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 Funding. Show all posts
Showing posts with label Funding. Show all posts

Monday, August 7, 2017

Study suggests why more skin in the game won't fix Medicaid

Don Sapatkin
Philly.com
Originally posted July 19, 2017

Here is an excerpt:

Previous studies have found that increasing cost-sharing causes consumers to skip medical care somewhat indiscriminately. The Dutch research was the first to examine the impact of cost-sharing changes on specialty mental health-care, the authors wrote.

Jalpa A. Doshi, a researcher at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, has examined how Americans with commercial insurance respond to cost-sharing for antidepressants.

“Because Medicaid is the largest insurer of low-income individuals with serious mental illnesses such as schizophrenia and bipolar disorder in the United States, lawmakers should be cautious on whether an increase in cost sharing for such a vulnerable group may be a penny-wise, pound-foolish policy,” Doshi said in an email after reading the new study.

Michael Brody, president and CEO of Mental Health Partnerships, formerly the Mental Health Association of Southeastern Pennsylvania, had an even stronger reaction about the possible implications for Medicaid patients.

The article is here.

Thursday, October 27, 2016

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP

Guest Post by Nathan Emmerich
BMJ Blogs
Originally posted October 5, 2016

Here is an excerpt:

Consider the following thought experiments. Imagine a drug that could be taken to significantly lessen the risk that a smoker would develop lung cancer, or a drug that would lessen the risk of ‘at risk’ individuals developing diabetes. In such cases would we be inclined to refuse public funds for such drugs merely because such individuals could lessen their risks even more by giving up smoking, or by losing weight and eating a healthy or, at least, healthier diet?

There is, certainly, something regrettable about having to spend public money on a drug that offsets risks generated by an individual’s own behaviour. Nevertheless, from an epidemiological – and therefore public health – perspective, the notion that an individual makes a choice about whether or not to smoke, or to have a bad diet, is too simplistic, even when we place the issue of addiction to one side. Thus, even when smoking cessation programmes are available and even when nutritional advice is within easy reach (as it increasingly is), plenty of people still smoke and consume a less than healthy diet.

Smoking and bad diets are correlated with a variety of demographic factors, and our choices are always made within particular cultural and socio-political contexts. Even so, some have questioned if the NHS should be funding stomach-stapling operations for those who are overweight, or if smokers and non-smokers can expect to receive the same level of treatment and care.

The entire blog post is here.

Friday, June 10, 2016

Decriminalizing Mental Illness — The Miami Model

John K. Iglehart
N Engl J Med 2016; 374:1701-1703

Here is an excerpt:

Miami-Dade’s initiative was launched in 2000, when Judge Leifman, frustrated by the fact that people with mental disorders were cycling through his court repeatedly, created the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP). As Leifman explained, “When I became a judge . . . I had no idea I would become the gatekeeper to the largest psychiatric facility in the State of Florida. . . . Of the roughly 100,000 bookings into the [county] jail every year, nearly 20,000 involve people with serious mental illnesses requiring intensive psychiatric treatment while incarcerated. . . . Because community-based delivery systems are often fragmented, difficult to navigate, and slow to respond to critical needs, many individuals with the most severe and disabling forms of mental illnesses . . . fall through the cracks and land in the criminal justice or state hospital systems” that emphasize crisis resolution rather than “promoting ongoing stable recovery and community integration.”

The article is here.

Tuesday, May 17, 2016

America’s Suicide Epidemic Is a National Security Crisis

Fredrik Deboer
Foreign Policy
Originally published April

Here is an excerpt:

Too many in our culture, meanwhile, still place the blame for suicide on its victims. It’s common, after high-profile suicides like that of actor and comedian Robin Williams, for some to argue that suicide is “the coward’s way out,” that taking one’s own life is somehow a cowardly act. Such attitudes are a flagrant failure of empathy, as well as a misunderstanding about the relationship between suicide and mental illness and addiction, both of which are strongly associated with suicide risk. Like many social problems, suicide does not have single and obvious causes but rather a concert of contributing factors working together. To blame suicide on a lack of personal character demonstrates ignorance about the nature of the problem. But such thinking contributes to the country’s persistent and deep inability to grapple with suicide in an open and healthy way.

The article is here.

Monday, February 29, 2016

Mental health care 'is ruining lives'

By Nick Triggle
Health correspondent - BBC
Originally posted February 15, 2016

Inadequate and underfunded mental health care in England is leading to thousands of "tragic and unnecessary deaths" a review has found.

The report - by a taskforce set up by NHS England - said around three-quarters of people with mental health problems received no help at all.

It said more needs to be done to tackle rising suicide rates.

Ministers agreed with the findings, committing a £1bn extra a year by 2020 to treat a million more people.

This is to come out of the £8.4bn the government has promised to the health service during this Parliament and comes on top of extra money already announced for children's services.

Prime Minister David Cameron said the plan would help put "mental and physical healthcare on an equal footing".

The article is here.

Editorial Note: In spite of federal legislation in the United States insuring mental health parity, there are frequent reports of insurance companies not following the law.  Additionally, the mental health system in the US is chronically underfunded through insurance companies as well as local, state, and federal systems.

Monday, March 16, 2015

Climate skeptic’s fossil fuel funding puts spotlight on journal conflict policies

By David Malakoff
Science Magazine
Originally published February 22, 2015

Here is an excerpt:

“We’re concerned about the lack of transparency in science… and a possible ethical breach in not disclosing potential conflicts of interest in an area with important public policy implications,” says Kert Davies, Executive Director of the CIC in Alexandria, Virginia. (Soon’s work, he notes, is routinely cited by politicians opposed to government action on climate, and widely disputed by mainstream climate researchers.)

Davies, a former Greenpeace staffer, helped spur the effort to use the federal Freedom of Information Act (FOIA) to obtain the documents that detail Soon’s funding sources. The law applies to the Smithsonian because it is a quasi-government entity (it operates the CfA in cooperation with the Harvard College Observatory). Greenpeace has been using such FOIA requests to document Soon’s sources of funding for years. Last week, Davies began providing recently-obtained documents to media outlets, including ScienceInsider,  leading to stories in the New York Times, Nature, The Guardian, the Boston Globe, and Inside Climate News.

The entire article is here.

Sunday, May 4, 2014

Securing money for research is hard for everyone – but then there's the sexism

Anonymous Academic
The Guardian
Originally published April 15, 2014

Here is an excerpt:

As anyone who has ever applied for research funding will know, getting research money is hard. Only 30% of applicants to major research councils are successful, making it a highly competitive process.

But a growing body of literature suggests that getting research funding may be additionally difficult for women, as the peer review process is rife with sexism.

The entire article is here.

Thursday, June 28, 2012

Catastrophic neglect of the basic sciences in medicine

The Lancet, Volume 379, Issue 9823, Page 1273, 7 April 2012

Talk with scientists who work in research-intensive schools of medicine and you hear a resonant message. The basic medical sciences are not only being neglected, they are being systematically eroded. This marginalisation will have damaging effects on clinical care over the next two decades. The foundations of fundamental knowledge about health will be fractured. The platform for applied research will have atrophied. Patient care will be harmed by the prevailing short-sighted and expedient approach to discovery science.

(cut)

The errors seem to be multiple. Project grants—3-year investments of modest sums (£300 000) into the careers of young scientists—have withered. Scientists tell us that this dramatic shift in policy—converting our funding bodies into versions of the Howard Hughes Medical Institute—is a laudable objective, but one with unanticipated negative consequences. Not the least of which is the excision of investment into future generations of young medical researchers. Such a perilous policy, pursued by some research councils and larger charities alike, is being driven by a political environment that emphasises big science and aggresive commercial returns on research investments.

Sunday, October 9, 2011

Mental-health cuts: Experts fear long-term costs

By Mary Reinhart
The Arizona Republic
azcentral.com

Arizona taxpayers are providing fewer services to fewer people with serious mental illnesses than they were last year, for annual savings of roughly $50 million.

But the short-term savings from state budget cuts threaten to have long-term consequences for patients, providers and the community, mental-health experts say.

The budget reductions eliminated services for about 12,000 Arizonans who don't qualify for Medicaid, removing the foundation of a system intended to keep the seriously mentally ill healthy and out of emergency rooms, hospitals, jails and prisons.

State lawmakers instead provided money for generic medication and additional funding to beef up a statewide crisis-response system to help prevent people from falling through the cracks. But in the 15 months since this population lost case management, brand-name prescription drugs, therapy, transportation and other benefits, more than 2,000 people have stopped receiving any state-funded services and are unaccounted for.

Local and county jails, emergency responders and hospitals often shoulder the costs when people with untreated serious mental illness, such as schizophrenia and bipolar disorder, fall into crisis.

The precise financial costs to those entities are unknown, but health professionals do know that it's far more expensive to treat people who have spiraled into crisis than to keep them stable. And once in crisis, health professionals say, it's more difficult for people to rebound, which means those higher costs continue to recur.

"It's a penny-wise and pound-foolish approach," said Bill Kennard, former executive director of the National Alliance on Mental Illness' office in Phoenix. "More people in jail and prison with mental illness, more time that law enforcement spends dealing with a health issue as opposed to a public-safety issue."

The costs

The state has not conducted an analysis that compares ongoing treatment with crisis costs.

But a March 2011 study that examined proposed mental-health cuts in Texas put the average daily cost of services at $12 for adults, compared with $401 a day in the state's mental hospital, $137 a day for a jail inmate with mental illness and $986 for an emergency-room visit.

The study, by Health Management Associates for the Texas Conference of Urban Counties, also showed that gaps in services put those discharged from psychiatric hospitals and jail at greater risk of relapse, readmission and recidivism.

Janey Durham, who is in charge of a workshop program at Mesa's Marc Center, said she lost 120 people to the budget cuts, including a man diagnosed with schizophrenia who deteriorated almost before her eyes. The non-profit agency center provides job training and other services to the mentally ill and developmentally disabled.

Durham said the man, a former alcoholic in his 50s, worked hard at his job in the manufacturing warehouse, at maintaining his sobriety and in treating his mental illness. But soon after the budget cuts forced him to switch to a generic medication, Durham said, he stopped taking his medication, started drinking again and grew increasingly paranoid, plagued by voices in his head.

Over the past year his erratic, disruptive behavior led Marc Center employees to call Mesa police at least once. He is believed to be homeless, she said, but contact with him has been sporadic since last winter.

Read the entire story here.