The report authored by the Center for the Study of Health Systems Change on the impact of demographics on inpatient hospital demand (discussed here earlier) is revealing on several levels: technology v demographics; shifts in utilization by type of procedure, and the impact of an aging population on inpatient v outpatient care.
One of the key takeaways is the note that local demographics can be quite different from national trends, and can actually counteract them entirely. For example, Phoenix is growing so rapidly, and has such a youthful demographic profile (about 10% of the population is over 65) that health care planners may as well ignore the national statistics as their population is significantly different.
At the other end of the spectrum is Syracuse NY, where a stagnant-to-declining population coupled with little influx of younger residents has resulted in a population bulge in the over-65 group (over 16% of the population is over 65, compared to a US average of 12.4%).
While local health care planners and politicians (well, maybe not politicians…) are well aware of these differences, those of us interested in national health care policy and planning would do well to remember that all health care is local, and the needs of individuals and areas trump national trends.

You’ve just got to read Matt Holt’s blow by blow report from the World Healthcare Congress.
Here is one of the more interesting excerpts.
Allan Hubbard, the Administration’s point man on health care
“Question to Hubbard – “Do you think HSAs could make the problem worse by driving the young, healthy or wealthy into these plans leaving the sicker in traditional plans which will drive up the cost of health care for the most vulnerable part of society?
Hubbard says that its not for the wealthy, as 40% of people getting them earn less than $50,000 (of course that means that 60% earn well more than the average, but lets leave that aside!) For the chronically ill–he says 2-5% of population–this doesn’t work so well. so Administration wants to allow employers to put a bigger amount in the HSA for the chronically ill. But thats the problematic part…”
Paduda comment – 2-5% of the populatin is chronically ill? Perhaps, although it depends on what your definition of “chronic illness” is. They drive a majority of health care costs, so Hubbard essentially admits that HSAs as conceived by the Administration don’t work for the chronically ill– and as for putting more dollars in there, isn’t that just encouraging usage?

While Massachusetts has adopted a program designed to cover almost all of the Commonwealth’s citizens with a pretty comprehensive health plan, Tennessee is pursuing a program that is considerably more modest in both plan design, expected enrollment, and cost.
According to the AP story published in Insurance Journal;
“The Cover Tennessee plan calls for a $150 monthly premium for basic health insurance, with the state kicking in $50. The individual would be responsible for the remainder, though businesses would be given the option of paying half.
The program would limit benefits, for example the number of nights for hospital stays, instead of requiring a high deductible to keep costs down for the insurer.” Copays will be modest for drugs and physician office visits, and individuals’ coverage will be portable.
This initiative began with a grant from the federal government (HHS in particular) to provide funding to study ways to cover the state’s uninsured. The report, a 119 page monster, provides a comprehensive and quite detailed review of the state’s population demographics, existing health insurance infrastructure,
Of note, “the largest portion of the uninsured worked more than 40 hours per week…for small businesses.” 20% of the uninsured work for employers who offer health benefits, but either can’t enroll yet, can’t afford their contribution, or are ineligible for the plan.
Unlike Massachusetts, the program will be limited to selected insurers. There will be competitive bidding, with the state soliciting bids from insurers, after which the plan will be implemented by the end of the year. My sense is this process will encourage insurers to adopt strict cost control measures.

Matthew Holt is doing an excellent job of reporting on the World Healthcare Congress