At the Intersection of Health, Health Care and Policy Cite this article as: Alan R. Weil Aging And Health Health Affairs, 34, no.1 (2015):6 doi: 10.1377/hlthaff.2014.1399
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/34/1/6.full.html
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2015 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on March 18, 2015 at NC STATE UNIVERISTY
from the editor-in-chief
DOI: 10.1377/hlthaff.2014.1399
Aging And Health by alan r. weil
T
he US Census Bureau pro jects that more than one in five Americans will be age sixty-five or older by 2030. This reflects dramatic growth from the current 13.7 percent. Last month we published internation al survey results showing significant shortcomings in access and care for older Americans. With this issue we launch a new series called “Aging and Health,” with support from the John A. Hartford Foundation.
aging and health Bruce Leff and colleagues explore qual ity of care for the four million adults in the US who are homebound. While it is commonplace to consider primary care as the linchpin of service integration for most patients, the authors remind us that “for homebound patients, tra ditional ambulatory primary care is un coordinated, inaccessible, and ineffec tive.” They go on to describe better care models for homebound patients and their efforts to develop quality indica tors for home-based primary and palli ative care. Another traditional measure of care quality is the receipt of preventive care. The “Welcome to Medicare” preventive care visit was created in 2005, with cov erage for an annual wellness visit added by the Affordable Care Act in 2011. Ex amining data from the Palo Alto Medi cal Foundation, in California, Sukyung Chung and colleagues discovered that preventive care visits nearly doubled among Medicare fee-for-service bene ficiaries between 2007 and 2013. They conclude that this evidence “supports the idea that relatively straightforward changes in coverage can have impor
6
health affairs
tant and rapid effects on the use of pre ventive services.” Additional papers reflect the sorts of topics we will continue to cover in this series. David Stevenson and colleagues document the evolution of hospice care from provision largely by indepen dent providers in 2000 to almost half of that care delivered through members of regional or national chains in 2011. Carrie Henning-Smith and Tetyana Shippee found that adults ages 40–65 had different expectations of their fu ture need for and how they would ob tain long-term services and supports depending upon their living circum stances—in particular, whether or not they had minor children at home. hospital prices Almost one of every three health care dollars is spent in a hospital. In 2006 California enacted the Hospital Fair Pricing Act, which limits the prices hospitals can charge low- and moder ate-income patients who are uninsured. Ge Bai finds that the law had a dramat ic effect: The median price paid by unin sured patients in California was 6 per cent higher than what Medicare paid in 2004, but in 2012 it had dropped to 68 percent below Medicare’s payment rates. In 2005 Medicare launched the Hos pital Compare initiative to give con sumers access to quality information with the goal of improving their choic es. The law did little to change con sumers’ behavior, but Avi Dor and col leagues found that it had a different effect: Private payers were able to nego tiate better prices, presumably by using the leverage created by having knowl edge about hospitals’ relative quality.
january 2015
families’ health care spending As the Affordable Care Act reduces the number of people without health in surance, it is worth remembering that the financial protection provided by in surance is incomplete. Peter Cunning ham updates work we published a few years ago to show continued growth in the share of families facing high medi cal costs, defined as more than 10 per cent of family income going toward insurance premiums and out-of-pock et expenses. Notable growth occurred among those with employer-sponsored insurance, for whom the percentage of families with high costs grew from 17.9 percent to 19.9 percent between 2007–09 and 2011. Cunningham notes that “this increase was attributable pri marily to increases in family spending on premiums,” as opposed to higher spending on deductibles and copay ments. Looking at a slightly different period, Mary Catlin and colleagues show that families’ out-of-pocket spending, which does not include premiums, grew very slowly in the 2007–10 period (1.4 per cent per year) compared to 2004–07 (5.3 percent per year). Out-of-pocket spending actually declined for all cov erage categories other than people with private health insurance. Micah Hartman and colleagues deliv er the news that US national health ex penditures grew in 2013 at the slowest rate since the federal government be gan tabulating spending. We will have to wait to see whether those slower growth rates translate into lower spending burdens for families. the reality of care In our Narrative Matters series, physi cian Carla Keirns describes how close she came to having a cesarean section when her first child was born, despite her repeatedly expressed desire for a natural delivery so long as it would not harm her baby. Her gripping story re minds us how hard it is to honor pa tients’ preferences in a health care sys tem steeped in tradition and culture. n
34:1
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12/18/14 12:16 PM
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/34/1/6.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2015 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on March 18, 2015 at NC STATE UNIVERISTY
from the editor-in-chief
DOI: 10.1377/hlthaff.2014.1399
Aging And Health by alan r. weil
T
he US Census Bureau pro jects that more than one in five Americans will be age sixty-five or older by 2030. This reflects dramatic growth from the current 13.7 percent. Last month we published internation al survey results showing significant shortcomings in access and care for older Americans. With this issue we launch a new series called “Aging and Health,” with support from the John A. Hartford Foundation.
aging and health Bruce Leff and colleagues explore qual ity of care for the four million adults in the US who are homebound. While it is commonplace to consider primary care as the linchpin of service integration for most patients, the authors remind us that “for homebound patients, tra ditional ambulatory primary care is un coordinated, inaccessible, and ineffec tive.” They go on to describe better care models for homebound patients and their efforts to develop quality indica tors for home-based primary and palli ative care. Another traditional measure of care quality is the receipt of preventive care. The “Welcome to Medicare” preventive care visit was created in 2005, with cov erage for an annual wellness visit added by the Affordable Care Act in 2011. Ex amining data from the Palo Alto Medi cal Foundation, in California, Sukyung Chung and colleagues discovered that preventive care visits nearly doubled among Medicare fee-for-service bene ficiaries between 2007 and 2013. They conclude that this evidence “supports the idea that relatively straightforward changes in coverage can have impor
6
health affairs
tant and rapid effects on the use of pre ventive services.” Additional papers reflect the sorts of topics we will continue to cover in this series. David Stevenson and colleagues document the evolution of hospice care from provision largely by indepen dent providers in 2000 to almost half of that care delivered through members of regional or national chains in 2011. Carrie Henning-Smith and Tetyana Shippee found that adults ages 40–65 had different expectations of their fu ture need for and how they would ob tain long-term services and supports depending upon their living circum stances—in particular, whether or not they had minor children at home. hospital prices Almost one of every three health care dollars is spent in a hospital. In 2006 California enacted the Hospital Fair Pricing Act, which limits the prices hospitals can charge low- and moder ate-income patients who are uninsured. Ge Bai finds that the law had a dramat ic effect: The median price paid by unin sured patients in California was 6 per cent higher than what Medicare paid in 2004, but in 2012 it had dropped to 68 percent below Medicare’s payment rates. In 2005 Medicare launched the Hos pital Compare initiative to give con sumers access to quality information with the goal of improving their choic es. The law did little to change con sumers’ behavior, but Avi Dor and col leagues found that it had a different effect: Private payers were able to nego tiate better prices, presumably by using the leverage created by having knowl edge about hospitals’ relative quality.
january 2015
families’ health care spending As the Affordable Care Act reduces the number of people without health in surance, it is worth remembering that the financial protection provided by in surance is incomplete. Peter Cunning ham updates work we published a few years ago to show continued growth in the share of families facing high medi cal costs, defined as more than 10 per cent of family income going toward insurance premiums and out-of-pock et expenses. Notable growth occurred among those with employer-sponsored insurance, for whom the percentage of families with high costs grew from 17.9 percent to 19.9 percent between 2007–09 and 2011. Cunningham notes that “this increase was attributable pri marily to increases in family spending on premiums,” as opposed to higher spending on deductibles and copay ments. Looking at a slightly different period, Mary Catlin and colleagues show that families’ out-of-pocket spending, which does not include premiums, grew very slowly in the 2007–10 period (1.4 per cent per year) compared to 2004–07 (5.3 percent per year). Out-of-pocket spending actually declined for all cov erage categories other than people with private health insurance. Micah Hartman and colleagues deliv er the news that US national health ex penditures grew in 2013 at the slowest rate since the federal government be gan tabulating spending. We will have to wait to see whether those slower growth rates translate into lower spending burdens for families. the reality of care In our Narrative Matters series, physi cian Carla Keirns describes how close she came to having a cesarean section when her first child was born, despite her repeatedly expressed desire for a natural delivery so long as it would not harm her baby. Her gripping story re minds us how hard it is to honor pa tients’ preferences in a health care sys tem steeped in tradition and culture. n
34:1
Downloaded from content.healthaffairs.org by Health Affairs on March 18, 2015 at NC STATE UNIVERISTY Jan_EIC.indd 1110
12/18/14 12:16 PM
