Category Archives: Access to Health Care
Kaiser Family Foundation Finds Modest Increase for Family’s Share of Employer-Sponsored Health Insurance
Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to a new Kaiser Family Foundation survey of more than 2,000 employers. That rise is moderate by historical standards according to the survey; since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).
The survey also found that large deductibles of at least $1,000 are common in employer-sponsored plans, especially for employees at smaller firms. This year, 38 percent of all covered workers face such a deductible. At small firms, 58 percent of covered workers now face deductibles of at least $1,000, including nearly a third (31 percent) who face deductibles of at least $2,000, up from 12 percent in 2008.
Additional findings of the survey:
- Nearly all large employers (at least 200 workers) offer at least one wellness program and more than a third (36 percent) of large employers who offer them also provide some kind of financial incentive for workers to participate, such as lower premiums or a lower deductible, receiving a larger contribution to a tax-preferred savings account, or gift cards, cash or other direct financial incentives.
- Among large firms offering health benefits, more than half (55 percent) offer some kind of biometric screenings to measure workers' health risks. Of these, 11 percent reward or penalize workers financially based on whether they achieve specific biometric outcomes.
"This will be an important issue to watch next year, as employers [under the Affordable Care Act can] ask workers to pay more because of their lifestyles and health conditions," said Kaiser Vice President Gary Claxton, the study's lead investigator and director of the Foundation's Health Care Marketplace Project.
Read more on access to health care.
CDC: $75.8M to Help Health Departments Prepare for, Respond to Infectious Diseases
The U.S. Centers for Disease Control and Prevention (CDC) has awarded approximately $75.8 million in grants to help state, territorial and certain local health departments prepare for—and respond quickly to—an array of infectious diseases. The grants are through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement. They will go to such critical areas as surveillance, detection, and outbreak response efforts in infectious disease areas such as foodborne diseases, influenza and healthcare-associated infections. “With many infectious diseases first identified at the local level, this funding ensures that state health departments are able to effectively prevent, detect and respond to such public health threats,” said Beth P. Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases.” Read more on infectious diseases.
Study: Quitting Smoking Even After Becoming Pregnant Reduces Risk, Complications of Low Birth Weight
While women who quit smoking right before or right after becoming pregnant will on average gain more pregnancy-related weight, and are also less likely to have babies who are born small, according to a new study in the journal Obstetrics and Gynecology. Low birth weight increases the risk for infections; breathing and respiratory disorders; delayed growth and social development; and learning disabilities. Other studies have also linked smoking during pregnancy to premature birth, birth defects and stillbirth. "The big thing to get out of this study is that quitting early in pregnancy is as helpful in respect to the birth weight of your baby as never having smoked while you were pregnant," said Amber Samuel, MD, a maternal-fetal medicine expert at Emory University School of Medicine in Atlanta. "I think that can be an inspiration to moms who are looking to make a change in their lives." Read more on maternal and infant health.
Malpractice Worries Mean More Tests, Higher Costs for Patients
Concern over malpractice suits increases the number of diagnostic tests ordered by physicians and referrals to emergency rooms, which in turns adds significantly to the costs of health care, according to a new study in the journal Health Affairs. This problem of “defensive medicine” cost the nation approximately $55.6 billion in 2008, or 2.4 percent of all U.S. health care spending. "It's an area where we can chip away at healthcare costs without causing pain to the patient, since these are services ordered not primarily because doctors think they're medically necessary," said Michelle Mello, senior author and professor of law and public health at the Harvard School of Public Health in Boston. Researchers examined the records of approximately 29,000 people who experienced chest pain, lower back pain or headache, but were not later diagnosed with a serious illness related to the complaint. The found that physicians with high levels of concern over malpractice suits ordered additional testing for people with headaches about 11 percent of the time (compared to 6 percent for doctors with low levels of concern) and for patients with lower back pain ordered additional tests about 30 percent of the time (compared to 18 percent). Read more on access to health care.
Poll: 10% of Americans Take Drugs Prescribed for Someone Else
Approximately 1 in 10 Americans has taken prescription drugs prescribed to somebody else, according to a new Reuters/Ipsos poll. About 6 in 10 say they did it for pain relief, while 1 in 5 said it was to sleep or manage stress and anxiety. The poll also found that it was generally not difficult to for people to get their hands on non-prescribed medications, with two-thirds of users saying they were given the drugs by a family member, friend or acquaintance. With prescription drug misuse already the second most abused category of drugs in the United States, this ease of access and casual approach to taking major narcotics is a serious public health issue with severe potential problems. Wilson Compton, MD, a division director at the National Institute on Drug Abuse, said that because prescription drugs are tailored to a person’s particular needs, it can be dangerous for someone else to take them. "Simply because it's a medicine that comes from a pharmacy does not mean it is without risk," he said. "There's a reason they require a prescription." Read more on prescription drugs.
Drug for Enlarged Prostate, Baldness Improves Ability to Identify Prostate Cancer Early
A recently completed study on the effects of a drug used to treat enlarged prostates and male pattern baldness also reduces the risk of prostate cancer by making it easier to identify and treat early, according to a new study in the New England Journal of Medicine. It also refutes concerns that finasteride, found in the prostate drug Proscar and the hair-loss drug Propecia, promotes more virulent prostate cancers."You take Proscar for six months to a year and it halves the size of your prostate, but the cancer inside your prostate does not shrink," said Otis Brawley, MD, chief medical officer for the American Cancer Society. "If I'm performing a biopsy on a smaller prostate, I'm more likely to hit that cancer than if I am sticking into a larger prostate. This drug wasn't causing more prostate cancer. It's causing more prostate cancer to be diagnosed." Approximately 1 in 6 men will be diagnosed with prostate cancer in their lifetime, with 3 to 5 percent dying from the disease. Read more on cancer.
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Part of Brown’s research includes how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. This is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think emergency departments can take the lead on to improve public health?
The United Nations Foundation believes that, for the biggest public health obstacles facing the world, it will take all nations and all sectors working toward solutions to succeed. So the Foundation works to make that a reality, bringing together partnerships, growing constituencies, mobilizing resources and advocating policies that can help everyone—in both the developing and developed world.
NewPublicHealth recently spoke with Kathy Calvin, President and Chief Executive Officer of the United Nations Foundation, about the organization’s many efforts to improve health both globally and locally—and how these two goals can support each other.
NewPublicHealth: What changes have you seen in global health during your time in the field?
Kathy Calvin: The number of nonprofits dedicated to health issues has quadrupled it seems, and real progress has been made, which is the most important point—that we’re actually seeing a reduction in maternal deaths and newborn deaths and preventable diseases such as measles and diarrhea and pneumonia. I mean, there’s just been enormous progress, with still much more to happen. But it’s been an exciting time after what I think has been a pretty discouraging period where no amounts of foreign aid seemed to be making a difference. I attribute that partly to some innovations in research and financing, but also to the fact that a lot of governments in Africa actually have prioritized women and prioritized health in some pretty significant ways. And I think we’ve had a very enlightened government in the last five years here, too, in terms of what we’re doing overseas.
So, it’s been exciting to see it. Health is not my background. I’ve really been privileged to see both how serious and significant the challenges are, but also how much good can be done with just a little bit of organized effort.
NPH: When you talk about enlightened government, what are some examples? What is making the difference now?
Calvin: Well ironically it isn’t all that political. In fact, some of the biggest shifts took place under President George W. Bush’s administration with his creation of the President’s Malaria Initiative—until then, there had been zero real depth of interest and progress on malaria—as well as PEPFAR, which some people criticized because it was so bilateral, but it had a huge impact in allowing the current administration to really set some ambitious goals for reducing and eliminating parent-to-child transmission and setting that audacious goal of an AIDS-free generation.
About 40 million U.S. workers don’t receive even a single paid sick day and millions of others can’t utilize sick leave to take care of a sick child. The result is sick kids in school—where they make others sick—and a dramatically increased likelihood of ending up in an emergency room rather than a doctor’s office.
About $1.1 billion in emergency department costs could be saved each year if every U.S. worker had access to paid sick days, according to Vicki Shabo, the Director of Work and Family Programs at the National Partnership for Women & Families. Shabo recently spoke with Grassroots Change about the importance of paid sick leave and the on-the-ground efforts to enact the essential public health initiative at the local level—while also battling government preemption efforts that would take away local ability to improve sick leave policies.
“Unfortunately, we’re seeing a trend,” she said. “It’s sobering and undeniable. There are preemption bills this year that have been introduced in 13 or so states, and several of them have passed. Last year we saw Louisiana pass preemption, and until we alerted some of the local groups on the ground, no one was paying attention to it.”
This and other examples illustrate the critical importance of grassroots efforts to combat preemption and promote improved sick leave policies, which Shabo says benefits workers and their families while having no negative economic impact. With the number of these grassroots advocates growing every day, the next step is improving training and providing more resources to improve policies statewide.
“The takeaway message is that progress is possible, it’s happening, and local grassroots activity is instrumental in the progress that’s been made. As we work federally, grassroots activity will continue to play a central role in future progress. We know that this is not something that we can do from Washington—it has to come from the ground up.”
The Robert Wood Johnson Foundation Human Capital portfolio’s blog, a forum for discussion about the challenges of building a diverse, well-trained health care workforce, features a “Day in the Life” series this week featuring public health nurses. With their own words, these nurses talk not just about what they do, but why they do it—the importance and meaning of their efforts.
For Anneleen Severynen, RN, MN, PHN, of the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State, it’s about being able to help one person at a time. Anneleen wrote about Charlie, a 60-year-old Native American man who started drinking at the age of 12, bounced around foster homes, returned from service in Vietnam hurting even more, and now calls himself a “lost cause” who expects to drink himself to death.
“As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.”
By helping him to open up she was also able to get Charlie to agree to a few medical tests. He was given a prescription for high blood pressure. She doesn’t know whether he’ll follow through, but she knows that because she took the time to listen, he now has a better chance.
“Every day I get the chance to make a difference in people’s lives, and to help them know that they matter. I can help one person at a time make small choices that will improve their lives and health. As long as there is someone to hear their stories, there are no lost causes.”
Even as the global population continues to grow, technological and societal advances mean that our world is constantly getting smaller. Or at least that we are becoming more interconnected.
Understanding this—that a person in a Midwestern U.S. state is better off when a person on the other side of the world has access to quality health care—the U.S. Department of Health and Human Services’ (HHS) Global Health Strategy is working with partners across the globe to improve the health of everyone.
"Although the chief mission of [HHS] is to enhance the health and well being of Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world," said HHS Secretary Kathleen Sebelius.
One of the most powerful initiatives has been the push toward greater immunization rates. Immunizations alone saved 3 million children’s lives in 2011. Over the past decade, premature deaths from measles have been cut by 71 percent and from tetanus by more than 90 percent. And polio is closer and closer to complete eradication.
Still, vaccine-preventable diseases still account for approximately one in four global deaths of children under the age of 5. And of the 22 million children who go without the full benefits of vaccines each year, it is often the poorest that are most affected.
Among the greatest continuing obstacles are the persistent myths surrounding vaccinations, such as the false and repeatedly debunked belief that they cause autism.
“Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.”
>> Read the full “Beyond our borders: Why the U.S. Department of Health and Human Services invests in global efforts” at DefeatDD.org.
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
Even Insured Low-income Immigrants Less Likely to Visit Doctors
About 47 percent of insured and uninsured low-income immigrant children saw a doctor in 2010, compared about 60 percent for U.S.-born children, according to a new study from the Migration Policy Institute (MPI). The report also found that immigrant adults are less likely (8 percent) than native-born adults (13 percent) to visit emergency rooms. As immigrants are generally not eligible for coverage under the Affordable Care Act, their care will in many cases fall to health departments. Read more on access to care.
Exercise Alone Won’t Lower Weight; Lifestyle Changes Also Required
Exercise alone is good for maintaining a healthy weight, but should be combined with other lifestyle changes if a person expects to lose weight and then keep it off. People also negate the positive effects of exercise by overindulging in their post-workout rewards. "There's a war between exercise and nutrition in our heads," said American Council on Exercise spokesperson Jonathan Ross. "People tend to overestimate the amount of physical activity they get. They work out a little bit and treat themselves a lot." Between 250 and 300 minutes of exercise each week is necessary for weight loss, according to Joseph E. Donnelly, MD, an exercise physiologist with the American College of Sports Medicine; the government’s recommendation of 150 minutes of moderate-intensity is for cardiovascular fitness. A single pound of fat is about 3,500 calories. Read more on physical activity.
Soda Company to Stop Adding, Promoting Antioxidants in Some 7UP Drinks
The Dr. Pepper Snapple Group has agreed to stop fortifying certain of its 7UP soft drinks with vitamins and will no longer claim the product has antioxidants. The agreement ends a class action lawsuit against the company. 7UP’s regular and diet Cherry Antioxidant, Mixed Berry Antioxidant and Pomegranate Antioxidant varieties had small amounts of vitamin E added at the time of the lawsuit. According to the complaint, the pictures of cherries, blackberries, cranberries, raspberries and pomegranates on various 7UP labels gave the impression that the antioxidants might have come from fruit, but there is no fruit juice of any kind in any variety of 7UP. And last week a federal magistrate ruled that a separate lawsuit against Coca-Cola, for what the Center for Science in the Public Interest says is deceptive marketing of its vitaminwater line of soft drinks, may proceed as a class action suit. Read more on nutrition.
With just 83 days to go until health insurance marketplaces open up to allow otherwise uninsured Americans to sign up for health coverage under the Affordable Care Act (ACA), NACCHO Annual has a good number of plenary and other sessions focused on the role of public health in implementing the law.
>>Read more NewPublicHealth coverage of NACCHO Annual.
In his address to the 1,000 plus attendees at this year’s NACCHO conference, Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, talked about what local health departments can do to support ACA. “This is an all hands on deck situation,” said Frieden. “We want to do a lot with improving quality of care, but first we’ve got to get people signed up.”
Frieden ticked off actions that local health departments can take to help support enrollment, including:
- Provide resources to the community on getting insured & the benefits of being insured, including free preventive care.
- Educate every resident served by the department, such as immunization, tuberculosis and STD clinic patients, on how they can enroll.
- Educate every organization that the health departments connects with, such as schools, courts and businesses, on how stakeholders can enroll.