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Highlights from AHCPR's January Research Activities

Media Advisory: March 2, 1998

The U.S. Department of Health and Human Service's Agency for Health Care Policy and Research (AHCPR) works to improve the quality of health care, reduce costs, and broaden access to essential services. Here are some of the findings described in the most recent issue of AHCPR's Research Activities.

Medicare and Private Insurers are Likely to Pay More Than Others for Similar Home Health Services

Expenditures for home health care have exploded in the past decade, growing from $5.6 billion in 1985 to nearly $25 billion in 1993. Patients insured by private health insurance or Medicare are more apt than others to be charged more for these services, concludes an AHCPR-supported study. It shows that in 1992, home health patients overall were charged an average of $75 per visit. Medicare patients were charged an average of $80 a visit, about $10 more than Medicaid patients, $19 more than patients paying out-of-pocket, and twice as much as patients with other primary sources of payment. Privately insured patients were charged more than other patients, with an average charge of $88 a visit. These differences persisted even after controlling for disparities across payers in mix of home services and home health agency characteristics. Medicare pays the agencies 25 percent of charges on average. Thus, agencies have the incentive to set charges above anticipated costs, typically at or above ceiling levels, according to Vicki A. Freedman, Ph.D., of RAND, and James D. Reschovsky, Ph.D., of the Center for Studying Health System Change, both formerly of AHCPR. They used the 1992 National Home and Hospice Care Survey to compare the average charge for a Medicare home health visit to the average charge for patients with other payment sources.

["Differences across payors in charges for agency-based home health services: Evidence from the National Home and Hospice Care Survey," Freedman, Vicki A., and Reschovsky, James D., October 1997 Health Services Research 32(4), pp. 433-452.]

Low-Risk Elderly Patients May Be Safely Discharged Early from The Hospital Following Bypass Surgery

In an effort to cut costs, more patients are being discharged from the hospital within five days of coronary artery bypass graft (CABG) surgery. This has raised concerns about quality of care, particularly for the elderly. But low-risk elderly patients discharged within five days of CABG did not have higher death or rehospitalization rates by two months later, according to an AHCPR-supported study. Led by Elizabeth R. DeLong, Ph.D., of Duke University, members of the Ischemic Heart Disease Patient Outcomes Research Team used Medicare discharge data from the 1992 National Claims History File. They examined the prevalence of early discharge among 83,347 non-HMO Medicare patients who underwent CABG in the United States in 1992. Patients discharged early tended to be younger and male and have fewer coexisting illnesses; they also had the lowest rates of death and hospital readmission and lower odds of experiencing an adverse outcome relative to patients with average post-operative stays. These results suggest that physicians are able to accurately identify low-risk elderly patients who are candidates for early discharge.

["Impact of early discharge after coronary bypass artery graft surgery on rates of hospital readmission and death," Cowper, Patricia A., Peterson, Eric D., Delong, Elizabeth, and others, October 1997 Journal of the American College of Cardiology 30, pp. 908-913.]

Use of Hormone Replacement Therapy Among Women Without Symptoms Has Doubled, But Remains Low

The number of postmenopausal women without menopausal symptoms such as hot flashes and fatigue, who reported use of hormone replacement therapy (HRT) more than doubled from 3 percent in 1989 to nearly 7 percent in 1993 and 1994. HRT use rates for women with symptoms stayed about the same. Primary care physicians other than obstetricians/gynecologists continued to prescribe HRT at a low rate (4-7 percent vs 23 percent of postmenopausal patient visits), according to an AHCPR-supported study. HRT use rates also varied substantially with socioeconomic status and geographic region. Primary care physicians seemed disinclined to prescribe HRT to prevent heart disease but seemed inclined to prescribe it to prevent complications from osteoporosis or hyperlipidemia (high blood fat levels). These low use rates and substantial HRT practice variations suggest missed opportunities to improve the health of women, conclude David Blumenthal, M.D., M.P.P., and his Harvard Medical School colleagues. Their findings are based on analysis of a nationally representative sample of 6,341 office visits by women 40 years of age and older to primary care physicians in 1993 and 1994.

["Low rates of hormone replacement in visits to United States primary care physicians," Stafford, Randall S., Saglam, Demet, Causino, Nancyanne, and Blumenthal, David," August 1997 American Journal of Obstetrics and Gynecology 177(2), pp. 381-387.]

More Employers Are Offering Health Insurance, But Fewer Workers Are Taking It

Growing numbers of Americans, particularly low-wage earners, are turning down health insurance offered by their employers, concludes a study by AHCPR economists. Health insurance premiums jumped 90 percent from 1987 to 1993. Companies who used to foot the bill for health insurance began asking workers to contribute a sizable portion of the premium. During the same period, wages for all workers rose 28 percent and stagnated for the lowest-paid workers. These changes may make insurance seem unaffordable to poor workers whose wages have stayed about the same in recent years, note Barbara Schone, Ph.D., and Philip Cooper, Ph.D., the study's authors. As a result, for workers earning less than $7 per hour, the percentage who bought the coverage they were offered decreased from 80 percent to 63 percent. In contrast, among workers earning more than $15 per hour, only 5 percent fewer declined coverage (91 percent to 86 percent). These findings are based on analysis of the 1987 Medical Expenditure Survey and 1996 Medical Expenditure Panel Survey of employed persons between the ages of 21 and 64.

["More offers, fewer takers for employment-based health insurance: 1987 and 1996," Cooper, Philip and Schone, Barbara, November 1997 Health Affairs 16(6), p. 142-149.]

Other Findings in Research Activities:

Benefits of occupational therapy for older adults.
Behavior problems among nursing home residents.
Race and residence differences in use of health services by the elderly.
Interactive computer game that encourages teens to delay parenting.
Stage of AIDS epidemic and consequences for blood screening.
Effects of mergers/acquisitions on primary care clinics.
Rural and urban differences in length of uninsurance periods.
Effect of health care financing system changes on access to care.
Role of price and other factors on consumer health plan choices.

For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 , E-Mail: SPrasad@ahrq.gov.

Internet Citation:

Highlights from AHCPR's January Research Activities. Media advisory, March 2, 1998. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/news/press/high0198.htm