Subject: Studies in the News 02-70 (November 18, 2002)


CALIFORNIA RESEARCH BUREAU
CALIFORNIA STATE LIBRARY
Studies in the News:
Health Care Supplement


Contents This Week

Introductory Material HEALTH
   Next wave of HIV/AIDS
   Trends in childhood asthma
   Follow-up study on breast cancer sugery
   High breast cancer rates for teachers
   Breast self-examination
   New allocations for the children's health insurance
   Benefits and costs of newer drugs
   Spending on prescription drugs
   Arthritis and joint problems common
   Tracking health care costs
   Rise in health care costs
   Health care reform
   Health insurance coverage
   Working families needing health insurance
   Retiree health benefits
   Military personnel health benefits
   Changes in health insurance coverage
   Concerns over health trends
   Doctor discipline faulty
   Cost of medical interpreters
   Long-term care insurance
   Alternatives to nursing home care
   Medicaid and low income uninsured
   Medicaid enrollment
   Reaching uninsured children through medicaid
   Health insurance and former welfare recipients
   Paid family leave benefits
   Medicare utilization for rural areas
   Private plan contracting in Medicare
   Physician access problem for Medicare
   Unmet mental health care needs
   Societal costs of mental illness
   Cost of prescription drugs
   Abstinence-only sex education programs
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • Items in the State Library collection can be checked out to state officials and staff.

  • Access to all materials listed will be provided by the State Information Reference Center, either by e-mail to cslsirc@library.ca.gov or by calling 654-0261.

The following studies are currently on hand:

HEALTH

AIDS

The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India and China. By David F. Gordon, National Intelligence Council. (NIC, Washington, DC) 2002. 32 p.

Full Text at: www.odci.gov/nic/pubs/other_products/ICA%20HIV-AIDS%20unclassified%20092302POSTGERBER.pdf

[“The counties – China, Ethiopia, India, Nigeria and Russia – comprise 40 percent of the world’s population and by 2010 collectively will have more HIV infected people than any other five counties…. By 2010, the number of infected people in these countries will grow to estimated 50 million to 75 million from the current estimated of 14 million to 23 million…. HIV, the AIDS virus, could harm the economic, social, political and military structure in each of the five counties.” San Francisco Chronicle (October 1, 2002) A5.]

[Request #S6722]

Return to the Table of Contents

ASTHMA

"Trends in Childhood Asthma: Prevalence, Health Care Utilization, and Mortality." By Lara J. Akinbami and Kenneth C. Schoendorf. IN: Pediatrics, vol. 110, no. 2 (August 2002) pp. 315-322.

["Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. The study found that recent data suggested that the burden from childhood asthma may have recently plateaued after several years of increasing, It also found that racial and ethnic disparities remain large for asthma health care utilization and mortality."]

[Request #S5807]

Return to the Table of Contents

CANCER

“Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer.” By Umberto Veronesi and others. IN: New England Journal of Medicine, vol. 347, no. 16 (October 17, 2002) pp. 1227-1232.

[“After monitoring … breast cancer patients for 20 years, researchers have concluded that women fare just as well with an operation that removes the cancerous lumps as they do by having the entire breast removed.” Sacramento Bee (October 17, 2002) A1.]

[Request #S6723]

Return to the Table of Contents

"High Breast Cancer Incidence Rates Among California Teachers: Results from the California Teachers Study." IN: Cancer Causes and Control, vol. 13, no. 7 (September 2002) pp. 625-635.

["Female Teachers Show Higher Cancer Rates: California's female teachers have sharply higher rates of a host of cancers, including breast, endometrial and ovarian cancer, than women of the same age and race statewide.... On average, those in the study delayed having children until they were older, if they had them at all; and at later ages, a high proportion used hormone replacement therapy." Sacramento Bee (October 2, 2002) 1.]

[Request #S6724]

Return to the Table of Contents

"Routinely Teaching Breast Self-Examination is Dead. What Does This Mean?" By Russell Harris and Linda S. Kinsinger. IN Journal of the National Cancer Institute, vol. 94, no. 19 (October 2002) pp. 1420-1421.

["Large campaigns to teach women how to check their breasts for cancer are a waste of time and can do more harm than good, a new study has found.... Breast self-examinations can lull women into a false sense of security and are no substitute for regular mammograms and clinical exams." San Francisco Chronicle (October 2, 2002) A3.]

[Request #S6725]

Return to the Table of Contents

CHILDREN

SCHIP FY 2003 State Allotments. By Federal Funds Information for States. FFIS Issue Brief, 02-52. (FFIS, Washington, DC) September 30, 2002. 5. p.

["States are given funds to help finance health insurance to poor and near-poor children not otherwise insured. States have substantial discretion over how to use available funds but must expend their annual allocations within three years, with unspent funding subject to redistribution."]

[Request #S6727]

Return to the Table of Contents

DRUG PRICES

Benefits and Costs of Newer Drugs: An Update. By Frank Lichtenberg, National Bureau of Economic Research. Working Paper No. 8996 (The Bureau, Cambridge, Massachusetts) June 2002. 13 p.

Full Text at: www.phrma.org/publications/publications//2002-10-07.584.pdf

["A new study cited the numeous benefits for the Medicare population of replacing older medicines with newer versions. These benefits include decreased hospital stays, fewer doctor visits, and lower nondrug expenditures.... The report said that replacing a drug approved 15 years ago with one approved five years ago would increase prescription drug costs by $18, but decrease other medical costs by $129." Health Care Policy Report (October 14, 2002) 1374.]

[Request #S6728]

Return to the Table of Contents

Employer Drug Benefit Plans and Spending on Prescription Drugs. By Geoffrey F. Joyce and others. IN: the Journal of the American Medical Association, vol. 288 no. 14 (October 9, 2002) [online.]

Full Text at: jama.ama-assn.org/issues/v288n14/ffull/joc21507.html

["According to the study authors, many employers are beginning to offer plans with three copayment levels.... Researchers found that the result of these changes is that workers' copayments have increased, while the average number of prescriptions filled has declined by more than 30 percent." Health Care Policy Report (October 14, 2002) 1372.]

[Request #S6729]

Return to the Table of Contents

HEALTH CARE

“Prevalence of Self-Reported Arthritis or Chronic Joint Symptoms Among Adults --- United States, 2001.” By J. Bolen and others. IN: MMWR: Morbidity and MortalityWeekly Report, vol. 51, no.42 (October 25, 2002) pp. 948-950

Full Text at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5142a2.htm

[“Arthritis and other chronic joint problems are far more widespead than estimated just five years ago, affecting one in three U.S. adults, or 69.9 million people in all…. Health officials and advocates said the numbers – and related health care cost – are expected to continue to rise as the baby boom generation reaches old age.” The Associated Press (October 25, 2002) 1.]

[Request #S6731]

Return to the Table of Contents

HEALTH CARE FINANCE

Tracking Health Care Costs: Hospital Spending Spurs Double-Digit Increase in 2001. By Bradley C. Strunk and others. Center for Studying Health System Change. (The Center, Washington, DC) September 2002. 2 p.

Full Text at: www.hschange.org/CONTENT/472/472.pdf

[“Contrary to popular wisdom, high prescription drug prices and Baby Boomers’ use of medicines are not the primary drivers of soaring health care spending.... Spending on outpatient hospital care soared 16.3 percent last year, the fastest-growing component of overall health care spending.” San Francisco Chronicle (September 15, 2002) B4.]

[Request #S6732]

Return to the Table of Contents

HEALTH CARE FINANCING

Towers Perrin Forecasts 15% Increase in Health Care Costs -- Highest Percentage Increase in More Than A Decade: Employees Will Pay More In Out-of-Pocket Costs: Press Release. By Towers Perrin. (Towers Perrin, New York, New York) October 2, 2002. 3 p.

Full Text at: www.towers.com/towers_news/news/press/news_frame_towers.asp?target=../PressRelease_2002/pr100202.htm

["Health-Care Costs Rising Fast; 'Consumer-Driven' Plans Seen: Health-care costs are rising even faster than feared, according to a survey that says the cost of health-benefit plans at big companies will rise an average of 15% in 2003.... Employees will bear 22% of the cost for family coverage in 2003, up from 21% this year, the survey said." Wall Street Journal (October 2, 2002) 1.]

[Request #S6733]

Return to the Table of Contents

HEALTH CARE REFORM

A New Vision for Health Care: A Leadership Role for Busines. By the Research and Policy Committee of the Committee for Economic Development (The Committee, Washington, DC) 2002. 64 p.

Full Text at: www.ced.org/docs/report/report_healthcare.pdf

["The United States' employer-based health care system is in serious trouble. Health care costs are again exploding at double-digit rates, the number of employees without health insurance continues to grow, and many health care services suffer from misuse, underuse, and overuse. This statement urges employers, along with government, not only to stay the course but to actively lead in implementing specific changes in private and public policies that could produce a health care system that works for all Americans."]

[Request #S6734]

Return to the Table of Contents

HEALTH INSURANCE

Health Insurance Coverage: 2001. By Robert Mills, U.S. Census Bureau. P60-220. (The Bureau, Washington, DC) September 30, 2002. 24 p.

Full Text at: www.census.gov/prod/2002pubs/p60-220.pdf

["More Without Health Insurance; Census Bureau Says 19% of Californians Don't Have Any Coverage: The report shows workers being pinched by a combination of rapidly rising health care costs and a weak economy.... In California, 19 percent of residents did not have coverage, the third-highest rate in the nation, after New Mexico and Texas." San Francisco Chronicle (September 30, 2002) A7.]

[Request #S6735]

Return to the Table of Contents

Working Families' Health Insurance Coverage, 1997-2001. By Bradley C. Strunk and James D. Reschovsky, Center for Studying Health System Change. (The Center, Washington, DC) August 2002. 4 p.

Full Text at: www.hschange.com/CONTENT/463/463.pdf

["Employer-Sponsored Insurance: Coverage Rates Remained Flat from 1997-2001: Despite a healthy national economy, the percentage of American workers covered by employer-sponsored health insurance did not increase significantly, according to a new report.... 'These findings tell us that relying on economic growth alone to reduce the number of uninsured won't work,' said Paul Ginsburg, HSC president." American Health Line (August 22, 2002) 1.]

[Request #S6736]

Return to the Table of Contents

Retiree Health Benefits: Time to Resuscitate? Executive Summary. By Watson Wyatt Worldwide (Watson Wyatt Worldwide, Washington, DC) 2002. Various pagings.

Full Text at: www.watsonwyatt.com/research/resrender.asp?id=W-559&page=1

[The report predicted that the trend toward reducing or eliminating retiree health benefits will hasten as health care costs climb.... The report blamed the erosion of job-based retiree health coverage on rising health care costs, growing retiree populations, uncertain business profitability and federal regulations that deter employers from prefunding retiree medical benefits." Health Care Policy Report (September 23, 2002)1267.]

[Request #S6737]

Return to the Table of Contents

Military Personnel: Active Duty Benefits Reflect Changing Demographics, But Opportunities Exist to Improve. By the U.S. General Accounting Office. GAO-02-935. (The Office, Washington, DC) September 2002. 77 p.

Full Text at: www.gao.gov/cgi-bin/getrpt?GAO-02-935

["DOD has instituted a number of benefits.... Many of these benefits address one of the most significant demographic changes -- an increase in service members with family obligations.... In comparing the types of benefits with those offered in the private sector, we did not identify significant gaps in the benefits available to military personnel. In fact, military benefits in some cases exceed those offered by the private sector."]

[Request #S6741]

Return to the Table of Contents

Changes in Insurance Coverage: 1994-2000 and Beyond. By John Holahan and others. The Henry J. Kaiser Health Foundation and The Urban Institute. (The Foundation, Washington, DC) August 2002. 31 p.

Full Text at: www.kff.org/content/2002/4065/4065.pdf

["During 1994 and 2000, a period of great economic prosperity, the most striking finding is that the uninsured rate was essentially unchanged -- 17.3 percent in 1994 and 17.2 percent in 2000. The period's prosperity brought extradordinary changes in income distribution. The number, of low income Americans fell by 8.2 million while middle - and high - income Americans increased by 2.0 million and 19.2 million respectively. Among each of the three income groups, however, the uninsurance rate actually increased. It was the movement of so many people up the income distribution, where uninsured rates were lower, that kept the uninsured rate essentially level over the period."]

[Request #S6744]

Return to the Table of Contents

HEALTH STATISTICS

Health, United States, 2002 with Chartbook on Trends in the Health of Americans. By P.N. Pastor and others, National Center for Health Statistics, Department of Health and Human Services. DHHS Publication No. 1232. (The Center, Hyattsville, Maryland) August 2002. 430 p.

Full Text at: www.cdc.gov/nchs/data/hus/hus02.pdf

["Americans Living Longer, Smoking Less: But Adults' Lack of Exercise Raises Concerns in a Report: Children born in 2000 can expect to live 76.9 years, according to preliminary data.... The occupational injury death rate dropped 17 percent to 4.3 deaths per 100,000 employed workers between 1992 and 2000.... The United States spent a larger share of its gross domestic product, or GDP, on health than any other industrialized country." Sacramento Bee (September 13, 2002) A9.]

[Request #S6738]

Return to the Table of Contents

HOSPITALS

"Doctor Discipline Faulty: Hospitals' Policing Yields Few Reports to Medical Board -- and Sometimes Years Later." By William Heisel and Mayrav Saar. IN: Orange County Register (September 22, 2002) p. 1+.

Full Text at: www2.ocregister.com/ocrweb/ocr/printArticle.do?id=3882

["Hospitals Discipinary Practices Designed to Weed Out Bad Doctors Often Protect Them Instead: An Orange County Register analysis of hospital and Medical Board of California records since 1997 found evidence of 50 doctors harming at least 119 patients and endangering untold others in hospitals.... Only seven were barred by their medical centers.... There are more than 100,000 doctors in the state and 481 hospitals, yet the board receives about 100 disciplinary reports from hospitals every year." Orange County Register (Sepember 22, 2002) 1.]

[Request #S6754]

Return to the Table of Contents

IMMIGRATION & IMMIGRANTS

Medical Interpreters May Improve Quality But Who Should Pay? By Stephen Robitaille. California HealthCare Foundation. (The Foundation, Oakland, California) September 16, 2002. 3 p.

Full Text at: www.chcf.org/healthcurrents/view.cfm?ItemID=20035

["As the demand for interpreters grows, so has the debate over who should pay for this increasingly important service, both in California and on the national stage. Translation services, while helpful, don't come cheap. Sources estimate that translators cost anywhere from $50 to $80 an hour and up, depending on whether the language is a common one in California, such as Spanish or Vietnamese, or is a less well known idiom."]

[Request #S6740]

Return to the Table of Contents

LONG TERM CARE

Benefits of Long-Term Care Insurance: Enhanced Care for Disabled Elders, Improved Quality of Life for Caregivers and Savings to Medicare & Medicaid. By the Health Insurance Association of America (The Association, Washington, DC) September 2002. 20 p.

Full Text at: membership.hiaa.org/PDFS/COMMUNICATIONS/020924LTCSTUDY.PDF

["Family caregivers benefit from a family member having private long-term care insuance because they suffer less stress and family caregivers double their chance of remaining in the workforce if the disabled elder they are caring for has private insurance." Health Care Policy Report (October 14, 2002) 1374.]

[Request #S6743]

Return to the Table of Contents

"Alternatives to Nursing Home Care: States Pursue Innovative Strategies." By Wendy Fox-Gage. IN: State Health Notes, vol. 23, no. 380 (September 23, 2002) pp. 1, 5+.

["Though most people in nursing homes would like to be someplace else, in-home and community care options are few. States are changing that by 'diverting' patients or letting homes offer other services.... The high cost of nursing homes and the desire of folks to live in the community have also prompted the federal Centers for Medicare and Medicaid Services to channel money into the nursing home transition grant program."]

[Request #S6745]

Return to the Table of Contents

MEDICAID

Kaiser Commission on Medicaid and the Uninsured: Can Medicaid Work for Low-Income Working Families? Prepared by Kathleen A. Maloy and others. Kaiser Family Foundation. (The Foundation, Menlo Park, California) 2002. 151 p.

Full Text at: www.kff.org/content/2002/4032/4032.pdf

["The primary goal of this project is to present a more complete picture of states' efforts to address the healh insurance needs of low-income working families by improving access to their Medicaid programs.... The study was designed to describe the states' Section 1931 Medicaid eligibility criteria as of June 2001, highlight variations among states, and understand why certain states were able to accomplish expansions and why other states did not."]

[Request #S6742]

Return to the Table of Contents

Medicaid Enrollment in 50 States: December 2001 Data Update. By Eileen R. Ellis, Vernon K. Smith, Health Management Associates, David M. Rousseau, The Kaiser Commission on Medicaid and the Uninsured. Prepared for The Henry J. Kaiser Family Foundation (The Foundation, Menlo Park, California) October 2002. 98 p.

Full Text at: www.kff.org/content/2002/4067/4067.pdf

["Taking a look at enrollment increases in specific categories, the report found more Medicaid participation by families, children, and pregnant women.... In previous years, states saw enrollment decline for families, children and pregnant women, the report said....Also the study found that enrollment of low-income elderly and disabled has increased steadily over the last four years." Health Care Policy Report (October 14, 2002) 1372.]

[Request #S6746]

Return to the Table of Contents

Reaching Uninsured Children Through Medicaid: If You Build It Right, They Will Come. By The Kaiser Commission on Medicaid and the Uninsured, The Kaiser Family Foundation (The Foundation, Menlo Park, California) June 2002. 37 p.

Full Text at: www.kff.org/content/2002/20020611/4040.pdf

["Discusses modernizing Medicaid and what it will take; expanded eligibility for children and families, improved program operations, and marketing 'the New Medicaid.' Reviews enrollment trends.... Presents the next several steps in modernizing medicaid." State Net (September 30, 2002)]

[Request #S6747]

Return to the Table of Contents

MEDI-CAL

Beyond Medi-Cal: Health Insurance Coverage among Former Welfare Recipients: Revised Edition. By Carole Roan Gresenz and Jacob Alex Klerman, Rand Corporation. Prepared for the Medi-Cal Policy Institute. (The Institute, Oakland, California) September 2002. 34 p.

Full Text at: www.medi-cal.org/images/pdficon.gif

["The compelling policy issue for California policymakers and program officials is the percentage of former welfare recipients and their children who are uninsured and, even more specifically, the percentage of those who are uninsured and who are eligible for but not enrolled in Medi-Cal or Healthy Families.... One in four former welfare recipients and one in five of their children are uninsured, and nearly all of these parents and children appear to be eligible for either Medi-Cal or Healthy Families."]

[Request #S6748]

Return to the Table of Contents

MEDICAL LEAVE

State Family Leave Benefit Initiatives in the 2001-2002 State Legislatures: Making Family Leave More Affordable. By the National Partnership for Women and Families (The Partnership, Washington, DC) 2002. Various pagings.

Full Text at: www.nationalpartnership.org/content.cfm?L1=8&L2=1&GuideID=51&ArticleID=0

["Existing paid leave laws, although not currently available to enough working men and women, show that a solution is possible. These programs allow some employees in various states to take certain types of leave while receiving some pay. This report takes a look at what is happening in each of the states regarding paid leave."]

[Request #S6749]

Return to the Table of Contents

MEDICARE

Trends in Special Medicare Payments and Service Utilization for Rural Areas in the 1990s. By Donna O. Farley and others, Rand Health. Prepared for the Centers for Medicare and Medicaid Services. MR-1595-CMS. (RAND, Santa Monica, California) 2002. 192 p.

["This report analyzes special payments that Medicare has been making to rural providers. These special payments are intended to support the rural health care infrastucture to help ensure access to care for Medicare beneficiaries. The research provides a comprehensive overview of these payments, including documentation of the supply of providers, trends in payments, and Medicare costs per beneficiary."]

[Request #S6750]

Return to the Table of Contents

The Future of Private Plan Contracting in Medicare. By Robert A. Berenson and Bryan E. Dowd, AARP Public Policy Institute (The Institute, WAshington, DC) July 2002. 54 p.

Full Text at: research.aarp.org/health/2002_12_medicare.pdf

["The study identifies several potential goals that can be achieved through Medicare's contracting with private plans: maximizing efficiency and fairness, reducing government spending, providing beneficiaries with additional benefits, promoting innovation, and increasing the number of health plan options in Medicare." Health Care Policy Report (September 23, 2002) 1270.]

[Request #S6751]

Return to the Table of Contents

Growing Physician Access Problems Complicate Medicare Payment Debate. By Sally Trude and Paul B. Ginsburg, Center for Studying Health System Change. Issue Brief No. 55. (The Center, Washington, DC) September 2002. 4 p.

Full Text at: www.hschange.com/CONTENT/466/466.pdf

["Access to Health Care a Problem: Americans are having increasing difficulty getting access to the medical care they need, according to a study.... And the problem could get worse for Medicare seniors if government payments to the doctors who treat them continue to decline.... Medicare physician fees dropped 5.4 percent this year, and are scheduled to drop by a similar magnitude in each of the next two years. A bill pending in Congress would reverse those cuts." Orange County Register (September 6, 2002) 1.]

[Request #S6752]

Return to the Table of Contents

MENTAL HEALTH

"Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status." By Sheryl Kataoka and others. IN: The American Journal of Psychiatry, vol. 159, no. 9 (September 2002) pp. 1548-1555.

["This study finds that ... nearly 80% of the children and adolescents who were defined as needing mental health services did not receive services.... The rate of unmet mental health care was greater among Latino than white children, among uninsured children than insured children." Children Defense Fund's Health Information Project (September 27, 2002).]

[Request #S6133]

Return to the Table of Contents

A Policymaker's Guide to Mental Illness by Timothy A. Kelly, Domestic Policy Studies Department, Heritage Foundation. (The Foundation, Washington, DC) 2002. 18 p.

Full Text at: www.heritage.org/Research/HealthCare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=8431

["Serious mental illness (SMI) is defined as: all cases of schizophrenia; severe cases of major depression and bipolar disorder; severe cases of panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder; severe cases of attention deficit/hyperactivity disorder; and severe cases of anorexia nervosa. Clinical symptoms and standard treatments for each of these serious mental illnesses are presented, as well as estimates of the number of Americans who currently suffer from each."]

[Request #S6753]

Return to the Table of Contents

PRESCRIPTION DRUGS

“Get The FDA Out Of The Way, And Drug Prices Will Drop.” By Gary S. Becker. IN: Business Week (September 16, 2002) p. 16

[“Congress has been under great pressure from the elderly and other consumer groups to control drug prices, because expenditures on medicines have risen sharply during the past two decades. But price controls would reduce the number of new drugs, since prices are high in part because research and development is so expensive. A much better approach is to eliminate Food & Drug Administration rules that drive up prices and reduce medical innovations.”]

[Request #S6755]

Return to the Table of Contents

SEX EDUCATION

Ignorance Only: HIV/AIDS, Human Rights and Federally Funded Abstinence-Only Programs in the United States. Texas: A Case Study. By Rebecca Schleifer and others. Human Rights Watch. (The Watch, New York, New York) September 2002. 49 p.

Full Text at: hrw.org/reports/2002/usa0902/USA0902.pdf

["Abstinence-only sex education programs are 'threatening' the health of young people by excluding information on condom use and other methods of preventing HIV transmission, according to a report. The report analyzes several abstinence-only programs and ad campaigns in Texas." HandNet WebClipper Digest (September 23, 2002)]

[Request #S6756]

Return to the Table of Contents

There are no studies in the current issue