Ohio Health Policy Review

Health care standards may be applied to Ohio school districts

The School Employees Health Care Board may soon require all Ohio school districts to follow statewide standards in an effort to cut rising health-care costs (source: Columbus Dispatch, Aug 30, 2007). According to the article, "A report released by the panel earlier this year said school districts could save up to $120 million a year in health-care costs by complying with best practices and maximizing their purchasing power by pooling with other districts for certain purchases such as prescription drugs."

Among the possible best practices being considered are requirements such as having an annual physical and using health-management programs to prevent common illnesses and problems like obesity. The article quotes Stephen F. Loebs, chairman of the School Employees Health Care Board, as saying the board will set specific requirements within nine months. School districts would then have to adopt the standards within a year. How the board would enforce the requirements is unclear since any enforcement policy would have to be approved by the Ohio General Assembly.

Accuracy of census report questioned

Questions are being raised about the accuracy of the Census Bureau's recent current population survey (CPS), which detailed Ohio-specific data on income, poverty, and health insurance coverage. In Youngstown, local officials question the placement of their city as having one of the lowest median household incomes in the country (source: The Vindicator, Aug. 30, 2007). In Portage County, questions are also being raised about the CPS numbers (source: The Record Courier, Aug. 30, 2007).

There are several reasons people are questioning the survey results. As mentioned in the Record Courier article, "Data for the census report is based on samplings of areas with errors possibly occurring from how respondents interpret questions and the willingness of people to accurately answer questions, among other issues, according to the bureau."  The Vindicator mentions that "The bureau's estimate comes with a very large margin of error."

The reason there is such a large margin of error is that the the CPS is an interstate survey, designed to collect data across the entire country. As a result, the survey size within Ohio is limited to a few thousand respondents. This makes the CPS's Ohio results less reliable than an intrastate survey like the Ohio Family Health Survey, which has a very large sample size (40,000 households) and therefore has a low margin of error. However, a large survey like that can only be done every few years because conducting it is a time and resource intensive process. By contrast, the CPS is conducted every year, giving more current data even if it isn't as accurate as a larger survey.

Grants from Cardinal Health to target preventable hospital errors

Cardinal Health Inc. of Dublin is is now accepting letters of intent for a new grant initiative aimed at helping hospitals and clinics cut down on preventable problems and deaths (source: Business First of Columbus article, Aug. 29, 2007). The company will give individual grants of as much as $50,000 to fund programs that increase quality patient care and improve operations. Cardinal is making the grants based on information from the Institute of Medicine, which estimated between 44,000 and 98,000 people die in the United States each year because of preventable medical errors. Cardinal will accept letters of intent for proposals until Oct. 12. More information here and here.

Federal value-driven health care initiative

Health and Human Services Secretary Mike Leavitt last week released summaries from four Federal departments and agencies on their work toward achieving the goals of a 2006 Presidential Executive Order on measuring quality and value in health care (source: HHS news release, Aug. 23, 2007). The Executive Order's four goals were to: 1) Connect the health care system through the adoption of interoperable health information technology; 2) Measure and make available results on the quality of health care delivery; 3) Measure and make available price information on the costs of health care items and services; and 4) Align incentives so that payers, providers, and patients benefit when care delivery is focused on achieving the best value of health care at the lowest cost.

Examples of meeting these goals by Federal agencies include the Office of Personnel Management promoting health care price and quality transparency through its contracts with private sector insurance carriers, and the Centers for Medicare and Medicaid Services providing a payment update to hospitals that report on a core set of quality measures for patients with conditions such as heart failure, heart disease, and pneumonia. More information is available here and here.

A number of Ohio organizations and businesses are participating in this effort, including the Health Action Council of Northeastern Ohio, Ohio KePRO, Ohio Public Employees Retirement System (OPERS), Ohio Transmission Corporation, and the Health Service Review of Ohio (source: Employer statements of support), while earlier this year Governor Strickland signed a statement in support of the value-drive health care goals (source: state and local government support).

Ohio Dept. Health finds 55% of schoolchildren experience tooth decay by 3rd grade

The Ohio Department of Health has released a new report on oral health among schoolchildren (PDF download of "Make Your Smile Count! A Survey of the Oral Health of Ohio Schoolchildren, 2004-2005"). The survey was conducted during the 2004-05 school year at 374 randomly selected Ohio public elementary schools and involved 14,029 third-grade students, each of whom received an oral health screening by trained dentists and dental hygienists. Among the report findings are that 55% of children experienced tooth decay by third grade, while more than one-quarter of surveyed children had cavities that had not been treated and 10 percent suffered from a toothache during the previous six months.

The survey also found that 25% of the children had cavities or other dental problems that required they see a dentist. While most children had reportedly visited a dentist during the past year, 22% had not. The most common reasons given for not receiving dental care were that the family couldn't afford it or because the family didn't have dental insurance.

According to the report, the findings from this survey were consistent with findings from a previous survey of schoolchildren conducted in 1998-99, and show that Ohio is falling short of national targets for oral health. The report also features county level data on children's oral health.

Ohio hospitals report $1.5 billion in "community benefit"

In a report released last month, the Ohio Hospital Association (OHA) stated that its member hospitals provided more than $1.5 billion in community benefit in 2005 (source: Building Healthy Communities PDF download). The hospital membership organization said that the amount of community benefit provided by its 166 community hospitals in 2005 included $320.8 million in Medicaid losses, $816 million in charity care, and $887 million in community activities, which included "immunization programs, health screenings, medical research and education costs, disaster relief, support for community programs and more" (Source: OHA press release).

The OHA release says that the $1.5 billion "understates the amount of community benefit provided by Ohio hospitals." Not included in the official total of $1.5 billion are the financial contributions hospitals make to subsidize bad debt ($313.1 million) and Medicare losses ($393.5 million). The OHA also stated that its member hospitals pumped $58.8 billion into the state’s economy and employed 522,898 Ohioans either directly or indirectly in 2005.

Ohio conference on regional health information organizations

A statewide conference on regional health information organizations will be held by the Ohio University College of Osteopathic Medicine, in partnership with the Ohio Department of Health's State Office of Rural Health, in Athens on Sept. 17-18, 2007. Titled "RHIOhio: Bridging the Digital Divide in Rural Ohio," the conference will "bring together healthcare professionals and educators, governmental officials, policy makers and industry representatives to discuss the opportunities and challenges of creating regional health information organizations (RHIOs) and deploying health information technologies (HIT) in rural Ohio communities." For conference and registration information, visit the RHIOhio site or contact Elissa Welch at (740) 597-3367.

New Census report: Almost 1.2 million uninsured Ohioans

According to the the U.S. Census Bureau's new Current Population Survey, Ohio's 3-year average uninsured rate from 2004 to 2006 was 10.7%, or 1,206,000 Ohioans. This puts Ohio's uninsured rate well below the 3-year national average of 15.3%. The survey also showed an increase in the number of uninsured children in the United States, going from 8 million (10.9%) of children without health insurance in 2005 to 8.7 million (11.7%) in 2006.

These findings are contained in Income, Poverty, and Health Insurance Coverage in the United States: 2006 report (PDF). The data were compiled from information collected in the 2007 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC).

In Ohio-specific data, the CPS showed that the state had an overall uninsured rate of 10.1%, or 1,138,000 Ohioans in 2006. 11.5% of Ohioans under 65 were uninsured in 2006, while 5.7% of kids under 18 lacked insurance (source: CPS Annual Social and Economic (ASEC) Supplement).

Overall, the report finds that real median household income in the United States climbed between 2005 and 2006, reaching $48,200. The nation’s official poverty rate also declined for the first time this decade, from 12.6% in 2005 to 12.3% in 2006. The number of people without health insurance coverage in the U.S. rose from 44.8 million (15.3%) in 2005 to 47 million (15.8%) in 2006 (Source: Census press release on report, Aug. 28, 2007).

Report says 26% of Ohio adults are obese

The Zanesville Times Recorder is reporting that 26% of Ohio adults are obese, and nearly as many don't exercise. The figures are based on a report from Trust for America’s Health, a research group that focuses on disease prevention ("More than a quarter of Ohio adults obese," Aug. 27, 2007). Ohio ranked 15th in the nation based on its percentage of obese adults. The report also stated that 14.2% of Ohio children ages 10 to 17 were overweight, giving the state a ranking of 22nd in the nation, while 24.4% of Ohio adults say they don't engage in any physical activity.  The national average is 22 percent.

The report, "F as in Fat: How Obesity Policies are Failing in America, 2007," also compares  obesity-related standards in schools among the 50 states (such as if states set nutritional standards for school meals, which the reports says Ohio fails to do).

Ohio death rates

The National Center for Health Statistics has released their final review of deaths from 2004 (PDF download of National Vital Statistics Reports, Volume 55, Number 19, August 21, 2007). When compared with 2003 data (PDF download of National Vital Statistics Reports, Volume 54, Number 13 April 19, 2006), Ohio recorded a slight drop in overall deaths, going from a death rate of 954.1 per 100,000 people to 927.5.

The death rates from selected diseases and causes also changed (note: all following rates are per 100,000 people in Ohio). The death rate from HIV disease dropped slightly from 2.1 in 2003 to 1.5 in 2004; the death rate from malignant neoplasms (cancer) dropped slightly from 219.3 to 217.6; the death rate from diabetes mellitus dropped slightly from 32.6 to 31.5; the death rate from diseases of heart dropped from 268.2 to 253.8; the death rate from accidents climbed from 32.9 to 36.9; and the death rate from suicides climbed from 9.4 to 11.5.