Subject: Studies in the News 05-46 (December 21, 2005)


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


Contents This Week

Introductory Material HEALTH
   Beer advertising reaches minors
   Diabetes and health coverage plans
   Effective medical care pays dividends
   Medical spending on the next generation
   Food safety concerns
   Adoption of health information technology
   Analysis of health care interventions
   Health information technology
   U.S. patients get less for health care dollar
   Higher medical care prices
   Hospitals quake safety costs
   Health plans with greater cost sharing
   Individual health insurance market
   Health insurance pools
   Medicare coordinated care
   Medi-Cal reimbursements in the schools
   State medicare clawbacks
   Health privacy concerns
   Cost-sharing of prescription drugs
   Schizophrenia drug treatments
   Tobacco smoke as a toxic air contaminant
   Flavored cigarettes and young smokers
   State roles in tobacco policy
   Public hospitals become safety nets
   Prescription drugs for the uninsured
   Snapshot of California's uninsured
PREVIOUSLY IN STUDIES IN THE NEWS
   Studies in the News, October - December 2005
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.

  • California State Employees may contact the State Information & Reference Center (916-654-0206; cslsirc@library.ca.gov) with the SITN issue number and the item number [S#].

  • All other interested individuals should contact their local library - the items may be available there, or may be borrowed by your local library on your behalf.

The following studies are currently on hand:

HEALTH

ALCOHOL & DRUG USE

"Saturated in Beer: Awareness of Beer Advertising in Late Childhood and Adolescence." By R.L. Collins and others. IN: Journal of Adolescent Health, vol. 37 no. 1 (July 2005) pp. 29-36.

["Despite nationwide age restrictions on alcohol consumption, most youth have tried alcohol by the end of high school, and half are currently drinkers by that time. Experts theorize that exposure to alcohol advertising, particularly ads whose content may hold special appeal for youth, may contribute to the problem."]

[Request #S54601]

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DIABETES

Managing Diabetes: Health Plan Coverage of Services and Supplies. By the U.S. Government Accountability Office. GAO-05-210. (The Office, Washington, DC) 2005. 36 p.

Full Text at: www.gao.gov/new.items/d05210.pdf

["Forty-five states (including California) required diabetes education, and 27 (including California) required medical nutrition therapy. National organizations concerned with diabetes patient care have worked with states to develop laws and regulations addressing these services in particular because other services, such as eye and foot exams, were thought to be covered by most health plans as general medical services."]

[Request #S54602]

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Effective Care. By the Dartmouth Atlas Project. (Center for Evaluative Clinical Sciences, Darmouth Medical School Hanover, New Hampshire) November 2005. 2 p.

Full Text at: www.dartmouthatlas.org/topics/effective_care.pdf

["Diabetes is a common and growing problem for american adults, and the underuse of effective care services for diabetics illustrates the problem. Practice guidelines call for an eye examination at least once every two years for people with diabetes. The Dartmouth Atlas Project found that in many hospital referral regions in 2001, fewer than half of medicare enrollees with diabetes had eye examinations. Why should our health care system underpay for such services as annual eye exams and then overpay for services to those who end up blind as a result?"]

[Request #S54626]

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ELDERLY

Health Status and Medical Treatment of the Future Elderly. By Dana P. Goldman and others. RAND. (RAND, Santa Monica, California) 2005. 264 p.

Full Text at: www.rand.org/pubs/technical_reports/2005/RAND_TR169.pdf

["The Centers for Medicare and Medicaid Services (CMS) must generate accurate publications of future spending for planning purposes. To investigate a better method for understanding how Medicaid breakthrough and demographic trends will affect future Medicare costs, CMS contracted with RAND to develop models to project how changes in health status, disease, and disability among the next generation of elderly will affect future spending."]

[Request #S54603]

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FOOD SAFETY

Outbreak Alert! Closing the Gaps in Our Federal Food-Safety Net. By Caroline Smith DeWaal and others. Center for Science in the Public Interest. (The Center, Washington, D.C.) November 2005. 23 p.

Full Text at: www.cspinet.org/new/pdf/outbreakalert2005.pdf

["Contaminated fruits and vegetables are causing more food-borne illness among Americans than raw chicken or eggs. Common sources of food illness include various bacteria such as salmonella and E. coli that can infect humans and animals then make their way into manure used to fertilize plants." Rueters (November 23, 2005) 1.]

[Request #S54604]

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HEALTH CARE

The State and Pattern of Health Information Technology Adoption. By Kateryna Fonkych. RAND. (RAND, Santa Monica, California) 2005. 52 p.

Full Text at: www.rand.org/pubs/monographs/2005/RAND_MG409.pdf

[“This report provides the technical details and results on the current state and dynamics of clinical Health Information Technology adoption in inpatient and outpatient settings. In addition, it describes how technology adoption pattern varies across different types of providers.]

[Request #S54606]

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Analysis of Health Care Interventions That Change Patient Trajectories. By James H. Bigelow and others. RAND. (RAND, Santa Monica, California) 2005. 171.

Full Text at: www.rand.org/pubs/monographs/2005/RAND_MG408.pdf

[“It is widely believed that broad adoption of Electronic Medical Record Systems will lead to significant healthcare savings, reduce medical errors, and improve health.... The monograph analyzes interventions to improve patient safety, increase preventive service, expand chronic disease management, and foster healthier lifestyles.”]

[Request #S54607]

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Extrapolating Evidence of Health Information Technology Savings and Costs. By Federico Girosi and others. RAND. (RAND, Santa Monica, California) 2005. 94 p.

Full Text at: www.rand.org/pubs/monographs/2005/RAND_MG410.pdf

["Electronic Medical Record Systems will effectively transform the U.S. healthcare system…. We quantify national-level efficiency savings that result from the ability to perform the same task with fewer resources (money, time, personnel, etc.) brought about by using Health Information Technology and compare them to the costs the nation has to incur in order to be able to realize those savings.”]

[Request #S54608]

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HEALTH CARE INDUSTRY

"Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries." By Cathy Schoen, and others. IN: Health Affairs, vol. 16, Web Exclusive. pp.W5-510 - W5-525. (November 3, 2005)

["Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.... Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.... The results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket." Washington Post (November 4, 2005) A2.]

Commonwealth Fund Press Release and Chartpack. Various pagings.
commonwealth fund

[Request #S54605]

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"Health Spending in the United States and the Rest of the Industrialized World." By Gerard F. Anderson and others. IN: Health Affairs, vol. 24, no. 4 (July/August 2005) pp. 903-914.

Full Text at: content.healthaffairs.org/cgi/reprint/24/4/903

["U.S. citizens spent $5,267 per capita for health care in 2002 -— 53 percent more than any other country.... The two most important reasons for higher U.S. spending appear to be higher incomes and higher medical care prices."]

[Request #S54609]

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HOSPITAL COSTS

California's Hospital Seismic Safety Law: Its History, Implementation and Progress. By Office of Statewide Health Planning and Development. 2005. 22 p.

Full Text at: www.pe.com/imagesdaily/2005/09-28/2005_State_Seismic_Report.pdf

["Inland hospitals expect to spend hundreds of millions of dollars over the next several years to repair or replace buildings that the state says are at significant risk of collapse during a major earthquake. The state's 2008 deadline to make the changes is unrealistic and could affect patient care by diverting money to construction."]

[Request #S54610]

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INSURANCE

The Price of Illness: Cost Sharing and Health Plan Benefits. By California Health Care Foundation. Insurance Markets Issue Brief. (The Foundation, Oakland, California) Septmeber 2005. 10 p.

Full Text at: www.chcf.org/documents/insurance/ThePriceofIllnessConsumerCostSharing.pdf

["Rising health insurance premiums threaten to make coverage unaffordable for many Californians, prompting insurers to introduce plans with greater cost sharing. Such new insurance formulations often appear first in the individual market, which serves as a crucible for product innovations because purchasers pay 100 percent of their premium, making them particularly price sensitive.... The analysis finds that individuals who purchase comparatively comprehensive coverage could still incur extensive medical expenses and run the risk of exposing themselves to unexpectedly high bills."]

[Request #S54611]

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Snapshot Individual Health Insurance Market. By California HealthCare Foundation. (The Foundation, Oakland, California) 2005. 24 p.

Full Text at: www.chcf.org/documents/insurance/SnapshotIndividualMarket05.pdf

["Among the questions addressed by the project are: 1) Who buys individual insurance? 2) How do consumers respond to price changes? 3) Can only healthy people purchase individual insurance? 4) Are there barriers, exclusive of price, to purchasing coverage?"]

[Request #S54612]

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Insurance Markets: What Health Insurance Pools Can and Can't Do. By California HealthCare Foundation. (The Foundation, Oakland, California) November 2005. 12 p.

Full Text at: www.chcf.org/documents/insurance/WhatHealthInsurancePoolsCanAndCantDo.pdf

[This issue brief begins by explaining why pools are not the same as large employer groups, then goes on to explore the risks any voluntary purchasing pool faces and the conditions necessary for a pool to overcome those obstacles and succeed."]

[Request #S54613]

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MEDICAID

Medicare Coordinated Care Demonstration Program After One Year. By Arnold Chen and other. Mathematica Policy Research Incorporated. (Mathematica, Princeton, New Jersey) July 29, 2005. 159 p.

Full Text at: www.mathematica-mpr.com/publications/pdfs/medicalcare.pdf

["This report describes the ... Medicare Coordinated Care Demonstration Project.... The following questions are addressed: 1) Who enrolls in the progam? 2) To what extent does the program engage physicians? 3) How well is the program implementing its approaches to improving patient health and reducing health care costs? The program has indeed enrolled patients with relatively high health care costs in the year prior to enrollment.... Using nurse care managers who have worked with patients’ physicians before has helped in facilitating communication.... The nurse care managers are providing patient education that combines factual information with help changing behavior and improving self-care skills."]

[Request #S54614]

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MEDI-CAL

Department of Health Services: Participation in the School-based Medi-Cal Administrative Activities Program Has Increased, but School Districts Are Still Losing Millions Each Year in Federal Reimbursements. By California State Auditor. (The Auditor, Sacramento, California) August 2005. 59 p.

Full Text at: www.bsa.ca.gov/pdfs/reports/2004-125.pdf

["School districts' reimbursements have significantly increased since fiscal year 1999-2000. Despite receiving $91 million for fiscal year 2002-03, we estimate school districts could have received at least $57 million more had all school districts participated."]

[Request #S54615]

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MEDICARE

Data Released for Calculating State Medicare Clawbacks. By Federal Funds Information for States. Issue Brief 05-45. (FFIS, Washington, DC) October 27, 2005. 4 p.

["The Centers for Medicare and Medicaid Services (CMS) sent a letter to the director of each state Medicaid agency. The letter informs them of data necessary to calculate their phased-down state contribution supporting the new Medicaid Part D program (the 'clawback'). These data will be used to calculate monthly state payments to the federal government in support of that program."]

[Request #S54616]

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PATIENTS' RIGHTS

National Consumer Health Privacy Survey 2005. By Forrester Research, Inc. (California Healthcare Foundation, Oakland, California) November 2005.

["Although two thirds of national respondents say they are aware of federal protections for their personal medical records, ... one out of eight consumers has put their health at risk by engaging in such behaviors as: avoiding their regular doctor, asking their doctor to fudge the diagnosis, paying for a test because they didn't want to submit a claim, or avoiding a test altogether. Chronically ill, younger and racial and ethnic minority respondents are more likely than average to practice one or more of these risky behaviors."]

Executive Summary. 5 p.
http://www.chcf.org/documents/ihealth/ConsumerPrivacy2005ExecSum.pdf

Slide Presentation. 35 p.
http://www.chcf.org/documents/ihealth/ConsumerPrivacy2005Slides.pdf

[Request #S54617]

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PRESCRIPTION DRUGS

The Effect of Cost-sharing on the Utilization of Prescription Drugs for Chronically Ill Patients. By Matthew Solomon, RAND. (RAND, Santa Monica, California) 2005. 135 p.

Full Text at: www.rand.org/pubs/rgs_dissertations/2005/RAND_RGSD193.pdf

["The utilization and cost of prescription drugs have risen dramatically over the past two decades. In an effort to control these rapidly rising costs, nearly all health plans have increased their cost-sharing requirements.... This dissertation seeks to explore the effect of cost-sharing on the initiation of and adherence to prescription drug therapy."]

[Request #S54618]

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SCHIZOPHRENIA

"The Choice of Antipsychotic Drugs for Schizophrenia." By Robert Freeman. And "Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia." By Jeffrey Lieberman and others. IN: New England Journal of Medicine, vol. 353 no. 12. (September 22, 2005) online.

["All but one of a group of new and expensive brand-name drugs used to treat schizophrenia were generally no more effective than much older, cheaper generic alternatives. Collectively, the Medi-Cal program laid out more than $621 million for more than 2 million prescriptions of these second-generation drugs.... The priciest drug, Zyprexa, cost Medi-Cal an average of $399.26 per prescription. Perphenazine, the generic used as a comparison in the study, cost just $65.14 per prescription on average.... Zyprexa was prescribed more than 35 times more often than perphenazine." San Francisco Chronicle (October 23, 2005) 1.]

[Request #S54619]

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SMOKING

Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. By California Environmental Protection Agency. (The Agency, Sacramento, California) 2005. 19 p.

Full Text at: www.arb.ca.gov/toxics/ets/finalreport/execsum.pdf

["The state of California established a program to identify the health effects of toxic air contaminants and to reduce exposure to these contaminants to protect the public health.... This report ... presents an evaluation of exposures to environmental tobacco smoke and the potential health effects associated with these exposures."]

[Request #S54620]

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New Cigarette Brands With Flavors That Appeal To Youth: Tobacco Marketing Strategies. By Carrie M. Carpenter and others. IN: Health Affairs, vol. 24, no.6 (November/December 2005) pp. 1601-1610.

["Tobacco manufacturers have recently introduced a proliferation of exotic brands featuring candylike flavors. We reviewed internal tobacco industry documents and patents to assess the role of flavored cigarettes in the targeting of young smokers. This research revealed the development of flavor delivery technologies hidden from consumers and public health professionals, including the use of a plastic pellet placed in the cigarette filter. These findings raise concerns as to the potential added health risks associated with using new flavored tobacco products, and they underscore the need for effective assessment and monitoring of tobacco products."]

[Request #S54621]

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State Roles in Tobacco Policy: A Snapshot for State Legislatures. By National Conference of State Legislatures. (NCSL, Denver, Colorado) 2005. 24 p.

[“This booklet provides an overview of the role of legislators in developing state tobacco policies…. In their role as guardians of the public’s health, states play a significant role in determining state tobacco policies, including youth access issues, restricting environmental tobacco smoke, and supporting cessation programs. States can also explore the consequences of levying excise taxes and determining how the revenues will be used.”]

[Request #S54622]

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UNINSURED

Safety Net Providers. By Jody Ruskamp-Hatz, National Conference of State Legislatures. NCSL Legisbrief. Vol. 13 No. 36 (NCSL, Denver, Colorado) August/September 2005. 2 p.

["Safety net providers organize and deliver a significant level of health care to uninsured, Medicaid and other vulnerable patients. They typically include public hospitals systems, community health centers and local health departments..... Public hospitals are the health care safety net for millions of Americans."]

[Request #S54623]

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Uninsured Californians and Access to Prescription Drugs. By Mistique Felton and others. The Nicholas C. Petris Center on Health Care Market and Consumer Welfare. (The Center, Berkeley, California) September 2005. 53 p.

Full Text at: www.petris.org/projects/uninsured_&_access_FULLREPORT.pdf

[“This report updates estimates of uninsured populations and their characteristics, and reviews existing programs that are designed to improve the access of the uninsured to prescription medications…. This report seeks to inform and improve our understanding of the issues surrounding access to prescription drugs in California.”]

[Request #S54624]

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Snapshot California's Uninsured 2005. By California HealthCare Foundation. (The Foundation, Santa Monica, California) 2005. 19 p.

Full Text at: www.chcf.org/topics/download.cfm?pg=insurance&fn=SnapshotCaliforniaUninsured05%2Epdf&pid=437052&itemid=115467

["The decline in employer-based health coverage and the increase in public health insurance coverage leave the number of uninsured in California unchanged from 2004 at approximately 6.5 million, or just over 20 percent of the non-elderly population.... The growth over time of the uninsured population is a complex problem, driven by numerous economic and demographic forces. This snapshot examines the issue in California through the lens of various factors to contribute to a better understanding of the influences that affect health coverage in the state."]

[Request #S54625]

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PREVIOUSLY IN STUDIES IN THE NEWS
[This section links to items in Studies in the News since the last Health Care Supplement.]

HEALTH CARE POLICY

"Health." IN: Studies in the News, (October-December 2005).

["Mental health service for adolescents;" "Child development services and Medicaid managed care;" "Ease of purchasing anabolic steroids;" "End of life care;" "Environmental toxins in people;" "Physical fitness in schools;" "Childhood obesity;" "Young caregivers in the U.S.;" "Health information technology;" "Health insurance coverage and Latino population;" "Medicare drug benefit options for Californians;" "Medicare drug benefit impacts nursing facilities;" "Medicare drug plan impact on chronic disease;" "Parents prescription drugs harming teens;" "Air pollution and mortality;" "Medicaid costs shift to states;" "How to lower prescription costs;" "Medicaid codes and child development;" "Pharmaceutical pricing lawsuit;" "Implementing telemedicine;" "Medicaid grants;" "Medicare and state pharmaceutical legislation;"]

[Request #S54627]

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