Health Policy Updates: January 20 2018

The proportion of uninsured Americans has started to inch up again, after falling for several years post-ACA. But why? The Trump Administration has been doing what it can to chip away at the ACA’s foundation, but without any major legislative victories. And it seems that this trend predating this, anyway.

“A recent estimate of the connection between a lack of insurance and mortality suggests that for every 800 people without insurance for a year, one will die — meaning that 4,000 more people may have died during the year than would have had they been covered. That increase in the percentage began in the first quarter of Donald Trump’s presidency.”

I found this to be the most interesting policy-relevant paper I happened across this week. With the goal of reducing unnecessary care and lowering health care costs, the state of Maryland placed its hospitals on global budgets – a reimbursement cap for all services. My prediction would have been that this would have worked! That hospitals would have responded to this dis-incentive and reduced excess care.

However, that isn’t what these researchers found. There were no big changes in hospital admissions, ED presentations, readmissions…compared to controls. Health policy can be difficult!

“…placebo analyses indicated that changes in Maryland were well within the range of changes in other states. Together, these findings provide no clear evidence that Maryland hospitals met their budgets by reducing hospital utilization or enhancing primary care beyond changes that would have been expected in the absence of global budgets.”

This paper on nurse practitioners in the health care work force caught my attention, too. Many states have restrictive laws that prevent NPs from working fully independently from physicians, which limits the number of patients they can serve. However, these researchers found that increased NP scope-of-practice was associated with greater preventive care use, and fewer emergency presentations for preventable causes.



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