After years of seeing decreasing numbers of uninsured children, California is poised to go the other direction.
For years, child enrollment in private health insurance plans decreased as companies scaled back on health care costs by increasing employees’ share of the premiums or by stopping dependent coverage altogether.
But those declines were offset by increased enrollment in public programs. Recognizing that half the uninsured children already qualified for Medi-Cal (California’s version of Medicaid), and Healthy families (the
state’s SCHIP program), school districts and advocates focused efforts on finding and enrolling those children.
But now, things aren’t looking so rosy. State and county budgets constraints threaten to erode the children’s enrollment gains in
Medi-Cal, Healthy Families and Healthy
Kids programs, county-organized health plans.
"Come next spring, you could have a double or triple whammy of kids
losing health coverage," said Joel Diringer, a consultant who helped
many California counties create the local programs.
Despite seemingly never-ending reports of layoffs in American newsrooms, a new model of investigative journalism has emerged and health care falls squarely into its areas worthy of significant scrutiny.
ProPublica is a nonprofit, investigative journalism organization that launched this year with promises to focus its efforts on "truly important stories, stories with moral force." Its Web site is up and filled with great content, including a section on health and science.
The founders/funders of ProPublica — led by the Sandler Foundation — believe "investigative journalism is at risk," and are pioneering this new model. Paul Steiger, a former managing editor of The Wall Street Journal, is at the helm.
What does this have to do with health care? ProPublica has targeted health care as an area worthy of investigation. That’s evident by the recent recruitment announcement of Charles Ornstein and Tracy Weber from the L.A. Times.
Hospital & Health Networks magazine announced America’s "100 Most Wired" hospitals for 2008 this week.
You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report.
Hospital & Health Networks created the "most wired" ranking a decade ago. This issue’s cover story says that wired hospitals have happier patients and higher quality measures than their less technologically advanced peers.
"Taken together, the patient satisfaction and quality indicator analyses
provide the strongest evidence in the 10-year history of the Most Wired
Survey and Benchmarking Study that information technology makes a
difference in both the patient experience and the quality of care."
Mr. HISTalk has a more cynical take on the ranking.
Barack Obama’s health reform proposal includes creating a center for comparative effectiveness research.
John McCain also has expressed support for this research.
And the American College of Physicians would like patients and doctors to use comparative effectiveness information when making health decisions.
What the heck are they talking about?
Policymakers, pundits and journalists have begun throwing around the term “comparative effectiveness” as if people know what it means.
I haven’t seen a formal survey, but I’m confident that the general public does not understand the concept behind this jargon nor the reasons why a national center might be needed to compare different medical treatments and procedures to find out what is most effective for different patients.
The first step to helping people understand these issues is to stop using the term comparative effectiveness. Using insider terms like this will ensure the public never engages in the issue and never buys into it. And public buy-in is important — crucial actually — says Gail Wilensky, the term’s mother of sorts.
Kensington, Minn. is barely a dot on the map. This small grid of concrete, where fewer than 300 people live, is a brief interruption amid the sprawling acres of green corn, soybean and wheat fields that cover Minnesota’s western plains.
Similar tiny villages exist every seven or so miles along the Soo Railroad route. These once busy agricultural hubs are now skeletons of commerce with rapidly aging populations.
About one-fifth of Americans live in rural areas, and providing health care to them is a challenge financially and logistically. Only 10 percent of the nation’s doctors practice in rural areas, and rural residents tend to be poorer and less likely to have employer-based insurance than urban dwellers. The list of challenges is long.
Health care journalists got some bad press last week following the release of a study that showed more often than not they fail to provide the necessary information to make health stories complete, meaningful and tell them in context.
I’m torn. I want to defend journalists who report on this incredibly complex beat and continue ripping on them. So I’ll do a little of both.
The key finding from University of Minnesota Journalism professor Gary Schwitzer’s study published in PLoS Medicine Journal was that “after almost two years and 500 stories, the project has found that journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.”
A veteran CNN health reporter, Schwitzer founded the Web site HealthNewsReview.org to grade health news stories. The study is based on those reviews. I interviewed Schwitzer when the site launched. Gary also wrote a post for THCB that talks a little bit about what his project hopes to achieve.
Walking through the government-run Gandhi Hospital in Hyderabad, India feels like stepping back 50 years in time. The nurses wear white dresses with those funny paper napkin hats. Exhausted people overflow the stuffy waiting rooms. Family members sleep and eat on the hallway floors while waiting for their sick loved ones, who lie on thin cots crammed together like sardines in the dim wards.
Before you get the impression that this scene depicts all health care in India, follow me to Rainbow Children’s Hospital or Apollo Health City located an hour away in the most affluent neighborhood of this city of 7 million. These corporate hospitals offer sparkling clean facilities, the latest technologies and even luxuries like flat-screen televisions in the super-deluxe patient rooms.
Apollo is the largest hospital corporation in Asia and a significant player in the international medical tourism industry. On a recent sweltering afternoon, Radhey Mohan, general manager of international patient services, gave me a tour of Apollo’s Hyderabad campus and told me about future plans to expand Apollo’s medical tourism business.
While these corporate hospitals offer state-of-the-art medical services
to foreigners seeking a bargain, such care is a dream for most
A primary doctor ranted anonymously this weekend on Kevin MD’s blog about the lack of appreciation for primary care in his small Midwestern town and predicted its future demise.
The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:
"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."
His rant has struck a chord in the medical blogosphere.
The debate over why health reform failed in California sparked up again following the release of a Field Poll in late April that found that nearly three-quarters of California respondents supported Gov. Arnold Schwarzenegger’s plan.
Following the poll’s release, Schwarzenegger told
the Associated Press he’s not giving up and will push his $14-billion plan forward. Despite his optimism, most
wonks in Sacramento have called it dead at least though 2009.
In a recent column, Sen. Sheila Kuehl, D-Santa Monica, diverts any blame for the reform’s failure from the vehemently opposed single-payer coalition, which she leads from her perch as chair of the all-powerful Senate Health Committee and author of the single-payer bill SB 840. Kuehl blames reform’s failure the governor’s unwillingness to challenge the insurance companies."In fact, the Governor’s plan appropriately fell," Kuehl writes, "because of the Governor’s own reluctance to make the difficult policy decisions necessary for the plan to be in any way affordable to the state as well as to businesses and individuals, but which would have stirred up strong opposition from insurance companies."
Well, not everyone agrees.
Over at Slate, veteran health care journalists Shannon Brownlee and Jeanne Lenzer raise tough questions about the lack of disclosure regarging four doctors’ ties to the makers of antidepressants, while they told audiences of public radio stations nationwide that the connections between suicide and antidepressants were largely overblown.
The radio program, Infinite Mind, produced the show in April titled Prozac Nation: Revisited.
Here is writers’ nutgraph:
"The radio show, which was broadcast nationwide and paid for in part by
the John D. and Catherine T. MacArthur Foundation, had the air of
quiet, authoritative credibility. Host Dr. Fred Goodwin, a former
director of the National Institute of Mental Health, interviewed three
prominent guests, and any radio producer would be hard-pressed to find
a more seemingly credible quartet. Credible, that is, except for a
crucial detail that was never revealed to listeners: All four of the
experts on the show, including Goodwin, have financial ties to the
makers of antidepressants. Also unmentioned were the "unrestricted
grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac."