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Variety Issue: Health Affairs' May Issue


Bethesda, MD -- The May issue of Health Affairs includes several studies that focus on aspects of the Affordable Care Act (ACA). As the ACA passes its fifth birthday, its effects are being felt throughout the health care system. Other studies in the variety issue examine unnecessary testing, health professional training, and other topics; all serve as a reminder of the many ways in which the health care system is changing.

Preventative coverage of the HPV vaccine:  more young women seek treatment.
ACA provisions implemented in 2010 require insurance plans to offer dependent coverage to 19- to 25-year-olds and to provide certain preventive services at no cost to the patient. Brandy Lipton and Sandra Decker, both of the National Center for Health Statistics, examined initiation and completion of the human papillomavirus (HPV) vaccine, which is one of the most expensive recommended vaccines, among young adult women. Using 2008-12 data from the National Health Interview Survey, the authors compared women ages 19-25 to a control group before and after the ACA provisions were implemented. They estimate that the ACA provisions increased the likelihood of young women ages 19-25 initiating and completing the vaccine by 7.7 and 5.8 percentage points, respectively. This translates into approximately 1.1 million additional women initiating and 854,000 completing this potentially life-saving preventive service. 
Hospital closures not likely to affect mortality rates.
Certain provisions of the ACA--for example, reductions in the rate of growth in hospital payments and reductions in disproportionate share and graduate medical education funding--could put increasing pressure on hospital finances and lead some to close. Policy leaders have voiced concerns that these closures could endanger the health of some patients seeking access to acute care services. In a finding that could reassure these policy makers, Karen Joynt of the Harvard T.H. Chan School of Public Health and coauthors examined data from 195 US communities in which a hospital closed between 2003 and 2011 and found no significant relationship between a hospital shutting its doors and detrimental patient outcomes for Medicare beneficiaries living in these communities. The authors speculated that the hospitals that closed over the past decade may have been of lower quality than those that did not--and might have been unable to effectively compete in the market.
Also covering an aspect of the Affordable Care Act:
Are routine screenings for pediatric psychiatric patients always necessary?
Patients, providers, and payers are all seeking to weed out unnecessary procedures and their related health care costs. Hospitals routinely conduct medical clearance examinations, including extensive blood and urine tests, on psychiatric patients with no known physical ailments, usually yielding normal results. To study this phenomenon, Joelle Donofrio at Harbor UCLA Medical Center and coauthors reviewed the electronic medical records of 1,082 pediatric psychiatric patients brought to the emergency department of Los Angeles County University of Southern California Medical Center between July 2009 and December 2010. They found that these tests were performed on 871 of these patients--with 94.3 percent of the patients with a normal medical exam having clinically insignificant test results. The median charge for these tests was $1,235 per patient. Based on these findings, the authors recommend replacing routine screening laboratory tests for this population with targeted diagnostic testing, which could result in an estimated annual savings of approximately $90 million dollars when extrapolated to the national level.
DataWatch:  Physicians' training:  public versus private.
Where a physician was educated--in a public or private institution--can affect practice choice. Michelle Washko and coauthors from the Health Resources and Services Administration used data of the US Department of Education's Integrated Postsecondary Education Data System (IPEDS) from the 2009-10 academic year to describe the contributions of public and private postsecondary institutions to the education of physicians. According to their findings, a total of 53.3 percent of physicians graduated from public medical schools in 2010, compared to 46.7 percent from private institutions. The authors also found that more new physicians had trained in public institutions everywhere in the United States except in the Northeast. As the study points out, physicians attending private-sector institutions are less likely to choose primary care or establish a practice in an underserved community. With a widening gap between supply and demand for primary care practitioners, educational pipelines are a key consideration for developing strategies to meet national health workforce needs. This study is part of Health Affairs'  DataWatch series.
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.