Abstract
The study by Sharma, Lebrun-Harris, and Ngo-Metzger (2014) sought to establish the link between quality of care, which they defined as health center penetration, and Medicare spending in low-income populations. They hypothesized that high penetration was associated with reduced Medicare spending. The study was successful in proving the hypothesis to be true. The findings of the study can be used in informing policy formulation to increase access to primary health care among the underserved populations in the United States.
Article Summary
The researchers argued that the Medicare program stands to save costs if access to primary care is enhanced among the populations that are underserved. Moreover, the authors of the study postulated that the net costs for Medicare beneficiaries would go down in regions with high numbers of health centers because access would increase, while primary care would be comprehensive. Obtaining primary care would reduce the need to use Medicare to cater for acute and post-acute conditions, leading to reduced Medical spending.
The researchers based their study on the background knowledge of the differences in health care costs, as well as quality of medical care due to variations in geographic locations of health centers in the United States. Previous studies had established that clinical quality was influenced by variations in the costs of practicing physicians in different regions, differences in payments as a result of varying policy decisions, market dynamics, as well disparities in provider training. Other variations were seen in the areas of the health status of a given population, the prevalence of specific diseases, as well as patient preferences in their use of available medical facilities.
This study considered the disparities that existed in hospital referral regions (HRR) in terms of the differences in the characteristics of the populations, the health status of the areas, and the contribution of the Medicare payments, as well as the locally available resources.
The data for conducting this study was obtained from several sources, such as the HRSA’s Uniform Data System and Centers for Medicare & Medicaid, among others. The available data was then categorized according to HRRs, which were mapped by the Dartmouth Atlas according to regional care markets in the US. A total of 307 HRRs were linked, as a result. Data on demographics, specific indicators of clinical quality, and use of health services was obtained from the HRR 2010 dataset. The beneficiaries’ spending was established by relying on the place of residence than the place where health care was received.
The main variable of interest that was used as a primary measure was the level of access to primary care for the underserved populations in every hospital referral region. The measure was defined as “health center penetration”. One of the outcomes that the authors sought to establish was the total spending for specified health care services in each hospital referral region. In terms of clinical quality, the authors set outcomes such as the number of readmissions to hospital, rate of visits to the emergency department, and the frequency of hospitalization due to preventable illnesses, among others.
The findings of the study indicated that Medicare beneficiaries across all HRR regions mainly suffered from chronic conditions like hypertension, heart failure, COPD, ischemic heart disease, and diabetes, among others. Areas that had high penetration of health centers had lower rates of the chronic diseases, compared to areas with low penetration of health centers. Moreover, HRRs that had high penetration also registered less Medicare spending (9.7% less) than the average spending per beneficiary. In terms of utilization of health services, areas with high penetration had lower utilization rates. Overall, the researchers proved that high penetration of health centers was associated with savings in Medicare spending and reduced hospitalization rates for preventable ailments.
Critical Analysis
Sharma, Lebrun-Harris, and Ngo-Metzger (2014) were successful in establishing the relationship between high penetration of health care centers and reduced costs of care. Therefore, the researchers were able to prove their hypotheses and achieved the aim of the study. The findings of the study established that increasing the number of health centers in a region could enhance access to primary care and reduce Medicare spending with up to 10% per beneficiary. Given that the authors used reliable data, the above finding can be used to formulate a policy for promoting health center penetration in regions that have lower penetration. The savings could go a long way in reducing the high cost of health care that the US is experiencing. Moreover, the costs that are saved can be used to improve health care delivery in areas that are underserved.
The researchers relied on secondary data, instead of primary data because they could answer their research questions fully without getting first-hand data. Resultantly, they were able to save the time and cost of conducting the study if they decided to do a primary research. The authors also highlighted the potential weaknesses in their research, thus cautioning users of their findings of the potential weaknesses in their results and warning against generalization. However, the many limitations that the researchers mentioned water down the credibility of the research findings, thereby making the case for using secondary data weaker. Overall, it is commendable that the researchers controlled for confounding variables that would have influenced the differences in health center penetration and Medicare spending, thereby adding weight to the credibility of the research findings.
Reference
Sharma, R., Lebrun-Harris, L. A., & Ngo-Metzger, Q. (2014). Costs and clinical quality among Medicare beneficiaries: Associations with health center penetration of low-income residents. Medicare & Medicaid Research Review, 4(3), 1-20.