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The Importance of Health Insurance Coverage

Why is health insurance coverage important?

  • It improves access to care
  • It’s associated with improved health outcomes
  • It supports appropriate health care utilization
  • It improves individuals’ and families’ financial well-being

A new briefing from the American Hospital Association discusses each of these facets on the impact of health coverage on consumers and the overall health system. The report also provides recent data trends on the number of insured and uninsured and a reference list for further information.

Source: The importance of health coverage. American Hospital Association, Nov. 2017. http://www.aha.org/content/17/importance-of-health-coverage-report.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org


How Well Does Insurance Coverage Protect Consumers from Health Care Costs?

In 2016, over a quarter of insured adults in the U.S. were underinsured — more than double the 2003 rate and and currently an estimated 41 million people. This is the finding from the latest Commonwealth Fund’s biennial health insurance survey that looked at the number of insured adults that had high out-of-pocket expenses and deductibles relative to their incomes.

The underinsured rates were highest [44-47%] for those purchasing individual coverage directly or through a Marketplace exchange and for the disabled under age 65 covered by Medicare.

The share of privately insured adults that had health plans without deductibles has shrunk by nearly half since 2003, while deductible amounts have increased. The number of insured adults with deductibles of $3000 or more has grown from 1% in 2003 to 13% in 2016.

Underinsured adults may defer needed medical care because of the costs and/or face medical debt and long term financial issues.

The survey report also discusses health policy implications of its findings.

Source: Collins SR and others. How well does insurance coverage protect consumers from health care costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. Commonwealth Fund Issue Brief, Oct. 2017. http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/oct/collins_underinsured_biennial_ib.pdf 

Posted by AHA Resource Center (312) 422-2050, rc@aha.org


Top 10 Issues Facing Community Hospital CEOs

Last month the American College of Healthcare Executives released the results of its annual CEO survey on the top concerns confronting community hospitals. The most pressing concerns of the CEOs in 2015 were:

  1. Financial challenges
  2. Patient safety and quality
  3. Governmental mandates
  4. Personnel shortages
  5. Patient satisfaction
  6. Physician-hospital relations
  7. Access to care
  8. Population health management
  9. Technology
  10. Reorganization [mergers, acquisitions, restructuring, partnerships]

Financial challenges has remained the top concern when compared to 2013 and 2014 surveys. Transition from volume to value, Medicaid reimbursement, bad debt, and increasing costs were among the financial challenges most often mentioned. Engaging physicians in improving the culture of safety/quality and in reducing clinically unnecessary tests and procedures were top concerns related to patient safety and quality.

Access to care and reorganization were new to the top 10 list in 2015, and personnel shortages rose to 4th place on the list, up from the 10th spot in 2014.

Source: Top issues confronting hospitals in 2015. American College of Healthcare Executives, Feb. 2, 1016. http://ache.org/pubs/research/ceoissues.cfm [press release: http://ache.org/pubs/Releases/2016/top-issues-confronting-hospitals-2015.cfm]

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Health Care Consumerism: Spending on Shoppable Services

A new report from the Health Care Cost Institute suggests that providing consumers with pricing to help them shop for health care may only have a modest impact on reducing overall health expenditures. Less than 7% of health expenditures are paid for by consumers for shoppable services.

Here are some numbers from the HCCI study:

  • About 43% of the $524.2 billion spent in 2011 on health care for the privately insured was considered shoppable.
  • Roughly a quarter of the privately insured population does not have a claim during a given year.
  • Around 15%, or almost $81 billion, was spent out of pocket on health care by privately insured consumers.
  • Of the out-of-pocket spending, $37.7 billion [7%] was spent on shoppable services.
  • Coinsurance and deductibles made up about three quarters of out-of-pocket shoppable spending.
  • Most out-of-pocket shoppable dollars [44%] were for ambulatory doctor services.

While price and quality information is important and should be available to consumers, it may be unrealistic to expect that it will drive major market changes. The HCCI analysis found less price variation for outpatient than for inpatient services, and the more shoppable outpatient services generally are lower-priced to start with. While consumers with serious health conditions or high deductibles could realize significant savings, there may be little value for many consumers to shop when there is minimal price variation.

The report concludes that one should be realistic about the power of consumers to control health care costs. Instead, it recommends efforts be focused directly on providers and payers who are better positioned to put downward pressure on prices.


Spending on shoppable services in health care. Health Care Cost Institute, Issue Brief #11, Mar. 2016. http://www.healthcostinstitute.org/files/Shoppable%20Services%20IB%203.2.16.pdf

Frost A and others. Health care consumerism: can the tail wag the dog? Health Affairs Blog, Mar. 2. 2016. http://healthaffairs.org/blog/2016/03/02/health-care-consumerism-can-the-tail-wag-the-dog-2/

Related sources:

White C; Eguchi M. Reference pricing: a small piece of the health care price and quality puzzle. National Institute for Health Care Reform, Research Brief 18, Oct. 2014. http://www.nihcr.org/Reference-Pricing2

Price transparency efforts accelerate: what hospitals and other stakeholders are doing to support consumers. American Hospital Association, Trendwatch, July 2014. http://www.aha.org/research/reports/tw/14july-tw-transparency.pdf

White C and others. Healthcare price transparency: policy approaches and estimated impacts on spending. West Health Policy Center, Policy Analysis, May 2014. http://www.westhealth.org/wp-content/uploads/2015/05/Price-Transparency-Policy-Analysis-FINAL-5-2-14.pdf

Muir MA and others. Clarifying costs: can increased price transparency reduce healthcare spending? William & Mary Policy Review 4: 319-366, 2013. https://www.wm.edu/as/publicpolicy/wm_policy_review/archives/volume-4/volume-4-issue-2/MuirAlessiKing_s13f.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

The Burden of Medical Debt: Survey Results

A quarter of U.S adults under age 65 report they or their household have had a problem paying a medical bill within the past year. While over half of the uninsured had medical bill difficulties, health insurance was no panacea against the problem. Around 20% of those with insurance also reported a problem paying medical bills. In fact, for households with medical bill payment issues, over 60% had health insurance.  Insurance deductibles make a difference in ability to pay a bill.

While those with low or moderate incomes are more commonly affected by the difficulty or inability to pay medical bills, people from all walks of life experience the problem. These are the findings from a survey jointly conducted by the Kaiser Family Foundation and the New York Times.

The report on the findings covers the circumstances leading to medical bill problems, the financial status of those with the problem, and the consequences that have resulted from the issue.


Hamel L and others. The burden of medical debt: results from the Kaiser Family Foundation/New York Times medical bills survey. Kaiser Family Foundation, Dec. 2015. https://kaiserfamilyfoundation.files.wordpress.com/2016/12/8806-the-burden-of-medical-debt-results-from-the-kaiser-family-foundation-new-york-times-medical-bills-survey1.pdf

Sanger-Katz M. Even insured can face crushing medical debt, study finds. New York Times, Jan. 5, 2016. http://www.nytimes.com/2016/01/06/upshot/lost-jobs-houses-savings-even-insured-often-face-crushing-medical-debt.html

Related: Cohen RA. Problems paying medical bills among persons under age 65: early release of estimates from the National Health Interview Survey, 2011-June 2014. National Center for Health Statistics, Feb. 2015. http://www.cdc.gov/nchs/data/nhis/earlyrelease/probs_paying_medical_bills_jan_2011_jun_2014.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Debunking Common Myths About Healthcare Consumerism

Consumers are taking a more active role in health care decision making, and healthcare consumerism will soon become a much more significant force according to a new report from McKinsey & Company. McKinsey identifies and debunks these key myths based on its survey and analysis of consumer behavior and attitudes:

  • Myth: Healthcare is different from other industries when it comes to expectations about the consumer experience.
  • Myth: Consumers know what they want and what drives their decisions.
  • Myth: Most consumers research their healthcare choices before making fact-based decisions based on their research.
  • Myth: Premium price is the only really important factor in purchase decisions.
  • Myth: Almost all consumers have a primary care physician and are highly reluctant to change doctors.
  • Myth: Retail clinics will remain a niche health solution.
  • Myth: Only young people are using technology to manage their health and healthcare needs.
  • Myth: Most people are willing to trust insurers to store their health records.

Both provides and payors should be ready to respond to and help shape healthcare consumerism as it evolves.

Source: Cordina J and others. Debunking common myths about healthcare consumerism. McKinsey & Company, Dec. 2015. http://www.mckinsey.com/insights/health_systems_and_services/debunking_common_myths_about_healthcare_consumerism

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Patient & Family Engagement: a Survey of US Hospital Practices

Patient and family engagement is associated with better health outcomes, higher patient ratings of quality, and reduced use of health services. So what are hospitals doing to engage patients and their families?

Results of a survey point to current practices used by hospitals in the US. Twenty-five consensus engagement strategies were covered in the survey; they addressed organizational practices, bedside practices, and information access and shared decision-making.

Researchers found a large variation in hospital implementation of engagement practices. About half of hospitals fully used 9 or more of the 25 patient and family engagement practices.

Among the most widely adopted engagement practices were:

  • Written policies on patients’ rights to identify which personal contacts they’d like to have actively involved in their care
  • Policy for unrestricted visitor access to at lease some units
  • Formal policy to disclose and apologize for medical errors

The practices less widely adopted were:

  • Involvement of patients or family as educators when training clinical staff
  • Patient and family advisory councils meeting within the last year
  • Patients and family members sitting on the patient and family advisory council

The most common barrier to implementation by hospitals was identified as competing priorities.


Source: Herrin J and others. Patient and family engagement: a survey of US hospital practices. BMJ Quality & Safety online first, June 2015. http://qualitysafety.bmj.com/content/early/2015/06/16/bmjqs-2015-004006.full

Related: Patient and family engagement and patient satisfaction: results of a national survey.  Health Research & Educational Trust in partnership with American Hospital Association. April 2015. http://www.hpoe.org/Reports-HPOE/2015/pfesurveyresultsjuly12015_final.ppt

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Apple Watch and Hospitals Using It in the News

The new Apple Watch has been in the news this week, but so have several hospitals that are using it with patients. Apple’s HealthKit mobile app is available with its Watch.

Cedars-Sinai Medical Center has linked its electronic medical records system to Apple’s HealthKit software, giving patients the option for adding their data to their health records. Ochsner Health System will be using the Apple Watch to manage hypertension in patients initially, but may add other patients with chronic diseases.

Mayo Clinic, Stanford University Hospital, and Duke University Hospital are also among the first hospitals or health systems connected to HealthKit system. Reuters news service has reported that 14 of 23 major hospitals it contacted have pilot programs using Apple’s HealthKit mobile software. Competitive services from Google and Samsung have also begun reaching out to some hospitals and others in the medical field..


Stempniak M. New Orleans Health System harnesses Apple Watch to manage chronic disease. H&HN Daily, April 27, 2015. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/April/Oschsner-Health-Apple-Watch-chronic-disease-blog-stempniak

Bowman D. Cedars-Sinai goes all-in on Apple HealthKit. FierceHealthIT.com, April 27, 2015. http://www.fiercehealthit.com/story/cedars-sinai-goes-all-apple-healthkit/2015-04-27

Comstock J. Apple Watch already has 264 health apps, unused pulse ox functionality, and a hospital pilot. MobiHealthNews.com, April 27, 2015. http://mobihealthnews.com/42900/apple-watch-already-has-264-apps-unused-pulse-ox-functionality-and-a-hospital-pilot/

Higgins T. Apple’s HealthKit linked to patients at big Los Angeles hospital. BloombergBusiness, April 26, 2015. http://www.bloomberg.com/news/articles/2015-04-26/apple-s-healthkit-linked-to-patients-at-big-los-angeles-hospital

Diamond D. A hospital is already giving Apple Watch to its patients. Forbes.com, April 24, 2015. http://www.forbes.com/sites/dandiamond/2015/04/24/can-apple-watch-make-patients-healthier-how-one-hospital-is-trying-to-find-out/

Farr C. Exclusive: Apple’s health tech takes early lead among top hospitals. Reuters, Feb. 5, 2015. http://www.reuters.com/article/2015/02/05/us-apple-hospitals-exclusive-idUSKBN0L90G920150205

Dvorak K. mHealth Summit 2014: HealthKit, EHR pilot programs show great promise, execs say. FierceMobileHealthcare.com, Dec. 20, 2014. http://www.fiercemobilehealthcare.com/story/mhealth-summit-2014-healthkit-ehr-pilot-programs-show-great-promise-execs-s/2014-12-10

Goldstein P. Apple moves into mobile healthcare with HealthKit software. FierceWireless.com, June 2, 2014. http://www.fiercewireless.com/story/apple-moves-mobile-healthcare-healthkit-software/2014-06-02

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

How Much Will It Cost? How Americans Use Prices in Health Care

How many Americans are trying to find how much their health care will cost them? How are they using the information they find? Public Agenda wanted to know and conducted a representative survey of Americans to find the answers.

Here are key results from their survey:

  • Over half of Americans [56%] say they’ve tried to determine their out-of-pocket costs before getting care.
  • Most Americans are open to looking for better-value care, with 71% indicating higher prices are not typically a sign of better quality care.
  • Looking for price information does not necessarily mean comparing prices.
  • For those who have compared prices, most believe it has saved them money.
  • Obstacles to increasing more cost comparisons exist. Half of Americans are unsure how to find price information. Over half [57%] don’t think doctors in their network charge differently for the same service.
  • Insurers and providers could do more to help Americans manage their health care costs. Most [69%] thought a website showing different charges would be helpful.

Further details are available in the report.

Source: How much will it cost? How Americans use prices in health care. Public Agenda, March 2015. http://www.publicagenda.org/files/HowMuchWillItCost_PublicAgenda_2015.pdf

Related resource: Transparency for consumers: a hospital toolkit. American Hospital Association, July 2014. http://www.ahacommunityconnections.org/content/14transparencytoolkit.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

National Hospital Ratings Systems Share Few Common Scores and May Generate Confusion

A new study reported in this month’s Health Affairs journal indicates that hospital rating systems could create more confusion than clarity for consumers. The researchers looked at four well-known national hospital rating systems and compared the hospitals that were ranked high and low in each of these systems:

And here’s what they found:

  • No hospital was rated highly across all four systems.
  • Only 10 of 844 hospitals rated as a high performer in one system were also rated highly in any of the other systems.

Why the discrepancy? Each system has its own methodology that uses or stresses different performance measures.

Source: Austin JM and others. National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Affairs, vol. 34, March 2015, pages 423-430. http://content.healthaffairs.org/content/34/3/423.abstract

Posted by AHA Resource Center (312) 422-2050, rc@aha.org