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The Benefits and Limitations of Information: Health Affairs' March Issue

Bethesda, MD--The March issue of Health Affairs contains papers focusing on the benefits--and the limitations--of information-gathering processes, as a way to solve health system problems. Studies in this variety issue examine US hospital rating systems, disclaimers on dietary supplements, state prescription drug monitoring programs, the value of US versus Western European cancer care and other topics.
National Hospital Rating Systems Show Little Agreement--What's A Consumer To Do? 
Matt Austin of Johns Hopkins Medicine and coauthors compared four well-known national hospital rating systems designed for use by US consumers: U.S. News & World Report's Best Hospitals; HealthGrades' America's 100 Best Hospitals; Leapfrog's Hospital Safety Score; and Consumer Reports' Health Safety Score. They analyzed ratings covering the time period from July 2012 to July 2013. With each system
using its own rating methods, having a different focus to its ratings, and stressing different measures of performance, the authors found that only 10 percent of the 844 hospitals rated as a high performer by one system were equally rated by any of the other rating systems. The complexity and opacity of the different rating systems, concluded the authors, "are likely to cause confusion instead of driving patients and purchasers to higher-quality, safer care." They recommend that organizations sponsoring ratings help patients interpret their data through the media and other information channels.
Mandatory Disclaimers On Dietary Supplements Do Not Change Consumer Behavior. 
The Food and Drug Administration (FDA) does not allow pharmaceutical manufacturers to promote their drugs for indications that the FDA has not approved, but a 2012 federal court case (US v. Caronia) held that this so-called "off-label marketing" could in fact be protected by the First Amendment. The court suggested that the FDA should instead just require that manufacturers add disclaimers to promotional messages that discuss off-label uses. But do disclaimers have any real impact on consumer perceptions about health-related promotional claims? The most common disclaimers in the marketplace currently are found on dietary supplements, warning consumers that the FDA has not approved these products. Aaron S. Kesselheim of Harvard Medical School and Brigham and Women's Hospital and coauthors conducted a systematic review of studies examining consumers' response to disclaimers on dietary supplements. Nearly all studies found "consumers were generally unaware of the disclaimer or attached no weight to it in their perceptions of the product." Thus, Kesselheim and coauthors concluded, "replacing FDA restrictions...with largely ineffective disclaimers risks returning the pharmaceutical market to a previous era in which such inappropriate marketing claims proliferated, to the likely detriment of the public health."
DataWatch: US Union Workers' Health Plans Are More "Family-Friendly." 
Approximately 11 percent of US wage and salary employees are union workers, accounting for health coverage for some 18-20 million Americans. In the only recent survey about collectively bargained health plans, conducted in the fall of 2013, Jon R. Gabel and coauthors from NORC at the University of Chicago surveyed the costs, covered benefits, and cost sharing of 175 collectively bargained health plans, and compared this data to employer-sponsored insurance as found in the 2013 Kaiser/HRET Employer Health Benefits Survey. The authors found that collectively bargained plans were more "family friendly." Annual contributions by workers for union family coverage averaged $828--a fraction of the $4,565 paid annually by workers with employer-sponsored family coverage. Collectively bargained plans have substantially lower deductibles, with an average in-network deductible of $202, one-fifth of employer-sponsored plans ($1,113). With the arrival in 2018 of the 40 percent "Cadillac tax" on high-cost premiums, note the authors, some of these generous plans will likely become scarcer. This study is part of Health Affairs' DataWatch series.

Another study examining different kinds of health plan benefits:


From England, Lessons Learned By The National Health Service In Paying For Value. 
In England, as is the case in the United States, containing health spending is a major focus of current health policy. A flattening budget coupled with growing service demand drove the country's National Health Service (NHS) to seek spending cumulative efficiency savings of 17 percent over four years beginning in 2011.  However, scaling back ineffective, overused, or inappropriate procedures, was largely left to the local commissioning organizations to identify and implement. Sophie Coronini-Cronberg of Imperial College London and coauthors identified six high-volume but low-value procedures and two benchmark procedures in England and compared their rates between 2002 and 2011 with the changes seen in the first year of efficiency savings, beginning in fiscal year 2011. Their study is believed to be the first to investigate whether reductions in low-value procedures coincided with a national mandate to improve efficiency. The authors found significant reductions in three of the six procedures in the program's first year and no change in benchmark procedures, compared to prior years' trends. They also noted that changes in the rates of all examined procedures varied widely across commissioning organizations. The authors' analysis suggests that "even modest reductions in such low-value procedures could represent significant savings" in the United States.
Also in the March issue, a curtain-raiser for the oral arguments in King v. Burwell:   
  • Entry Point: The Affordable Care Act Returns To The US Supreme Court by Timothy S. Jost
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.