By Brenda Goodman
HealthDay Reporter
Originally published May 16, 2013
As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.
Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.
The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.
The entire story is here.
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 Access to Health Care. Show all posts
Showing posts with label Access to Health Care. Show all posts
Friday, May 31, 2013
Wednesday, May 15, 2013
One Step Forward On Mental Health Parity
The American Psychiatric Association
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Press release on May 1, 2013
Yesterday, the United States District Court for the District of Vermont became the first court in the country to interpret the Mental Health Parity and Addiction Equity Act of 2008—and that decision is favorable to mental health patients.
In C. M. v. Fletcher Allen Health Care, Inc., plaintiff C. M. challenges her health plan’s administration of mental health benefits. Specifically, she alleges that the Plan violates MHPAEA by: (1) requiring pre-approval for routine mental health services but not for medical-surgical services; (2) conducting concurrent reviews of mental health services but not requiring such reviews for medical-surgical services; and (3) initiating automatic review processes triggered by a fixed number of visits for mental health services but not for medical-surgical services.
The defendant argued that the Interim Final Regulations under MHPEA require that, in addition to demonstrating that mental health services were treated in a different manner than medical-surgical services, patients have to demonstrate that “no clinically appropriate standard of care would permit a difference,” to prove violation of MHPAEA. The Court disagreed, finding that “the Parity Act was promulgated to eliminate impermissible disparity in the benefits afforded for mental health and substance abuse disorders when compared to those afforded medical/surgical conditions. ... It stands to reason that plan administrators would also bear the burden of establishing, under the Parity Act, why mental health and medical benefits are treated differently based upon divergent clinical standards.”
According to Colleen Coyle, General Counsel of the American Psychiatric Association, “this is significant because it clearly puts the burden on the insurance industry to provide clinically appropriate standards of care to justify treating mental health claims differently than medical-surgical claims. Mental health and substance disorder patients have a right to know whether they are being treated differently than patients with other physical or surgical issues, and if so, on what clinical grounds the insurance companies justify that difference.” The APA assisted the plaintiff’s counsel in briefing the MHPAEA arguments in this case, has filed another lawsuit against insurers Anthem and WellPoint, and is in the process of challenging several other insurance carriers it believes are violating mental health parity.
Lead attorney representing C.M., Alison J. Bell, partner at Langrock Sperry & Wool, LLP, said, “Mental health parity is an important lifeline for my client, who was denied benefits for medical care desperately needed in order to live a healthy life. We are grateful for the APA’s assistance with MHPAEA issues.”
Meiram Bendat, founder of Psych-Appeal, which assists mental health professionals and their patients in challenging insurance denials for mental health treatment, added “Psych-Appeal has worked hard to bring the parity issues to the forefront in this case and proudly hails its collaboration with plaintiff's counsel and the American Psychiatric Association."
Last weekend, former Congressman Patrick Kennedy held a round table discussion with psychiatrists, patients, mental health advocates, and political leaders about mental health parity, and the need for patients to speak out publicly about disparate treatment of mental health claims in order to ensure that the full vision of MHPAEA is realized. (Read one of the patient stories as previously provided in hearings held by the Connecticut Health Care Advocate’s office.) James Scully, CEO and Medical Director of the APA stated, “The APA applauds plaintiff C.M. and others who spoke at the round table last week for having the courage to stand up for the right to care. We look forward to the day when parity is fully realized and those with a mental illness and/or substance use disorders can expend their energy and resources conquering the illness, rather than battling the insurance companies for the coverage to which they are entitled and for which they and their employer have paid.”
The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.
Tuesday, April 30, 2013
A Health Provider Strives to Keep Hospital Beds Empty
By Annie Lowrey
The New York Times
Originally published April 23, 2013
On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.
For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.
This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.
The entire story is here.
The New York Times
Originally published April 23, 2013
On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.
For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.
This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.
The entire story is here.
Friday, April 26, 2013
Online Medical Professionalism: Patient and Public Relationships
Policy Statement From the American College of Physicians and the Federation of State Medical Boards
Ann Intern Med. 16 April 2013;158(8):620-627
Abstract
User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient–physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies.
Because of the creation and use of information online and the widespread use of the Internet and Web 2.0 platforms, physicians and others are increasingly required to consider how best to protect patient interests and apply principles of professionalism to new settings. As new technologies and practices, such as social networking, are embraced, it is paramount to maintain the privacy and confidentiality of patient information, demonstrate respect for patients, ensure trust in physicians and in the medical profession, and establish appropriate boundaries. To protect patients and the public and promote quality health care, it is critical to strike the proper balance to harness opportunities while being aware of inherent challenges in using technology. But as others have pointed out, “Connectivity need not come at the expense of professionalism”.
Organizational statements addressing these issues are starting to appear, but they may not provide specific guidance to deal with and anticipate concerns. Innovations often bring benefits, but rapid introduction of technology sometimes outpaces existing policies, laws, and guidelines. This article provides a framework for analyzing medical ethics and professionalism issues in online postings and interactions, including the use of electronic resources for clinical or direct patient care involving patient information outside of the electronic health record, and the nonclinical or personal use of these media. It presents the implications of online activities for patients, physicians, the profession, and society and contains recommendations that address online communication with patients, the use of social media sites to gather and share information about patients, physician-produced blogs, physician posting of personal information that patients can access, and communications among colleagues about patient care.
Ann Intern Med. 16 April 2013;158(8):620-627
Abstract
User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient–physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies.
Because of the creation and use of information online and the widespread use of the Internet and Web 2.0 platforms, physicians and others are increasingly required to consider how best to protect patient interests and apply principles of professionalism to new settings. As new technologies and practices, such as social networking, are embraced, it is paramount to maintain the privacy and confidentiality of patient information, demonstrate respect for patients, ensure trust in physicians and in the medical profession, and establish appropriate boundaries. To protect patients and the public and promote quality health care, it is critical to strike the proper balance to harness opportunities while being aware of inherent challenges in using technology. But as others have pointed out, “Connectivity need not come at the expense of professionalism”.
Organizational statements addressing these issues are starting to appear, but they may not provide specific guidance to deal with and anticipate concerns. Innovations often bring benefits, but rapid introduction of technology sometimes outpaces existing policies, laws, and guidelines. This article provides a framework for analyzing medical ethics and professionalism issues in online postings and interactions, including the use of electronic resources for clinical or direct patient care involving patient information outside of the electronic health record, and the nonclinical or personal use of these media. It presents the implications of online activities for patients, physicians, the profession, and society and contains recommendations that address online communication with patients, the use of social media sites to gather and share information about patients, physician-produced blogs, physician posting of personal information that patients can access, and communications among colleagues about patient care.
Friday, March 29, 2013
Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception
By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013
Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.
At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.
As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.
Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.
The entire Op Ed is here.
The study debunking the "rate shock" rumor is here.
Forbes - Op Ed
Originally published on March 26, 2013
Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.
At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.
As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.
Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.
The entire Op Ed is here.
The study debunking the "rate shock" rumor is here.
Tuesday, March 5, 2013
Bitter Pill: Why Medical Bills Are Killing Us
By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Time: Health & Fitness
Originally published February 20, 2013
Here are some excerpts:
I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.
When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.
Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?
What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?
The entire story is here.
Friday, March 1, 2013
Federal Government To Run Insurance Marketplaces In Half The States
By Phil Galewitz and Alvin Tran
Kaiser Health News
Originally published February 15, 2013
It's official. The Obama administration will be running new health insurance marketplaces in 26 states— including the major population centers of Texas, Florida and Pennsylvania.
The federal government had hoped more states this week would agree to form a partnership exchange—the deadline to apply was Friday—but the offer was largely rebuffed. New Jersey, Ohio and Florida, several of the biggest states that had not declared their intentions, officially said no late in the week.
"I have determined that federal operation of the Exchange is the responsible choice for our state," New Jersey Gov. Chris Christie, a Republican, wrote in letter Friday to Kathleen Sebelius, secretary of the Department of Health and Human Services.
For consumers, it should make little difference whether the new Internet sites are run from state capitals or Washington, D.C. But federal regulators hoped states would shoulder some of the work and stakeholder groups such as hospitals and insurers wanted states to help as well. The exchanges will open for business Oct. 1.
The entire story is here.
Editorial Note: Since Kaiser Health News reported this information, Florida Gov. Rick Scott now accepted the federal government's assistance to set up the health exchange for Florida.
Kaiser Health News
Originally published February 15, 2013
It's official. The Obama administration will be running new health insurance marketplaces in 26 states— including the major population centers of Texas, Florida and Pennsylvania.
The federal government had hoped more states this week would agree to form a partnership exchange—the deadline to apply was Friday—but the offer was largely rebuffed. New Jersey, Ohio and Florida, several of the biggest states that had not declared their intentions, officially said no late in the week.
"I have determined that federal operation of the Exchange is the responsible choice for our state," New Jersey Gov. Chris Christie, a Republican, wrote in letter Friday to Kathleen Sebelius, secretary of the Department of Health and Human Services.
For consumers, it should make little difference whether the new Internet sites are run from state capitals or Washington, D.C. But federal regulators hoped states would shoulder some of the work and stakeholder groups such as hospitals and insurers wanted states to help as well. The exchanges will open for business Oct. 1.
The entire story is here.
Editorial Note: Since Kaiser Health News reported this information, Florida Gov. Rick Scott now accepted the federal government's assistance to set up the health exchange for Florida.
Tuesday, February 19, 2013
SGR Repeal Bill Favors Primary Care
Robert Lowes
MedScape Medical NewsOriginally published February 06, 2013
Two members of Congress today reintroduced an ambitious bill that would repeal Medicare's sustainable growth rate (SGR) formula for setting physician pay and gradually phase out fee-for-service (FFS) reimbursement.
One major difference this time around for the bipartisan bill, originally introduced in May 2012, is that its price tag appears considerably lower, making passage more likely.
When Reps. Allyson Schwartz (D-PA) and Joe Heck, DO (R-NV), proposed this legislation last year, the Congressional Budget Office (CBO) had estimated that repealing the SGR and merely freezing current Medicare rates for 10 years would cost roughly $320 billion.
Since then, the CBO has reduced that 10-year estimate on the basis of lower than projected Medicare spending on physician services for the past 3 years. In a budget forecast released yesterday, the agency put the cost of a 10-year rate freeze at $138 billion.
The immediate effect of the bill from Schwartz and Dr. Heck, titled the Medicare Physician Payment Innovation Act, would be to avert a Medicare pay cut of roughly 25% on January 1, 2014, that is mandated by the SGR formula. Instead, the bill maintains 2013 rates through the end of 2014.
After 2014, Medicare would begin to shift from FFS to a methodology that rewards physicians for the quality and efficiency of patient care. From 2015 through 2018, the rates for primary care, preventive, and care coordination services would increase annually by 2.5% for physicians for whom 60% of Medicare allowables fall into these categories. Medicare rates for all other physician services would rise annually by 0.5%.
Meanwhile, the bill calls on the Centers for Medicare & Medicaid Services (CMS) to step up its efforts to test and evaluate new models of delivering and paying for healthcare (experiments with medical homes, accountable care organizations, and bundled payments are already underway). By October 2017, CMS must give physicians its best menu of new models to choose from. Two menu options would allow some physicians unable to fully revolutionize to participate in a modified FFS scheme.
The entire article is here.
Friday, February 15, 2013
Clergy are not doctors — and the U.S. has its own Savita Halappanavars
By Irin Carmon
Salon.com
Originally published February 7, 2013
The death of Savita Halappanavar — the woman who died of sepsis in Ireland after being denied her request for termination of a nonviable pregnancy — drew outrage and attention in the United States late last fall, but one crucial point was often missed. Even in America, where abortion is mostly legal, cases like Halappanavar’s are a known reality in Catholic hospitals.
Take one case detailed to medical sociologist Lori Freedman by the doctor involved. A woman 16 weeks pregnant with twins was diagnosed with a molar pregnancy, which can lead to cancer, and “didn’t want to carry the pregnancy further.” She went to the hospital with vaginal bleeding, but unluckily for her, it was a Catholic one. There, the ethics committee decided that a uterine evacuation was tantamount to abortion, because there was a slim chance one of the fetuses would survive.
According to another doctor who witnessed the situation, “The clergy who made the decision Googled molar pregnancy.”
The woman was transferred out, Freedman wrote in a recent study published in the American Journal of Bioethics Primary Research, “despite the fact that terminating a bleeding molar pregnancy is safer in the hospital setting due to a high risk of hemorrhage.” What Freedman learned tracked closely with her previous studies focused on doctors’ concerns about miscarriage care in Catholic hospitals in situations very much like Halappanavar’s. Many doctors told her they preferred to send patients elsewhere rather than navigate the ethics committee.
The tension between religious beliefs and denial of medical care is currently playing out in the courtroom battles over the contraceptive coverage requirements under Obamacare, and for years, in legislative battles over “conscience clauses” that allow medical providers to opt out of some procedures. But some doctors’ consciences are being violated in the opposite fashion: Their recommendations for what is best for the women’s health and life, and often the wishes of the women themselves, are being circumvented by ethics committees at ever-expanding Catholic hospitals.
The entire story is here.
Thanks to Gary Schoener for this article.
Salon.com
Originally published February 7, 2013
The death of Savita Halappanavar — the woman who died of sepsis in Ireland after being denied her request for termination of a nonviable pregnancy — drew outrage and attention in the United States late last fall, but one crucial point was often missed. Even in America, where abortion is mostly legal, cases like Halappanavar’s are a known reality in Catholic hospitals.
Take one case detailed to medical sociologist Lori Freedman by the doctor involved. A woman 16 weeks pregnant with twins was diagnosed with a molar pregnancy, which can lead to cancer, and “didn’t want to carry the pregnancy further.” She went to the hospital with vaginal bleeding, but unluckily for her, it was a Catholic one. There, the ethics committee decided that a uterine evacuation was tantamount to abortion, because there was a slim chance one of the fetuses would survive.
According to another doctor who witnessed the situation, “The clergy who made the decision Googled molar pregnancy.”
The woman was transferred out, Freedman wrote in a recent study published in the American Journal of Bioethics Primary Research, “despite the fact that terminating a bleeding molar pregnancy is safer in the hospital setting due to a high risk of hemorrhage.” What Freedman learned tracked closely with her previous studies focused on doctors’ concerns about miscarriage care in Catholic hospitals in situations very much like Halappanavar’s. Many doctors told her they preferred to send patients elsewhere rather than navigate the ethics committee.
The tension between religious beliefs and denial of medical care is currently playing out in the courtroom battles over the contraceptive coverage requirements under Obamacare, and for years, in legislative battles over “conscience clauses” that allow medical providers to opt out of some procedures. But some doctors’ consciences are being violated in the opposite fashion: Their recommendations for what is best for the women’s health and life, and often the wishes of the women themselves, are being circumvented by ethics committees at ever-expanding Catholic hospitals.
The entire story is here.
Thanks to Gary Schoener for this article.
Monday, January 21, 2013
Wealth but not health in the USA
The Lancet
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Volume 381, Issue 9862
Page 177
Last week, American people, health-care workers, and policy makers received shocking news. Despite spending more on health care per person than other high-income countries, Americans die sooner, are least likely to reach the age of 50 years, and have higher rates of disease or injury. When judged by health alone, Americans are less healthy from birth to 75 years of age than people in 16 other economically wealthy countries, and this health disadvantage has been getting worse for 30 years, especially among women.
In a report released on Jan 9 from the US National Research Council and Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health, comprehensive mortality and morbidity data are presented, comparing the USA with affluent democratic countries including Australia, Canada, France, Italy, most of the Nordic countries, Spain, and the UK. Life expectancy is shorter at birth for American men than for men in any of the other 16 countries, and American women fare little better—Denmark is the only country that has a lower life expectancy for women at birth. In nine key areas of health, Americans fare least well, or are near the bottom of the tables. These areas are: infant mortality and low birthweight; injuries and homicides; teenage pregnancies and sexually transmitted infections; HIV/AIDS prevalence; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability. This health disadvantage applies to those with health insurance, a college education, higher incomes, and healthy behaviours as well as to those without.
Some good news in the report is that those Americans who reach 75 years live longer than their peers in other countries, and that Americans have low death rates from stroke and cancer. Moreover, current smoking rates are low, which should lead to future health benefits, and household income is relatively high.
US health spending was US$2·7 trillion in 2011, which is $8700 for every person in the country, and represents 17·9% of the economy—far greater than any other economically advanced country. But spending on health care bears little relation to good health.
Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame....
The entire story is here.
Wednesday, January 9, 2013
Employers Must Offer Family Care, Affordable or Not
By ROBERT PEAR
The New York Times
Originally published: December 31, 2012
In a long-awaited interpretation of the new health care law, the Obama administration said Monday that employers must offer health insurance to employees and their children, but will not be subject to any penalties if family coverage is unaffordable to workers.
The requirement for employers to provide health benefits to employees is a cornerstone of the new law, but the new rules proposed by the Internal Revenue Service said that employers’ obligation was to provide affordable insurance to cover their full-time employees. The rules offer no guarantee of affordable insurance for a worker’s children or spouse. To avoid a possible tax penalty, the government said, employers with 50 or more full-time employees must offer affordable coverage to those employees. But, it said, the meaning of “affordable” depends entirely on the cost of individual coverage for the employee, what the worker would pay for “self-only coverage.”
The new rules, to be published in the Federal Register, create a strong incentive for employers to put money into insurance for their employees rather than dependents. It is unclear whether the spouse and children of an employee will be able to obtain federal subsidies to help them buy coverage — separate from the employee — through insurance exchanges being established in every state. The administration explicitly reserved judgment on that question, which could affect millions of people in families with low and moderate incomes.
The entire story is here.
Wednesday, December 26, 2012
'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'
By Russ Mitchell
Kaiser Health News
Originally published December 18, 2012
Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse.
The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. "If I'd had to wait until 67 for Medicare," Lewis said, "I'd be dead."
A proposal to raise the Medicare eligibility age from 65 to 67 to ratchet down spending is one of the more explosive ideas in the fiscal talks between House Speaker John Boehner and the White House. The negotiations are aimed at a deficit deal to avert automatic tax increases and spending cuts slated to take effect Jan. 1. Liberal Democrats say they loathe the Medicare proposal, but the White House has not taken a public position on it.
President Barack Obama was open to a similar proposal last year during his failed effort to reach a "grand bargain" with Republicans. And many expect it to pop up again in next year’s discussions about curbing entitlement costs if it is not included in this year’s deal.
The entire article is here.
Wednesday, December 19, 2012
New Taxes to Take Effect to Fund Health Care Law
By ROBERT PEAR
The New York Times
Originally Published: December 8, 2012
For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.
The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.
Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.
To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.
The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.
The entire article is here.
Sunday, December 16, 2012
Mental health and disadvantage in Indigenous Australians
Editorial
The Lancet
Volume 380, Issue 9858, Page 1968
Last week, Australia's National Mental Health Commission released A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention, its first such publication. The report card takes a whole-of-life approach, recognising that, like everyone else, people who have a mental illness need a stable home, a decent education, a job, good physical health, and a support network, as well as access to high-quality treatment and services.
There is a special focus on the first Australians, the Aboriginal and Torres Strait Islanders, who still face enormous disadvantages when compared with the general population. This disadvantage starts before birth. For example, three in ten Aboriginal and Torres Strait Islanders, including pregnant women, report barriers to accessing health services. 50% of pregnant Aboriginal and Torres Strait Islander women smoke. And one in seven new Indigenous mothers have postnatal depression. As the report notes, a child born into these circumstances does not have an auspicious start in life. Furthermore, an Indigenous child is two and a half times more likely to be born into the lowest income group, and has a one in two chance of living in a one-parent household when compared with the general population. All these factors play into adolescence and adulthood, and increase the risk of mental health problems and associated issues such as substance misuse in the Indigenous population. Up to 15% of the 10-year life expectancy gap compared with non-Indigenous Australians has been attributed to mental health disorders.
The report recommends the development and implementation of an Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing Plan to commence in 2013 as well as training and employment of more Indigenous people in mental health services. This must be a national government priority, as should addressing the deep health and social inequalities faced by Aboriginal and Torres Strait Islanders. Australia's Indigenous population should have the opportunity to thrive, not just survive.
doi:10.1016/S0140-6736(12)62139-4
The Lancet
Volume 380, Issue 9858, Page 1968
Last week, Australia's National Mental Health Commission released A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention, its first such publication. The report card takes a whole-of-life approach, recognising that, like everyone else, people who have a mental illness need a stable home, a decent education, a job, good physical health, and a support network, as well as access to high-quality treatment and services.
There is a special focus on the first Australians, the Aboriginal and Torres Strait Islanders, who still face enormous disadvantages when compared with the general population. This disadvantage starts before birth. For example, three in ten Aboriginal and Torres Strait Islanders, including pregnant women, report barriers to accessing health services. 50% of pregnant Aboriginal and Torres Strait Islander women smoke. And one in seven new Indigenous mothers have postnatal depression. As the report notes, a child born into these circumstances does not have an auspicious start in life. Furthermore, an Indigenous child is two and a half times more likely to be born into the lowest income group, and has a one in two chance of living in a one-parent household when compared with the general population. All these factors play into adolescence and adulthood, and increase the risk of mental health problems and associated issues such as substance misuse in the Indigenous population. Up to 15% of the 10-year life expectancy gap compared with non-Indigenous Australians has been attributed to mental health disorders.
The report recommends the development and implementation of an Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing Plan to commence in 2013 as well as training and employment of more Indigenous people in mental health services. This must be a national government priority, as should addressing the deep health and social inequalities faced by Aboriginal and Torres Strait Islanders. Australia's Indigenous population should have the opportunity to thrive, not just survive.
doi:10.1016/S0140-6736(12)62139-4
Sunday, December 9, 2012
Witness
One Case at a Time Blog
observations from an anesthesiologist and mother of
two
Originally published January 2012
The anesthesia scheduling office accidentally placed me in
an operating room tomorrow with a patient who is a Jehovah’s Witness. It was a
paperwork slip-up; I am new and someone forgot to put my name on the “never”
list. There are three options for anesthesiologists at my hospital: You will
provide anesthesia for Jehovah’s Witnesses
- For all operations
- Only for operations that are not expected to involve great blood loss
- Never
Of course, all anesthesiologists agree to care for
Jehovah’s Witnesses who have a life-threatening emergency if we are the only one
available.
I had chosen number three: never. I called the scheduling
office and they apologized and switched me to a different operating room.
My lack of faith in any nameable higher being is so firm
that I can not reconcile it with what Jehovah’s Witnesses would ask me to do.
Their practice comes, of course, from the bible. According to watchtower.org,
the official website of the Jehovah’s Witnesses, the belief that “Taking blood
into body through mouth or veins violates God's laws” comes from three biblical
passages: Gen. 9:3, 4; Lev. 17:14; Acts
15:28, 29.
(cut)
I am morally incapable of letting someone bleed to death.
In my operating room, when I am delivering anesthesia, I am responsible
completely for that person’s life. This responsibility weighs heavily on me
until each patient is safely out of the operating room. I welcome the weight. I
care for each person deeply.
Thanks to Ed Zuckerman for this information.
Friday, December 7, 2012
Arizona studies envision telemedicine on smartphones
By: Lorri Allen
Cronkite News Service
Originally published: Nov 21, 2012
Until now, telemedicine has largely involved capital-intensive studios and cameras isolated to one area of a hospital. But the Mayo Clinic and a University of Arizona center dedicated to telemedicine are pioneering work aimed at moving care to smartphones.
That means practicing medicine in remote and underserved communities will become cheaper, quicker and more effective, according to Dr. Bart Demaerschalk, a neurologist at Mayo Clinic Hospital.
"What we're attempting to do is to make it even easier for the clinical specialist to insert themselves in a virtual manner for the patient in the remote environment," he said. "A mobile device should fulfill that goal."
Dr. Ronald Weinstein, director of the Arizona Telemedicine Program, sees it as a natural progression.
"Telemedicine is rapidly evolving into being next-generation or even a generation beyond by going to mobile health or e-health, and the concept du jour is that the smartphone is the telemedicine workstation," he said.
That's happening at Benson Hospital, where health care workers use Skype on iPads to save time.
"It's very low-cost and it's to facilitate communication between our ER docs and admissions," said John Roberts, information technology director.
The entire story is here.
Monday, December 3, 2012
Dealing With Doctors Who Take Only Cash
By PAUL SULLIVAN
The New York Times
Originally published: November 23, 2012
Here is an excerpt:
The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.
The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.
A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.
While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.
Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?
The entire story is here.
Sunday, October 28, 2012
U.S. Set to Sponsor Health Insurance
By Robert Pear
The New York Times
Originally published October 27, 2012
The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.
These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.
The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.
Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide.
The entire story is here.
The New York Times
Originally published October 27, 2012
The Obama administration will soon take on a new role as the sponsor of at least two nationwide health insurance plans to be operated under contract with the federal government and offered to consumers in every state.
These multistate plans were included in President Obama’s health care law as a substitute for a pure government-run health insurance program — the public option sought by many liberal Democrats and reviled by Republicans. Supporters of the national plans say they will increase competition in state health insurance markets, many of which are dominated by a handful of companies.
The national plans will compete directly with other private insurers and may have some significant advantages, including a federal seal of approval. Premiums and benefits for the multistate insurance plans will be negotiated by the United States Office of Personnel Management, the agency that arranges health benefits for federal employees.
Walton J. Francis, the author of a consumer guide to health plans for federal employees, said the personnel agency had been “extraordinarily successful” in managing that program, which has more than 200 health plans, including about 20 offered nationwide.
The entire story is here.
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