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Health Articles In the
News
The
Economics of Health Care
Shreveport Times July 4, 2006
By: Dr. Michael Fleming
The economics of health care. Never was there such an oxymoron. Where we
have come over the past 30 years is not where any of us wanted to come.
Now we have definite quality issues in health care. The most common
cause of bankruptcy in this country is related to medical bills. Over 46
million Americans are uninsured at some point in every year, and as many
as 75 million are underinsured. And it has been suggested that a third
of our health care expenditures, now at nearly $18 trillion annually,
are for preventable problems related to lifestyle.
But we really don't have a "health" care system. In fact, it is a "sick
care" system. Our system pays when we are sick, but not to prevent
illness, which would save huge sums of money. Let's start this series by
looking at where health care takes place and where the money is spent.
Of the nearly $18 trillion, the largest portion, nearly a third, is for
hospitals; the next largest at over 21 percent is for physician and
clinical services. Prescription drugs account for less than 11%. Nursing
home care and home care are at about 6.5% and 2.5% respectively.
Government public health activities, that part of spending that we all
look toward protecting us from deadly pandemics and disasters, receives
only about 3%. But the cost of administration and insurance is over
double that amount at $120 billion.
So this would suggest that most health care takes place in hospitals,
right? Nope, in fact, in any given month only about 3% of all health
care occurs in hospitals, and about 5.5% in emergency departments. Over
85 % of health care in this country occurs in physicians' offices. The
pyramid is obviously upside down-we are spending the most for "sick"
care, and less on health care.
Where is this headed? Anyone who has tried to access the system without
insurance, anyone who has paid for a prescription, anyone who has
looked, really looked, at a hospital bill knows too well. It is a system
that is spinning out of control, and stopping the avalanche appears
almost impossible. But, in fact, there is some hope out there.
First is personal responsibility. The medical costs for obesity-related
illness add up to about $75 billion every year, smoking another $75
billion and an additional $80 billion in lost productivity: violence,
abuse and suicide costs range from $84 billion to more than $300 billion
per year.
And there are many more: alcohol, drug abuse, sexually transmitted
diseases, teen pregnancy and accidents and injuries. The cost estimates
I use come from a variety of sources, but when you add them up, it's
about $800 billion. That's more than double the national bill for
Medicaid, about half the national health care bill of $1.7 trillion
dollars.
Second is system change. Edwards Demming, the "father" of quality
improvement, once said every system produces exactly the results for
which it was designed. So if we keep working in a faulty system and
expect different results, well…??
Dr. Michael Fleming is a past president of the American Academy of
Family Physicians.
National campaign against hospitals saves more than
120,000 lives.
Shreveport Times, June 15, 2006
By Mike Stobbe, The Associated Press
Hospitals have reduced lethal mistakes and breakdowns in care to prevent
the unnecessary deaths of more than 120,000 patients in the past 18
months, said leaders of an unprecedented national campaign.
"I think this campaign signals no less than a new standard of health
care in America," said Dr. Donald Berwick, a Harvard professor who
organized the campaign.
About 3,100 hospitals took part in the project, sharing mortality data
and carrying out study-tested procedures that prevent infections and
mistakes.
"We in health care have never seen or experienced anything like this,"
said Dr. Dennis O'Leary, who heads the Joint Commission on Accreditation
of Healthcare Organizations.
Experts say the cooperative effort was unusual for a competitive
industry that traditionally avoids dealing publicly with patient-killing
problems.
Berwick announced the campaign's results Wednesday morning at a hospital
conference in Atlanta. O'Leary was one of hundreds of industry officials
in attendance.
Medical mistakes were the focus of a widely noted 1999 national report
that estimated 44,000 to 98,000 Americans die each year from errors.
That year, Berwick-president of the Institute for Healthcare
Improvement, a Massachusetts based nonprofit organization, challenged
health care leaders to improve care quality.
In December 2004, he stepped up the challenge by announcing a "100,000
Lives Campaign." He set a June 14, 2006 deadline to sign up at least
2,000 U.S. hospitals in the effort and implement six types of changes.
Americans less healthy than the British
By: Carla K. Johnson The Times, Shreveport, LA
And Mike Stobbe Wednesday, May 3, 2006
The Associated Press
Chicago--White, middle-aged Americans-even those who are rich-are far
less healthy than their peers in England, according to stunning new
research that erases misconceptions and has experts scratching their
heads.
Americans had higher rates of diabetes, heart disease, strokes, lung
disease and cancer-findings that held true no matter what income or
education level
Those dismal results are despite the fact that U.S. health care spending
is double what England spends on each of its citizens.
"Everybody should be discussing it: Why isn't the richest country in the
world the healthiest country in the world?" asks study co-author Dr.
Michael Marmot, an epidemiologist at the University College London in
England.
The study, based on government statistics in both countries, adds
context to the already-known fact that the United States spends more on
health care than any other industrialized nation, yet trails in rankings
of life expectancy.
The United States spends about $5,200 per person on health care while
England spends about half that amount in adjusted dollars.
Even experts familiar with the weaknesses in the U.S. health system
seemed stunned by the study's conclusions.
"I knew we were less healthy, but I didn't know the magnitude of the
disparities," said Gerard Anderson, an expert in chronic disease and
international health at Johns Hopkins University who had no role in the
research.
Just why the United States fared so miserably wasn't clear. Answers
ranging from too little exercise to too little money and too much stress
were offered.
Even the U.S. obesity epidemic couldn't solve the mystery. The
researchers crunched numbers to create a hypothetical statistical world
in which the English had American lifestyle risk factors, including
being as fat as Americans. In that model, Americans were still sicker.
Smoking rates are about the same on both sides of the pond. The English
have a higher rate of heavy drinking.
Only non-Hispanic whites were included in the study to eliminate the
influence of racial disparities. The researchers looked only at people
ages 55 through 64, and the average of the samples was the same.
Americans reported twice the rate of diabetes compared to the English,
12.5% versus 6%. For high blood pressure, it was 42 % for Americans
versus 34% for the English. Cancer showed up in 9.5% of Americans
compared to 5.5% of the English.
The upper crust in both countries was healthier than middle-class and
low-income people in the same country. But, richer Americans' health
status resembled the health of the low-income English.
"It's something of a mystery," said Richard Suzman of the U.S. National
Institutes of Health, which helped fund the study.
Health experts have known the U.S. population is less healthy than that
of other industrialized nations, according to several important
measurements, including life expectancy. The U.S. ranks behind about 24
other countries, according to the World Health Organization.
Seniors' Medicare expenses will grow dramatically, experts say
By: Larry Wheeler The Times-Shreveport, LA
lwheeler@gns.gannett.com Wednesday, May 3, 2006
WASHINGTON-Seniors will face substantial out-of-pocket cost increases as
the Medicare program becomes more expensive, experts warned Tuesday.
The typical senior couple today has an annual income of approximately
$35,000, with 20% of their disposable income dedicated to Medicare
premiums and other cost-sharing requirements, said John Palmer, a
Syracuse University professor and a member of the Social Security and
Medicare board of trustees.
In 25 years, seniors will spend 40% of their disposable income on
Medicare expenses, Palmer said at an event sponsored by the American
Enterprise Institute, a policy think tank.
"It's a big problem for beneficiaries," Palmer said.
The grim prediction came as a panel of experts dissected the annual
Social Security and Medicare trustees report issued just 24 hours
earlier.
The report showed Medicare could go broke in 2018, two years earlier
than was predicted in last year's report.
Although the new Medicare Part D prescription drug benefit is actually
costing an estimated 20% less than expected, other factors will continue
driving up health care costs for retirees, said Richard Foster,
Medicare's chief actuary.
Monthly premiums for Medicare Part B, which covers physician and
outpatient services, will increase approximately 11% next year to
$98.23. That's on top of increases of 17% in 2005 and 13% in 2006.
Six years ago, the Medicare Part B premium was $45.50 per month.
Generally, the Part B premium is deducted directly from beneficiaries'
Social Security checks, cutting into each year's cost-of-living
adjustment intended to help retiree benefits keep pace with inflation.
Seniors can save money by joining one of the new Medicare-approved
prescription drug plans, Mark McClellan, administrator of the Centers
for Medicare and Medicaid Services told those attending the AEI
briefing.
The drug plans are delivering prescriptions "at much lower costs and
better benefits than many independent experts predicted", McClellan
said.
McClellan described a complex series of initiatives under way at
Medicare that he said would improve the delivery of quality health care
while controlling costs.
Nevertheless, health care cost increases and heavy demand are expected
to continue driving the Medicare system toward insolvency unless
Congress acts, said Douglas Holtz-Eakin, a former director of the
Congressional Budget Office. But there are no easy solutions, he said.
The rising cost of health care is the single most important policy
problem we face as a nation, "Holtz-Eakin said. "we are not going to
grow our way out of the problem. You cannot tax your way out of the
problem. You are not going to legislate your way out of the problem. You
have to find something deeper."
Grave Medicare ills await attention while Bush tackles Social
Security
The program provides health insurance to 42 million old or disabled
people.
By: Alan Fram The Times, Shreveport, LA
The Associated Press March, 2005
WASHINGTON - A looming Medicare shortage is 7 times the size of the one
that Social Security faces and nearly 4 times the entire federal debt.
It is not being addressed by President Bush and Congress, and, to some,
that is just as well.
Social Security, which Bush has hoisted atop his domestic agenda, is
$3.7 trillion short of what it will need for benefits over the next 75
years, under the latest federal projections. Medicare, the health care
program for the elderly, must find an estimated $27.8 trillion.
By 2018, Social Security is on track to start paying more annually to
recipients than it collects in payroll taxes - an ominous tipping point
that Medicare reached last year.
While Social Security is expected to exhaust its reserves in 2042,
Medicare should deplete the trust fund financing its hospital benefits
in 2019, the latest forecasts show.
Medicare's problems are full of political and technical complexities
that are thornier than those confronting Social Security.
That makes it a daunting mix the White House would rather tackle later.
"Once we modernize and save Social Security for a young generation of
Americans, then it will be time to deal with the unfunded liabilities in
Medicare," Bush told reporters last month.
Social Security supports 47 million people, most of whom are elderly or
disabled. It is the largest federal program at $517 billion this year.
Medicare, costing $325 billion, provides health insurance to 42 million
old or disabled people.
Though Medicare is smaller today, the government and public trustees who
oversee both programs projected last year that Medicare's costs would
overtake Social Security's by 2024 and nearly double them by 2078.
Helping make Social Security the current priority for the president and
fellow Republicans is its relatively clear problems and potential
solutions. It faces a crunch from the retirement of baby boomers
starting later this decade. It either will need more money from the 12.4
% payroll tax that workers and their employers split, or cuts in
benefits, or extra federal borrowing.
Medicare faces the same demographic tidal wave - plus the added costs
and complications of health care. Progress in medicine and medical
technology are helping increase health care costs by about 7% a year -
more than double general inflation.
As a result, few people think Medicare expenses can be definitively
contained without stemming the growth of overall medical costs - an
intricate task on which there is little consensus. It also would involve
taking on the potent lobbies of the nation's doctors and other health
care providers.
"I don't think anybody has a good idea how to resolve" Medicare's woes,
said Senate Budget Committee Chairman Judd Gregg, R-N-H. He acknowledges
that he lacks the votes to overhaul Medicare in the budget that Congress
will write this year. "Let's solve the one we can solve."
Governors wary of Medicaid cuts
By: Brian Tumulty The Times, Shreveport, LA
Gannett News Service January 20, 2005
WASHINGTON - A bipartisan group of 14 governors met Wednesday to discuss
ways to persuade the administration to not cut federal support for the
Medicaid program under which states share in the cost of health services
to the poor and elderly.
"I strongly hope they don't balance the budget on the backs of state
taxpayers", said Gov. Jim Doyle D-WI. Referring to the administrations
2006 budget expected to be released Feb. 7.
President Bush has promised to cut the deficit - which hit a record $413
billion in 2004 - in half within 5 years.
Medicaid is one of the largest federal entitlement programs and provides
health care to more than 40 million people.
In 2003, federal and state Medicaid costs totaled $261 billion, up
20%from $217 billion in 2001, according to the administration.
The federal share of Medicaid costs ranges from a high of 77.1% in
Mississippi to a low of 50% in NY, NJ, IL, MN and 8 other states.
The growth of the program also has put a strain on state budgets. Some
states - Such as TN, MS and AR - that have cut back on eligibility have
been sued, noted Gov. Mike Huckabee, R. AR.
Bush's nominee to oversee the federal-state Medicaid partnership as
secretary of health and human services declined at a Senate confirmation
hearing Wednesday to discuss possible cuts.
The HHS secretary-designee, former UT Gov. Michael Leavitt, said he
favored keeping as mandatory spending the health services targeted for
required populations. But, he indicated that spending on optional
populations should remain optional.
That means health services for pregnant women and certain uninsured
children could be in jeopardy in states that can't cope with a federal
spending cap, responded Sen. Jay Rockefeller, D-WV, "Our state can't".
Leavitt said spending limits do not necessarily mean fewer people would
be eligible. "I believe Medicaid is not efficient," Leavitt said. "I
don't think it's meeting its potential to serve the poor".
In a telephone interview later in the day, the director of the Centers
for Medicare and Medicaid Services said the administration wants to work
with the governors.
"It's absolutely right that they need more ability to test out and then
broadly implement effective approaches to get better care to more people
at a lower cost," said Dr. Mark McClellan. "That is the only way to make
the Medicaid program sustainable."
Medicaid lists nursing home care, as a required service, but the
outdated federal law does not list less expensive alternatives that more
than 10 states have waivers for, according to McClellan.
"It is better to pay $10,000 or $15,000 a year for strong home care
supports than to pay $50,000 for a nursing home", McClellan said. "We
can do it cheaper and provide better satisfaction to more people."
There already are eligibility and spending caps on certain parts of the
Medicaid program, McClellan said.
"We know they face some challenges with their budget." Said Huckabee.
"We're saying first, do no harm".
"There are structural problems with Medicaid" said Gov. Mark Warner,
D-VA., Chairman of the National Governors Association. "The increasing
number of people who choose not to have health care, who are basically
tree riders, default into Medicaid if they have a catastrophic illness."
Study finds medication errors harm 1.5 million a year
Shreveport Times 7-21-06
By: Elizabeth Weise, Gannett News Service
Medication errors are among the most common medical errors, harming at
least 1.5 million people every year. The problem is so serious that, on
average, a hospital patient is subject to at least one medication error
per day.
These are among the findings in a report released Thursday by the
Institute of Medicine, chartered by Congress to advise the government on
science and medical issues.
The extra medical costs of treating medication-related injuries
occurring in hospitals alone conservatively amount to $3.5 Billion a
year, the report states. The IOM panel estimates that at least a quarter
of these injuries are preventable.
"The good news is that many of these errors are preventable, and
preventing them will save money in the long run," says J. Lyle Bootman,
co-chairman of the IOM panel that crafted the report and dean of the
College of Pharmacy at the University of Arizona, Tucson.
The report recommends that all health care providers and pharmacies be
using electronic prescribing systems by 2010.
Because the similarity of drug names causes up to a quarter of all
medication errors, the IOM committee called for the standardization of
drug-naming terms. The pharmaceutical industry should develop a plan to
deal with drug naming, labeling and packaging problems by the end of
next year, the report states.
The panel called use of medications "ubiquitous," noting that in any
given week, more than four of 5 U.S. adults take at least one medication
and almost a third take at least five different drugs.
For patients, it is key to be an active participant in your own care,
says Albert Wu, a panel member and professor of health policy and
management at Johns Hopkins University in Baltimore.
"If (your medication) comes in a different color or different shape,
don't just assume that they sent you the right pill - call and ask,"
Bootman says. If a doctor isn't available, ask the pharmacist who issued
the drug, he says. Other IOM recommendations for patients include:
- Read, understand and follow the instructions for each drug you
take. More than 50% of patients, don't take their medications
exactly as prescribed, the report states.
- Keep a list of all medications and all non-prescription drugs
taken, as well as all vitamins and herbal remedies. Review the list
with your health care provider at every visit to make sure there
aren't dangerous drug interactions.
Other IOM recommendations for the pharmaceutical Industry:
- The Food and Drug Administration should help standardize the
text and design of medication leaflets so consumers can understand
them.
- The National Library of Medicine should create a website that is
a comprehensive, understandable source of information about drugs
and fund a national telephone line for people who don't have
Internet access.
- The study was sponsored by the U.S. Department of Health and
Human Services and Centers for Medicare and Medicaid Services.
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