TAG: "Health policy"

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.

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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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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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