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Reports from 2004 & early 2005
AMERICANS PAYING ALMOST TWICE PRESCRIPTION COST OF OTHER COUNTRIES
US prescription drug prices reached 81% above the average prevailing in seven other wealthy nations in 2003. This is the highest excess on record. The yearly rise in US drug prices, relative to the average in other nations, since 2000 is shown as are country-by-country comparisons over time. (U.S. prices rose despite a weakening dollar, which should have had the effect of making foreign prices slightly higher, other things equal.) Drug makers claim that research depends on high US prices, and therefore argue against price cuts here. We conclude that US price controls are inevitable--caused by the drug makers' own successes in garnering high and growing revenue from the U.S. market in recent decades. This year, the U.S. will provide the world's drug makers with roughly one-half of their world-wide total. Generating dollars to finance research and sustain profits can be made compatible with substantially lower U.S. prices.
CLICK HERE for the original document from Boston University .
DYING FOR BASIC CARE - For Blacks, Poor Health Care Access Cost 900,000 Lives
More than 886,000 deaths could have been prevented from 1991 to 2000 if African Americans had received the same care as whites, according to an analysis in the December issue of the American Journal of Public Health. The study estimates that technological improvements in medicine -- including better drugs, devices and procedures -- averted only 176,633 deaths during the same period. That means "five times as many lives can be saved by correcting the disparities [in care between whites and blacks] than in developing new treatments," Steven H. Woolf, lead author and director of research at Virginia Commonwealth University's Department of Family Medicine, said in a telephone interview with the Post for this article appearing 12/21/2004 on Page HE01 by JW Payne.
We were trying to say that there was something you could do in medical research to improve health outcomes," said co-author David Satcher, former U.S. Surgeon General. "But if you didn't focus more on the translation of that into especially the populations that tended to be left behind . . .you were not going to get as much out of the research as you would otherwise. Access to care is a big factor. African Americans and Hispanics are much more likely to be uninsured and underinsured and underserved" and may not seek care as often as whites, Satcher said. "So a great part of it is really focusing on how do we get prevention programs, intervention programs [and] treatment programs to people in underserved communities?
Winston Price, president of the Washington-based National Medical Association (NMA), called the findings "staggering" and said the study sheds new light on a concern that has existed for decades. The NMA, which calls itself "the collective voice of physicians of African descent," recently launched the W. Montague Cobb/NMA Health Policy Institute, dedicated to eliminating racial disparities in health care.
"Socioeconomic conditions represent a more pertinent cause of disparities than race," the study states. "An intriguing question is whether more lives are saved by medical advances or by resolving social inequities in education and income."
US COMPANIES AND EMPLOYEES CONTINUE TO STRUGGLE WITH DOUBLE-DIGIT RATE
INCREASES
On average, Hewitt forecasts that companies will experience 2005 cost increases of 11.5% for health maintenance organization plans (HMOs), 10.5% for traditional indemnity plans, 11% for preferred provider organizations (PPOs) with projected employee contribution increases of 15% across all plan types. That means from 2004 to 2005, the average cost per person for major companies will increase from $6,519 to $7,269 for HMOs; $6,823 to $7,573 for PPOs; $7,192 to $8,019 for POS plans; and $6,793 to $7,506 for indemnity plans, according to Hewitt's database of more than 2,000 health plans in 139 U.S. markets, including 300 major employers and more than 18 million health plan participants."While there are many different variables that factor into regional health care cost increases, one of the most powerful drivers is the level of consolidation in the market," added (Hewitt's national health care practice leader Jack) Bruner. "Plans and providers continue to merge in many cities, reducing the purchasing power and number of options available to employers."
CLICK HERE for the original document from Hewitt
BETTER DATA FOR UNDERSTANDING RACIAL DISPARITIES IN HEALTH CARE
The first problem confronted in resolving the problems of racial disparities in health care was: How can we call for change in this area if the health care systems we are asking to improve do not have information about the race or ethnicity of their patients? So the first challenge we undertook was to promote the collection of better data on race and ethnicity by health plans and health care providers. Here data presented on how institutions can collect better data.
CLICK HERE for the original report from Robert Woods Johnson Foundation
MEDICARE ADVANTAGE IS WIDELY VIEWED AS FAILURE, FEWER AND WORSE CHOICES NOW
The role of private health plans in Medicare expanded substantially in 2004 under the Medicare Modernization Act, which builds on plan experience under Medicare+Choice. Medicare+Choice, recently renamed Medicare Advantage, was created in 1997 to offer more managed care choices for beneficiaries. Although sponsors originally hoped Medicare+Choice would lead to a greater role for private plans in Medicare, this report notes that the program is widely viewed as a failure, with plans leaving and beneficiaries having fewer, less attractive choices when the program ended in 2003 than they did when it began. As private plans continue to be a focal point for changing Medicare in the future, the researchers note that policymakers need a better understanding of the dynamics of the system to facilitate a successful transition.
CLICK HERE for the original report from Robert Woods Johnson Foundation
SOME STATES HAVE ESPECIALLY HEAVY BURDEN IN PAYING PRESCRIPTION DRUG BILLS
A new report from the Boston University School of Public Health finds that the rising burden of prescription drug costs is especially heavy in states where people are older, sicker, and have lower incomes, and offers evidence that drug price cuts are the only practical solution. This report documents the nationwide rise in the burden of drug costs as a share of personal income and the striking differences in that burden among the states.2 Focusing on burden means considering not only the level of drug spending in a state, but also the state’s capacity to absorb it. States facing the highest drug cost burdens will feel the most urgent political need to act to reduce the burden, other things equal. So will states suffering greater increases in the burden of drug costs. We also examine characteristics of states that are associated with higher drug cost burdens. We find that these tend to be poorer, older states, with higher illness rates.
CLICK HERE for the original article from Boston University
ONE IN EVERY SEVEN US FAMILIES HAVE TROUBLE PAYING MEDICAL BILLS
When asked, 'During the past 12 months have you or your family had any problems paying medical bills?' about 20 million families, or one in seven American families, reported problems paying medical billsAbout 20 million American families representing 43 million people reported problems paying medical bills in 2003, according to a new study by the Center for Studying Health System Change (HSC). While uninsured families are more likely to have medical bill problems, two-thirds of families with problems paying medical bills have health insurance coverage. Of all families with medical bill problems, almost two-thirds reported difficulty paying for other basic necessities rent, mortgage payments, transportation or food as a result of medical debt. People in families with medical bill problems also reported much greater trouble getting care because of cost concerns one in three did not get a prescription drug, one in four delayed care and one in eight went without needed care.
CLICK HERE for the original article from Health Systems Change
61% OF MEDICARE DOLLARS THAT WILL BE SPENT TO BUY MORE PRESCRIPTIONS TO REMAIN WITH DRUG MAKERS AS ADDED PROFITS
Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.
An estimated 61.1 % of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits. This windfall means an estimated $139 billion dollars in increased profits over eight years for the world's most profitable industry. At $17 billion annually, this means about a 38 percent rise in drug maker profit. This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.
CLICK HERE for the Report (Acrobat)
US COULD SAVE AT LEAST $286 BILLION ANNUALLY WITH NHI
A study by researchers at Harvard Medical School and Public Citizen published in the International Journal of Health Services finds that health care bureaucracy last year cost the United States $399.4 billion. The study estimates that national health insurance (NHI) could save at least $286 billion annually on paperwork, enough to cover all of the uninsured and to provide full prescription drug coverage for everyone in the United States.
The study was based on the most comprehensive analysis to date of health administration spending, including data on the administrative costs of health insurers, employers health benefit programs, hospitals, nursing homes, home care agencies, physicians and other practitioners in the United States and Canada. The authors found that bureaucracy accounts for at least 31 percent of total U.S. health spending compared to 16.7 percent in Canada. They also found that administration has grown far faster in the United States than in Canada.
Published in Jan 2004 in the International Journal of Health Services
Best link at PNHP CLICK HERE
COVERAGE AND COST IMPACTS OF THE PRESIDENT'S HEALTH INSURANCE TAX CREDIT AND
TAX DEDUCTION PROPOSALS
The President's tax credit and tax deduction proposals for non-group health insurance, when fully implemented, would increase the number of people with health insurance by almost 1.3 million, at a cost of more than $4,700 per newly insured person ($2.1 BIL in total cost). While the net change in the number of people with insurance is relatively small, these policies would result in a substantial movement of individuals away from employer-based coverage and into the non-group market, or in some cases, into being uninsured. Also of significance, the tax credit and tax deduction policies together result in a lower number of newly insured people, and a higher cost for each person newly insured, than the tax credit policy would achieve standing alone.
By offering tax subsidies for non-group health insurance, the policies would reduce the preference under current tax law for employer-based coverage over non-group insurance, with the likely result that fewer employers would offer health benefits to their employees. In some cases, these employees would not find other insurance, either because they would not want to pay the premiums for non-group insurance or because health problems could make it difficult for them to find affordable coverage in some states. People with health problems who lose employer-based coverage would likely face higher premiums and more coverage restrictions in the non-group health insurance market than they currently face when receiving health benefits through work. These same problems-relatively high premiums and coverage restrictions-already exist for people with health problems purchasing non-group health insurance in most states today.
Who benefits from the proposed policies? The newly insured under the tax credit policy (and the results for the combined policies are almost identical) tend to be younger and healthier than the uninsured overall, and tend to be younger than the under 65 population as a whole. This raises the question of whether these policies could be modified to provide more assistance to older or less healthy uninsured people, or whether an additional policy response, such as a public coverage expansion, would be needed to increase insurance access for these more costly groups of uninsured people.
Published in Jan 2004 in the International Journal of Health Services
Best link at PNHP CLICK HERE
INFLUENCE OF DIRECT TO CONSUMER PHARMACEUTICAL ADVERTISING AND PATIENTS' REQUESTS ON PRESCRIBING DECISIONS: TWO SITE CROSS SECTIONAL SURVEY
Barbara Mintzes, Morris L Barer, Richard L Kravitz, Arminée Kazanjian, Ken Bassett, Joel Lexchin, Robert G Evans, Richard Pan and Stephen A Marion
Only the United States and New Zealand allow advertising of prescription drugs directed at patients. US spending on such advertising grew rapidly during the 1990s, reaching $2.47bn in 2000. The dramatic increase in investment by the US pharmaceutical industry is evidence of an expected effect on sales. On the rationale that such advertising provides important information to consumers and patients who may benefit from advertised products, pharmaceutical manufacturers have campaigned in the European Union and Canada for the relaxing of current regulatory restrictions. We examined the relation between direct to consumer advertising and patients' requests for prescriptions and the relation between patients' requests and prescribing decisions.
CLICK HERE for this Report
BUSH, CONGRESS SHOULD DEVELOP UNIVERSAL HEALTH SYSTEM, IOM PANEL SAYS
The Institute of Medicine issued a report in which the agency for the first time formally recommended that by 2010 the United States implement a universal health insurance system to "prevent more unnecessary suffering, death and economic costs to society," the Washington Post reports (Stein, Washington Post, 1/15). The IOM based the report, titled "Insuring America's Health: Principles and Recommendations," on three years of research and five previous reports on the cost of health insurance (Kemper, Los Angeles Times, 1/15). A committee of academics, business leaders, health insurers and health care providers drafted the 205-page report (Appleby, USA Today, 1/15). The report concluded that the large number of uninsured U.S. residents -- about 43.6 million, or 15.2% of the population -- "results in unnecessary sickness and death, weakens the nation's economy and undermines the entire health care system," the Times reports (Los Angeles Times, 1/15).
According to the 16-member committee, "The lack of health insurance for tens of millions of Americans has serious negative consequences and economic costs not only for the uninsured themselves but also for their families, the communities they live in and the whole country," adding, "The situation is dire and expected to worsen." The five previous IOM reports found that uninsured residents receive about 50% less medical care as those with health insurance, a trend that "tends to leave them sicker and likely to die younger," the Post reports.
About 18,000 residents die each year because they lack health insurance. [In terms of loss of life that's a World Trad Center attack every two months, even if its "business as usual for the Bush Administration"]
GOOD HEALTH, A SHARED RESPONSIBILITY WHICH GENERATES WEALTH
It could be that European governments are no more ethical, humanitarian or altruistic than political leaders in the USA and that cultural differences account for very little of the difference in the current disaster known loosely as the US "health care system". Maybe its due to these two aspects of European consciousness: (1) that in accordance with the human rights laws they (and the USA too) have signed they acknowledge health care as a high priority obligation of every nation and a fundamental right of their people, (2) they are willing to admit what the data clearly demonstrate -that good health generates wealth.
Good health is a shared responsibility. Different actors must work together to foster good health across the EU. The EU and the Member States must cooperate respecting the varying distributions of responsibility under the Treaty, and harvesting the benefits of EU-wide networks for delivering the best solutions. The EU must achieve synergies with national authorities, stakeholders and international organisations and foster co-operation between the Member States. Healthcare and health systems are the responsibility of the Member States. Member States decide on how to manage their health systems, the size of the budget to allocate to health and healthcare, which medicines to reimburse, which technology to use. When citizens fall ill, they expect to have prompt access to treatment. And when there is a disease outbreak, they expect their governments to protect them.
Not just an obligation, nations are motivated by their own material best interests. As Byrne puts it "Health generates wealth". It is acknowledged that "health is closely intertwined with economic growth and sustainable development. There is evidence that investing in health brings substantial benefits for the economy. According to the WHO, increasing life expectancy at birth by 10% will increase the economic growth rate by 0.35% a year. On the other hand, ill health is a heavy financial burden. 50% of the growth differential between rich and poor countries is due to ill-health and life expectancy."
Editorial written about this report by Project EINO director
Summary of EU report CLICK HERE
The Health Impact of Resolving Racial Disparities: An Analysis of US Mortality Data
American Journal of Public Health, December 2004, By SH Woolf RE Johnson, GE Fryer, G Rust, D Satcher
The US health system spends far more on the "technology" of care (e.g., drugs, devices) than on achieving equity in its delivery. For 1991 to 2000, we contrasted the number of lives saved by medical advances with the number of deaths attributable to excess mortality among African Americans. Medical advances averted 176,633 deaths, but equalizing the mortality rates of Whites and African Americans would have averted 886,202 deaths. Achieving equity may do more for health than perfecting the technology of care.
Resolving the causes of higher mortality rates among African Americans can save more lives than perfecting the technology of care. Policymakers could act on this information without waiting for more precise projections. The prudence of investing billions in the development of new drugs and technologies while investing only a fraction of that amount in the correction of disparities deserves reconsideration. It is an imbalance that may claim more lives than it saves.
Abstract in American Journal of Public Health Dec 2004 CLICK HERE
Primary Care And Health System Performance: Adults' Experiences In Five Countries,
By Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Karen Davis, Kinga Zapert, and Jordon Peugh
This paper reports on a 2004 survey of primary care experiences among adults in Australia, Canada, New Zealand, the United Kingdom, and the United States.
Across multiple dimensions of care, the United States stands out for its relatively poor performance. With the exception of preventive measures, the U.S. primary care system ranked either last or significantly lower than the leaders on almost all dimensions of patient-centered care: access, coordination, and physician-patient experiences. These findings stand in stark contrast to U.S. spending rates that outstrip those of the rest of the world. The performance in other countries indicates that it is possible to do better. However, moving to a higher-performing health care system is likely to require system redesign and innovative policies.
The challenge in all five countries is finding the right combination to improve primary care and move to a high-performance care system. The lack of a strong patient-centered or primary care orientation in the United States emerges throughout the survey and underscores the importance of examining international strategies that could be adapted and instituted at home.
Full Report in the journal "Health Affairs" CLICK HERE
ILLNESS AND INJURY AS CONTRIBUTORS TO BANKRUPTCY
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.92.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.
Full Report in the journal "Health Affairs" CLICK HERE
HEALTH COSTS ABSORB ONE-QUARTER OF ECONOMIC GROWTH, 2000 - 2005
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.
February 9, 2005
The expected $621 BIL rise in U.S. health care spending from 2000 to 2005 will consume nearly one-quarter of the nation's projected economic growth (rise in GDP) of $2,579 billion ($2.6 trillion). Had health spending in those five years grown only as fast as GDP, the U.S. would have saved $280 billion in 2005 (one-seventh of expected health cost), and $1 trillion in five years. Health spending growth averaged 8.1 percent yearly-more than two-thirds (69 percent) over GDP's 4.8 percent. One-half of health spending goes to clinical and administrative waste, excess prices, and theft. Physicians can identify clinical waste. Careful cost controls should rest on physicians' decisions about services needed by each patient. Pathology is remorseless but resources are finite, so trade-offs are essential. There are no blank checks. Trustworthy methods of paying doctors should minimize incentives to over- or under-serve. Variations on this approach have been called "bedside rationing" or "professionalism within a budget."
For the links to the press release and the full report CLICK HERE
http://www.bu.edu/dbin/sph/departments/health_services/health_reform.php
The full report CLICK HERE
US NATIONAL HEALTHCARE DISPARITIES REPORT , 2004
Agency for Healthcare Research and Quality (AHRQ), February 2005
AHRQ released the 2004 National Healthcare Quality Report finding both evidence of improving quality as well as specific areas in which major improvements can be made. The 2004 National Healthcare Disparities Report indicates that there are disparities related to race, ethnicity, and socioeconomic status in the American health care system. The reports measure quality and disparities in four key areas of health care: effectiveness, patient safety, timeliness and patient centeredness. They also present data on the quality of and differences in access to services for clinical conditions, including cancer, diabetes, end-stage renal disease, heart disease, and respiratory diseases; and for nursing home and home health care.
Available online as PDF file [152p.] from AHRQ CLICK HERE
THREE VIEWS OF PERSONAL RESPONSIBILITY AND THE RIGHT TO HEALTH CARE
OVERCOMING DISPARITIES IN U.S. HEALTH CARE
By William H. Frist
Patients must be central to our efforts to improve health care. For instance, a person with a chronic illness such as diabetes must essentially "own" that illness if he or she is to have any hope of effectively managing it. Providers can help with high-quality treatment and the best recommendations, but patients must act on those recommendations. They must stop smoking, eat right, exercise, take their medication, and monitor their blood sugar, based on their own volition and usually outside of the clinical setting. Public policies must encourage patients to embrace personal responsibility.
Policies that promote dignity and personal responsibility will help decrease individuals' risky behavior. The major causes of death among African Americans, for instance, are heart disease, cancer, stroke, accidents, and diabetes. Most of these are chronic diseases rather than acute illnesses, and all of these causes of death are at least arguably preventable. Further, the top three can be reduced by decreasing tobacco use alone. We must promote policies that help people address individual behavior, such as smoking.
Some have voiced concerns that health care is somehow different: that the therapeutic relationship between doctor and patient should not be subject to competitive forces. Further, many argue that quality chasms and health disparities cannot be fixed by fostering competition. Certainly, competition does not provide all of the answers. We will need a strong safety net and vigorous attention to vulnerable populations. But all of our immediate health care system problems-rising costs, questionable quality, patient safety, rising numbers of uninsured people, and, yes, health disparities-are interrelated and can be improved by empowering patients and providers. We simply cannot afford to forgo the lower costs and increased quality and value that the right kind of competition will drive.
Abstract in the journal "Health Affairs" CLICK HERE
THE ROLE OF THE FEDERAL GOVERNMENT IN ELIMINATING HEALTH DISPARITIES
Health Affairs, March/April 2005, By Edward M. Kennedy
The state of U.S. minority health is an embarrassment to the nation. Minority communities are struggling with rising numbers of uninsured citizens, festering epidemics, and lower health care quality, all of which mean increased rates of diseases and preventable deaths. To end the minority health crisis, Congress and the Bush administration need to step up to the plate by increasing health insurance coverage and investing in cultural competence, workforce diversity, minority data collection and reporting, and overall public health. Greater resources should be given to the HHS Office for Civil Rights and Office of Minority Health, both of which lead the fight to reduce disparities. All of these efforts must be integrated into the larger effort to increase access and improve quality of care, since we face not only a minority problem, but a national problem. In addition, the country must be mindful that health is inextricably tied to educational opportunities for children, job security and living wages for families, safe and affordable community housing, and pension stability and social security for seniors. Elimination of disparities in health depends in part on progress in each of these critical areas.
Health insurance for all is still my overarching goal, so that the basic right to health care can become a reality for all citizens.
Abstract in the journal "Health Affairs" CLICK HERE
THE ROLE OF HEALTH INSURANCE COVERAGE IN REDUCING RACIAL/ETHNIC DISPARITIES IN HEALTH CARE
by Marsha Lillie-Blanton and Catherine Hoffman:
"To assess whether insurance expansions could be expected to reduce racial/ethnic disparities in access to care, this paper reviews evidence from studies specifically designed to quantify the contribution of health insurance to racial/ethnic disparities in access. The studies provide evidence that a sizable share of the differences in whether a person has a regular source of care could be reduced if Hispanics and African Americans were insured at levels comparable to those of whites."
Abstract in the journal "Health Affairs" CLICK HERE
STATEHEALTHFACTS.ORG
Updated Medicaid, Hospital, and Women's Health data.
Data from State Health Facts CLICK HERE
MEDICAID & SCHIP
Updates to total Medicaid spending data including spending by service, spending on acute care, and spending on long-term care.
Data from State Health Facts CLICK HERE
CURRENT MONTHLY MEDICAID ENROLLMENT
Data from State Health Facts CLICK HERE
PROVIDERS & SERVICE USE
Updates from the American Hospital Association for all hospital topics including the number of hospitals, beds, admissions, outpatient visits, emergency room visits, inpatient days, and the expense per inpatient day.
Data from State Health Facts CLICK HERE
WOMEN'S HEALTH
Updates to women's health data include the latest figures for pap smears and mammograms, and the number of states that have Medicaid waivers to cover family planning.
Data from State Health Facts CLICK HERE
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