TAG: "Health policy"

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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Hospital charges vary widely for women giving birth


UCSF study examines charges for uncomplicated deliveries.

Renee Hsia, UC San Francisco

Renee Hsia, UC San Francisco

Women giving birth in California can face a huge cost difference in their hospital bills, according to a new UC San Francisco study.

The study found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For a C-section, women were billed between $8,312 and nearly $71,000. Few of the women in the study had serious health issues and most were discharged within six days of admission.

For the more than half million women who give birth at California hospitals every year, medical costs are difficult to predict and can result in differences of thousands of dollars among facilities even in the same geographic area, the researchers said.

“Unlike other industries, the way health care is priced and paid for is notoriously opaque, making it difficult for patients to act as educated, price-comparing consumers,” the authors wrote.

The study was released online Jan. 16 in BMJ Open.

“This is unfortunately the appalling state of affairs of health care in the United States,” said lead author Renee Y. Hsia, M.D., an associate professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at the UCSF-affiliated San Francisco General Hospital & Trauma Center and a faculty member of the UCSF Institute for Health Policy Studies.

“Childbirth is the most common reason for hospitalization, and even for an uncomplicated childbirth, we see a staggering difference in what hospitals charge, even for the same, average patient,” Hsia said. “These charges affect not only the uninsured, but also the fee-for-service reimbursements by some private insurers, which can translate to out of pocket costs for patients.”

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Minorities’ health would benefit most from beverage sugar tax


UCSF research team concludes that tax would result in lower rates of diabetes, heart disease.

Kirsten Bibbins-Domingo, UC San Francisco

Kirsten Bibbins-Domingo, UC San Francisco

Taxing sugar-sweetened beverages is likely to decrease consumption, resulting in lower rates of diabetes and heart disease, and these health benefits are expected to be greatest for the low-income, Hispanic and African-American Californians who are at highest risk of diabetes, according to a new analysis led by researchers at UC San Francisco.

Over the course of the next decade, lowered incidence of these diseases would save over half a billion dollars in medical costs, concluded the research team, which includes members from Oregon State University and the Mailman School of Public Health at Columbia University.

The researchers previously modeled the national health effects of a penny-per-ounce tax over the course of 10 years and found that it would reduce consumption among adults by 15 percent, modestly lower the prevalence of diabetes and obesity and prevent tens of thousands of coronary heart events, strokes and premature deaths. The new study considered a range of reductions in sugary beverage consumption among Californians.

In the new study, assuming a decline of 10 to 20 percent in the consumption of soda and other sugary beverages from the tax, researchers concluded that new cases of diabetes and coronary heart disease would drop statewide, and those health benefits would be greatest in poor and minority communities. The analysis, published Dec. 11 in the online journal PLOS ONE, predicted that overall, one in 20,000 Californians would avoid diabetes. This estimate would double for Hispanics and poor Californians and triple for African Americans.

”Poor and minority communities in California and nationally have very high rates of diabetes, a chronic condition with potentially devastating health complications,” said Kirsten Bibbins-Domingo, M.D., Ph.D., UCSF professor of medicine and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Although many steps are needed to reverse the rising diabetes trends in the state, our study suggests that efforts to curb sugary beverage consumption can have a significant positive impact, particularly in those most likely to be affected.”

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Unhappy meals?


Majority of very young children in California eat fast food at least once a week.

UCLA Center for Health Policy ResearchA surprisingly large percentage of very young children in California, including 70 percent of Latino children, eat fast food regularly, according to a new policy brief by the UCLA Center for Health Policy Research.

The study found that 60 percent of all children between the ages of 2 and 5 had eaten fast food at least once in the previous week.

The majority of the state’s young children also do not eat enough fruits and vegetables, with only 57 percent of parents reporting that their child ate at least five fruit and vegetable servings the previous day.

“A weekly happy meal is an unhappy solution, especially for toddlers,” said Susan Holtby, the study’s lead author and a senior researcher at the Public Health Institute. ”Hard-working, busy parents need support to make healthy food selections for their kids.”

The new study used data from several cycles of the California Health Interview Survey (CHIS) to examine dietary behaviors of very young children, including their consumption of fast food, sugar-sweetened beverages, fruits and vegetables, and to gauge how much influence parents have over what their children eat.

The study’s authors found that in both 2007 and 2009, about two-thirds of children between the ages of 2 and 5 ate at least one fast food meal during the previous week, and 29 percent ate two or more. About 10 percent of children in this age group ate three or more fast food meals the previous week.

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Health insurance increases preventive care but not risky behaviors


Findings contradict common concern about expanded coverage.

New research from UC Davis physician Anthony Jerant shows that having health insurance increases the use of important services such as cancer screenings, but changes in coverage do not tend to alter health behaviors.

New research from UC Davis physician Anthony Jerant shows that having health insurance increases the use of important services such as cancer screenings, but changes in coverage do not tend to alter health behaviors.

People with health insurance are more likely to use preventive services such as flu shots and health screenings to reduce their risk of serious illness, but they are no more likely than people without health insurance to engage in risky health behaviors such as smoking or gaining weight, researchers at UC Davis and University of Rochester have found.

The findings, published in the November-December issue of the Journal of the American Board of Family Medicine, contradict the common concern that expanding health care coverage may encourage behaviors that increase utilization and costs.

“The notion that people with insurance will exhibit riskier behavior is referred to by economists as ‘ex ante moral hazard’ and has its roots in the early days of the property insurance industry,” said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study. “After buying fire insurance, some people wouldn’t manage fire hazards on their property. But health care is different. Someone might not care if their insured warehouse burns down, but most people want desperately to avoid illness.”

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UCSF to establish Health Workforce Research Center


Center to examine capacity of health care workforce to meet growing long-term care needs.

Joanne Spetz, UC San Francisco

Joanne Spetz, UC San Francisco

UC San Francisco has been awarded one of three Cooperative Agreements from the U.S. Bureau of the Health Professions to establish the UCSF Health Workforce Research Center (HWRC).

According to director Joanne Spetz, Ph.D., the task of the center will be to examine the supply, demand, distribution and capacity of the health care workforce to meet the needs of older adults and persons with disabilities, many of whom will be likely to prefer receiving long-term care at home or in community-based settings.

“The aging of the U.S. and global populations – the so-called ‘Silver Tsunami’ – means that an increasing number of us will require long-term care when we can no longer care for ourselves,” said Spetz, a professor of economics at the UCSF Philip R. Lee Institute for Health Policy Studies in the Department of Family and Community Medicine and associate director of research strategy at the UCSF Center for the Health Professions.

“Simply managing the activities of daily living often requires ongoing care from a combination of licensed and unlicensed health workers,” she observed. “We believe that the demand for these workers will increase significantly in the coming years. Health policy decision-makers need tools and strategies to ensure that the U.S. has an adequate workforce to meet our long-term care needs.”

Spetz will lead the UCSF HWRC with Deputy Director Susan Chapman, Ph.D., R.N., associate professor in the Department of Social and Behavioral Sciences at the UCSF School of Nursing. The center represents a collaboration among the Institute for Health Policy Studies, the UCSF Center for the Health Professions and the UCSF School of Nursing. Spetz and Chapman also are affiliated faculty at the Center for the Health Professions.

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UC Davis institute receives grants to support health policy presence


Institute for Population Health Improvement to raise awareness of evidence-based policies.

Kenneth Kizer, UC Davis

Kenneth Kizer, UC Davis

The Institute for Population Health Improvement (IPHI) has received grants totaling $423,236 from the California HealthCare Foundation and The California Endowment to increase awareness of evidence-based policies to address a wide range of health issues facing California and the nation.

The new grants support the establishment of the California Health Policy Forum in IPHI and management of the Sacramento Health Policy Briefings series, provide centralized leadership for both programs within IPHI, and broaden UC Davis’ presence in policy issues at the state capitol. The programs are designed to inform legislative and state agency staff, and are open to anyone interested in the topics, including the public and students.

“The California HealthCare Foundation and The California Endowment have a long history of supporting efforts to provide independent and nonpartisan platforms for education, idea sharing and conversations about important health-related issues facing the state,” said Kenneth W. Kizer, IPHI director and a distinguished professor at the UC Davis School of Medicine and the Betty Irene Moore School of Nursing. “The grants will enable these programs to better serve their target audiences.”

A $214,325 grant from the California HealthCare Foundation supports outreach and logistical coordination for the Sacramento Health Policy Briefings series. These briefings focus on health care service delivery and related policy issues. An Oct. 31 briefing held at the California State Association of Counties Conference Center, for example, focused on bringing greater transparency to cancer care in California.

A $100,000 grant from The California Endowment and a second grant from the California HealthCare Foundation for $108,911 will establish the California Health Policy Forum within IPHI and focus on building capacity among legislative and state agency staff responsible for developing and implementing health policy. A wide range of health, health care and population health topics will be addressed, and IPHI will be developing all of the topics, content and speakers for the project’s briefings and policy briefs. A component of the grant from The California Endowment further strengthens efforts to develop evidence-based health policy in California by supporting state health policy staff attendance at conferences and educational forums to obtain the latest evidence, innovations and thinking on pressing health issues.

Kizer is the principal investigator on the grants and Karen K. Shore, an established policy thought leader in the state, will direct the program.

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Researchers offer solutions to looming health care provider shortage


Authors suggest increasing scope of practice for non-physician health professionals.

Thomas Bodenheimer, UC San Francisco

Thomas Bodenheimer, UC San Francisco

The United States faces a severe shortage of primary health care providers, due to a wave of aging baby boomers, epidemics of diabetes and obesity, and the Affordable Care Act, which aims to bring health care coverage to millions more Americans.

In a series of papers published in the November issue of Health Affairs, researchers at UC San Francisco advocated a number of potential solutions to the problem.

In an analysis and commentary, Thomas S. Bodenheimer, M.D., M.P.H., a UCSF professor of family and community medicine, and Mark D. Smith, M.D., M.B.A., president and CEO of the California HealthCare Foundation, cited estimates that the U.S. will have a shortage of 52,000 primary care physicians by 2025. To meet the shortage, they suggested the creation of physician-led patient care teams of licensed and unlicensed health care personnel who have been empowered to provide an expanded scope of care. They also advocated increased participation by patients in providing more of their own care.

“The traditional solution to a shortage of physicians has been to mint more,” said Smith. “But that won’t close the gap, because demand is too strong and too few medical students are choosing primary care.”

Instead, said Bodenheimer, “The gap can only be narrowed by empowering all team members to care for a large number of patients based on the team members’ training and abilities.”

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Public insurance fills health coverage gap, new UCLA analysis shows


“Public programs have stepped in as employers have stepped out.”

Mother and childIn the years leading up to implementation of the Affordable Care Act, the percentage of Californians who received their health insurance through public programs continued to rise, likely in direct response to the loss of job-based coverage in the state, according to a new analysis by the UCLA Center for Health Policy Research.

The data for the analysis, collected in 2012 by the California Health Interview Survey, represents the most recent comprehensive statewide source of information on health insurance trends. The fact sheet was funded by The California Endowment and The California Wellness Foundation.

According to the analysis, the percentage of non-elderly state residents receiving health insurance through an employer dipped just below 50 percent in 2011 and remained there in 2012 — a 6 percentage-point decrease since 2001.

Public programs, such as Medi-Cal and Healthy Families, insured nearly 20 percent of Californians in 2012, a 3 percentage-point increase since 2009 and a 5 percentage-point increase since 2001.

“In effect, public programs have stepped in as employers have stepped out,” said Shana Alex Lavarreda, the center’s director of health insurance studies and the lead author on the fact sheet. “The data refutes any lingering arguments that employer-based insurance is the solution to our health care coverage crisis.”

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Summit explores potential of price transparency to lower medical costs


UCSF Center for Healthcare Value convenes gathering of stakeholders to discuss strategies.

Representatives from diverse stakeholder groups, including patients, consumers, employers, doctors and hospitals converged at an Oct. 18 summit on UCSF's Mission Bay campus to discuss possible strategies to increase price transparency in health care. (Photo by Susan Merrell, UC San Francisco)

Representatives from diverse stakeholder groups, including patients, consumers, employers, doctors and hospitals converged at an Oct. 18 summit on UCSF's Mission Bay campus to discuss possible strategies to increase price transparency in health care.

Amid growing calls for price transparency in health care, U.S. Health and Human Services Secretary Kathleen Sebelius earlier this year ordered the release of pricing data for the 100 most common hospital services.

The move put a spotlight on the drastic price differences for health care services in  hospitals across the country as well as within communities, and that consumers are largely unaware of the wide-ranging costs.

For example, the cost of a joint replacement in the U.S. ranges between $5,300 and $223,000. Average inpatient hospital charges for services to treat heart failure range from $21,000 to $46,000 in Denver and from $9,000 to $51,000 in Jackson, Miss.

With a focus on the potential for price transparency to help lower the cost of medical care, UC San Francisco’s Center for Healthcare Value (CHV) and its partners, Consumers Union and Catalyst for Payment Reform, convened “The Future of Health Care Price Transparency in California: A Multi-Stakeholder Summit” on Oct. 18 to examine the issue.

The nearly 100 attendees included representatives from diverse stakeholder groups, including patients, consumers, employers and labor unions that buy health care on behalf of their members, insurers, doctors and hospitals.

“Price transparency is a challenging issue, but it’s worth our attention,” says R. Adams Dudley, M.D., M.B.A., a professor of medicine and health policy at UCSF and organizer of the summit.

“Right now it’s virtually impossible for patients to know ahead of time how much health care services will cost, and all we see is the total bill going up and up,” he added. “If we expect consumers to shop for care or health plans and employers to be able to work with providers to figure out fair prices for care, we need to be able to know current prices.”

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New study finds spike in sugary drink consumption among California teens


Sugary beverage consumption has dropped in children under 12, but “teens are in trouble.”

Still bubbling overWhile consumption of soda and other sugary drinks among young children in California is starting to decline, a new study released today shows an alarming 8 percent spike among adolescents, the biggest consumers of these beverages.

Based on interviews with more than 40,000 California households conducted by the California Health Interview Survey (CHIS), the study, “Still Bubbling Over: California Adolescents Drinking More Soda and Other Sugar-Sweetened Beverages,” provides a comprehensive look at youth (2- to 17-year-olds) consumption of sugary drinks, charting consumption patterns from 2005–07 to 2011–12 .

The study, which also provides county-by-county youth consumption rates, was produced collaboratively by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy.

The most encouraging finding was the dramatic drop in the proportion of young children drinking sugary beverages daily over the seven-year period. Only 19 percent of 2- to 5-year-olds drink a sugary beverage daily, a 30 percent decline from the 2005–07 reporting period. Among 6- to 11-year-olds, 32 percent were daily consumers in 2011–12, representing a 26 percent drop since 2005–07.

Of greatest concern, however, is the significant rise among the biggest consumers of sugary drinks — adolescents (12- to 17-year-olds). Today, a full 65 percent of California adolescents drink sugary beverages daily, an 8 percent climb since 2005–07. And while the study’s authors point out that roughly the same proportion of these youth are drinking soda, 23 percent more are consuming energy and sports drinks every day.

“California has made real progress in reducing the consumption of sugary beverages among young children,” said Susan Babey, Ph.D., the report’s lead author. “But teens are in trouble. Soda or sports drinks should be an occasional treat, not a daily habit. If this trend isn’t reversed, there may be costly consequences for teens, their families and the health care system in the form of increased obesity and diabetes.”

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