A new chartbook by the Kaiser Family Foundation shows that on most, though not all indicators, California’s health care system fares poorly when compared to the U.S. as a whole. The report, Health Care Trends and Indicators in California and the United States, shows that many more Californians have no health insurance than in the rest of the U.S., but when they do have insurance it tends to be more comprehensive and cost less than elsewhere.

The report, which compares key trends and indicators in California’s health care system with those in the rest of the country, is authored by researchers at the Foundation and the Center for Health and Public Policy Studies at the University of California, Berkeley.

• News Release: California’s Health Care System Looks Significantly Different From Rest of Nation’s

• Table
• Chartbook

Issues in the 2000 Election: Education

The Washington Post/Henry J. Kaiser Family Foundation/Harvard University national survey on “Issues in the 2000 Election: Education” is the first in a series of surveys examining policy issues in the 2000 national elections. This survey, conducted May 11-22, 2000, of a nationally representative sample of registered voters also included an oversample of “education-oriented” registered voters. This survey and all surveys in this series, are designed to provide a more in-depth look at the attitudes of issue-oriented voters and compare them to registered voters in general. Results from this survey were released by The Washington Post in June 2000.

• Toplines/Survey

A national survey of 2,500 insured adult Americans on their experiences with health plans-documents problems people have experienced with their plans, the impact of those problems, and how people resolve their disputes with their health plans. The survey was designed and analyzed by the Kaiser Family Foundation staff with advice and input from Consumer Reports under a joint project developed to help consumers resolve difficulties with health plans. Highlights from the survey were featured in the July issue of Consumer Reports along with findings from a similar readership survey conducted by the magazine.

• Topline

This issue brief, prepared for the Kaiser Family Foundation’s Capitol Hill Briefing Series on HIV/AIDS, provides an overview of key HIV/AIDS research issues and activities. It includes information about the types of HIV/AIDS research, who conducts HIV/AIDS research, funding for HIV/AIDS research, and remaining challenges for such research over the next several years.

Issue Brief (.pdf)

The majority of Americans are satisfied with their health insurance plan, but most insured adults in the United States have had some problem with their health plan in the last year according to a new survey released by the Kaiser Family Foundation

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MOST CONSUMERS GENERALLY POSITIVE ABOUT THEIR HEALTH PLAN, BUT FIFTY-ONE PERCENT REPORT HAVING SOME PROBLEM IN THE PAST YEAR

Few Consumers Are Aware of Mechanisms Available for Resolving Disputes

(Washington, DC) Although Americans report mostly positive experiences with their health insurance plans, one in two say they’ve had a problem with their plan in the last year, according to a new survey released by the Kaiser Family Foundation. Most problems appear minor and easy to resolve, but a significant minority involve serious reported consequences and are difficult to settle.

The survey of 2,500 insured adults ages 18-64 found that most consumers are confused about where to turn for help in resolving problems with their health plans, especially with regard to the right to appeal health plan decisions to an independent expert. The survey was designed and analyzed by Kaiser Family Foundation staff with advice and input from Consumer Reports under a joint project developed to help consumers resolve difficulties with health plans. Highlights from the survey will be featured in the July issue of Consumer Reports.

“When one out of every two people reports having a problem with their health plan, it suggests that the pressure behind the patients’ rights debate is grounded in real patient experiences, not just anecdotes,” said Drew Altman, Ph.D., president of the Kaiser Family Foundation. “But we also need to keep in mind that most of these problems are more hassle than horror story,” he added.

Consumer Experience Influences Satisfaction with Health Plan

Most people (83%) who have had contact with their plan in the last year say that their recent experiences in dealing with their plan have been positive. Even among those who say they have had a problem with their plan, most (71%) report their recent experiences as positive.

In fact, most people appear satisfied with their plan overall — 64% give their plan a grade of A or B. However, those in “strict” managed care plans (with features common in HMOs) grade their plans lower (53% give an A or B) than those in “loose” managed care plans (70% give their plan an A or B) or those remaining in traditional health insurance (of whom 74% give their plan an A or B).

Problems Reported by Consumers

Overall, 51% of insured Americans under age 65 report having some problem with their health plan in the last year. Women, those in “strict” managed care plans, and those who are in fair or poor health or who have a health condition are most likely to report problems.

Types of problems

The types of problems reported involved:

• Delays or denials of coverage or care (reported by 17% of all people and 32% of people with problems),
• Difficulty seeing a physician (14% of all people; 27% of people with problems),
• Billing and payment problems (12% of all people; 23% of people with problems), and
• Problems related to communication or customer service difficulties (7% of all people; 14% of people with problems).

Consequences of the Problems

More than a third (38%) of people who report problems with their health plan said there was no financial consequence, time lost from life activities, or impact on health status. Forty-three percent of those who reported problems identified moderate overall consequences, while 18% (or 9% of all insured adults) identified more serious consequences.

Financial Consequences: Almost two in five (38%) of people experiencing problems (or 19% of all insured adults) say there was a financial consequence to the problem (i.e., they ended up paying more for treatment or services than they normally would have).

In most cases (53%) where there was a problem that had a financial consequence, the amount at issue was under $200. In 14% of these cases (5% of those with a problem), there was a cost of $1,000 or more.

Lost Time: About one in five (21%) of people experiencing problems say they lost time from work, school, or other major life activities as a result. While most cases involved relatively little time lost, it amounted to at least a week in 28% of these cases.

Health Declines: About one in five (21%) of people with problems say they experienced a decline in health as a result. Most said it was “not too serious,” though a small minority (6% of those with a problem of any kind) said the decline resulted in a permanent or long-lasting disability.

“While many of the problems reported have relatively minor consequences, they clearly cause aggravation,” said Mollyann Brodie, Ph.D., vice president for Public Opinion and Media Research for the Kaiser Family Foundation. Sixty-two percent of people experiencing problems said it caused them stress (28% “a lot,” 34% “some”). In general, people reported similar levels of stress for dealing with their health insurance company as for doing their taxes and dealing with their auto mechanic.

Problem Resolution

The survey showed that most people who had a problem with their health plan sought some means inside their plan to resolve the problem, while few turned to external resources.

• 73% contacted someone at the plan or their own physician
• 46% referred to plan documents for information
• 25% contacted a friend or family member for assistance.

Only 21% of those with a problem contacted someone outside of their plan for help, including 13% who contacted someone at work whose job it is to deal with health insurance issues, just 2% who contacted a state agency and 1% each who contacted a lawyer or an elected official. Six percent filed a formal appeal including 1% who filed with an independent review organization.

Most people are satisfied with the resolution to their problems–nearly half said their problem was resolved to their satisfaction. Twenty-three percent said it was resolved, but not the way they would have liked, and 28% said their problem had not yet been resolved.

More serious problems appear to be more difficult to resolve. Among those whose problems had a high impact (involving financial consequences, lost time, or reported health declines), only 20% said the problem was resolved to their satisfaction, 31% said it was resolved but not the way they would have liked, and 49% said the problem had not yet been resolved.

Many problems are resolved relatively quickly; 40% of those whose problems had been resolved said it took less than a week. However a substantial number take much longer 29% took more than a month to resolve.

When asked what resources would be helpful in resolving health plan problems, people gave the highest marks to appeals to an independent medical expert (87% said it would be “very” or “somewhat” helpful), an independent place to turn for help (84%), and someone at work whose job it is to deal with health insurance issues (81%). Somewhat fewer people identified a state agency (74%), or the right to sue (69%) as helpful.

Consumer Awareness

Most people appear confused about where to go for help if they have a problem with their health plan and whether they have a right to appeal health plan decisions to an independent expert. The vast majority (89%) of people say they do not know the name of the state agency that regulates HMOs and other health plans. Forty percent of people do not know whether they have the right to appeal a health plan decision to the state or to an independent medical expert.

In the 21 states (including DC) where consumers did have that right at the time of the survey (33 states currently offer the right to at least some people), 54% of consumers either said they did not have that right, didn’t know or didn’t answer the question. And in the states that did not provide the right to an independent appeal at the time of the survey, 39% of consumers thought mistakenly that they did have such a right.

“As Congress debates giving patients new rights, the truth is that most people remain in the dark about some they already have. Some states are way ahead of Congress on this issue, but most people who live in these states don’t even know it,” said Larry Levitt, director of The Changing Health Care Marketplace Project for the Kaiser Family Foundation.

For more information about the Consumer Reports Survey, contact Joan Tripi at: (914) 378-2436.

Methodology

The Kaiser Family Foundation National Survey of Consumer Experiences with Health Plans was designed and analyzed by researchers at the Kaiser Family Foundation. Fieldwork was conducted by telephone by Princeton Survey Research Associates between October 20 and December 8, 1999. The survey included a nationally representative random sample of 2,500 adults age 18 to 64 who have health coverage other than Medicare. Interviews were conducted in both English and Spanish. The margin of sampling error for the total sample is plus or minus 2 percentage points. For the 1,278 respondents who experienced some problem with their health plan in the past year, the margin of sampling error is plus or minus 3 percentage points. The margin of sampling error may be higher for some of the other sub-groups as noted in the analysis.

Because many people are unsure of – or don’t know — what kind of health insurance they have, respondents were asked a series of questions about their health plan to establish what type of coverage they actually have. They were asked if they were required to do any of the following by their plan: choose doctors from a list and pay more for doctors not on the list; select a primary care doctor or medical group; and/or obtain a referral before seeing a medical specialist or a doctor outside the plan. Respondents were listed as being in “strict” managed care if they reported their plans had all of these characteristics; listed as being in “loose” managed care if they had some but not all; and were listed as having “traditional” health insurance if they reported their plans had none of these characteristics.

In order to classify respondents into groups based on the overall impact of their problem with their health plan, we developed a scoring system related to the severity of the reported impact of the problem across four dimensions: 1) how long care was delayed, 2) financial impact, 3) health status impact, and 4) time loss from work or other activities.

This survey was produced as part of a joint project between Consumer Reports and the Kaiser Family Foundation designed to improve how consumers resolve problems with their health insurance plans. Under the project, researchers at the Kaiser Family Foundation designed and conducted this national survey of consumers, with advice and input from Consumer Reports staff. Articles appearing in Consumer Reports in conjunction with this project were produced with full editorial control by the magazine.

The Kaiser Family Foundation, based in Menlo Park, California, is a nonprofit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. Copies of the survey toplines and chartpack publication #3025 are available online at /, or by calling the Foundation’s Publications Request Line at 1-800-656-4533.

This issue paper updates the July 1999 report and provides a general overview of federal Medicaid eligibility policy for the low-income disabled population. This paper focuses on four broad groups of individuals with disabilities: children under 18; adults under 65 who are not living in institutions; adults under 65 who are living in institutions; and adults under 65 who are also eligible for Medicare. In addition, this paper includes the new eligibility options offered under the Ticket to Work and Work Incentives Act of 1999. This issue paper does not attempt to describe Medicaid eligibility policy for the low-income disabled in each state. Instead, the focus is on the federal policies that structure the eligibility choices that states make.

TV shows and movies are an important source of information for teens and others about sexual health issues. Many teens rank entertainment media as a top source of information about sexuality and sexual health. This fact sheet combines information from several Kaiser Family Foundation studies on the issues of teens and sex and the role popular television plays on this subject.

The Impending Catastrophe: A Resource Book On The Emerging HIV/AIDS Epidemic in South Africa

A report prepared by Abt Associates South Africa, Inc. and commissioned by theloveLife program.

Click here for the full report, in PDF. Note: This 34-page document has lots of graphics and may download slowly.

Executive SummarySouth Africa is certain to experience severe consequences arising from its AIDS epidemic. Over 3.5 million people are currently estimated to be HIV infected, and this number is projected to more than double over the next decade – unless major behavioral changes are adequately promoted and realized. Younger people are most severely affected by the disease with around 60% of all adults who acquire HIV becoming infected before they turn 25.

Young women are particularly vulnerable. They are at greater risk of infection due to biological, social and economic factors; they are also more vulnerable to the various effects of the epidemic. While not fully representative, a recent KwaZulu-Natal voluntary survey of university students demonstrated infection rates of 26% in women and 12% in men, aged 20 to 24, and 36% in women and 23% in men, aged 25 to 29. These data further emphasize the need for priority prevention programmes for young people and women.

Orphans are perhaps the most tragic and enduring legacy of the HIV/AIDS epidemic. By 2005 there are expected to be around 800 000 orphans (under age 15). This figure will rise to more than 1.95 million in 2010. Models of providing support for these vulnerable children and their communities urgently need to be explored because traditional coping mechanisms are likely to break down.

The sharpest economic effect of the South African epidemic will probably be on wealth distribution rather than on the size of the economy as a whole. In the field of human and social development, however, the consequences are expected to be much more profound. Increased illness and deaths, and reduced life expectancy, will clearly compromise development objectives, while the survival of poor households will be made more difficult.

Increasingly, HIV/AIDS is expected to be a major determinant of the ability of households to extricate themselves from longstanding poverty. Virtually no research has been done on the impact of HIV at household level, and how government might most effectively target relief. Such relief is urgently required.

Also a priority is the provision of good information to people with HIV/AIDS, so that they can gain access to available support and allocate their resources in a way that reduces the effects of the disease on themselves and their households. There is also a need for efficient grant or other support systems, not only for the HIV-disabled, but also for the elderly and others involved in child support to relieve household economic hardships. It is important that available resources are targeted at the most vulnerable households, communities and sub-groups, and that the resources are directed towards supporting all affected people, not just those who are infected or ill. Every effort should also be made to reinforce traditional and new community- and family-based coping mechanisms.

The HIV/AIDS epidemic far outweighs any other threat to the health and well being of South African employees. AIDS deaths will soon exceed all other causes of death put together among the South African workforce. Although data on workforce infection levels is very limited, the number of employees lost to AIDS over the next ten years could be the equivalent of around 40 to 50% of the current workforce in some South African companies. Accelerated skills development in both young and working-age populations will be critical in containing the impact of the HIV/AIDS epidemic on the economy.

However, the high mortality rate among current and future employees implies that skills development without effective HIV/AIDS prevention might be a poor investment. South Africa already faces enormous challenges in human development owing to training backlogs, inherited inequities and inefficiencies in the education system. Substantial investment in preventing HIV transmission in trained workers is therefore warranted. Businesses have a key role to play in the area of prevention and also in reducing denial and stigma. The most significant costs of the epidemic for most companies are likely to be indirect, including increased absenteeism due to illness or funeral attendance, lost skills, training and recruitment costs, and reduced work performance and lower productivity.

One of the most obvious economic consequences of the HIV/AIDS epidemic is the need for increased resources to care for the sick and dying. Both public and private health sectors will be seriously affected. Projected expenditure will almost certainly not be sustainable, given public and private sector affordability constraints. This implies that some rationing will have to occur to reconcile needs with available resources. It is possible that HIV-related disease sufferers will experience a greater degree of rationing than other health service users. The challenge for both public and private sectors is to shift to more cost-effective modes of therapy for HIV/AIDS sufferers, rather than resorting to irrational or even discriminatory exclusion from services. These cost effective modes will need to include a re-orientation towards lower cost hospice type care instead of acute hospitalization, as well as consistent and substantial support to community-based care initiatives. These interventions have not yet received much attention from the public sector.

At the primary care level, widespread secondary prevention programmes, such as TB and pneumonia prophylaxis, should be urgently implemented. South Africa’s TB control programme is already over-extended and new strategies to respond to the increased burden of TB cases are urgently required. Widespread use of anti-retroviral therapy for AIDS-sick people does not appear at this stage to offer a realistic solution. Even in the relatively wealthy private sector, large price reductions would be required before net savings in health care costs could be expected. AIDS activists and international agencies would spend their time more effectively by advocating delivery of basic programmes of care, and continue efforts to promote anti-retrovirals to prevent mother-to-child transmissions.

With no prospect of an AIDS vaccine in the foreseeable future, HIV prevention requires sustained promotion of healthier and safer sexual behaviour. Achieving this within a context of many situations and cultures is a complex task, requiring integrated inter-sectoral approaches implemented at all levels of society. Prevention programmes must create a social consciousness and environment that leads to appropriate behavioral change. This requires active efforts to reduce stigma and discrimination around HIV/AIDS. While the vast majority of those at high risk in sexually active age groups have already been infected, considerable opportunity still exists to prevent new HIV infections amongst succeeding waves of teenagers. This group presents important opportunities for targeted interventions.

The Impending Catastrophe: A Resource Book on the Emerging HIV/AIDS Epidemic in South Africa

Indications show that South Africa’s 15-25 year olds are the most severely affected by the continuing spread of the HIV disease in that country. According to a report released May 11, 2000, by Abt Associates (South Africa) Inc., an international consulting firm, the rate of new infections among this group is as high as 60%, with young women being particularly vulnerable. Over 3.5 million people are currently estimated to be HIV infected in South Africa, and this number is projected to more than double over the next decade unless major behavioral changes are adequately promoted and realized. This report is a resource book and offers detailed analysis and data of the disease s impact on South Africa’s health, economic and social systems.

• Executive Summary
• Full Report

This chart book provides a comprehensive portrayal of information related to the uninsured, including trends and major shifts in coverage, a profile of the uninsured, an assessment of why so many Americans are uninsured, and data documenting the difference that health insurance makes in the lives of Americans. The chart book includes detailed tables with data broken down by demographics and by state.

• Chartbook
• Fact Sheet: The Uninsured and Their Access to Health Care