State Trends in Premiums and Deductibles, 2003-2010: The Need for Action to Address Rising Costs

Examines the rise in employer-based insurance premiums and deductibles and as a percentage of median household income. Projects average family coverage premiums in 2020 if federal health reform is not implemented and historical rates of increase continue

State Trends in Premiums and Deductibles, 2003-2011: Eroding Protection and Rising Costs Underscore Need for Action

Rapidly rising health insurance premiums and higher cost-sharing continue to strain the budgets of U.S. working families and employers. Analysis of state trends in private employer-based health insurance from 2003 to 2011 reveals that premiums for family coverage increased 62 percent across states -- rising far faster than income for middle- and low-income families. At the same time, deductibles more than doubled in large and small firms. Workers are thus paying more but getting less-protective benefits. If trends continue at their historical rate, the average premium for family coverage will reach nearly $25,000 by 2020. The Affordable Care Act's reforms should begin to moderate costs while improving coverage. But with private insurance costs projected to increase faster than incomes over the next decade, further efforts are needed. If annual premium growth slowed by one percentage point, by 2020 employers and families would save$2,029 annually for family coverage.View the related infographic

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

The Health Status of Southern Children: A Neglected Regional Disparity

Purpose: Great variations exist in child health outcomes among states in the United States, with southern states consistently ranked among the lowest in the country. Investigation of the geographical distribution of children’s health status and the regional factors contributing to these outcomes has been neglected. We attempted to identify the degree to which region of residence may be linked to health outcomes for children with the specific aim of determining whether living in the southern region of the United States is adversely associated with children’s health status. Methods: A child health index (CHI) that ranked each state in the United States was computed by using statespecific composite scores generated from outcome measures for a number of indicators of child health. Five indicators for physical health were chosen (percent low birth weight infants, infant mortality rate, child death rate, teen death rate, and teen birth rates) based on their historic and routine use to define health outcomes in children. Indicators were calculated as rates or percentages. Standard scores were calculated for each state for each health indicator by subtracting the mean of the measures for all states from the observed measure for each state. Indicators related to social and economic status were considered to be variables that impact physical health, as opposed to indicators of physical health, and therefore were not used to generate the composite child health score. These variables were subsequently examined in this study as potential confounding variables. Mapping was used to redefine regional groupings of states, and parametric tests (2-sample t test, analysis of means, and analysis-of-variance F tests) were used to compare the means of the CHI scores for the regional groupings and test for statistical significance. Multiple regression analysis computed the relationship of region, social and economic indicators, and race to the CHI. Simple linear-regression analyses were used to assess the individual effect of each indicator. Results: A geographic region of contiguous states, characterized by their poor child health outcomes relative to other states and regions of the United States, exists within the “Deep South” (Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina, South Carolina, and Florida). This Deep-South region is statistically different in CHI scores from the US Census Bureau– defined grouping of states in the South. The mean of CHI scores for the Deep-South region was \u3e1 SD below the mean of CHI scores for all states. In contrast, the CHI score means for each of the other 3 regions were all above the overall mean of CHI scores for all states. Regression analysis showed that living in the Deep- South region is a stronger predictor of poor child health outcomes than other consistently collected and reported variables commonly used to predict children’s health. Conclusions: The findings of this study indicate that region of residence in the United States is statistically related to important measures of children’s health and may be among the most powerful predictors of child health outcomes and disparities. This clarification of the poorer health status of children living in the Deep South through spatial analysis is an essential first step for developing a better understanding of variations in the health of children. Similar to early epidemiology work linking geographic boundaries to disease, discovering the mechanisms/pathways/causes by which region influences health outcomes is a critical step in addressing disparities and inequities in child health and one that is an important and fertile area for future research. The reasons for these disparities may be complex and synergistically related to various economic, political, social, cultural, and perhaps even environmental (physical) factors in the region. This research will require the use and development of new approaches and applications of spatial analysis to develop insights into the societal, environmental, and historical determinants of child health that have been neglected in previous child health outcomes and policy research. The public policy implications of the findings in this study are substantial. Few, if any, policies identify these children as a high-risk group on the basis of their region of residence. A better understanding of the depth and breadth of disparities in health, education, and other social outcomes among and within regions of the United States is necessary for the generation of policies that enable policy makers to address and mitigate the factors that influence these disparities. Defining and clarifying the regional boundaries is also necessary to better inform public policy decisions related to resource allocation and the prevention and/or mitigation of the effects of region on child health. The identification of the Deep South as a clearly defined sub-region of the Census Bureau’s regional definition of the South suggests the need to use more culturally and socially relevant boundaries than the Census Bureau regions when analyzing regional data for policy development

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Quantitative studies of Theileria parva in the bovine host

A preliminary quantitative study on the population growth rate of Theileria parva in the bovine host failed to confirm the constant growth rate independent of size of infective dose reported by earlier workers. Experiments in methodology were performed therefore to standardize the techniques for obtaining (a) accurate estimates of infection rates from biopsy smears, (b) representative samples from a superficial lymph node source. A further experiment was carried out to establish that such samples were representative of the total parasitic biomass. These techniques were applied in a wider ranging quantitative study using four infective doses at ten fold intervals for infecting animals. The resultant growth rates were again dependent on the size of the infective dose. A definitive experiment, using five infective doses at ten fold intervals confirmed the divergence of growth rates. It was also shown that the severity of the clinical reaction, and the survival time was dependent on the size of the infective dose. The implications of these results in relation to immunization of cattle against T. parva are discussed.The standardized methods were applied also in a chemoprophylactic study to observe the growth rates of T. parva as affected by different regimens of tetracycline. Other possible applications of these standardized methods are discussed

Multi-Factor Impact Analysis of Agricultural Production in Bangladesh with Climate Change

Diverse vulnerabilities of Bangladesh's agricultural sector in 16 sub-regions are assessed using experiments designed to investigate climate impact factors in isolation and in combination. Climate information from a suite of global climate models (GCMs) is used to drive models assessing the agricultural impact of changes in temperature, precipitation, carbon dioxide concentrations, river floods, and sea level rise for the 2040-2069 period in comparison to a historical baseline. Using the multi-factor impacts analysis framework developed in Yu et al. (2010), this study provides new sub-regional vulnerability analyses and quantifies key uncertainties in climate and production. Rice (aman, boro, and aus seasons) and wheat production are simulated in each sub-region using the biophysical Crop Environment REsource Synthesis (CERES) models. These simulations are then combined with the MIKE BASIN hydrologic model for river floods in the Ganges-Brahmaputra-Meghna (GBM) Basins, and the MIKE21Two-Dimensional Estuary Model to determine coastal inundation under conditions of higher mean sea level. The impacts of each factor depend on GCM configurations, emissions pathways, sub-regions, and particular seasons and crops. Temperature increases generally reduce production across all scenarios. Precipitation changes can have either a positive or a negative impact, with a high degree of uncertainty across GCMs. Carbon dioxide impacts on crop production are positive and depend on the emissions pathway. Increasing river flood areas reduce production in affected sub-regions. Precipitation uncertainties from different GCMs and emissions scenarios are reduced when integrated across the large GBM Basins' hydrology. Agriculture in Southern Bangladesh is severely affected by sea level rise even when cyclonic surges are not fully considered, with impacts increasing under the higher emissions scenario

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions

State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013

From 2010 to 2013—the years following the implementation of the Affordable Care Act—there has been a marked slowdown in premium growth in 31 states and the District of Columbia. Yet, the costs employees and their families pay out-of-pocket for deductibles and their share of premiums continued to rise, consuming a greater share of incomes across the country. In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms. Workers are paying more but getting less protective benefits. Costs are particularly high, compared with median income, in Southern and South Central states, where incomes are below the national average. Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families, and employers will likely require action to address rising costs of medical care services