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New research suggests that hospital visits decrease as the level of cost the patient bears go up. While this might be worrisome--we don't want people to avoid hospital trips and end up sicker--the study also found that the higher co-pays actually didn't have a negative effect on patient health. In fact, they saw no increase in negative clinical events such hospitalization, intensive care admission or deaths. To gather their data, researchers followed more than two million …

While emergency department use by the uninsured remains an ongoing concern, a new study has found that ED overuse by insured patients is also a problem, at least in California. Researchers with the California HealthCare Foundation (CHCF) found that patients with chronic illnesses, in particular, made medically unnecessary visits to emergency departments. These patients had a positive image of ED care, and felt they had nowhere else to go, given that their primary care doctor was closed or …

There are several issues here. First, is the hospital efficiently managed? If its costs are excessive because it is poorly run, it is unreasonable to expect anyone, insured or otherwise, to compensate it for its inefficiency. Second, does it have any idea what its costs are? Many hospital accounting systems aren't very good. If it could credibly quantify its costs and communicate them to both uninsured patients and third party payers, it would be helpful. While Medicare may dictate prices that the hospital feels it must accept due to the high number of patients insured by the program, it should be able to negotiate more reasonable payment terms with private insurers. Again, a robust accounting system would be helpful in negotiations. With respect to the uninsured, I just don't think it is reasonable to charge them more that about 10 to 15 percent above what it accepts from private insurance for the same service or, if less, 25 percent above Medicare for the same set of services even if the patient is wealthy. I suggest that hospital executives might ask themselves how they would feel if they were on the receiving end of bills to the uninsured knowing what the hospital routinely accepts as full payment from insurers, including Medicare. If Medicare is paying mostly on the basis of DRG's and private insurers are paying either on a case rate or per diem basis (depending on the treatment), the same approach should be used for the uninsured.

A report released by the HHS's Agency for Healthcare Research and Quality has found that privately-insured Americans still pay more out-of-pocket costs for mental healthcare and substance abuse recovery than they do for other medical services. Consumers paid for 31 percent of mental health services such as psychotherapy, behavioral counseling, medication management and other outpatient mental healthcare. But they only paid 21 percent out-of-pocket for other types of medical care. This is …

The Federation of American Hospitals (FAH) isn't happy with CMS decision to end the ban on specialty hospitals. Last week CMS announced that these hospitals could operate under the condition that they report their financial structures and physicians' financial ties to patients. Failing to do so would result in a $10,000 a day fine. The FAH thinks this isn't enough to ensure specialty hospitals play by …

U.S. Health and Human Services Secretary Michael Leavitt wants to use Katrina-devastated New Orleans as a laboratory to test a newly-coherent healthcare delivery and financing system in a city that's never had such a thing before. City and state officials have officially kicked off the Louisiana Health Care Redesign Collaborative, a 40-member group that's to spend the next three months coming up with a plan. The goal is to propose major changes in Medicare and Medicaid rules (which may …

Miami's Jackson Memorial Hospital has undertaken a program to provide high-class patient hospitality services in an effort to attract affluent, international and privately insured patients. "We arrange everything--the doctor, the room, the transportation, accommodations for family. It's a concierge service from beginning to end," Diamela Corrales, manager of patient-hospitality services, told the Orlando Sentinel. But such service comes only to those who are willing--and …

Last week a study from Wennberg's Dartmouth group found that there were vast variations in the amount of "physician resources" used to produce similar care outcomes in intensive care settings. This week a RAND study followed up on data released in their much-quoted 2003 study which showed that patients receive the correct care from their providers only a little over 50 percent of the …

In a web exclusive for Health Affairs, Tennessee Blue Cross Blue Shield President Vicky Gregg discusses the lessons of her non-profit's continued financial success and the meltdown of the TennCare experiment. The CEO's interview with economist James Robinson touches on two key healthcare stories: the controversy over the profitability of non-profits and the issue of Medicaid reform.

On pricing: "There was a considerable pushback to the …

A report released earlier this week by the Center for Studying Health System Change (HSC) examines trends in hospital emergency departments. Emergency department visits are up 26 percent over the last year. Researchers believe a major factor in the increase is the trend among patients to rely on emergency departments for primary care, even though the venue is an inefficient and expensive way of providing primary care. The group also notes the increasing role EDs are playing in attracting …