MHA Press Room

Most Docs Surveyed Claim Less Control Over Healthcare Delivery

Nearly three out of four physicians say they have less control over the way they practice medicine than they did five years ago, according to a new Internet survey from Jackson Healthcare.

Survey: HIPAA privacy rule continues to hinder research

According to a new survey by the Association of Academic Health Centers, the Health Insurance Portability and Accountability Act privacy rule continues to have a negative impact on the scope, pace and cost of health care research. Nearly 60% of academic health center executives and researchers responding to the survey said the HIPAA privacy rule has constrained the types of research they can perform.

In addition, almost 64% said complying with the rule has slowed the pace of research, and 71% said it has driven up the cost of research. They said the privacy provisions also have negatively impacted researchers’ ability to recruit study participants, with 45% characterizing the overall impact as negative or strongly negative.

NIH launches Web site on clinical studies for children

The National Institutes of Health has launched a Web site on "Children and Clinical Studies." The site describes why research in children is important, how studies are conducted, and what measures are taken to protect participants' safety and privacy.

"We hope this new resource will help parents and others learn more about how clinical studies are conducted in children, so they can make well-informed decisions about whether to enroll their child in a study,” said Elizabeth Nabel, M.D., director of NIH's National Heart, Lung, and Blood Institute.

Study: Evidence on disease management benefits limited

Disease management programs for patients with chronic health problems can improve health care quality and disease control, and in the case of patients with congestive heart failure, reduce hospital admission rates, according to a new study by the RAND Corp. But it’s unclear whether these programs improve long-term health outcomes or reduce costs, the authors said.

For example, patients with depression who were enrolled in disease management programs were more likely to use outpatient care and prescription drugs, increasing costs, the study found. Most of the evidence to date is derived from small programs at a single health care site, focused on high-risk patients and following patients for about one year.

The programs typically involved patient education, care planning and follow-up by a nurse or case manager. “Until a stronger base of evidence has been developed, public and private purchasers of disease management services should be skeptical about vendor claims and should demand supporting evidence based on transparent and scientifically sound methods,” the authors said.

Health care leads to fewer deaths from heart disease

A study last week in the New England Journal of Medicine attributes nearly half of the decline in U.S. deaths from coronary heart disease from 1980-2000 to medical treatment. The mortality rate from coronary heart disease fell by 50% over the 20-year period to 267 per 100,000, resulting in 341,745 fewer deaths.

The authors estimate that 159,330 deaths were prevented or postponed due to medical therapies, such as the use of prevention medications or rehabilitation after heart attack or revascularization, initial treatments for heart attack or unstable angina, and treatments for heart failure and hypertension. The use of revascularization for chronic angina resulted in an estimated 15,690 fewer deaths, the study found.

[ via AHA News Now ]

Mississippi Health Policy Research Center releases new policy briefs, policy paper

The Mississippi Health Policy Research Center's Social Science Research Center at Mississippi State University recently released three new health policy briefs and one new health policy paper:

• Policy Brief – What is the Usual Source of Care? Medical Homes and Continuity of Care in Mississippi Medicaid (Part 1 of 3) – Carol Campbell, Jeralynn S. Cossman, and Jarryl B. Ritchie.
• Policy Brief – What is the Usual Source of Care? Where Are the Children Receiving Health Care? (Part 2 of 3) – Carol Campbell, Jeralynn S. Cossman, and Jarryl Ritchie.
• Policy Brief – What is the Usual Source of Care? Who provides the Children’s Health Care? (Part 3 of 3) – Carol Campbell, Jeralynn S. Cossman, and Jarryl Ritchie.
• Policy Paper – What is the Usual Source of Care? Medical Homes & Continuity of Care in Mississippi Medicaid – Carol Campbell, Jeralynn S. Cossman and Jarryl Ritchie.

For more information, contact Alicia Falls @ Alicia.falls@ssrc.msstate.edu or 601.898.9339.

To view other health policy publications, visit their Web site.

Commonwealth report finds U.S. healthcare lagging

The U.S. healthcare system ranks last or next-to-last in five areas—quality, access, efficiency, equity and healthy lives—when compared with five other nations, even though it spends more per person on healthcare, according to a new report from the Commonwealth Fund.

The results released May 15 are from the third edition of Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, which also released analysis on these six health systems in 2006 and 2004. Overall, Germany was the only country to receive a score of “1,” the highest ranking possible, while the U.S. earned an overall score of “6,” the same mark it received in 2006 and 2004.

This year’s report said the U.S. is most notably different from the other countries surveyed because it does not provide universal health insurance coverage. “It is not surprising, therefore, that the United States substantially underperforms other countries on measures of access to care and equity in healthcare between populations with above-average and below-average incomes,” the report said.

It also showed that the U.S. spent more on health expenditures per person in 2004—$6,102—than the other five countries. Germany spent $3,005 per capita, while the United Kingdom, which earned an overall ranking of “2,” spent $2,546. And in terms of quality, other countries are “further along than the U.S. in using information technology and a team approach to managed chronic conditions and coordinate care,” the authors said in the report’s executive summary. The other three countries examined were Australia, Canada and New Zealand.

[ via Jessica Zigmond, Modern Healthcare's Daily Dose ]

Docs a big influence on surgery decisions: survey

Despite advances in consumerism in healthcare, physicians continue to hold sway in deciding where their patients will have major elective surgery, according to a survey in the March issue of the Archives of Surgery. While most patients participated in the decision, the survey said, physicians were the main decisionmakers in about one-third of the cases.

Researchers say the study is increasingly relevant as the CMS and private insurers encourage hospitals to become more transparent in providing information about pricing, volume and outcomes at a time when many consumers are taking more active roles in their medical care.

Researchers surveyed 500 Medicare patients in 2004 who had undergone one of five elective high-risk operations about three years earlier. About 42% of the patients said they decided “equally” with their physicians about where they would have surgery; 31% said the physician was the “main” decisionmaker; 22% said they primarily made the decision themselves; and 5% said a family member played a leading role.

“While many patients participate in the decisionmaking process and may desire objective information to inform their decisions, a substantial proportion of patients are not involved at all,” the researchers concluded. “Research is needed to help us understand whether patients would like a greater role in deciding where to have major surgery and, if so, how to facilitate such involvement.”

[ via Michael Romano, Modern Healthcare's Daily Dose ]

Older mothers more likely to deliver by Cesarean, study finds

Older mothers with normal, full-term pregnancies are more likely to undergo Cesarean delivery than younger women with similarly low-risk pregnancies, according to a new national study . Regardless of their age, first-time mothers also are much more likely to deliver by Cesarean than women who have given birth before.

Researchers for the National Institutes of Health examined birth certificates for 8 million U.S. children born from 1995-2000 to evaluate the risks of pregnancy complications associated with advancing age. Mothers over 35 were more likely than younger women to experience complications during pregnancy and delivery.

The number of U.S. women giving birth at age 30 or older doubled from 1980-2004, while the number giving birth at 40 or older nearly quadrupled.

Americans say Congress should expand health coverage

Expanding coverage for the uninsured should be the top health care priority for Congress and the president, according to a poll of American adults released Dec. 14 by the Kaiser Family Foundation. Asked to pick their top health care priority, most Americans said expanding coverage (35%) or reducing health care costs (30%). Democrats placed a higher priority on expanding coverage, while Republicans emphasized costs. Only 6% of Americans said the top health care priority should be reducing spending on government health programs.