Category Archives: Access to Health Care
Study: Newly Insured Visit Emergency Departments More Often
While some experts have speculated that expanded insurance under the Affordable Care Act would decrease the rate of emergency department visits, a new study in the journal Science indicates that newly insured people actually visit the departments significantly more than people who were uninsured. The study of 25,000 Medicaid lottery participants in Oregon in 2008 found that people who received expanded coverage increased their visits by 40 percent—or 0.41 visits—over a period of 18 months. The visits encompassed all manner of health issues, included issues that could have been treated by a primary care physician and would have been covered by the insurance. Read more on access to health care.
Electronic Media Use During Family Meals Tied to Poorer Nutrition and Communication
The use of electronic devices—including television, music with headphones and texting—by teens during meals is linked to less nutritious food and poorer family communication, according to a new study in the Journal of the Academy of Nutrition and Dietetics. In a survey of more than 1,800 parents, researchers asked how often adolescent children used a variety of electronics during family meals, whether they had any rules regarding their use and whether they felt family meals were important; the children were asked questions about family communication, such as how often they discussed their problems with their parents. The study found that two thirds of the teens watched television or movies some of the time, with one quarter watching frequently. Other electronic activities were less common, occurring 18 to 28 percent of the time. About 75 percent of the families had limits on mealtime media. "There is no magic number of how many (family meals) to have, not all food at meals has to be 100% healthy and having electronic media at meals is not all bad (e.g., an occasional movie night with dinner) if it facilitates family time," said lead author Jayne A. Fulkerson. "But, parents can take small steps to have quality time with their children by reducing media use at mealtimes." Read more on nutrition.
Smoking Adds $17 Billion to Post-Surgery Costs Each Year
Smoking-related complications following surgery—for both current and former smokers—add an estimated $17 billion in direct U.S. medical costs each year, according to a new study in JAMA Surgery. The study, led by David Warner, MD, of the Mayo Clinic, looked at surgical patients between April 2008 and December 2009. While the costs for initial hospitalizations was relatively consistent for current smokers, former smokers and people who never smoked, post-surgery costs were an estimated $400 higher for current smokers and $273 higher for former smokers. Read more on tobacco.
More Than One Million People Now Enrolled for Health Insurance Coverage under the Affordable Care Act
The Centers for Medicare and Medicaid Services (CMS), which administers the health insurance provisions of the Affordable Care Act (ACA) reported late last week that more than one million people have now enrolled for coverage under the ACA.
CMS also reported that December enrollment as of December 27 was seven times that of October and November. Open enrollment will continue through March, with rolling dates for first day of coverage. Read more on the Affordable Care Act.
U.S. Flu Cases on the Rise
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported last week that rates of flu are on the rise in the United States, with the 2009 H1N1 virus the predominant strain. The good news is that this year’s flu vaccine is protective against H1N1.
According to CIDRAP, officials from the Centers for Disease Control and Prevention have said that the 2009 H1N1 virus has a greater impact on younger adults and older children than seasonal flu strains typically do.
The numbers of U.S. flu cases are usually highest January through March, which means that people who have not had flu shots yet still have time to protect themselves. Full immunity from the vaccine can take up to two weeks from the time of the injection. Use the CDC’s Flu Vaccine Finder to find a flu shot in your neighborhood. Read more on outbreaks.
New Orleans Health Commissioner to become Federal Health IT Administrator
New Orleans Health Commissioner Karen DeSalvo, MD, has been appointed the new National Coordinator for Health Information Technology (IT), replacing Farzad Mostashari, who left the position earlier this year. In a memo to employees of the U.S. Department of Health and Human Services (HHS), which oversees the office of the National Coordinator, HHS Secretary Kathleen Sebelius noted that Dr. DeSalvo boosted the use of health IT as "a cornerstone of [New Orleans’s] primary care efforts and a key part of the city's policy development, public health initiatives and emergency preparedness." Dr. DeSalvo will begin her post in mid-January. Under Dr. DeSalvo's leadership, New Orleans also received the inaugural Robert Wood Johnson Foundation Roadmaps to Health Prize.
New Infographic, Premium Payment Extension Will Help People Signing up for Health Insurance Coverage
Americans Health Insurance Plans, the trade association of many of the U.S. health insurance companies, has released a very easy to understand new infographic that helps simplify the steps for buying health insurance on the federal or state exchanges under the Affordable Care Act.
The new infographic is not the only bonus from the trade association this season. Last week the group announced that most insurers are extending the deadline for people purchasing coverage to pay their premiums to January 10, so long as signup for the plan is before January 1. Coverage for those signups will be retroactive to January 1.
Telehealth Technology Could Help Obese Youth Get Better Treatment, Lose Weight
Telehealth technology—a secure computer system that enables patients to speak “face-to-face” with doctors who are far away—could be an effective strategy to help obese youth who are trying to lose weight, according to new research from UCLA. With a multidisciplinary approach often the prescribed for treating obesity, telehealth services would reduce travel time while giving patients access to expertise that might not be available in their area. This would be especially helpful for low-income families. The UCLA study linked UCLA health care providers with patients at their local health clinics, finding that 80 percent of the 45 study subjects were happy with the technology and would use it again. "One surprise was how natural it was to talk with each other through the telehealth system, even though we never met the patients in person," said lead author Wendy Slusser, MD, medical director of the Fit for Healthy Weight program at Mattel Children's Hospital UCLA and director of pediatric wellness programs at the Venice Family Clinic. "The interaction was very much like being in the same room together. Some kids even thought it was fun to see themselves on the screen." Read more on access to health care.
Study: Psychiatrists Less Likely than Other Doctors to Accept Insurance
Psychiatrists are less likely than other doctors to accept private insurance, according to a new study in JAMA Psychiatry. Researchers analyzed government data from 2005 to 2010, which surveyed approximately 1,250 doctors each year, finding that from 2005 to 2010 the percentage of psychiatrists who accepted private insurance dropped from 72 percent to 55 percent. In comparison, over that same time the rate for doctors in other areas only dropped from 93 percent to 89 percent. While the study does not explain the vast difference, Jeffrey Lieberman, MD, president of the American Psychiatric Association, said reimbursement is a major concern, according to Reuters. "Many doctors can't afford to accept insurance because (insurance companies) don't pay them for the time," he said. "It involves taking more time with the patient and often treating them with psychotherapy.” Read more on mental health.
Even Mild Hits to the Head Can Cause Brain Damage
Even mild hits to the head that don’t cause concussion can still lead to problems with memory and thinking, according to a new study in the journal Neurology. Researchers equipped 80 football and ice hockey players with special helmets that gathered data on mild hits; while none of the players were diagnosed with a concussion, they still showed signs of deficits in thinking after the season. "This suggests that concussion is not the only thing we need to pay attention to," said Tom McAllister, MD, chairman of the department of psychiatry at the Indiana University School of Medicine. "These athletes didn't have a concussion diagnosis in the year we studied them ... and there is a subsample of them who are perhaps more vulnerable to impact. We need to learn more about how long these changes last and whether the changes are permanent." Read more on injury prevention.
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.
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.
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.
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.
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.
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.