TAG: "Health policy"

Hospital charges for blood tests vary widely across California


UCSF study highlights difficulty of knowing health care prices.

Renee Hsia, UC San Francisco

New UC San Francisco research shows significant price differences for 10 common blood tests in California hospitals, with some patients charged as little as $10 for one test while others were charged $10,169 for the identical test.

The analysis of charges at more than 150 California hospitals looked at blood tests that are often required of patients, such as lipid panel, basic metabolic panel, and complete blood cell count with differential white cell count.

Hospital ownership and teaching status help explain a portion of the variation – prices generally were lower at government and teaching hospitals. Factors such as location, labor costs, patient capacity and percentage of uninsured population generally did not account for the price differences, the authors said, making it difficult for patients to know their costs in advance and to “act as rational consumers.”

The report was published in BMJ Open today (Aug. 15).

Charges for a basic metabolic test ranged from $35 to $7,303, depending on the hospital; the median charge was $214. The most extreme price difference was found in charges for a lipid panel: the median charge was $220, but overall charges ranged from $10 to as much as $10,169.

The results are of particular concern, said the authors, since there isn’t much room for variability in blood tests. Moreover, because the tests are identical across providers, consumers might be expected to think that hospital charges would be similar.

“You may hear people say that, ‘Charges don’t matter’ or that ‘No one pays full charges,’” said senior author Renee Y. Hsia, M.D., an associate professor of emergency medicine at UCSF and director of health policy studies in the Department of Emergency Medicine. She is also an attending physician in the emergency department at San Francisco General Hospital and Trauma Center.

“However, uninsured patients certainly face the full brunt of raw charges, especially if they don’t qualify for charity care discounts,” Hsia said. “And as employers are switching to more consumer-directed health plans with higher deductibles and co-pays, the out-of-pocket costs of even insured patients can be affected by these charges.”

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Medical schools urged to increase enrollment of undocumented immigrants


Accepting students eligible for federal DACA program could help address nation’s shortage of primary care physicians, UCLA center says.

Youhali Balderas-Medina Anaya, UCLA

A paper by researchers at the UCLA Center for the Study of Latino Health and Culture urges medical schools to do more to increase their enrollment of undocumented immigrants seeking access to the medical professions.

The authors of “Undocumented Students Pursuing Medical Education: The Implications of Deferred Action for Childhood Arrivals,” published in the current issue of the journal Academic Medicine, suggest that these students, who are often highly motivated and qualified, can help alleviate the nationwide shortage of primary care physicians, particularly in underserved, low-income areas.

“This country is in great need of primary care physicians to fill the ongoing shortage, yet qualified undocumented pre-medical students are still being denied access to medical schools because of concerns regarding their status,” said Dr. Yohualli Balderas-Medina Anaya, a resident physician in the department of family medicine at the David Geffen School of Medicine at UCLA and the paper’s lead author.

The authors suggest that Deferred Action for Childhood Arrivals (DACA), an initiative signed by the Obama administration in 2012 that allows certain young undocumented immigrants to work legally in the U.S. without fear of deportation, could help shore up the numbers.

“With DACA,” Anaya said, “undocumented pre-med students can help address this growing shortage. We are calling upon the medical and academic community to support undocumented students applying to medical school. We can all benefit from helping these students enter and successfully complete medical school.”

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Study finds health claims misleading for sports, energy drinks


‘Health halo’ around popular drinks obscures risks to children.

A new report by UC Berkeley researchers questions the health claims of popular energy, sports, tea and fruit drinks on the market.

In a report released today (Aug. 6), the authors evaluated 21 popular drinks with health claims — from immune boosters to energy enhancers — on their labels and in their marketing materials.

“We often see labels on energy and sports drinks that tout health benefits, but the sugar levels in these products rival that of sodas,” said lead author Patricia Crawford, director of the Atkins Center for Weight and Health and UC Berkeley adjunct professor of nutritional sciences and toxicology. “They are essentially sodas without the carbonation, but they give the misleading impression that they are healthy.”

The report, “Looking Beyond the Marketing Claims of New Beverages,” was commissioned by the California Center for Public Health Advocacy. Click here to access the full report, fact sheets and press release.

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Low-income diabetics up to 10 times likelier to lose a limb than wealthier patients


Most amputations preventable with earlier medical care, UCLA researchers say.

Carl Stevens, UCLA

It’s no secret that poverty is bad for your health. Now a new UCLA study demonstrates that California diabetics who live in low-income neighborhoods are up to 10 times more likely to lose a toe, foot or leg than patients residing in more affluent areas of the state. Earlier diagnosis and proper treatment could prevent many of these amputations, the researchers say.

The study authors hope their findings, published in the August issue of Health Affairs, will motivate public agencies and medical providers to reach out to patients at risk of late intervention and inspire policymakers to adopt legislation to reduce barriers to care.

“I’ve stood at the bedsides of diabetic patients and listened to the surgical residents say, ‘We have to cut your foot off to save your life,’” said lead author Dr. Carl Stevens, a clinical professor of medicine at the David Geffen School of Medicine at UCLA. “These patients are often the family breadwinners and parents of young children — people with many productive years ahead of them.

“When you have diabetes, where you live directly relates to whether you’ll lose a limb to the disease,” added Stevens, an emergency physician for 30 years at Harbor–UCLA Medical Center. ”Millions of Californians have undergone preventable amputations due to poorly managed diabetes. We hope our findings spur policymakers nationwide to improve access to treatment by expanding Medicaid and other programs targeting low-income residents, as we did in California in 2014.”

Dylan Roby, UCLA

The authors used data from the UCLA Center for Health Policy Research’s California Health Interview Survey, which estimated the prevalence of diabetes among low-income populations by ZIP code. They blended these statistics with household-income figures from the U.S. Census Bureau and hospital discharge data from the Office of Statewide Health Planning and Development that tracked diabetes-related amputations by ZIP code.

The result was a detailed set of maps showing diabetic amputation rates by neighborhood for patients 45 and older — the age range at greatest risk for amputation from disease complications.

“Neighborhoods with high amputation rates clustered geographically into hot spots with a greater concentration of households falling below the federal poverty level,” said co-author Dylan Roby, director of health economics at the UCLA Center for Health Policy Research and an assistant professor at the UCLA Fielding School of Public Health. “Amputation rates in California were 10 times higher in the poorest neighborhoods, like Compton and East Los Angeles, than in the richest neighborhoods, such as Malibu and Beverly Hills.”

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Odds of dying higher for hospital patients near closed emergency departments


UCSF study finds ED closures hurt surrounding communities as well as patients.

Renee Hsia, UC San Francisco

In the first analysis of its kind, UC San Francisco research shows that emergency department closures can have a ripple effect on patient outcomes at nearby hospitals.

In a study of more than 16 million emergency admissions to California hospitals between 1999 and 2010, researchers found that patients who were admitted to facilities located in the vicinity of an emergency department (ED) that had recently closed experienced 5 percent higher odds of dying than patients admitted to hospitals that were not near a recently closed ED.

The odds of dying were even higher for patients with certain time-sensitive conditions, especially heart attack (15 percent higher odds), stroke (10 percent) and sepsis (8 percent). The findings are of particular concern nationwide, said the authors, because the annual number of ED visits increased by 51 percent between 1996 and 2009, while the number of available emergency departments dropped by 6 percent.

The report will be published in the August issue of Health Affairs.

“Emergency department closures are affecting many more patients than previously thought,” said senior author Renee Y. Hsia, M.D., an associate professor of emergency medicine at UCSF and director of health policy studies in the department of emergency medicine. She is also an attending physician in the emergency department at San Francisco General Hospital and Trauma Center. “Most importantly, people who live in the area of nearby closures but whose own hospital did not close are still negatively affected by increased wait times and crowding in their own emergency department,” she said.

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3 of 4 California children with mental health needs don’t get treatment


Barriers to care persist, even though 95 percent have health insurance.

More than 300,000 California children between the ages 4 and 11 need mental health care, but only one in four is treated, according to a new policy brief from the UCLA Center for Health Policy Research — this, despite the Centers for Disease Control and Prevention recommending early-childhood intervention as a critical step in reducing the severity of mental health problems in adulthood.

“Without early assessment, you miss warning signs, as well as opportunities to intervene,” said D. Imelda Padilla-Frausto, a researcher at the center and lead author of the study. “Waiting can lead to more serious problems later.”

While about 8.5 percent of all California children in the 4-to-11 age group are identified as having mental health care issues — including conduct problems, emotional symptoms, hyperactivity and problems with peers — parents reported that 70.8 percent of these children went without emotional or psychological counseling over the previous year, according to the study, which used California Health Interview Survey (CHIS) data from 2007–09.

The study looked at a number of factors that contribute to mental health needs among children and obstacles that may contribute to a lack of treatment.

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Fact sheets provide snapshot of adult Californians’ health by race, ethnicity


UCLA report digs deeper into differences among groups within Latino, Asian populations.

The UCLA Center for Health Policy Research has issued a series of easy-to-read fact sheets with health statistics on five major ethnic and racial groups in California — whites, Latinos, blacks, Asians and American Indians/Alaska Natives, as well as more detailed information on Latino and Asian subgroups.

A new visual report also provides infographics on key findings from the profiles, which used data from the 2011–12 California Health Interview Survey (CHIS) to explore a range of health topics, from insurance status to fruit-and-vegetable consumption to binge drinking.

The profiles provide a detailed and reliable source of information for policymakers, advocates, researchers, media and others interested in understanding the health of adult Californians, particularly those from previously understudied ethnic and racial minority groups.

Of specific interest are key health statistics for five groups within California’s Latino population (which accounts for 9.5 million of the state’s 27.8 million adults), including separate data for U.S.-born Mexicans and Mexicans born outside of the U.S., and health information on half a dozen Asian groups (3.9 million). Latino ethnic groups covered include Mexican, Salvadoran, Guatemalan, other Central American and South American. Asian groups include Chinese, Filipino, Japanese, Korean, Vietnamese and South Asian.

Among the findings for California’s estimated 27.8 million adults:

Number of uninsured
Approximately 6.2 million California adults (26.6 percent of the state’s adult population) had no health insurance for all or part of the past year.

Insured through work
Nearly six of 10 Asians in the state had employment-based health insurance, compared with five of 10 Californians overall. Among Asian ethnic groups, the figure ranged from a high of more than 7 of 10 for South Asians to fewer than 4 of 10 for Koreans. For Latinos overall, fewer than 4 of 10 had employment-based insurance was, while Guatemalans had the lowest rate — 2 of 10.

Mexican groups and poverty
More than 70 percent of adult Mexicans born outside the U.S. had household incomes under 200 percent of the federal poverty level (less than $46,100 for a family of four in 2012). For U.S.-born Mexicans, the proportion was much lower, at 44.3 percent.

Walking and health
About one-third of all Californians walked regularly on a weekly basis. Latinos had one of the highest rates, at nearly 35 percent, and Salvadorans were the most frequent walkers, with a 41 percent rate.

Californians and obesity
More than 6.8 million Californians — a full quarter of the adult population — were obese. Less than one in 10 Asians was obese, while nearly four in 10 blacks and American Indians/Alaska Natives were.

Read the full 2011–2012 Racial and Ethnicity Health Profiles.

View UCLA Newsroom article

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California’s public hospitals could face $1.5B funding gap


California will fare better than other states but will still feel pain.

Dylan Roby, UCLA

Public hospitals in California that serve the poorest patients could face a $1.54 billion funding shortfall in 2019, when federal funding cuts go into effect. Those cuts, along with health care cost inflation, could jeopardize the financial stability of the state’s safety-net hospital system, according to a study by the UCLA Center for Health Policy Research and Virginia Commonwealth University published in the June issue of the journal Health Affairs.

Several county hospitals — including LAC + USC Medical Center, Santa Clara Valley Medical Center, Alameda Health System, Harbor–UCLA Medical Center and Olive View–UCLA Medical Center — may be especially vulnerable because they receive the highest disproportionate-share hospital (DSH) payments in the state and are located in regions with large numbers of undocumented immigrants who are not eligible for Medi-Cal, California’s version of the Medicaid program.

“Hospitals that can least afford a cut are the most at risk,” said Dylan Roby, director of the UCLA center’s Health Economics and Evaluation Research Program. “Policymakers should ensure that the impending shift in federal funding does not destabilize institutions that are the backbone of public health in California.”

California’s safety-net hospitals rely heavily on federal DSH funding, which compensates them for treating the most vulnerable patients — those who are uninsured and those on Medicaid, primarily children, pregnant women, the disabled and the elderly. In 2010, DSH funds paid more than half of $2 billion in DSH costs ($1.1 billion) to the 21 safety-net hospitals included in the study, with county and state funds covering the rest.

But with impending DSH cuts, the study estimates payments would drop to roughly $830 million to $980 million and leave hospitals struggling to cover $1.38 billion to $1.54 billion in DSH costs in 2019. As many as 4 million Californians and 30 million Americans nationwide are still likely to be uninsured at that time. Without a strong safety-net hospital system, those patients will have few places to turn to for care.

Consequence of legislation

The cuts are a consequence of the Affordable Care Act, whose authors anticipated that as more patients gained health coverage under the ACA, they would generate more revenue for public hospitals, decreasing the need for DSH payments.

But the newly insured patients may not be revenue-generators at public hospitals, and there will be many remaining uninsured patients, according to the study, which used the California Simulation of Insurance Markets to model hospitals’ future patient payer mix. For instance, some of the newly insured patients at public hospitals may switch to private hospitals and take their insurance payments with them.

Other states may fare worse

Hospitals in other states that opted out of expanding their Medicaid programs could be much harder hit than California for two reasons: They won’t get federal funding from Medicaid expansion, and their DSH payments will be cut.

“As challenging as these cuts will be for safety-net hospitals in California, they will be much worse in other states,” said Katherine Neuhausen, lead author of the study and a clinical assistant professor at Virginia Commonwealth University who conducted the research as a Robert Wood Johnson Foundation Clinical Scholar at UCLA. “Safety-net hospitals in states that do not expand Medicaid and those in states that do not target DSH payments to the hospitals with the greatest need could be in jeopardy.”

Public hospitals on a ‘shoestring’

Still, California is not immune to the coming budgetary realignment.

California highly targets its DSH payments to 21 public hospitals (just 4 percent of the state’s hospitals), including 15 county hospitals and six University of California hospitals. Many of these public hospitals — which operate half the state’s trauma centers and a quarter of the burn centers, as well as teaching hospitals — are in low-income areas with few paying patients and are especially vulnerable to any loss of funds.

“They’re already operating on a shoestring,” Roby said.

At LAC + USC Medical Center, half the people receiving outpatient services were found to be uninsured, and more than a third were on Medicaid. At hospitals statewide, the figures were much lower: 21.3 percent and 29.3 percent, respectively.

California awards DSH payments to public hospitals based on their numbers of uninsured and Medicaid discharges and their share of uncompensated care costs. Therefore, public hospitals with greater uncompensated care costs and more low-income patients should retain more of their DSH funds, according to the authors.

The authors conclude that California and other states can take steps to close the funding gap and keep hospitals stable. Hospital leaders, they say, could work with policymakers to make sure DSH payments are targeted to the safety-net hospitals that serve the most uninsured and Medicaid patients; states that expanded Medicaid under the ACA could pay higher reimbursement rates to safety-net hospitals for people who are newly eligible for Medicaid, which is already done in California; and safety-net hospital leaders in states that opted out of Medicaid expansion could seek out additional county and state subsidies.

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Could a modest investment expand Medi-Cal to state’s undocumented residents?


A little investment could go a long way, UC Berkeley/UCLA study finds.

Approximately 690,000 to 730,000 undocumented Californians could gain access to routine and preventive health care in 2015 with just a 2 percent increase in state Medi-Cal spending – estimated at $353 million to $369 million – according to a joint study by UC Berkeley’s Center for Labor Research and Education and the UCLA Center for Health Policy Research.

The study looks at certain provisions of the proposed Health for All Act, or Senate Bill 1005, proposed by state Sen. Ricardo Lara (D-Huntington Park/Long Beach) and under consideration in the state Legislature. The proposed legislation would make all low-income Californians who are excluded from federal health reform, including undocumented immigrants, eligible for Medi-Cal. More than 1.4 million undocumented Californians – ineligible for Affordable Care Act coverage programs due to their immigration status  – are uninsured.

“California would be the first in the nation to make its health-insurance program inclusive of all low-income residents and their families, including those who are undocumented,” said Laurel Lucia, policy analyst at the UC Berkeley Labor Center.

The proposed policy would complement the state’s recent role in expanding immigrants’ rights in the absence of federal immigration reform; this includes moves to provide driver’s licenses to all residents and to extend financial aid to undocumented college students who arrived in the United States as children, said Lucia.

The proposed change would move California from a system of disjointed emergency care to more rational and comprehensive care at a relatively low cost per person, according to the study authors. According to the study, some 60 percent of health care costs for California’s low-income, undocumented adults are already paid under long-standing federal policy. Matching dollars are provided by the federal government to the state for emergency and pregnancy-related services available to all low-income Californians, regardless of immigration status. But undocumented immigrants, who make up 9 percent of California’s workforce, often lack access to health-promoting, cost-effective preventive and routine services.

“The undocumented don’t get sufficient access to preventive care and often wait as long as possible before seeking care,” said Nadereh Pourat, director of research at the UCLA Center for Health Policy Research. “Providing preventive care helps the undocumented stay healthy and allows them to continue to contribute to California’s economy.”

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Diabetes linked to a third of state’s hospitalizations


UCLA study highlights impact the disease is having on California’s health care costs.

Patients with diabetes account for one in three hospitalizations in California, according to a comprehensive new study on the prevalence of diabetes in hospitals and its impact on providers and spiraling health care costs.

The study of hospital discharge records, conducted by the UCLA Center for Health Policy Research with support from the California Center for Public Health Advocacy, found that among all hospitalized California patients aged 35 or older — the age group that accounts for most hospitalizations — 31 percent had diabetes.

Although diabetes may not be the initial reason for these hospitalizations, the disproportionate share of patients with diabetes highlights the impact this disease is having on California’s health care costs.

The research also showcases the percent of hospitalizations of patients with diabetes and related costs by county.

“If you have diabetes, you are more likely to be hospitalized, and your stay will cost more,” said Ying-Ying Meng, lead author of the study and a researcher at the UCLA Center for Health Policy Research. “There is now overwhelming evidence to show that diabetes is devastating not just to patients and families but to the whole health care system.”

Diabetes is one of the nation’s fastest-growing diseases and one of the most costly. It adds an extra $1.6 billion every year to hospitalization costs in California, with hospital stays for patients with diabetes costing nearly $2,200 more than stays for non-diabetic patients, according to the study. Three-quarters of that care is paid through Medicare and Medi-Cal, the study authors found, including $254 million in costs that are paid by Medi-Cal alone.

The disease is responsible for a long list of complications, including blindness, kidney disease, cardiovascular disease, amputations and premature death. Since 1980, diabetes cases have more than tripled nationally to 20.9 million. In California alone, diabetes cases have increased by 35 percent in 10 years.

“For far too many families, diabetes has become a common and painful reality,” said Dr. Harold Goldstein, executive director of the California Center for Public Health Advocacy. “In very stark terms, this study shows local health care providers and policymakers the enormity of the diabetes epidemic in their counties.”

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Dentist shortage bites California as more choose to practice out of state


Older dentists nearing retirement, newer dentists more specialized.

A lingering recession, the elimination of Medicaid dental reimbursements and a glut of established dentists in wealthier, populated areas may explain why more new dentists are practicing outside California, according to a new policy brief from the UCLA Center for Health Policy Research.

“Good access to dental care depends on having a robust supply of new dentists in California,” said Nadereh Pourat, director of research at the center and lead author of the study. “We need a new generation of dentists to replace the many dentists who are close to retirement.”

While California still saw an increase in the number of dentists and had more licensed dentists —35,000 plus — than any other state in 2012, the number of those licensed to practice in California who opted to reside or work out of state grew 6 percent between 2008 and 2012.

The migration is especially noticeable among new dentists. In 2012, 86 percent of those licensed within the previous five years practiced in the state — a 10 percent drop from 2008. In addition, new dentists in 2012 made up a smaller share of the state’s overall supply. Of all regions, the San Joaquin Valley tallied the highest percentage of new dentists, who made up 15 percent of the local supply.

A noteworthy development: Analysis showed one group — women — made up almost half of all newly licensed dentists in California in 2012.

Age may also start affecting supply. Nearly one-quarter of actively licensed dentists in California have been practicing for 30 years or more and are close to retirement age. Northern and Sierra counties had the highest proportion of dentists nearing retirement, at 40 percent.

The report also suggests that it may become tougher for adults to get basic oral care than gum surgery, as more new dentists are specializing.

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In California, Great Recession pushes millions of adult children home


Older parents are paying.

Californians anticipating an empty nest in their golden years are now faced with a rocky reality: The Great Recession and its jobless recovery have forced many adult children home, increasing household expenses by 50 percent or more for many families, according to a new study by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development.

The study includes a county-by-county breakdown of the costs of supporting an extended family in California.

For a variety of reasons — lack of a job, job loss, divorce, home foreclosure — more than 2.3 million adult children in California were living with their parents in 2011, 63 percent more than in pre-recession 2006. There were 433,000 older adults, age 65 and over, who housed approximately 589,000 of those adult children.

“A college degree is no guarantee of a job today, and an unprecedented number of families have been forced to return to a multigenerational household,” said Steven P. Wallace, associate director at the UCLA Center for Health Policy Research and a co-author of the study. “Until the economy provides the kinds of jobs that allow all adults to be self-sufficient, families will need help.”

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