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Declining Medicine Use and Costs: For Better or Worse? A Review of the Use of Medicines in the United States in 2012
Declining Medicine Use and Costs: For Better or Worse? A Review of the Use of Medicines in the United States in 2012 (PDF)
Source: IMS Institute for Health Informatics
From press release:
Total spending on U.S. medicines fell 3.5 percent on a real per capita basis in 2012 and the use of healthcare services overall declined for the second consecutive year, according to a new study released today by the IMS Institute for Healthcare Informatics.
The report – Declining Medicine Use and Costs: For Better or Worse? – finds that total dollars spent on medications in the U.S. reached $325.8 billion last year, or real per capita spending of $898, down $33 from 2011. Underlying drivers for the overall decline in healthcare service use included fewer patient visits to office-based physicians, fewer non-emergency admissions to hospitals and outpatient facilities, and a less severe flu season in the early part of 2012. Patent expiries in 2012 contributed $28.9 billion to the reduction in medicine spending. This was their largest-ever impact as millions of patients accessed lower-cost generic versions of additional medicines.
Patients with insurance paid higher deductibles, copays and co-insurance for their overall healthcare, but prescription drug copays for most patients declined. At the same time, new transformative medicines became available to treat a large number of diseases with small or strictly defined patient populations.
“Characteristics of the Population With Consumer-Driven and High-Deductible Health Plans, 2005–2012,” and “Retirement Plan Participation and Asset Allocation, 2010”
Source: Employee Benefit Research Institute
Characteristics of the Population With Consumer-Driven and High-Deductible Health Plans, 2005–2012
- Generally, the population of adults within both high-deductible (HDHP) and traditional health plans have been split 50–50 between men and women. In contrast, differences in gender have been found between consumer-driven health plan (CDHP) enrollees and those with traditional coverage.
- In most years, CDHP enrollees were less likely than those with traditional coverage to be between the ages of 21 and 34, and the CDHP population was more likely than traditional-plan enrollees to be in households with $150,000 or more in income in every year except 2009 and 2010.
- CDHP enrollees were roughly twice as likely as individuals with traditional coverage to have college or post-graduate educations in nearly all years of the survey.
- CDHP enrollees have consistently reported better health status than traditional-plan enrollees, exhibiting better health behavior than traditional-plan enrollees with respect to smoking and (except for 2010 and 2011), exercise, and sometimes obesity rates.
Retirement Plan Participation and Asset Allocation, 2010
- The likelihood of a working family head participating in a retirement plan increased with the size of his or her employer. In 2010, among family heads working for employers with 10–19 employees, 22.4 percent participated in a plan, compared with 67.2 percent of family heads who worked for employers with 500 or more employees.
- In 2010, 18.9 percent of family heads who participated in an employment-based retirement plan had a defined benefit (DB) plan only, while 65.0 percent had a defined contribution (DC) plan only, and the remaining 16.1 percent had both a DB and a DC plan. This was a significant change from 1992, when 42.3 percent had a DB plan only, and 40.8 percent had a DC plan only.
- Asset allocation within a family head’s retirement plan seems to be affected by his or her ownership of other types of retirement plans. Those who own an IRA are more likely to be invested all in stocks if they also own a 401(k)-type of plan. Those who own a DB plan and a 401(k)-type plan are less likely to allocate their DC plan to all interest-earning assets.
State Spending On Consumer Assistance Could Have ‘Huge Impact’ On Marketplace Enrollment
State Spending On Consumer Assistance Could Have ‘Huge Impact’ On Marketplace Enrollment
Source: Kaiser Health News
Florida is on course to spend $6 million to reach out to nearly 4 million uninsured people and help them sign up for coverage in the federal health law’s online marketplace this fall.
Maryland will spend more than four times as much, or about $24.8 million, to help about 730,000 uninsured. The District of Columbia expects to spend about $9 million assisting 42,000 uninsured.
The wide variation in spending to hire and train people to provide consumer assistance in the first year of the new marketplaces could have a major impact on how many people actually get coverage under Obamacare, experts say.
Yet states with some of the nation’s highest uninsured rates, such as Florida and Texas, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, according to a Kaiser Health News analysis.
Sticky Ages: Why Is Age 65 Still a Retirement Peak?
Sticky Ages: Why Is Age 65 Still a Retirement Peak?
Source: Center for Retirement Research at Boston College
When Social Security’s Full Retirement Age (FRA) increased to age 66 for recent retirees, the peak retirement age increased with it. However, a large share of people continue to claim their Social Security benefits at age 65. This paper explores two potential explanations for the “stickiness” of age 65 as a claiming age: Medicare eligibility and workers’ lack of knowledge about their future Social Security benefits. First, we analyze the impact of Medicare eligibility by comparing two groups – one has an FRA of exactly 65; the other, between age 65 and 2 months and age 66. We find that the group with later FRAs who do not have access to retiree health benefits through their employer are more likely to claim Social Security at age 65. We interpret this finding as evidence that Medicare eligibility persuades more people to retire, because they can begin receiving federal health coverage. Individuals without access to retiree health insurance at work are 7.5 percentage points more likely to retire soon after their 65th birthdays and are 5.8 percentage points less likely to delay retirement until the FRA than those with that insurance. This result fits into extensive research showing that access to health insurance is an important component of the retirement decision. On the question of whether misinformation about Social Security benefits may drive individuals to claim at age 65, we find that some individuals are unable to accurately forecast their retirement benefits. However, our analysis suggests that there is no relationship between this confusion and the age 65 peak for claiming Social Security.
Immigration Reform: A Long Road to Citizenship and Insurance Coverage
Immigration Reform: A Long Road to Citizenship and Insurance Coverage
Source: Health Affairs
The 2012 presidential election transformed the national debate regarding unauthorized immigrants and US immigration policy in general. There had long been strong political resistance, especially among Republicans, to legalizing unauthorized immigrants. But on Election Day 2012, Latino voters turned out in large numbers, affecting the results in Florida and several Southwestern states and helping propel President Barack Obama to reelection. Republican losses in key states were attributed in part to voters’ perceptions that the party’s rhetoric on immigration had been too harsh. Almost overnight, immigration reform seemed to rise from the bottom to the top of Washington’s policy agenda.
No one has more at stake in this development than the estimated 11 million unauthorized immigrants in the United States.1 As of 2007 almost 60 percent of unauthorized immigrants lacked health insurance, and they accounted for about one-seventh of the country’s uninsured population.2,3
Yet as the Affordable Care Act is fully implemented, and millions of people gain access to coverage through new private insurance options or an expanded Medicaid program, under the law unauthorized immigrants will still be frozen out. Legally present immigrants without permanent resident status, such as students and temporary workers, will also be excluded from Medicaid, as will adults and, in some states, children who have been permanent residents for fewer than five years.
Does Access to Health Insurance Influence Work Effort Among Disability Cash Benefit Recipients?
Does Access to Health Insurance Influence Work Effort Among Disability Cash Benefit Recipients?
Source: Center for Retirement Research at Boston College
There is considerable policy concern about “DI lock” – that tying public health insurance coverage to cash disability benefit receipt contributes to the low exit rates due to work. This concern led Congress to institute continued health insurance eligibility after disability beneficiaries leave the cash-benefit rolls for work-related reasons. However, unlike the long literature on “job lock,” the importance of the DI lock hypothesis – either before or after these extensions – has remained unquantified.
This paper tests whether “perceived DI lock” remains among disability beneficiaries, and whether state health insurance policies help alleviate the problem and encourage work among beneficiaries. The analysis includes both DI and SSI beneficiaries and tests if there are differential patterns between the two programs. We exploit state variation in the access and cost of health insurance caused by regulation of the non-group market, the existence of Medicaid buy-in programs, and Medicaid generosity, as well as detailed disability and health insurance program interactions. While we find little evidence overall of persistent DI-lock, heterogeneity is very important in this context. Our estimates suggest that increasing health insurance access does increase the likelihood of positive earnings among a subset of disability beneficiaries. We find evidence of SSI lock among beneficiaries with some Medicaid expenditures and find that both non-group health insurance regulation and generous Medicaid eligibility help alleviate the problem. We find evidence of remaining DI lock among individuals who do not have access to supplemental health insurance outside of Medicare. Medicaid buy-in programs alleviate the remaining DI lock.
Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–Septe mber 2012
Source: National Center for Health Statistics
Highlights
• In the first 9 months of 2012, 45.3 million persons of all ages (14.7%) were uninsured at the time of interview, 57.5 million (18.6%) had been uninsured for at least part of the year prior to interview, and 33.8 million (11.0%) had been uninsured for more than a year at the time of interview.
• In the first 9 months of 2012, the percentage of children under age 18 who were uninsured at the time of interview was 6.6%.
• Among adults aged 19–25, the percentage uninsured at the time of interview was 26.3% (7.9 million) in the first 9 months of 2012.
• Among adults aged 19–25, 57.0% were covered by a private plan in the first 9 months of 2012.
• In the first 9 months of 2012, 30.7% of persons under age 65 with private health insurance at the time of interview were enrolled in a highdeductible health plan (HDHP), including 10.7% who were enrolled in a consumer-directed health plan (CDHP). More than 50% of persons with a private plan obtained by means other than through employment were enrolled in an HDHP. An estimated 21.5% of persons with private health insurance were in a family with a flexible spending account (FSA) for medical expenses.
Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder
Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder(PDF)
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
The HealthCare.gov Plan Finder is the first comprehensive, online portal that assists consumers in comparing their health insurance coverage options. All private health insurers in the individual and small group markets are required to submit information to populate the Plan Finder. The data collection conducted by CMS to populate the Plan Finder represents the first national attempt to identify these insurers and the products and plans they offer. To realize the benefits of expanded consumer information, the data displayed on the Plan Finder must be complete and accurate.
HOW WE DID THIS STUDY
We reviewed CMS’s policies and procedures, survey responses, and interview responses regarding oversight of insurers’ data submissions. We selected a purposive sample of 98 small group products and 94 individual plans displayed on the Plan Finder for its November 2011 and January 2012 updates, respectively. For each sampled product and plan, we identified aberrant or inconsistent data displayed on the Plan Finder and determined whether displayed data were consistent with information provided by insurers’ telephone customer service representatives.
WHAT WE FOUND
Most private insurers reported data to the Plan Finder. However, gaps exist in CMS’s oversight of private insurers’ compliance with Plan Finder reporting requirements. CMS did not conduct targeted follow-up with insurers that did not report detailed pricing and benefit information. CMS also has not been able to identify the entire population of insurers required to report basic company and product information. In addition, CMS has not asked insurers to certify to the completeness of submitted data in accordance with Federal regulation. CMS implemented numerous strategies to monitor data accuracy. However, the data displayed on the Plan Finder for the sample of products and plans contained some inconsistencies that may confuse consumers. The products and plans displayed were not always available for sale or were not always recognized by insurers’ representatives. When products and plans were available and were recognized, 81 percent of their data displayed on the Plan Finder matched the information provided by insurers’ representatives.
WHAT WE RECOMMEND
Our findings indicate that additional efforts are needed to oversee private insurers’ compliance with reporting requirements for the HealthCare.gov Plan Finder and to ensure that the data displayed on the Plan Finder are accurate.
Therefore, we recommend that CMS:
(1) Establish and implement procedures to identify and pursue private insurers that do not submit required data to the Plan Finder,
(2) Ensure that each private insurer’s Chief Executive Officer or Chief Financial Officer certifies to the completeness of data submitted to the Plan Finder,
(3) Design and implement additional strategies to ensure Plan Finder data accuracy, and
(4) Validate that products and plans submitted to the Plan Finder are available for sale.
CMS generally concurred with our recommendations and is taking steps to address them.
International Federation of Health Plans 2012 Comparative Price Report
International Federation of Health Plans 2012 Comparative Price Report
Source: International Federation of Health Plans
The International Federation of Health Plans, (iFHP) a network of leading health insurance CEO’s from over 25 countries, has released the 2012 Comparative Price Report. This is the fourth annual survey of prices of the cost of specific medical and products and services, compiled from data collected by iFHP member plans.
The study aims to help plans better understand why health care costs are so much higher in some countries than others. The survey data showed that average US prices were once again the highest of those in the countries surveyed for nearly all of the common services and procedures reviewed.
London-based iFHP CEO Tom Sackville said "We hope the release of this updated report on our price survey will be a step forward in creating a more informed knowledge base for all our member countries, allowing them to better assess the impact of unit prices on the cost of health care."
Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA
Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA
Source: Urban Institute
Analysis of the 2008-2010 American Community Survey indicates that 535,000 uninsured veterans and 174,000 uninsured spouses of veterans —or 4 in 10 uninsured veterans and 1 in 4 uninsured spouses—have incomes below 138 percent of poverty and could qualify for Medicaid or new subsidies for coverage under the Affordable Care Act. Most have incomes below 100 percent of poverty and will only have new coverage options if their state expands Medicaid. Since uninsurance is related to greater problems accessing care, increased Medicaid enrollment could improve the likelihood that their health care needs are being met.
Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges
Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges
Source: Kaiser Family Foundation
To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards. It was jointly authored by policy experts at the Kaiser Family Foundation, The Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital and the Jacobs Institute of Women’s Health at The George Washington University.
Quick Health Facts 2012: Selected State Data on Older Americans
Quick Health Facts 2012: Selected State Data on Older Americans
Source: AARP Public Policy Institute
Quick Health Facts 2012: Selected State Data on Older Americans provides a snapshot of each state’s health care landscape by providing comparable state-level and national data for over 70 indicators. This report, which is part of a biannual series on state-level data, is designed to reflect current health care priorities, with a particular focus on data that is relevant to the provisions of the recently upheld health care reform legislation. For example:
- The Demographics section presents data on the 50- to 64-year-old population that shows what percentage of the population could be eligible for health insurance premium and cost-sharing assistance starting in 2014.
- In the Medicare section, the number of Medicare Part B beneficiaries who paid an income-related premium in 2008 is an indicator of how many Medicare Part D enrollees could pay an income-related premium.
- The Coverage and Capacity section includes data on private employers that currently offer health care coverage; many employers will be required to offer health insurance starting in 2014.
In some cases, indicators have been broken down into age subsets to highlight the variation among different age groups.
Uninsured Veterans and Family Members: Who are They and Where Do They Live?
Uninsured Veterans and Family Members: Who are They and Where Do They Live?
Source: Robert Wood Johnson Foundation
One in 10 of the nation’s 12.5 million nonelderly veterans report either not having health insurance coverage or using Veterans Affairs (VA) health care, according to the 2010 American Community Survey (ACS). This report, prepared by the Urban Institute and released by the Robert Wood Johnson Foundation, is the first-ever to provide estimates of uninsurance among veterans and their families both nationally and at the state level, and to assess the potential for the Affordable Care Act (ACA) to reduce their uninsurance rates.
Veterans are less likely than the rest of the nonelderly population to be uninsured. Both uninsured veterans and their family members report significantly less access to health care than their counterparts with insurance coverage.
Record Number of Children Covered by Health Insurance in 2011
Record Number of Children Covered by Health Insurance in 2011
Source: Carsey Institute
Using data from the 2008 through 2011 American Community Survey, this brief describes rates of children’s health insurance coverage nationally, by region, and place type (that is, rural, suburban, and central city). In addition, it details the composition of coverage in the United States, specifically the proportion of children covered by private and public insurance. Author Michael Staley reports that rates of insurance coverage for children under age 18 increased from 90 percent in 2008 to 92.5 percent in 2011 and that the proportion of children covered by public health insurance increased substantially for the fourth consecutive year in every kind of place—rural, suburban, and in central cities. Rates of private insurance coverage among children decreased for the fourth consecutive year. Staley discusses how possible cuts to federal insurance programs could impact children’s coverage, in addition to policy considerations for increasing the overall rate of insurance.
Views on Health Coverage and Retirement: Findings from the 2012 Health Confidence Survey/Tax Preferences and Mandates: Is the Danish Savings Experience Applicable to the United States?
Source: Employee Benefit Research Institute
Views on Health Coverage and Retirement: Findings from the 2012 Health Confidence Survey,®
- More than one-half of Americans (54 percent) reported that access to health insurance in their retirement decision was extremely important, and another 28 percent reported it was very important in 2012.
- Overall, more than one-half of workers (53 percent) reported that they planned to work longer than they would like in order to continue receiving health insurance through work, although only 19 percent of retirees reported that they had worked longer than they would have liked to in order to continue receiving health insurance through work.
- In 2003, 15 percent of workers reported that they would retire earlier than planned if they were guaranteed access to health insurance, but by 2012, 27 percent reported that they would retire earlier than planned under that condition.
Tax Preferences and Mandates: Is the Danish Savings Experience Applicable to the United States?
- In an environment where lawmakers are struggling to raise tax revenue, public-policy tax “expenditures” have come under heavy scrutiny—in particular, tax preferences to boost retirement savings in employer- provided retirement plans.
- A recent study based on data from Denmark has called into question the usefulness of such retirement tax expenditures in boosting real savings.
- The study of Danish workers explored only the impact that changes in tax incentives for work place retirement plans might have on worker savings behaviors; of critical importance, it did not explore how employers might respond to changes in retirement savings tax incentives. Evidence suggests U.S. employers would react negatively to a loss of tax incentives by reducing or ending their retirement plans.
- While the study of Danish savings behaviors presented the impact of tax-incentives and the “nudges” of automatic mandatory savings as an “either/or” solution, the optimal solution—certainly for a voluntary system such as the one currently in place in the U.S.—may well be a combination of the two.
Survey of Charges Billed by Out-of-Network Providers: A Hidden Threat to Affordability
Survey of Charges Billed by Out-of-Network Providers: A Hidden Threat to Affordability
Source: America’s Health Insurance Plans
This report provides a snapshot, state-by-state, of exorbitant charges billed by out-of-network physicians in the 30 largest states by population. It is designed to illustrate the value of provider networks and a growing problem faced by consumers who want affordable, meaningful, access to out-of-network providers.
The information was collected in a survey of AHIP member plans. The plans were asked to provide the three highest billed charges in 2011 and their corresponding zip codes from non-participating providers for each of the 24 CPT procedure codes within the 30 most populous states. This report updates a similar survey report done by AHIP and Dyckman & Associates, LLC in 2009.
New from the GAO
New GAO Reports
Source: Government Accountability Office
PRIVATE HEALTH INSURANCE
Expiration of the Health Coverage Tax Credit Will Affect Participants’ Costs and Coverage Choices as Health Reform Provisions Are Implemented
GAO-13-147, Dec 28, 2012
New From the GAO
New GAO Report
Source: Government Accountability Office
U.S. POSTAL SERVICE
Status, Financial Outlook, and Alternative Approaches to Fund Retiree Health Benefits
GAO-13-112, Dec 4, 2012
The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis
Source: Kaiser Family Foundation
A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population.
This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.
Monitoring HIV Care in the United States: A Strategy for Generating National Estimates of HIV Care and Coverage
Source: Institute of Medicine
Approximately 1.2 million people in the United States live with HIV, and the number grows each year. In July 2010, the federal government released the National HIV/AIDS Strategy (NHAS), aimed at reducing HIV transmission, increasing access to care, improving health outcomes, and reducing health disparities for people living with HIV. NHAS is designed to build on Affordable Care Act provisions that will increase access to health insurance for people with HIV.
A critical part of federal efforts will be to accurately monitor the scope of the HIV/AIDS epidemic and the availability and success of treatment and prevention programs. For help in structuring its plans, the White House Office of National AIDS Policy asked the IOM to prepare two reports – the first was released in March 2012 – on monitoring HIV care in the U.S.
Data collected from a nationally representative sample of people with HIV can be used to help monitor the effect of the ACA on health care coverage and utilization. Monitoring will provide an enhanced means of assessing the effect of the NHAS and the ACA on care received by people with HIV – knowledge that can inform future planning and guide potential redistribution of resources to improve the efficiency and quality of care and reduce health disparities.
