Healthcare Triage: Is Medicaid Coverage Better or Worse than Private Insurance?
As we have discussed repeatedly here on HCT, it’s better for patients to have Medicaid than to be uninsured, contrary to critics of the program. But is having Medicaid, as those critics also say, much worse than having private insurance?
This episode was adapted from a column Austin and I wrote for the Upshot. Links to further reading and sources can be found there.
http://www.fiercehealthcare.com/healthcare/study-investments-patient-care-lead-to-better-outcomes
An MIT study suggests hospitals get more bang for their buck when they spend money on emergency care versus long-term care.
The study, which was published in the current issue of Journal of Health Economics, compared data on outcomes between hospitals that make a substantial upfront investment in inpatient care after a patient experiences an emergency with those that rely more heavily upon skilled nursing facilities and other long-term care options postdischarge.
“We find that patients who go to hospitals that rely more on skilled nursing facilities after discharge, as opposed to getting them healthy enough to return home, are substantially less likely to survive over the following year,” says Joseph Doyle, Erwin H. Schell Professor of Management at the MIT Sloan School of Management, in an article posted on MIT’s news site.
The study sought to weed out inefficiencies in hospital spending that contribute to the higher per capita cost of healthcare in the United States compared to the rest of the world. Statistics from the Organisation for Economic Co-operation and Development peg spending in the United States at 40% higher than the next-highest spender, which MIT notes has led to questions about “significant inefficiencies” in terms of where all that money gets spent.
When the high costs of care get passed along to patients, they can cause a ripple effect in terms of overall population health. In one survey, as many as one in four Americans said they chose to forgo medical care because of prohibitive costs.
The MIT study found that hospitals that spent approximately $8,500 above the average 90-day spend of $27,500 per patient saw a two-percentage-point decrease in their patients’ mortality risk. That compares to findings of a five-percentage-point increase in mortality when hospitals focus their spending on postdischarge nursing facilities.
Doyle suggests these results could form the basis of a new quality metric looking at hospitals with worse outcomes and a higher proportion of downstream spending.
A deadly new drug-resistant fungus has been linked to the deaths of four hospital patients in the U.S., according to a report released Friday from the Centers for Disease Control and Prevention.
The fungus, called Candida auris, preys on the sickest patients and can spread in hospitals. Although doctors have been concerned about the spread of antibiotic-resistant bugs for many years, this fungus is relatively new on the world scene. It was first identified in Japan in 2009 and has since spread around the globe, emerging in South America, the Middle East, Africa and Europe, according to the CDC.
The CDC first identified the fungus as a potential threat in 2013, based on a possible case in the U.S., and has been on the lookout for the fungus since June. In its new report, the CDC said the fungus has been detected in a total of 13 patients since May 2013; the agency provided details on the first seven cases, which were reported in New York, Illinois, Maryland and New Jersey.
All of the patients had serious underlying medical conditions, including cancer, and had been hospitalized an average of 18 days when they tested positive for the fungus. Two patients had been treated in the same health care facility and had nearly identical fungal strains. Doctors can’t say for sure if the patients died from the fungus or their underlying health problems.
But health officials say the nation’s hospitals need to be on alert.
“We need to act now to better understand, contain and stop the spread of this drug-resistant fungus,” said Thomas Frieden, director of the CDC. “This is an emerging threat, and we need to protect vulnerable patients and others.”
HENRY KOTULA 