Medical malpractice - april 2011 update.

Although the malpractice crisis--the inability of health care providers to obtain affordable liability insurance--has abated in many states, medical liability costs and pressures remain a concern. In addition, the perceived threat of litigation spurs "defensive medicine"--the practice of ordering services primarily to reduce the physician's liability exposure rather than because they are medically necessary. There is wide consensus that liability pressure undermines efforts to curb overuse of health services, although there is disagreement about the magnitude of its effect. This Update reviews the evidence on the effects of medical malpractice reforms published since the Medical Malpractice: Impact of the Crisis and Effects of State Tort Reforms synthesis was released in 2006. Key findings include: Except for caps on noneconomic damages, there is little evidence that other traditional tort reforms affect medical liability costs or defensive medicine. Average awards are reduced by 20 percent to 30 percent, and premiums in states with caps on noneconomic damages rise 6 percent to 13 percent more slowly than premiums in states without caps. There is evidence that tort reforms-particularly caps on noneconomic damages-reduce health spending, but the size of the reduction is subject to debate. Because of the lack of success of many traditional tort reforms, a number of innovated tort reforms are receiving increased attention. Although they show promise in theory, they have not been widely evaluated so the evidence of their effectiveness is weak.

Tax subsidies for private health insurance - july 2009 update.

Tax subsides for employer-sponsored health insurance are the largest subsidy for private health insurance and support key mechanisms of the U.S. insurance system, but they overwhelmingly benefit high-wage employees. When employers purchase or provide insurance for their employees, their contributions to the premium are excluded from income and payroll taxes. This tax exclusion provided more than $100 billion in income and payroll tax subsidies in 2002. High-income workers benefit more from these subsidies than those with lower incomes because of their higher marginal tax rate. Applying the tax exclusion in their respective tax brackets means high-income families (those earning more than $200,000) receive a subsidy worth one-third of the premium, while the lowest income families receive a subsidy worth just 10 percent. Despite these issues, ESI is a successful mechanism in many ways, covering a significant majority of Americans and providing a good pooling mechanism.

Research glut and information famine: making research evidence more useful for policymakers.

The gap between the two worlds of researchers and policymakers renders the use of research in the policy-making process problematic. Policymakers have three primary needs in their use of research evidence: clear translation, accessible and easy-to-use information, and relevance to the policy context. These needs are sometimes at odds with the priorities of the research community. This paper describes the Robert Wood Johnson Foundation's Synthesis Project, which aims to strengthen links between research and policy making by synthesizing evidence on pressing health policy questions.

Racial and ethnic disparities in access to and quality of health care.

Racial and ethnic disparities in access to care and quality of care are pervasive but not universal. This Synthesis reviews the evidence on racial and ethnic disparities. Key findings include: disparities exist in many indicators of access, such as having a usual source of care, number of ambulatory visits, and receiving recommended preventive care, but some disparities are reduced or nearly eliminated after adjusting for factors such as income and insurance coverage. Hispanics have a large gap relative to Whites in many access factors. Spanish-speaking Hispanics have the greatest disparities relative to non-Hispanic whites, suggesting language is a barrier. Both Blacks and Hispanics are less likely than Whites to identify a doctor's office as their usual source of care, which can point to problems with continuity of care and less favorable outcomes. The most significant disparities in quality of care involve newer therapies and invasive procedures. Adjusting the data for insurance coverage demonstrates that expanding coverage will reduce but not eliminate disparities.

Tax subsidies for private health insurance.

The exclusion from income and payroll taxes for employer-paid health insurance premiums amounted to more than $240 billion in 2010. As policy-makers search for ways to pay for health care reform and contain health care costs, this exclusion is coming under scrutiny, despite the fact that employee-sponsored insurance (ESI) is an integral part of the health insurance system. This update of a 2003 synthesis looks at the tax subsidy for private health insurance. Key findings include: The current tax subsidy benefits higher-income workers the most. The tax exclusion is worth more to those in higher tax brackets, higher-income workers are three times more likely to work for firms who offer ESI than lower-income workers, and they are more likely to purchase ESI when offered because they can afford it. Families earning $10,000 to $20,000 annually spend more than 25 percent of their income on health insurance but the value of their tax subsidy is only $1,500. By contrast, earners over $200,000 spend less than 5 percent on health insurance but their benefit is worth $4,500. Workers who cannot afford ESI or are ineligible, including the self-employed and many part-time workers, do not receive this subsidy when they purchase private, non-group coverage.