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Treatment Failure |
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Written by Bernd Wollschlaeger, MD, FAAFP, FASAM
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Monday, 08 October 2012 08:44 |
Attached a link to a provocative editorial titled "Simple Treatments, Ignored" focusing on the poor outcome of hypertension treatment. The editorial reflects on the findings of a recent federal health analysis which found that nearly one-third of all American adults have high blood pressure and more than half of them don't have it under control. The new analysis, issued last recently by the Centers for Disease Control and Prevention, found that 67 million Americans had high blood pressure and that 31 million of them were being treated with medicines that reduced their blood pressure to a safe level. The remaining 36 million fell into three groups: people who were not aware of their hypertension, people who were aware but were not taking medication, and those who were aware and were treated with medication but still had hypertension. There are many missed opportunities for people with high blood pressure to gain control. Doctors, nurses and others in health care systems should identify and treat high blood pressure at every visit. The editorial not only points out that this is an abysmal record for a medical condition that is easy to detect and treat but also features solutions. Kaiser Permanente says that, in Northern California, it increased the percentage of patients whose hypertension was under control from 44 percent in 2001 to 87 percent in 2010. Over approximately the same period, stroke mortality declined by 42 percent, heart attacks by 24 percent and the most serious type of heart attack by 62 percent. The organization created a hypertension registry to track patients and the care they were getting; eased the burden on doctors by using pharmacists to initiate drug therapy and medical assistants to monitor patients' progress; made it easy for patients to get free blood pressure checks; and showed doctors how their record on controlling blood pressure compared with others in the system. In my opinion our healthcare system is dysfunctional and deeply flawed. The system is still characterized by the separation of functions and tasks delivered by a plethora of healthcare providers who collect mountains of paper, or now Terabyte of data, but fail to share such data efficiently to coordinate care. We must break down these walls of isolation and collaborate in teams. Patient Centered Medical Homes can provide solutions to this problem but we need to accelerate its implementation and deploy community-based healthcare teams comprised of doctors, nurses, social workers, pharmacists, community activists etc. We have to break down the barriers built by professional organizations which protect the interest of its members, but lost their focus on public health. Such a local, regional and national strategy can control healthcare costs, improve quality of care and decrease debilitating morbidity related to chronic diseases. What are we waiting for? Dr. Wollschlaeger is a frequent contributor to FHIweekly and Specialty Focus. You can read more of his articles by visiting http://floridadocs.blogspot.com/.
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Last Updated on Saturday, 13 October 2012 09:21 |
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Is the ACA Relevant in 2012 Healthcare Debate? |
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Written by Paul Gionfriddo
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Monday, 01 October 2012 07:02 |
Our Health Policy Matters A column focusing on federal, state and local health policy Why did the health care debate in this year's election campaign pivot so quickly from the Affordable Care Act to Medicare? It may well be because of this: While people still feel strongly about ACA, they don't really see it as relevant to them. But Paul Ryan made Medicare relevant to everyone when he proposed changing the program for the under-55 population. Some new data from the U.S. Census Bureau may explain why most people don't see ACA as relevant to them. We learned this month that the number and percentage of people without health insurance changed modestly in the year after ACA passed. The number of uninsured people went from 50 million to 48.6 million. The percentage of uninsured decreased from 16.3 percent to 15.7 percent. These changes were small, as were some others. The percentage of people with employer-based insurance decreased slightly, from 45.7% in 2010 to 45.1% in 2011, and the percentage of people who purchase private insurance directly remained the same, at 3.6%. Despite rumors of a "government takeover" of health insurance, government programs also experienced modest changes. The Medicaid population grew from 48.5 million, or 15.8% of the population, to 50.8 million, or 16.5%. Medicare recipients grew by 2 million, from 44.9 million people (14.6%) to 46.9 million people (15.2%). And the populations experiencing the biggest gains because of ACA aren't very big when compared to the population as a whole.
- Nearly 3 million young adults under the age of 26 are covered on their parents' insurance plans as a result of ACA, but they represent less than 1% of the population - and some were already on their parents' plans before ACA passed because they were still in school.
- Approximately 3.6 million Medicare donut hole recipients saved drug money in 2011 because of ACA, but they also represent only about 1% of the population - and they were already on the Medicare program anyway.
- 4.5 million early retirees remained on employer plans after ACA - but many of these had been on those plans anyway; it was the plans that became eligible for financial relief under ACA.
- Approximately 13 million people got insurance rebates because of ACA in 2012, but many of those rebate dollars were credited to employers, not to individuals. Perhaps another 1% of the population - one third of those covered by individual insurance only - actually received the full value of the rebate in the form of a check.
These numbers are just big enough to elicit a yawn from more than 95% of the population. Click HERE to read the entire blog post. |
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Last Updated on Saturday, 13 October 2012 09:24 |
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Mental Health Policy Mistakes |
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Written by Paul Gionfriddo
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Monday, 17 September 2012 08:01 |
Our Health Policy Matters A column focusing on federal, state and local health policy My son Tim is among the 6% of us with a serious mental illness. His illness has been incredibly hard on his family, which is pretty common. It has been worse on him. I believe strongly that public policy mistakes led Tim to where he is in life. I have written about this in a new Our Health Policy Matters column Mental Health Policy Mistakes and the Sons and Daughters Who Pay for Them. The column is very personal, but there's more. Health Affairs, the leading health policy journal in the nation, has just published a longer version of Tim's story and mine. Entitled How I Helped Create a Flawed Mental Health System That's Failed Millions - and My Son, this September 2012 Narrative Matters essay covers twenty years of Tim's life in Connecticut, Texas, and California, from the time he first showed symptoms of mental illness as a child to his present day life on the streets of San Francisco. Health Affairs is making the full article available free of charge to both subscribers and non-subscribers at this link. Tim's story wasn't easy to write, and it may not be easy to read. You will be the best judge of its relevance and value to you after you read it, and I would welcome your response and feedback. My bottom line: We can do much better than we have for people with mental illnesses, but only if we are willing to try. |
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Last Updated on Saturday, 13 October 2012 09:25 |
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So how's that health care in Switzerland turning out? |
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Written by by Aaron Carroll
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Friday, 14 September 2012 12:21 |
The Incidental Economist Contemplating health care with a focus on research, an eye on reform Many of my more conservative counterparts like to point to Switzerland as an example of a system they would favor more. It's a private-insurance system that is all run at the level of the individual. You don't get insurance through the government or your job; you buy it on your own. There's a mandate, but there are also subsidies for the poor, aiming to keep everyone's contributions to health care below 10% of their income. There are also fairly high co-pays and deductibles. It's a fairly expensive system, although still cheaper than ours. It performs decently in terms of quality. There are plenty of things that today's conservative will find unappealing, but it's probably closer to ideal for them than what we have today. Click HERE to finish blog post.
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The Worst States for Your Health 2012 |
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Written by Paul Gionfriddo
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Monday, 10 September 2012 07:21 |
Our Health Policy Matters A column focusing on federal, state and local health policy What do South Carolina, Texas, Louisiana, and Mississippi have in common? They all find themselves among the worst states for your health in this week's Our Health Policy Matters rankings. And along with Florida and Iowa, they all have governors who have already declared that they don't want to expand Medicaid to uninsured adults in their states. The states near the bottom of the rankings also rank poorly in spending Medicaid dollars to keep people in the community and in spending on public health and prevention. And they should be nervous about the changes Paul Ryan has proposed for the Medicare program, because Medicare spending on community services is the one area in which many of these states shine. To read the full column and see the full rankings of all the states, click here. |
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Last Updated on Monday, 10 September 2012 08:00 |
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To what extent is health care spending growth technology driven? |
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Written by Austin Frakt
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Monday, 10 September 2012 07:18 |
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Last Updated on Monday, 10 September 2012 07:59 |
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Health reform prospects if Gov. Romney wins |
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Written by Don Taylor
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Friday, 07 September 2012 00:00 |
freeforall health policy and budget wonkery and the politics of where they meet I know that conventions don't typically provide a lot of policy details, but my overall impression after Tampa is that Gov. Romney has further muddled his potential to undertake any significant health reform if he is elected President. The most consequential thing I heard this week along these lines was when Rep. Ryan seemed to say that a Romney administration would restore the Medicare cuts that the ACA enacted and that the House Republican budget passed, restoring the status quo. At the same time, Medicare is somehow still terribly unsustainable and we must do something.....but not for 10 years. I understand that if they don't win the election, they don't even get a chance, but Republicans always seem to be playing for the short run political gain on health reform, and in doing so boxing themselves in by reducing their future options. Could they take an obvious simple deal? A few weeks back I concluded a post assessing the impact on health policy of naming Rep. Ryan to the ticket in this way: If Gov. Romney and Rep. Ryan win, then I assume that means Republicans will keep the House and retake the Senate. I fully expect under those circumstances that the ACA will be repealed. Lots of my friends are worried about what the Republicans will then put in place of the ACA. I am actually more worried that they would do what they have done the past 19 months in the House on replace: nothing. Now I am worried that they have nearly pledged to do so. And that (nothing) would be easy to accomplish given the political inertia of a Republican controlled House and Senate that had come to power in large part by running against the ACA. From my perch, Republicans just don't seem to be able to get beyond what they are against when it comes to health reform. To use a football analogy, they are pretty good on defense, but don't seem to have an offense. This is the primary blog of Don Taylor, Associate Professor of Public Policy of Duke University that focuses on health policy, the federal budget and the politics of these key public policy issues. Professor Taylor is the author of Balancing the Budget is a Progressive Priority published by Springer in April 2012. |
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