Category Archives: Access to Health Care

Nov 27 2013
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Public Health News Roundup: November 27

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Study: U.S. Graphic Warning Labels Could Get 8.6M Smokers to Quit
A new study out of Canada indicates that the U.S. Food and Drug Administration may have underestimated the potential impact of graphic warning labels on tobacco products. From 2000 to 2009, the warning labels cut Canada's smoking rate somewhere between 12 and 20 percent, which would be the equivalent of between 5.3 million and 8.6 million U.S. smokers. That's also 33 to 53 times larger than the FDA's estimates when they pushed for the warning labels--and when the tobacco industry successfully challenged the measure, with the court pointing to the low impact as one of the reasons for the ruling. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found," said Jidong Huang, MD, the study's author. "Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future." Read more on tobacco.

Expanding Nurse Practitioner Abilities Could Save Patients $472M by 2015
Expanding which health services nurse practitioners at retail health clinics can provide could save at least $34 per visit, or as much as $472 million in health costs by 2015, according to a new study in the journal Health Affairs. The estimated 6,000 retail health clinics, often found in chain pharmacies or "big box" stores, provide walk-in care for minor health problems. The rules for nurse practitioners vary from state to state, with some allowing them to prescribe medications and practice independently of a doctor's supervision. Researchers looked at insurance claims from 2004 through 2007, finding that the state's that grant wider latitude also tend to see lower costs for the patients:

  • $704 -- Average cost of treatment in the 14 days after a traditional doctor's office visit
  • $543 -- Average cost of care during and after a retail visit in states where nurse practitioners had no independence and could not prescribe medication
  • $484 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without the supervision of a doctor
  • $509 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without supervision and prescribe medication

Read more on access to health care.

New Estimate Puts 2009 Swine Flu Global Death Toll at More than 200K
The death toll from the 2009 swine flu epidemic was likely far higher than previously believed, according to a new study in the journal PLoS Medicine. Previously, the total stood at about 18,500 laboratory-confirmed deaths, though experts considered that to be a low estimate because it only factored in confirmed cases of H1N1. A new study, bringing together 60 researchers in 26 countries, now places the toll at as many as 203,000 global deaths--or 11 times higher than the previous estimate. "This study confirms that the H1N1 virus killed many more people globally than originally believed," study lead author Lone Simonsen, a research professor in the department of global health at the George Washington University School of Public Health and Health Services. "We also found that the mortality burden of this pandemic fell most heavily on younger people and those living in certain parts of the Americas." Read more on global health.

Nov 14 2013
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Public Health News Roundup: November 14

DOT and HUD Release Neighborhood Affordability Tool
The U.S. Departments of Housing and Transportation (HUD and DOT, respectively) have released a Location Affordability Portal, a new tool that lets users estimate housing and transportation costs for neighborhoods across the country.

“Many consumers make the mistake of thinking they can afford to live in a certain neighborhood or region just because they can afford the rent or mortgage payment. Housing affordability encompasses much more than that,” said HUD Secretary Donovan. “The combined cost of housing and transportation consumes close to half of a working family’s monthly budget, and the [Portal] will help to better inform consumers, help them save money, and provide them with a broader perspective of their housing and transportation options.”

The new tool was developed with the input of real-estate industry professionals, academics, and staff from HUD and DOT, and uses statistical models that were developed from various sources that capture key neighborhood characteristics including population density, transit and job access, average number of commuters and distance of commutes, average household income and size, median selected monthly owner costs. and median gross rent. Read more on housing and transportation.

Health Index May Reduce Hospital Readmissions
A health risk score used during hospital stays using routine data from hospital electronic medical records may be able to identify patients at high risk of unplanned hospital readmission, according to a study published in Medical Care.

The score is calculated automatically using patient data such as vital signs, nursing assessments, skin condition, heart rhythms and laboratory tests. Lower Rothman Index scores (from a maximum of 100) indicate a higher risk of readmission. The study evaluated the ability of the Rothman Index to predict hospital readmission, based on data from more than 2,700 patients hospitalized during 2011. The researchers found that patients whom the Index calculated as being high risk for readmission were 2.5 times as likely to be readmitted within 30 days of discharge as patients calculated by the Index to be low risk.

About 20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, at an estimated cost of $17 billion per year, according to the study authors. Medicare has begun reducing payments by up to 2 percent for hospitals with high readmission rates. Read more on community health.

Rapid Flu Testing in the ER Leads to More Effective Treatment
Using rapid influenza tests to diagnose flu in patients who come to the emergency room results in fewer unnecessary antibiotics, increased prescriptions for antiviral medicines, and fewer additional lab tests compared to patients diagnosed with influenza without testing, according to a new study the Journal of the Pediatrics Infectious Diseases Society.

Among patients diagnosed with influenza without rapid testing, 23 percent of the emergency department visits included a prescription for antibiotics, which are not effective in to treat influenza because it is a viral infection. However, for patients who were diagnosed by rapid testing, only 11 percent of visits resulted in the patient getting antibiotics. Additional laboratory tests, including chest X-rays, blood tests, and urinalysis, were also ordered less frequently for patients whose influenza illness was diagnosed with a rapid test.

"While other studies have shown that physicians can accurately diagnose influenza without testing, our results suggest that using an influenza test increases diagnostic certainty and leads to the physician providing more specific and appropriate care,” says Anne J. Blaschke, MD, PhD, of the University of Utah School of Medicine, the study’s lead author. Read more on infectious disease.

Nov 11 2013
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Public Health News Roundup: November 11

Survey: Violence in PG-13 Films Tripled in Past Two Decades
When the movie rating PG-13 debuted, PG-13 movies and R movies tended to have about the same amount of gun violence. Today PG-13 sometimes have more gun violence than R movies, and the overall amount of gun violence in the movies approved for the younger demographic has more than tripled in the past two decades, according to a new study in the journal Pediatrics. The researchers looked at 945 films sampled from the 30 top-grossing films annually between 1950 and 2012. "It doesn't take a lot of imagination to figure out there are going to be disturbed kids who are going to see this kind of content," said Daniel Romer, of the University of Pennsylvania's Annenberg Public Policy Center in Philadelphia. "The problem for parents is they can no longer rely on the PG-13 rating to tell them there isn't a lot of violence in those films.” James Sargent, MD, from the Geisel School of Medicine at Dartmouth and the Norris Cotton Cancer Center in Lebanon, New Hampshire, who was not involved in the study, said the findings demonstrate that the Motion Picture Association of America needs "to go back to the drawing board and fix their rating system so those movies are rated R for violence." Read more on violence.

New Federal Rules Ensure Mental Health Treatment Equal to Physical Health in Health Plans
New rules issued by the U.S. Departments of Health and Human Services, Labor and the Treasury on Friday will ensure that mental health is treated equal to physical health when it comes to co-pays, deductibles and visit limits that are features of health plans. Among the specific protections:

  • Ensuring that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings
  • Eliminating the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on “clinically appropriate standards of care,” which clinical experts advised was not necessary and which is confusing and open to potential abuse
  • Clarifying the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law

“These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices, and increase health plan transparency,” said Labor Secretary Thomas E. Perez. “Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.” Read more on access to health care.

Women of Limited Financial Means Often Wait to Seek Help with Breast Lumps
High costs of examination and treatment may be keeping younger women with limited finances from seeking early medical attention for breast lumps, according to a new study in the journal Cancer. Researchers found in a survey of women aged 40 and younger that while 80 percent found an abnormality in their breast on their own, 17 percent waited at least three months before seeing a doctor, with 12 percent of those who delayed treatment also having to wait at least 90 days between their appointment and receiving a diagnosis. Kathryn Ruddy, MD, of the Mayo Clinic in Rochester, Minn., said that future development of interventions should focus on this financial disparity that is also a health disparity. "The findings may lead to research focusing on whether reducing co-pays and hidden costs of seeking medical care—such as parking charges, child-care expenses and lost wages—may improve the timeliness of diagnosis in this population," she said. Read more on cancer.

Oct 18 2013
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Twentysomething? Have We Got an Affordable Care Act Story For You

Alarmed at recent surveys that show only about ten percent of young Americans who say they are very familiar with the Affordable Care Act (ACA), staff reporters at Kaiser Health News (KHN) have crafted a clever article—winsome graphics included—aimed at getting the attention of millennials about the new health law in time for them to sign up before looming deadlines.  

Getting the attention of millennials on the state or federal health insurance exchanges, recently launched and going through overhauls, is crucial for two key reasons. One is that young adults no longer on their parents' plan (now allowed until age 26 under the ACA) often don’t bother with health insurance because they believe they’re invincible, so why shell out hundreds to thousands in premiums and deductibles? That works fine unless an accident or illness ensues, which can cost hundreds of thousands or more.  

file Kaiser Health News graphic aimed to appeal to "young invincibles"

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Oct 17 2013
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Public Health News Roundup: October 17

Electronic Laboratory Reporting Increasing
Federal agencies are reopening today after a 16 day shutdown and public health updates such as FluView from the Centers for Disease Control and Prevention are expected to come back online within the new few days. CDC’s last news release before the shutdown was on the increasing capability of laboratories to report findings to local and state health agencies electronically. The report was published in the most recent issue of Morbidity and Mortality Weekly Report (MMWR).

According to CDC, the number of state and local health departments receiving electronic reports from laboratories has more than doubled since 2005, however, progress is still needed. The MMWR report shows that only about a quarter of the nation’s labs are reporting electronically and that electronic reporting lags for some diseases behind others. For example, 76 percent of reportable lab results for general communicable diseases were sent electronically, compared to 53 percent of HIV results and 63 percent of results for sexually transmitted diseases. Read more on infectious disease.

District Laws and Policies Reduce Sugary Foods and Drinks at School Parties
Schools with a district policy or state law discouraging sugary foods and beverages were 2.5 times more likely to restrict those foods at school parties than were schools with no such policy or law, according to a new study published online in the Journal of Nutrition Education and Behavior.

Researchers at the University of Illinois at Chicago School of Public Health examined the linkages between state laws, district, and school-level policies for classroom birthday and holiday parties through surveys of more than 1,999 schools in 47 states.

About half the schools had either no restrictions or left the decision to teachers; one-third had school-wide policies discouraging sugary items; and fewer than 10 percent actually banned sweets during holiday parties or did not allow parties.

The study was supported by the Robert Wood Johnson Foundation. Read more on nutrition.

Children of Same Sex Marriages Less Likely to be Covered by Health Insurance
Children with same sex parents are less likely to have private health insurance than children with married opposite-sex parents, according to a recent study in Pediatrics. Using data from the 2008-2010 American Community Survey on children aged 0-17 years, the researchers found that 78 percent of children with married opposite-sex parents had private health insurance coverage, compared to 63 percent of children with same-sex fathers and 68 percent of those with same-sex mothers.

However, in states with legal same-sex marriage or civil unions, or in states that allowed second-parent adoptions, the disparities in private health insurance was lower for children of same-sex parents, suggesting that children of gay and lesbian households benefited from these policies. The American Academy of Pediatrics endorsed same-sex marriage in March. Read more on access to health care.

Oct 16 2013
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Public Health News Roundup: October 15

American Heart Association: Doctors Should Routinely Ask About Physical Activity
A new scientific statement from the American Heart Association says that doctors should evaluate their patients’ physical activity habits as routinely as checking blood pressure and other risk factors for cardiovascular diseases. The statement was published in the journal Circulation.

The statement says that an exercise checkup should cover types, frequency, duration and intensity of physical activity at work, home and during leisure time.

The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity five days a week or more, or at least 20 minutes of vigorous aerobic activity three days a week or more and moderate- to high-intensity muscle strengthening at least two days a week. Read more on heart health.

People with Mental Health Problems More Likely to be Uninsured
A new University of Minnesota study published in Health Affairs finds that people with mental health problems are more likely to be uninsured and rely on public insurance than people without mental health problems. The study reviewed national insurance coverage rates from 1999 to 2010. The study authors say the implementation of the Affordable Care Act will give many more people with mental health problems access to health insurance – particularly in states such as Minnesota that have that have opted to expand their Medicaid programs. The researchers also say that people with mental health problems on public insurance have better access to care and lower cost barriers than the uninsured or those with private health insurance coverage.
 
Kathleen Rowan, the lead author of the study and a doctoral student in health services research, policy, and administration at the University of Minnesota School of Public, says, “unfortunately, most persons with mental illness do not receive needed care due in part to a lack of health insurance coverage and the cost of treatment.” Read more on mental health.

Study: Research to Delay Aging is a Better Investment Than Cancer, Heart Disease Research
A new study in current issue of Health Affairs finds that research to delay aging and the infirmities of old age would produce better health and economic returns than advances in some fatal diseases such as cancer or heart disease.

The study found that even modest gains in the scientific understanding of how to slow the aging process would result in an additional 5 percent of adults over the age of 65 remaining healthy rather than disabled every year from 2030 to 2060, or 11.7 million more healthy adults over age 65 remaining healthy by 2060.

The analysis was conducted by scientists from a consortium of research centers. “Even a marginal success in slowing aging is going to have a huge impact on health and quality of life. This is a fundamentally new approach to public health that would attack the underlying risk factors for all fatal and disabling diseases,” said S. Jay Olshansky, professor of epidemiology at the UIC School of Public Health and one of the study’s authors. “We need to begin the research now. We don’t know which mechanisms are going to work to actually delay aging, and there are probably a variety of ways this could be accomplished, but we need to decide now that this is worth pursuing.” Read more on aging.

Oct 15 2013
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Public Health News Roundup: October 15

Even Low Levels of Air Pollution Tied to Low Birth Weights
Even low levels of pollution can increase the risk of low-birth weight babies, according to a new study in The Lancet Respiratory Medicine. Researchers analyzed data on more than 74,000 women in 12 European countries, finding that all types of air pollution were linked to both increased risk of low birth weights and smaller average head circumference at birth.  The determined that every increase of 5 micrograms per cubic meter (mcg/m3) of fine particulate matter also increases the risk of low birth weight by 18 percent. The European Union’s current regulations call for a limit of 25 mcg/m3, but the study found the risk is still there at limits below this threshold; lowering it to the World Health Organization's guideline of 10 mcg/m3 could prevent as many as 22 percent of the cases. "Our findings suggest that a substantial proportion of cases of low birth weight at term could be prevented in Europe if urban air pollution—particularly fine particulate matter—was reduced," said lead author Marie Pedersen, MD, from the Centre for Research in Environmental Epidemiology in Barcelona, Spain. Read more on infant and maternal health.

Regular Exercise Can Boost Sperm Count, Improve Odds of Conception
Regular exercise—especially done outdoors—may boost a man’s sperm count and improve the odds of conception, according to a new study to be presented at the International Federation of Fertility Societies and the American Society for Reproductive Medicine in Boston. Researchers found that men who spent about an hour a day exercising had a 48 percent higher concentration than men who spent less than one hour a week exercising. The study also found clear associations between higher sperm counts and time spent either outdoors or lifting weights. Possible explanations include higher vitamin D levels in men who spent time outdoors in the sunshine and the increased testosterone levels and insulin sensitivity that come with lifting weights. Also, contradicting popular conceptions, the study found no link between caffeine and alcohol and decreased fertility. Read more on sexual health.

Study: Hospital CEO Salaries Tied to Patient Satisfaction, Not Quality of Care
Hospital CEO salaries tend to be higher at hospitals with high patient satisfaction ratings, and does not seem on average to be linked to either their quality of care nor the benefits they offer to their communities, according to a new study in JAMA Internal Medicine. "I was hoping I'd see even some modest relationship with quality performance," said lead researcher Ashish Jha, MD. "I think we were a little disappointed." Researchers at the Harvard School of Public Health analyzed data on 1,877 CEOs from 2,681 private, non-profit hospitals across the country, finding an average salary of $596,000; those in the lowest 10 percent earned about $118,000 and those in the highest earned about $1.7 million. While many different factors account for the wide range, Jha said the growing emphasis on improving quality measures suggests that the quality of care should be a factor when determining executive salaries. "If you're going to ask doctors and nurses to be accountable, if you're going to ask patients to be accountable…then I think we should make sure that everybody's in, and that senior managers of hospitals also have a stake in insuring high-quality care." Read more on access to health care.

Sep 26 2013
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Public Health News Roundup: September 26

Average Monthly Cost of Mid-tier Insurance Under Affordable Care Act Estimated at $328
The average monthly cost of a mid-tier health insurance plan under the Affordable Care Act will be $328, and government subsidies will also help reduce that cost for most Americans, according to a new report from the U.S. Department of Health and Human Services. The health exchanges open for enrollment next week and the federal government hopes to enroll as many as 7 million people within the first year. The cost varies from state to state, with Minnesota projected to have the least expensive plan at $192 per month and Wyoming projected to have the highest at $516. Read more on access to health care.

NIH Initiative Will Help Move Science from the Laboratories to the Commercial Sector
The U.S. National Institutes of Health (NIH) has awarded $31.5 million in grants to establish three inaugural NIH Centers for Accelerated Innovations that will work to improve how basic science discoveries move from laboratories to commercial products. The Centers are funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) and will focus on technologies to improve the diagnosis, treatment, management and prevention of heart, lung, blood and sleep disorders and diseases. “These centers essentially will offer a one-stop shop to accelerate the translation of early-stage technologies for further development by the private sector and ultimate commercialization,” said Gary H. Gibbons, MD, director of NHLBI. As a result, the public will gain access sooner to new biomedical products that improve human health while also benefiting from the economic growth associated with the creation of new companies and the expansion of existing ones.” Read more on research.

‘Cycling’ Drugs Could Help Combat Antibiotic-resistant Bacteria
“Cycling” between antibiotics may extend their life and effectiveness, while also enabling doctors to stay ahead of drug-resistant bacteria, according to a new study in the journal Science Translational Medicine. "You cycle between drugs that have reciprocal sensitivities," said study co-author Morten Sommer, a lead researcher with the Novo Nordisk Foundation Center for Biosustainability at the Technical University of Denmark. "If you become resistant to drug A, you will become more sensitive to drug B. That way, you can cycle between drug A and drug B without increasing resistance in the long term.” With the increased use—and overuse—of antibiotics, antibiotic-resistant bacteria are becoming an increasingly serious public health problem, leading researchers and health care professionals in search of new ways to combat the problem. More than 2 million people are made ill and more than 23,000 people die every year in the United States due to antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.

Sep 19 2013
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Public Health News Roundup: September 19

Confusing ‘Sell-by’ and ‘Best-before’ Labeling Leads to Billions of Pounds of Wasted Food
Inconsistent “sell-by” and “best-before” dates on package labels lead Americans to needlessly discard billions of pounds of food every year, according to a new study by Harvard Law School and the Natural Resources Defense Council. The labels are meant to inform retailers about a food product’s peak freshness. "The labeling system is aimed at helping consumers understand freshness, but it fails—they think it's about safety. And (consumers) are wasting money and wasting food because of this misunderstanding," said co-author Emily Broad Lieb, who led the report from the Harvard Law School's Food Law and Policy Clinic. The study recommends that “sell-by” dates be reconfigured so as to be invisible to consumers, that a uniform label system is created and that technology-based “smart labels” be used more often. "Under the current patchwork of state and federal laws, consumers are left in the lurch, forced to decipher the differences between 'sell-by' and 'best if used by,' and too often food is either thrown out prematurely, or families wind up consuming dangerous or spoiled food," said Congresswoman Nita Lowey (D-NY), in a release. Read more on food safety.

Study: Hospitals that Perform the Most Surgeries Also Have Lowest Readmission Rates
A new study from the New England Journal of Medicine indicates that the higher quality of care during a surgical procedure, the lower the likelihood of the patient being readmitted for additional surgery. It also found that hospitals that performed the most procedures also, on average, delivered a higher quality of care. In a review of about 480,000 patients discharged from more than 3,000 U.S. hospitals, the researchers found that one in seven were readmitted within 30 days, with the hospitals that did the most procedures having both the lowest readmission rates and the lowest death rates. Hospitals with the most surgeries had readmission rates of about 12.7 percent, compared to 16.8 percent for hospitals with the fewest procedures. "If hospitals performing very few surgeries do not have the volume required to create highly reliable care systems despite their best quality-improvement efforts, perhaps they should not be performing them," said Don Goldmann, MD, chief medical and scientific officer of the Institute for Healthcare Improvement in Boston, who was not involved in the study. "This is a provocative suggestion and deserves careful consideration before being implemented." Read more on access to health care.

HHS ‘Meaningful Consent’ Website to Help Providers, Patients Understands EHR Sharing
As electronic health records (EHRs) become more common, a new website from the U.S. Department of Health and Human Services (HHS) will help health care providers and patients determine exactly how they want their electronic patient health information shared. Meaningful Consent will address issues such as the laws and policies related to the health information exchange (HIE). It also includes strategies and tools for providers, certain health information organizations and other implementers of health information technology. The site also provides background, lessons learned, videos and customizable tools from the HHS Office of the National Coordinator for Health Information Technology’s eConsent pilot project, which tested the use of tablet computers to provide patients with better information on EHRs. Read more on technology.

Sep 16 2013
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Public Health News Roundup: September 16

U.S. Youth Exercise, Diet Improved Over Past Decade
Exercise and dietary habits of U.S. kids and teenagers seems to have improved over the past decade, according to a new study in the journal Pediatrics. The study found that from 2001-2002 to 2009-2010, the average number of days per week being physically active for at least 60 minutes for sixth through tenth graders climbed from 4.3 to 4.5; the days eating breakfast before school climbed from 3 to 3.3; and hours per day watching television dropped from 3.1 to 2.4. The findings suggest that it takes time for public health efforts to translate into behavioral changes. "I would like to believe that all the public health efforts focusing on increasing physical activity and increasing fruit and vegetable consumption are having an effect, because that seems to be a pattern," said Ronald Iannotti, study author from the University of Massachusetts Boston. "The fact that (obesity) is leveling off, that's a surprise and a major change from the steady increase that we've seen over time.” Read more on pediatrics.

Study: Kids of Same-sex Couples Less Likely to Have Private Health Insurance
Children of same-sex parents are less likely to have private health insurance, although the rates improve in states that recognize same-sex marriages or unions, according to a new study in the journal Pediatrics. Approximately two-thirds of U.S. youth with same-sex parents have private health insurance, compared to approximately 78 percent of U.S. youth with married heterosexual parents. When accounting for additional factors such as parental incomes and education level, researchers determined that youth living with same-sex parents were as much as 45 percent less likely to have private health insurance than were youth living with married heterosexual parents. The findings indicate yet another public health benefit of same-sex marriage, as access to health insurance directly affects a child’s health; previous studies have shown a connection between legal unions and improved mental health for gay and lesbian adults. A likely cause for the disparity is the fact that employers have not had to extend coverage to an employee’s same-sex partner or that employee’s children. "I think we are going to see more and more research like this that shows how marriage-equality laws have far-reaching health consequences," said Richard Wight, a researcher at the University of California, Los Angeles, who was not a part of the study. Read more on LGBT issues.

HHS: $67M for Expanded Preventive and Primary Care for 130,000 Americans
The U.S. Department of Health and Human Services (HHS) has awarded approximately $67 million for the creation of 32 new health service delivery sites to expand access to individuals, families and communities across the country. The sites will provide improved preventive and primary health care to more than 130,000 people. Another $48 million will go toward the approximately 1,200 existing centers. “Health centers have a proven track record of success in providing high quality health care to those who need it most,” said HHS Secretary Kathleen Sebelius. “New health center sites in some of the neediest communities in the country will provide access to health care for individuals and families who otherwise may have lacked access to high quality, affordable and comprehensive primary care services.” Read more on access to health care.