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Saturday, December 29, 2012

Health Care Reform Articles - December 29, 2012


Chronic MaineCare shortfalls — a symptom of a disease we can treat

By Philip Caper, Special to the BDN
Posted Dec. 27, 2012, at 1:35 p.m.
About a year ago, facing a budgetary shortfall, the Maine Legislature had a knock-down, drag-out fight over Gov. Paul LePage’s proposal to save $220 million by throwing 65,000 Maine residents off MaineCare.
At that time, I predicted that the Legislature “can look forward to a repeat performance in a year or two unless they have the courage, wisdom and bipartisanship to attack the fundamental flaws in the ways we finance and deliver [all] health care services.” Well, they didn’t. And now they are.
The recently announced “unexpected” cost overrun of more than $100 million attributable mostly to MaineCare will no doubt lead to a repeat of last year’s fight. At the same time, Maine hospitals are clamoring for almost $500 million in past-due MaineCare payments.
The Legislature is now under different management. Maybe the Democrats can succeed where the Republicans failed. But to do so they will have to finally be willing to look at the big picture.
At a national level, Congress and the Obama administration are contemplating cutbacks in Medicare eligibility as one way to reduce federal spending. Such cuts, like those in MaineCare, will simply shift those costs to the private sector.
That shift will only exacerbate existing private-sector health care cost problems. Out-of-control costs have had a dampening effect on employment, depressed wages and discouraged entrepreneurship by creating job lock. They have also encouraged employers to shift whatever costs they can to their workers and to public-sector programs such as MaineCare. Walmart is the poster child for this phenomenon, but it’s hardly alone.
MaineCare cost overruns are only a symptom of larger problems in our health care system as a whole. They cannot be solved in isolation. Trying to do so is a losing strategy.
The Legislature now has an opportunity to revisit a solution they have failed to embrace in the past under both Democratic and Republican leadership — movement toward a single, publicly managed health care system for all the people of Maine.



Doctors with financial conflicts influence drug treatment guidelines

By John Fauber and Ellen Gabler, Milwaukee Journal Sentinel (MCT)
Posted Dec. 28, 2012, at 10:00 a.m.
MILWAUKEE — Doctors with financial ties to drug companies have heavily influenced treatment guidelines that recommend the most lucrative drugs in American medicine, an analysis by the Milwaukee Journal Sentinel and MedPage Today has found.
The guidelines affect how doctors across the country treat patients for everything from diabetes to asthma, chronic pain, depression and high cholesterol.
Issued by leading medical associations and government institutions, treatment guidelines are supposed to be based on rigorous science. But the committees that write them have been dominated by doctors who have worked as paid speakers, consultants or advisers for companies selling the recommended drugs.
Critics say the financial relationships have corrupted medicine, resulting in cases where guidelines make dangerous or ineffective recommendations. Drug companies and some doctors counter that those with conflicts are often top experts in their field.
The Journal Sentinel examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the United States.
The drugs sit in the medicine cabinets of millions of Americans — Nexium for acid reflux, Lipitor for high cholesterol, Cymbalta for depression and OxyContin for pain. Their collective sales topped $94 billion in 2011, accounting for 30 percent of drug revenue in the United States.
An analysis of the guideline panels, which involved 293 doctors, found:
Nine guidelines were written by panels where more than 80 percent of doctors had financial ties to drug companies.
Four panels did not require members to disclose any conflicts of interest. Of the 16 that did, 66 percent of doctors on the panels had ties to drug companies.
Some guidelines written by conflicted panels recommend drugs that have not been scientifically proven to safely treat conditions, leading to inappropriate or over prescribing. Medical experts have raised such questions about guidelines for anemia, chronic pain and asthma.
Research funded by drug companies was not counted as a conflict in the Journal Sentinel analysis because experts disagree whether research poses as much of a conflict as speaking, consulting and advising.
The findings offer the latest glimpse into how pharmaceutical companies, with billions in sales at stake, exert a powerful but often unrecognized influence over the practice of American medicine.


‘Gaping security holes’ expose health systems’ data, researchers reveal

By Robert O'Harrow Jr., The Washington Post
Posted Dec. 26, 2012, at 6:04 p.m.
As the health care industry rushed onto the Internet in search of efficiencies and improved care in recent years, it has exposed a wide array of vulnerable hospital computers and medical devices to hacking, according to documents and interviews.
Security researchers warn that intruders could exploit known gaps to steal patients’ records for use in identity theft schemes and even launch disruptive attacks that could shut down critical hospital systems.
A yearlong examination of cybersecurity by The Washington Post has found that health care is among the most vulnerable industries in the country, in part because it lags behind in addressing known problems.
“I have never seen an industry with more gaping security holes,” said Avi Rubin, a computer scientist and technical director of the Information Security Institute at Johns Hopkins University. “If our financial industry regarded security the way the health care sector does, I would stuff my cash in a mattress under my bed.”
Compared with financial, corporate and military networks, relatively few hacks have been directed at hospitals and other medical facilities. But in recent months, officials with the Department of Homeland Security have expressed growing fear that health care presents an inviting target to activist hackers, cyberwarriors, criminals and terrorists.
“These vulnerabilities may result in possible risks to patient safety and theft or loss of medical information,” a DHS intelligence bulletin said in May.
Security researchers are starting to turn up the same kinds of trivial-seeming flaws that earlier opened the way for hackers to penetrate financial services networks, Pentagon systems and computers at firms such as Google.
Rubin has documented the routine failure to fix known software flaws in aging technology and a culture in which physicians, nurses and other health care workers sidestep basic security measures, such as passwords, in favor of convenience.
Another researcher found that a system used to operate an electronic medicine cabinet for hospital prescriptions in Oklahoma could be easily taken over by unauthorized users because of weaknesses in the software interface.
OpenEMR, an open-source electronic medical records management system that is about to be adopted worldwide by the Peace Corps, has scores of security flaws that make it easy prey for hackers.
The University of Chicago medical center operated an unsecure Dropbox site for new residents managing patient care through their iPads, using a single user name and password published in a manual online.

The Smart Money: Entitlement Reform


by Gina Hamilton
Out of every dollar spent by the federal government, 47 cents is spent on entitlements. 
Entitlements are things that people paid taxes specifically to support, such as Social Security and Medicare, and low-income supports, such as Medicaid, as well as interest on the national debt.  Because people are living longer, combined with a blip in the demographics that we call the Baby Boom, the funding for these programs isn't keeping up with the costs.
It's not surprising that Congress turns its eyes to entitlements when it is trying to solve a fiscal problem; it's a huge part of the budget, and entitlements are guaranteed.  But there are options for reform that won't hurt the neediest and seniors, if Congress can just get its collective head around a few points.

Maine officials acting amid a surge in gonorrhea

The 441 infections in 2012, many involving people in their 20s, is quadruple the number reported in 2008.

By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
The annual incidence of gonorrhea in Maine has more than quadrupled since 2008, when the state had the nation's second-lowest infection rate, according to the Maine Center for Disease Control and Prevention.

Service providers taking stock of mental health, substance abuse cuts

By Matthew Stone, BDN Staff
Posted Dec. 28, 2012, at 6:55 p.m.
AUGUSTA, Maine — Agencies that provide services to people with mental health and substance abuse problems started to assess the impact Friday of $13.4 million in cuts to the state’s health and human services budget as part of a $35.5 million curtailment order issued this week by Gov. Paul LePage.
The cuts hit health and human services and local school aid — the two areas that account for the largest portion of state spending — hardest. The curtailment is a temporary measure designed to keep the state budget in balance amid revenue collections that have fallen short of earlier projections.
The $13.4 million in Department of Health and Human Services cuts include $2.2 million in funding reductions for state contracts with providers that serve people with substance abuse problems and mental illness.
Bonnie Smith, DHHS’ deputy commissioner for programs, said the department tried to find as many areas to cut as possible without eliminating services.
“That process went on in depth for many, many long days and nights. None of this was taken lightly,” she said. “We’re doing everything we can to make sure that services are not interrupted, that we’re not having people without services who are in need.”


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Thursday, December 27, 2012

Health Care Reform Articles - December 27, 2012


7-Eleven Shifts Focus to Healthier Food Options


By 


The chain that is home of the Slurpee, Big Gulp and self-serve nachos with chili and cheese is betting that consumers will stop in for yogurt parfaits, crudité and lean turkey on whole wheat bread.
7-Eleven, the convenience store chain, is restocking its shelves with an eye toward health. Over the last year, the retailer has introduced a line of fresh foods for the calorie conscious and trimmed down its more indulgent fare by creating portion-size items.
The change is as much about consumers’ expanding waistlines as the company’s bottom line. By 2015, the retailer aims to have 20 percent of sales come from fresh foods in its American and Canadian stores, up from about 10 percent currently, according to a company spokesman.
“We’re aspiring to be more of a food and beverage company, and that aligns with what the consumer now wants, which is more tasty, healthy, fresh food choices,” said Joseph M. DePinto, the chief executive of 7-Eleven, a subsidiary of the Japanese company, Seven & i Holdings.
Convenience stores have typically been among the most nimble of retailers. In the 1980s, they added Pac-Man arcade games as a way to keep customers in stores longer and to buy more merchandise. They installed A.T.M.’s a decade later, taking a slice of the transaction fees. More recently, they built refrigerated dairy cases, with milk, eggs, cheese and other staples.
But just as they have taken business from traditional supermarkets, convenience stores have faced increased competition from the likes of Dunkin’ Donuts and Starbucks, which offer a basic menu of fresh foods for consumers on the go.
At the same time, a major profit driver for convenience stores — cigarettes — has been in steady decline over the last decade as the rate of smoking has dropped in the United States.
Fresh foods can help offset some of those losses. The markup on such merchandise can be significant, bolstering a store’s overall profits. It’s also a fast-growing category.

Health care tax hikes for 2013 may be just start

By Ricardo Alonso-Zaldivar

WASHINGTON — New taxes are coming Jan. 1 to help finance President Obama’s health care overhaul.
Most people may not notice, because the taxes are aimed at the health industry and high-income taxpayers. But they will pay attention if Congress starts taxing employer-sponsored health insurance, one option in play if lawmakers can ever agree on a budget deal to reduce federal deficits.
The tax hikes already on the books, taking effect in 2013, fall mainly on people who make lots of money and on the health care industry. But about half of Americans benefit from the tax-free status of employer health insurance.
Workers pay no income or payroll taxes on what their employer contributes for health insurance, and in most cases on their own share of premiums as well.
It’s the single biggest tax break the government allows, outstripping the mortgage interest deduction, the deduction for charitable giving, and other better-known benefits. If the value of job-based health insurance were taxed like regular income, it would raise nearly $150 billion in 2013, according to congressional estimates.
By comparison, wiping away the mortgage interest deduction would bring in only about $90 billion.
‘‘If you are looking to raise revenue to pay for tax reform, that is the biggest pot of money of all,’’ said Martin Sullivan, chief economist with Tax Analysts, a nonpartisan publisher of tax information.


Approaching Illness as a Team

The Cleveland Clinic, long considered a premier medical system, is gaining new renown for innovation in improving the quality of care while holding down costs.
In its most fundamental reform, the clinic in the past five years has created 18 “institutes” that use multidisciplinary teams to treat diseases or problems involving a particular organ system, say the heart or the brain, instead of having patients bounce from one specialist to another on their own.
The Neurological Institute, for example, provides both inpatient or outpatient care for those with strokes and brain tumors, as well as those with epilepsy, multiple sclerosis, depression and sleep disorders, among other conditions.
On a recent visit, we observed one such team, consisting of a neurosurgeon, a neurologist, a neuroradiologist, a neurologist with advanced training in intensive care, a physical and rehabilitation doctor, a medical resident, a physical therapist and a nurse. As they made rounds from patient to patient, they had a portable computer that displayed electronic medical records so that the whole team could see how the patient was doing and plan the course of care for the day.
This team approach can improve the quality of care because all the experts are involved in deciding the best treatment option, which can save time and money. The neurological team, by consensus, has been better able to determine which acute stroke patientsneed a risky and expensive treatment that involves threading a catheter through an artery in the leg up into the brain to destroy a clot. It cut the use of that treatment in half, reducing costs and deaths and improving outcomes.
The Cleveland Clinic has strong leverage to drive such reforms because its staff physicians are salaried and are granted only one-year contracts and subjected to annual performance reviews. Those reviews apply measures of quality, like patient improvement, patient satisfaction and cost reductions. It raises the pay of those who get high marks, reduces the pay of poor performers and even terminates some doctors who fall short. This approach could become more widespread as more hospitals and doctors move toward the salary-based model.
Data analysis to evaluate how well treatments work is also a big part of the medical practice. For instance, the clinic analyzed outcomes for heart surgery patients and found that those who had received blood transfusions during surgery had higher complication rates afterward and a lower long-term survival rate. As a result, it has adopted strict guidelines that limit the use of transfusions.
Such judgments about a treatment’s effectiveness are made by doctors, not by financial administrators, so they tend to be accepted. One analysis found that suturing could be done as well with a $5 silk stitch as with a $400 staple, leading to a big drop in the use of the staples. At the same time, the clinic has also carried out simpler reforms, like improving sterile conditions, which has reduced catheter-related bloodstream infections by more than 40 percent and urinary tract infections by 50 percent. All this has happened in a remarkably short time. Patients seem to like the treatment they get. A federal government survey of patient opinion last fall found that 80 percent of the patients gave the Cleveland Clinic a high rating over all and 84 percent would recommend it to others, well above the state and national averages in the 69 percent to 71 percent range.

Walking the Tightrope on Mental Health Coverage

By 

Insurance covers more mental health care than many people may realize, and more people will soon have the kind of health insurance that does so. But coverage goes only so far when there aren’t enough practitioners who accept it — or there aren’t any nearby, or they aren’t taking any new patients.
In the days after the Newtown, Conn., school shooting, parents and politicians took to the airwaves to make broad-based proclamations about the sorry state of mental health care in America. But a closer look reveals a more nuanced view, with a great deal of recent legislative progress as well as plenty of infuriating coverage gaps.
The stakes in any census of mental health insurance coverage are high given how many people are suffering. Twenty-six percent of adults experience a diagnosable mental disorder in any given year, and 6 percent of all adults experience a seriously debilitating mental illness, according to the National Institute of Mental Health. Twenty-one percent of teenagers experience a severe emotional disturbance between the ages of 13 and 18.
According to this year’s Society for Human Resource Management survey of 550 employers of all sizes, including nonprofits and government entities, 85 percent offer at least some mental health insurance coverage. A 2009 Mercer survey found that 84 percent of employers with more than 500 employees covered both in-network and out-of-network mental health and substance abuse treatments.
For now, some people who have no health insurance or who buy it on their own may avoid purchasing mental health coverage too, or may avoid seeking treatment for things like addiction or depression. This happens for many of the same reasons that there has historically been less mental health coverage than there has been for other illnesses. The earliest objections among insurance providers and employers had to do with whether mental disorders existed at all, according to Howard Goldman, a professor of psychiatry at the University of Maryland school of medicine. Then there were questions about whether treatment actually worked. Next, concerns arose over cost and how often people would avail themselves of costly mental health treatments.
But a subset of adults who have good insurance coverage still avoid treatment for mental illness to this day, according to Edward A. Kaplan, senior vice president and national practice leader for the Segal Company, a benefits consultant that works with many unions. “Culturally, a lot of people driving trucks don’t believe in it and suffer through,” he said. “And a lot of transport unions don’t trust employers and think they will look at it and use it to retaliate against the workers.”
For many of the people who do have mental health coverage, there is now a bit more of it at a lower cost than there might have been five years ago, even if mental health insurance over all remains much less generous than it was many years ago when employees did not pay as much out of pocket. That’s because a 2008 federal law requires employers with more than 50 employees that do offer mental health coverage to have no more restrictions than there are for physical injuries or surgery, and no higher costs.




A Conservative Case for the Welfare State

By BRUCE BARTLETT

Bruce Bartlett held senior policy roles in the Reagan and George H.W. Bush administrations and served on the staffs of Representatives Jack Kemp and Ron Paul. He is the author of “The Benefit and the Burden: Tax Reform – Why We Need It and What It Will Take.”
At the root of much of the dispute between Democrats and Republicans over the so-called fiscal cliff is a deep disagreement over the welfare state. Republicans continue to fight a long-running war against Social Security, Medicare, Medicaid and many other social-welfare programs that most Americans support overwhelmingly and oppose cutting.
TODAY’S ECONOMIST
Perspectives from expert contributors.
Republicans in Congress opposed the New Deal and the Great Society, but Republican presidents from Dwight D. Eisenhower through George H.W. Bush accepted the legitimacy of the welfare state and sought to manage it properly and fund it adequately. When Republicans regained control of Congress in 1994 they nevertheless sought to repeal the New Deal and Great Society programs they had always opposed.
Energized by their success in abolishing the principal federal welfare program,Aid to Families With Dependent Children, in 1996, Republicans tried to abolish Social Security as well, through partial privatization during the George W. Bush administration, and they more recently have attempted to change Medicaid into a block grant program with funds going to the states and to turn Medicare into a voucher program.
In the 40th anniversary edition of his book, “Capitalism and Freedom,” Milton Friedman advised conservatives to use crises as opportunities to advance their agenda. “Only a crisis – actual or perceived – produces real change,” he contended.

Thus Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.
This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state. Historically, it has been conservatives like the 19th century chancellor of Germany, Otto von Bismarck, who established the welfare state in Europe. They did so because masses of poor people create social instability and become breeding grounds for radical movements.

Human toll emerging in shortage of some cancer drugs

By Chelsea Conaboy

Dozens of cancer drugs have been in short supply in recent years as manufacturers closed factories, stopped making products, or halted operations because of quality control problems. Researchers have struggled to quantify the effect shortages have had on patient care, and an article published Wednesday by the New England Journal of Medicine ­advances that effort.
When a factory closure in 2010 resulted in the shortage of a key drug used to treat children and adolescents with Hodgkin’s lymphoma, doctors thought a comparable drug ­already on the market would provide a suitable substitute. But a study found that the people who received the substitute were more likely to relapse, requiring more aggressive care and sometimes suffering severe side effects.
The article — said by the authors to be the first to document the effect on patients of a specific shortage — illuminates how little is known about what the lapses in drug supply will mean for people’s health.
“These are business issues and manufacturing problems that are ongoing and have very real effects on patients,” said ­Erin Fox, who tracks shortages as director of drug information at University of Utah Hospitals and Clinics. “A lot of patients had their regimens altered, and I think we are just starting to see what the impact of those shortages was.”

Republicans rejecting their own ideas

By , Published: December 26

We know that the House of Representatives has been unable to reach a sensible deal to avoid unnecessary fiscal trouble at the first of the year because of right-wing Republicans’ aversion to tax increases.
But there is another issue on which conservatives are creating needless difficulties for themselves and the country: It’s harder and harder for politicians on the right to think straight about health care.
Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective.
Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law. The mechanisms would allow more than20 million Americans to buy coverage. They were originally a conservative idea for large, trustworthy marketplaces where individuals and families could buy plans of their choice.
Many liberals preferred a national exchange, in which the federal government could institute strong rules to protect consumers and offer broader options. This was the path the House took, but the final Senate-passed law went with state-level exchanges in deference to Republican sensibilities.
To ensure that governors could not just prevent their residents from having access to the new marketplaces, the bill required the federal government to run them if states defaulted. So, irony of ironies, in declining to set up state exchanges, conservative governors are undermining states’ rights and giving liberals something far closer to the national system they hoped for. As Robert Laszewski, an industry critic of Obamacare, told The Post’s N.C. Aizenman, conservative governors are engaging in “cut-off-your-nose-to-spite-your-face” behavior.
This is one of many forms of conservative health-care unreason. The “fiscal cliff” debate has been distorted because the problems confronting federal finances are consistently misdescribed. We do not have “an entitlement problem.” We have a giant health-care cost problem.

Affordable Care Act presents many unknowns for California officials

It's unclear how many Californians will sign up when the healthcare law takes effect in 2014, making it difficult for the Brown administration to estimate the costs of expanded coverage.

SACRAMENTO — As California positions itself at the vanguard of the national healthcare overhaul, state officials are unable to say for sure how much their implementation of the federal Affordable Care Act will cost taxpayers.
The program, intended to insure millions of Americans who are now without health coverage, takes states into uncharted territory. California, which plans to expand coverage to hundreds of thousands of people when the law takes effect in 2014, faces myriad unknowns. The Brown administration will try to estimate the cost of vastly more health coverage in the budget plan it unveils next month, but experts warn that its numbers could be way off.
Officials don't know exactly how many Californians will sign up for Medi-Cal, the public health insurance program for the poor. Computing the cost of care for each of them is also guesswork. And California is waiting for key rulings from federal regulators that could have a major effect on the final price tag, perhaps in the hundreds of millions of dollars.
"No one has ever tried to do anything like this before," said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank. "Any numbers attached to this are just a guess."
The uncertainty comes as the state's finances are improving but still precarious. Voters approved billions of dollars in new taxes last month, but Sacramento nevertheless faces a shortfall of $1.9 billion that must be bridged in fiscal 2013-14.
Unanticipated costs associated with the healthcare changes could undermine California's efforts to improve its standing on Wall Street and keep the economy moving. They could force fresh cuts in services if they consume much more of the state budget than Brown is able to approximate.
In addition, some Democrats in the Legislature hope to restore certain health benefits, such as dental coverage for Medi-Cal recipients, that have been eliminated or reduced amid the persistent financial crises of recent years. The cost of any services that are revived could rise as more people become eligible for them.

Five ways your health care will change in 2013

By Sarah Kliff, The Washington Post
Posted Dec. 26, 2012, at 6:05 p.m.
WASHINGTON — The Affordable Care Act’s biggest year is, without a doubt, 2014: That’s when the federal subsidies to purchase health insurance roll out. It’s also when penalties for not buying coverage kick in.
But many of the big changes will start gradually in 2013. They range from increasing payments to Medicaid doctors to upping Medicare taxes to the exchanges’ very first open-enrollment period.
Here’s a quick guide to what will happen in health care in the next year.


To LePage: Take advantage of Affordable Care Act

By John E. Nale, Special to the BDN
Posted Dec. 25, 2012, at 2:59 p.m.
The governor’s decision to not “lift a finger” to set up Maine’s health insurance exchange and to not otherwise take advantage of the Affordable Care Act is a missed opportunity for the governor and our state. The ACA is here to stay. It was passed by both houses of Congress, upheld in large part by the U.S. Supreme Court and reaffirmed by a majority of the people with the re-election of President Barack Obama. It is now “the law of the land.”
The question now is: Will Gov. Paul LePage lead us in taking full advantage of the law for the benefit of the people, or will he continue to fight it by not acting, by not participating, by not “lifting a finger”? Can he now put the people of Maine above tea party politics? By putting people above politics the governor can lead in the redesign of the health care and health insurance systems in Maine. By “lifting a finger” to help set up Maine’s health insurance exchange, we can design insurance policy benefits that focus on our needs as Mainers, with an emphasis on health, as well as insurance. The ACA allows each state to design and adopt state-specific required minimum benefits that we, as Mainers, need and can afford. If we don’t participate, we get whatever some bureaucrat in Washington and insurance company lobbyist comes up with.





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Monday, December 24, 2012

Health Care Reform Articles - December 24, 2012

Happy Holidays All!

German Health Care Attracts Foreign Patients


By  and 


BERLIN — When Jalal Talabani, the president of Iraq, needed advanced medical care for a stroke suffered this week, he flew not to the United States or Britain but to Germany, for treatment here in the capital.
For many Americans, Germany is known as a way station where soldiers wounded in Iraq and Afghanistan received immediate medical care on United States military bases. But it is also a popular destination for wealthy and prominent patients from the Middle East, Russia and beyond, experts say.
Before the Arab Spring uprisings, the Egyptian president Hosni Mubarak traveled to Munich in 2004 for back treatment and to Heidelberg in 2010 to have his gallbladder removed. Last year, President Nursultan Nazarbayev of Kazakhstan reportedly had a surgical procedure on his prostate at the University Medical Center Hamburg-Eppendorf.
According to German government statistics, the number of hospital patients from the United Arab Emirates rose to 1,754 from 339 between 2000 and 2010, the most recent year available. From Saudi Arabia, the figure climbed to 712 from 143. The numbers from Iraq were smaller but still rose to 176 from 95. Over the same period, the number of Russians jumped to 4,873 from 842.
“We have one of the worldwide best health care systems and people from abroad know that,” said Isabella Beyer, research associate in medical tourism at the Bonn-Rhein-Sieg University of Applied Sciences. Mr. Talabani, 79, is among them; he was treated in Germany before for back trouble.
Mr. Talabani is now being cared for at Berlin’s Charité hospital, which is more than 300 years old and is one of Europe’s largest university hospitals. The storied institution was home to several Nobel Prize winners, including Robert Koch and Paul Ehrlich. A spokeswoman for Charité, Manuela Zingl, confirmed that Mr. Talabani was being treated there but said that she could not disclose any information on his condition because of rules on medical privacy.

When The Doctor Works For The Insurance Company

by TRACEY SAMUELSON

Some insurance companies are taking a page out of their own history books: running their own doctors' offices and clinics. Though the strategy previously had mixed results, insurers think that by providing primary care for patients, they might reduce costly diseases and hospital stays in the long run.

Dr. Michael Byrne spent eight years working for a Brooklyn hospital and he saw firsthand why the United States spends more on healthcare than any other country in the world.

"I would regularly see patients who were admitted to the hospital, I took care of, who got better and we'd discharge with plan of care," he said. "And they'd come back either to the E.R. sick or to the floor. It's a common occurrence."
Roughly 25 percent of patients hospitalized in Brooklyn were back in the hospital within a month, according to Byrne. They wouldn't fill their prescriptions or take their medications; they'd miss appointments for follow-up tests or consultations with specialists.

Surgical study cites objects left in patients, other errors that should ‘never’ occur

By Sarah Kliff, The Washington Post
Posted Dec. 21, 2012, at 8:57 a.m.
They sound like some of the worst mistakes a surgeon could make: Leaving an instrument inside a patient. Operating on the wrong body part — or the wrong person. They’re aptly named “never” events, the errors that should never, ever occur.
Turns out, however, these “never” events happen quite frequently, about 500 times a year. Between September 1990 and September 2010, new research in the journal Surgery found evidence of 9,744 paid malpractice claims for never events.
About half of those cases were ones in which surgeons left an object inside the patient (separate research suggests that the most frequently forgotten items are sponges). The other half were cases where the surgeon operated on the wrong part of the body or performed the wrong procedure. A small number, 17, involved surgeons operating on the wrong person altogether.
These events are dangerous: When the researchers analyzed a smaller cohort of data, from 2004 through 2010, they found that 6.6 percent of patients experiencing a never event subsequently died. A third had a permanent injury and 59 percent had a temporary injury.
Patients who received the wrong procedure were at highest odds of death or permanent injury. The research also found that younger patients had significantly better odds of surviving a never event than did patients over 60.
Keep in mind, these data only draw from malpractice claims that were paid. The data would not capture a never event where a patient did not experience harm.
It’s hard to know whether this study even captures the full breadth of never events. As the study’s lead author Winta Mehtsun, a surgeon at Johns Hopkins University School of Medicine, points out, their data only cover malpractice claims. They don’t touch cases never filed.
“Although the data we utilized captured surgical never events resulting in malpractice claims, many do not reach legal process and are then only voluntarily disclosed, with little coordination among reporting bodies,” he writes in the Surgery article.
What the data do suggest is that we do know a bit about which doctors are most likely to experience never events. They are, perhaps unsurprisingly, doctors who had already experienced malpractice claims. Younger doctors also had higher odds of settling malpractice claims for never events.


Walking the Tightrope on Mental Health Coverage


By 


Insurance covers more mental health care than many people may realize, and more people will soon have the kind of health insurance that does so. But coverage goes only so far when there aren’t enough practitioners who accept it — or there aren’t any nearby, or they aren’t taking any new patients.
In the days after the Newtown, Conn., school shooting, parents and politicians took to the airwaves to make broad-based proclamations about the sorry state of mental health care in America. But a closer look reveals a more nuanced view, with a great deal of recent legislative progress as well as plenty of infuriating coverage gaps.
The stakes in any census of mental health insurance coverage are high given how many people are suffering. Twenty-six percent of adults experience a diagnosable mental disorder in any given year, and 6 percent of all adults experience a seriously debilitating mental illness, according to the National Institute of Mental Health. Twenty-one percent of teenagers experience a severe emotional disturbance between the ages of 13 and 18.
According to this year’s Society for Human Resource Management survey of 550 employers of all sizes, including nonprofits and government entities, 85 percent offer at least some mental health insurance coverage. A 2009 Mercer survey found that 84 percent of employers with more than 500 employees covered both in-network and out-of-network mental health and substance abuse treatments.
For now, some people who have no health insurance or who buy it on their own may avoid purchasing mental health coverage too, or may avoid seeking treatment for things like addiction or depression. This happens for many of the same reasons that there has historically been less mental health coverage than there has been for other illnesses. The earliest objections among insurance providers and employers had to do with whether mental disorders existed at all, according to Howard Goldman, a professor of psychiatry at the University of Maryland school of medicine. Then there were questions about whether treatment actually worked. Next, concerns arose over cost and how often people would avail themselves of costly mental health treatments.



N.Y.U. and Other Medical Schools Offer Shorter Course in Training, for Less Tuition


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Training to become a doctor takes so long that just the time invested has become, to many, emblematic of the gravity and prestige of the profession.
But now one of the nation’s premier medical schools, New York University, and a few others around the United States are challenging that equation by offering a small percentage of students the chance to finish early, in three years instead of the traditional four.
Administrators at N.Y.U. say they can make the change without compromising quality, by eliminating redundancies in their science curriculum, getting students into clinical training more quickly and adding some extra class time in the summer.
Not only, they say, will those doctors be able to hang out their shingles to practice earlier, but they will save a quarter of the cost of medical school — $49,560 a year in tuition and fees at N.Y.U., and even more when room, board, books, supplies and other expenses are added in.
“We’re confident that our three-year students are going to get the same depth and core knowledge, that we’re not going to turn it into a trade school,” said Dr. Steven Abramson, vice dean for education, faculty and academic affairs at N.Y.U. School of Medicine.
At this point, the effort involves a small number of students at three medical schools: about 16 incoming students at N.Y.U., or about 10 percent of next year’s entering class; 9 at Texas Tech Health Science Center School of Medicine; and even fewer, for now, at Mercer University School of Medicine’s campus in Savannah, Ga. A similar trial at Louisiana State University has been delayed because of budget constraints.
But Dr. Steven Berk, the dean at Texas Tech, said that 10 or 15 other schools across the country had expressed interest in what his university was doing, and the deans of all three schools say that if the approach works, they will extend the option to larger numbers of students.



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