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Discusses research papers on public reporting of health quality information in the United States. Nationwide survey of how hospitals disclose their medical errors to the public; Reporting standards by the U.S. Joint Commission Accreditation of Healthcare Organizations; Wisconsin-based study of the impact of public versus private reporting of hospital quality performance data.

The events of 11 September 2001 continue to drive the U.S. national agenda, pushing aside issues that were formerly front and center. In this set of Web exclusives, a paper by public opinion expert Robert Blendon and colleagues from the Harvard School of Public Health demonstrate that turmoil overseas, fears of terrorism at home, and pocketbook issues have thrust health care aside. Blendon's most recent survey, conducted in June 2002, shows that health care has dropped out of the top-five ranking when Americans are asked to name the two most important issues for the government to address. Americans are showing greater dissatisfaction with the availability and affordability of health care, and it has grown since last year, when people were more frightened by anthrax and terrorist attacks. Blendon and colleagues conclude that while health care may be a lower priority than it was a year ago and may play less of a role in the 2002 congressional elections than it did in 2000, rising public dissatisfaction with the health care system means that it could reemerge as an issue. [ABSTRACT FROM AUTHOR]

While Congress struggles to resolve the long-standing omission of prescription drugs from Medicare coverage, Medicare+Choice (M+C) plans have stood out as one place seniors can go to get such coverage. The withdrawal of M+C plans from many markets now means that lawmakers no longer view them as the silver bullet for saving taxpayers' money and providing increased benefits. However, this paper by Kenneth E. Thorpe and Adam Atherly shows that M+C plans have become a refuge for lower-income seniors: More than one-third of M+C enrollees have incomes between $10,000 and $20,000 a year. What those seniors get from the program is added benefits similar to those provided to seniors who purchase Medigap coverage or receive retiree coverage from an employer. The authors found that M+C plans provided $6 billion in added benefits to enrolles in 2001 when compared with Medicare-only fee-for-service (FFS) coverage. After subtracting premiums, those added benefits amount to about $750 per enrollee, of which $471 was prescription drug coverage. The authors also quantify the added benefits in the top ten M+C markets in 2001: from $1,735 in Orange County, California, to $394 in Pittsburgh. But even as the authors demonstrate the value of M+C as a safety-net program, they also paint a dire picture of federal efforts to reverse health plans' desertion. The authors analyze three plans for increasing M+C payments to lure plans back into the program, as drafted by President George W. Bush, Rep. Nancy Johnson (R-CT), and the Medicare Payment Advisory Commission (MedPAC). Under the best scenario, President Bush's proposal, M+C enrollment would stabilize at about five million. [ABSTRACT FROM AUTHOR]

President George W. Bush and some congressional leaders wish to expand insurance coverage by offering tax credits to people who buy individual policies, as a way to offset the decline in employer-based coverage. But an analysis of individual-market insurance policies by Jon Gabel and colleagues shows that cost sharing in such plans far exceeds cost sharing in employer group plans. The analysis found higher deductibles, higher out-of-pocket maximum limits, and lower rates of prescription drug and mental health coverage in the individual plans than in the group plans. On average, individual insurance covers 63 percent of the health care bill. Group insurance covers 75 percent. The good news for individual policies is that a hypothetical twenty-seven-year-old man with no medical conditions can expect on average to pay one-third less for an individual policy than for a group policy. The bad news is that a healthy fifty-five-year-old man on average pays about 60 percent more in the individual market than in the group market. The analysis also found that for people with incomes at 200 percent of poverty who fall within the top 25 percent of health care users, cost sharing in individually purchased plans would amount to 11 percent of income, as opposed to just 6 percent for the same people in group plans. The study questions whether the $1,000 tax credit being proposed by President Bush would be sufficient to help all but the youngest and healthiest to purchase individual policies. Gabel is vice-president of health system studies at the Health Research and Educational Trust; his coauthors are researchers and statisticians there. Two Perspectives accompany Gabel's paper: one by Donald Young and Thomas Wildsmith of the Health Insurance Association of America, and one by Tom Hefty of Cobalt Corporation, Milwaukee, Wisconsin. [ABSTRACT FROM AUTHOR]

Discusses the paper entitled `Choice Matters,' by Karen Davis, et al. which focused on socioeconomic groups' choices and satisfaction regarding managed care plans.