Naseem S. Miller

WASHINGTON – Roughly 8.7% of Americans aged 12 years or older used illicit drugs in 2009, an increase of 0.7% from 2008, according to a national survey. The rise was largely driven by an increase in marijuana use.

Rates of illicit drug use among youth aged 12-17 years also increased by 0.7%, from 9.3% in 2008 to 10% in 2009.

The data is part of the 2009 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration.

Photo credit: © Ron Hilton/iStockphoto.com

The increase in drug use is driven by several factors, SAMHSA officials said, including economic stress and unemployment, but also by the increased discussion about medical marijuana.

“This survey is really important,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy during a press briefing to release the data. “This is a big wake-up call. We need to be doing more.”

Dr. H. Westley Clark, director of the SAMHSA Center for Substance Abuse Treatment, said that physicians can pay closer attention to signs of illicit drug use in their patients, and get familiar with federal substance abuse resources for health professionals such as the National Institute of Drug Abuse’s NIDAMed.

Approximately 67,500 U.S. residents were interviewed for this year’s installment of the National Survey on Drug Use and Health. They were queried on use of illicit drugs including marijuana/hashish, cocaine/crack, heroin, hallucinogens, and inhalants, as well as nonmedical use of prescription-type psychotherapeutic medications.

According to the survey estimates, marijuana was the most-commonly used drug – with approximately 16.7 million current-month users – followed by psychotherapeutics (7 million), cocaine (1.6 million), hallucinogens (1.3 million), inhalants (0.6 million), and heroin (0.2 million).

The rate of nonmedical use of prescription-type drugs among users aged 18-25 years increased steadily from 2002 to 2009, according to the survey, rising from 5.5% in 2002 to 6.3% in 2009. The increase was primarily driven by misuse of pain relievers. Overall, for U.S. residents 12 years or older, pain relievers had the highest rate of nonmedical use (2.1%), followed by tranquilizers (0.8%), stimulants (0.5%), and sedatives (0.1%).

Of those who misused prescription-type pain relievers, 55% of people 12 years or older got prescription-type pain relievers from a friend or relative for free. More than 17% got their pain relievers from one doctor, 5% got them from a dealer or stranger, and 0.4% bought them on the Internet.

The rate of illicit drug use also rose among U.S. residents aged 50-59 years, from 2.7% in 2002 to 6.2% in 2009 during the month prior to the survey. The trend, according to the survey, reflects the growing aging population.

The rate of misuse decreased for just two drugs – cocaine and methamphetamine – according to the survey. Misuse of cocaine decreased from 2.0% in 2008 to 1.4% in 2009 and the rate for methamphetamine decreased from 0.6% to 0.2% over the same period. Officials attributed the drops to more public awareness about the drugs.

The rates of alcohol and tobacco use remained relatively stable between 2008 and 2009, according to the survey.

Federal officials called for more community collaboration, from faith groups to health care providers, to increase awareness about the dangers of illicit drug use. They also stressed the importance of prevention, intervention, and treatment.

WASHINGTON – Roughly 8.7% of Americans aged 12 years or older used illicit drugs in 2009, an increase of 0.7% from 2008, according to a national survey. The rise was largely driven by an increase in marijuana use.

Rates of illicit drug use among youth aged 12-17 years also increased by 0.7%, from 9.3% in 2008 to 10% in 2009.

The data is part of the 2009 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration.

Photo credit: © Ron Hilton/iStockphoto.com

The increase in drug use is driven by several factors, SAMHSA officials said, including economic stress and unemployment, but also by the increased discussion about medical marijuana.

“This survey is really important,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy during a press briefing to release the data. “This is a big wake-up call. We need to be doing more.”

Dr. H. Westley Clark, director of the SAMHSA Center for Substance Abuse Treatment, said that physicians can pay closer attention to signs of illicit drug use in their patients, and get familiar with federal substance abuse resources for health professionals such as the National Institute of Drug Abuse’s NIDAMed.

Approximately 67,500 U.S. residents were interviewed for this year’s installment of the National Survey on Drug Use and Health. They were queried on use of illicit drugs including marijuana/hashish, cocaine/crack, heroin, hallucinogens, and inhalants, as well as nonmedical use of prescription-type psychotherapeutic medications.

According to the survey estimates, marijuana was the most-commonly used drug – with approximately 16.7 million current-month users – followed by psychotherapeutics (7 million), cocaine (1.6 million), hallucinogens (1.3 million), inhalants (0.6 million), and heroin (0.2 million).

The rate of nonmedical use of prescription-type drugs among users aged 18-25 years increased steadily from 2002 to 2009, according to the survey, rising from 5.5% in 2002 to 6.3% in 2009. The increase was primarily driven by misuse of pain relievers. Overall, for U.S. residents 12 years or older, pain relievers had the highest rate of nonmedical use (2.1%), followed by tranquilizers (0.8%), stimulants (0.5%), and sedatives (0.1%).

Of those who misused prescription-type pain relievers, 55% of people 12 years or older got prescription-type pain relievers from a friend or relative for free. More than 17% got their pain relievers from one doctor, 5% got them from a dealer or stranger, and 0.4% bought them on the Internet.

The rate of illicit drug use also rose among U.S. residents aged 50-59 years, from 2.7% in 2002 to 6.2% in 2009 during the month prior to the survey. The trend, according to the survey, reflects the growing aging population.

The rate of misuse decreased for just two drugs – cocaine and methamphetamine – according to the survey. Misuse of cocaine decreased from 2.0% in 2008 to 1.4% in 2009 and the rate for methamphetamine decreased from 0.6% to 0.2% over the same period. Officials attributed the drops to more public awareness about the drugs.

The rates of alcohol and tobacco use remained relatively stable between 2008 and 2009, according to the survey.

Federal officials called for more community collaboration, from faith groups to health care providers, to increase awareness about the dangers of illicit drug use. They also stressed the importance of prevention, intervention, and treatment.

WASHINGTON – Roughly 8.7% of Americans aged 12 years or older used illicit drugs in 2009, an increase of 0.7% from 2008, according to a national survey. The rise was largely driven by an increase in marijuana use.

Rates of illicit drug use among youth aged 12-17 years also increased by 0.7%, from 9.3% in 2008 to 10% in 2009.

The data is part of the 2009 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration.

Photo credit: © Ron Hilton/iStockphoto.com

The increase in drug use is driven by several factors, SAMHSA officials said, including economic stress and unemployment, but also by the increased discussion about medical marijuana.

“This survey is really important,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy during a press briefing to release the data. “This is a big wake-up call. We need to be doing more.”

Dr. H. Westley Clark, director of the SAMHSA Center for Substance Abuse Treatment, said that physicians can pay closer attention to signs of illicit drug use in their patients, and get familiar with federal substance abuse resources for health professionals such as the National Institute of Drug Abuse’s NIDAMed.

Approximately 67,500 U.S. residents were interviewed for this year’s installment of the National Survey on Drug Use and Health. They were queried on use of illicit drugs including marijuana/hashish, cocaine/crack, heroin, hallucinogens, and inhalants, as well as nonmedical use of prescription-type psychotherapeutic medications.

According to the survey estimates, marijuana was the most-commonly used drug – with approximately 16.7 million current-month users – followed by psychotherapeutics (7 million), cocaine (1.6 million), hallucinogens (1.3 million), inhalants (0.6 million), and heroin (0.2 million).

The rate of nonmedical use of prescription-type drugs among users aged 18-25 years increased steadily from 2002 to 2009, according to the survey, rising from 5.5% in 2002 to 6.3% in 2009. The increase was primarily driven by misuse of pain relievers. Overall, for U.S. residents 12 years or older, pain relievers had the highest rate of nonmedical use (2.1%), followed by tranquilizers (0.8%), stimulants (0.5%), and sedatives (0.1%).

Of those who misused prescription-type pain relievers, 55% of people 12 years or older got prescription-type pain relievers from a friend or relative for free. More than 17% got their pain relievers from one doctor, 5% got them from a dealer or stranger, and 0.4% bought them on the Internet.

The rate of illicit drug use also rose among U.S. residents aged 50-59 years, from 2.7% in 2002 to 6.2% in 2009 during the month prior to the survey. The trend, according to the survey, reflects the growing aging population.

The rate of misuse decreased for just two drugs – cocaine and methamphetamine – according to the survey. Misuse of cocaine decreased from 2.0% in 2008 to 1.4% in 2009 and the rate for methamphetamine decreased from 0.6% to 0.2% over the same period. Officials attributed the drops to more public awareness about the drugs.

The rates of alcohol and tobacco use remained relatively stable between 2008 and 2009, according to the survey.

Federal officials called for more community collaboration, from faith groups to health care providers, to increase awareness about the dangers of illicit drug use. They also stressed the importance of prevention, intervention, and treatment.

Americans used more illicit drugs – from marijuana to Ecstasy to pain relievers – in 2009, compared to 2008, according to the annual National Survey on Drug Abuse and Health, conducted by by the U.S. Substance Abuse and Mental Health Services Administration.

Among the findings are flat or increasing trends in substance abuse among youth aged 12-17 years, according to the survey. Marijuana use in this age group increased from 6.7% in 2008 to 7.3% in 2009.

In addition, illicit drug use among young adults aged 18-25 years increased from 19.6% in 2008 to 21.1% in 2009. The increases were driven largely by increases in the use of marijuana, according to the survey.

“The results are a wake-up call to the nation,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy, during a press briefing on Wednesday morning.

To learn more about the survey, watch the video interview with Dr. Westley Clark, director of SAMHSA's Center for Substance Abuse Treatment.

Americans used more illicit drugs – from marijuana to Ecstasy to pain relievers – in 2009, compared to 2008, according to the annual National Survey on Drug Abuse and Health, conducted by by the U.S. Substance Abuse and Mental Health Services Administration.

Among the findings are flat or increasing trends in substance abuse among youth aged 12-17 years, according to the survey. Marijuana use in this age group increased from 6.7% in 2008 to 7.3% in 2009.

In addition, illicit drug use among young adults aged 18-25 years increased from 19.6% in 2008 to 21.1% in 2009. The increases were driven largely by increases in the use of marijuana, according to the survey.

“The results are a wake-up call to the nation,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy, during a press briefing on Wednesday morning.

To learn more about the survey, watch the video interview with Dr. Westley Clark, director of SAMHSA's Center for Substance Abuse Treatment.

Americans used more illicit drugs – from marijuana to Ecstasy to pain relievers – in 2009, compared to 2008, according to the annual National Survey on Drug Abuse and Health, conducted by by the U.S. Substance Abuse and Mental Health Services Administration.

Among the findings are flat or increasing trends in substance abuse among youth aged 12-17 years, according to the survey. Marijuana use in this age group increased from 6.7% in 2008 to 7.3% in 2009.

In addition, illicit drug use among young adults aged 18-25 years increased from 19.6% in 2008 to 21.1% in 2009. The increases were driven largely by increases in the use of marijuana, according to the survey.

“The results are a wake-up call to the nation,” said Gil Kerlikowske, director of White House Office of National Drug Control Policy, during a press briefing on Wednesday morning.

To learn more about the survey, watch the video interview with Dr. Westley Clark, director of SAMHSA's Center for Substance Abuse Treatment.

Children who are underinsured outnumber uninsured children and are almost as likely as are uninsured children to have problems with health care access and quality, according to an analysis of 2007 data.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.”

While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as are uninsured children to have problems with health care access and quality, according to an analysis of 2007 data.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.”

While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as are uninsured children to have problems with health care access and quality, according to an analysis of 2007 data.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.”

While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON – By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlfaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

“While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced,” Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. “For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers.”

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, “Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance.”

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. “A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise,” she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that “As the provisions are implemented over time, their actual impact may well differ considerably from these estimates.”

The office’s 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, “and continue the work of estimating the impact of reform on overall national health spending.”

The authors had no relevant financial disclosures.

WASHINGTON - By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlthaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

"While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced," Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. "For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers."

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, "Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance."

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. "A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise," she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that "as the provisions are implemented over time, their actual impact may well differ considerably from these estimates."

The office's 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, "and continue the work of estimating the impact of reform on overall national health spending."

The authors had no relevant financial disclosures.

WASHINGTON - By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlthaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

"While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced," Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. "For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers."

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, "Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance."

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. "A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise," she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that "as the provisions are implemented over time, their actual impact may well differ considerably from these estimates."

The office's 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, "and continue the work of estimating the impact of reform on overall national health spending."

The authors had no relevant financial disclosures.

WASHINGTON - By 2019, nearly 93% of U.S. residents will be covered by health insurance, with nearly 20% of the gross domestic product being consumed in the process, federal actuaries announced at a press briefing Sept. 8.

U.S. health spending is expected to grow on an average annual rate of 6.3% over the next 10 years, 0.2% faster than was projected before passage of the Affordable Care Act (ACA), and reach an estimated $4.6 trillion by 2019, according to an analysis by officials in Office the Actuary at the Centers for Medicare and Medicaid Services (doi:10.1377/hlthaff.2010.0788 Health Affairs 2010;29:10).

The projections update an analysis done in February. This time, they take into account the impact of the ACA as well as changes to the COBRA premium subsidies and Medicare physician fee schedule.

With those changes, the average annual growth rate for health care spending will increase from 6.1% before reform to 6.3% after, according to the authors.

"While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced," Andrea Sisko, lead author of the analysis and a CMS economist, said during the press briefing. "For example, we projected increased in spending by greater number of insured persons, which is largely offset by slower projected Medicare spending growth as well as lower Medicaid prices paid to providers."

Meanwhile, the implementation of ACA provisions including the Pre-Existing Condition Insurance Plan and the extension of coverage of dependents under age 26 years are estimated to increase national health spending by $10.2 billion through 2013, according to the analysis.

The authors also looked at administrative spending by federal and state governments, projecting that to cost $71.1 billion over the next decade.

But Nancy-Ann DeParle, director of the White House Office of Health Reform, wrote in a blog post published early Thursday morning, "Today’s report by the Office of the Actuary confirms a central point of the Affordable Care Act passed by Congress and signed by President Obama: The Act will make health care more affordable for all Americans with insurance."

She added that by 2019, per capita health spending will average $14,720 instead of the $16,120 projected by the Actuary before the Act was enacted into law. "A close look at this report’s data suggest that for average Americans, the Affordable Care Act will live up to its promise," she wrote.

This year, health spending is projected to reach $2.6 trillion – 17.5% of the gross domestic product – a 0.2% increase from the pre-reform projections. Authors noted the increase is driven largely by postponement of physician payment cuts under the Medicare sustainable growth rate (SGR) formula and changes to the COBRA legislations.

The major spike in health spending will be in 2014 when an additional 30 million Americans are expected to gain coverage. Overall spending is projected to increase 9.2% that year, compared with the 6.6% that was estimated in February.

Meanwhile, patients’ out-of-pocket health care spending is expected to decrease by 1.1%, instead of rising 6.4%, since more people will be insured.

By 2019, private health insurance spending is projected to account for 32% of national health spending (compared with 30% in the February analysis); Medicaid and the Children’s Health Insurance Program (CHIP) are to account for 20% (up from 18%). Medicare, out-of-pocket expenses and other public programs make up the rest of the spending.

The authors said that they didn’t change any of the economic or demographic information from their February report, and that the analysis focuses on health spending only. The data analysis was done at payer level only and the authors said they had no sector-level data.

They cautioned that "as the provisions are implemented over time, their actual impact may well differ considerably from these estimates."

The office's 2011 national health spending projections will shift the analysis to an additional year into the future, the authors wrote, "and continue the work of estimating the impact of reform on overall national health spending."

The authors had no relevant financial disclosures.

Children who are underinsured outnumber uninsured children and are almost as likely to have problems with health care access and quality, according to a study of more than 90,000 children.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, wrote lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

They analyzed data collected from the 2007 National Survey of Children's Health, conducted by random-digital-dial interviews with the parents or guardians of 91,642 children. They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as were those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes-insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, noted Dr. Kogan, adding that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

Study limitations included the cross-sectional design, which made it difficult to establish the direction of causality; that the data exclude institutionalized children; and that data collected in a phone survey are subject to biases.

“This problem is more prevalent than the number of uninsured kids,” and should be taken into account in future policy considerations, Dr. Kogan wrote, noting that HRSA plans to repeat the study within the next few years.

In an editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

But the law “may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured,” he added. While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely to have problems with health care access and quality, according to a study of more than 90,000 children.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, wrote lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

They analyzed data collected from the 2007 National Survey of Children's Health, conducted by random-digital-dial interviews with the parents or guardians of 91,642 children. They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as were those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes-insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, noted Dr. Kogan, adding that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

Study limitations included the cross-sectional design, which made it difficult to establish the direction of causality; that the data exclude institutionalized children; and that data collected in a phone survey are subject to biases.

“This problem is more prevalent than the number of uninsured kids,” and should be taken into account in future policy considerations, Dr. Kogan wrote, noting that HRSA plans to repeat the study within the next few years.

In an editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

But the law “may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured,” he added. While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely to have problems with health care access and quality, according to a study of more than 90,000 children.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, wrote lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

They analyzed data collected from the 2007 National Survey of Children's Health, conducted by random-digital-dial interviews with the parents or guardians of 91,642 children. They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as were those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes-insured peers—55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, noted Dr. Kogan, adding that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

Study limitations included the cross-sectional design, which made it difficult to establish the direction of causality; that the data exclude institutionalized children; and that data collected in a phone survey are subject to biases.

“This problem is more prevalent than the number of uninsured kids,” and should be taken into account in future policy considerations, Dr. Kogan wrote, noting that HRSA plans to repeat the study within the next few years.

In an editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

But the law “may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured,” he added. While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

FDA Accepts Historical Controls

The Food and Drug Administration has begun accepting historical controls for studies testing new antiepilepsy drugs in treatment-resistant patients. The agency decision followed a New York University study in the journal Epilepsia that found that patients who were controls in past epilepsy-drug studies can also be valid controls for future studies. Previously, the agency required an internal control group in studies. In those studies, patients received a test drug or a suboptimal, maintenance dose of an established drug. In the process, the patient would undergo a withdrawal phase followed by a monotherapy phase. But since new antiepilepsy drugs rarely demonstrate superiority to existing therapies, placebos or pseudoplacebos were the only acceptable internal controls but were unsuitable because of the control patients' risk of seizures. Studies with historical controls will attract more patients and physicians than have studies with internal controls, the authors said.

MRI Better Than CT Scan in Stroke

The American Academy of Neurology has issued a new guideline calling diffusion MRI superior to noncontrast CT scanning for the diagnosis of ischemic stroke within 12 hours of symptom onset. “Specific types of MRI scans can help reveal how severe some types of stroke are” and find lesions early, said Dr. Peter Schellinger of the Johannes Wesling Clinical Center in Minden, Germany, in a statement on the academy's Web site. According to the guideline, published in the journal Neurology, a major study showed that MRI accurately detected stroke 83% of the time, whereas the figure for CT scanning was 26%. The guideline didn't address MRI for the evaluation of cerebral hemorrhage. Noncontrast CT is the current diagnostic standard for acute stroke, according the statement, and is still appropriate, depending on availability, cost, and other factors. To read the guideline in detail, visit

www.neurology.org/cgi/reprint/75/2/177

Bill: Part D Should Cover Off-Label Uses

Rep. Mary Jo Kilroy (D-Ohio) has introduced a bill to require Medicare Part D coverage for many off-label uses of prescription drugs in chronic diseases such as multiple sclerosis. “Doctors and patients should be able to decide the best safe and effective medications for their treatments,” said Rep. Kilroy in a statement on the National Multiple Sclerosis Society's Web site. The bill proposes off-label coverage when the use is supported by peer-reviewed medical literature and is recognized by the Department of Health and Human Services. Medicare Part B generally recognizes off-label prescriptions, but Part D doesn't cover such use for drugs prescribed to patients with most chronic diseases. Because Part D does cover off-label uses of cancer drugs, the bill is entitled the “Part D Off-Label Prescription Parity Act.”

Preventive Training Supported

The Department of Health and Human Services has awarded 15 grants totaling $9 million to train about 55 residents in preventive medicine. Some of the funds come from the American Recovery and Reinvestment Act of 2009. The support will go to accredited schools of public health and medicine, as well as hospital-based residency programs, according to the agency. Griffin Health Services Corp., the parent company of Griffin Hospital in Derby, Conn., was awarded the top grant of $1.4 million. The Johns Hopkins Bloomberg School of Public Health received $1.1 million, and the University of California, Davis, received about $1 million, DHHS said.

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects—including previously unidentified risks and known adverse events that occur more frequently than expected—that might not become apparent until after a medicine becomes available to a large, diverse population. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, according to the agency.

FDA Accepts Historical Controls

The Food and Drug Administration has begun accepting historical controls for studies testing new antiepilepsy drugs in treatment-resistant patients. The agency decision followed a New York University study in the journal Epilepsia that found that patients who were controls in past epilepsy-drug studies can also be valid controls for future studies. Previously, the agency required an internal control group in studies. In those studies, patients received a test drug or a suboptimal, maintenance dose of an established drug. In the process, the patient would undergo a withdrawal phase followed by a monotherapy phase. But since new antiepilepsy drugs rarely demonstrate superiority to existing therapies, placebos or pseudoplacebos were the only acceptable internal controls but were unsuitable because of the control patients' risk of seizures. Studies with historical controls will attract more patients and physicians than have studies with internal controls, the authors said.

MRI Better Than CT Scan in Stroke

The American Academy of Neurology has issued a new guideline calling diffusion MRI superior to noncontrast CT scanning for the diagnosis of ischemic stroke within 12 hours of symptom onset. “Specific types of MRI scans can help reveal how severe some types of stroke are” and find lesions early, said Dr. Peter Schellinger of the Johannes Wesling Clinical Center in Minden, Germany, in a statement on the academy's Web site. According to the guideline, published in the journal Neurology, a major study showed that MRI accurately detected stroke 83% of the time, whereas the figure for CT scanning was 26%. The guideline didn't address MRI for the evaluation of cerebral hemorrhage. Noncontrast CT is the current diagnostic standard for acute stroke, according the statement, and is still appropriate, depending on availability, cost, and other factors. To read the guideline in detail, visit

www.neurology.org/cgi/reprint/75/2/177

Bill: Part D Should Cover Off-Label Uses

Rep. Mary Jo Kilroy (D-Ohio) has introduced a bill to require Medicare Part D coverage for many off-label uses of prescription drugs in chronic diseases such as multiple sclerosis. “Doctors and patients should be able to decide the best safe and effective medications for their treatments,” said Rep. Kilroy in a statement on the National Multiple Sclerosis Society's Web site. The bill proposes off-label coverage when the use is supported by peer-reviewed medical literature and is recognized by the Department of Health and Human Services. Medicare Part B generally recognizes off-label prescriptions, but Part D doesn't cover such use for drugs prescribed to patients with most chronic diseases. Because Part D does cover off-label uses of cancer drugs, the bill is entitled the “Part D Off-Label Prescription Parity Act.”

Preventive Training Supported

The Department of Health and Human Services has awarded 15 grants totaling $9 million to train about 55 residents in preventive medicine. Some of the funds come from the American Recovery and Reinvestment Act of 2009. The support will go to accredited schools of public health and medicine, as well as hospital-based residency programs, according to the agency. Griffin Health Services Corp., the parent company of Griffin Hospital in Derby, Conn., was awarded the top grant of $1.4 million. The Johns Hopkins Bloomberg School of Public Health received $1.1 million, and the University of California, Davis, received about $1 million, DHHS said.

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects—including previously unidentified risks and known adverse events that occur more frequently than expected—that might not become apparent until after a medicine becomes available to a large, diverse population. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, according to the agency.

FDA Accepts Historical Controls

The Food and Drug Administration has begun accepting historical controls for studies testing new antiepilepsy drugs in treatment-resistant patients. The agency decision followed a New York University study in the journal Epilepsia that found that patients who were controls in past epilepsy-drug studies can also be valid controls for future studies. Previously, the agency required an internal control group in studies. In those studies, patients received a test drug or a suboptimal, maintenance dose of an established drug. In the process, the patient would undergo a withdrawal phase followed by a monotherapy phase. But since new antiepilepsy drugs rarely demonstrate superiority to existing therapies, placebos or pseudoplacebos were the only acceptable internal controls but were unsuitable because of the control patients' risk of seizures. Studies with historical controls will attract more patients and physicians than have studies with internal controls, the authors said.

MRI Better Than CT Scan in Stroke

The American Academy of Neurology has issued a new guideline calling diffusion MRI superior to noncontrast CT scanning for the diagnosis of ischemic stroke within 12 hours of symptom onset. “Specific types of MRI scans can help reveal how severe some types of stroke are” and find lesions early, said Dr. Peter Schellinger of the Johannes Wesling Clinical Center in Minden, Germany, in a statement on the academy's Web site. According to the guideline, published in the journal Neurology, a major study showed that MRI accurately detected stroke 83% of the time, whereas the figure for CT scanning was 26%. The guideline didn't address MRI for the evaluation of cerebral hemorrhage. Noncontrast CT is the current diagnostic standard for acute stroke, according the statement, and is still appropriate, depending on availability, cost, and other factors. To read the guideline in detail, visit

www.neurology.org/cgi/reprint/75/2/177

Bill: Part D Should Cover Off-Label Uses

Rep. Mary Jo Kilroy (D-Ohio) has introduced a bill to require Medicare Part D coverage for many off-label uses of prescription drugs in chronic diseases such as multiple sclerosis. “Doctors and patients should be able to decide the best safe and effective medications for their treatments,” said Rep. Kilroy in a statement on the National Multiple Sclerosis Society's Web site. The bill proposes off-label coverage when the use is supported by peer-reviewed medical literature and is recognized by the Department of Health and Human Services. Medicare Part B generally recognizes off-label prescriptions, but Part D doesn't cover such use for drugs prescribed to patients with most chronic diseases. Because Part D does cover off-label uses of cancer drugs, the bill is entitled the “Part D Off-Label Prescription Parity Act.”

Preventive Training Supported

The Department of Health and Human Services has awarded 15 grants totaling $9 million to train about 55 residents in preventive medicine. Some of the funds come from the American Recovery and Reinvestment Act of 2009. The support will go to accredited schools of public health and medicine, as well as hospital-based residency programs, according to the agency. Griffin Health Services Corp., the parent company of Griffin Hospital in Derby, Conn., was awarded the top grant of $1.4 million. The Johns Hopkins Bloomberg School of Public Health received $1.1 million, and the University of California, Davis, received about $1 million, DHHS said.

FDA to Share Drug-Risk Findings

The FDA will post on its Web site summaries of postmarketing safety analyses on recently approved drugs and biologics, including brief discussions of steps that are being taken to address identified safety issues. The new summaries will cover side effects—including previously unidentified risks and known adverse events that occur more frequently than expected—that might not become apparent until after a medicine becomes available to a large, diverse population. The initial reports will contain information on drugs and biologics approved since September 2007, including several drugs for infections, hypertension, and depression, according to the agency.

As many as 30 million women could benefit from the health reform law over the next decade, according to an analysis of the Affordable Care Act by the Commonwealth Fund. This includes up to 15 million women without health insurance who could get subsidized coverage; 14.5 million insured women who will benefit from improved coverage or reduced premiums; and an estimated 100,000 uninsured women who could gain coverage under the Pre-Existing Condition Insurance Plan.

The study authors said that although women are as likely as men to be uninsured, their health care needs leave them more vulnerable to high health care costs and they are more likely to lose their health insurance. Insurance carriers consider women, especially those of child-bearing age, to be at a higher risk than men, according to the study. In addition, most policies sold on the individual market won't cover the cost of pregnancy, according to the study. Women also are more likely to delay their care and be more central in coordinating health care for their families.

Although this is good news for women across the nation, the question remains whether there will be enough physicians to provide care for them.

Physician shortage in the United States is documented through dozens of studies by organizations such as the Association of American Medical Colleges, in addition to several states.

But Karen Davis, Ph.D., Commonwealth Fund's president, said that there are provisions in the Affordable Care Act that could help alleviate the current physician shortage and encourage more physicians to accept Medicaid and Medicare patients.

For instance, there will be an increase in primary care fees that are paid by Medicare, and Medicaid reimbursement rates for physicians will come up to Medicare level in the next several years, she explained.

But, “the big improvement comes from increased funding for community health centers,” Davis said. She said that the Act's provisions will double the capacity of community health centers, which mostly provide care to low-income patients.

Some of the ACA provisions that benefit women will start as early as September of this year. Others, such as expansion of Medicaid eligibility and new state insurance exchange with premium and cost-sharing subsidies of up to 400% of federal poverty level, will go into effect after 2014.

The report, titled “Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010” is the first in a series of analyses by the Commonwealth Fund, focusing on how health reform will affect various groups and populations.

As many as 30 million women could benefit from the health reform law over the next decade, according to an analysis of the Affordable Care Act by the Commonwealth Fund. This includes up to 15 million women without health insurance who could get subsidized coverage; 14.5 million insured women who will benefit from improved coverage or reduced premiums; and an estimated 100,000 uninsured women who could gain coverage under the Pre-Existing Condition Insurance Plan.

The study authors said that although women are as likely as men to be uninsured, their health care needs leave them more vulnerable to high health care costs and they are more likely to lose their health insurance. Insurance carriers consider women, especially those of child-bearing age, to be at a higher risk than men, according to the study. In addition, most policies sold on the individual market won't cover the cost of pregnancy, according to the study. Women also are more likely to delay their care and be more central in coordinating health care for their families.

Although this is good news for women across the nation, the question remains whether there will be enough physicians to provide care for them.

Physician shortage in the United States is documented through dozens of studies by organizations such as the Association of American Medical Colleges, in addition to several states.

But Karen Davis, Ph.D., Commonwealth Fund's president, said that there are provisions in the Affordable Care Act that could help alleviate the current physician shortage and encourage more physicians to accept Medicaid and Medicare patients.

For instance, there will be an increase in primary care fees that are paid by Medicare, and Medicaid reimbursement rates for physicians will come up to Medicare level in the next several years, she explained.

But, “the big improvement comes from increased funding for community health centers,” Davis said. She said that the Act's provisions will double the capacity of community health centers, which mostly provide care to low-income patients.

Some of the ACA provisions that benefit women will start as early as September of this year. Others, such as expansion of Medicaid eligibility and new state insurance exchange with premium and cost-sharing subsidies of up to 400% of federal poverty level, will go into effect after 2014.

The report, titled “Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010” is the first in a series of analyses by the Commonwealth Fund, focusing on how health reform will affect various groups and populations.

As many as 30 million women could benefit from the health reform law over the next decade, according to an analysis of the Affordable Care Act by the Commonwealth Fund. This includes up to 15 million women without health insurance who could get subsidized coverage; 14.5 million insured women who will benefit from improved coverage or reduced premiums; and an estimated 100,000 uninsured women who could gain coverage under the Pre-Existing Condition Insurance Plan.

The study authors said that although women are as likely as men to be uninsured, their health care needs leave them more vulnerable to high health care costs and they are more likely to lose their health insurance. Insurance carriers consider women, especially those of child-bearing age, to be at a higher risk than men, according to the study. In addition, most policies sold on the individual market won't cover the cost of pregnancy, according to the study. Women also are more likely to delay their care and be more central in coordinating health care for their families.

Although this is good news for women across the nation, the question remains whether there will be enough physicians to provide care for them.

Physician shortage in the United States is documented through dozens of studies by organizations such as the Association of American Medical Colleges, in addition to several states.

But Karen Davis, Ph.D., Commonwealth Fund's president, said that there are provisions in the Affordable Care Act that could help alleviate the current physician shortage and encourage more physicians to accept Medicaid and Medicare patients.

For instance, there will be an increase in primary care fees that are paid by Medicare, and Medicaid reimbursement rates for physicians will come up to Medicare level in the next several years, she explained.

But, “the big improvement comes from increased funding for community health centers,” Davis said. She said that the Act's provisions will double the capacity of community health centers, which mostly provide care to low-income patients.

Some of the ACA provisions that benefit women will start as early as September of this year. Others, such as expansion of Medicaid eligibility and new state insurance exchange with premium and cost-sharing subsidies of up to 400% of federal poverty level, will go into effect after 2014.

The report, titled “Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010” is the first in a series of analyses by the Commonwealth Fund, focusing on how health reform will affect various groups and populations.

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can’t imagine having to go back to paper.

Going from paper to the electronic system wasn’t an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks’ annual most wired survey. Click to see a video . The 99 hospitals and health systems that made the list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions.

The survey, conducted since 1999, aims to benchmark hospitals’ progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems. In addition, wired hospitals have made strides in areas such as medication management.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System’s chief information officer. Implementing the right electronic systems can help improve quality of patient care and efficiency at the hospitals, he said.

This is especially true for specialists such as hospitalists, who tend to care for a variety of patients. Having to view the patients’ information and status quickly can be laborious in paper, but an electronic system that displays the patient history, allergies, and medications can be a lot more helpful. “It’s all about efficiency, patient quality, and patient outcome,” Mr. Brown said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients’ ability to log their diet and exercise in a system, and patients’ ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation’s health care systems and providers – big and small – have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors’ offices elsewhere in their state or across the nation.

That’s mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn’t a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you’ve got to figure out a way to do it, and if you do it, you might get a few carrots. They haven’t made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that the meaningful-use criteria provide an incentive that didn’t exist before. And then there is the incentive to boost physician recruitment. Mr. Brown observed that many graduating residents won’t join a health system or practice that’s not wired. “For new doctors, [being wired] is an expectation,” he said.

Dr. Michota said he wasn’t convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.”

Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

There’s no disputing the fact that being a wired hospital benefits hospitalists, “because we’re a group of physicians who trade patients back and forth,” Dr. Michota said. “We do a lot of signing in and signing out of patients who are really sick, and there are a lot of important details that need to be exchanged.

“I think for hospitalists, fully wired hospitals are attractive, because they let you multitask,” he said.

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can’t imagine having to go back to paper.

Going from paper to the electronic system wasn’t an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks’ annual most wired survey. Click to see a video . The 99 hospitals and health systems that made the list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions.

The survey, conducted since 1999, aims to benchmark hospitals’ progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems. In addition, wired hospitals have made strides in areas such as medication management.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System’s chief information officer. Implementing the right electronic systems can help improve quality of patient care and efficiency at the hospitals, he said.

This is especially true for specialists such as hospitalists, who tend to care for a variety of patients. Having to view the patients’ information and status quickly can be laborious in paper, but an electronic system that displays the patient history, allergies, and medications can be a lot more helpful. “It’s all about efficiency, patient quality, and patient outcome,” Mr. Brown said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients’ ability to log their diet and exercise in a system, and patients’ ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation’s health care systems and providers – big and small – have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors’ offices elsewhere in their state or across the nation.

That’s mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn’t a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you’ve got to figure out a way to do it, and if you do it, you might get a few carrots. They haven’t made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that the meaningful-use criteria provide an incentive that didn’t exist before. And then there is the incentive to boost physician recruitment. Mr. Brown observed that many graduating residents won’t join a health system or practice that’s not wired. “For new doctors, [being wired] is an expectation,” he said.

Dr. Michota said he wasn’t convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.”

Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

There’s no disputing the fact that being a wired hospital benefits hospitalists, “because we’re a group of physicians who trade patients back and forth,” Dr. Michota said. “We do a lot of signing in and signing out of patients who are really sick, and there are a lot of important details that need to be exchanged.

“I think for hospitalists, fully wired hospitals are attractive, because they let you multitask,” he said.

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can’t imagine having to go back to paper.

Going from paper to the electronic system wasn’t an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks’ annual most wired survey. Click to see a video . The 99 hospitals and health systems that made the list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions.

The survey, conducted since 1999, aims to benchmark hospitals’ progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems. In addition, wired hospitals have made strides in areas such as medication management.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System’s chief information officer. Implementing the right electronic systems can help improve quality of patient care and efficiency at the hospitals, he said.

This is especially true for specialists such as hospitalists, who tend to care for a variety of patients. Having to view the patients’ information and status quickly can be laborious in paper, but an electronic system that displays the patient history, allergies, and medications can be a lot more helpful. “It’s all about efficiency, patient quality, and patient outcome,” Mr. Brown said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients’ ability to log their diet and exercise in a system, and patients’ ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation’s health care systems and providers – big and small – have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors’ offices elsewhere in their state or across the nation.

That’s mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn’t a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you’ve got to figure out a way to do it, and if you do it, you might get a few carrots. They haven’t made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that the meaningful-use criteria provide an incentive that didn’t exist before. And then there is the incentive to boost physician recruitment. Mr. Brown observed that many graduating residents won’t join a health system or practice that’s not wired. “For new doctors, [being wired] is an expectation,” he said.

Dr. Michota said he wasn’t convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.”

Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

There’s no disputing the fact that being a wired hospital benefits hospitalists, “because we’re a group of physicians who trade patients back and forth,” Dr. Michota said. “We do a lot of signing in and signing out of patients who are really sick, and there are a lot of important details that need to be exchanged.

“I think for hospitalists, fully wired hospitals are attractive, because they let you multitask,” he said.