The best country for mothers
The best country for mothers
Global push to guarantee health coverage leaves U.S. behind
China, Mexico and other countries far less affluent are working to provide medical insurance for all citizens. It's viewed as an economic investment.
By Noam N. Levey, Washington Bureau
5:00 AM PDT, May 12, 2012
WASHINGTON — Even as Americans debate whether to scrap President Obama's healthcare law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.
China, after years of underfunding healthcare, is on track to complete a three-year, $124-billion initiative projected to cover more than 90% of the nation's residents.
Mexico, which a decade ago covered less than half its population, just completed an eight-year drive for universal coverage that has dramatically expanded Mexicans' access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is a fifth of America's, just 1% of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana — two of the world's poorest nations — are working to create networks of insurance plans to cover their citizens.
"This is truly a global movement," said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. "As countries advance, they are realizing that creating universal healthcare systems is a necessity for long-term economic development."
China, after years of underfunding healthcare, is on track to complete a three-year, $124-billion initiative projected to cover more than 90% of the nation's residents.
Mexico, which a decade ago covered less than half its population, just completed an eight-year drive for universal coverage that has dramatically expanded Mexicans' access to life-saving treatments for diseases such as leukemia and breast cancer.
In Thailand, where the gross domestic product per person is a fifth of America's, just 1% of the population lacks health insurance. And in sub-Saharan Africa, Rwanda and Ghana — two of the world's poorest nations — are working to create networks of insurance plans to cover their citizens.
"This is truly a global movement," said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health. "As countries advance, they are realizing that creating universal healthcare systems is a necessity for long-term economic development."
Cutbacks Hurt a State’s Response to Whooping Cough
By KIRK JOHNSON
MOUNT VERNON, Wash. — Whooping cough, or pertussis, a highly infectious respiratory disease once considered doomed by science, has struck Washington State this spring with a severity that health officials say could surpass the toll of any year since the 1940s, before a vaccine went into wide use.
Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.
The response to the epidemic has been hampered by the recession, which has left state and local health departments on the front lines of defense weakened by years of sustained budget cuts.
Addiction Diagnoses May Rise Under Guideline Changes
By IAN URBINA
WASHINGTON — In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.
The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book.
In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.
Part medical guidebook, part legal reference, the manual has long been embraced by government and industry. It dictates whether insurers, including Medicare and Medicaid, will pay for treatment, and whether schools will expand financing for certain special-education services. Courts use it to assess whether a criminal defendant is mentally impaired, and pharmaceutical companies rely on it to guide their research.
Psychiatry Manual Drafters Back Down on Diagnoses
By BENEDICT CAREY
In a rare step, doctors on a panel revising psychiatry’s influential diagnostic manual have backed away from two controversial proposals that would have expanded the number of people identified as having psychotic or depressive disorders.
The doctors dropped two diagnoses that they ultimately concluded were not supported by the evidence: “attenuated psychosis syndrome,” proposed to identify people at risk of developing psychosis, and “mixed anxiety depressive disorder,” a hybrid of the two mood problems.
They also tweaked their proposed definition of depression to allay fears that the normal sadness people experience after the loss of a loved one, a job or a marriage would not be mistaken for a mental disorder.
But the panel, appointed by the American Psychiatric Association to complete the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., did not retreat from another widely criticized proposal, to streamline the definition of autism. Predictions by some experts that the new definition will sharply reduce the number of people given a diagnosis are off base, panel members said, citing evidence from a newly completed study.
http://www.nytimes.com/2012/05/09/health/dsm-panel-backs-down-on-diagnoses.html?hpw&pagewanted=print
Diagnosing the D.S.M.
By ALLEN FRANCES
AT its annual meeting this week, the American Psychiatric Association did two wonderful things: it rejected one reckless proposal that would have exposed nonpsychotic children to unnecessary and dangerous antipsychotic medication and another that would have turned the existential worries and sadness of everyday life into an alleged mental disorder.
But the association is still proceeding with other suggestions that could potentially expand the boundaries of psychiatry to define as mentally ill tens of millions of people now considered normal. The proposals are part of a major undertaking: revisions to what is often called the “bible of psychiatry” — the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. The fifth edition of the manual is scheduled for publication next May.
I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.
A New Approach To Cutting MA’s Health Costs: Throw Spaghetti
Rachel Zimmerman and Carey Goldberg
When Massachusetts passed sweeping health insurance reform in 2006, a crucial piece was missing from the landmark legislation: how to control rising medical costs.
Today, state lawmakers unveiled an ambitiousnew proposal to do just that, including new ways to pay doctors and hospitals, a specific cap on health-care spending tethered to economic growth and a tax on the state’s most expensive hospitals if they can’t justify their prices.
13.5% of Maine adults skipped medical care because they couldn’t afford it, report finds
Posted May 08, 2012, at 6:56 p.m.
An estimated 109,000 Maine adults went without medical care in 2010 because they couldn’t afford it, according to a new study.
Hit hardest were the uninsured, who were far more likely to report having unmet health care needs because of the cost, according to the study released this week by the Robert Wood Johnson Foundation.
Forty percent of adults lacking health coverage in Maine reported skipping medical care because of the expense, compared with 8.3 percent of insured adults.
Even those with insurance visited the doctor less often over the study’s 10-year period. The report shows that Maine’s uninsured are going without care despite free care offered at Maine hospitals, said Mitchell Stein, policy director for the progressive advocacy group Consumers for Affordable Health Care.
Meanwhile, residents with health insurance coverage are increasingly burdened with a higher share of health care costs, such as under high-deductible plans, he said.
“While I’m not surprised [by the report’s findings], I’m saddened,” Stein said. “It just highlights the real crisis that continues to face our health care system.”
Taking care of MaineCare
osted May 07, 2012, at 2:34 p.m.
If you’re on MaineCare or you’re a doctor or medical care provider, the computer problems at the Maine Department of Health and Human Services concern you because you rely in some way on the department’s ability to accurately process medical claims.
If you live in Maine, you probably care about errors because a lot of state and federal tax dollars are used to fund the department. In 2011, the total budget was $3.3 billion.
So you might have been disconcerted to learn recently that the department had overpaid $10.7 million to providers for about 7,700 Mainers who no longer were eligible for MaineCare, which is Maine’s version of Medicaid.
It happened because a system responsible for determining whether a patient was eligible for services was not communicating with a different system responsible for processing the claims. That means people who were deemed ineligible did not have their cases closed when they should have been.
It’s an unfortunate mistake. But it’s not a calamity when you look at the greater context. If anything, the department’s biggest hurdle will be to overcome its chronic image problem. Though the current situation is different, the department has experienced serious data-management problems going back nearly a decade.
Public confidence will be restored only if the department handles the problem openly, allows an independent and complete review of what went wrong, makes the best possible effort to fix the problem and then doesn’t let it happen again.
Christie Vetoes Health Insurance Exchange
By KATE ZERNIKE
In a swipe at President Obama’s signature health care legislation, Gov. Chris Christie of New Jersey vetoed on Thursday an online marketplace that the Legislature created to help residents and small businesses buy health insurance.
The Affordable Care Act, the federal law passed in 2010, requires most Americans to have health insurance and mandates states to have health care benefits exchanges to help them buy it. With theSupreme Court debating whether the health care law is constitutional, Mr. Christie said in his veto message that the exchange, approved in March, was “premature” and could impose “unnecessary obligations upon the state’s citizens.”
“Indeed, the very constitutionality of the Affordable Care Act is cloaked in uncertainty, as both the individual mandate to procure health insurance as well as the jurisdictional mandate to establish an exchange may not survive scrutiny by the Supreme Court,” he wrote.
“Because it is not known whether the Affordable Care Act will remain, in whole or in part, it would be imprudent for New Jersey now to create an exchange before these critical threshold issues are decided with finality by the court,” he added.
Republican state officials stall on setting up health insurance marketplaces
By N.C. Aizenman,
In about two dozen states across the country, the insurance marketplaces at the heart of the 2010 health-care law remain in limbo, with Republican governors or lawmakers who oppose the statute refusing to act until the Supreme Court decides its constitutionality.New Jersey’s Republican governor, Chris Christie, joined the ranks Thursday, vetoing a bill from the majority Democratic legislature that would have set up the Garden State’s version of the “exchanges,” through which individuals and small businesses could shop for insurance.
In states with Democratic governors, such as New Hampshire and Minnesota, it is often Republican-dominated legislatures that are causing the hold-up. And in six states where Republicans hold both branches of government, including Kansas and South Dakota, state assemblies haven’t even considered laws to establish the marketplaces.
Though the battles primarily break along partisan lines, there have been at least a half-dozen exceptions. Last spring, the Republican governor of Nevada chose not to stand in the way of an exchange bill adopted by the majority Democratic assembly. And the Republican insurance commissioner of Mississippi is using existing authority to set up an exchange with the blessing of the Republican governor.
New Cautions About Long-Term Use of Bone Drugs
By TARA PARKER-POPEIn an unusual move that may prompt millions of women to rethink their use of popular bone-building drugs, the Food and Drug Administration published an analysis that suggested caution about long-term use of the drugs, but fell short of issuing specific recommendations.
The F.D.A. review, published in The New England Journal of Medicine online on Wednesday, was prompted by a growing debate over how long women should continue using the drugs, known as bisphosphonates, which are sold as generic versions of brands like Fosamax and Boniva, as well as Novartis’s Reclast.
The concern is that after years of use, the drugs may in rare cases actually lead to weaker bones in certain women, contributing to “rare but serious adverse events,” including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.
Although the concerns about the long-term safety of bone drugs are not new, the F.D.A. performed its own systematic review of the effectiveness of bisphosphonates after years of use. The agency’s analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.
An Endless Quest for Weight-Loss Pills
By DANIELLE OFRI, M.D.Right after residency, I took a summer job in a family practice in a beach town on Long Island, covering Fridays and weekends for the regular doctors. The setting was quite different from my training in an urban hospital. It was a bit of a culture shock to go from a world of critically ill hospitalized patients to an outpatient suburban setting where most weekend appointments were for sore throats, rashes and sprained ankles. But I quickly became a pro at Lyme disease identification.
Joon Park Danielle Ofri, M.D.
One day, a woman in her early 40s came for an appointment. She asked me to prescribe fen-phen, a weight-loss pill that combined the drugs fenfluramine and phentermine and was being heavily marketed at the time.
I remember gazing at her from across the desk, thinking that she certainly didn’t look overweight, and asked her why she wanted weight-loss pills.
She grasped the skin around her stomach and said ruefully, “I’ve been trying to get rid of these extra pounds after having kids.”
I leaned over to see what she was holding in her grip. It looked like a normal amount of stomach to me.
Diet Drug Wins Panel’s Approval
By ANDREW POLLACK
Government advisers recommended approval on Thursday of a weight-loss drug developed by Arena Pharmaceuticals, making it likely that a new obesity treatment will reach the market this year.
An advisory committee to the Food and Drug Administration voted 18 to 4, with one abstention, that the benefits of the drug, lorcaserin, outweighed the risks.
If the F.D.A. approves the drug by its scheduled deadline of June 27, lorcaserin would be the first new prescription diet pill to reach the market in 13 years. The agency does not have to follow committee recommendations, although it usually does.
Another obesity medicine, Qnexa, developed by Vivus, was endorsed by the same committee in February. The F.D.A. is scheduled to decide whether to approve it by July 17.
Lorcaserin and Qnexa received negative votes from the committee in 2010, and the F.D.A. then did not approve them.
The positive votes this time stem in part from new data provided by the companies. But they also seem to reflect a growing feeling, voiced by several members of the advisory committee Thursday, that new tools are needed to treat a major health problem.
About one-third of adults in the United States are obese, and excess weight raises the risk of diabetes, heart disease and other illnesses.
Arthritis Pill From Pfizer Wins Support Of U.S. Panel
By KATIE THOMAS
A federal advisory panel recommended approval on Wednesday of a rheumatoid arthritis pill that could offer patients an alternative to the injectable medicines already on the market, but several members expressed concern about safety and urged the Food and Drug Administration to require rigorous follow-up studies.
The arthritis advisory committee voted 8 to 2 that the drug, known as tofacitinib, offered enough benefits to overcome potential safety risks, including higher rates of lymphoma and other cancers and serious infections. The agency, which is scheduled to decide on approval by August, usually — but not always — follows the advice of advisory committees.
Pfizer, which is developing tofacitinib, has hailed the drug as one of its most promising prospects as the company works to regain sales after its blockbuster cholesterol drug, Lipitor, lost its patent protection last year.
If the drug is approved, it could prove to be a potent competitor to Humira, a drug made by Abbott that brought in nearly $2 billion in sales during the first quarter of this year.
Senate Inquiry Into Painkiller Makers’ Ties
By BARRY MEIER
Two senior senators said on Tuesday that they had opened an investigation into financial ties between producers of prescription painkillers and pain experts, patient advocacy groups and organizations that set guidelines on how doctors use the drugs.
In a letter, the Senate Finance Committee said that it was undertaking the inquiry to make sure that doctors and patients were getting accurate information about the medications’ risks and benefits, uncolored by the financial interests of producers.
The letter was signed by Max Baucus, Democrat of Montana and chairman of the Finance Committee, and by Charles E. Grassley, Republican of Iowa.
“Overdoses on narcotic painkillers have become epidemic and it’s becoming clear that patients aren’t getting a full and clear picture of the risks posed by their medications,” Senator Baucus said in a statement. Senator Grassley, in a statement, added: “The problem of opioid abuse is bad and getting worse.”
The committee also sent letters Tuesday to several academic experts seeking information about their ties to producers.
Itemized medical bills should be standard operating procedure
Most bills from L.A. County healthcare providers are short on details, but patients deserve a full accounting of what treatment was provided and at what price.
David LazarusMay 11, 2012
It's tough enough to be without health insurance. But do healthcare providers have to make it even worse by treating you like a moron?
Santa Monica resident Tom Wilde recently received bills from a downtown Los Angeles clinic and the L.A. County/USC Medical Center totaling almost $2,500. What exactly were the charges for? The bills didn't say.
There was no itemizing of procedures and prices. No diagnosis. No treatment date. No nothing. Just a notation of "new charges" and the amount due.
"They certainly wouldn't send such a bill to an insurance company," Wilde, 51, told me. "Insurance companies want to know exactly what they're paying for."
So you'd think. But we'll get back to that.
http://www.latimes.com/business/la-fi-lazarus-20120511,0,3750551,print.column
A Decade Of Health Care Access Declines For Adults Holds Implications For Changes In The Affordable Care Act
Abstract
The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper’s analysis of national survey estimates found that access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist. We also found that children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—generally maintained or improved their access to care during the same period. This provides a reason for optimism about the ability of the coverage expansion in the Affordable Care Act to improve access for adults, but it suggests that eliminating the law or curtailing the coverage expansion could result in continued erosion of adults’ access to care.
Maine budget cuts target Medicaid
The Associated Press
PORTLAND — Tricia Clark will keep her fingers crossed when the Legislature reconvenes this week and takes up a budget plan that calls for sharp cuts in Medicaid and health care spending.
Nurse practitioners want to fill new care demands
Panel on Health Reform Focuses on Ditching the Insurance Industry
Prominent health care critics speaking in Portland staunchly support and defend a single-payer system
By Amanda WaldroupeThe Lund Report (Portland, Ore.), April 27, 2012
PORTLAND, Ore. -- Three prominent critics of the country’s current health care system and ardent reform advocates appeared in Portland today to discuss their views on health reform, President Obama’s Patient Protection and Affordable Care Act, and what ought to be done to ensure that everyone has access to quality health care.
Cathy Schoen, senior vice president of the Commonwealth Fund, spoke, as well as Drs. Arnold Relman and Marcia Angell, former editors of the New England Journal of Medicine. Dr. Bruce Goldberg, director of the Oregon Health Authority, also participated. The event was sponsored by the advocacy group, Mad As Hell Doctors and Physicians for a National Health Program.
Schoen put the United State’s health care system in the context of other Western, developed countries. “We are the most expensive country in the world in what we spend per person, and in our share of the economy,” she said. “And we don’t get the outcomes that you expect.”
http://www.pnhp.org/print/news/2012/may/panel-on-health-reform-focuses-on-ditching-the-insurance-industry
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