Health Affairs

From Health Affairs

New Studies on Forecasting Life Expectancy And New Cardiac Surgery Programs

Bethesda, MD -- Health Affairs is releasing two studies online today as Web Firsts, both on timely topics. For those who assume that the next generation of Americans will live longer than their parents, a new “three-dimensional” method of forecasting vital health statistics shows how this may not prove to be the case. The second study evaluates new cardiac centers that opened in the last decade, a time when demand decreased—and find that “their creation has led to a fight for shares of a shrinking market.” The studies will also appear in the August edition of Health Affairs.

New Forecasting Methodology Indicates More Disease And Earlier Mortality Ahead For Today’s American Children
By Eric N. Reither, S. Jay Olshansky, and Yang Yang
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2011.0092
Reither is affiliated with Utah State University in Logan; Olshansky with the University of Illinois in Chicago; and Yang with the University of North Carolina in Chapel Hill.

 

Most Americans enjoy better health today than in the past, with significant declines in death rates from the top three causes of death: heart disease, cancer, and stroke. However, as the authors point out, death rates provide “only a limited, ‘two-dimensional’ vision of the future by failing to take into account the potentially different risk factors accumulated by people who are still alive.” The authors studied patterns in heart disease mortality published by the National Center for Health Statistics to illustrate how traditional projection methods fail to account for the impact of the US obesity epidemic on the longevity of younger Americans. Whereas traditional, two-dimensional methods predicted continued declines in mortality from coronary heart disease for men under the age of 50, the authors found that mortality rates actually slowed among men ages 45-49 and reversed among men ages 25-29 after 2000. Importantly, these adverse health consequences of obesity were accurately predicted by a new, ‘three-dimensional’ model that accounts for poorer health among recent generations of Americans. “Because this three-dimensional perspective anticipates substantial increases in morbidity and related health care expenditures, it suggests that the appropriate public policy response is to redouble efforts to develop and implement effective obesity prevention programs and other targeted interventions,” say the authors. “We suggest that traditionally reported national vital statistics be supplemented with three-dimensional models that, by focusing on living rather than extinguishing cohorts, more reliably predict the future of health and longevity.”

New Cardiac Surgery Programs Established From 1993 To 2004 Led To Little Increased Access, Substantial Duplication Of Services
By Frances Leslie Lucas, Andrea Siewers, David C. Goodman, Dongmei Wang, and David E. Wennberg
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0210
Lucas and Siewers are affiliated with the Center for Outcomes Research and Evaluation at the Maine Medical Center in Portland; Goodman is with the Dartmouth Medical School in Lebanon, NH: Wang is with the Dartmouth Institute in Lebanon; and Wennberg is president of Health Dialog Analytic Solutions, Inc. in Portland, ME. Some funding for this manuscript was provided by the National Heart, Lung, and Blood Institute.

 

While the number of coronary artery bypass surgeries performed in the United States has been decreasing since the late 1990s, more than 300 new cardiac surgery programs were recently launched. In the past, many states required certificates of need before a program was established. However, once this federal mandate was repealed, many states did away with their similar laws. With cardiac services contributing 25 to 40 percent of a hospital’s net revenues, do the new programs improve access or exacerbate the duplication of services?

To answer those questions, the authors examined Medicare claims data for the new cardiac surgery programs to identify where new cardiac surgery programs were created between 1993 and 2004 and to assess their impact on geographic access. The authors found that the 276 programs opened in general hospitals and 25 opened in specialty hospitals. The majority of the programs opened in the East and Midwest with a very high concentration in the mid-Atlantic region. For those states that repealed their certificate-of-need laws during this time, 78 percent of the programs were opened after the law’s demise. The median travel time for Medicare beneficiaries declined from seventeen minutes in 1993 to fourteen minutes in 2004. For residents of rural areas, the travel time decreased by about ten minutes. Overall, travel time to the nearest cardiac surgery program changed little and the creation of new programs led to a fight for shares of a shrinking market. “Despite potential benefits for some patients, particularly those living in rural areas, we found substantial evidence of duplication of services in highly competitive markets, as well as the proliferation of specialty cardiac hospitals, without improvements in geographic access for the vast majority of patients,” state the authors. “Flawed though it may be, the certificate-of-need process is one way for society to avoid spending money to needlessly duplicate a service that already exists, in some cases within the same ZIP code. If the nation is serious about restraining the rate of growth of health spending, such programs may need to be reinvigorated or reinstated in states that have dismantled them.”

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at www.healthaffairs.org. You can also find the journal on Facebook and Twitter and download Narrative Matters on iTunes. Address inquiries to Sue Ducat at (301) 841-9962 or sducat@projecthope.org