Health Affairs, 22, no. 5 (2003): 250-252 doi: 10.1377/hlthaff.22.5.250 © 2003 by Project HOPE	New Online   Obama's Success & Next Steps   3 Health Policy Options for President Obama   A Hybrid Proposal   Bipartisan Compromise

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Publications & Reports

Top Bioterrorism Preparedness Hospitals Medicare Prescription Drug Prices Books Received

Free copies of this report are available at www.cfr.org/pdf/Responders_TF.pdf.

Homeland Insecurity: Building the Expertise to Defend America from Bioterrorism, an 8 July 2003 report of the Partnership for Public Service, finds that the skilled medical and scientific personnel charged with responding to bioterrorism attacks "constitute a civilian ‘thin blue line’ that is retreating both in terms of capacity and expertise." Based on interviews with officials at five federal agencies—the Centers for Disease Control and Prevention (CDC), National Institute of Allergy and Infectious Diseases, Food and Drug Administration (FDA), Animal and Plant Health Inspection Service, and Food Safety and Inspection Service—as well as representatives from other areas of biodefense research, the researchers found that biodefense agencies are finding it increasingly hard to recruit new talent, have an aging workforce, and are losing many of their talented scientific minds to the private sector. The report forecasts a 25 percent increase in the number of bioterrorism experts needed to address coming threats. To recruit new scientific and medical talent and retain existing workers, the report proposes that the federal government conduct an audit of bioterrorism and public health needs; focus the attention of agency leaders on staffing issues; launch a recruitment and retention campaign; and grow new talent by offering scholarships, offering to repay student loans, offering training to current workers, and offering job rotations between the public and private sectors.

Free copies of this report are available at www.ourpublicservice.org.

Information Technology Strategy Could Strengthen Federal Agencies’ Abilities to Respond to Public Health Emergencies, a May 2003 report from the U.S. General Accounting Office (GAO), finds that the six federal agencies in charge of responding to bioterrorism and other public health threats have some seventy information technology (IT) systems in several categories charged with responding to a public health emergency. The categories include detection, surveillance, communication, and supporting functions to identify and combat a bioterrorist attack or a public health outbreak such as severe acute respiratory syndrome (SARS). The GAO report found mixed efforts at coordinating the functions of the various IT systems, from a total lack of coordination to joint development of initiatives. It says that emergency response can be speeded up by interoperable systems that are developed and implemented because of common, agreed-upon standards and that activities to implement such standards are ongoing. For example, the CDC has developed such an IT architecture, the report says. Ensuring more coordinated data standards is less likely without an overall IT strategy, the report says; so far, none exists.

Free copies are available at www.gao.gov.

Hospitals

Top Bioterrorism Preparedness Hospitals Medicare Prescription Drug Prices Books Received

 
Health Care Industry Market Update: Acute Care Hospitals, a 14 July 2003 publication of the Centers for Medicare and Medicaid Services (CMS), says that hospital profit margins are averaging between 3 and 5 percent, close to historical averages, but notes some pessimistic signs for both for-profit and not-for-profit institutions. Stock prices for the for-profit sector have dropped sharply—even lower than the last valuation trough of 1999—because of greater scrutiny both of mergers by the Federal Trade Commission and of Medicare "outlier" payments to some for-profit chains. Meanwhile, credit rating downgrades are still exceeding upgrades in the not-for-profit sector. In addition, hospital admissions slowed in the first quarter, although that trend has yet to be explained. "Analysts have continued to clamor for explanations as recent commentary by public hospital companies suggest that low patient volumes continue in the second quarter," the report says. While profit margins are close to historical averages, there are variations among facilities. Those that are underperforming are harmed both by their smaller cash flow and by their inability to access capital for maintenance and expansion. The report notes that well-capitalized facilities—many of them for-profit, with access to equity capital—have been able to invest in improvements and expand market share, while undercapitalized facilities have lost market share, making them targets for acquisition. That acquisition activity has picked up, particularly in rural markets, by for-profit chains wanting to purchase a sole community hospital or a single hospital in a two-hospital market. Among publicly traded companies, capital spending is on the rise, and hospitals have added inpatient bed capacity for the first time since 1984. The report also says that expenses are continuing to rise, although labor costs have begun to moderate because hospitals are doing a better job of managing labor shortages. Malpractice costs also are on the rise.

Free copies are available at www.cms.hhs.gov.

2003 ASHP Pharmacy Staffing Survey, a 15 July 2003 publication of the American Society of Health System Pharmacists, finds some stabilization in health system pharmacy staffing, although hospitals with fewer than 100 beds are facing bigger problems. The pharmacist vacancy rate in 2003 fell to 5.6 percent from 6.9 percent in 2002, and the pharmacy technician rate fell slightly to 4.3 percent from 4.6 percent. Hospital pharmacy staff turnover in 2003 also has dropped slightly, to 7.5 percent from 8.5 percent in 2002. Among hospitals with daily census of 100 patients or fewer, the vacancy rate for pharmacists is 7 percent, while in hospitals with daily census of 400 or more, the vacancy rate is 4.9 percent. Hospitals of 100 patients or fewer had a lower pharmacy technician vacancy rate, 3.6 percent, than hospitals with 400 or more, 4.9 percent.

The number of respondents seeing a shortage of entry-level front-line pharmacists has declined from 84 percent to 75 percent, and of clinical specialists from 71 percent to 67 percent. The percentage of respondents seeing a shortage of entry-level pharmacy technicians dropped from 31 percent to 22 percent. More than half of the respondents said that pharmacy vacancies had delayed expansion of pharmacy programs or services or have resulted in a reduction of services. Nearly half said that vacancies have "resulted in reduced pharmacist vigilance with medication safety hospital-wide," while 38 percent said that vacancies "have resulted in an increase in errors in the pharmacy."

Free copies are available at www.ashp.org.

Medicare

Top Bioterrorism Preparedness Hospitals Medicare Prescription Drug Prices Books Received

 
The Medicare Preferred Provider Organization Demonstration: Overview of Design, Characteristics, and Outstanding Issues of Interest, a July 2003 publication of the AARP Public Policy Institute, finds that early experience with the new choices aimed at attracting beneficiaries to the demonstration’s preferred provider organizations (PPOs) has not been encouraging with respect to reducing seniors’ exposure to high medical bills. The PPOs test an array of benefits—including prescription drug coverage—and cost sharing, to better understand seniors’ preferences. "While lower than Medigap premiums, PPO premiums under the demonstration are still high—a large share of beneficiaries must...pay approximately $1,000 a year or more," the report says. "Even though the premiums could still attract some moderate-income beneficiaries unable to afford Medigap yet not wanting to relinquish provider choice in favor of (a Medicare+ Choice) plan, the demonstration products seem particularly likely to appeal to those already covered—either through an employer or their own Medigap coverage—thereby doing little to increase the proportion of beneficiaries without supplemental coverage." The report notes that the demonstration has attracted a "diverse group of firms offering PPO plans in a range of geographic areas." But it "has not...attracted new firms or elicited firm interest in products that would be available in areas where managed care has not already taken hold" under Medicare+Choice. With respect to the current Medicare reform debate, the report says that the PPO demonstration so far shows that reforms relying on private-sector plans may not be feasible nationwide. Adequate funding also is crucial, the report says. "It is instructive that the demonstration PPOs generally charge higher premiums than do HMOs. While demonstration PPO benefits are not uniformly less generous, and cost sharing in some PPOs is higher...than in HMOs, it remains true that...the ability of demonstration plans to offer more benefits without increasing premiums has been modest."

Free copies are available at www.research.aarp.org/health/2003_07_medicare_ppo.html.

Prescription Drug Prices

Top Bioterrorism Preparedness Hospitals Medicare Prescription Drug Prices Books Received

 
Out-of-Bounds: Rising Prescription Drug Prices for Seniors, a 9 July 2003 report from Families USA, documents prices for the fifty drugs most frequently used by seniors. The drugs’ prices increased an average of 6 percent from January 2002 to January 2003, compared with a 1.8 percent inflation rate for the rest of the economy (if energy costs are excluded). Of those fifty drugs, more than half rose in price at least three or more times the rate of inflation, while one-quarter did not increase. The drug with the biggest price increase was Claritin, rising 21.1 percent in 2002, or twelve times the rate of inflation. Average five-year inflation rates for thirty-eight of the fifty drugs that have been on the market since at least January 1998 is 29.2 percent, two and a half times the inflation rate over the same time. Fifteen of the fifty drugs monitored in the past year were generic drugs, and nine of those saw no price increases in the past year. Of the brand-name drugs, only Prilosec, Norvasc, and Paxil did not increase in price. Prices for the fifteen generic drugs rose only 2.6 percent in 2002, compared with 7.1 percent for brand-name drugs.

Free copies are available at www.familiesusa.org.

Books Received

Top Bioterrorism Preparedness Hospitals Medicare Prescription Drug Prices Books Received

 
Dual Loyalty and Human Rights in Professional Practice: Proposed Guidelines and Institutional Mechanisms, by Physicians for Human Rights (Boston: PHR, 2002), 145 pp., $25.

Entitlement Politics: Medicare and Medicaid, 1995–2001, by David G. Smith (Hawthorne, N.Y.: Aldine de Gruyter, 2002), 432 pp., $61.95 (cloth), $28.95 (paper).

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