News & Trends

IOM call for universal health care coverage; AAOHN study on violence in the workplace; Hewitt and Kaiser study on shrinking retiree benefits




Universal health coverage by 2010. That’s the message the Institute of Medicine is trying to hit home in its new report Insuring America's Health: Principles and Recommendations. With more than 43 million uninsured Americans putting pressure on an already stressed health care system, a select panel of IOM members challenged the president and Congress to achieve universal health coverage in the U.S. by 2010.

Rather than provide a specific blueprint for a revised health care system, the panel offered the following five general principals for policy makers to consider:

  • Health care coverage should be universal.

  • Health care coverage should be continuous.

  • Health care coverage should be affordable to individuals and families.

  • The health insurance strategy should be affordable and sustainable to society.

  • Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable.

The report also detailed the consequences of a lack of health insurance. Among the findings: uninsured Americans receive about half the medical care of those with health insurance — thus they get sicker and die sooner; roughly 18,000 unnecessary deaths occur annually due to lack of insurance; tax dollars paid for an estimated 85 percent of the nearly $35 billion in unreimbursed medical care for the uninsured in 2001; and the U.S. loses the equivalent of $65 billion to $130 billion each year as a result of the poor health and early deaths of uninsured adults.

RNs had a turnover rate of 15.5 percent last year, according to a Bernard Hodes Group survey conducted from April to October 2003. The average vacancy rate for registered nurses was 13.9 percent. Other vacancies included 15.7 percent for occupational therapists, 14.6 percent for physical therapists and 14.2 percent for respiratory therapists.


Malpractice costs account for less than two percent of health care spending, says a recent report from the Congressional Budget Office. Evidence indicates that malpractice insurance premiums are indeed lower when tort liability is restricted than they would have been otherwise, but even a large savings in premiums has only a small direct impact on health care spending.


Nearly 43 percent of caregivers providing care for an end-stage Alzheimer patient with dementia suffer from significant depression during the patient’s final few months, says a new study published in the New England Journal of Medicine. This percentage is higher than depression rates among family caregivers of patients with other terminal illnesses, including cancer. Why the higher rate? Patients with Alzheimer’s live an average eight years after initial diagnosis, and the extent and type of care required are extremely demanding.



Almost 20 percent of the workforce has experienced workplace violence first-hand, reveals a recent study by the American Association of Occupational Health Nurses (AAOHN). What’s more, a majority of those surveyed didn’t even recognize a number of key "red flags." Fewer than 4 percent were able to identify some of the most common warning signs normally witnessed in potential offenders, such as mood changes, personal hardships, mental health issues, negative behavior, verbal threats and a past history of violence.

As a result of the survey, the AAOHN offers a number of guidelines to help employers develop workplace prevention and education programs, including the following:

  • Management should conduct a thorough risk assessment and develop workplace violence prevention policies and programs that address potential risks in environmental design (security cameras, key card access), administrative controls and behavioral strategies.
  • Programs should clearly define the spectrum of workplace violence (ranging from harassment to homicide), and delineate employee responsibilities for recognizing and reporting signs.
  • Ask for and integrate employee ideas when developing and implementing a violence prevention program.
  • Create a confidential and seamless reporting system. Encourage workers to report any and all concerns to a single representative.
  • Incorporate a variety of communications tools such as posters, newsletters, staff meetings and new employee materials.

Five organizations have been certified through the Primary Stroke Care Certification program the Joint Commission on Accreditation of Healthcare Organizations launched last November. Created to recognize hospital stroke care programs that meet national quality standards which raise the level of care provided to patients suffering from stroke, an additional 11 organizations are currently seeking certification.


HMOs witnessed a 60 percent increase in profits for the first quarter of 2003, according to a new study by Weiss Ratings. The $2.3 billion profit for the first three months of 2003 was an $854 million increase over the $1.4 billion earned in the first quarter of 2002. Furthermore, over 80 percent of HMOs earned a profit in 2003, compared to nearly 62 percent just two years prior.


Reducing medical errors and improving efficiency with modern information technology is the way to solve rising health care costs — not simple cost-shifting — Commonwealth Fund President Karen Davis recently told a U.S. Senate Committee in an invited testimony. Strategies such as consumer-directed health care will not only fail to stop rising costs, but they may even have adverse affects for patients by contributing to excessive financial burdens, particularly on poorer and sicker patients, she said.



The aging workforce may soon be faced with only two options: retire early or don’t get sick. Last year, 10 percent of large employers cut health benefits for future retirees, and one in five said they’re likely to eliminate retiree coverage within the next three years, says a new study from Hewitt Associates and the Kaiser Family Foundation.

Hit hard with double-digit cost increases for retiree benefits, employers have enacted on a number of changes in the past year including: almost three-quarters (71 percent) of large-private sector firms increased retiree contributions to premiums, 57 percent increased drug copayments, 32 percent imposed a three-tiered drug copay, 34 percent increased deductibles, 29 percent increased out-of-pocket limitations and 53 percent increased general cost-sharing requirements.

Looking to the future, the survey also revealed that 86 percent plan to increase retiree contributions within the next three years. On average, retiree health care costs account for almost one quarter of all health care costs for large employers.

Seventy-seven percent of employees enrolled online for their benefits in 2003, according to new research from Hewitt. That represents a seven percent increase from 2002 and more than a 25 percent increase from 2000. The study also discovered that just four percent enrolled through interactive voice response, and 19 percent through call centers, compared to 2002’s eight percent and 23 percent respectively.


Clinicians should screen all adults for obesity, the U.S. Preventive Services Task Force recommends. Clinicians should also offer obese patients intensive counseling, as well as behavioral interventions to lose weight. Meanwhile, only 23 percent of employers cover gastric bypass surgery in their primary medical plan, according to a recent Mercer Human Resource Consulting survey. The procedure averages $15,000 to $25,000 per patient, with follow-up treatments and complications pushing the total costs to over $100,000.


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Feb. 13, 2004;22.