For those of you who can’t get enough health policy minutia here are some interesting studies released just last week:
- The IMS Institute for Healthcare Informatics reported on the other one percent, the top one percent of health care utilizers, in a study to examines cost drivers, beneficiary characteristics and utilization trends in the under 65 market. The paper found substantial differences in spending and utilization between the privately insured under-65 and Medicare 65-and-over populations, and that care setting and treatment use vary considerably between the two segments, resulting in a different distribution of costs across outpatient, inpatient and pharmacy services. The report also found that the top one percent of health plan members spend nearly $100,000 annually per member on health services, in contrast to $3,837 per member for the overall plan population. The top 20% of members with the greatest need for healthcare services are responsible for more than 80% of total healthcare spending.
- The nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR) has released an analysis that claims that 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 because the plan options in place in the states that could be used as benchmark models for the essential health benefit requirements that take effect on January 1, 2014, for state individual and small-group markets already offer fairly rich benefits. The study specifically looked at the state of Maryland, which is a very mandate-heavy state. It concluded that almost all of Maryland’s mandates, which include in vitro fertilization, would be included as essential health benefits, regardless of which benchmark plan the state selects. Maryland’s liability for mandates in 2016 would range from about $10 million to $80 million—depending on the benchmark plan selected—if the state retained all mandates, according to the analysis.
- Senator Bernard Sanders has released a new report that highlights dental coverage and provider access as an emerging crisis. According to the report, as many as one-third of all Americans do not have dental coverage. Furthermore, lack of dental care can be a risk factor for other serious health conditions like diabetes and heart disease, and in order to meet the country’s current needs relating to oral health, there would be needed almost another 10,000 new professionals in the dental health field.
- A study by the California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research and the UC Berkeley Center for Labor Research and Education found that more than 100,000 Californians could miss out on enrolling in the state’s exchange because of language barriers. The study makes us wonder just what exchange navigators will be doing because it estimates that only 42% of limited-English-proficient adults eligible to receive premium subsidies should be expected to sign up for the exchange. That figure jumps to 53% if language isn’t a factor, according to the study, which still leaves 47% of the eligible population projected to skip enrolling in the exchange health coverage plans.