Costs, costs, costs
Unrelenting costs increases and the economic meltdown are eroding the benefits of the Massachusetts health plan, according to a new study from the D.C.-based Urban Institute:
“Massachusetts continues to move forward on comprehensive health reform. Uninsurance is at historically low levels, despite the recent economic downturn. Building on that coverage expansion, access to and affordability of care in the Commonwealth have improved. Notwithstanding these successes, some of the early gains in reducing barriers to care and improving the affordability of care had eroded by fall 2008, reflecting trends that predate health reform in Massachusetts: Constraints on provider capacity and increasing health care costs.”
A Boston Globe story points out that ER use has not gone down.
One number that remained unchanged, the report found, was the roughly 15 percent of Massachusetts residents who reported throughout the surveys that they used hospital emergency rooms for non-urgent care. One key goal of the state’s initiative was to drive down ER use — which can be expensive — by extending insurance to nearly everyone, so they could regularly visit their family physicians.
Once again, I read the comments here with interest. This seems to be a big venue for intense, conservative opposition to major elements of health reform. Some of the commenters — to be kind — don’t seem very well informed. Check them out.
Also, note that the Globe picked up on the
continuing use of the ER for primary care of last resort in April.
The flu that wouldn’t go away
The Mass. Dept. of Public Health keeps posting the same notice with new numbers on top. The numbers heading into June: confirmed case count 413, with 27 hospitalizations. A few more schools have closed.
The World Health Organization counts more than 13,000 cases worldwide — about 11,000 of those in North America. Of the 95 deaths globally, 10 were in the US and 83 in Mexico.
The flu also generated a lot of news, according to a Pew Research Center survey.
It’s only second time that a health-related story made the No. 1 spot in America since they began counting in 2007. What was the other top health story? The guy who got on a plane with tuberculosis.
The health reform tactic that refuses to go away
Here’s what Marcia Angell would have said about the single payer approach, had she only been invited to the Senate Finance Committee health reform meeting this week:
{IMAGELEFT:http://www.massdevice.com/sites/default/wp-content/uploads/headshots/Angell_Marcia_100x100.jpg}“The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it — an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments.”
The piece drew a lot of supportive letters to the editor and a few in opposition,
like this one:
“Angell’s solution — to change the system to one wherein healthcare providers would be punished financially for doing tests and procedures — means a severe restriction in the quality and amount of care that providers would be able to offer their patients. And in a single-payer system, patients would have no alternatives. It would be like the post office before the days of Federal Express.”
I don’t know why people use the Post Office as the apex of inefficiency. I always get my mail.
Buyer beware
An article last week on the Health Affairs website suggests that hospitals themselves don’t always get what they pay for.
The research, which looked at hospital spending, not charges, was written by the practice-pattern variation watchers at Dartmouth and Amitabh Chandra of Harvard’s Kennedy School:
{IMAGELEFT:http://www.massdevice.com/sites/default/wp-content/uploads/headshots/Chandra_Amitabh_100x100.jpg}“Numerous studies in the United States have examined the association between quality and spending at the regional level. … For all of the quality indicators studied, the association with spending is either nil or negative. The absence of positive correlations suggests that some institutions achieve exemplary performance on quality measures in settings that feature lower intensity of care.”
The
Dartmouth Institute for Health Policy and Clinical Practice lays claim to the discipline of Evaluative Clinical Sciences. I find much of their work helpful in understanding the illogic of the health care system:
“Healthy skepticism about new treatments and medical “breakthroughs,” an understanding of the risks and benefits of many common therapies and surgeries, and unique educational programs have produced more informed agents of change among physicians, health professionals, the media, and the public.”
But I would edit that sentence.
Harvard and BPA
Harvard students have a little drinking problem, according to a new study on polycarbonate bottles and bisphenol A. One week of polycarbonate bottle use increased the BPA concentrations in their urine by two-thirds. Here’s the abstract from Environmental Health Perspectives.
The Globe reported that a Harvard prof was inspired to do a new study on the suspect by-product of some plastics when she saw her students drinking out of bottles.
“Led by Jenny Carwile, a Harvard School of Public Health doctoral student, 77 Harvard students in the study drank all cold beverages from stainless steel bottles for a week to wash BPA out of their bodies and minimize exposure. Then the students were given two refillable polycarbonate bottles made with BPA to drink all cold beverages from for one week. Urine samples taken over that week showed the students’ BPA levels spiked the second week to levels normally found in the general population.”
The same day this story ran, the Milwaukee Journal Sentinel ran a BPA story that said “government regulators relied on the trade association to do much of their work for them. The FDA relied on two studies — both paid for by chemical makers — to form the framework of its draft review declaring BPA to be safe.”
Tidbits
— Except for the gratuitous dig at that nebulous evil known as “the media”, I enjoyed learning on the
Running a Hospital blog that the house staff and interns at BIDMC give each other “awards” like the Golden Washcloth in categories like “Nicest General Orders.”
— As a non-manager who had to learn to manage my own business affairs, I can relate to these docs:
“A physicians group at Beth Israel Deaconess Medical Center has filed a lawsuit charging Bank of America Corp. with negligence and “wrongful debit” for allowing a former employee of the hospital to deposit into his own accounts more than 100 checks made out to patients.”
{IMAGELEFT:http://www.massdevice.com/sites/default/wp-content/uploads/headshots/Kemler_Norman_100x100.jpg}— Globe obit writer Gloria Negri offers
a nostalgic good-bye to Canton Dr. Norman Kemler, “who made house calls in the middle of the night and visited his hospitalized patients on weekends.” He died April 19 at age 92.
There’s more by Tinker Ready over at Boston Health News.