The Health Care Blog – Page 696 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why Aren’t Medical Prices Infinity?

Sep 22, 2011• 26

By DAVID DRANOVE

This blog continues my exploration of mysteries of health economics. The title of the blog may seem inane, but when a senior colleague asked me this question 25 years ago, it changed my life. And the answer helps us understand a lot about what is wrong with today’s healthcare system.

I was in my second or third year as an Assistant Professor at the University of Chicago when my brilliant senior (but still young) colleague Dennis Carlton asked me to explain how medical providers set their prices. I told him that we needed to throw the traditional textbook economics model of pricing out the window. This wasn’t a market where price sensitive consumers chose among homogeneous sellers, with the result that prices in competitive markets converged towards marginal cost. Instead, consumers had insurance that paid for all or nearly all medical bills. Moreover, patients were loyal to primary care physicians and their referral networks. As a result, patients rarely shopped around for the best price. This was when Dennis asked me why prices weren’t infinity. The question stumped me! I supposed that insurers would only pay usual, customary, and reasonable rates but that didn’t prevent providers from asking for infinity and occasionally getting it. Perhaps providers didn’t want to appear unseemly or were bound by ethical constraints. Or perhaps, as I ultimately responded, medical prices were inflating so rapidly that they would soon reach infinity.Continue reading…

Preparing for the Exchanges

Sep 22, 2011• 1

By John R. Graham

What is the biggest waste of effort in American health care today?

I’d suggest it is the hustle and bustle to establish PPACA’s Health Benefits Exchanges. The health insurers’ trade association, AHIP, has an entire educational series on “preparing for exchanges.” The likelihood of exchanges being up and running by January 2014 is vanishingly close to zero. Indeed, they may not exist at all except in very few states – whether or not President Obama wins re-election.

Last January, I wrote in The Health Care Blog that states should not collaborate with the federal government in establishing exchanges. Almost all states have taken this course. Recent days have brought forward new evidence that exchanges are facing even bigger problems than previously understood. The New York Times reports that Republican state senators are blocking a bill that would allow the state to establish an exchange and claim federal handouts to get it up and running. (A few weeks previously, Kansas governor Brownback actually sent a $31.5 million federal PPACA grant back to D.C.).

If they can’t get a PPACA exchange up and running in New York, of all places, where the heck will they? Only 13 states have passed pro-exchange legislation (and some of these bills don’t do much more than establish study groups).

Health 2.0 Code-a-thon: Novartis invites all-comers to innovate around their API

Sep 21, 2011• 1

By DAVE CHASE

As Health Innovation Week kicks off, before 1300 of our best friends arrive for the Health 2.0 Conference on Sunday-Tuesday, on Saturday we are hosting a Health 2.0 Code-a-thon in San Francisco at the PariSOMA loft (11am Saturday 25th to 3pm Sunday 26th). Spots are filling up fast but you can register here & yes, it’s free and there’s $10,000 in prizes at stake (not to mention pizza & beer). But it’s not just SiliValley techies who care. Big pharma Novartis is getting into challenges big time including sponsoring one at this very code-a-thon. THCB favorite (and CEO of Avado) Dave Chase explains more–Matthew Holt

“We’ve spent billions developing new drugs and we’ve spent billions marketing drugs but we’ve spent nothing on the actual use of our drugs.” That is how a senior executive at a major pharmaceutical company described the model in which they’ve operated historically. In a “do more, bill more” reimbursement environment, there was little economic incentive for a pharmaceutical company to pay close attention to what was happening with patients in clinical practice. This has been in stark contrast with clinical trials where a trial makes or breaks a drug. For obvious reasons, in clinical trials, there is a tremendous amount of attention paid to what happens with an individual’s use of a drug.

Times have changed. Not only have the first warning shots been fired across the bow of the pharmaceutical industry, the first shots have landed. Whether the payer is a national government or private insurance company, increasingly, they are refusing to pay for drugs that haven’t demonstrated efficacy in clinical practice (not just trials).

Some Myths About Social Security and Medicare

Sep 20, 2011• 37

By LINDA BERGTHOLD

It’s the season of political misinterpretations and outright lies. Websites like Politifact try to sort things out. But people still seem willing to believe the most negative things about two of our most durable social programs – Social Security and Medicare. Are they really in terrible trouble and will disappear soon?

If you are over 65, have a parent or friend who is, please read and pass along. I have written some of this before, but when we hear political candidates saying inflammatory things about these programs, it seems like a little truth-telling is never redundant.

Myth #1: Social Security is in grave financial condition and must be reformed now!

Actually, Social Security is completely funded until 2036 (that’s 25 years from now!) and even if we did nothing to fix it, it would still cover 78% of the costs after 2036. So why are the Republicans trying to make it into an urgent issue and scare everyone in the meantime? In Gov. Perry’s case, he is stuck with charges he made in his book Fed Up! and may feel he has to stay with his argument to avoid a flip flop. It doesn’t seem to be working. Bachmann and Romney and Gingrich have all risen to the defense of Social Security, but we should all be wary about the conversation, because part of their solution may be to privatize the program. Given the behavior of the stock market in the past few years, that doesn’t sound very reassuring.

Myth #2 – Medicare is in grave financial condition and must be reformed now.

This is not completely a myth. Medicare does need reform. It does not need to be turned into a voucher program, but it needs better data systems so that it can pay providers more quickly and track fraud more effectively. It also needs to get tougher on reimbursements for new treatments which are much more expensive than existing treatments but provide no greater benefit. Lobbyists for the companies that make these new treatments and devices have pretty much had their way with Medicare for years. One of the solutions in the Affordable Care Act was the establishment of the Independent Payment Advisory Board (IPAB), which was supposed to provide solutions to Medicare’s problems without undue interference from lobbyists and Congress (who rely on lobby money for their campaigns). Unfortunately, the IPAB is under fire and may not ever be implemented.Continue reading…

HealthVault as a Platform for Research Development

Sep 20, 2011• 2

By SEAN NOLAN

Greetings from Alaska flight 3, Reagan National to Seattle-Tacoma, seat 16C.

I’m on my way home after a great day at the Institute of Medicine’s Digital Learning Collaborative workshop. The overall goal behind the conversation was to identify core gaps and opportunities around creating feedback loops in the health system — how can we accelerate capturing learning about what works, and then integrate it back into general practice.

The room was full of smart folks and there were a ton of great observations, but the two themes that really stuck with me were:

It’s clear that to make real improvements we have to reach beyond the office visit and find ways to bridge between the “real lives” of citizens/consumers and the traditional healthcare world.
There is a ton of research and pilots running on either side of this bridge, but not a lot that reaches across it — and there is a perception that doing that work is really difficult.

Interestingly, not very long ago I was at the USENIX workshop on Health Security and Privacy*** — a very different conference (much longer hair than at IOM) — but exactly the same themes emerged from those sessions.

Is the Foreclosure Crisis Making People Sick?

Sep 19, 2011• 4

By Sanjay Basu, MD

The housing crisis that precipitated our ongoing recession began with the foreclosure of 15% of US mortgages. There remains substantial disagreement, however, about whether and how public health departments should specifically address health problems experienced by the people who lost their homes in this crisis. While poor housing quality and homelessness have been statistically correlated to illness for many years, some argue that the correlation merely represents the influence of other factors that are common among people with housing insecurity: indebtedness and inability to pay for medical services, unemployment and associated insurance loss, food insecurity, mental illness, substance abuse, or family instability resulting in poor healthcare seeking or inadequate medical adherence.

As a result, it’s not obvious whether having health departments improve housing availability or quality will necessarily improve health conditions among the groups who face foreclosure. If better housing is really directly linked to better health outcomes, then health departments should expect a return on their investment in housing programs for this group. But if the statistical finding is merely secondary to other factors like indebtedness, then the money might be better spent elsewhere, for example in debt repayment programs, or in preventing the type of predatory banking practices that lead to the foreclosures. In this post, we try to answer the question: is the foreclosure crisis making people sick? And if so, what interventions have been shown to work, if any?

From Couch Potato to Quantified Self

Sep 19, 2011• 7

By JOSEPH KVEDAR, MD

I’ve been interested in the growing population of folks who self-track objective data for health purposes. The phenomenon is referred to either as personal informatics or the Quantified Self. Both concepts have a following and both are intimately tied into the value of connected health. Connected Health adds value in two fundamental ways: self–care and just-in-time care. In both cases, objective, quantified data is a critical piece of success. For those individuals who are even a bit motivated to improve their health, quantified, objective information leads to insights that prompt behavior change.

I had a chance the other day to catch up with Gary Wolf, who is one of the founders of Quantifiedself.com, a frequent contributor to the New York Times Sunday Magazine and a Contributing Editor at Wired. We had an inspiring discussion about the intersections of Quantified Self and Connected Health.

Gary was a bit out of breath, having just wrapped up the first Quantified Self Conference in Mountain View, CA. Gary was very excited about the conference and its impact. More than 100 projects were presented, 60 talks were given and more than 25% of participants presented. When I asked him what was ‘the hook,’ i.e. why is QS taking off so fast, his response was that, “people are reaching the realization/hope that personal data have personal meaning.” We both agree that the growing interesting in quantification is bringing us beyond the ‘data is geeky’ stage to an era where there is a real movement around the collection of data and the use of that data to gain insight about health and affect behavior change.Continue reading…

Minute Clinics Threaten Doctors: Who Wins?

Sep 19, 2011• 16

By MICHAEL KIRSCH, MD

All of us have been to fast food establishments. We go there because we are in a hurry and it’s cheap. We love the convenience. We expect that the quality of the cuisine will be several rungs lower than fine dining.

We now have a fast medicine option available to us. Across the country, there are over 1000 ‘minute-clinics’ that are being set up in pharmacies, supermarkets and other retail store chains. These clinics are staffed by nurse practitioners who have prescribing authority, under the loose oversight of a physician who is likely off sight. These nurses will see patients with simple medical issues and will adhere to strict guidelines so they will not treat beyond their medical knowledge. For example, if a man comes in clutching his chest and gasping, the nurse will know not to just give him some Rolaids and wish him well. At least, that’s the plan.

Primary care physicians are concerned over the metastases of ‘minute-clinics’ nationwide. Of course, they argue from a patient safety standpoint, but there are powerful parochial issues worrying physicians. They are losing business. They have a point that patients should be rightly concerned about medical errors and missed diagnoses at these medical care drive-ins. These nurses, even with their advanced training, are not doctors. It is also true serious or even life threatening conditions can masquerade as innocent medical complaints and might not be recognized by a nurse who treats colds and ankle sprains.

The Safety Net Is Working

Sep 17, 2011• 15

By Henry Aaron

Most of the newspaper coverage of the just-released Census Bureau data on health insurance coverage has focused changes in coverage between 2009 and 2010. Since the advent of the Great Recession, the reduction in health insurance coverage has been dominated by the simple fact that as unemployment has risen, since most families with prime-age earners receive health insurance as a fringe benefit of employment, the number of uninsured has risen. The increase was large from 2008 to 2009 when unemployment rose rapidly. From 2009 to 2010, when unemployment stabilized at high levels, the increase was smaller, although still disturbingly large.

If one looks back a bit farther, however, some noteworthy differences by age group emerge, as shown in the table. Health insurance coverage fell for all age groups but one from 2007 to 2010 and over the longer period starting with the boom year of 1999. That coverage would have fallen in both periods is unsurprising because, as noted, health insurance for most people is linked to employment and unemployment rose over both of those periods.

Ten Years Cancer-Free

Sep 16, 2011• 3

By benjamin rubenstein

I enter the large, dark room, approach the table in the middle, and lie face-down. I bury my head in a pillow and close my eyes. I hear the nurse exit and close the door behind her. The door locks, and the “Radiation” sign illuminates.

I hear the machine turn on and move, get in position, and hover over me. I fidget to get comfortable one last time, and then I do not move. I focus on my breathing and I focus on my muscles not twitching. The energy about to exit the machine over the next ten minutes—the amount in about 180 CT scans—will burn my skin, which is already tomato-red from the previous 24 sessions I’ve had. It will blaze through my intestines, muscles, nerves, and now-dead bone. Most importantly it will annihilate the cancer cells that I believe have already been dead for 11 months. Dead from the first of 14 cycles of chemo. Dead because I felt them burning alive, a pain I will never forget and a pain I wish I hadn’t taken Tylenol to mask.

Minutes later, the machine stops making noise. I hear the nurse open the massive steel door and say that radiation is over. I follow her into the lobby. She says she will miss me, hugs me, and gives me a Hershey’s bar. I am confident that I will never receive another milliliter of chemotherapy. I will never again lie motionless in front of a machine that shoots waves of destructive energy through me. I will never again be termed a “cancer patient”; be seen as the Sick Kid; have another nurse say she will miss me.

It is Friday, September 14, 2001, at 3:40 p.m.. I am a bone cancer survivor, age 17.