Reading list

Employment-Based Health Benefits: Recent Trends and Future Outlook, by Paul Fronstin (Inquiry)

The employment-based health benefits system established its roots many years ago. It was during World War II that many more employers began to offer health benefits. Recently, however, both the percentage of workers with employment-based health benefits and the comprehensiveness of such coverage have been declining. This paper examines recent trends in employment-based health benefits. It also considers the likely future of this important workplace benefit in light of shifts from defined benefit to defined contribution models of employee benefits and with regard to the implementation of health reform.

Why Employers Will Continue to Provide Health Insurance: The Impact of the Affordable Care Act, by Linda J. Blumberg, Matthew Buettgens, Judith Feder and John Holahan (Inquiry)

The Congressional Budget Office, the Rand Corporation, and the Urban Institute have estimated that the Patient Protection and Affordable Care Act (ACA) will leave employer-sponsored coverage largely intact; in contrast, some economists and benefit consultants argue that the ACA encourages employers to drop coverage, thereby making both their workers and their firms better off (a “win–win” situation). This analysis shows that no such “win–win” situation exists and that employer-sponsored insurance will remain the primary source of coverage for most workers. Analysis of three issues—the terms of the ACA, worker characteristics, and the fundamental economics of competitive markets—supports this conclusion.

The Relationship between Hospital Market Competition, Evidence-Based Performance Measures, and Mortality for Chronic Heart Failure, by Jared Lane K. Maeda and Anthony T. Lo Sasso (Inquiry)

Using data from the Joint Commission’s ORYX initiative and the Medicare Provider Analysis and Review file from 2003 to 2006, this study employed a fixed-effects approach to examine the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at seven days, 30 days, 90 days, and one year for patients with chronic heart failure. We found that, on average, higher adherence with most of the Joint Commission’s heart failure performance measures was not associated with lower mortality; the level of market competition also was not associated with any differences in mortality. However, higher adherence with the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentiles of the mortality distribution was associated with incrementally lower mortality rates. These findings suggest that targeting evidence-based processes of care might have a stronger impact in improving patient outcomes.

The Trillion Dollar Conundrum: Complementarities and Health Information Technology, by David Dranove, Christopher Forman, Avi Goldfarb and Shane Greenstein (The National Bureau of Economic Research)

We examine the heterogeneous relationship between the adoption of electronic medical records (EMR) and hospital operating costs at thousands of US hospitals between 1996 and 2009. Combining data from multiple sources, we first identify a puzzle that has been seen in prior studies: Adoption of EMR is generally associated with a slight increase in costs. We draw on the literature on information technology as a business process innovation to analyze why this average effect arises, and explain why it masks important differences over time, across locations, and across hospitals. We find evidence consistent with this approach, namely, that: (1) EMR adoption is initially associated with a rise in costs; (2) EMR adoption at hospitals in favorable conditions – such as urban locations – leads to a decrease in costs after three years; and (3) Hospitals in unfavorable conditions experience a sharp increase in costs even after six years.

Tackling Rising Health Care Costs in Massachusetts, by John Z. Ayanian, and Philip J. Van der Wees (The New England Journal of Medicine)

Unfinished Journey — A Century of Health Care Reform in the United States, by Jonathan Oberlander (The New England Journal of Medicine)

Quality-of-Life Effects of Prostate-Specific Antigen Screening, by Eveline A.M. Heijnsdijk, Elisabeth M. Wever, Anssi Auvinen, Jonas Hugosson, Stefano Ciatto, Vera Nelen, Maciej Kwiatkowski, Arnauld Villers, Alvaro Páez, Sue M. Moss, Marco Zappa, Teuvo L.J. Tammela, Tuukka Mäkinen, Sigrid Carlsson, Ida J. Korfage, Marie-Louise Essink-Bot, Suzie J. Otto, Gerrit Draisma, Chris H. Bangma, Monique J. Roobol, Fritz H. Schröder and Harry J. de Koning (The New England Journal of Medicine)

Background: After 11 years of follow-up, the European Randomized Study of Screening for Prostate Cancer (ERSPC) reported a 29% reduction in prostate-cancer mortality among men who underwent screening for prostate-specific antigen (PSA) levels. However, the extent to which harms to quality of life resulting from overdiagnosis and treatment counterbalance this benefit is uncertain.

Methods: On the basis of ERSPC follow-up data, we used Microsimulation Screening Analysis (MISCAN) to predict the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening. Various screening strategies, efficacies, and quality-of-life assumptions were modeled.

Results: Per 1000 men of all ages who were followed for their entire life span, we predicted that annual screening of men between the ages of 55 and 69 years would result in nine fewer deaths from prostate cancer (28% reduction), 14 fewer men receiving palliative therapy (35% reduction), and a total of 73 life-years gained (average, 8.4 years per prostate-cancer death avoided). The number of QALYs that were gained was 56 (range, −21 to 97), a reduction of 23% from unadjusted life-years gained. To prevent one prostate-cancer death, 98 men would need to be screened and 5 cancers would need to be detected. Screening of all men between the ages of 55 and 74 would result in more life-years gained (82) but the same number of QALYs (56).

Conclusions: The benefit of PSA screening was diminished by loss of QALYs owing to postdiagnosis long-term effects. Longer follow-up data from both the ERSPC and quality-of-life analyses are essential before universal recommendations regarding screening can be made.

Quality of Life and Guidelines for PSA Screening, by Harold C. Sox (The New England Journal of Medicine)


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