Hospitals and Physicians

Somewhere along its tortuous path to enactment, health care reform turned into health insurance reform. Although providing coverage to more than 30 million uninsured Americans and eliminating the unsavory practices of the insurance industry are major achievements, the Affordable Care Act does not do much — at least in the short term — to change the care most Americans receive or to slow the growth in health care costs. In this article, Robert Berenson presents some of the elements in the legislation that offers the potential for cutting costs, and more pointedly also presents some areas ripe for action that the legislation did not touch. In particular, he points to the growing issue of provider market power in negotiating payment rates with health insurers as one that needs immediate attention.

Political battles over malpractice reform have recurred for 35 years, starting at the state level. Many states have enacted caps on awards and other tort reforms amid liability insurance crises proclaimed in the mid-1970s, mid-1980s, and early 2000s. Since the mid-1990s, Republicans have unsuccessfully sought similar malpractice limits at the federal level. Sharp run-ups in claims rates preceded the first two crises; the last seemed more driven by increases in awards and other costs, along with insurance market developments. Defensive medicine arose separately as a national policy issue in the late 1960s. At the time, medical liability was expanding from the very low level of the 1950s because of shifts in both tort doctrines and social culture.

This brief examines rates of ED visits associated with ACSC diagnoses in the first few years of Healthy Kids (2005-06). Low rates of ED use for ACSC suggest that high use is not a major problem among program enrollees. The rate of ACSCs as a proportion of ED visits also did not decline over the study period, suggesting that while the Healthy Kids evaluation shows an impact upon perceived access to care and affiliation with a primary care provider, the expansion may not have a significant impact upon relatively rare events, such as pediatric hospital stays and ED visits.

This analysis shows that pediatric hospitalization rates are low both nationally and in Los Angeles County in comparison to adult hospitalization rates, and have gradually declined since 2000. This downward trend shows the impact of changes in the health care system that increasingly emphasizes ambulatory care and prevention over inpatient care. ACSC hospitalization rates decreased in Los Angeles, for both low- and high-income groups after the CHI was implemented (February 2003) compared to before implementation. Disparities, however, remain, and more work is needed to help close the gap in access to care for low income families in Los Angeles. Los Angeles: University of Southern California. July 2009.

It is widely known that improving access to ambulatory care helps prevent hospitalizations for ambulatory care sensitive conditions. The Children's Health Initiative of Greater Los Angeles (CHI) formed in order to improve children's access to primary care by increasing Medi-Cal and Healthy Families enrollment. Previous reports showed the CHI reduced the overall rate of preventable hospitalizations in low-income children. This study examines if the CHI similarly reduced preventable hospitalizations for low-income children in Los Angeles County by analyzing hospitalization rates in Los Angeles for lower income compared to higher income children, and calculating hospitalization rates for ambulatory care sensitive conditions.