2014 Year in Review

The year began with great news out of Oregon and the release of more data from the Oregon Health Insurance Experiment, one of the two best studies we have on the effect of insurance on health care and costs (the other is the of the in1970s).

Oregon had a in emergency department visits for patients gaining Medicaid, sending a warning call to states implementing the Medicaid expansion of the Affordable Care Act. Early on we should expect a bump in health care utilization, especially in the only area of the health care universe where access is available to everyone regardless of ability to pay. Prudent investments in primary care need to take place as well.

Throughout the year, several other reports addressing emergency care emerged in the health policy literature. Wilson and Cutler demonstrated that hospital-based emergency departments would see in states that implement all aspects of the ACA as opposed to those that reject it. Most intriguing, however, was the calculation—often noted by physicians—that the only patients from whom emergency departments can make a profit are those with private insurance. Patients covered by public insurance like Medicaid and the uninsured are loss leaders for EDs. Regardless, someone is paying for that care. Whether you prefer it to be through higher premiums for the privately insured or through higher taxes, the choice is yours.

Reports from California showed that had adverse effects on mortality, not only for the people directly affected by the closure but also at surrounding institutions. With threatening the financial security of safety net hospitals, stakeholders for all hospitals must be on alert. Despite concerns with the ACA, millions have gained coverage because of it, which is good news for providers of emergency care.

Health IT

The literature in 2014 continued to show benefits to implementing health information technology. A study by Low et al. showed accruing to providers, payers, and society in 75% of studies addressing the issue. Another study showed that technical assistance and financial incentives improved in conjunction with health IT. However, improvements were noted only in measured outcomes, not unmeasured ones. This is not unexpected as previous research has shown evidence of the “” phenomenon.

Doctors and hospitals expanded their use of health information technology in 2014, but few have met standards. Recent government reports suggest that many doctors will see penalties on their Medicare payments next year as a consequence.

Cost of Care

Now that to millions of Americans and the rates of uninsured are at an all time low, focus for reformers will likely shift to . High deductible health plans, common in the Obamacare marketplaces, show a trend of about of outpatient services.

Other cost-saving interventions proven effective in 2014 include , , and seeking certain outpatient tests.

Unfortunately, not all designs may be as effective as once thought—at least, not for the Medicaid population. Given the same price for generics or brand name prescriptions, patients preferred the brand name.

Additionally, clinicians have a as to the cost of expensive healthcare services, such as orthopedic devices. Provider-led cost control will remain elusive until price transparency allows doctors to better understand the cost of care for their own patients.

Access to Care

Millions more have health care coverage than in recent years, yet the mounting concern is whether or not coverage will equate to access. Rhodes, et al. found that is limited for all payers across the nation. The situation is especially worrisome for or those with no coverage at all.

Amid a which similarly described poor access despite coverage, many were shocked to find out that . That amounts to 1.5 million without any form of coverage and 200,000 stuck in states that are caught in the ACA’s Medicaid gap.

With all we know about the problems of being uninsured, recent data suggest that the value and impact of health insurance can be quantified. To , 830 Americans need to gain coverage. While an expensive threshold for most medical interventions, mortality reduction is for the benefits of health insurance. Financial security, improved morbidity, and peace of mind immediately come to thought for me.

What’s next?

The beauty of what we do here at Policy Prescriptions® is that we get to learn about the best and most rigorous evidence in health policy, public health, and health economics to inform concerned Americans and influence policy decisions. Just as physicians practice evidence-based medicine whenever possible, we hope our efforts here will encourage lawmakers and other decision-makers to practice evidence-based health policy.

That said, evidence shows that as part of the ACA. I hope President Obama and Congressional Democrats would be willing to compromise with Republicans on that point in order to achieve to the health reform law (speeding up the implementation of the Cadillac Tax immediately comes to mind).

Evidence regarding other aspects of the ACA, such as , shows that certain payment reforms may never work. Others, such as the , may have solid benefits.

We will continue our quest to bring you the best evidence in a timely and understandable manner so you can remain informed about the issues at hand in health policy. We hope that you use this information constructively to communicate with your elected representatives and other policy-makers to implement changes that best improve the practice environment for clinicians and the health of our patients.