Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Health Care Policy. Show all posts
Showing posts with label Health Care Policy. Show all posts

Wednesday, March 9, 2022

As Suicide Attempts Rise in America, Mental Health Care Remains Stagnant

Kara Grant
MedPageToday.com
Originally posted 19 JAN 22

Despite the substantial increase in suicide attempts among U.S. adults over the last decade, use of mental health services by these individuals didn't match that growth, data from the National Surveys on Drug Use and Health (NSDUH) revealed.

From 2008 to 2019, suicide attempts among adults increased from 481.2 to 563.9 per 100,000 (adjusted odds ratio [aOR] 1.23, 95% CI 1.05-1.44, P=0.01), reported Greg Rhee, PhD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And according to their study in JAMA Psychiatry, there was a significant uptick in the number of individuals that attempted suicide within the past year who said they felt they needed mental health services but failed to receive it (34.8% in 2010-2011 vs 45.5% in 2018-2019).

Overall, the researchers found no significant changes in the likelihood of receiving past-year outpatient, inpatient, or medication services for mental health reasons, nor any change in substance use treatment services. An increase in the number of visits to mental health centers was detected, but even this change was no longer significant after correcting for different sources of mental health care.

"One would hope that as suicide attempts increase, the percentage of individuals who receive treatment in proximity to their attempt would also increase," Rhee and colleagues wrote. "Current suicide prevention interventions largely focus on individuals connected to treatment and high-risk individuals who have contact with the health care system."

"However, our finding that less than half of suicide attempters had clinical contact around the time of their attempt suggest[s] that it is not only important to expand initiatives for high-risk individuals with clinical contact, but also to implement public health-oriented strategies outside the formal treatment system," they suggested.

Friday, March 30, 2018

Trump Wants More Asylums — and Some Psychiatrists Agree

Benedict Carey
The New York Times
Originally published March 5, 2018

Here is an excerpt:

The third, and perhaps most critical, point of agreement in the asylum debate is that money is lacking in a nation that puts mental health at the bottom of the health budget. These disorders are expensive to treat in any setting, and funds for hospital care and community supports often come out of the same budget.

In his paper arguing for the return of asylums, Dr. Sisti singled out the Worcester Recovery Center and Hospital in Massachusetts.

This $300 million state hospital, opened in 2012, has an annual budget of $80 million, 320 private rooms, a range of medical treatments and nonmedical supports, like family and group therapy, and vocational training. Its progress is closely watched among mental health experts.

The average length of stay for adolescents is 28 days, and the average for continuing care (for the more serious cases) is 85 days, according to Daniela Trammell, a spokeswoman for the Massachusetts Department of Mental Health.

“Some individuals are hospitalized for nine months to a year; a smaller number is hospitalized for one to three years,” she wrote in an email.

Proponents of modern asylums insist that this kind of money is well spent, considering the alternatives for people with mental disabilities in prison or on the streets. Opponents are not convinced.

The article is here.

Friday, January 5, 2018

Changing genetic privacy rules may adversely affect research participation

Hayley Peoples
Baylor College of Medicine Blogs
Originally posted May 26, 2017

Do you know your genetic information? Maybe you’ve taken a “23andMe” test because you were curious about your ancestry or health. Maybe it was part of a medical examination. Maybe, like me, you underwent testing and received results as part of a class in college.

Do you ever worry about what could happen if your information landed in the wrong hands?

If you do, you aren’t alone. We’ve previously written about legislation affecting genetic privacy and public resistance to global data sharing, and the dialog about growing genetic privacy concerns only continues.

Wired.com recently ran an interesting piece on the House Health Plan and its approach to pre-existing conditions. While much about how a final, Senate-approved Affordable Care Act repeal and replace plan will address pre-existing conditions is still speculation, it brings up an interesting question – with respect to genetic information, will changing rules about pre-existing conditions have a chilling effect on research participation?

The information is here.

Sunday, December 24, 2017

Moral Choices for Today’s Physician

Donald M. Berwick
JAMA. 2017;318(21):2081-2082.

Here is an excerpt:

Hospitals today play the games afforded by an opaque and fragmented payment system and by the concentration of market share to near-monopoly levels that allow them to elevate costs and prices nearly at will, confiscating resources from other badly needed enterprises, both inside health (like prevention) and outside (like schools, housing, and jobs).

And this unfairness—this self-interest—this defense of local stakes at the expense of fragile communities and disadvantaged populations goes far, far beyond health care itself. So does the physician’s ethical duty. Two examples help make the point.

In my view, the biggest travesty in current US social policy is not the failure to fund health care properly or the pricing games of health care companies. It is the nation’s criminal justice system, incarcerating and then stealing the spirit and hope of by far a larger proportion of our population than in any other developed nation on earth.  If taking the life-years and self-respect of millions of youth (with black individuals being imprisoned at more than five times the rate of whites), leaving them without choice, freedom, or the hope of growth is not a health problem, then what is?

The article is here.

Wednesday, June 21, 2017

The Specialists’ Stranglehold on Medicine

Jamie Koufman
The New York Times - Opinion
Originally posted June 3, 2017

Here is an excerpt:

Neither the Affordable Care Act nor the Republicans’ American Health Care Act addresses the way specialists are corrupting our health care system. What we really need is what I’d call a Health Care Accountability Act.

This law would return primary care to the primary care physician. Every patient should have one trusted doctor who is responsible for his or her overall health. Resources must be allocated to expand those doctors’ education and training. And then we have to pay them more.

There are approximately 860,000 practicing physicians in the United States today, and too few — about a third — deliver primary care. In general, they make less than half as much money as specialists. I advocate a 10 percent to 20 percent reduction in specialist reimbursement, with that money being allocated to primary care doctors.

Those doctors should have to approve specialist referrals — they would be the general contractor in the building metaphor. There is strong evidence that long-term oversight by primary care doctors increases the quality of care and decreases costs.

The bill would mandate the disclosure of procedures’ costs up front. The way it usually works now is that right before a medical procedure, patients are asked to sign multiple documents, including a guarantee that they will pay whatever is not covered by insurance.  But they will have no way of knowing what the procedure actually costs. Their insurance may cover 90 percent, but are they liable for 10 percent of $10,000 or $100,000?

We also need more oversight of those costs. Instead of letting specialists’ lobbyists set costs, payment algorithms should be determined by doctors with no financial stake in the field, or even by non-physicians like economists. An Independent Payment Advisory Board was created by Obamacare; it should be expanded and adequately funded.

The article is here.

Friday, May 12, 2017

Physicians, Not Conscripts — Conscientious Objection in Health Care

Ronit Y. Stahl and Ezekiel J. Emanuel
N Engl J Med 2017; 376:1380-1385

“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.

The article is here, and you need a subscription.

Here is an excerpt:

Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).

Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.

Sunday, July 24, 2016

Nation’s psychiatric bed count falls to record low

By Lateshia Beachum
The Washington Post
Originally published July 1, 2016

The number of psychiatric beds in state hospitals has dropped to a historic low, and nearly half of the beds that are available are filled with patients from the criminal justice system.

Both statistics, reported in a new national study, reflect the sweeping changes that have taken place in the half-century since the United States began deinstitutionalizing mental illness in favor of outpatient treatment. But the promise of that shift was never fulfilled, and experts and advocates say the result is seen even today in the increasing ranks of homeless and incarcerated Americans suffering from serious mental conditions.

The article is here.

Friday, April 10, 2015

Ethics of Money in Medicine

By Danielle Ofri
Physician, Writer, Editor


Here is an excerpt:

But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices.  But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.

Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.

When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities.  Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.

The entire article is here.

Tuesday, April 7, 2015

Healthcare Accounted For Almost Half Of 2014 Client Breaches

By Christine Kern
Health IT Outcomes
Originally published March 12, 2015

A Kroll study has found the healthcare industry accounted for 49 percent of the company’s “client events” during 2014, followed by business services (retail, insurance, and financial services) at 26 percent, and higher education at 11 percent. The study further found malicious intent breach events increased while those caused by human error declined.

Tuesday, March 31, 2015

Mental health coverage unequal in many Obamacare plans

By Laura Ungar and Jayne O'Donnell
USA Today
Originally posted March 9, 2015

Insurance coverage for mental and physical illness remains unequal despite promises that Obamacare would help level the playing field, mental health advocates and researchers say.

A new study by the Johns Hopkins Bloomberg School of Public Health found that consumer information on a quarter of the Obamacare plans that researchers examined appeared to go against a federal "parity" law designed to stop discrimination in coverage for people with mental health or addiction problems.

This makes it nearly impossible for consumers to find the best plan to cover their mental health needs, the research suggests.

The entire article is here.

Friday, February 27, 2015

Medical Necessity and Unnecessary Care

By Paul Keckley
The Health Care Blog
Originally posted January 29, 2015

Unnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.

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What does it mean?

Documentation is key. Accurate clinical documentation across sites and systems of care is table stakes.

Transparency about medical necessity and unnecessary care is assured. Data about the performance of every practitioner, hospital, and health system will be widely accessible.

The entire blog post is here.

Monday, January 26, 2015

Kaiser's 2,600 mental health workers strike in California

By Olga R. Rodriguez
AP via Yahoo News
Originally published January 13, 2014

Kaiser Permanente mental health professionals throughout California went on a strike Monday to protest what they say is a lack of staffing that affects care.

The health care provider's 2,600 psychologists, therapists and social workers began the weeklong walkout to demand that Kaiser Permanente offer timely, quality mental health care at its psychiatry departments and clinics, said Jim Clifford, a union member and San Diego psychiatric therapist.

Clifford said some patients have to wait up to two months for follow-up appointments, which prolongs the recovery process.

The entire article is here.

Thursday, November 13, 2014

Equitable Access to Care — How the United States Ranks Internationally

Karen Davis, Ph.D., and Jeromie Ballreich, M.H.S.
N Engl J Med 2014; 371:1567-1570
October 23, 2014
DOI: 10.1056/NEJMp1406707

Here are two excerpts:

According to a 2013 Commonwealth Fund survey of adults in 11 high-income countries, the United States ranks last on measures of financial access to care as well as of availability of care on nights and weekends. Uninsured people in the United States are particularly likely to report encountering barriers to care.

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The United Kingdom, France, Germany, Norway, Sweden, and Switzerland stand out as leaders in ensuring equitable financial access to care. Switzerland, which provides coverage through nonprofit private insurance plans with deductibles, ensures that cost sharing is lower for lower-income individuals. The United Kingdom, Norway, and Sweden have public health care systems for the entire population with little or no patient cost sharing and allow a limited role for private insurance. France has a public insurance system, and Germany has a social insurance system with competing private “sickness funds.”

Monday, November 10, 2014

More Insurers Put Spending Limits On Medical Treatments

By Michelle Andrews
NPR
Originally published October 21, 2014

To clamp down on health care costs, a growing number of employers and insurers are putting limits on how much they'll pay for certain medical services such as knee replacements, lab tests and complex imaging.

A recent study found that savings from such moves may be modest, however, and some analysts question whether "reference pricing," as it's called, is good for consumers.

The California Public Employees' Retirement System (CalPERS), which administers the health insurance benefits for 1.4 million state workers, retirees and their families, has one of the more established reference pricing systems.

The entire article is here.

Thursday, October 16, 2014

Should nutritional supplements and sports drinks companies sponsor sport? A short review of the ethical concerns

By Simon M. Outram and Bob Stewart
J Med Ethics doi:10.1136/medethics-2014-102147

Abstract

This paper proposes that the sponsorship of sport by nutritional supplements and sport drinks companies should be re-examined in the light of ethical concerns about the closeness of this relationship. A short overview is provided of the sponsorship of sport, arguing that ethical concerns about its appropriateness remain despite the imposition of severe restrictions on tobacco sponsorship. Further, the paper examines the main concerns about supplement use and sports drinks with respect to efficacy, health and the risks of doping. Particular consideration is given to the health implications of these concerns. It is suggested that they, of themselves, do not warrant the restriction of sponsorship by companies producing supplements and sports drinks. Nevertheless, it is argued that sports sponsorship does warrant further ethical examination—above and beyond that afforded to other sponsors of sport—as sport sponsorship is integral to the perceived need for such products. In conclusion, it is argued that sport may have found itself lending unwarranted credibility to products which would otherwise not necessarily be seen as beneficial for participation in sports and exercise or as inherently healthy products.

The entire article is here.

Thursday, October 9, 2014

Panel Urges Overhauling Health Care at End of Life

By Pam Belluck
The New York Times
Originally posted on September 17, 2014

The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.

The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.

“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”

The entire article is here.

Monday, August 4, 2014

Bottlenecks in Training Doctors

By The Editorial Board
The New York Times
Originally published July 19, 2014

The new head of the Department of Veterans Affairs, Sloan Gibson, told a Senate committee last week that he needed $17.6 billion over the next three years to hire some 1,500 doctors, 8,500 nurses and other clinicians to reduce the unconscionably long waiting times that many veterans now endure before they are able to see a doctor.

That news was bad enough, but the department’s problems are emblematic of an even deeper problem: a nationwide shortage of doctors, especially primary care doctors, and other health care professionals, that will only get worse in coming years. No less alarming, the current medical education system is ill-equipped to train the number of professionals needed.

Experts disagree over how bad the current shortages are. But virtually all agree that the problem is acute in rural areas and in poor urban neighborhoods. As of June 19, according to one estimate cited by analysts in the Department of Health and Human Services, there was a shortage of 16,000 primary care physicians in such underserved areas.

The entire story is here.

Friday, July 11, 2014

Why haven't more states expanded Medicaid yet?

By California Healthline
www.philly.com
Originally posted June 26, 2014

Two years after Roberts issued the majority opinion upholding the Affordable Care Act, the decision to expand Medicaid is far from settled. Despite predictions that all states will eventually embrace Medicaid expansion, a significant number continue to hold out.

At last count, 26 states and the District of Columbia intend to expand Medicaid, while four are actively considering it and 20 have no plans to expand the program at this time.

The Medicaid expansion was considered the sleeper issue in the legal case against the ACA that ultimately made its way up to the Supreme Court. Stakeholders were closely watching issues like the constitutionality of the individual mandate, not thinking Medicaid would be significant. And yet, in a surprise decision, the Supreme Court effectively took the teeth out of one of the law's major efforts to expand health insurance, by making it illegal to penalize states for not participating in the Medicaid expansion.

The entire article is here.

Wednesday, June 4, 2014

Healthy behavior matters. So are we responsible if we get sick?

By Bill Gardner
The Incidental Economist
Originally published May 30, 2014

I have been warned my whole life that I shouldn’t smoke. The evidence that smoking affects health is overwhelming. Suppose I understand all this, but I smoke anyway. And then I get lung cancer. Am I responsible for what happened to me, given that I was aware of the consequences yet behaved recklessly anyway?

Whether we are responsible for our health affects how we think about health policy. The ACA subsidizes insurance, and thus the cost of health care, for millions of Americans. Many people feel that it is right to care for those who are ill through no fault of own, but they do not understand why they should be responsible when someone becomes sick through reckless behaviour or self-indulgence. Our intuition is that such people are (to some degree) morally responsible for their fate.

The entire article is here.

Friday, May 23, 2014

Architect Of Health Law Says Reform Is 'Never Finished'

The University of New Orleans
Originally published May 7, 2014

Two polls released this week reveal challenges ahead for the Affordable Care Act.

Gallup found the nation’s uninsured rate dropped to 13.4 percent last month, the lowest monthly uninsured rate since the company began tracking it in 2008. But that means 32 million people remain without coverage.

And a Pew Research Center poll shows that 55 percent of Americans disapprove of the 2010 health care reform law, which mandates that everyone have health insurance and that it be made available to even those with pre-existing medical conditions.

The entire story is here.