Category Archives: Health

Are New York City’s Public Hospitals Becoming the Main Provider of Inpatient Services for the Mentally Ill?

With Sexually Transmitted Disease Cases Rising in New York City, What Happened to Spending on Treatment and Prevention?

How Much Has the Affordable Care Act Reduced the Share of Uninsured Patients Treated by the City’s Public Hospitals?

With the full implementation of the Affordable Care Act, the share of adults in New York City without health insurance dropped from 20.9 percent in 2013 to 13.8 percent in 2014, a 7.1 percentage point decline. To gauge the effect on New York City Health + Hospitals, we focus on adult outpatient visits to H + H hospitals and diagnostic and treatment centers because some conditions that require inpatient stays, such as medical emergencies, allow for temporary Medicaid eligibility.

  • Although the city’s public hospital system saw a reduction in the share of outpatient visits by uninsured adults, the decline was less steep—4.0 percentage points—than the city as a whole.
  • In 2015, the share of H + H’s outpatient visits by uninsured adults (25.2 percent) was 11.4 percentage points greater than the share of uninsured adults in the general population.
  • For both the city’s population and H + H’s patients, those adults who gained health insurance did so through Medicaid or commercial insurance in approximately equal proportions.

  • Both the share of adult outpatient visits by uninsured patients and the impact of the Affordable Care Act on this share vary widely across H + H facilities.
  • The hospital centers serving the largest shares of adult outpatients who are uninsured include Elmhurst, Queens, Bellevue, and Woodhull.
  • Although each of these four hospital centers saw declines in the share of adults without insurance from 2013 through 2015, all of the decreases fell short of the reduction in the share of uninsured for the city as a whole. Woodhull saw by far the smallest decline, 1.8 percentage points.

Prepared by Erin Kelly
 New York City Independent Budget Office

Print version available here.

SOURCES Department of Health & Mental Hygiene, New York City Community Health Survey, 2014. Health & Hospital Corporation Payor Mix Reports, September 2015 and September 2014, as reported to the Finance Committee.
NOTES: For the share of outpatient visits by uninsured adults at H + H facilities, pre-Affordable Care Act reflects fiscal year 2013 and post-Affordable Care Act reflects fiscal year 2015. For the share of New York City adults who are uninsured, pre-Affordable Care Act reflects calendar year 2013 and post Affordable Care Act reflect calendar year 2014, as reported by the Department of Health and Mental Hygiene Community Health Survey for those years. Coney Island Hospital is not included in the chart breaking out visits by facility because Hurricane Sandy had a lasting impact on the number of visits the hospital was able to provide in 2013 and 2014.

New York City By The Numbers

IBO Homepage

Does City Spending on Antismoking Efforts Affect Smoking Rates?

A recently released American Cancer Society annual report says that based on federal Centers for Disease Control and Prevention guidelines New York State failed to invest sufficient funds last fiscal year on antismoking efforts. IBO’s review of New York City’s own spending on antismoking programs finds that spending levels have varied widely in recent years—and that after trending downward the local adult smoking rate has been increasing.

In 2002, the city’s Department of Health and Mental Hygiene launched its tobacco control plan for reducing smoking among city residents. The plan included: hiking taxes on tobacco products; distributing cessation aids for current smokers; advocating for and enforcing antismoking legislation; and running public education campaigns on the consequences of tobacco use. Spending rose steeply in 2007, with the increase driven by advertising, media campaigns, and nicotine replacement therapies, rather than agency staffing. Tobacco control spending jumped again in 2008—reaching more than 10 times the 2001 level—even as spending on agency staff barely grew. A three-year decline in spending followed in 2009 through 2011, with all of the cuts coming from sources other than health department staff.

chartnycbtn45a

  • The impact of the tobacco control plan on smoking behaviors occurs with a lag because of the time it takes individuals to  cut back or quit—and particularly for spending programs, the time it takes to launch new initiatives.
  • In calendar year 2002, the city and state each hiked their excise taxes on cigarettes to $1.50, for a total of $3.00 per pack. With additional state increases in 2008 and 2010, the combined state and local tax is now $5.85 per pack, plus an additional $1.01 per pack federal tax.
  • The big increase in city spending on antismoking programs, along with the tax increases, have been credited with reducing the smoking rate in the city during a period when the U.S. smoking rate barely declined. In 2010, the city’s smoking rate fell to 14.0 percent, a 15-year low and 5.3 percentage points below the U.S. rate.
  • After 2010, smoking rates in the city began to rise, reaching 16.1 percent in 2013 (the latest data available), just 1.7 percentage points below the U.S. rate. The increase in the city’s smoking rate occurred in tandem with declines in spending on tobacco control programs. City spending on antismoking campaigns in 2011-2014 averaged about a third less than during the 2007-2010 peak spending period.
  • Health department officials have cited the decline in spending on tobacco control as a cause of the increase in the share of adults who smoke. With $5.0 million budgeted for tobacco control in the current fiscal year, less than half the amount spent in 2014, there is concern that the smoking rate could continue to rise.

Prepared by Erin Kelly
New York City Independent Budget Office

SOURCES: Department of Health and Mental Hygiene, Community Health Survey 2002-2013; Centers for Disease Control and Prevention, National Health Interview Survey, 2013

Print version available here.

New York City By The Numbers

IBO Homepage

Are New York City’s Part-Time, Low-Income Workers More Reliant On Medicaid than Similar Workers in Other Parts of the State?

More than half (51.3 percent) of the state’s lowest income part-time workers—those with incomes at or below 200 percent of the federal poverty level—resided in New York City in 2012.

  • A greater reliance on Medicaid among New York City’s lowest income part-time workers may be linked to their lower rate of enrollment in employer-sponsored health insurance compared with the rest of the state.
  • A smaller share of low-income, part-time workers was uninsured in the city than in the downstate suburbs. But an even smaller share of these workers was uninsured upstate, where the rate of enrollment in employer-sponsored health insurance was highest in the state.

For more details on regional differences in health insurance coverage across New York State, see IBO’s recent report “Medicaid, Employer-Sponsored Health Insurance & the Uninsured in New York: Regional Differences in Health Insurance Coverage.”

New York City Independent Budget Office

SOURCE: American Community Survey Public Use Microdata Sample 2012
NOTES: Percentages do not sum to 100. Direct purchase insurance and Medicare are excluded, and individuals may have both employer-sponsored health insurance and Medicaid. The federal poverty level for a family of four in 2012 was about $23,500.

Print version available here.

New York City By The Numbers

IBO Homepage

How Many Mentally Ill Inmates Are in City Jails? How Does This Compare with the Capacity of the City’s Psychiatric Facilities?

NOTES: Jail numbers are the average for all of fiscal year 2013 and include inmates as young as 16. Psychiatric facility capacity numbers are point in time numbers as of April 2014 and are for adults only.
  • Of the daily average of 11,827 inmates in New York City jails, 37 percent, or 4,376 inmates on any given day, had a mental health diagnosis.
  • The combined capacity of all New York City inpatient psychiatric facilities is only slightly higher at 4,518.

Prepared by Christina Fiorentini and Nashla Rivas Salas
New York City Independent Budget Office

SOURCES: Mayor’s Management Report Fiscal 2013; New York State Division of Budget; New York State Office of Mental Health

Print version available here.

New York City By The Numbers

IBO Homepage

Will New York City Hospitals That Treat Many Low-Income Patients Face The Heaviest Penalties Under New Federal Reimbursement Policies?

Two new federal policies tying Medicare reimbursements to quality of care took effect in October 2012. Hospitals are now penalized for excess readmissions. An additional penalty or bonus can be awarded, based on adherence to clinical standards and ratings on patient surveys.

Hospitals that serve the city’s poor−public hospitals and private safety-net hospitals−generally face heavier penalties than other hospitals. Penalties for 8 out of 12 public hospitals and 4 out of 6 safety-net hospitals exceed the citywide average of 0.97 percent of reimbursements.

Medicare accounts for $777 million of expected inpatient revenues in 2013 at Health & Hospitals Corporation facilities, about 30 percent of all anticipated inpatient revenues, ranging from $21 million at North Central Bronx Hospital to $112 million at Bellevue.

nycbtn15

SOURCES: United Hospital Fund; U.S. Centers for Medicare & Medicaid Services
NOTES: Some hospitals have more than one campus, but penalties/bonuses are systemwide. Private safety-net hospitals, as defined by the United Hospital Fund (UHF), are those where Medicaid and uninsured patients comprised more than 50 percent of admissions, other than births, in 2008.

Prepared by Christina Fiorentini
New York City Independent Budget Office

PDF version here.

New York City By The Numbers IBO Homepage