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Health Affairs Looks At Economic Trends & Quality Trade-Offs


Articles in October issue examine the pursuit of improved physical and mental health


Bethesda, MD -- Health Affairs' October issue evaluates the successes, the costs, and the quality trade-offs of improving physical and mental health in the United States. As Founding Editor John Iglehart says in his October letter, "Medical advances...have extended life expectancy and reduced the prevalence of diseases that stalk modern society. Paradoxically, though, for every success, an equally difficult challenge remains." Also, with multiple shootings and related incidents fresh in our collective memories, the issue contains a discussion about the cost barriers to mental health care.


Featured articles include:


Barriers to Mental Health Care. As American society knows all too well, many people with mental illness fail to seek treatment. Kathleen Rowan and coauthors of the University of Minnesota analyzed data from the Integrated Health Interview Series of working-age adults who were interviewed between 1999 and 2010. They found a significant increase in the percentage of the population classified as having moderate mental health problems, from 3.7 percent in 1999 to 5.1 percent by 2010. There was also a significant increase in the proportion of this group who had public health coverage (from 25.9 percent to 34.8 percent) and a decline in those with private coverage (from 50.2 percent to 39.8 percent.) The authors point out that public insurance typically provides coverage with limited to no out-of-pocket costs and fewer treatment limits than private coverage. Although the authors see the Affordable Care Act as an important opportunity to expand health insurance coverage to people with mental health disorders, they caution that those now eligible to purchase private insurance might still encounter financial hurdles to accessing care.


The Health and Economic Benefits of "Delayed Aging." Although most medical research focuses on managing or eradicating individual diseases, Dana Goldman of the University of Southern California and coauthors demonstrate the value of an alternative approach to address the underlying biological mechanisms of disease. Using the Future Elderly Model--a simulation of future health and spending of older Americans--the authors compared such an approach with optimistic "disease specific" scenarios, evaluating impact on longevity, disability, and major entitlement program costs. The authors estimate that delayed aging could increase life expectancy by an additional 2.2 years and generate more than $5 trillion in social value. When aging is delayed, say the authors, all fatal and disabling disease risks are also lowered. Although delayed aging would also greatly increase entitlement outlays, the authors demonstrate that these costs can be managed through modest policy changes, such as indexing the eligibility ages for Social Security and Medicare.


  • On a related topic, an article by Ankur Pandya of Weill Cornell Medical College and coauthors looked at the impact of some of the future risk factors for cardiovascular disease. Using nine National Health and Nutrition Examination Survey waves from 1973 to 2010, the authors forecast disease risk and prevalence from 2015 to 2030. They found that despite continued improvements in the disease's treatment and declining smoking rates, increasing obesity rates, the aging population, and declining mortality from the disease should cause a rise in health care costs, disability, and reductions in the quality of life associated with increased disease prevalence. "Prevention efforts should be intensified," the authors urge, to curb the imminent spike in cardiovascular disease forecasted by their model.

How Does the Quality of Hospital Care Vary by Insurance Type? Although a considerable body of health policy research has documented differences in hospital characteristics as contributing factors to differences in the quality of care, this article examined the extent to which a patient's type--or lack--of insurance may also play a role. Christine Spencer of the University of Baltimore and coauthors from Johns Hopkins University compared hospital quality for patients according to their insurance status using pooled 2006-08 State Inpatient Database records from the Agency for Healthcare Research and Quality (AHRQ). They measured within-hospital quality based on AHRQ's innovative Inpatient Quality Indicators. Mortality due to heart attacks, pneumonia, and hip replacement were among the indicators examined. Among the authors' findings: Within hospitals, patients with private insurance had lower risk-adjusted mortality rates than Medicare patients for 12 out of the 15 indicators examined. The authors recommend that policy makers pay particular attention to how well patients fare under various insurance plans, because the type of insurance does appear to make a difference in the care that hospitals provide.


Three other papers of interest in the October issue:


Please join Health Affairs Founding Editor John Iglehart on Tuesday, October 8, at the National Press Club in Washington, DC, for a Health Affairs briefing about the October 2013 thematic issue, "Economic Trends and Quality Trade-Offs." Panels will spotlight two noteworthy studies from the issue. Here are agenda details and how to register.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.