Ex-Prisoners In Need of Care

There’s a gap in the proverbial health care safety net that’s big enough for a whale to swim through.

People who are incarcerated, on probation, or on parole — what a recent study calls the “justice-involved population” — make up 22% of the 13 million newly eligible people.

“The justice-involved population has a higher disease burden than the general population, yet as many as 90% of justice-involved people lack health insurance at the time of their release from incarceration,” says the study, published in Health Affairs. “This disparity between disease burden and access can drive up the cost of health care, result in worse outcomes, and cause patients to seek care later than appropriate and in care settings that are often isolated and lack care coordination.”

Health reform means that much of what health insurance plans did is being taken on by providers. An obvious example is the Choosing Wisely campaign, an effort by physician professional organizations to cut down on overtreatment and overtesting.

Forget about patients not refilling their prescriptions. Many don’t fill them the first time, according to a study in the Canadian journal Plos One (http://tinyurl.com/non-adherence-study).

New prescriptions were given to 232 patients from April to August 2010 at St. Michael’s Hospital in Toronto. Twenty-eight percent exhibited primary non-adherence at 7 days after discharge; 24 percent at 30 days. Perhaps more surprising is that patients discharged to home had a better adherence rate (26 percent) than those discharged to a nursing home (43 percent). There were no significant demographic differences between the adherent and non-adherent groups. Participants were all 66 or older; the average age was 78.

Many economists wonder if health insurance exchanges will actually perform one of their primary functions when they open in October — increasing the competition among health insurers offering products to millions of new beneficiaries. This according to Stateline, a wire service for the Pew Charitable Trusts (http://tinyurl.com/Pew-exchanges).

Clinician executives at health insurance plans can stop worrying about whether consumers are savvy enough to navigate the changing landscape of coverage and start worrying about how small businesses will fare under the Affordable Care Act. (Well, keep worrying about both because both will continue to be problems.)

Let’s just look at small businesses for now. Expect a learning curve, to say the least, according to a study by EHealth, the parent company of eHealthInsurance, a private health insurance exchange. (See:”Small Employer Health Insurance Survey” )