Article Content

ABC News/Kaiser/USA Today Poll Spotlights Problems Americans Are Having Because of Healthcare Costs

One in four Americans (25%) say that they or a family member in their household had problems paying medical bills during the past 12 months, according to a new poll conducted jointly by ABC News, the Kaiser Family Foundation, and USA Today. That's the highest share of Americans reporting a problem paying medical bills in a series of Kaiser surveys taken since 1997. Among individuals reporting a problem this year, nearly seven in 10 (69%) have health insurance.


These findings are part of a nationally representative survey on healthcare in America that was featured in a weeklong series of reports on ABC News programs,, and in USA Today. The survey examined Americans' views and experiences related to healthcare costs and quality and their attitudes toward possible policy solutions. Key findings of the surveys are as follows:


* About one in four (28%) Americans say that in the past year they or a family member have put off medical treatment because of its cost. Of persons who delayed treatment, seven in 10 (70%) say that the care was for a serious medical condition.


* Among individuals with health insurance, most (60%) are worried about not being able to afford coverage over the next few years, with 27% saying they are very worried.


* More than half (54%) of persons without health coverage say the main reason is because they can't afford it, and another 15% say they can't get it because of poor health, illness, or age. In comparison, just 4% say the main reason they lack health insurance is because they think they don't need it.


* Eight in 10 Americans (80%) say they are dissatisfied with the overall cost of healthcare to the nation. When asked about their own concerns about the healthcare system, cost comes out far ahead of quality. Four in 10 say that they are dissatisfied with their personal health care costs, compared with one in 10 who say they are dissatisfied with the quality of their healthcare.



The Health Care in America Survey is a nationally representative survey of 1,201 adults conducted between September 7 and 12, 2006. The margin of sampling error is plus or minus three percentage points for results based on total respondents. Representatives of ABC News, the Henry J. Kaiser Family Foundation, and USA Today worked together to develop the survey questionnaire. Full survey results are available at News reports using the survey are available at and


Qube Learning System Chosen by aQuire Training Solutions for Game-Based Training of Senior Care Professionals

QBInternational (, a global provider of the game-based Qube Learning System platform for online training, has been chosen by aQuire Training Solutions to create an online training program for line staff of assisted living and skilled nursing communities nationwide.


aQuire Training Solutions is a new member of the product family of the Institute for Senior Living Education (ISLE-Ed). The Institute for Senior Living Education ( provides online learning resources for senior care professionals, such as the well-known, a source for approved continuing education online courses for senior care professionals. aQuire plans to implement the Qube Learning System for programming support and site hosting for a complete line of game-based training courses designed to address the training and retention needs of assisted living and nursing home line staff, including caregivers and nursing assistants. Courses that use the Qube will be available on demand to an unlimited number of online learners, providing a timely and cost-effective way for senior care communities to solve staff training challenges inherent within the industry. The project includes a full spectrum of training courses for line employees along with a comprehensive library of courses on Alzheimer's and memory care and OSHA-mandated safety topics.


aQuire Training Solutions use the full line of Qube authoring tools and methodologies, including QBooks, QLibris, and QGames. QLibris is a fully hosted, zero-client, highly scalable authoring platform used to create, maintain, and support QGames, QBooks, and QLibraries. QLibris provides extensive SQL data mining and reporting capabilities to track learning effectiveness and learner usage. QGames are the heart of the Qube's instructional design methodology, consisting of instructionally effective, easily customizable online learning activities designed to increase retention by the learner in a fun, engaging environment. QBooks are customizable content delivery modules with all the functionality of the Web and the familiar look and feel of an actual page-turning book.


The Qube is the first complete, online product training and communication toolkit that delivers effective, on-demand, game-based product training to sales forces, channel partners, and distributors around the world. The Qube combines proven Web technology with compelling game-based interactivity. The resulting product training and communication toolkit greatly exceeded the results of traditional systems when tested in academic studies. For more information, visit the Web site


Medicaid Spending Growth Hits Near Record Low State Revenues Rebound

State revenues increased faster than Medicaid spending for the first time since 1998, according to a new 50-state survey released by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU). The survey finds that an improved economy combined with the implementation of the new Medicare prescription drug benefit has contributed to a 2.8% growth rate in Medicaid spending for state fiscal year (FY) 2006-the lowest rate of growth in a decade and the fourth consecutive year in which Medicaid spending growth has slowed. Positive economic conditions also contributed to a slowdown in Medicaid enrollment growth, which in turn helped reduce spending growth. The 1.6% enrollment growth for FY 2006 is the lowest rate since 1999-nearly half the 3% growth predicted by Medicaid officials for the year.


Looking forward to FY 2007, the survey finds that a handful of states (five) plan to restrict eligibility, whereas more than half (26) plan to restore cuts from previous years, expand to new populations, or make positive changes to Medicaid's application and enrollment process. States are also contemplating new options and implementing new requirements created by the passage of the Deficit Reduction Act (DRA) in 2006 although few have used the flexibility to change benefits and cost-sharing requirements for FY 2007. The budget survey of state officials, conducted by KCMU and Health Management Associates for the sixth consecutive year, found that the spending growth of 2.8% would have been even lower (1.7%) had states not been required to finance a portion of the new Medicare prescription drug benefit via what is known as a clawback payment.


Despite the slowed growth, state Medicaid officials indicate that growing healthcare costs and the erosion of employer-sponsored health coverage are two reasons that overall pressure to constrain Medicaid spending has not subsided. In fact, based on budgets that states adopted for FY 2007, Medicaid spending growth is projected to increase to 5% next year.


Medicaid Policy Initiatives for FY 2006 and FY 2007

Although cost control remains a priority, state Medicaid officials seem to have moved away from a primary focus on cost containment to a range of priorities that includes expanding or restoring eligibility and benefits, improving quality, and changing the delivery of long-term care services. All states implemented at least one cost-containment strategy in FY 2006, and 49 states plan at least one strategy for FY 2007. As in previous years, most cost-containment strategies targeted provider rates and prescription drug spending. Balancing the cost-control strategies, 49 states implemented in FY 2006 or planned for FY 2007 strategies to enhance provider rates or expand or restore benefits or eligibility. States are increasingly focusing on three particular areas for change in their Medicaid programs: disease management, quality initiatives to provide better long-term value for program dollars and improve healthcare for beneficiaries, especially high-cost cases, and enhancement of long-term care services in home and community settings to reorient the long-term care system away from institutional settings, such as nursing homes, when appropriate.


State Reactions to the Deficit Reduction Act

With several new Medicaid changes included in the DRA, states are also adjusting their programs to accommodate required changes and contemplating options available via the new law. More than half the states expect the new citizenship documentation requirements to cause a decline in Medicaid enrollment. Most states also expect that the impact on beneficiaries of more stringent asset transfer provisions for Medicaid nursing home eligibility will be "moderate" or "significant" but will have a limited fiscal impact on the Medicaid program.


States have plans to take advantage of new flexibility in the DRA to change their delivery of long-term care services. Two-thirds (34) of all states are moving forward with a long-term care partnership policy to encourage the purchase of private long-term care insurance, applying for a "Money Follows the Person" demonstration grant to increase the use of community versus institutional services or adopting the cash and counseling option that allows for self-direction of personal assistance services. Several states are using more than one of the approaches. Few states have yet to take advantage of new flexibility provided in the DRA to change benefits or impose cost-sharing in FY 2007. Nine states reported that their plans to pursue a Medicaid waiver were changed after the passage of the DRA. Kentucky, West Virginia, and Idaho (all states that had been seeking Medicaid waivers to change their programs) have used the DRA to change benefits. Kentucky also used new cost-sharing options. Other states are considering the new options for the future.


The report "Low Medicaid Spending Growth Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey State Fiscal Years 2006 and 2007" and related materials are available online at


The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on healthcare coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, DC office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in healthcare and public policy. The Kaiser Family Foundation is a nonprofit, private operating foundation dedicated to providing information and analysis on healthcare issues to policymakers, the media, the healthcare community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.


Oregon Hospice Social Worker Publishes New Resource for Hospice Professionals, Patients, and Families

Hospice social worker Marty Hogan has published "Sacred Vigil," a comprehensive tool to guide dying individuals and family caregivers through the final stages of death. Written in short, digestible chapters, "Sacred Vigil" provides a compassionate and detailed look at the final stages of death, conveying to readers the common feelings and physical changes that dying people experience. The 65-page booklet offers ideas for ways to soothe the dying person and enhance comfort and peace while providing ways for the family and loved ones to cope during this difficult time. Hogan provides a broad and diverse array of inspirational readings, prayers, songs, poems, and tools for creating a sacred space and suggestions for including children in the dying experience. In addition to "Sacred Vigil," Sacred Vigil Press has just published Hogan's second booklet, "Telling My Life's Story," a 35-page guide for recording a dying person's reflection on life.


Marty Hogan, LCSW, is a hospice social worker with Providence Hospice in Medford, OR. She has more than 13 years of experience in home care and hospice social work and has worked in a variety of settings.


For more information on "Sacred Vigil" and upcoming booklets, visit


Joint Commission and National Quality Forum Announce the 2006 John M. Eisenberg Patient Safety and Quality Awards

The National Quality Forum (NQF) and the Joint Commission on Accreditation of Healthcare Organizations have announced the 2006 recipients of the annual John M. Eisenberg Patient Safety and Quality Awards. The honorees selected in each of the four award categories are:


Individual Achievement-Donald Berwick, MD, MPP, KBE, is president, CEO, and cofounder of the Institute for Healthcare Improvement in Boston. Dr. Berwick has published extensively in professional journals in the areas of healthcare policy, decision analysis, technology assessment, and healthcare quality management. Dr. Berwick has received numerous awards and honors for his work, including the Joint Commission's 1999 Ernest A. Codman Award and, in 2001, the first Alfred I. DuPont Award for excellence in children's healthcare from Nemours, one of the nation's largest pediatric healthcare provider organizations. In 2002, he was given the Award of Honor from the American Hospital Association for outstanding leadership in improving healthcare quality. In 2004, he was inducted as a fellow of the Royal College of Physicians in London. In 2005, in recognition of his exemplary work for the National Health Service in the UK, he was appointed honorary Knight Commander of the Most Excellent Order of the British Empire-the highest award given to non-British citizens.


Research-Jerry H. Gurwitz, MD, is a nationally recognized expert in geriatric medicine and the use of drug therapy in the elderly. He holds the Dr. John Meyers Endowed Chair in Primary Care Medicine at the University of Massachusetts Medical School, where he is chief of the Division of Geriatric Medicine and Professor of Medicine and Family Medicine/Community Health. He also serves as the executive director of the Meyers Primary Care Institute. He has been the recipient of the William B. Abrams Award in Geriatric Clinical Pharmacology from the American Society for Clinical Pharmacology and Therapeutics and the George F. Archambault Award from the American Society of Consultant Pharmacists. Dr. Gurwitz's most recent research efforts relate to developing and testing interventions to reduce the risk of medication errors that lead to adverse drug events in the elderly.


Innovation in Patient Safety and Quality at a Regional Level (Two Recipients)-Minnesota Alliance for Patient Safety (MAPS), established in 2000, is a partnership among the Minnesota Hospital Association, Minnesota Medical Association, Minnesota Department of Health, and more than 50 other public-private healthcare organizations to improve patient safety. MAPS is a forum for sharing best practices and fostering commitment to patient safety improvement efforts. Pennsylvania Patient Safety Authority is an independent state agency charged with taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety in hospitals, ambulatory surgical facilities, birthing centers, and other facilities.


Innovation in Patient Safety and Quality at a Local Level- The Wichita Citywide Heart Care Collaborative represents 35 institutions that developed multidisciplinary teams in November 2003 to meet the common goal of providing quality care in their community. This unique initiative enlisted the support of the city's key decision makers to work together to improve patient care. Their combined efforts have provided valuable lessons and opportunities for sharing in-depth knowledge, resulting in the establishment of patient safety and quality improvement goals that exceeded the reach of any one of the organizations working in isolation.


The patient safety awards program, launched in 2002 by NQF and the Joint Commission, honors John M. Eisenberg, MD, MBA, former administrator of the Agency for Healthcare Research and Quality (AHRQ). Dr. Eisenberg was one of the founding leaders of the NQF and sat on its board of directors. In his roles both as AHRQ administrator and chair of the federal government's Quality Inter-Agency Coordination Task Force, he was a passionate advocate for patient safety and healthcare quality and personally led AHRQ's grant program to support patient safety research.


For more information, visit the Joint Commission's Web site,

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.