Jane Anderson

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

African Americans, Hispanics, American Indians, and Alaska Natives were hospitalized for the H1N1 flu at rates that were nearly twice those of whites, according to a report from the Trust for America’s Health.

The report, Fighting Flu Fatigue, also found that both H1N1 and seasonal flu vaccination rates were lower for African Americans and Hispanics than they were for whites.

CDC

The lower rates for immunizations and higher hospitalization rates among minority populations could reflect lower rates of health care coverage among those groups, Litjen Tan, Ph.D., director of medicine and public health for the American Medical Association, said in a conference call discussing the findings.

"If you have coverage, if you have insurance, you’re more likely to access care [more quickly] than if you don’t," Dr. Tan said. "If you’re insured, you’re going to go in faster," for care before hospitalization becomes necessary.

The report found that African American hospitalization rates from the H1N1 flu were 29.7/100,000 people, compared with white hospitalization rates of 16.3/100,000 people. Hispanic hospitalization rates were 30.7 /100,000 people, and American Indians/Alaska Natives had a hospitalization rate of 32.7/100,000 people.

Some specific states and cities studied also found that mortality rates from H1N1 were much higher in minorities than in whites, the report said. For example, in Illinois, the mortality rate for Latinos was 6/100,000 and the mortality rate for African Americans was 7 /100,000, compared with 3/100,000 for whites.

Meanwhile, H1N1 vaccination rates were generally lower for minorities than for whites, although there were some variations.

In African Americans, vaccination rates were 9.8% lower for adults and 4.2% lower for children, compared with the rates for whites.

In Hispanics, vaccination rates were 11.5% lower for adults than for whites, but rates for Hispanic children were 5.5% higher than for whites. Seasonal flu vaccination rates were 21.7% lower for Hispanic adults and 2.6% lower for Hispanic children than for whites, the report found.

By the end of June 2010, about 27% of all Americans had been vaccinated against H1N1, the report said. About 70% of seniors and 24% of adults under age 50 get a seasonal flu vaccine each year, according to Dr. Tan.

The Trust for America’s Health report urged new measures to build on the success of the efforts to prevent the H1N1 flu and improve overall vaccination rates. The United States risks going back to a "national complacency" surrounding the flu, rather than building on last year’s efforts, Jeffrey Levi, Ph.D., the group’s executive director, said during the briefing on the report.

"We’re at a crossroads," he said. "The flu is often seen as nothing more than a simple nuisance," but it causes significant morbidity and mortality that’s "largely preventable with vaccine."

To improve vaccination rates, physicians and public health officials should strive to make getting a flu vaccine as easy and as routine as possible, Dr. Tan said. "Getting a flu vaccine every year should be a routine part of your fall activities," he said. "When you get a turkey for Thanksgiving or presents for Christmas, you should think of getting a flu vaccine."

In addition, physicians and public health officials need to continue encouraging health care workers to get flu vaccines and to that ensure pharmaceuticals and medical equipment are up to date in case of an outbreak, the report said.

The Trust for America’s Health study was supported by a grant from the Robert Wood Johnson Foundation.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published Nov. 18.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to "How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries," published online in the journal Health Affairs.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing. "There could be some effects early on, but the big difference should show up in 2015 or 2016."

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn’t paid as much as expected. Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

"We emerged as the only country in the study where being insured doesn’t guarantee you’ll be covered when you get sick," said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

"Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick," according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients’ income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. "The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law."

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to "bend the cost curve," she said, adding that "we see about half a percentage point slowdown" in the annual increase in health care costs as a result of ACA provisions.

Major Finding: Hospitals ranged from 53.7% to 91.4% in their compliance with Centers for Medicare and Medicaid surgical processes of care measures, but a hospital's score didn't correspond to its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

Data Source: Medicare inpatient claims data Jan. 1, 2005, through Dec. 31, 2006, and Surgical Care Improvement Project scores reported on the Hospital Compare Web site.

Disclosures: The study's authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.

Risk-adjusted patient outcomes don't vary between hospitals, regardless of how well they scored on the measures of quality-process compliance behind Medicare's Hospital Compare Web site, researchers have found.

“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.

The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, they said.

The study looked at data from 2,000 hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).

The CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly. The data are then posted at www.hospitalcompare.hhs.gov

They looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.

Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital's score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. Patients at hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.

The lack of correlation between “process compliance,” as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.

They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”

Major Finding: Hospitals ranged from 53.7% to 91.4% in their compliance with Centers for Medicare and Medicaid surgical processes of care measures, but a hospital's score didn't correspond to its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

Data Source: Medicare inpatient claims data Jan. 1, 2005, through Dec. 31, 2006, and Surgical Care Improvement Project scores reported on the Hospital Compare Web site.

Disclosures: The study's authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.

Risk-adjusted patient outcomes don't vary between hospitals, regardless of how well they scored on the measures of quality-process compliance behind Medicare's Hospital Compare Web site, researchers have found.

“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.

The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, they said.

The study looked at data from 2,000 hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).

The CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly. The data are then posted at www.hospitalcompare.hhs.gov

They looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.

Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital's score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. Patients at hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.

The lack of correlation between “process compliance,” as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.

They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”

Major Finding: Hospitals ranged from 53.7% to 91.4% in their compliance with Centers for Medicare and Medicaid surgical processes of care measures, but a hospital's score didn't correspond to its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

Data Source: Medicare inpatient claims data Jan. 1, 2005, through Dec. 31, 2006, and Surgical Care Improvement Project scores reported on the Hospital Compare Web site.

Disclosures: The study's authors were supported by several federal grants and funds from the Robert Wood Johnson Foundation.

Risk-adjusted patient outcomes don't vary between hospitals, regardless of how well they scored on the measures of quality-process compliance behind Medicare's Hospital Compare Web site, researchers have found.

“Despite the intentions of the CMS [Centers for Medicare and Medicaid Services] to provide patients with information that will facilitate patient choice of high-quality hospitals, currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery,” wrote the authors, from the University of Michigan and the Michigan Surgical Collaborative for Outcomes Research and Evaluation, both in Ann Arbor.

The fault may lie in the Surgical Care Improvement Project (SCIP) measures used to generate the Hospital Compare data, which mainly track very rare complications, such as deep venous thrombosis, and less important events, such as superficial surgical site infections, they said.

The study looked at data from 2,000 hospitals on three SCIP outcomes measures: 30-day postoperative mortality, venous thromboembolisms, and surgical site infections (Arch. Surg. 2010;145:999-1004).

The CMS mandates reporting of two sets of SCIP data – one on infection and one on venous thromboembolism – for hospitals to receive annual payment increases. Hospitals submit their data quarterly. The data are then posted at www.hospitalcompare.hhs.gov

They looked at patient outcomes after six high-risk surgical procedures: abdominal aortic aneurysm repair, aortic valve repair, coronary artery bypass graft, esophageal resection, mitral valve repair, and pancreatic resection.

Compliance rates with the SCIP measures ranged considerably from 53.7% to 91.4%, but the study found little evidence of a consistent relationship between a hospital's score and its rates of risk-adjusted mortality, venous thromboembolism, or surgical site infection.

The authors also looked at data on extended lengths of stay, which can result from numerous postoperative complications. Patients at hospitals that most often complied with SCIP were 12% less likely to experience an extended stay relative to middle-compliance hospitals, but there was no difference between the middle- and lowest-compliance hospitals.

The lack of correlation between “process compliance,” as measured by SCIP numbers, will be important as quality measures have increasing impact on reimbursements for care, said the authors. “If there is a weak link between process compliance and surgical outcomes, CMS public reporting and pay-for-performance efforts will be unlikely to stimulate important improvements or to help patients find the safest hospitals,” they wrote.

They advised the CMS to “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;29:2022-6).

To measure adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rose by 4.2% in the intervention group compared to the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared to the control group.

Such value-based benefit designs can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost is not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.). “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” she said in an interview.

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their drugs. If the researchers studied patients paying $150 out of pocket for a medication, and if that cost were dropped to $15, they might see a greater effect, he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” she said in an interview. “Not making appointments, not going in for testing, not filling the prescription all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;29:2022-6).

To measure adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rose by 4.2% in the intervention group compared to the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared to the control group.

Such value-based benefit designs can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost is not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.). “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” she said in an interview.

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their drugs. If the researchers studied patients paying $150 out of pocket for a medication, and if that cost were dropped to $15, they might see a greater effect, he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” she said in an interview. “Not making appointments, not going in for testing, not filling the prescription all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;29:2022-6).

To measure adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rose by 4.2% in the intervention group compared to the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared to the control group.

Such value-based benefit designs can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost is not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.). “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” she said in an interview.

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their drugs. If the researchers studied patients paying $150 out of pocket for a medication, and if that cost were dropped to $15, they might see a greater effect, he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” she said in an interview. “Not making appointments, not going in for testing, not filling the prescription all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

HHS Offers Health Center Grants

The Department of Health and Human Services will make up to $335 million available to existing community health centers to help them increase access to preventive and primary care, including dentistry, behavioral counseling, and vision and pharmacy services. To apply for the bonus funding, community health centers must show HHS how they plan to use the money to increase their medical capacity and their services to underserved populations. HHS also has announced awards of $727 million to 143 community health centers across the country to make capital improvements. These are the first awards to community health centers in a series to be paid out from the health care reform act passed last spring.

Wired Practices Make More Money

Medical practices that have adopted electronic health records (EHRs) perform better financially than practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

NIH Funds Resistance Research

The National Institute of Allergy and Infectious Diseases has okayed four new contracts for large clinical trials designed to address the problem of antimicrobial resistance. The trials will evaluate alternatives to antibiotics as treatments for diseases such as acute otitis media, community-acquired pneumonia, and gram-negative bacteria infections, which frequently resist first-line antibiotics. Each trial will enroll at least 1,000 participants who have been diagnosed with these conditions. The new trials are part of a two-pronged government approach to antimicrobial research: learning how to protect the usefulness of available drugs while facilitating the development of new antibiotics. The institute already has begun four large trials looking at antimicrobial resistance, and the four new trials are similarly designed to answer specific questions on how to improve treatment strategies, such as by adjusting dosage and duration of treatment, the trials' announcement said.

Drug-Related Hospitalizations Up

Hospitalizations for drug-induced conditions more than doubled between 1997 and 2008 for Americans aged 45 years and older, according to a report from the Agency for Healthcare Research and Quality. Meanwhile, admissions related to prescription- and illicit-drug problems grew by 96% for people aged 65-84 years and by 87% for those older than 85, the agency said. By comparison, the number of drug-related hospital admissions declined by 11% among adults aged 18-44 years. In the older groups, hospitalizations increased most for three types of drug-related conditions: drug-induced delirium; poisoning or overdose by codeine, meperidine, and other opiate-based pain medicines; and withdrawal from drug addictions, AHRQ said. Medicare and Medicaid paid 54% of the $1.1 billion tab for these hospitalizations.

Lawsuit Targets Michigan Blues

The State of Michigan and the U.S. Department of Justice have filed suit in federal court accusing nonprofit health insurer Blue Cross Blue Shield of Michigan of illegally using its market power to raise prices for hospital services provided to members of competing health plans. The suit alleges that the Michigan Blues plan's “Most Favored Nation” clauses, included in reimbursement contracts with approximately half of the state's hospitals, gave the insurer an unfair advantage by forcing hospitals to charge other insurers more for the same services. A joint investigation by the state's attorney general and the Department of Justice found that the insurer increased its use of the clauses in 2007, threatening to slash payments to 45 small, rural hospitals by up to 16% if they refused to comply. According to the investigation, the insurer used similar clauses with at least 23 larger hospitals but offered them increased reimbursement, as long as all other insurers had to pay more. Blue Cross Blue Shield of Michigan said in a statement that the lawsuit seeks to restrict its ability to provide deeply discounted rates to its members.

Vitals

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

HHS Offers Health Center Grants

The Department of Health and Human Services will make up to $335 million available to existing community health centers to help them increase access to preventive and primary care, including dentistry, behavioral counseling, and vision and pharmacy services. To apply for the bonus funding, community health centers must show HHS how they plan to use the money to increase their medical capacity and their services to underserved populations. HHS also has announced awards of $727 million to 143 community health centers across the country to make capital improvements. These are the first awards to community health centers in a series to be paid out from the health care reform act passed last spring.

Wired Practices Make More Money

Medical practices that have adopted electronic health records (EHRs) perform better financially than practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

NIH Funds Resistance Research

The National Institute of Allergy and Infectious Diseases has okayed four new contracts for large clinical trials designed to address the problem of antimicrobial resistance. The trials will evaluate alternatives to antibiotics as treatments for diseases such as acute otitis media, community-acquired pneumonia, and gram-negative bacteria infections, which frequently resist first-line antibiotics. Each trial will enroll at least 1,000 participants who have been diagnosed with these conditions. The new trials are part of a two-pronged government approach to antimicrobial research: learning how to protect the usefulness of available drugs while facilitating the development of new antibiotics. The institute already has begun four large trials looking at antimicrobial resistance, and the four new trials are similarly designed to answer specific questions on how to improve treatment strategies, such as by adjusting dosage and duration of treatment, the trials' announcement said.

Drug-Related Hospitalizations Up

Hospitalizations for drug-induced conditions more than doubled between 1997 and 2008 for Americans aged 45 years and older, according to a report from the Agency for Healthcare Research and Quality. Meanwhile, admissions related to prescription- and illicit-drug problems grew by 96% for people aged 65-84 years and by 87% for those older than 85, the agency said. By comparison, the number of drug-related hospital admissions declined by 11% among adults aged 18-44 years. In the older groups, hospitalizations increased most for three types of drug-related conditions: drug-induced delirium; poisoning or overdose by codeine, meperidine, and other opiate-based pain medicines; and withdrawal from drug addictions, AHRQ said. Medicare and Medicaid paid 54% of the $1.1 billion tab for these hospitalizations.

Lawsuit Targets Michigan Blues

The State of Michigan and the U.S. Department of Justice have filed suit in federal court accusing nonprofit health insurer Blue Cross Blue Shield of Michigan of illegally using its market power to raise prices for hospital services provided to members of competing health plans. The suit alleges that the Michigan Blues plan's “Most Favored Nation” clauses, included in reimbursement contracts with approximately half of the state's hospitals, gave the insurer an unfair advantage by forcing hospitals to charge other insurers more for the same services. A joint investigation by the state's attorney general and the Department of Justice found that the insurer increased its use of the clauses in 2007, threatening to slash payments to 45 small, rural hospitals by up to 16% if they refused to comply. According to the investigation, the insurer used similar clauses with at least 23 larger hospitals but offered them increased reimbursement, as long as all other insurers had to pay more. Blue Cross Blue Shield of Michigan said in a statement that the lawsuit seeks to restrict its ability to provide deeply discounted rates to its members.

Vitals

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

HHS Offers Health Center Grants

The Department of Health and Human Services will make up to $335 million available to existing community health centers to help them increase access to preventive and primary care, including dentistry, behavioral counseling, and vision and pharmacy services. To apply for the bonus funding, community health centers must show HHS how they plan to use the money to increase their medical capacity and their services to underserved populations. HHS also has announced awards of $727 million to 143 community health centers across the country to make capital improvements. These are the first awards to community health centers in a series to be paid out from the health care reform act passed last spring.

Wired Practices Make More Money

Medical practices that have adopted electronic health records (EHRs) perform better financially than practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “While the implementation process can be very cumbersome, these data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

NIH Funds Resistance Research

The National Institute of Allergy and Infectious Diseases has okayed four new contracts for large clinical trials designed to address the problem of antimicrobial resistance. The trials will evaluate alternatives to antibiotics as treatments for diseases such as acute otitis media, community-acquired pneumonia, and gram-negative bacteria infections, which frequently resist first-line antibiotics. Each trial will enroll at least 1,000 participants who have been diagnosed with these conditions. The new trials are part of a two-pronged government approach to antimicrobial research: learning how to protect the usefulness of available drugs while facilitating the development of new antibiotics. The institute already has begun four large trials looking at antimicrobial resistance, and the four new trials are similarly designed to answer specific questions on how to improve treatment strategies, such as by adjusting dosage and duration of treatment, the trials' announcement said.

Drug-Related Hospitalizations Up

Hospitalizations for drug-induced conditions more than doubled between 1997 and 2008 for Americans aged 45 years and older, according to a report from the Agency for Healthcare Research and Quality. Meanwhile, admissions related to prescription- and illicit-drug problems grew by 96% for people aged 65-84 years and by 87% for those older than 85, the agency said. By comparison, the number of drug-related hospital admissions declined by 11% among adults aged 18-44 years. In the older groups, hospitalizations increased most for three types of drug-related conditions: drug-induced delirium; poisoning or overdose by codeine, meperidine, and other opiate-based pain medicines; and withdrawal from drug addictions, AHRQ said. Medicare and Medicaid paid 54% of the $1.1 billion tab for these hospitalizations.

Lawsuit Targets Michigan Blues

The State of Michigan and the U.S. Department of Justice have filed suit in federal court accusing nonprofit health insurer Blue Cross Blue Shield of Michigan of illegally using its market power to raise prices for hospital services provided to members of competing health plans. The suit alleges that the Michigan Blues plan's “Most Favored Nation” clauses, included in reimbursement contracts with approximately half of the state's hospitals, gave the insurer an unfair advantage by forcing hospitals to charge other insurers more for the same services. A joint investigation by the state's attorney general and the Department of Justice found that the insurer increased its use of the clauses in 2007, threatening to slash payments to 45 small, rural hospitals by up to 16% if they refused to comply. According to the investigation, the insurer used similar clauses with at least 23 larger hospitals but offered them increased reimbursement, as long as all other insurers had to pay more. Blue Cross Blue Shield of Michigan said in a statement that the lawsuit seeks to restrict its ability to provide deeply discounted rates to its members.

Vitals

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages involve neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were nonprocedural and relied on talking to and examining patients, they noted. “The major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study researchers said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages involve neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were nonprocedural and relied on talking to and examining patients, they noted. “The major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study researchers said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages involve neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were nonprocedural and relied on talking to and examining patients, they noted. “The major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour, the study researchers said. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned slightly more than $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

“The present findings suggest that legislators, health insurance administrators, medical group directors, health care plan managers and executives, residency directors, and health policy makers should consider taking action to increase incomes or reduce work hours for specialties near the bottom of the wage ranking list, particularly generalist specialties,” Dr. Leigh and his colleagues wrote.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant conflicts of interest.

View on the News

Failure Could Lead to Cuts in All Fees

“Despite physician concerns about payment reform, failure to change payment systems may be worse for providers,” Michael E. Chernew, Ph.D., wrote in an accompanying commentary. “If we retain the current fee-for-service system, there will likely be significant downward pressure on payment rates for all providers … hoping that payment reform (or fee cuts) will not materialize seems overly optimistic.”

It's likely that any payment reform will have significant effects on the basic business model of many physician practices, but providers can find ways to save costs within most of the reforms by reducing redundant and unnecessary care, according to Dr. Chernew (Arch. Intern. Med. 2010;170:1742-4).

“Payment reform will surely generate some provider backlash, and surely bundled payments will create tension between physicians and other types of providers, among different specialties, and between primary care and specialist physicians,” he wrote. “Moreover, the transition to new payment systems may not be easy, requiring considerable investment and organizational change.”

But failing to act could lead to worse consequences for physicians, he wrote.

MICHAEL E. CHERNEW, PH.D., is a professor of health care policy at Harvard Medical School. He reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant conflicts of interest.

View on the News

Failure Could Lead to Cuts in All Fees

“Despite physician concerns about payment reform, failure to change payment systems may be worse for providers,” Michael E. Chernew, Ph.D., wrote in an accompanying commentary. “If we retain the current fee-for-service system, there will likely be significant downward pressure on payment rates for all providers … hoping that payment reform (or fee cuts) will not materialize seems overly optimistic.”

It's likely that any payment reform will have significant effects on the basic business model of many physician practices, but providers can find ways to save costs within most of the reforms by reducing redundant and unnecessary care, according to Dr. Chernew (Arch. Intern. Med. 2010;170:1742-4).

“Payment reform will surely generate some provider backlash, and surely bundled payments will create tension between physicians and other types of providers, among different specialties, and between primary care and specialist physicians,” he wrote. “Moreover, the transition to new payment systems may not be easy, requiring considerable investment and organizational change.”

But failing to act could lead to worse consequences for physicians, he wrote.

MICHAEL E. CHERNEW, PH.D., is a professor of health care policy at Harvard Medical School. He reported no relevant financial conflicts of interest.

Physicians are dissatisfied with the current Medicare reimbursement system and want reform, yet they disagree on what type of reform they would be willing to accept.

“Most physicians believe that Medicare reimbursements are inequitable, and yet there is little consensus among them regarding major proposals to reform reimbursement,” Dr. Alex D. Federman and his colleagues from Mount Sinai School of Medicine, New York, said regarding their national survey of physicians' opinions on reform, published in the Archives of Internal Medicine.

“Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending, and improve health care quality will be difficult,” the investigators noted.

The investigators surveyed physicians between June and October 2009 – at the height of the congressional debate on health reform. Of 2,518 physicians who received a version of the survey addressing reimbursement reform, 1,222 (49%) responded.

A total of 78% of respondents agreed that under Medicare some procedures are compensated too highly while others aren't compensated enough to cover costs, according to the survey results. However, when asked about specific methods to reform Medicare payment, the physicians surveyed showed little agreement.

More than two-thirds of physicians said they opposed bundled payments, with surgeons – who have the most experience with bundling – expressing the lowest levels of support for this strategy (Arch. Intern. Med. 2010;170:1735-42).

“Because bundled payments are likely to be implemented in one form or another, this mechanism ought to be carefully explained to physicians to promote broad acceptance and smooth implementation,” Dr. Federman and colleagues wrote.

Half of the responding physicians said they supported financial incentives to improve quality, and “support for incentives was more common and more consistent across all specialties compared with shifting and bundling payments,” the investigators wrote. “Actual experience with financial incentives to improve quality could have directly informed physicians' generally more positive views of these types of reimbursement mechanisms.”

Physicians disagreed on whether to shift some portion of payments from procedures to management and counseling, with those who conduct procedures saying they were against it and those who do more management and counseling coming out in favor of it, the study said.

Still, about 17% of surgeons and 27% of physicians in other more procedurally oriented specialties said they supported such a shift, “indicating that underpayment of management and counseling even in procedurally oriented specialties is a concern for many physicians.”

The investigators reported no relevant conflicts of interest.

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Failure Could Lead to Cuts in All Fees

“Despite physician concerns about payment reform, failure to change payment systems may be worse for providers,” Michael E. Chernew, Ph.D., wrote in an accompanying commentary. “If we retain the current fee-for-service system, there will likely be significant downward pressure on payment rates for all providers … hoping that payment reform (or fee cuts) will not materialize seems overly optimistic.”

It's likely that any payment reform will have significant effects on the basic business model of many physician practices, but providers can find ways to save costs within most of the reforms by reducing redundant and unnecessary care, according to Dr. Chernew (Arch. Intern. Med. 2010;170:1742-4).

“Payment reform will surely generate some provider backlash, and surely bundled payments will create tension between physicians and other types of providers, among different specialties, and between primary care and specialist physicians,” he wrote. “Moreover, the transition to new payment systems may not be easy, requiring considerable investment and organizational change.”

But failing to act could lead to worse consequences for physicians, he wrote.

MICHAEL E. CHERNEW, PH.D., is a professor of health care policy at Harvard Medical School. He reported no relevant financial conflicts of interest.