Paul Hughes-Cromwick

Access to Health Care and Nonemergency Medical Transportation: Two Missing Links

Although lack of access to nonemergency medical transportation (NEMT) is a barrier to health care, national transportation and health care surveys have not comprehensively addressed that link. Nationally representative studies have not investigated the magnitude of the access problem or the characteristics of the population that experiences access problems. The current study, relying primarily on national health care studies, seeks to address both of those shortcomings. Results indicate that about 3.6 million Americans do not obtain medical care because of a lack of transportation in a given year. On average, they are disproportionately female, poorer, and older; have less education; and are more likely to be members of a minority group than those who obtain care. Although such adults are spread across urban and rural areas much like the general population, children lacking transportation are more concentrated in urban areas. In addition, these 3.6 million experience multiple conditions at a much higher rate than do their peers. Many conditions that they face, however, can be managed if appropriate care is made available. For some conditions, this care is cost-effective and results in health care cost savings that outweigh added transportation costs. Thus, it is found that great opportunity exists to achieve net societal benefits and to improve the quality of life of this population by increasing its access to NEMT. Furthermore, modifications to national health care and transportation data sets are recommended to allow more direct assessment of this problem.

When the Cost Curve Bent — Pre-Recession Moderation in Health Care Spending

Is the recent moderation in the rate of growth of U.S. health care spending likely to continue? A new analysis shows that the moderation predated the recession by more than 2.5 years, so the bend in the curve cannot be attributed solely to the economy.

Quantifying national spending on wellness and prevention

PURPOSE We estimate national health expenditures on prevention using precise definitions, a transparent methodology, and a subdivision of the estimates into components to aid researchers in applying their own concepts of prevention activities. METHODOLOGY/APPROACH We supplemented the National Health Expenditure Accounts (NHEA) with additional data to identify national spending on primary and secondary prevention for each year from 1996 to 2004 across eight spending categories. FINDINGS We estimate that NHEA expenditures devoted to prevention grew from

National spending on cardiovascular disease, 1996-2008.

83.2 billion in 1996 to

Cost-effectiveness of access to nonemergency medical transportation : Comparison of transportation and health care costs and benefits

159.8 billion in 2004, in current dollars. As a share of NHEA, this represents an increase from 7.8 percent in 1996 to 8.6 percent in 2004. This share peaked at 9 percent in 2002 and then declined due to reductions in public health spending as a percent of NHEA between 2002 and 2004. Primary prevention represents about half the expenditures, consisting largely of public health expenditures--the largest prevention element. ORIGINALITY/VALUE OF PAPER: Our 2004 estimate that 8.6 percent of NHEA goes to prevention is nearly three times as large as the commonly cited figure of 3 percent, but depends on the definitions used: our estimate falls to 8.1 percent when the research component is excluded, 5.1 percent when consideration is limited to primary prevention plus screening, 4.2 percent for primary prevention alone, and 2.8 percent if we count only public health expenditures. These findings should contribute to a more informed discussion of our nations allocation of health care resources to prevention.

Consumer-Driven Healthcare: Information, Incentives, Enrollment, and Implications for National Health Expenditures

To the Editor : In spite of great strides made in recent years to improve its prevention and treatment, cardiovascular disease (CVD) remains the most costly contributor to national health expenditures ([1,2][1]). As part of an effort to improve our understanding of the appropriate allocation of

A Framework for Measuring Low-Value Care

Although a lack of access to nonemergency medical transportation (NEMT) is a barrier to health care, national transportation and health care surveys and data sets have not comprehensively addressed this link. The current study builds on earlier work that identified and described the population that lacks access to health care because of transportation barriers by examining the combined transportation and health care impacts of providing access to NEMT for those who currently lack such access. The goal of this study was to compare the costs and benefits, including the potentially large net health benefits, of providing NEMT to those who lack access to it. This analysis uses data from the Medical Expenditure Panel Survey, which is administered by the Agency for Healthcare Research and Quality; the National Transit Database; and data provided by selected NEMT providers, as well as the transportation and health care literature. By a focus on 12 prevalent and costly medical conditions experienced by those who lack access to NEMT, it was determined that the provision of NEMT to those who currently lack it results in a net cost savings across the transportation and health care domains for four of these conditions (prenatal care, asthma, heart disease, and diabetes) and is cost-effective for the remaining eight conditions (influenza vaccinations, breast cancer screening, colorectal cancer screening, dental care, chronic obstructive pulmonary disease, hypertension, depression, and end-stage renal disease). These cost-effectiveness analyses take into account increased life expectancy and improved quality of life and indicate that the provision of additional transportation is worth the investment for these eight conditions. On the basis of these findings, it was concluded that the provision of NEMT to those transportation-disadvantaged individuals who lack access to it would result in net societal benefits for all 12 conditions examined.

Cost Benefit Analysis of Providing Non-Emergency Medical Transportation

We highlight the importance of information for consumerdriven healthcare (CDHC), describe barriers, display data on adoption rates and product features, and use a new health modeling approach to investigate the potential impact on national healthcare expenditures. We conclude with an assessment of the prospects for CDHC as a revolution of information, competition, and market orientation; and we discuss potential pitfalls, including concern regarding vulnerable populations. While the jury is out on the ultimate effects, enrollment in CDHC programs—while still small—is growing rapidly; utilization and costs for subscribers appear to be moderating; and creative benefit structures emphasize health promotion alongside previously unseen cost consciousness.

What Is Currently Spent on Prevention as Compared to Treatment

BACKGROUND It has been estimated that more than 30% of health care spending in the United States is wasteful, and that low-value care, which drives up costs unnecessarily while increasing patient risk, is a significant component of wasteful spending. OBJECTIVES To address the need for an ability to measure the magnitude of low-value care nationwide, identify the clinical services that are the greatest contributors to waste, and track progress toward eliminating low-value use of these services. Such an ability could provide valuable input to the efforts of policymakers and health systems to improve efficiency. METHODS AND RESULTS We reviewed existing methods that could contribute to measuring low-value care and developed an integrated framework that combines multiple methods to comprehensively estimate and track the magnitude and principal sources of clinical waste. We also identified a process and needed research for implementing the framework. CONCLUSIONS A comprehensive methodology for measuring and tracking low-value care in the United States would provide an important contribution toward reducing waste. Implementation of the framework described in this article appears feasible, and the proposed research program will allow moving incrementally toward full implementation while providing a near-term capability for measuring low-value care that can be enhanced over time.