Clip files / Local news from the states

This column features selected short items about state health care policy.

State’s senior drug program offered as national model

WASHINGTON, DC—Nevada’s Senior RX program, which helps low-income elderly buy prescription drugs, has been offered as a model as Congress studies ways to provide pharmacy benefits to seniors nationwide. One of Gov. Kenny Guinn’s deputies told a House health subcommittee the benefit program took off in popularity once it was simplified and eliminated the need for beneficiaries to contribute to monthly premiums. The program offers a maximum prescription benefit of $5,000 a year for seniors with an annual income of $21,500 or less. There are no premiums, but there is a copay of $10 for generic drugs and $25 for other medications. "Gov. Guinn believes that Senior RX can be a model for other states and, potentially, for a national prescription plan for seniors," said deputy chief of staff Michael Hillerby.

Mr. Hillerby told lawmakers that Senior RX "is now running at full capacity," with 7,500 seniors enrolled. He estimated that may amount to between 30% to 50% of low-income seniors in Nevada who do not otherwise have prescription drug insurance. He was among seven experts to speak to the subcommittee debating prescription drug benefits for low-income seniors.

Las Vegas Review-Journal, April 18

Health indicators are improving for most racial and ethnic groups, says HHS report

There has been significant improvement in the health of racial and ethnic minorities but there still are important disparities among different populations, a recent U.S. Department of Health and Human Services report says.

The report contains national trends in racial- and ethnic-specific rates for 17 health status indicators during the 1990s. The five racial and ethnic groups reported on showed improvements in rates for 10 of the 17 indicators.

"Our goal is to eliminate disparities in health among all population groups by 2010," says Secretary of Health and Human Services (HHS) Tommy Thompson. "While we are making progress, the report shows how far we still have to go."

The report was part of Healthy People 2000, an HHS program to set health goals for each decade and then measure their progress. The health status indicators reported on reflect various aspects of health and include infant mortality; teen births; prenatal care; low birth weight; death rates for all causes and for heart disease, stroke, lung and breast cancer, suicide, homicide, and motor vehicle crashes; and work-related injuries. Infectious diseases such as tuberculosis and syphilis also are included. The percent of children in poverty and the percent of the population living in communities with poor air quality round out the set of measures developed to allow comparisons among national, state, and local areas on a broad set of health indicators.

All racial and ethnic groups experienced improvement in rates for 10 of the indicators: prenatal care; infant mortality; teen births; death rates for heart disease, homicide, motor vehicle crashes, and work-related injuries; the tuberculosis case rate; syphilis case rate; and poor air quality.

For five other indicators — total death rate and death rates for stroke, lung cancer, breast cancer, and suicide — there was improvement in rates for all groups except American Indians or Alaska natives. The percent of children living in poverty improved for all groups except Asians or Pacific Islanders, and the percent of low birth weight infants improved only for black non-Hispanics.

"A clear lesson for public health is that efforts to achieve progress for all must be targeted and tailored to the needs of specific groups," says Centers for Disease Control and Prevention director Jeffrey P. Koplan, whose agency prepared the report. "For example, the drop in the syphilis rate followed an intense campaign to eliminate syphilis community by community."

Meanwhile, a health quality survey by the Commonwealth Fund in New York City finds that on a wide range of health care quality measures, minority Americans do not fare as well as whites. African-Americans, Asian Americans, and Hispanics are more likely than whites to experience difficulty communicating with their physician, to feel that they are treated with disrespect when receiving health care services, and to experience barriers to care, including lack of insurance or a regular doctor. And a substantial proportion of minorities feel they would receive better care if they were of a different race or ethnicity.

Hispanics and Asian Americans frequently stand out as the least well served by our health care system, according to the Commonwealth Fund. On the other hand, the survey indicated that progress has been made in health care for African-Americans. Receipt of preventive care reported by African-Americans was similar to or higher than that reported by whites. Levels of patient satisfaction also were comparable.

The survey demonstrated that broad racial and ethnic categories could sometimes mask significant variation in health care experiences, particularly within the Hispanic and Asian American populations. The Commonwealth Fund says that a complex set of factors such as fewer years in the United States, limited proficiency with English, low incomes, and lack of health insurance, appear to be influencing the health care experiences of those having problems.

"Many findings, however, were disturbing for all Americans, regardless of race or ethnicity," the report says. "More than one of five adults surveyed thought they or a family member had experienced a medical error on the part of a doctor, hospital, or pharmacy. One of four Americans had not followed a doctor’s advice at some point in the past two years, while barely more than half understood information they were given by their doctor’s office. Also, rates of cancer screening remain below recommended levels.

"The survey results underscore the importance of three factors in ensuring that minority populations receive optimal medical care: effective patient-physician communication, overcoming cultural and linguistic barriers, and access to affordable health insurance. Findings also highlight the need for alternatives to hospital emergency rooms as sources of primary care in low-income communities; improvement in continuity of care; and greater opportunity for health centers, hospitals, and other minority health care providers to participate in the latest quality improvement innovations. Finally, the survey identified many areas where continued improvements in quality and access to care — reducing medical errors, improving information for patients, emphasizing continuity of care — will benefit all Americans."

The Fund says that public policy can play an important role in improving minority Americans’ interactions with the health care system. HHS, it notes, has provided guidance on how to ensure linguistically and culturally appropriate health care services. In addition, a few states are implementing policies to help finance interpreter services.

Beyond language, the report says, clinicians need training in communicating and interacting effectively with patients from different cultures. "Public policy should support and evaluate training efforts undertaken by medical schools and residency programs, as well as other health professions’ training, to determine the most effective strategies for improving patient outcomes," the report says.

The Fund says additional attention also needs to be paid to preventive care. In particular, it says, Hispanic and Asian American populations would benefit from expanded health screening and education programs targeted to immigrant communities. Lack of health insurance is a key barrier for these adults.

Although African-Americans are receiving preventive services at rates at least comparable to whites, their health outcomes remain worse. The Fund says that accounting for this disparity will require close examination of other points of health care delivery where problems may be occurring, such as in access to specialized care or patients’ ability to carry out instructions at home.

"Perhaps most fundamental to ensuring quality medical care for minority Americans is the availability of affordable, comprehensive health insurance," according to the Fund report. "Policy-makers must continue to develop options for expanding health coverage and assess them for their potential to reduce uninsured rates for minority groups. Information from the survey regarding health care experiences, social and economic circumstances, problems with care, and sources of care could help guide insurance coverage policies that are sensitive to the diverse needs of minority populations."