Health Affairs, 24, no. 4 (2005): 1169-1171 doi: 10.1377/hlthaff.24.4.1169 © 2005 by Project HOPE	New Online   McAllen, TX & Beyond: An Expert Roundtable   Geography & Reform   Medicaid or Insurance Exchange?   Siren Song of New GME   Public Plan Option: Pro & Con

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Publications & Reports

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

Foundation and the Greenwall Foundation. Copies are at www.iom.edu/report.asp?id=26661.

Health Care Costs

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
Encouraging Workers To Save: The 2005 Retirement Confidence Survey, an April 2005 publication of the Employee Benefit Research Institute (EBRI), indicates that 58 percent of workers surveyed are "very" or "somewhat" confident that they will have enough money in retirement to take care of medical expenses, while 47 percent of those surveyed believe that they will have enough money to pay for long-term care. Seven percent of workers are "very confident" and 30 percent "somewhat" confident that Medicare will continue to provide benefits of at least equal value to benefits received by retirees today, while 20 percent of retirees are "very" confident and 42 percent "somewhat" confident of continuing to receive the same benefits. Of workers who reported that they were behind schedule in saving for retirement, 35 percent said that medical expenses are a major factor, and 30 percent said that such expenses are a minor factor.

Copies are at www.ebri.org/ibpdfs/0405ib.pdf.

Long-Term Care

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
"Long-Term Care Financing: Growing Demand and Cost of Services Are Straining Federal and State Budgets," 27 April 2005 congressional testimony from the U.S. Government Accountability Office (GAO), reports that the number of elderly people who cannot perform basic activities of daily living (ADLs) without assistance is expected to double between 2000 and 2040. That could result in a quadrupling of spending on long-term care services between 2000 and 2050, to $379 billion (in constant dollars). Medicaid is the major source of long-term care funding, representing nearly half of all spending in 2003; because of this, the increase in the number of seniors and other disabled people needing long-term care will continue to test the fiscal limits of federal and state governments. The GAO reports that the number of people age eighty-five or older—the age group most likely to need long-term care services—is expected to increase more than 250 percent between 2000 and 2040, driving the increase in long-term care needs. While prevalence of disability among the elderly has held constant, the sheer number of aging baby boomers is expected to more than counteract decreases in disability. The total number of disabled elderly people is expected to as much as double from its current level, to as many as 12.1 million, by 2040. While changes in financing such as expansion in the number of elderly people covered by long-term care insurance policies could reduce government spending for long-term care, improvements in that market need to be made, the report notes. Questions remain about the affordability and the value of the coverage relative to premiums, and many consumers assume that they will never need long-term care, which makes education about long-term care a vital component of long-term care policy in the future. The GAO recommends that Congress consider how to determine societal responsibilities for long-term care; consider the potential role of social insurance; encourage personal preparedness; recognize the benefits, burdens, and costs of informal caregiving; assess the balance of federal and state responsibilities regarding how Medicaid is financed; and develop financially sustainable public commitments.

Copies are available at www.gao.gov/new.items/d05564t.pdf.

Mental Health/Substance Abuse

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
Task Force Recommendations: Mental Health, Substance Abuse, and Domestic Violence in Oklahoma, a 17 February 2005 report of the Oklahoma Governor’s and Attorney General’s Blue Ribbon Task Force, finds that untreated and undertreated people with mental illnesses or substance abuse problems and addiction and survivors or perpetrators of domestic violence and sexual abuse "represent a significant portion of those entering the state’s criminal justice system." According to the report, these conditions represent about $3 billion a year in direct costs to the state and accounts for "half of all criminal justice expense [and] more than 11 percent of health care system expense; and are major contributors to the need for extensive social services." As a result of substance abuse, mental illness, and domestic violence, the state also loses $5 billion a year in human productivity. Eighteen percent of the state’s inmates are being treated for a diagnosable mental illness, and 50 percent of all criminal justice system expense is attributable to substance abuse issues. "Incarceration should be reserved to address societal problems involving violent or otherwise true criminal behavior and as a last resort for nonviolent offenses," the report says. "It is the least cost effective governmental function." The report recommends prevention and early intervention by identifying groups that are at risk for such problems or people already suffering from such problems, along with interventions by educators, law enforcement, and state agencies; expanding and staffing therapeutic-model courts and pretrial jail diversion programs; establishment of minimum training standards for personnel who provide services to substance abusers, mentally ill people, or domestic violence victims; and development of a workforce that can serve these people.

Copies are available at www.odmhsas.org/brexec.pdf.

Patient Safety

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
HealthGrades Quality Study: Second Annual Patient Safety In American Hospitals Report, a 2 May 2005 report by HealthGrades, found that nearly 1.2 million total patient safety incidents occurred in nearly 39 million hospitalizations in the Medicare population in 2001–2003. Hospitals are having increasing rates of occurrence of six key quality indicators, while another six have seen decreasing rates. The indicators that have seen worsening rates are metabolic derangements, respiratory failure, bedsores, postoperative pulmonary embolus or deep vein thrombosis, and hospital-acquired infections, with an average increase in occurrence of 20 percent or more over the four years studied (2000–2003). The indicators that have been improving were death in low-mortality diagnoses, failure to rescue, iatrogenic pneumothorax, postoperative hip fracture, postoperative hemorrhage or hematoma, and postoperative wound dehiscence, which improved on average by less than 10 percent. The highest incidence rates were failure to rescue, bedsores, and postoperative sepsis, which accounted for 62 percent of all patient safety incidents among Medicare patients hospitalized in 2001–2003. Of the total 298,865 deaths among patients suffering from one or more of those medical errors, 81 percent were attributable to the errors. Hospital infection rates increased 20 percent during 2000–2003, accounting for 9,552 deaths and costing $2.6 billion—almost 30 percent of the total excess cost related to those patient-safety incidents. The report said that hospital-acquired infections correlated with overall performance and performance on the other quality measures, which suggests "that hospital-acquired infection rates could be possibly used as a proxy of overall hospital patient safety." The sixteen quality measures studied accounted for $2.9 billion a year. The report recommends further "research and development of tools to help providers implement best practices and improve."

Copies are available at www.healthgrades.com/media/DMS/pdf/PatientSafetyInAmericanHospitalsReportFINAL42905Post.pdf.

Public Health

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
Altered Standards of Care In Mass Casualty Events, an April 2005 expert-panel report published by the Agency for Healthcare Research and Quality (AHRQ), finds that the goal of any health care system treating patients in a mass-casualty event should be to maximize the number of lives saved. To adjust to such circumstances, health care providers will need to adjust from a standard practice of "doing everything possible to save every life" to allocating "scarce resources in a different manner to save as many lives as possible." However, the panel noted, many preparedness efforts do not help practitioners understand the "altered standards of care" necessary to meet the demands of a mass-casualty event. Acceptance of such standards will require them to be "fair and clinically sound," and they must be developed through a process that is transparent and "judged by the public to be fair." Triage procedures need to be flexible enough to adjust to the size and speed of the event and must be able to adjust to a growing number of casualties. Event planning needs to take into account the factors common to all mass-casualty events, such as an adequate supply of providers, as well as those factors that are specific to each hazard. Nonmedical issues related to adjusting the standards of care for a mass-casualty event include the authority to activate those standards, legal issues, compensation for providers, and communication with the public. The expert panel recommends that local health care provider networks develop "general and event-specific guidance" for adjusting their health care resources during mass-casualty events; develop and implement a process to address finance, communication, and other nonmedical issues during such events; develop a risk communication strategy for before, during, and after an event; identify laws affecting care delivery and consider modifying them for mass-casualty events; develop tools to verify the credentials of medical care providers during such events; and expand efforts to train providers to respond effectively.

Copies are available at www.ahrq.gov/research/altstand/altstand.pdf.

Books Received

Top Bioethics Health Care Costs Long-Term Care Mental Health/Substance Abuse Patient Safety Public Health Books Received

 
Falling through the Safety Net: Americans without Health Insurance, John Geyman (Monroe, Maine: Common Courage Press, 2005), 213 pp., $29.95 (cloth), $18.95 (paper).

Health Security for All: Dreams of Universal Health Care in America, Alan Derickson (Baltimore: Johns Hopkins University Press, 2005), 240 pp., $30.

The Price of Smoking, Frank A. Sloan, Jan Ostermann, Gabriel Picone, Christopher Conover, and Donald H. Taylor Jr. (Cambridge, Mass.: MIT Press, 2005), 320 pp., $40.

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