSC) and KFF.

Addressing Hospital Pricing Leverage through Regulation: State Rate Setting

Amid growing evidence that rising prices—especially for hospital care—play a key role in rising premiums for privately insured people, policy makers may want to revisit a tool—rate setting—used decades ago by a number of states to constrain hospital costs, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Health Plan-Provider Price Negotiations: Passing the Buck to Employers

Given the negotiating clout of so-called must-have hospitals and physician groups, even dominant health plans are wary of disrupting the status quo by trying to constrain prices, perhaps because insurers can simply pass along higher costs to employers and their workers, according to a study by the Center for Studying Health System Change (HSC) published in the May edition of Health Affairs.

Home Health and Durable Medical Equipment Major Drivers of Medicare Spending Variation

Most analyses of geographic variation in Medicare spending have focused on total spending, but a new Health Affairs study by researchers at HSC and Mathematica Policy Research looks at differences in spending across categories of medical services, such as diagnostic tests and durable equipment, finding considerable variation across 60 communities. Even among communities with high or low total health care use, the study found very different combinations of services were used to produce medical care.

Limited Options to Manage Specialty Drug Spending

Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change (HSC).

Hospital Geographic Expansion: The New Medical Arms Race?

Hospitals’ longstanding competitive focus on cutting-edge technology, niche specialty services and amenities to attract physicians and patients has set the stage for the next chapter in hospital competition—targeted geographic expansion into new markets with well-insured people, according to a study by HSC published in the April edition of Health Affairs.

Can Promoting Primary Care Help Bend the Cost Curve?

The national health care reform law includes a temporary five-year, 10-percent increase in what Medicare pays for primary care services provided by primary care clinicians. In a new Commonwealth Fund issue brief, researchers at the Center for Studying Health System Change (HSC) and Mathematica Policy Research model what would likely happen if the payment increase were permanent. The study concludes that increased spending on primary services would be more than offset by lower Medicare spending for other services—primarily hospitalizations, outpatient services and post-acute care—with the net result a drop in longer-term Medicare spending of nearly 2 percent.

Great Recession Accelerated Long-Term Decline of Employer Health Coverage

Between 2007 and 2010, the share of U.S. children and working-age adults with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Slower Growth in Medicare Spending—Is This the New Normal?

While the economic downturn and other temporary factors likely have a role in slowing Medicare spending growth, past cost-control efforts and the looming specter of broader provider payment reform may signal a longer-term slowdown in Medicare spending growth, according to a perspective by researchers at the Center for Studying Health System Change (HSC), published online today in the New England Journal of Medicine.

State Benefit Mandates and National Health Reform

While the national health reform law requires states to pay for health benefit mandates that exceed a minimum package of covered services, states’ financial liability for mandates is likely to be relatively small, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Health Status and Hospital Prices Key to Regional Variation in Private Spending

Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices—especially for hospital care—also play a key role, accordingto a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Increasing Physician Fees Expands Access to Care, While Coverage Expansion Effects Mixed

Increasing physician fees clearly increased children's access to physician services, while coverage expansions under the Children's Health Insurance Program had more modest effects on children's access to care, according to a study by HSC published online in the journal Health Services Research.

Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients

Indianapolis’ major hospital systems continue to encroach on each other’s traditional territories, engaging in a battle of bricks and mortar in suburban areas to compete for well-insured patients, according to a new Community Report released today by HSC.

1 in 5 Americans in Families with Problems Paying Medical Bills in 2010

More than one in five Americans were in families with problems paying medical bills in 2010—about the same proportion as in 2007, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation (RWJF).

Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage

While there’s little debate about a growing primary care workforce shortage in the United States, it’s less clear whether existing workforce policies—such as educational loan forgiveness or scholarships and higher payment rates—can boost the supply of practitioners quickly enough, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Prescription Drug Access Problems Remain Level Between 2007 and 2010

Despite the weak economy and more people lacking health insurance, the proportion of Americans reporting problems affording prescription drugs remained level between 2007 and 2010, with more than one in eight going without a prescribed drug in 2010, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation.

A Third of Adults Discharged from a Hospital Don't See a Doctor Within 30 Days

One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Surprising Decline in Consumers Seeking Health Information

After a striking rise in the last decade, the proportion of American adults seeking information about a personal health concern from a source other than their doctor dropped to 50 percent in 2010, down from 56 percent in 2007, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation (RWJF).

Transmitting and Processing Electronic Prescriptions: Physician Practices and Pharmacies

This study focuses on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies. It explores facilitators of and barriers to the electronic transmission of new prescriptions and renewals and pharmacy e-prescription processing.

Federally Qualified Health Centers Poised for Significant Role in Reform

Tracing their roots to the civil rights movement and the 1960s’ War on Poverty, federally qualified health centers (FQHCs) have grown from fringe providers to mainstays of many local health care system safety nets, according to a study released today by HSC.

Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs

While federal and state policy makers face many complex decisions about the design and operation of new state-based health insurance exchanges, the overarching goal of the exchanges is straightforward—promoting healthy competition among insurers to provide better health care at lower total cost, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Employer-Sponsored Health Insurance: Down but Not Out

Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to a study released today by HSC.

Health Care's Role in Deficit Reduction—Guiding Principles

Cutting federal health care spending over the next 10 years will be particularly challenging for the congressional super committee charged with proposing $1.2 trillion in additional deficit reduction by Thanksgiving, according to a perspective by researchers at HSC published online today in the New England Journal of Medicine.

HSC's 16th Annual Wall Street Comes to Washington Conference on Oct. 12

HSC's 16th Annual Wall Street Comes to Washington conference was held on Wednesday, Oct. 12, 2011, in Washington, D.C. A transcript of the conference is now available.

Low Patient Activation and Hispanic Immigrants' Access Barriers

Increasing Hispanic immigrants’ ability to take a more active role in managing their health and health care may be as important as expanding health coverage in reducing access disparities, according to a study by the Center for Studying Health System Change (HSC) published in the October edition of Health Affairs.

Reforming Provider Payment—The Price Side of the Equation

Unless public and private health care payers send consistent signals to providers through payment reform about controlling both the price and quantity of care, they risk working at cross purposes, according to a perspective by Paul B. Ginsburg, president of the Center for Studying Health System Change (HSC), published online today in the New England Journal of Medicine.

Economic Downturn Strains Miami Health Care System

Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a new Community Report released today by HSC.

Adding Patients to the Decision Equation

While evidence suggests that patients’ medical decisions in the United States, even momentous ones, are seldom well informed, greater use of shared decision making between clinicians and patients might help bridge the gap between the care patients want and the care they actually receive, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Ginsburg Testifies at Ways & Means Health Panel on Provider Market Power

While consolidation contributes to dominant hospitals’ upper hand in negotiating higher payment rates from private insurers, other factors, including consumer perceptions of quality and desire for broad provider choice, provision of highly specialized services, and geographic niches, contribute to providers’ market power, economist Paul B. Ginsburg, Ph.D., president of HSC, told Congress today.

Mixed Signals: Americans’Problems Getting Medical Care Decline Modestly

Likely reflecting the severe economic downturn and subsequent decline in demand for health care, the proportion of Americans who reported going without or delaying needed care declined modestly between 2007 and 2010, according to a national study released today by the HSC and funded by the Robert Wood Johnson Foundation.

Ginsburg Named Among Top 100 Most Influential in Health Care

For the eighth time, HSC President Paul B. Ginsburg was named to Modern Healthcare's 100 Most Influential in Health Care list. To view the complete list click here.

Hospitals Rush to Employ Physicians to Shore Up Referrals, Admissions

While not new, the pace of hospital employment of physicians has quickened in many communities, driven largely by hospitals’ quest to increase market share and revenue, according to a study released today by HSC.

Why Jumpstarting Local Economies through Health Care Expansions Hampers Federal Deficit Reduction

Understanding why health care spending growth is a problem from a national perspective, while simultaneously an attractive way to promote economic growth from a local perspective, is key to identifying ways to finance health care that better align local interests with those of the nation, according to a commentary published today by HSC.

Physicians Key to Health Maintenance Organization Popularity in Orange County

The extent of health plan delegation of financial risk and utilization management to physicians caring for health maintenance organization (HMO) enrollees makes Orange County stand out from many health care markets, according to a new Community Report released today by HSC.

Syracuse Health Care Market Works to Right-Size Hospital Capacity

Largely stable over the last three years, the Syracuse health care market continues to grapple with the challenge of finding the right level and mix of hospital capacity, according to a new Community Report released today by HSC.

Economic Downturn Slows Phoenix’s Once-Booming Health Care Market

After more than a decade of rapid population growth and a thriving economy, Phoenix’s once-booming health care market has adopted a more cautious outlook amid the lingering effects of the great recession, according to a new Community Report released today by HSC.

Developments Affecting Health Care Spending and What Can Be Done

HSC President Paul B. Ginsburg, Ph.D., spoke at a U.S. Chamber of Commerce conference titled "Controlling Costs: The Price of Good Health" in Washington, D.C.

Improving Health Care Access for Low-Income People

Communities that formally build collaborative health care safety nets can offer lessons for national health reform by offering roadmaps on how to improve access, reduce the use of unnecessary emergency and inpatient care, and improve people’s health, according to a qualitative study by HSC published in the July edition of Health Affairs.

Health Information Technology and Small Physician Practices

As policy makers try to jumpstart health information technology (HIT) in small physician practices, lessons from independent practice associations—networks of small medical practices—can offer guidance in overcoming barriers to HIT adoption and use, according to a new study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Health Care Markets Weather Economic Downturn, Brace for Health Reform

Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from HSC's 2010 site visits to 12 nationally representative metropolitan communities.

Spending to Save—Accountable Care Organizations and the Medicare Shared Savings Program

While criticism that the government set the bar too high for accountable care organizations (ACOs) has been fast and furious, the proposed rule for the Shared Savings Program is a wake-up call that Medicare is serious about achieving better care for individuals, better health for populations and lower growth in expenditures, according to a perspective by HSC President Paul B. Ginsburg, published online today in the New England Journal of Medicine.

Health Care Certificate-of-Need (CON) Laws: Policy or Politics?

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, accordingto a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Care Coordination Among Specialists, Primary Care, Care Management and Patients

Ann S. O'Malley, M.D., M.P.H., HSC senior health researcher, testified before the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, on research on medical practices' experiences and needs as they use electronic health records as a tool to support the coordination of care for patients.

HSC Researcher Testifies at Senate Hearing on Emergency Department Use

While there is a common perception that emergency department crowding is driven primarily by uninsured people, most of the growth in emergency department volume between 1995 and 2008 was driven by insured people, Peter Cunningham, Ph.D., a senior fellow at HSC, told Congress today.

E-Prescribing and Information to Improve Physician Prescribing Decisions

While many e-prescribing systems have features to provide access to important external patient information—drugs prescribed by physicians in other practices and patient formularies, for example—physician practices face challenges using these tools effectively, according to a study released today by HSC.

Primary Care Physician Willingness and Capacity to Treat More Medicaid Patients

Supporting increased capacity among primary care physicians already treating many Medicaid patients may be the best way to help ensure adequate capacity for people gaining Medicaid coverage under health reform coverage expansions starting in 2014, according to a national study by researchers at HSC and the Kaiser Family Foundation (KFF).

Geographic Variation in Health Care: Changing Policy Directions

While research on geographic variation in health care use and spending has pushed the twin issues of uneven care and costs to the fore, it’s ultimately the broader health care system—not geography—that matters most in improving efficiency and quality, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Achieving Health Information Technology's Potential to Improve Care is Daunting Task

While health information technology (HIT) holds great promise in helping clinicians improve patient care, realizing that potential will require progress on multiple fronts, according to a perspective by Ann S. O’Malley, M.D., M.P.H., a senior researcher at HSC, published today in the New England Journal of Medicine.

Lansing's Dominant Hospital, Health Plan Strengthen Market Positions

In an insular market wary of outsiders, Lansing’s dominant hospital system—Sparrow Health System—and health plan—Blue Cross Blue Shield of Michigan—have reinforced their already-strong market positions, according to a new Community Report released today by HSC.

Primary Care Physician Supply and Health Reform Medicaid Expansions

In much of the country, growth in Medicaid enrollment under health reform will greatly outpace growth in the number of primary care physicians willing to treat new Medicaid patients, according to a national study released today by HSC.

Hospital Employment of Physicians Surges in Greenville-Spartanburg, S.C.

In an area already notable for high rates of physician employment, the two largest hospital systems in Greenville and Spartanburg, S.C., have greatly increased employment of physicians with an eye toward capturing more referrals and admissions, according to a new Community Report released today by HSC.

Coordination Between Emergency and Primary Care Physicians

An examination of emergency and primary care physicians’ ability—and willingness—to communicate found that haphazard communication and poor coordination can undermine effective care, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Follow the Money: Why are High-Cost Medicare Beneficiaries So Costly?

In the quest to unravel the role of supply and demand in health care costs, policy makers may need to reconsider a commonly held premise that the supply of physicians, hospital beds and other health care resources is a major factor driving high Medicare costs, according to a study by HSC published online in the journal Health Services Research.

Little Rock Health Care Safety Net Stretched by Economic Downturn

The economic downturn has been milder in Little Rock than elsewhere, but increased unemployment and an almost 15 percent uninsurance rate have strained the area’s fragmented health care safety net, according to a new Community Report released today by HSC.

Lessons from the Field: Making Accountable Care Organizations Real

An examination of provider efforts to improve patient care illustrates that changing care delivery requires substantial investments—both time and money—even among groups of providers affiliated with one another for many years, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Communication Disconnect Between Primary Care and Specialist Physicians

When it comes to sharing information about patient referrals and consultations, primary care and specialist physicians have decidedly different views about how often their colleagues communicate with them, according to a national study by researchers at HSC in the Jan. 10 Archives of Internal Medicine.

Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts

Northern New Jersey is a community of contrasts with affluent suburbs and financially strong health care providers juxtaposed against the fragile health care safety net of impoverished inner-city Newark, according to a new Community Report released today by HSC.

Physician Ownership of Medical Equipment Highlights Self-Referral Issue

Amid cost and quality concerns about overuse of advanced imaging on patients, one in six physicians in 2008 reported their practice owned or leased advanced imaging equipment, according to a national study released today by the HSC.

If You Build Health Insurance Exchanges, Will the Healthy Come?

Almost one-third of uninsured people eligible to receive subsidies to buy insurance through state-based exchanges have had no recent problems with their health, access to medical care or paying medical bills, according to a national study released today by HSC.

Workplace Clinics: A Sign of Growing Employer Interest in Wellness

Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services, according to a new study by HSC.

NEJM Health Policy Report Examines Medicare Physician Payment Policies

Repeated down-to-the-wire congressional interventions to avert double-digit Medicare physician payment rate cuts have hit closest to home for practicing physicians, but other policies to improve the accuracy of physician payment and reform provider payment more broadly may prove as important in the long run, according to a health policy report by Paul B. Ginsburg, Ph.D., published online today by the New England Journal of Medicine.

Seattle Hospital Competition Heats Up, Raising Cost Concerns

Known as a market where hospital systems focus on particular niches rather than head-to-head competition, Seattle now faces growing competition as hospital systems vie for market share in the city and seek new affiliations and growth in affluent suburbs, according to a new Community Report by HSC.

Wide Variation in Private Insurer Payment Rates Evidence of Hospital Market Power

Wide variation in private insurer payment rates to hospitals across and within local markets suggests that some hospitals have significant market power to negotiate higher-than-competitive prices, according to a study released today by HSC commissioned by Catalyst for Payment Reform.

Physician E-mail with Patients Uncommon

Despite indications that many patients want to communicate with their physicians via e-mail, physicians’ use of e-mail with patients is the exception rather than the rule, according to a new national study released today by HSC.

Comparative Effectiveness Research and Medical Innovation

Determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research—can help foster beneficial medical innovation, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Transcript of HSC's 15th Annual Wall Street Comes to Washington Conference Now Available

HSC's 15th Annual Wall Street Comes to Washington conference was held on Tuesday, Sept. 28, 2010, in Washington, D.C. A transcript of the conference is now available.

Cleveland Hospital Systems Expand Despite Weak Economy

Attracting well-insured suburban patients, expanding profitable specialty-service lines and winning physician loyalty are the main fields of competition between the two dominant Cleveland health systems, leading to ever-more consolidation of the hospital and physician sectors, according to a new Community Report released today by HSC.

Physician Reimbursement and Participation in Medicaid

Peter J. Cunningham, Ph.D., HSC senior fellow and director of quantitative research, testified before the Medicaid and CHIP Payment and Access Commission (MACPAC) on physician reimbursement and participation in Medicaid.

CBO Principal Analyst Joins HSC as Senior Researcher

Chapin D. White, Ph.D., formerly a principal analyst at the Congressional Budget Office (CBO), has joined the Center for Studying Health System Change (HSC) as a senior health researcher.

Affordability of Medical Care a Moving Target for Families

While more Americans under 65 with employer health coverage faced problems paying medical bills between 2003 and 2007, increased out-of-pocket spending on health services played only a small part in the rising financial stress for families, according to an HSC study published online in the journal Medical Care Research and Review.

Damage Caps No Cure for Physician Fear of Malpractice Suits

Even in states with economic damage caps in malpractice suits, physicians remain highly concerned about being sued, suggesting that many popular tort reform proposals may do little to deter the practice of defensive medicine that contributes to unnecessary health spending, according to a study by researchers at HSC in the September Health Affairs.

State Health Reform Dominates Boston Health Care Market

Massachusetts’ 2006 landmark health reform law has reverberated throughout the Boston health care market as providers, insurers, employers and consumers adjust and adapt to a post-reform world of nearly universal health insurance coverage, according to a new Community Report released today by HSC.

Detroit: Motor City to Medical Mecca?

Despite a weak economic outlook, Detroit area hospital systems plan to spend more than $1.3 billion in the coming years on capital improvements, leading some to hope that medical care can help revitalize the area’s economy, according to a new Community Report released today by HSC and the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

While employer wellness programs have spread rapidly in recent years, few firms implement comprehensive programs likely to make a meaningful difference in employees’ health, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Even When Physicians Adopt E-Prescribing, Use of Advanced Features Lags

Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by HSC.

Politics and Policy of Comparative Effectiveness

Interest in evaluating which health care interventions work best under what circumstances has surged in recent years as policy makers seek tools to moderate the cost of public entitlement programs and to facilitate affordable coverage expansions. This Mathematica Issue Brief, coauthored by HSC Vice President Elizabeth Docteur, looks at the comparative effectiveness research initiative passed as part of health care reform and the policy challenges relevant to the successful implementation of comparative effectiveness research.

Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World?

Wellness and prevention strategies are fast becoming a standard feature of employer-based health benefits in hopes of countering rapidly rising health care costs that drive higher insurance premiums. Panelists at an HSC conference titled Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World? explored how effective employer-sponsored wellness and prevention initiatives focus on health improvement as a business strategy that foster work and community environments that help people lower risk factors. An HSC Issue Brief describing the conference proceedings is now available.

Policy Options for Design of the Temporary High-Risk Health Coverage Pool

While 5.6-million to 7-million Americans may qualify for health coverage through the new temporary national high-risk pool program, the $5 billion allocated until 2014 will cover only a small fraction of those in need, according to a new Policy Analysis from the National Institute for Health Care Reform (NIHCR). Policy makers will face hard choices to stretch the funding to cover uninsured people with pre-existing medical conditions, and the analysis reviews key issues that must be resolved as the high-risk program is implemented.

Primary Care: Current Problems and Proposed Solutions

In 2005, approximately 400,000 people provided primary medical care in the United States. Yet primary care faces a growing crisis, in part because increasing numbers of U.S. medical graduates are avoiding careers in adult primary care, according to a new article published in Health Affairs.

Electronic Medical Records Help and Hinder Communication with Patients and Other Clinicians

Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication—real-time, face-to-face or phone conversations—with patients and other clinicians, according to a new HSC study released today.

For More Americans, Health Care Costs At Least 10 Percent of Family Income

Almost one in five Americans—or 19.1 percent of the nonelderly population—lived in families spending more than 10 percent of before-tax income on health care in 2006, up from one in seven Americans (14.4%) in 2001, according to an HSC study published online today by Health Affairs.

Ginsburg Testifies Before Joint Senate and House Committees in Maryland on Hospital Rate Setting

Paul B. Ginsburg, Ph.D., HSC president and research director of the National Institute for Health Care Reform, testified before a joint hearing of the Maryland Senate Finance Committee and House Health and Government Operations Committee on hospital rate setting.

Ginsburg Testifies Before the Massachusetts Division of Health Care Finance and Policy

Paul B. Ginsburg, Ph.D., HSC president and research director of the National Institute for Health Care Reform, testified before the Massachusetts Office of Health and Human Services, Division of Health Care Finance and Policy, on health care spending trends.

Quantitative/Qualitative Researchers Join HSC

Anna S. Sommers, Ph.D., and Tracy Yee, Ph.D., recently joined the Center for Studying Health System Change (HSC) as health researchers.

Growing California Hospital-Physician Market Power Foreshadows Challenges to National Health Reform

While the high cost of private health insurance has drawn plenty of attention in the health reform debate, an underlying driver of higher insurance premiums—the growing market power of hospitals and physicians to negotiate higher payment rates—has gone largely unexamined, according to an HSC study published online today by Health Affairs.

Modest and Uneven—Physician Efforts to Reduce Racial/Ethnic Disparities

While many U.S. physicians identify language or cultural barriers as obstacles to providing high-quality patient care, physicians' efforts to overcome communication barriers are modest and uneven, according to a new national study released today by HSC.

Medicare Fees and Volume of Physicians' Services

While Medicare physician fees have remained relatively flat in recent years—and actually have declined when considering inflation—the volume of services to Medicare beneficiaries has grown. To many, this implies a "volume offset,"—physicians respond to fee cuts by increasing services. Examining eight services provided to Medicare beneficiaries (different types of visits and two cardiac diagnostic tests), this study found no evidence of volume-offset behavior by physicians.

Early Impacts of the Recession on Health Care Safety Net Providers

While the recession increased demands on the health care safety net as Americans lost jobs and health insurance, the impact on safety net providers has been mixed and less severe—at least initially—than expected in some cases, according to a new HSC study of five communities—Cleveland; Greenville, S.C.; northern New Jersey; Phoenix; and Seattle.

Episode-Based Payments: Charting a Course for Health Care Payment Reform

As consensus grows that true reform of the U.S. health care system requires a move away from fee-for-service payments, designing alternative payment methods, including episode-based payments, has emerged as a high priority for policy makers, according to a new Policy Analysis from the National Institute for Health Care Reform.

Elizabeth Docteur Joins HSC as Vice President and Director of Policy Analysis

Elizabeth Docteur, M.S., former deputy director of the health division of the Organization for Economic Cooperation and Development (OECD), will join the Center for Studying Health System Change on Jan. 11 as vice president and director of policy analysis.

Gap Exists Between Vision for Electronic Medical Records and Clinicians' Experiences

A gap exists between policy makers' expectations that current commercial electronic medical records (EMRs) can improve coordination of patient care and clinicians' real-world experiences with EMRs, according to a study by HSC published online in The Journal of General Internal Medicine.

Use of Care Management Tools for Patients with Chronic Conditions Varies Widely

Use of care management tools—such as group visits or patient registries—varies widely among primary care physicians whose practices care for patients with four common chronic conditions—asthma, diabetes, congestive heart failure and depression—according to a new national study released today by HSC.

California's Health Economies: Cost Pressures, Changing Markets and New Models of Care

In July 2009, the California HealthCare Foundation (CHCF), in partnership with HSC, published six regional health care market reports resulting from site visits to California communities. The six markets—Fresno, Los Angeles, Oakland/San Francisco, Riverside/San Bernardino, Sacramento, and San Diego—reflect a range of economic, demographic, health care delivery, quality, and financing conditions. Today, CHCF published four reports examining specific health system issues illuminated by this six-market study.

• Shifting Ground: Erosion of the Delegated Model in California
  
• California's Safety Net: The Role of Counties in Overseeing Care
  
• A Tighter Bond: California Hospitals Seek Stronger Ties with Physicians
  
• Managed Care in California: Cost Concerns Influence Product Design

HSC's Paul B. Ginsburg Named Research Director of the National Institute for Health Care Reform

While continuing in his role as HSC President, Paul B. Ginsburg will serve as research director of the nonpartisan, nonprofit National Institute for Health Care Reform—an initiative of the International Union, UAW; Chrysler Group LLC; Ford Motor Company; and General Motors to conduct high-quality, objective health policy research and analyses to improve the organization, financing and delivery of U.S. health care.

Getting to the Real Issues in Health Care Reform

If current congressional health care reform proposals become law it would be only the start of the reform process, according to a policy perspective by HSC President Paul B. Ginsburg, Ph.D., published online on Nov. 12 by the New England Journal of Medicine.

Despite Transparency, New Hampshire Health Care Price Variation Remains

Price variation for certain outpatient medical procedures has not decreased in New Hampshire since the state launched the HealthCost price transparency program in early 2007, according to a study released today by HSC and funded by the California HealthCare Foundation.

Health Insurers Pursue Growth Potential of Individual Market

Insurers are pursuing strategies to tap the growth potential of the individual health insurance market, including entering less-regulated markets and developing lower-cost, less-comprehensive products targeting younger, healthy consumers, according to a study released today by HSC.

Hospital Strategies to Engage Physicians in Quality Improvement

While physicians are essential to hospital quality improvement efforts, competing time and financial pressures pose hurdles to physician participation, according to a study released today by HSC.

University of California Physician Joins HSC as Visiting Senior Fellow

Patrick S. Romano, M.D., M.P.H., has joined the Center for Studying Health System Change (HSC) as a visiting senior fellow while on sabbatical as a professor of medicine and pediatrics at the University of California, Davis School of Medicine.

Policy Perspective: Affordable Health Coverage for Near-Elderly Americans

Among the policy options to expand health coverage for Americans aged 55 to 64—the near elderly—comprehensive reform of the individual insurance market, coupled with a Medicaid expansion for those with very low incomes, would be the most effective and far-reaching approach, according to a new Policy Perspective from HSC.

Two HSC Articles Appear in September/October Health Affairs

Two September/October Health Affairs articles from HSC researchers explore whether U.S. health care spending is excessive and the role of Medicare governance in provider payment policy.

A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey

Almost 75 percent of physicians were accepting all or most new Medicare patients, the vast majority of physicians contracted with managed care plans, and slightly fewer than six in 10 physicians provided charity care in 2008, according to findings released today from the nationally representative HSC 2008 Health Tracking Physician Survey.

Does Telemonitoring of Patients—the eICU—Improve Intensive Care?

While nearly 10 percent of U.S. hospital intensive care unit (ICU) beds use advanced telemonitoring—known as eICUs—there has never been a systematic evaluation of how the innovative approach to caring for critically ill patients affects quality and costs, according to a study by HSC published today as a Web exclusive in the journal Health Affairs.

Suburban Poverty and the Health Care Safety Net

As suburban poverty increases, the availability of health care services for low-income and uninsured people in the suburbs has not kept pace, according to a new study by HSC of five communities—Boston, Cleveland, Indianapolis, Miami and Seattle.

Exploring Six California Health Economies

California is large and diverse, and health care is organized, delivered and financed differently across the state. To help inform local leaders, policymakers, the public and the media about regional differences in health care affordability, access and quality, the California HealthCare Foundation funded HSC to conduct in-depth site visits in six California regions. Regional reports were published today.

Chronic Burdens: The Persistently High Out-of-Pocket Health Care Expenses Faced by Many Americans

Over a two-year period, 20 percent of nonelderly adults who had a chronic health condition spent more than 5 percent of their income on out-of-pocket expenses and health insurance premiums, according to a study released today by The Commonwealth Fund and conducted by Peter J. Cunningham, Ph.D., a senior fellow at HSC. Among people with three or more chronic conditions, the proportion spending 5 percent of income—39 percent—was nearly double.

Health Care Quality Transparency Initiatives

Until consumers are motivated to investigate differences in hospital and physician quality, the main value of public quality reporting will likely be to spur providers to improve their performance, according to a Commentary published today by HSC. In a separate Issue Brief released today, HSC researchers highlight two quality transparency initiatives: CalHospitalCompare, a report card for hospitals, and Massachusetts Health Quality Partners, a report card for primary care physician groups.

Emergency Physician Joins HSC as Senior Researcher

Emily Carrier, M.D., M.S.C.I., an emergency physician, has joined the Center for Studying Health System Change (HSC) as a senior health researcher.

Pham Receives AcademyHealth New Investigator Award

HSC Senior Researcher Hoangmai H. Pham, M.D., M.P.H., has received AcademyHealth’s 2009 Alice S. Hersh New Investigator Award, which recognizes the contribution of new scholars to the field of health services research. Pham was recognized for her body of work, which focuses on the organization of care delivery, how providers respond to incentives, quality of care, health care disparities and how each of these areas intersects with payment policy.

How Does Health Coverage and Access to Care for Immigrants Vary by Length of Time in the U.S.?

While, overall, immigrants have a high uninsured rate and face greater access barriers relative to U.S.-born residents, many immigrants eventually gain health insurance and improved access to health care as they acquire language and job skills, improve their economic standing and become more familiar with the U.S. health care system, according to a study released today by the Kaiser Family Foundation (KFF). The research, conducted by HSC Senior Fellow Peter J. Cunningham, Ph.D., and KFF Senior Policy Analyst Samantha Artiga, examines how health coverage and access to care for nonelderly adults vary based on immigrants' length of time in the U.S.

Physician Performance Measurement

Physicians wield significant influence—directly and indirectly—over the quality and cost of health care, but early efforts to measure physician performance may prove a lost opportunity to improve the nation's health care system if methodological and other shortcomings are not addressed, according to a commentary published today by HSC.

Efficiency and Quality: The Role of Controlling Health Care Cost Growth in Health Care Reform

Expanding health insurance coverage to the more than 45 million uninsured Americans is a key U.S. policy goal, but expanding coverage without steps to contain rapidly rising health care costs is a recipe for failure. This Center for American Progress paper by HSC President Paul B. Ginsburg, Ph.D., focuses on steps that can be taken as part of health reform to slow the trend of health spending, including steps that Congress can take now, as well as direction for developing and implementing longer-term policies.

HSC Study Underscores Need for Quality Metrics to Measure Overuse of Care

Although rapid X-rays or other imaging for uncomplicated low-back pain are rarely indicated, almost 1 in 3 elderly Medicare patients received imaging services within a month of low-back pain diagnosis, according to a study by researchers at HSC in the May 25 Archives of Internal Medicine.

The Dollars and Sense of Prevention: A Primer for Health Policy Makers

Registration is now open for HSC's June 8, 2009, conference titled "The Dollars and Sense of Prevention: A Primer for Health Policy Makers."

Coordination of Care by Primary Care Practices

Despite wide recognition that the fragmented U.S. health care system does a poor job of coordinating patients' care, little information is available about how physicians can improve care coordination, both within and across practices and care settings, according to a study released today by HSC.

General Hospitals, Specialty Hospitals and Financially Vulnerable Patients

Despite initial challenges recruiting staff and maintaining service volume and patient referrals, general hospitals were generally able to respond to the initial entry of specialty hospitals with few, if any, changes in the provision of care for financially vulnerable patients, according to a study by HSC of three markets with established specialty hospitals—Indianapolis, Phoenix and Little Rock, Ark.

Two-Thirds of Primary Care Physicians Can't Get Mental Health Services for Patients

About two-thirds of U.S. primary care physicians reported in 2004-05 that they couldn’t get outpatient mental health services for their patients—a rate that was at least twice as high as for other services, according to a national study published today as a Web Exclusive in the journal Health Affairs.

Financial and Health Burdens of Chronic Disease Grow

Almost three in 10 working-age Americans with diabetes, asthma, depression or other chronic conditions lived in families with problems paying medical bills in 2007—a significant increase from two in 10 in 2003, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation.

Ginsburg Testifies at House Energy and Commmerce Health Panel on Transparency

Despite well-intentioned efforts in recent years by government, employers, health plans and others to foster health care price and quality transparency, most Americans still choose doctors and hospitals the old-fashioned way—they rely on recommendations from friends and families and physicians, economist Paul Ginsburg, Ph.D., president of HSC, told Congress today.

Preventing and Managing Chronic Conditions: What’s Working in the Real World?

Innovative approaches to promote wellness and manage chronic conditions will be the focus of a Center for Studying Health System Change (HSC) conference on April 8—the second of four HSC conferences on significant health policy topics sponsored by the Pharmaceutical Research and Manufacturers of America (PhRMA), DMAA: The Care Continuum Alliance and the American College of Preventive Medicine.

Insurer Personal Health Records: Can They Bridge the Information Gap?

While many major health insurers have created personal health records (PHRs) to allow enrollees to electronically store and organize their health care information, whether patients and physicians will embrace the new electronic tool remains an open question, according to an HSC study published today in the journal Health Affairs.

Access to Prescription Drugs for Medicare Beneficiaries

The introduction of the outpatient Medicare drug benefit in 2006 did little to close longstanding prescription drug access gaps between white and African-American seniors, healthier and sicker beneficiaries, and lower-income and higher-income beneficiaries, according to a national study released today HSC.

Care Coordination Daunting for Physicians

Illustrating the formidable task of coordinating care, a typical primary care physician who treats elderly Medicare patients must coordinate care with 229 other physicians working in 117 different practices, according to a study by researchers at HSC, Memorial Sloan-Kettering Cancer Center and the Dana-Farber Cancer Institute in the Feb. 17 Annals of Internal Medicine. A related editorial is also available.

Consumer-Directed Health Care: Promise and Performance

The performance of consumer-driven health care has fallen short of both the aspirations of its proponents and the fears of its critics, according to a study released today as a Web exclusive in the journal Health Affairs. Growth of the organizational forms favored by advocates of consumer-driven health care, such as high-deductible health plans and individually purchased insurance, has been anemic.

Access to Prescription Drugs Declines Among Nonelderly Americans

The proportion of children and working-age Americans who went without a prescription drug because of cost jumped to one in seven in 2007, up from one in 10 in 2003, according to a national study released today be HSC and funded by the Robert Wood Johnson Foundation.

Studies Examine Patient Trust in Physicians and Patient Views of Care Coordination

Patients with high medical costs are less likely to trust that their physician will put their interests first, while less than half of patients reported that their primary care physician always seemed informed about specialist care received, according to two studies by the Center for Studying Health System Change (HSC) published online in The Journal of General Internal Medicine.

Living on the Edge: Health Care Expenses Strain Family Budgets

Financial pressures on families from medical bills increase sharply when out-of-pocket spending for medical care exceeds 2.5 percent of family income, according to a new national study by HSC.

American Families' Use of Retail-Based Health Clinics Remains Modest

Despite rapid growth of retail clinics, only a tiny fraction of American families in 2007 had ever used the in-store clinics, typically located in pharmacies, supermarkets and big-box retailers, according to a national study released today by the Commonwealth Fund and conducted by HSC.

Making Medical Homes Work: Moving from Concept to Practice

Key operational issues facing medical home initiatives include how to qualify physician practices as medical homes; how to match patients to their medical homes; how to engage patients and other providers to work with medical homes in care coordination; and how to pay practices that serve as medical homes, according to a new Policy Perspective from researchers at the Center for Studying Health System Change (HSC) and Mathematica Policy Research (MPR).

Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

Despite myriad initiatives to encourage people to use health care price and quality information, most Americans still rely on word-of-mouth and physician recommendations to choose health providers, according to a new HSC study funded by the California HealthCare Foundation.

The Fraying Link Between Work and Health Insurance

Most nonelderly Americans still obtain health insurance coverage through an employer, but the percentage of nonelderly persons with employer-sponsored insurance coverage has declined steadily since 2000, according to a study released today by the Kaiser Family Foundation (KFF). The research, conducted by HSC Senior Fellow Peter J. Cunningham, Ph.D., and KFF Senior Policy Analysts Samantha Artiga and Karyn Schwartz, examines the factors driving the decrease in employer-sponsored insurance since 2000.

Medicaid Payment Delays Deter Physician Participation

Although low fees discourage physicians from treating Medicaid patients, payment delays also play an important role in physician decisions to avoid Medicaid patients, according to an HSC study published as a Web exclusive in the journal Health Affairs.

Massachusetts Health Reform: High Costs and Expanding Expectations May Weaken Employer Support

While employer support was key to enacting Massachusetts' landmark law to gain near-universal health coverage, high costs and expanding expectations may dampen employer support as the reform plays out, according to a new study by HSC.

How Engaged Are American Consumers in Their Health and Health Care?

The level of patient activation—a person's ability to manage their health and health care—varies considerably in the U.S. population, with less than half of adults (41.4%) at the highest level, according to a new national study by HSC.

High and Rising Health Care Costs: Demystifying U.S. Health Care Spending

Concern about high and rising health care costs in the U.S. has increased sharply in recent years. With the increase in costs and the lack of affordability of health insurance for many Americans, health policy experts are discussing whether steps can be taken to expand insurance coverage while keeping costs down. The Robert Wood Johnson Foundation today released a report written by HSC President Paul B. Ginsburg, Ph.D., that synthesizes research on health care costs.

Problems Paying Medical Bills Increase for U.S. Families Between 2003 and 2007

The proportion of Americans in families with problems paying medical bills increased to 19.4 percent in 2007, up from 15.1 percent in 2003, according to a new national study released today by HSC and funded by The Commonwealth Fund.

The growth translates to more than 57 million Americans in families with medical bill problems in 2007—an increase of 14 million people since 2003.

Hospitals Cautious in Helping Physicians Purchase Electronic Medical Records

Despite regulatory changes allowing hospitals to help physicians purchase electronic medical records (EMRs), hospitals are proceeding cautiously, according to a study released today by HSC.

Three HSC Studies Appear in September/October Health Affairs

Studies from the Center for Studying Health System Change (HSC) in the September/October edition of Health Affairs explore the impact of hospitalists on care coordination, the current state of hospital-physician relations and the transition from managed care to consumerism at the community level.

Health Plans Ramp Up Hospital-Physician Price and Quality Transparency Tools

While health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study released today by HSC.

Ginsburg Named Among 100 Most Powerful in Health Care

HSC President Paul B. Ginsburg was named to Modern Healthcare's 100 Most Powerful in Health Care list. To view the complete list click here.

More Americans Seeking Health Information, Especially on the Internet

In 2007, 56 percent of American adults—more than 122 million people—sought information about a personal health concern from a source other than their doctor, up from 38 percent, or 72 million people, in 2001, according to a national study released today by HSC.

Safety-Net Providers Caught in the Competitive Crossfire

As private physicians and hospitals shed unprofitable patients and services, safety net providers are balancing their mission to serve the needy with steps to attract higher-paying patients to shore up their margins, according to a study by HSC published today as a Web Exclusive in the journal Health Affairs.

Rising Rates of Chronic Health Conditions: What Can Be Done?

HSC held its Rising Rates of Chronic Conditions: What Can Be Done? conference on July 31, 2008. A transcript of the conference is now available.

Community Efforts to Expand Dental Services for Low-Income People

Recognizing the difficulties low-income people face in getting dental care, many communities are attempting to provide more dental services to vulnerable residents, according to a study released today by the Center for Studying Health System Change (HSC).

HSC's Wall Street Comes to Washington Conference

HSC held its 13th annual Wall Street Comes to Washington Conference on July 9, 2008. A transcript of the conference is now available. A webcast of the conference is also available, courtesy of kaisernetwork.org.

Innovations Lacking in Provider Payment Reform for Chronic Disease Care

Despite wide recognition that existing physician and hospital payment methods do not foster high-quality and efficient care for people with chronic conditions, little innovation in provider payment strategies is occurring, according to a new study by HSC commissioned by the California HealthCare Foundation.

Americans' Access to Medical Care Deteriorates, 2003-2007

More than 20 percent of the U.S. population in 2007—one in five people—reported not getting or delaying needed medical care in the previous 12 months, up significantly from 14 percent—one in seven people—in 2003, according to a national study released today by HSC.

Progress on Health System Disaster Surge Capacity at Risk

Communities fear waning attention to health system surge capacity—the space, supplies, people and command structure to care for many injured or ill people—could jeopardize progress to respond in a terrorist attack, natural disaster or infectious disease pandemic, according to a study released today by HSC.

Employers and Health Plans Bet on Health and Wellness Initiatives to Stem Costs

Health plan initiatives to promote health and wellness among workers are now commonplace, despite an acknowledged lack of evidence of an investment payoff, according to a study released today by HSC.

Ginsburg Testifies Before U.S. Senate Finance Committee

How the United States finances health care and our pervasive unwillingness to confront the difficult trade-offs inherent in containing costs, improving quality and expanding coverage contribute to the seemingly intractable problem of stemming rising health care costs, HSC President Paul Ginsburg told the U.S. Senate Finance Committee today.

Caution Urged Before Abandoning Employer Health Coverage in Favor of Individual Coverage

In an article published in the May/June Health Affairs, HSC President Paul B. Ginsburg, Ph.D., discusses the advantages and shortcomings of employer-based health coverage, how individual health insurance could be a viable alternative to employer-based coverage, and why care should be taken not to undermine employers’ role in providing coverage.

Safety Net Emergency Departments: Creating Safety Valves for Non-Urgent Care

Faced with more patients seeking care for non-emergencies, safety net hospital emergency departments are working to redirect patients to outpatient clinics, community health centers and private physicians, with varied results, according to a study released today by HSC.

Racial and Ethnic Health Disparities Linked to Physician Practice Resources

Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients and receive lower private insurance payments, according to a national study funded by the Commonwealth Fund and published today as a Web exclusive in the journal Health Affairs.

Public Health Workforce Shortages Imperil the Nation's Health

As the post-9/11 spotlight on shoring up the nation's public health system fades, local health departments face a mounting workforce crisis as they struggle to recruit, train and retain qualified workers ranging from nurses to epidemiologists, according to a study released today by HSC.

Ginsburg Presentation: Health Care Costs 101

HSC President Paul B. Ginsburg, Ph.D., delivered a presentation titled "Health Care Costs 101" at the Association of Health Care Journalists annual meeting in Washington, D.C. Click here to access the slides used in the presentation.

Lots of Window Shopping, But Modest Consumer-Driven Health Plan Adoption

While adoption of high-deductible health plans coupled with spending accounts remains modest, supporters believe consumer-directed health plans will take hold as part of a larger employer strategy to confer more responsibility on workers for health care costs, lifestyle choices and treatment decisions, according to a new study released by HSC.

Demands on Nurses Grow as Hospital Quality Improvement Activities Increase

Hospitals face growing tensions and trade-offs when allocating nurses between the competing priorities of direct patient care and quality improvement efforts, according to a new study by HSC.

Milbank Quarterly Article Examines Decline in Physician Charity Care

Changes in physicians' income, practice ownership and practice size play a large role in their decisions to start or stop treating charity care and Medicaid patients, according to an HSC study published in the March edition of the Milbank Quarterly.

Connecting the Electronic Dots Among Disparate Health Providers

Barriers to sharing patient clinical data electronically among rival hospitals, doctors and health plans remain high as concerns about loss of competitive advantage and data misuse hamper participation in local health information exchanges, according to a new study released by HSC and the National Institute for Health Care Management Foundation.

Rapid Growth Prompts Health Plans to Target Advanced Imaging Services

Faced with double-digit annual increases in the use of advanced imaging services, such as CT and PET scans, health plans are stepping up efforts to slow the proliferation of advanced imaging services, according to a new study by HSC.

Missing Price Information Hampers Usefulness of State Prescription Drug Web Sites

Extensive gaps in price information seriously hamper the effectiveness of state drug price comparison Web sites, according to a study released today by HSC.

State Budget Cycles Hinder Health Care Safety Net Stability

The sensitivity of state budgets to economic cycles contributes to instability in public health insurance eligibility, benefits and provider payments, as well as support for safety net hospitals and community health centers, according to a study released today by HSC.

HSC Researchers Win ACHE Award

HSC Consulting Researchers Robert Berenson, M.D., and Thomas Bodenheimer, M.D., and HSC Senior Researcher Mai Pham, M.D., have been named the winners of the American College of Healthcare Executives 2008 Dean Conley Award for their article "Specialty-Services Lines: Salvos in the New Medical Arms Race," published in the July/August 2006 edition of Health Affairs.

Higher Costs and Stagnant Incomes Increase Financial Burden of Health Care

Rising out-of-pocket expenses and stagnant incomes increased the financial burden of health care for more Americans between 2001 and 2004, especially for the privately insured, according to a national study supported in part by the Commonwealth Fund and published in the January/February edition of Health Affairs.

Don't Break Out the Champagne: Slowdown in Health Spending Growth Unlikely to Last

The continued slowdown in personal health care spending growth in 2006 reported by government economists is unlikely to last, according to a perspective by HSC President Paul B. Ginsburg, Ph.D., published in the January/February Health Affairs.

Community Health Centers Adapt to Increased Demand for Care

Despite significant federal funding increases, community health centers—the backbone of the nation's safety net—are struggling to meet rising demand for care, particularly for specialty medical, dental and mental health services, according to a new study released by HSC.

Communities Struggle with High Medical Cost Burdens

The number of people with high medical cost burdens varies widely across the nation, reflecting differences in the number of both uninsured and underinsured people. Those states with the largest numbers of individuals with high medical expense face numerous difficulties in achieving affordable coverage, and lack of action at the federal level has driven many to undertake their own heath care reform efforts. Reliance on state efforts alone, however, is unlikely to lead to major national expansions in coverage and will not alleviate persistently high degrees of medical cost variation across the country, according to a report by an HSC researcher released today by The Commonwealth Fund.

Hospital Emergency On-Call Coverage: Is There a Doctor in the House?

As emergency departments face ever-rising demands, hospitals are confronting greater problems obtaining emergency on-call coverage from specialist physicians, according to study released today by HSC.

Why Do Hispanics Have So Little Employer-Sponsored Health Insurance

Poor education, lack of citizenship and the inability to speak English—all more common among Spanish-speaking Hispanics—result in lower wages and fewer jobs that offer health insurance, according to an article by HSC researchers in the fall edition of the journal Inquiry.

Unhealthy Trends: The Future of Physician Services

Left unchecked, most trends in how physicians organize and practice medicine are likely to lead to higher spending and declining access to care for lower-income people, according to an article by HSC researchers in the November/December edition of Health Affairs

Health Care Cost and Access Challenges Persist Across the Country

Little has changed in local health care markets since 2005 to break the cycle of rising costs, declining insurance coverage and widening access inequities, according to initial findings from HSC's 2007 site visits to 12 nationally representative metropolitan communities.

A conference was held today for the release of this Issue Brief. A webcast and transcript of the conference are now available. Links to both are available below.

Variation in Clinical IT Across Physician Specialties

While practice setting and size are the strongest predictors of physicians' access to clinical information technology (IT) in their practices, significant variation in IT adoption exists across specialties, according to a national study released today by HSC.

Insurance-Related and Racial/Ethnic Disparities in Access to Care

Health surveys have shown that the uninsured and racial/ethnic minorities are more likely than privately insured and whites to report unmet medical needs. Among 15 symptoms that medical doctors believe should prompt people to seek care—such as shortness of breath, chest pain, persistent headache or loss of consciousness—80 percent of uninsured did not obtain care, compared to 52 percent of privately insured and 39 percent of Medicare beneficiaries, according to a study by HSC researchers in the September edition of the journal Medical Care. In addition, Hispanics were less likely than whites to get the care they need. Findings also show that differences in perceived need for care among insured and racial/ethnic groups did not explain access disparities.

Proportion of Physicians in Solo/Two-Physician Practices Drops

The proportion of physicians in solo and two-physician practices decreased significantly from 40.7 percent in 1996-97 to 32.5 percent in 2004-05, according to a new national study released today by HSC.

Despite the shift away from the smallest practices, physicians are not moving to multispecialty practices, the study found. The proportion of physicians in multispecialty practices decreased from 30.9 percent to 27.5 percent between 1998-99 and 2004-05. Some experts believe that large, multispecialty practices, which combine primary care physicians and a range of specialists in the same practice, are the organizational structure with the greatest potential to provide consistently high-quality care.

Affordability Remains a Key Concern in Massachusetts Health Reform

As Massachusetts' landmark effort to reach nearly universal health coverage continues, affordability of coverage remains a key concern for individuals and small employers, according to a study released today by HSC.

Health Affairs Article Details Care Redesign at Seattle Medical Center

The tale of one Seattle medical center's quest to improve care and reduce costs illustrates the obstacles physicians face in practicing more efficiently under a fee-for-service payment system that overpays for some medical services and underpays for others, according to a study by researchers at HSC published today as a Web Exclusive in the journal Health Affairs. An accompanying HSC Issue Brief on this topic was also releasaed today.

Exodus of Men from Primary Care Drives Shift To Medical-Specialty Practice

An exodus of men from primary care practice is driving a marked shift in the physician workforce toward such specialties as cardiology and dermatology, reinforcing concerns about a looming shortage of primary care physicians, according to a new national study released today by HSC.

HSC's Wall Street Comes to Washington Conference

HSC's 12th annual Wall Street Comes to Washington conference was held on Thursday, June 14. A transcript of the conference is now available, as well as a webcast, courtesy of Kaisernetwork.org.

Potentially Avoidable Hospitalizations of Medicare Patients

Elderly Medicare patients at high risk for hospitalization for two common conditions—bacterial pneumonia and chronic obstructive pulmonary disease (COPD)—were more likely to stay out of the hospital if treated by experienced physicians, according to a study by researchers at HSC and Memorial Sloan-Kettering Cancer Center (MSKCC) in the June edition of the journal Medical Care.

But patients of physicians reporting more difficulty accessing ancillary services for patients—for example, home oxygen or respiratory therapy—and physicians treating more poor patients were at higher risk of hospitalization for both conditions, the study found.

High-Performance Health Plan Networks: Early Experiences

Despite broad interest among employers and health plans, a nascent move to steer patients to physician specialists who score well on efficiency and quality measures is off to a slow start, according to a study by HSC.

HSC Researcher Testifies on Health Plan Care Management Activities

HSC Associate Director Debra Draper, Ph.D., testified on commercial health plans' care management activities and the impact on costs, quality and outcomes at a Senate Finance Committee hearing on the Medicare Advantage program.

Many Physicians Don't Routinely Consider Insured Patients' Out-of-Pocket Costs

Increased patient cost sharing is likely to miss the mark in safely reducing health care spending because many physicians do not routinely consider insured patients’ out-of-pocket costs when recommending expensive medical care, according to a study by researchers at HSC and the University of Chicago Hospitals in the April 9 Archives of Internal Medicine.

Wide Gap Between Vision for E-Prescribing and Reality in Physician Offices

While physicians who have embraced e-prescribing wouldn't go back to paper prescriptions, they report major barriers to using advanced e-prescribing features that many advocates believe offer the greatest potential to improve the safety and quality of health care, according to a study by HSC researchers published today as a Web exclusive in the journal Health Affairs.

Consumer Tolerance for Inaccuracy in Physician Performance Ratings

While consumer tolerance for inaccurate physician performance ratings varies widely, more than one-third of Americans believe such ratings should be no more than 5 percent inaccurate, according to a national study released today by HSC.

Use of Clinical Practice Guidelines by Physicians Grows

The proportion of primary care physicians reporting that clinical practice guidelines had a very large or large effect on their practice increased significantly from 1997 to 2005, from 16.4 percent to 38.7 percent, according to a study by HSC ressearchers published in the Journal of General Internal Medicine.

Revising Medicare's Physician Fee Schedule—Much Activity, Little Change

Without an effective way to track changes in medical practice and physician productivity, the underlying structure of Medicare’s physician fee schedule has defied gravity, generally rewarding specialty procedures at the expense of primary care services, according to a perspective by economist Paul B. Ginsburg, Ph.D., and Robert Berenson, M.D. in the March 22 New England Journal of Medicine.

Care Patterns in Medicare and Their Implications for Pay for Performance

Medicare beneficiaries' care is spread over so many physicians that determining which physician should qualify for additional payment is a moving target under current pay-for-performance (P4P) designs, according to a study by researchers at the Center for Studying Health System Change (HSC) and Memorial Sloan-Kettering Cancer Center in the March 15 New England Journal of Medicine.

Restoring Fiscal Sanity 2007: The Health Spending Challenge

HSC President Paul B. Ginsburg explores the role of private payers in moving toward more efficient health spending in a chapter in the just-released Brookings Institution book, Restoring Fiscal Sanity 2007: The Health Spending Challenge, edited by Alice Rivlin and Joseph Antos.

Ginsburg to Serve on CBO Panel of Health Advisers

HSC President Paul B. Ginsburg will serve as a member of the Congressional Budget Office's newly formed Panel of Health Advisers. Panel members will meet periodically to examine research in health policy and advise the agency on its analyses of health care issues.

Benefit Design Innovations: Implications for Consumer-Directed Health Care

Current health insurance benefit designs that simply rely on higher, one-size-fits-all patient cost sharing have limited potential to curb rising costs, but innovations in benefit design can potentially make cost sharing a more effective tool, according to a study released today by HSC.

Self-Pay Markets in Health Care: Consumer Nirvana or Caveat Emptor?

Even when patients must pay the full cost of medical care out of pocket, there's limited comparison shopping for the lowest-price, highest-quality care, according to a study by HSC researchers published as a Web exclusive in the journal Health Affairs. In an accompanying article, HSC President Paul Ginsburg, Ph.D., points out that current efforts to increase price transparency for health care services often downplay complex decisions about medical care, patients' dependence on physicians for guidance and the need for information on quality.

Quality-Based Physician Incentives Up Slightly, but Productivity Incentives Still Dominate

While the proportion of physicians in group practice whose compensation is based in part on quality measures increased from 17.6 percent in 2000-01 to 20.2 percent in 2004-05, far more physicians face financial incentives tied to individual productivity, according to a national study released today by HSC.

GAO Analyst Joins HSC as Health Researcher

Ann C. Tynan, M.P.H., previously a senior health policy analyst at the U.S. Government Accountability Office (GAO), has joined the Center for Studying Health System Change (HSC) as a health researcher.

Hospital-Physician Rift Leads to Medical Arms Race

Deteriorating relations between hospitals and physicians are imperiling a wide range of health care objectives—including adoption of information technology, the implementation of pay-for-performance programs and care for the uninsured—HSC researchers reported in a Health Affairs Web exclusive published today.

4 in 10 Workers in Consumer-Directed Health Plans Lack Choice

While consumer-directed health plan proponents often assert that the high-deductible plans linked to savings accounts offer enrollees greater choice and autonomy in the health care marketplace, 39 percent of the estimated 2.7 million workers enrolled in employer-sponsored CDHPs had no choice of another type of health plan in 2006, according to a national study released HSC.

Recalibrating Medicare Payments for Inpatient Care

Small but important steps to improve the accuracy of Medicare inpatient hospital payment rates could help stem a growing medical arms race, but policy makers will need to follow through in the coming years with more comprehensive reforms, according to a perspective by economist Paul B. Ginsburg, Ph.D., in the Nov. 16 New England Journal of Medicine.

Employers View Health Benefits as an Important Recruitment and Retention Tool

Despite intense health care cost pressures, firms covering more than 90 percent of the nation's workforce view health benefits as an important tool to attract and retain qualified workers, according to a national study by researchers at HSC and the Commonwealth Fund published in the November/December edition of Health Affairs.

The Role of Competition in Driving Clinical Data Exchange

Recent policy efforts to encourage the use of health information technology are emphasizing development of communitywide health information exchanges to share clinical data across patient care settings. The study—published in the November/December edition of Health Affairs—found that most large hospitals have or are developing physician portals to provide admitting physicians with remote access to patient records, but there is little data sharing among unaffiliated organizations. Competition among hospitals for physicians is a key factor driving adoption of these proprietary systems. In contrast, provider and health plan competition and adversarial relationships between providers and plans are viewed as major barriers to communitywide clinical data sharing.

Safety Net Expansions and Racial/Ethnic Disparities

This study—published in the November/December edition of Health Affairs—explores whether increased community health center (CHC) funding under the Bush administration narrowed racial/ethnic gaps in access to care among low-income people.

Clinical IT Gaps Persist Between Small and Large Physician Practices

Physicians in smaller practices continue to lag well behind physicians in larger practices in reporting the availability of clinical information technology (IT) in their offices. The proportion of physicians reporting access to IT for each of five clinical activities increased across all practice settings between 2000-01 and 2004-05. However, adoption gaps between small and large practices persisted for two of the clinical activities—obtaining treatment guidelines and exchanging clinical data with other physicians—and widened for the other three—accessing patient notes, generating preventive care reminders and writing prescriptions

University of Michigan Physician Joins HSC as Senior Researcher

Matthew M. Davis, M.D., M.A.P.P., associate professor of pediatrics, internal medicine and public policy at the University of Michigan, has joined HSC as a part-time senior health researcher.

Health Care Spending Growth Stays High in 2005

Health care spending growth stayed in a high-altitude holding pattern in 2005 as costs per privately insured American grew 7.4 percent -—virtually the same rate of increase as the previous two years, according to anHSC published today as a Web Exclusive in Health Affairs.

Physician-Patient E-mail Disconnect

Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to a national study released today by HSC.

Health Plan Pay-for-Performance Strategies

In a quest to reduce costs, improve quality and increase hospital and physician efficiency, most health plans in 12 communities across the country are adopting pay-for-performance (P4P) programs that tie financial incentives to improved provider performance, according to a study by HSC researchers in the September edition of The American Journal of Managed Care.

The Impact of Quality-Reporting Programs on Hospital Operations

While reporting programs have raised the profile of hospital quality measurement and improvement in 12 communities across the country, lack of coordination among reporting programs and inadequate resources hinder efforts to improve patient care, according to a study by HSC researchers published in Health Affairs.

CTSonline Updated with 2004-05 Physician Survey Results

Want to find out how many hours of charity care physicians typically provide? Or whether doctors believe they can spend enough time with their patients? How about the percentage of physicians earning more than $300,000 a year? Answers to these questions and many others are available through HSC's CTSonline, which was recently updated with results from the 2004-05 Community Tracking Study (CTS) Physician Survey.

Debra Draper Joins HSC as Director of Site Visits and Senior Researcher

Debra A. Draper, Ph.D., M.S.H.A., assistant director of the health care team at the U.S. Government Accountability Office (GAO), has joined HSC as director of site visits and senior researcher.

Medicaid Patients Increasingly Concentrated Among Physicians

Despite increases in Medicaid payment rates and enrollment, the proportion of U.S. physicians accepting Medicaid patients has decreased slightly over the past decade, according to a national study released today by HSC.

Immunization Disparities in Older Americans

Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive vaccinations, according to an HSC study published in the August edition of the American Journal of Preventive Medicine.

Specialty-Service Lines: Salvos in the New Medical Arms Race

The proliferation of heart institutes, cancer centers, orthopedic hospitals and other niche specialty centers signals an escalation in a new medical arms race as hospitals and physicians develop and market profitable specialty-service lines, according to a study by Center for Studying Health System Change (HSC) researchers published today as a Web Exclusive in the journal Health Affairs.

Hospital Emergency Department Use Varies Greatly Across the U.S.

Contrary to popular belief, communities with high levels of uninsured, Hispanic or immigrant residents generally have much lower rates of per person hospital emergency department use than other communities, according to a study by HSC published today as a Web exclusive in the journal Health Affairs.

Bioterrorism Preparedness Efforts Strengthen Public Health Capabilities

National initiatives to improve bioterrorism preparedness have strengthened communities' overall public health readiness, but concerns remain about hospitals' ability to handle a sudden surge of patients during an emergency, according to a study by HSC researchers in the July/August edition of the journal Health Affairs.

Hospital Steps Ease Nurse Shortage in Near Term but Long-Term Worries Persist

While many hospitals in 12 communities across the country report that short-term measures, such as higher pay and temporary staff, have helped ease nurse staffing shortages, serious doubts remain about hospitals’ ability to meet future nursing needs, according to a study by Center for Studying Health System Change researchers (HSC) published today as a Web Exclusive in the journal Health Affairs.

Wall Street Comes to Washington Conference

HSC held its eleventh annual Wall Street Comes to Washington conference in Washington, D.C., on June 21. A transcript of the meeting is now available, as well as a webcast at kaisernetwork.org.

Physicians Lose Ground in Real Income Between 1995 and 2003

In sharp contrast to other professionals, physicians' net income from the practice of medicine declined about 7 percent between 1995 and 2003 after adjusting for inflation, according to a new national study by HSC.

Physician Access to Clinical Information Technology Grows

Physician access to practice-based clinical information technology (IT) grew significantly between 2000-01 and 2004-05, according to a national study released today by HSC.

HSC's Cunningham Wins NIHCM Research Award

HSC Senior Researcher Peter Cunningham, Ph.D., has won the National Institute for Health Care Management Foundation's (NIHCM) 2006 research award for excellence in original and creative health care research. Cunningham and coauthor Len Nichols, Ph.D., formerly HSC's vice president and now with the New America Foundation, were recognized for an article published in the December 2005 edition of Medical Care Research & Review—"The Effects of Medicaid Reimbursement on Access to Care of Medicaid Enrollees: A Community Perspective."

Congressional Testimony: Consumer Information on Health Care Cost and Quality

Better consumer information about health care costs, quality and treatment alternatives could help stem rapidly rising health costs, but some are overselling the potential of consumer empowerment to reshape the health care system, economist Paul Ginsburg, Ph.D., HSC president, told a congressional committee today.

Five HSC Studies Appear in May/June Health Affairs

Five studies from the Center for Studying Health System Change (HSC) appear in the May/June edition of Health Affairs, on topics ranging from the hospital building boom to care for the seriously mentally ill to local market perspectives on consumer-driven health plans.

Proportion of U.S. Physicians Without Managed Care Contracts Ticks Up

After remaining stable since the mid-1990s, the proportion of U.S. physicians without any managed care contracts rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study released today by HSC.

Community Safety Nets and Prescription Drug Access for Uninsured People

As the number of uninsured Americans increases, community safety net providers are stretching limited resources to meet growing prescription drug needs for low-income, uninsured people under age 65, according to a new HSC study.

Public Employee Health Benefits Weather Rising Costs and Tight Budgets

Generous public employee health benefits have survived major threats so far, but the growing gap between public- and private-sector benefits, coupled with new accounting rules for government agencies, could force public officials to make more far-reaching benefit changes, according to a HSC study published today as a Web exclusive in the journal Health Affairs.

Community Approaches to Caring for Uninsured People

Faced with rising uninsurance rates and little response from state and federal governments, local communities have developed a range of approaches to provide care to uninsured people, according to a study by HSC published today as a Web-exclusive in the journal Health Affairs.

Population Aging Plays Small Role in Growing Demand for Hospital Services

While the aging of the baby boomers is an oft-cited justification for the sharp increase in U.S. hospital construction, population aging will play a relatively small role in rising demand for inpatient hospital care over the next decade, according to an HSC study published today as a Web exclusive in the journal Health Affairs.

U.S. Physician Charity Care Continues Decade-Long Decline

The proportion of U.S. physicians providing charity care dropped 8 percentage points in the last decade, falling to 68 percent of physicians in 2004-05 from 76 percent in 1996-97, according to a national study released today by HSC.

Reflections on a Decade of Tracking Health System Change

Despite a decade of tumultuous change, the perennial problems of high costs, uneven quality and inequitable access continue to plague the U.S. health care system, according to a commentary published today by HSC.

Testimony: Consumer Price Shopping

HSC President Paul Ginsburg testified today before the House Committee on Energy and Commerce Subcommittee on Health on consumer price shopping in health care. Ginsburg testified that fostering consumer price shopping for health services can potentially help contain costs but cautioned that some are overselling the magnitude this potential.

Specialty Hospitals, Price Competition and the Medical Arms Race

Purchasers in three communities with significant specialty hospital development—Indianapolis, Little Rock and Phoenix—generally believe specialty hospitals are contributing to a medical arms race that is driving up costs without demonstrating clear quality advantages, according to a HSC study.

HSC Receives First Annual Health Services Research Impact Award

HSC is one of two teams to be awarded AcademyHealth's first annual Health Services Research (HSR) Impact Award for research examining the rapid growth of specialty hospitals. The award recognizes outstanding research that has been successfully translated into health policy, management or clinical practice.

Two HSC Studies Published in Health Affairs

Two studies by HSC researchers—one on the impact of Medicaid/SCHIP cuts on emergency department use, and the other on hospital payment issues—were published in the January/February edition of Health Affairs

Vast Majority of Physicians Still Welcome Medicare Patients

Despite an earlier payment cut, the proportion of U.S. physicians willing to treat Medicare patients stabilized in 2004-05, with nearly three-quarters reporting their practices were open to all new Medicare patients, according to a national study released today by HSC.

High Costs, More Uninsured and Malpractice Insurance Woes Stress Miami

Exceptionally high health care costs, low levels of health insurance coverage and a difficult medical malpractice insurance environment for physicians and hospitals continue to stress the Miami health care market, according to a new Community Report released today by HSC.

Slow Start for Physician Pay for Performance (P4P) in Many Communities

Despite the national buzz about the potential of offering financial rewards to physicians to improve patient care, pay-for-performance (P4P) initiatives are still on the drawing board in many local communities, according to a study released today by HSC.

Economic Disparities Drive Widening Rift in Health Care Access and Quality

As health care gobbles up an ever-larger share of the U.S. economy, the inability or unwillingness to ensure equal access to high-quality health care is fueling a widening rift between rich and poor Americans, according to a study by HSC published today as a Web-exclusive article in the journal Health Affairs.

Dec. 2 Conference Webcast Now Available

The Transformation of Competition in Health Care conference—cosponsored by HSC, Health Affairs and the Kaiser Permanente Institute for Health Policy—was held on Dec. 2. A Webcast of the conference is now available, courtesy of kaisernetwork.org.

Effects of Medicaid Reimbursement on the Access to Care of Medicaid Enrollees

Higher Medicaid reimbursement rates increase the number of physicians in a community that accept Medicaid patients. And higher Medicaid acceptance rates by physicians increase the likelihood of Medicaid patients having a usual source of care and reduce unmet medical needs and emergency department use, according to an article by Peter Cunningham, HSC senior researcher, in the December edition of Medical Care Research and Review.

Influence of Blue Cross Blue Shield Grows in Boston

Blue Cross Blue Shield of Massachusetts’ growing ascendance is felt across the Boston health care market, influencing nearly all aspects of the marketplace from provider contract negotiations to state-level policy deliberations, according to a new Community Report released today by HSC.

Growing Pressures Converge in Hospital Emergency Departments

Converging pressures in hospital emergency departments (EDs)—ranging from persuading specialists to provide on-call coverage to dealing with growing numbers of patients with serious mental illness—have the potential to compromise access to emergency care and spur already rapidly rising health care costs.

Population Growth in Greenville Spurs Hospital Competition

The pattern of population growth in the Greenville, S.C., area has led to heightened competition for profitable services among the market's three largest hospital systems, according to a new Community Report released today by HSC.

Ginsburg Article Outlines Health Care Competition in Last Decade

Understanding the roller-coaster experience of market forces in the U.S. health care system in the past decade provides an important context for the role competition is likely to play in shaping health care in the coming years, according to an article by HSC President Paul B. Ginsburg, Ph.D., in the November/December edition of the journal Health Affairs.

Syracuse Confronts Rising Health Care Costs; Hospital Competition Grows

Competition among Syracuse's four hospitals has intensified as Crouse Hospital—the area's largest—strives to regain market share lost during a bankruptcy reorganization, according to a Community Report released today by HSC.

Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care

When confronted with a serious new medical symptom, insured and uninsured people share similar perceptions about the need to see a medical provider, according to a new HSC study. However, among people who believed they needed care, the uninsured were less than half as likely to get care.

Hospitals Alter Billing and Collection Practices for the Uninsured

Many hospitals have adopted more generous charity-care guidelines for uninsured patients after a barrage of publicity about aggressive hospital billing and collection practices and a spate of lawsuits alleging hospitals overcharging uninsured patients, according to an Issue Brief released today by HSC.

Lansing's Economic Doldrums Threaten Broad Health Care Benefits

The languishing economy in Lansing and the rest of Michigan is threatening workers’ broad health benefits and the ability of local and state governments to sustain coverage for low-income people, according to a new HSC Community Report.

Quality Efforts Expand as Seattle Health Plan Products Evolve

In an effort to control health care costs and improve the quality of care, Seattle employers and health plans are pursuing new strategies to directly influence provider quality and efficiency, according to a new Community Report released today by HSC.

Population Growth Continues to Strain Phoenix Health System Capacity

A population boom in Phoenix continues to strain the health system, despite significant recent hospital expansions. Coupled with insufficient emergency department and inpatient capacity, the rapid population growth contributes to frequent ambulance diversions and treatment delays.

2005 Premium Increase Slows but Still Rises Three Times Faster Than Workers’ Wages

HSC Vice President Jon Gabel coauthored two Health Affairs articles based on the Kaiser Family Foundation and Health Research and Educational Trust 2005 Annual Employer Health Benefits Survey. The first article found average premiums for employer-sponsored insurance rose 9.2 percent in 2005, down from 11.2 percent in 2004 and the first single-digit increase since 2000. The second article focuses on the availability, enrollment, premiums and cost sharing for high-deductible health plans offered with health reimbursement arrangements (HRAs) or health savings accounts (HSAs). Both Health Affairs articles are available free at the Kaiser Family Foundation Web site.

Hundreds of Thousands of Medically Vulnerable Children Uninsured

While public health insurance provides a vital safety net to millions of children with special health care needs, ranging from learning disorders to severe disabilities, more than 650,000 of these medically vulnerable children are uninsured, according to a new national study by HSC researchers.

Market Changes Set Stage for Growing Health Care Cost and Access Problems

Fierce competition among hospitals and physicians for profitable specialty services is driving costly inpatient and outpatient expansions, especially in more affluent areas with well-insured populations, according to initial findings from HSC's 2005 site visits to 12 nationally representative communities. A webcast and transcript of the briefing is available at kaisernetwork.org.

Ginsburg Named to Modern Healthcare's Top 100 List

For the third time, HSC President Paul B. Ginsburg made Modern Healthcare's 100 Most Powerful People in Healthcare list at number 21. To find out who else made the list and why, visit Modern Healthcare

Hospital Capacity Constraints Continue to Stress Orange County, Calif.

A number of factors have come together to make hospital capacity constraints more severe in Orange County, Calif., according to a new HSC Community Report.

When the Price Isn't Right: How Inaccurate Payments Drive Expensive Medical Care

Unintentionally inflated prices for certain medical services are spurring intense competition among physicians and hospitals to expand cardiac, orthopedic and high-end imaging services, potentially sparking a powerful new health care cost driver, according to an HSC study published as a Web-exclusive article in the journal Health Affairs.

Urban-Suburban Hospital Disparities Grow in Northern New Jersey

Hospitals and physicians are aggressively expanding capacity to deliver profitable specialty services in suburban areas of northern New Jersey, fueling concerns about health care costs, according to a new HSC Community Report.

Many Elderly Medicare Patients Don't Receive Recommended Preventive Care

Many elderly Medicare patients fail to get routine preventive care, but patients cared for by board-certified physicians in larger practices treating fewer poor patients are more likely to receive cancer screenings and other preventive care, according to a study by researchers at HSC and Memorial Sloan-Kettering Cancer Center in the July 27 Journal of the American Medical Association.

Little Rock Hospitals and Physicians Continue to Vie for Profitable Services

Financial pressures continue to spur competition between Little Rock hospitals and physicians for profitable health care services, especially cardiac and orthopedic care, according to a new HSC Community Report.

Wall Street Comes to Washington Conference

HSC held its tenth annual Wall Street Comes to Washington conference in Washington, D.C., on July 13. A transcript of the meeting is now available, as well as a webcast at kaisernetwork.org.

Access and Quality: Does Rural America Lag Behind?

Access to and quality of medical care generally are equivalent or superior in rural areas compared with urban areas. However, rural residents have greater difficulty obtaining mental health services and generally face greater financial barriers to care, according to an HSC study in the July/August edition of the journal Health Affairs.

Local Market Perspectives on Medicare Advantage Regional Plans

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 established regional preferred provider organizations (PPOs) as a new private-plan option for beneficiaries in the Medicare Advantage program, starting in 2006. An article by HSC researchers in the July/August edition of the journal Health Affairs explores health plan perspectives on offering Medicare Advantage PPOs.

Most Medicare Outpatient Visits to Physicians with Limited Clinical IT

A majority of Medicare fee-for-service outpatient visits in 2001 were to physicians without significant information technology (IT) support for patient care, according to a study released today by HSC.

Hospital Competition Transforms Indianapolis Health Care Market

The building boom that spawned four new heart facilities in Indianapolis two years ago has continued unabated, raising concerns about higher health care costs in an already high-cost market, according to a new Community Report released today by HSC.

Reprieve from Faster-Growing Health Care Spending Stalled in 2004

The reprieve from faster-growing health care costs stalled in 2004 as costs per privately insured American grew 8.2 percent--virtually the same rate of increase as in 2003, according to an HSC study published today as a Web-exclusive article in the journal Health Affairs.

Older Americans Less Willing to Sacrifice Physician-Hospital Choice to Save Costs

Elderly Americans are much less willing than working-age Americans to limit their choice of physicians and hospitals to save on out-of-pocket medical costs. In 2003, only 45 percent of seniors 65 and older were willing to trade broad provider choice to save money, compared with 70 percent of people 18 through 34, according to a new HSC study.

Leadership Changes Reinvigorate Cleveland Health Care Market

New leaders at Cleveland’s two major hospital systems--the Cleveland Clinic Health System (CCHS) and University Hospitals Health System (UHHS)––have helped strengthen the organizations’ financial positions and soothe long-standing rivalries, according to a new Community Report from HSC.

Prescription Drug Affordability Woes Grow for Americans

More Americans—especially those with chronic conditions such as diabetes, asthma and depression—are going without prescription drugs because of cost concerns, according to a new HSC study.

Medicaid Cost Containment and Access to Prescription Drugs

More than one-fifth of all adult Medicaid enrollees in 2003 reported they couldn’t afford to get at least one prescription filled, according to a HSC study published in the May/June edition of the journal Health Affairs.

Americans Reassess Health Care Choice-Cost Trade-offs

More Americans are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs. Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to trade broad choice of providers for lower out-of-pocket costs increased from 55 percent to 59 percent—after the rate had been stable since 1997, according to a new HSC study.

Medicare Seniors’ Access to Physician Care Stabilized between 2001 and 2003

After a significant decline in 2001, Medicare seniors' access to physician services stabilized in 2003. Similar to Medicare seniors, privately insured near-elderly people between the ages of 55 and 64 experienced a spike in access problems in 2001, indicating system-wide capacity constraints were curtailing access to physician services for both groups of patients.

Ten Years of Tracking Health System Change

HSC President Paul Ginsburg moderated a panel discussion on "Ten Years of Tracking Health System Change: The Evolution of Competition" at the AcademyHealth 2005 National Health Policy Conference.

Health Market Changes Spur Use of Hospitalists Across the U.S.

Mounting financial pressures, increasing problems with patient flow in hospitals, a growing focus on patient safety, and rising malpractice costs have spurred the use of a new breed of physicians who specialize in caring for hospitalized patients, according to a study by HSC researchers in the February edition of the Journal of General Internal Medicine

Rural Physician Incomes On Par with Urban Physicians

Lower incomes are an oft-cited obstacle to recruiting rural physicians, but average physician incomes in rural and urban areas do not differ significantly, according to a new HSC study, and after adjusting for cost-of-living differences, rural physicians have 13% more purchasing power.

Physician Researcher Joins HSC

Ann S. O’Malley, M.D., M.P.H., an assistant professor at Georgetown University Medical Center, has joined the Center for Studying Health System Change (HSC) as a senior health researcher.

High Medical Care Costs Prompt Many to Seek Alternatives

Nearly 6 million American adults turned to complementary and alternative medicine in the past year to treat such conditions as depression and chronic pain because conventional medical treatment was too expensive.

Health Care Spending Growth Slowdown Stalls in First Half of 2004

The brief respite from faster-growing health care costs sputtered in the first half of 2004 as health costs per privately insured American grew 7.5 percent—virtually the same rate as in 2003, according to a study released jointly today by HSC and the Employee Benefit Research Institute.

Safety Net Awareness Low Among Uninsured

More than half of all uninsured Americans are unaware of a community safety net provider where they can receive lower-cost, affordable health care, according to a new HSC study.

As the Health Insurance Underwriting Cycle Turns: What Next?

The boom-and-bust pattern in health insurance markets—known as the underwriting cycle—is likely to be more muted in the coming years, reducing premium volatility but possibly leading to higher average premiums, according to a study by HSC researchers published in the November/December edition of the journal Health Affairs.

Health Insurance Gap Persists Among Minorities and White Americans

The health insurance gap among Latino, black and white Americans persisted in 2003, with one in three Latinos, one in five blacks and one in 10 whites under age 65 lacking health insurance, according to a national study released today by HSC.

Controlling Health Care Costs; Both Presidential Candidates Sidestep Issue

While both presidential candidates have served up proposals to ease voter angst about the affordability of health care, neither candidate tackles the core issue of controlling health care cost growth, according to an article by HSC President Paul Ginsburg in the Oct. 14, New England Journal of Medicine.

Safety Net Provider Location and Access to Care for the Uninsured

A new article in the October edition of Health Services Research looks at the link between proximity to a safety net provider and access to care.

Information Technology for Patient Care Varies Across Physician Practices

While there’s wide enthusiasm for harnessing the power of information technology (IT) to improve U.S. medical care, fewer than a quarter of physicians in 2001 could generate electronic treatment reminders for use during patient visits and only about 10 percent could write electronic prescriptions, according to a national study released today by HSC.

Rising Health Costs, Medical Debt and Chronic Conditions

The proportion of low-income, privately insured, working-age Americans with chronic conditions, such as diabetes, asthma or depression, spending more than 5 percent of their incomes on out-of-pocket medical costs jumped from 28 percent to 42 percent between 2001 and 2003, according to a national study released today by HSC.

Rising Health Insurance Costs Key to Decline of Private Coverage for Children

In recent years, rising health insurance costs have likely played a key role in the decline of American children with private health coverage, according to a study by researchers at HSC and the Agency for Healthcare Research and Quality (AHRQ) published in the September/October edition of the journal Health Affairs.

Access to Medical Care Improves for Low-Income Kids and Adults

Despite sluggish economic growth and rapidly rising health care costs, Americans' access to needed medical care improved slightly between 2001 and 2003, especially among low-income children and adults, according to a national study released today by HSC.

Wall Street Comes to Washington

Health care cost trends likely will continue slowing through the end of 2004, but the longer-term outlook for a sustained slowdown largely depends on the strength of the economy, according to market and health policy experts at the Center for Studying Health System Change’s (HSC) ninth annual Wall Street roundtable. An Issue Brief summarizing the analysts' discussion at the June 24 event attended by 200 people is now available.

Managed Care Rebound? Health Plans' Cost Containment Strategies

Responding to rising costs, some health plans are bringing back such unpopular practices as utilization review, increasing out-of-pocket expenses, and steering patients to more cost-effective providers, according to a Web-exclusive article published in Health Affairs

Separate—Perhaps, Unequal? Physicians Treating Black and White Medicare Patients

To a large extent, different groups of physicians treat elderly black and white Medicare patients, providing new insights into possible explanations for the pervasive health disparities between blacks and whites, according to a study by researchers at Memorial Sloan-Kettering Cancer Center and HSC in the Aug. 5 New England Journal of Medicine.

Job Loss, Rising Premiums Take Toll on Employer Health Coverage in 2003

The proportion of Americans under age 65 with employer health coverage fell dramatically from 67 percent in 2001 to 63 percent in 2003, translating into almost 9 million fewer people with employer coverage after accounting for population growth, according to a HSC study.

No Groundswell Yet Among Employers for Consumer-Driven Health Plans

Many employers are skeptical that high-deductible health coverage tied to employer-funded spending accounts—known as consumer-driven health plans—can reduce their health costs, according to a new HSC study.

Medical Debt a Problem for Almost 20 Million American Families

Almost 20 million American families had problems paying medical bills in 2003, forcing many to make tough trade-offs between medical, food and housing expenses, according to a national study by HSC.

Testimony: Health Plan Role in Negotiating Lower Hospital Prices Often Overlooked

Health plans play an important intermediary role between consumers and hospitals by negotiating lower prices for hospital care—not by providing patients with a great deal of price information, but by forming networks of hospitals that have agreed to accept negotiated prices, HSC President Paul Ginsburg, told a congressional committee today.

Low-Income People Face Serious Gaps in Specialty Care

Despite signs that low-income and uninsured people’s access to primary health care services has improved, serious gaps in care exist, especially for specialty physician, mental health and dental care, according to a new HSC study

Health Care Spending Growth Slows in 2003

Health care spending per privately insured American increased 7.4 percent in 2003—the first major slowdown in spending growth in nearly a decade, according to an HSC study published today as a Web-exclusive article in the journal Health Affairs.

Employers Pass the Buck on Rising Health Care Costs

Rather than dramatic health benefit overhauls, most employers have made modest changes, primarily by shifting costs to workers through larger premium contributions or higher out-of-pocket costs to fill a prescription or see a doctor, according to a new HSC study.

Financial Rewards for Higher Quality Care

Health plans increasingly are dangling a carrot—higher payments—to get physicians and hospitals to improve patient care, according to a study released today HSC.

Aid Increased Community Preparedness for Public Health Emergencies

Many U.S. communities are better prepared for public health emergencies since the Sept. 11 terrorist attacks, but weaknesses remain, particularly in communications and information technology (IT) and workforce education and training, according to a study by HSC researchers published in the May/June edition of the journal Health Affairs.

PPOs and Medicare: No Panacea for Cost, Quality Issues

While policy makers hope that private plans—especially preferred provider organizations (PPOs)—can increase benefits, improve quality and slow cost growth in Medicare, Medicare PPOs likely will face serious challenges to achieving these goals.

Federal Aid Strengthens Health Care Safety Net

An infusion of federal funding has helped many communities expand services and strengthen linkages among health care safety net providers.

Health Plans Redeploy Targeted Care Restrictions

Confronted with conflicting pressures to contain costs and provide unfettered access to care, health plans are stepping up scrutiny of some high-cost services while shifting more financial and care management responsibilities to consumers, according to a study released today by HSC.

Confidence Waning in Competition as Health Care System Cure

Confidence in market competition to spur high-quality, affordable health care is waning in communities across the country, according to research by HSC published in the March/April edition of the peer-reviewed journal Health Affairs.

The research is the topic of the HSC/Health Affairs conference held on March 12. A webcast of the conference is now available, courtesy of The Robert Wood Johnson Foundation. A full transcript will be available soon.

Nichols Testifies about 10 Myths of the Uninsured

HSC Vice President Len Nichols testified before the U.S. House Ways and Means health subcommittee about the 10 myths of the uninsured.

Hospital Emergency Department Diversion Crisis Eases

The nationwide surge in emergency department ambulance diversions has eased as hospitals improved capacity management to free up beds and communities increased coordination to prevent diversions, according to a new HSC Issue Brief released today.

Health Insurance Tax Credit Proposals Would Do Little to Increase Coverage

A comparison of out-of-pocket health care spending by lower-income uninsured people with their expected spending if they bought nongroup, or individual, insurance shows that nearly all would spend more—often much more—even with a tax credit to help offset the cost of coverage, according to a study by HSC researchers published today as a Web-exclusive article in the journal Health Affairs.

Leapfrog Patient-Safety Standards a Stretch for Most Hospitals

While the Leapfrog Group’s ambitious campaign to improve patient safety in hospitals has sparked national awareness, few hospitals are close to meeting the group’s standards for computerized prescriptions, specially trained intensive care unit (ICU) physicians and volume thresholds for certain high-risk procedures, according to a new HSC study.

Ginsburg: Prospects for Health Savings Accounts Uncertain

New health savings accounts—as currently configured—are unlikely to be the tonic free-market advocates crave for the U.S. health care system or the poison pill feared by detractors, according to a commentary by Paul Ginsburg in Modern Healthcare magazine.

Blue Plan Conversions and Mergers Likely to Continue

Recent regulatory setbacks have slowed the pace of for-profit conversions and mergers among Blue Cross and Blue Shield health plans, but the trend is likely to resume among the Blues as plans adapt conversion strategies, according to a study released today by HSC.

Patient Cost Sharing Conference Issue Brief

HSC's Patient Cost Sharing: Promises and Pitfalls conference on Dec. 3, 2003, featured presentations and a panel discussion on cost-sharing trends and the implications for consumers. An Issue Brief describing the conference discussion is now available.

Health Plan-Provider Contract Showdowns Simmer Down

With the balance of power having tilted toward hospitals and doctors, hotly contested contract disputes between health plans and providers have cooled down in recent years, according to a study released today by HSC.

Working-Age Minorities Face Greater Prescription Drug Affordability Problems

Working-age African Americans and Latinos—particularly those with chronic conditions such as diabetes and heart disease—are much more likely than white Americans to report they cannot afford all of their prescription drugs, according to a national study released today by HSC.

Health Care Spending Growth Slows Sharply

Health care spending growth per privately insured American slowed in the first half of 2003, increasing 8.5 percent, a sharp drop from the 10 percent increase in the second half of 2002, according to a study released today by HSC.

HSC Conference Examines Promises and Pitfalls of Patient Cost Sharing

The Center for Studying Health System Change (HSC) conducted a conference Dec. 3, titled "Patient Cost Sharing: Promises and Pitfalls." A transcript and webcast of the conference are now available.

Patients Face Cost-Choice Trade-offs With Tiered-Provider Networks

In a bid to control costs and regain leverage over hospitals and doctors, more health plans are experimenting with tiered-provider networks, which typically give patients a broader choice of hospitals and physicians if they are willing to pay more out of pocket, according to a study released today by HSC.

Health Affairs Studies Examine Specialty Facilities and Hospital Capacity

Two Center for Studying Health System Change (HSC) studies—one on the rapid growth of physician-owned specialty facilities, and the other examining hospital capacity issues—were released today in the journal Health Affairs.

· Focused Factories? Physician-Owned Specialty
  Facilities

· Does U.S. Hospital Capacity Neet to Be Expanded?

HSC Commentary Examines Health Care Cost-Coverage Conundrum

In their annual essay on the health care system, HSC President Paul Ginsburg and Vice President Len Nichols explore the difficult trade-offs inherent in containing health care costs and expanding health insurance coverage to the estimated 43.6 million uninsured Americans.

Insured Americans Drive Surge in Hospital Emergency Department Visits

Contrary to beliefs that uninsured Americans are a major cause of increased emergency department crowding, insured Americans accounted for most of the 16 percent rise in hospital emergency room visits between 1996-97 and 2000-01, according to a national study released today by HSC.

Boston Health Care Market Stabilizes, but Potential Troubles Loom

Compared with the hospital and health plan contract disputes and financial woes of two years ago, the Boston health care market has stabilized as hospitals and plans regained their financial footing, according to a new Community Report released today by HSC.

Employers Embrace Disease Management to Control Costs, Improve Quality

With managed care’s promise to reduce costs and improve quality fading, more employers and health plans are aiming extra attention at patients with chronic conditions and costly, complex illnesses, according to an Issue Brief released today by HSC.

Market Conditions Can Allow Providers to Shift Costs to Private Payers to Offset Government Cuts

Hospitals and physicians likely can raise prices to private insurers to offset payment reductions from Medicare and other government health programs if market conditions are right, according to a Health Affairs article that clashes with traditional health care economic theory.

Medical Malpractice Insurance Fallout Varies Across Communities

The fallout from rapidly rising medical malpractice insurance premiums is prompting some physicians to refer more patients to already crowded emergency departments, refuse to provide on-call emergency department coverage and decline elective referrals, according to a study released today by HSC.

CTSonline Provides Easy Access to CTS Household Survey Results

HSC's interactive Web-based system CTSonline now has results from the Community Tracking Study Household Survey. Topics include: health insurance status; use of health care services; employer health insurer offerings; access to health care; patient trust and satisfaction; and consumer information.

Benefits of and Barriers to Large Medical Group Practice

For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. However, gaining negotiating leverage with health insurance plans was eight times more likely than quality improvement to be a motivation for creating large medical groups, according to an article by HSC researchers published in the Archives of Internal Medicine.

Health Insurance Hikes and Malpractice Insurance Woes Disrupt Miami Health Care

Rapidly rising health insurance premiums and a medical malpractice insurance meltdown threaten to decrease health insurance coverage and access to health care in Miami, according to a new Community Report released today.

Wall Street Comes to Washington Conference

HSC held its Eighth Annual Wall Street Comes to Washington conference in Washington, D.C., on June 18. An Issue Brief summarizing the panelists' discussion has been released.

Phoenix Health Care Market: Population Boom, Sluggish Economy

Rapid population growth, rising unemployment and a continuing influx of undocumented immigrants are pushing health care capacity to the brink in Phoenix, according to a new Community Report released today.

Ginsburg Named to Modern Healthcare's Top 100 list

For the second year in a row, HSC President Paul B. Ginsburg made Modern Healhcare's 100 Most Powerful People in Healthcare List. To find out who else made the list and why, visit Modern Healthcare.

Fragile but Resilient: Most Community Health Care Safety Nets Stronger

Fragile by nature, many community health care safety nets for low-income and uninsured people have grown stronger in recent years thanks to improved business practices and some new funding, according to a study released today by HSC.

Issue Brief No. 66
News Release

HMO Resurgence in Orange County Bucks National Trend

Bucking the national retreat from tightly managed care, health maintenance organizations (HMOs) continue to dominate the Orange County, Calif., health care market, according to a new Community Report released today by HSC.

Has Bioterrorism Preparedness Improved Public Health?

The national push to prepare for terrorist attacks has bolstered communities' public health readiness, but concerns are growing that the national smallpox vaccination campaign could detract from traditional core public health activities, according to a study released today by HSC.

African-American Medicare Beneficiaries and the Prescription Drug Gap

Elderly African-American Medicare beneficiaries are more than twice as likely as whites to report they can't afford prescription medications, according to a national study released today by HSC.

SCHIP Making Progress: Increased Take-up Contributes to Coverage Gains

Previous research based on HSC's Community Tracking Study (CTS) showed that while coverage expansions through the State Children's Health Insurance Program (SCHIP) greatly increased children's eligibility for public or private health insurance coverage, uninsurance rates remained unchanged because of low take-up by eligible children. However, more recent data show that this is changing.

Little Rock Employers Shift More Health Care Costs to Workers

Rapidly rising health insurance premiums are prompting Little Rock employers to shift more costs to workers, who—as a result—are finding coverage to be increasingly difficult to afford, according to a new Community Report released today by HSC.

Cost Concerns Grow in Syracuse Despite New Health Plan Competion

More health plan consolidation, higher health care costs and persistent hospital difficulties signal increasing concern about the future of the Syracuse health market, according to a new Community Report released today by HSC.

Tracking Health Care Costs in 2002

Health care spending per privately insured American jumped 9.6 percent in 2002, growing nearly four times faster than the overall U.S. economy, according to a study by HSC published today as a Web-exclusive article in the journal Health Affairs.

Market Developments Signal Cost Hikes in Greenville

The end of exclusive contracts between dominant Greenville Hospital System (GHS) and two major health plans, along with increased hospital expansion, may signal higher health care cost growth in Greenville, S.C., according to a new Community Report released today by HSC.

Contract Dispute Reaffirms Blues' Dominant Position in Lansing

A bitter contract dispute between Lansing's largest health plan and hospital system threatened to disrupt the otherwise stable health care market, but a last-minute reprieve averted a major dislocation of consumers, according to a new Community Report released today by HSC.

Health Care Market Changes Promise Little Relief From Rising Costs

As employers shift more health care costs to workers, hospitals and physicians—unleashed by the retreat of tightly managed care—are competing fiercely for profitable specialty services, threatening to drive costs even higher, according to initial findings from HSC's latest round of community site visits.

Physicians: So Much to Do, So Little Time

While physicians spent about two additional hours a week on patient care in 2001 than in 1997, more doctors say they don't have enough time with patients, according to a national tracking study released today by HSC.

Specialty Hospital Building Boom Threatens General Hospitals

General hospitals fear a rise in physician-owned specialty hospitals will siphon off the most profitable patients, leaving them with the sickest, costliest patients, according to a study released today by HSC. The study was released at an HSC-sponsored conference—Specialty Hospitals: Focused Factories or Cream Skimmers?—held today in Washington, D.C.

Rising Costs Dominate Northern New Jersey Health Care Market

Higher hospital payment rates and more use of health care services are driving rapid cost increases in northern New Jersey, forcing employers to confront steep health insurance premium increases, according to a new Community Report released today.

Economic Boom a Bust for Physician Income

Average physician net income from the practice of medicine dropped 5 percent in real dollars between 1995 and 1999, while other skilled professionals’ average income increased 3.5 percent, according to a national study released today by HSC.

Seattle's Economic and Budget Woes Threaten Health Coverage Expansions

Seattle's struggling economy and rapidly rising health care costs, coupled with a state budget deficit, threaten to unravel recent gains in health insurance coverage, according to a new Community Report released today.

Most Americans Don't Seek Health Information

Contrary to popular belief that Americans avidly seek health information— especially on the Internet—more than six out of 10 American adults in 2001 sought no information about a health concern, according to a national study released today by HSC.

Nichols Testifies on Ways to Address the Uninsured

If Congress wants to make headway on reducing the number of Americans without health insurance, it also will have to tackle the problems of waste and uneven quality of care in the current health system, HSC Vice President Len Nichols, Ph.D. told Congress today.

Congressional Testimony
News Release

Intense Competition and Rising Costs Dominate Cleveland's Health Care Market

After an aggressive building boom, the two giants of the Cleveland health care market—the Cleveland Clinic Health System and University Hospitals Health System—are now vying to attract patients and physicians amid rapidly rising health care costs, according to a new Community Report released today.

Cleveland Community Report
News Release

Ginsburg to FTC: Potential for Competition Limited

When employers retreated from tightly managed care, they unwittingly dampened competitive forces to cut costs and improve quality in local health care markets, especially in communities with significant hospital consolidation, HSC President Paul Ginsburg told federal antitrust officials today.

Click here to view the PowerPoint presentation.
News Release
Hearing Transcript
Click here for testimony by additional HSC researchers

Ginsburg Speaks at AAHP Health Policy Conference

HSC President Paul B. Ginsburg, Ph.D., opened the American Association of Health Plans' annual health policy conference today, delivering an address titled "Can We Expand Coverage Amid Rising Costs?"

Special Edition of Journal Focuses on Local Health Market Changes

As the rise and fall of managed care reverberated throughout the U.S. health care system in recent years, a roller coaster of change in health care organization and financing occured in local communities, according to research by HSC published in a special edition of Health Services Research.

Click here for a list of the articles.
News Release

Competition Revs Up the Indianapolis Health Care Market

Indianapolis hospitals and physicians are competing fiercely over patients and profits from lucrative specialty services, especially cardiac care, according to a new Community Report.

Indianapolis Community Report - Competition Revs Up the Indianapolis Health Care Market
News Release

Nichols Testifies on Association Health Plans

Allowing small employers to band together to offer health insurance through association health plans poses risks to insurance market costs and stability, HSC Vice President Len Nichols told Congress today.

Congressional Testimony
News Release

Many Physicians View Treatment Guidelines Positively

Sometimes dismissed as "cookie-cutter" medicine, treatment guidelines for specific medical conditions influenced more than half of all U.S. physicians in 2001, and nearly two-thirds of affected physicians viewed guidelines positively, according to a new Issue Brief.

Issue Brief No. 60 - Physicians and Care Management: More Acceptance Than You Think
News Release

Physician Career Satisfaction Varies Across Communities

While career satisfaction among physicians nationally has changed little since 1997, there is wide variation in physician satisfaction in communities across the country, according to a study by Harvard Medical School and Center for Studying Health System Change (HSC) researchers published in the Jan. 22 Journal of the American Medical Association.

Journal Article Abstract
News Release

Specialist Physicians Back in the Driver's Seat

As managed care plans eased restrictions in the late 1990s, the proportion of specialist physicians who believe they have enough control over clinical decisions to meet patients’ needs jumped sharply between 1997 and 2001, increasing 13 percentage points from 72.7 percent to 85.7 percent, according to a national tracking study released today by HSC.

Tracking Report No. 7 - Back in the Driver's Seat: Specialists Regaining Autonomy
News Release

SCHIP, Medicaid Expansions Lead to Shifts in Children's Coverage

Expanded public health insurance eligibility, along with aggressive outreach to enroll eligible children, helped decrease the proportion of low-income, uninsured children in America, according to a new Issue Brief released today.

HSC Releases Report from Individual Insurance Conference

As policy makers in Washington consider the use of tax credits to encourage uninsured Americans to buy health insurance, researchers and policy experts debated the merits of the individual insurance market at a conference sponsored by HSC and Health Affairs. An Issue Brief summarizing the conference has been released.

Mounting Pressures: Physicians Serving Medicaid Patients and the Uninsured

The proportion of physicians providing charity care and treating Medicaid patients declined between 1997 and 2001, according to a tracking study released today.

Despite Backlash, Most Physicians Contract with Managed Care Plans

Despite the backlash against managed care, nine out of 10 U.S. physicians continued to contract with at least one managed care plan between 1997 and 2001, according to a study released today by HSC.

Tracking Report No. 5 - Kinder and Gentler: Physicians and Managed Care, 1997-2001
News Release

HSC/Health Affairs Hold Individual Insurance Market Conference

HSC and Health Affairs conducted a conference today titled "Individual Health Insurance: Fact, Opinion and Policy" featuring some of the nation’s leading experts on this topic. Panelists discussed what is working and what is not working in the individual insurance market and examine proposals for change and expansion. The conference was held in conjunction with the release of a Web-exclusive issue of Health Affairs, featuring two articles by HSC researchers.

Small Employers Pare Health Benefits; Increase Worker Costs

Rapidly rising health insurance premiums hit small employers particularly hard, prompting many to pay a larger share of premiums, raise copayments and deductibles, reduce benefits and switch insurance, according to a new HSC study. A second study found that health insurance brokers can provide small employers with valuable services, such as obtaining prices for coverage, explaining benefits to employees and resolving claims disputes.

Hill Staffer Joins HSC as Public Affairs Manager for Policy

Senate health aide Kyle Kinner, J.D., has joined HSC as a public affairs manager for policy. Kinner most recently served as a legislative assistant to U.S. Sen. John Edwards of North Carolina.

Spending on Hospital Care Drives Double-Digit Jump in Health Care

Spending on health care jumped 10 percent in 2001, the first double-digit increase in more than a decade, according to a study by HSC published today as a Web-exclusive article in the journal Health Affairs.

The findings also are detailed in a new HSC Data Bulletin—Tracking Health Care Costs: Hospital Spending Spurs Double-Digit Increase in 2001.

Aging Baby Boomers Play Limited Role in Rising Health Care Cost Trends

Contrary to popular belief, the aging of the baby boom generation plays a limited role in rapidly rising health care costs for people under age 65, according to a study released today by HSC.

Reservations Available for HSC's Health Care Cost Report

Health insurance premiums jumped nearly 13 percent in 2002—the biggest leap in a decade. Find out what's driving premiums up in the definitive study of health care costs to be released Sept. 25.

HSC Researcher Speaks at FTC Conference

Cara Lesser, senior health researcher and director of HSC's site visits, spoke at the Federal Trade Commission Workshop on Competition in Health Care Markets.

Declining Access to Physician Services Not Just a Medicare Problem

A growing proportion of Medicare beneficiaries and older privately insured people are having problems obtaining medical care and experiencing long waits for physician appointments, according to a study released today by HSC

New Research Looks at Efforts to Improve Quality

Three articles have been published in the September/October edition of the journal Health Affairs about quality improvement activities in local health care markets. The articles are based on HSC's 2000-01 site visits to 12 nationally representative communities across the United States. The research offers an early look at community level efforts to improve quality on the part of purchasers, health plans and providers.

Ginsburg Named to ‘100 Most Powerful People in Healthcare’ List

Click here to find out who readers of Modern Healthcare choose along with HSC President Paul B. Ginsburg.

Economic Boom Failed to Boost Employer Coverage for Working Families

The proportion of Americans in working families covered by employer-sponsored health insurance remained almost flat between 1997 and 2001, with the recent economic boom only suspending a long and steady decline in employer-sponsored health insurance, according to a national tracking study issued today by HSC.

Consumer Confidence in Health Care on the Rise

Privately insured consumers’ confidence in the health care system increased slightly between 1997 and 2001, signaling that people have noticed the easing of managed care restrictions, according to a national tracking study issued today by HSC.

Ginsburg Speaks on Health Care Costs

HSC President Paul Ginsburg participated in a luncheon briefing on health care costs and health coverage sponsored by the Alliance for Health Reform. A webcast, which was carried live on C-SPAN, is available from Kaisernetwork.org

Nichols Speaks at NCSL Annual Meeting

HSC Vice President Len Nichols recently spoke about health care costs at the annual meeting of the National Conference of State Legislatures. A webcast of the session—New Thinking in Health Care Costs—is available from Kaisernetwork.org.

Current Tax Credit Proposals Offer Little Help to Older, Sicker Americans

Only about one in 100 uninsured people aged 55-64 in poor health would receive tax credits covering at least half of the estimated cost of an individual health insurance policy under leading congressional and White House proposals, according to a national study issued today by HSC.

HSC's Seventh Annual Wall Street Comes to Washington Roundtable

HSC's seventh annual "Wall Street Comes to Washington: Market Watchers and Policy Analysts Evaluate the Health Care System" roundtable was held Tuesday, June 11, 2002. An Issue Brief summarizing the panelists' discussion has been released.

HSC Releases 2001 Annual Report

The report—Navigating a Changing Health System: Mapping Today's Markets for Policy Makers—features essays by HSC's President Paul Ginsburg and Vice President Len Nichols.

New Study Shows Changes in Health Plan-Provider Risk Contracting

Over the past several years many health plans adopted risk-contracting arrangements that transferred financial risk and care management responsibilty to physician groups and hospital-sponsored integrated delivery systems. A decline in reliance on risk contracting is evident in nearly all of the markets in HSC's Community Tracking Study, according to a study published in the July/August issue of Health Affairs.

Physician Researcher Joins HSC

Hoangmai H. Pham, M.D., M.P.H., a general internal medicine fellow at Johns Hopkins University School of Medicine, has joined the Center for Studying Health System Change (HSC) as a physician researcher.

Everything You Always Wanted to Know About Physicians Now Online

Want to find out how many hours of charity care physicians typically provide? Or whether doctors believe they can spend enough time with their patients? How about the percentage of physicians earning more than $300,000 a year? HSC's new CTSonline system provides easy access to CTS Physician Survey results.

Health Insurance Gap Plays Major Role in Minority Access-to-Care Disparities

Ethnic and racial disparities in access to medical care among uninsured working-age Americans are much greater than disparities among insured people, according to a national tracking study issued today by HSC.

Ginsburg Points to 2001 Hospital Spending Increase

Strong demand and higher prices for hospital care helped drive overall 2001 health care spending increases to the highest level in a decade, HSC President Paul Ginsburg told Congress Tuesday.

News Release
Written Testimony

Reversal of Fortune: Medicare+Choice Collides With Market Forces

As policy makers consider stopgap measures to prop up Medicare’s struggling managed care program, Medicare+Choice, a new HSC study indicates longer-term reforms need to reflect broader market conditions that influence health plans’ decisions to participate.

News Release
Issue Brief No. 52 - Reversal of Fortune: Medicare+Choice Collides With Market Forces

Rising Health Care Costs Might Spark Resurgence of HMOs

Cost considerations—not whether people are healthy or sick—play a major role in privately insured people's decision to enroll in health maintenance organizations (HMOs) when they have a choice of health plans, according to an HSC study published in the May/June edition of the journal Health Affairs.

News Release
Journal Abstract

Sick People in For-Profit HMOs Less Satisfied with Health Care

Sick people enrolled in for-profit health maintenance organizations (HMOs) were less satisfied with their care, had higher out-of-pocket costs and rated their interactions with physicians lower than similar people in nonprofit HMOs, according to a study by HSC researchers published in the April 25 New England Journal of Medicine.

More Than 1 in 4 Medicaid Beneficiaries Can't Afford Prescription Drugs

Medicaid beneficiaries in states with aggressive prescription-drug cost controls are twice as likely to report they can't afford medications as people in states with less stringent policies, according to a new HSC Issue Brief.

One in Seven Americans Faces Problems Getting Needed Medical Care

More than 41 million Americans reported problems getting needed medical care in 2001, and nearly two-thirds cited cost as the reason, according to a new national tracking study issued today by HSC.

News Release
Tracking Report No. 1 - Treading Water: Americans' Access to Needed Medical Care, 1997-2001
Kaisernetwork Webcast

State Health Policy Makers Value Research Relevance and Timeliness

Nearly half of the health policy research coming over the transom of state policy makers lacks relevance to current debates, and more than a third goes unread by overwhelmed officials, according to a new HSC study published in the March/April edition of the journal Health Affairs.

News Release
Article Abstract

Ginsburg Cautions Medicare Beneficiary Access to Physicians Slipping

Fewer physicians accepting new Medicare patients, longer waits for appointments and physicians working more hours are all telltale signs that Medicare beneficiaries’ access to physicians is slipping, Paul B. Ginsburg, Ph.D., HSC president, told Congress today.

News Release
Opening Statement
Written Testimony

HSC Launches New Web Site

HSC has made a number of improvements to enhance the site's speed and appearance and to make it even easier to find the HSC research and information you need. Major changes include a restructured Policy Research navigation, a new CTS Data section and an improved search function.

Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America

At least 7.4 million working-age Americans with chronic conditions—including diabetes, heart disease and depression—lacked health insurance in 1999, according to a new HSC study. And two-thirds also had low incomes, putting them in triple jeopardy.

News Release
Issue Brief No. 49 - Triple Jeopardy: Low Income, Chronically Ill and Uninsured in America
Issue Brief No. 50 - Options for Expanding Health Insurance for People with Chronic Conditions

Most Physicians Don’t Face Financial Incentives Perceived to Conflict with Patients’ Interests

Physicians are more likely to face direct financial incentives aimed at improving patient care than incentives that might curtail needed care, according to a new HSC Issue Brief.

News Release
Issue Brief No. 48 - Physicians More Likely to Face Quality Incentives Than Incentives That May Restrain Care

Richard Sorian Joins HSC as Public Affairs Director and Senior Researcher

Richard Sorian, currently a senior researcher at Georgetown University’s Institute for Health Care Research and Policy, will join the Center for Studying Health System Change (HSC) on Feb. 1 as director of public affairs and senior researcher.

News Release

Premium Subsidies for Employer-Sponsored Health Insurance

Only about 500,000 of the 16 million people working in small firms not currently offering health insurance would gain coverage through a 30 percent employer-targeted premium subsidy, according to a new HSC study. Yet, some state and local officials are hopeful subsidies can leverage public and private funding to expand coverage, a second HSC study shows.

News Release
Issue Brief No. 46 - Employer Health Insurance Premium Subsidies Unlikely to Enhance Coverage Significantly
Issue Brief No. 47 - Premium Subsidies for Employer-Sponsored Health Coverage: An Emerging State and Local Strategy

HSC's Conference on Emerging Local Market Trends

HSC's "Emerging Health Care Market Trends: Insights from Communities" conference was held on December 10. A transcript and other conference information can be found here.

Consumers Face Higher Costs as Health Plans Move to Slow Drug Spending

Insured consumers used to paying $5 or $10 for prescription drugs increasingly may face sticker shock at pharmacy counters as health plans take more aggressive steps to control rapidly rising drug costs, according to a new HSC Issue Brief.

Local Outreach Key to Enrolling Children in Public Health Insurance

Local outreach efforts led by health care providers, schools, employers and community and religious groups can play important roles in identifying children who are eligible for public health insurance but not enrolled, according to a new HSC Issue Brief.

Tracking Health Care Costs

Contrary to conventional wisdom, hospital spending -- not prescription drugs -- accounted for the largest share of increased health care costs in 2000, according to an HSC study published on HealthAffairs.org as a Web-exclusive article.

Sixth Annual Wall Street Comes to Washington Conference

A new Issue Brief is now available summarizing the discussion at HSC's sixth annual "Wall Street Comes to Washington: Market Watchers and Policy Analysts Evaluate the Health Care System" roundtable held in July 2001.

Proportion of Physicians Providing Charity Care Drops

New HSC Issue Brief shows the proportion of physicians providing charity care dropped from 76 percent to 72 percent between 1997 and 1999, raising concerns that access to care for poor and uninsured people could decline in the future.

Minority Physicians Face More Difficulties Obtaining Needed Care for Patients

African-American and Hispanic physicians are much more likely than white physicians to report being unable to obtain needed hospital admissions and specialty referrals for patients, according to an HSC study published in Medscape General Medicine. You will have to register at the Medscape site for free access to the article and editorial.

HSC Issues 2000 Annual Report

The report -- Analyzing the Changing Health System: The Path Taken and the Road Beyond -- features an essay by HSC President Paul B. Ginsburg and highlights HSC's new policy research focus on private insurance coverage, access to care for the uninsured and managed care and market trends.

Sixth Annual Wall Street Comes to Washington Conference

HSC's sixth annual "Wall Street Comes to Washington: Market Watchers and Policy Analysts Evaluate the Health Care System" roundtable was held Thursday, July 12, 2001.

Health Plan-Provider Contract Showdowns Trigger Network Instability

HSC releases two new Issue Briefs describing the growing trends of plan-provider showdowns and the resulting network instability. Consumers may face higher costs, threats to caregiver choice and anxiety as plans scramble to maintain networks.

HCFO Seeks Research Proposals Using HSC's Community Tracking Study

The Changes in Health Care Financing and Organization Program (HCFO) is requesting proposals to conduct research and analyses using data sets from the HSC's Community Tracking Study. Proposals are due Aug. 31, 2001. More information is available at the HCFO Web site.

New HSC Book Examines Health System Change

Consumer backlash against managed care has sparked considerable changes in the U.S. health care system. What are these changes and what are their implications for consumers and public policy. Find out in Understanding Health System Change: Local Markets, National Trends, edited by HSC's Paul Ginsburg and Cara Lesser. The book is available at the Health Administration Press website.

Emergency Room Diversions: A Symptom of Hospitals Under Stress

Too many patients, too few beds and a severe nursing shortage mean hospitals across the country must increasingly divert critically ill patients to other emergency rooms, according to a new HSC study.

Gaps in Preventive Care Narrow Between African-Americans and Whites; Hispanics Lag Behind

New HSC study finds that longstanding disparities in preventive care between whites and African-Americans are narrowing, but Hispanics continue to receive significantly less preventive care than both groups.

Issue Brief No. 34

News Releases

At the Brink: How Harvard Pilgrim Got in Trouble

HSC followed the Harvard Pilgrim story closely as part of its continuous tracking of Boston, and produced a publication that puts this event in broader context. This document discusses the causes of the plan’s financial problem and the state’s response, which has preserved the organization.

Issue Brief No. 33

44% of Health Care Cost Increase Attributable to Pharmaceutical Spending

Nearly half of health care cost increases in 1999 were due to increased prescription drug spending, according to an HSC study published this month in Health Affairs. The study, "Tracking Health Care Costs: Inflation Returns" also addresses the sharp increase of premium rates that outpaced the increases in underlying cost, thus marking a turn in the insurance underwriting cycle.

Data Bulletin No. 20

News Releases

Percentage of Uninsured Children Dropping in Some Communities

Boston, Little Rock and Syracuse saw a significant decline in the percentage of uninsured children between 1996-97 and 1998-99 even though the national percentage did not change, according to a new HSC study.

Data Bulletin No. 19

News Releases

Overall, Negative Views About HMOs Bias Consumer Ratings

Newly released HSC research suggests that most surveys overstate differences in how people in HMOs versus other types of plans rate their care.

Issue Brief No. 30

News Releases

HSC Launches New, Dynamic Web Site

A topically driven web site was launched today by HSC to make its growing number of analyses more accessible.

News Releases

Community Safety Nets Stretching to Catch Immigrant Patients

With the federal government opting to provide little health care aid to legal and illegal immigrants alike, communities across the country are stretching already-strained safety nets to care for more immigrant patients, according to a study released today by HSC.