Archive for the ‘General’ Category

The UK: American Healthcare Reform’s Mirror Image

Wednesday, July 25th, 2012

If you want to see a twin of our healthcare reform battle, try the other side of the Atlantic: England is undertaking the biggest reform of its government healthcare program, the National Health Service, as part of its massive 5-year austerity program. “After a year in parliament, more scrutiny than any bill in living memory, and more than 1,000 amendments in the House of Commons and the House of Lords,” as the Guardian newspaper put it, “MPs cast their final vote for the (reform) bill.” At its heart are plans which will give primary care providers more sway over the NHS’s £106 billion annual budget, and introduce more private competition. British reform moves quicker than ours — the program takes effect over the next 12 months. A major plank of the reform is the NHS Mandate, under which the government will set targets for improvement in 60 areas of care, such as patients surviving after cancer treatment, and medical errors. The goals? Reduce administration costs by one third.

And, in another instance of seeing double, we’re watching the other side working hard to repeal it and vowing to do so on Day One if they win the next election. “The government’s reforms to the NHS in England have undermined the service and opened the door to privatization,” said (opposition) shadow health secretary Andy Burnham, who championed Labour’s motion, which claims that treatments and services are being rationed in the NHS. In an opposition-led debate on the NHS on 16 July 2012, Mr. Burnham said: “We will repeal the bill; it is a defective, sub-optimal piece of legislation that is saddling the NHS with a complicated mess.” But (government) Health Minister, Simon Burns said: “Far from the meltdown that some gleefully predicted, we have seen a robust and resilient NHS delivering better care for patients. Waiting times remain low and stable, in fact below where they were at the last general election.”

So, just to recap, here we have the conservatives championing reform and austerity and the liberals pleading for repeal in opposition to a privatized system and rationing.  All of this, of course, is part of the cost-cutting program that some say caused Britain to fall back into a double-dip recession. After the 2010 general election, Prime Minister David Cameron, leader of a coalition of the Conservatives and the Liberal Democrats, initially said that the austerity program would finish by 2015. During this period, more than £80 billion would be raised by spending cuts and tax rises. However, the program was extended to 2017 last fall with further savings £30 billion hoped for.

Just How Fat Are We?

Tuesday, July 24th, 2012

In the race to create the most addictive app (or maybe it’s a next-generation Angry Birds game) the BBC has launched an online Biomass Meter that tells you where the percentile where you fall in terms of corpulence worldwide and, most compellingly, lets you see where in the world you’d fit in given your waistline (I’d be at home Brazil, Iran or South Africa). This calculator is based on research data pulled together by a team of researchers at the London School of Hygiene and Tropical Medicine, using UN data on population size in 177 countries, together with estimates of global weight from the WHO and mean height from national health examination surveys.

Interesting timing given that (according the New York Times) last month, researchers affiliated with the World Health Organization and the London School of Hygiene and Tropical Medicine reported that, worldwide, people’s waistlines are expanding, with the total combined weight of human beings on Earth now exceeding 287 million tons. About 3.5 million tons of that global human biomass is due to obesity, a third of which exists in North America, although we account for only 6 percent of the world’s population.

The biggest culprit ? Voluntary inactivity, according to a study in the Lancet. Led by Pedro C. Hallal, a professor at the Federal University of Pelotas in Brazil, the study finds that 31.1 percent of the world’s adults, or about 1.5 billion people, are almost completely sedentary, meaning that they do not meet the minimum recommendation of 150 minutes of walking or other moderate activity per week, or about 20 minutes a day.

But surely we can look to our teenagers as models of physical vitality, correct? Not quite. Teenagers do worse. More than 80 percent of young people ages 13 to 15 worldwide are not getting the hour a day of vigorous exercise recommended for their age group. North America leads (or wheezingly lags) the world in not exercising, with 43.3 percent of Americans not doing the bare minimum. But, it’s spreading: more than 30 percent of Russians and 27 percent of Africans are sedentary. And what’s the most sedentary nation on Earth? Malta, population 419,000, 72 percent of whom won’t be appearing on The Biggest Loser.

According to the Lancet study, the effect of being a couch potato is comparable to smoking. “Smoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from non- communicable diseases, physical inactivity and smoking each contribute about 5 million deaths each.”

US News Names New Hospital as Best

Monday, July 23rd, 2012

Massachusetts General Hospital or Mass General is No. 1 for the first time, according to the US News & World Report Best Hospitals rankings. It marks the end of a 21-year run for Johns Hopkins that started in 1991, the year after U.S. News began publishing Best Hospitals.

When Mass General was founded, James Madison was President, Napoleon was Emperor of France and the Juliana, the first ever steam-powered ferryboat, began operation.   Only Pennsylvania Hospital (1751) and New York–Presbyterian Hospital (1771) are older. The fact that Mass General hasn’t taken the top spot before may come as a surprise to some, given its pedigree: It was the original teaching affiliate and flagship of Harvard Medical School; it remains the largest hospital-based research program in the United States, with an annual research budget of more than $400 million; and is renowned in such specialties as diabetes & Endocrinology, Ear, Nose & Throat, Neurology & Neurosurgery, Ophthalmology, Orthopedics, and Psychiatry.

The 950-bed medical center each year admits about 48,000 inpatients and handles nearly 1.5 million visits in its outpatient programs at the main campus and satellite facilities. It also delivers more than 3,600 babies annually. It is now the largest non-government employer in the city of Boston, with more than 19,000 employees, including a nursing staff of 2,900. In addition, its 3,600-member medical staff includes physicians, dentists, psychologists, podiatrists, residents and fellows.

MGH is owned by Partners HealthCare, which was formed by MGH and Brigham and Women’s Hospital in 1994. MGH is also a member of the consortium which operates Boston MedFlight.

June 2012: Jobs Fizzle

Monday, July 16th, 2012

80,000 was the number. 200,000 is what we need for this to feel like a recovery. And 8.2 is the number that keeps hanging on.  The nation’s unemployment rate was unchanged at 8.2% (that’s 13 million unemployed workers) for the second consecutive month, the Labor Department said Friday.   Businesses added just 84,000 jobs, while governments cut 4,000. Monthly job growth averaged 226,000 in the first quarter but slowed dramatically to an average 75,000 a month in the second quarter.

In response, the Dow Jones industrial average fell 124.20 points to close at 12,772.47, wiping out the Dow’s gain for the week, and Treasuries rose as investors moved their money into lower-risk assets. And the Presidential campaigns took the opportunity to issue a number of extrapolations and the usual host of inaccuracies and overreaches. The Democrats claimed that the unemployment rate has been trending down since hitting 10.10% in October 2009; what they forget to point out is that that’s because of the large numbers of discouraged workers – almost 1 million — who’ve stopped looking for jobs. The Republicans, on the other hand, said that the jobs report proves that the Obama administration’s policies haven’t worked, forgetting that the US was hemorrhaging 700,000 jobs a month when Obama took office. According to Politifact, Obama’s record is 22 consecutive months of private-sector job growth, beginning in Feb. 2010, during which the number of jobs grew by almost 3.16 million, or about 143,000 per month.

Putting the candidates aside, the reasons for the anemic job numbers have started to sound like a bad drinking-game song being played by the pundits as they make the circuit of the talk shows: The warm weather drew construction and manufacturing activity into January and February, but dampened spring hiring; the manufacturing sector contracted for the first time in three years in June;  retail sales were weak, Corporate profits fell in the first quarter of 2012,  the first decline since 2008, according to the Commerce Department; the European Central Bank cut interest rates – a sign of nervousness about their prospects; the end-of-year fiscal cliff sent ripples through the public and private sectors with its specter of higher taxes and reduced government spending; a lame-duck Congress couldn’t pass a Jobs Bill; Republican governors made draconian cuts and instituted public-worker layoffs at the state level; and the Administration didn’t put a big enough stimulus in place which is creating an undertow. Take your pick.

So, are there any bright spots? A few.  Friday’s report showed ticks upward in average hourly earnings (to $23.50, from $23.44 in May) and the length of the typical private sector workweek (34.5 hours, from 34.4). Also, a curious fact is that the number of teens in the workforce spiked by 140,000 to 4,528,000, or 3.2% of the entire U.S. workforce:  So why are teens making out so well in this first month of summer while everyone else, well, isn’t? The Daily Kos reports from 5 May 2012:  President Obama’s Jobs program, which is lining up commitments from the private sector and from government to create summer jobs and internships for young people, has announced commitments for 90,000 paying jobs, up from the 70,000 previously announced in January.

10 Percent of America’s Veterans Have No Healthcare Coverage

Tuesday, June 12th, 2012

Ten percent of the nation’s 12.5 million non-elderly veterans do not have health insurance coverage or use Veterans Administration (VA) health care according to the 2010 American Community Survey (ACS).  The Urban Institute report, which was released by the Robert Wood Johnson Foundation, is the first to provide estimates of a lack of insurance among veterans and their families both nationally and at the state level, and to assess the potential for the Patient Protection and Affordable Care Act (ACA) to reduce these rates.  Veterans are less likely be uninsured than the overall population.  Uninsured veterans and their families report significantly less access to healthcare than their counterparts with insurance coverage.  Forty-one percent of veterans who lack healthcare coverage have untreated medical needs, while nearly 34 percent have put off getting care because of the expense.

The ACA’s coverage provisions have the potential to increase coverage among the U.S. population, including uninsured veterans.  An estimated 50 percent of veterans who currently do not have insurance would qualify for expanded Medicaid coverage; another 40 percent have the potential to receive subsidized coverage through health insurance exchanges if they lack access to affordable employer coverage.  Not surprisingly states that have made minimal progress in setting up health insurance exchanges have the most uninsured veterans — nearly 40 percent.  Success in bringing coverage to uninsured veterans will depend primarily on aggressive ACA implementation and enrollment efforts.

The Veterans Administration (VA) –  with more than 1,400 hospitals nationally and nearly 15,000 physicians – covers the majority of veterans, although not all: Eligibility is determined by income, injuries sustained in combat and length of service.  Because of the eligibility requirements, 1.3 million veterans and 0.9 million family members have no healthcare coverage.

Uninsured veterans typically are younger than those with coverage and less likely to have been injured in combat.  Uninsured veterans tend to have higher unemployment rates, less income and usually are not married — all of which reduce the odds of having private coverage.  “Their lower likelihood of being full-time workers and being married likely contribute to their lack of coverage, as these attributes are characterized by lower access to employer-sponsored health insurance,” according to the Urban Institute study.

Writing for the Non-Profit Quarterly, Rick Cohen notes that “Among the states with the worst rates of uninsured veterans, Louisiana, Oregon, and Idaho all top 14 percent, and Montana comes in at a woeful 17.3 percent.  This past weekend, the streets of Washington, D.C. were occupied by participants in the Rolling Thunder demonstration, the annual Memorial Day gathering of veterans (and non-veterans) on motorcycles focused on calling the nation’s attention to the POW/MIA issue.  The Robert Wood Johnson Foundation report would suggest that, in the U.S., there is an abundance of veterans and their families who are being treated as if MIA when it comes to health insurance.”

According to Dr. Jonathan D. Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne,  “A Harvard study estimated that more than 2,200 veterans died in 2008 due to lack of insurance.  You may have thought that veterans can automatically be treated at a veterans’ hospital, but this is not the case.  Uninsured veterans face a “means test” based on their income.  The test determines their priority level for care and how much they have to pay.  And if the system doesn’t have enough money, it can stop enrolling veterans if they fail the means test – as happened from 2003 to 2009.  But even if the VA were able to fully cover every veteran, it would still leave a lot of veterans without care because they do not live near a VA hospital.  And even if they live near a hospital, they still may need to drive far away to get services that aren’t available locally.  There are laws that make it illegal for an insurance company to force patients to drive an excessive distance to stay in their network, yet we think nothing of making veterans drive long distances simply to get the care to which they are entitled.”

Cost of Alzheimer’s High in Dollars and Caregiver Devotion

Tuesday, March 13th, 2012

As baby boomers age, the cost of caring for those stricken with Alzheimer’s Disease has nowhere to go but up. By 2050, the cost of treating Alzheimer’s is likely to rise from $172 billion per year in 2010 to more than $1 trillion per year in 2050.  The disease could cost Americans $20 trillion over the next few decades, according to a report from the Alzheimer’s Association.

“We saw it coming.  We knew the numbers were going to be high in the number of people getting the disease.  We as an organization have been preparing for this,” said Nancy Rainwater, vice president of communications for the Alzheimer’s Association Greater Illinois chapter.  “But to think of trillions of dollars…just the amount of money was pretty staggering.”

The statistics were calculated using an analytical model based on data from research and national surveys.  Part of the problem lies in how successful treatment has become for other diseases, Rainwater said.  “We’re living longer, so that has a lot to do with it,” she said.  “There has been so much work in other diseases – cancer, diabetes, heart disease – and people are surviving those diseases.  But then there’s a higher risk, as people age, of getting Alzheimer’s.  You look at statistics of those diseases, and the rates of death have all declined, whereas Alzheimer’s disease has increased.”

Researchers believe that the number of Americans aged 65 and older with Alzheimer’s will more than double to 13.5 million by 2050 as the population ages.  By the middle of the 21st century, nearly 50 percent of people with the disease will be in its most severe – and costly – stage.  “People in the earlier stages don’t necessarily need as much care or support,” said Darby Morhardt, social worker and research associate professor at Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center.  “But as they deteriorate, as they decline, they have more and more difficulty managing their daily care, so that care needs to be provided by someone.  Often that’s where most of the money is spent, on those last years.”

What’s most stunning is Alzheimer’s human and financial toll. According to the Alzheimer’s Association’s 2011 Facts and Figures Report, 5.4 million Americans (one in eight older Americans) suffer from the debilitating illness.  Joy Johnston of Atlanta knows how difficult caring for a parent with Alzheimer’s can be.  Her father, Patrick, like more than five million other Americans, had been diagnosed with Alzheimer’s Disease.  “It can be heartbreaking at times,” Joy said in reference to caring for her father.  “You have to relearn your relationship with your loved one.”  Caring for a family member with Alzheimer’s can take a profound financial and emotional toll.  Nearly 15 million Americans are unpaid caregivers for those sick with dementia, according to the Alzheimer’s Association.  Do the math, and it adds up to about 17 billion hours of unpaid care valued at $202 billion in 2010 alone.

To help with the staggering cost of care, the Obama Administration has included $26 million in the proposed 2013 budget.  That money will go to education, outreach and support for families affected by the disease.

“Caregivers are often in a situation where their feelings and what they have to do are in conflict,” Dr. Peter Rabins said.  “That’s very hard for most of us because we’ve related with people that we love in a certain way. The disease forces a change in that relationship.”  Rabins, the director of psychiatry at Johns Hopkins School of Medicine, notes that medical bills can pile up quickly.  “That’s a tremendous financial challenge for many families.” Rabins said.

Money isn’t the only sticking point.  The emotional costs take root as soon as dementia is diagnosed.  Family members often begin grieving a death of someone who is still physically present but disappearing mentally.  “Those feelings of loss can become quite chronic,” Rabins says.

“It’s the sort of crisis that policymakers, clinicians know is happening,” said Len Fishman, CEO of Hebrew Senior Life, the largest provider of elder care services in Massachusetts.  “I don’t think the country has absorbed it yet and in a couple of decades when the number of Alzheimer’s cases has doubled, people will look back and say,  ‘Why didn’t we know this was coming?’”

National statistics suggest that it takes an average three to four people to help care for each Alzheimer’s patient living at home; approximately 11 million Americans are currently helping to care for the estimated 70 percent of Alzheimer’s patients who are able to be at home.  That statistic does not include paid caregivers.

Although Medicaid pays for Alzheimer’s day programs for some low-income seniors; Medicare does not.  As a result, many patients and their families must pay privately for Alzheimer’s care until they’ve spent enough money to qualify for Medicaid.  Medicaid does pay for long-term nursing home care, but not the less restrictive assisted living for seniors.

Will Cuts in Healthcare Save the Federal Budget?

Tuesday, December 6th, 2011

Healthcare budget and policy experts are waiting for Washington to eventually face the difficult task of finding even more savings to cut the deficit.  They anticipate that health spending — which makes up more than 20 percent of the federal budget — will be targeted.  Some healthcare leaders are already planning to redirect a debate they’re expecting in 2013.  They hope to prevent spending from being shifted from one part of the system to another.  Jack Lewin, chief executive of the American College of Cardiology, said that proposals to address the basic causes of high healthcare costs have mostly been ignored in Washington.

“We talk about them all the time, but there’s nothing that we’re doing in any of these proposals to get that done,” Lewin said.  “What we would like to get on the table that’s not there is a paradigm shift in thinking about how you control costs.”  According to Thomas Scully, a former Medicare administrator under President George W. Bush and now a senior counsel at Alston & Bird, an Atlanta-based law firm, “There’s going to be a Round Two (of cuts), but after the election, because of the economic pressures exerted by the national debt.”

Proposals include reducing payments to providers; asking beneficiaries to pay more for coverage; and raising the Medicare eligibility age.  The healthcare interests that might take another hit in 2013 want to start planning now.  Several key healthcare leaders – the majority of whom have been through other cost-cutting campaigns — say efforts to reduce spending too often transfer costs from the federal budget and individuals, insurers, doctors and hospitals.

These worries have caused “people from dramatically different quarters to start thinking about what to do to get their hands around this” and redirect the conversation, said Karen Ignagni, president of America’s Health Insurance Plans.  “I’ve been talking to a range of stakeholders about how to work together…to urge policymakers to look at what’s already out there now and build on it.”

The Patient Protection and Affordable Care Act (ACA) is one element of this debate.  Administration officials and other supporters of the law say it will help drive down costs through initiatives designed to promote primary care, emphasize on preventive medicine, study treatments to evaluate their effectiveness and rate hospitals and other providers on quality.  Other healthcare authorities counter that the law will not strongly impact costs because its reforms are small and will mature incrementally.

Additionally, the law saves money by cutting Medicare payments to hospitals and other providers; it also places some unwelcome standards on health plans.  For example, insurers cannot reject people with pre-existing conditions, must justify rate increases of 10 percent or more, and send rebates to consumers if they don’t spend a minimum of 80 percent of premiums on healthcare.

Writing in the Washington Post, Drew Altman and Larry Levitt – both with the Kaiser Family Foundation — note that “Healthcare costs are driving people into poverty.  Indeed, if the burden of healthcare expenses were not taken into account, then 10 million fewer people would have been classified as poor.  One of the biggest jumps in poverty under the new method is among people with private health insurance.  We tend to think of such people, most of whom get coverage through their jobs, as being better equipped to handle the cost of getting sick.  But even those who are insured are increasingly vulnerable to high healthcare costs, in no small part because, as costs keep rising, employers have shifted more of the burden onto workers.  The share of employees with an insurance deductible of $1,000 or more for single coverage has tripled in the past five years.  The trend is especially strong among small businesses, where half of workers faced a deductible of at least $1,000 in 2011.  For those on the edge of poverty, a big medical bill could send you over it — even if you have insurance.  The effect of healthcare costs is particularly acute for the elderly, with the proportion of seniors living in poverty increasing from nine percent under the official census measure to 16 percent under the alternative measure.  An astounding 49 percent of seniors are living at or below twice the poverty level, a threshold at which people are still considered low-income (up from 35 percent under the official method).

“It’s up to us to get really serious with the agenda so that, when the time comes after the election, we are prepared to offer serious proposals that deal with costs and that do not impair the quality of care,” said Ron Pollack, executive director of the consumer group Families USA.

Showdown As Opposing Medicare Ads Debut

Wednesday, November 30th, 2011

A coalition of advocacy groups such as the Americans United for Change, Service Employees International Union, American Federation of State, County, the Municipal Employees and Service Employees International Union and Moveon.org recently started running a series of ads telling lawmakers not to cut Medicare benefits.  In particular, the ads target Representative Denny Rehberg (R-MT), Senator Dean Heller (R-NV) and Senator Scott Brown (R-MA).

“If you vote to cut Medicare, Representative Rehberg, I will remember it every time I visit my doctor.  I’ll remember you cut Medicare and Medicaid every time I fill my prescription,” says an elderly woman narrator in one of the ads.  “I’ll remember you cut Medicare every time I fall or get hurt. I’ll remember you protected millionaires over protecting my health. My friends will remember it, too — all of them.  Call Senator Heller.  Tell him to protect Medicare and Medicaid.”

Brian Walsh, the National Republican Senatorial Committee communications director, made light of the Democratic message, arguing that the half-trillion dollars they shifted out of Medicare to pay for healthcare reform makes their argument hollow.  “The irony of this pathetic attack ad is that in each of these three races, it’s actually the Democrat candidates who are all firmly on record supporting the $500 billion in Medicare cuts that were included in their massive healthcare overhaul,” said Walsh.  “The big labor unions funding this ad know that, but yet they are doing everything they can to mislead voters in Montana, Nevada and Massachusetts.”

In the meantime, the United States Chamber of Commerce is running commercials attacking Senators Sherrod Brown (D-OH) and Jon Tester (D-MT).  Friends of the U.S. Chamber criticize Tester for supporting “government-run healthcare” and challenges Brown on energy taxes.  The business community has been under unprecedented threat,” Rob Engstrom, part of a two-man team running the chamber’s political operation, said.  The trade group plans to break its previous political spending record — $50 million — to try to elect a more business-friendly Congress.  The Montana ad reminds viewers about Tester’s votes for “government-run healthcare” then urges voters to “call Senator Tester and tell him to stop supporting big government and start fighting for Montana’s families.”

Americans United for Change explains why it is running ads about protecting Medicare and Medicaid.  “For decades, seniors have relied on Medicare being a guaranteed benefit and those less fortunate have depended on Medicaid to provide long-term care and coverage for children.  These programs need to be strengthened to ensure they remain available for future generations, which means not gutting and decimating benefits, leaving low-income children, seniors, and people with disabilities out in the cold.  The key to making Medicare sustainable is reining in costs, not dumping more expenses onto seniors.  We are working to set the right priorities for an economically secure future while continuing to protect healthcare coverage for those who can least afford it.”

Writing for the Huffington Post, Sam Stein describes the Democratic ads as “Not exactly the most visually stimulating videos, the ads warn lawmakers that they will pay a political price for cutting Medicare or Medicaid.  That may prove to be popular politics — certainly, polls show that voters want the two healthcare programs protected — but the notion that cuts won’t ultimately be pursued is highly unlikely.  Aides on the Hill from both political parties have long agreed that there is room to trim down Medicare’s provider-side components.  Reforms to Medicaid, whether in the form of decreased help to the states or something more structural, have also been discussed.”

ER Visits on the Rise, Thanks to Quick Treatment

Monday, October 24th, 2011

Visits to hospital emergency rooms soared to an all-time high of 136 million in 2009, according to new estimates provided by the Centers for Disease Control and Prevention (CDC).  This represents an approximately 10 percent increase from the 2008 statistic of 123.8 million.  The CDC study is one of three examinations of ER use being released at the American College of Emergency Physicians meeting.  

According to the CDC, patients under the age of 15 accounted for 21 percent of ER visits in 2009; patients between 15 and 24 made up 15 percent; patients between 25 and 44 accounted for 28 percent; patients between 45 and 64, 21 percent; and patients 65 and older, 15 percent.  Breaking visits down by gender, the CDC noted that women visited the ER at a rate of 48 visits per 100, while men had a rate of 42.   

The expected sources of payments for ER visits were private insurance, 39 percent; Medicaid or State Children’s Health Insurance Program, 29 percent; Medicare, 17 percent; other and unknown, five percent each.  Nineteen percent of ER visitors reported that they had no insurance.  The most typical reasons for visiting the ER were stomach and abdominal pain, 9.6 million; fever, 7.4 million; chest pain, 7.2 million; cough, 4.7 million; headache, four million; and shortness of breath and back symptoms, 3.7 million each.  

Physicians attributed the sharp increase to both greater demand for services and improvements that allow ERs to treat patients faster.   “With the economy, people have lost their coverage and, given the fact the emergency department is the safety net, they come to us,” said Dr. Jay Kaplan, an emergency physician at Marin General Hospital who serves on the board of the emergency physicians’ organization.  The physicians contend that it is counterproductive to discourage patients from going to the ER to save money in healthcare costs because they say it doesn’t.  “We’re efficient.  We take care of acute patients and that’s what we do well,” said Dr. Paul Kivela, managing partner of Napa Valley Emergency Medical Group, and a board member of the American College of Emergency Physicians.  

According to Dr. Michael Gerardi, an ACEP board member, he and his colleagues want comprehensive medical liability reform that includes indemnification based on recognized guidelines, caps on non-economic damages and medical courts where providers are judged by medical peers.  “In America, we sue far too often for bad outcomes and not deviations from standard of care,” Gerardi said.  “The overall anxiety of patients and the lack of acceptance that bad outcomes happen are driving costs.”  Because ERs are safety-net providers, they have become increasingly overcrowded.  One factor is the passage in 1986 of the Emergency Medical Treatment and Labor Act, which requires hospitals to provide people with emergency services, despite their inability to pay.  

It has been estimated that 13.7 percent of all emergency room visits could be treated in retail medical clinics, which are typically based in pharmacies or grocery stores.  These facilities are equipped to treat a limited number of minor conditions, such as throat infections or urinary tract infections.  An additional 13.4 percent of emergency room visits could be handled by urgent-care clinics — an independent medical facility that can handle a broader scope of problems, such as minor fractures and more serious injuries.  Urgent-care clinics typically are open on evenings and weekends, fulfilling the need for patients with occurring before or after typical physician office hours.

Apple’s Visionary Steve Jobs Dies at Age 56

Monday, October 10th, 2011

Apple’s iconic co-founder and CEO Steve Jobs, who altered the habits of millions by reinventing computing, music and mobile phones, has died at the age of 56.  With Jobs’ passing, Apple has lost a visionary leader who inspired personal computing and products such as the iPod, iPhone and iPad.  In the world of medicine, the iPad has made a significant impact. Chilmark Research estimates that 22% of United States doctors are using iPads as of the end of 2010. A survey by Aptilon indicates that 80% of the remainder plan to buy an iPad sometime in 2011.  These innovations made Jobs one of his generation’s most significant industry leaders.  His death, following a long fight with a rare form of pancreatic cancer and a liver transplant, set off an outpouring of tributes as world leaders, business rivals and customers mourned his early death and celebrated his historic achievements.

“The world has lost a visionary.  And there may be no greater tribute to Steve’s success than the fact that much of the world learned of his passing on a device he invented,” said President Barack Obama.  Even Bill Gates, his rival at Microsoft, joined in the laments.  “For those of us lucky enough to get to work with him, it’s been an insanely great honor,” Gates said.

With a passion for minimalist design and a genius for marketing, Jobs laid the groundwork for Apple to flourish after his death, according to analysts and investors.  A college drop-out, Jobs altered technology in the late 1970s, when the Apple II became the first personal computer to gain a wide following.  He repeated his early success in 1984 with the Macintosh, which built on the breakthrough technologies developed partially at Xerox Parc to create the personal computing experience.

“Steve’s brilliance, passion and energy were the source of countless innovations that enrich and improve all of our lives. The world is immeasurably better because of Steve,” Apple said.  “His greatest love was for his wife, Laurene, and his family.  Our hearts go out to them and to all who were touched by his extraordinary gifts.”

According to Apple co-founder Steve Wozniak, “We’ve lost something we won’t get back,” he said.  “The way I see it, though, the way people love products he put so much into creating means he brought a lot of life to the world.”  Wozniak said that Jobs told him around the time he left Apple in 1985 that he had a feeling he would not live beyond the age of 40.  Because of that, “a lot of his life was focused on trying to get things done quickly,” Wozniak said.  “I think what made Apple products special was very much one person, but he left a legacy,” he said.  Wozniak hopes the company can continue to succeed despite Jobs’ death.

Computerworld raises the question “Where will that excitement come from now?”  When Jobs stepped down as CEO in August, industry analysts said that Apple, with a team of talented, creative employees, will be able to continue his tradition for ingenuity, if not all of his passion, perfectionism and energy.  “Steve’s excitement for technology will still come from Apple and from the team that Jobs carefully built that worked with him to give us the iPhone and iPad and many other successful products,” said Carolina Milanesi, a Gartner analyst.

“Jobs didn’t just change mobile phones — he reinvented them,” said Ken Dulaney, an analyst at Gartner.  “That was typical Steve.”  In another example, the iPad took user-centric values inherent in the touch-screen iPhone and larger-screen laptops, and found a useful compromise — a classic expression of Jobs’ ability to combine technological concepts, art and ideas and deliver a product that was termed “magical,” according to analysts.  “Apple, under Jobs’ leadership, focused on the user experience first and the technology second,” said Jack Gold, an analyst at J. Gold Associates.  “This focus was groundbreaking in that most tech companies were just the opposite.  Apple pioneered hiring many usability specialists, human factor engineers and designers before it was fashionable to do so.  Jobs’ vision of technology was to make a smooth intersection into our lives and our work, and that was what put Apple ahead of the pack.  He redirected engineering from technical engineering to engineering for usability.”

One question that has industry analysts abuzz is whether Apple will be able to maintain its dominant position now that Jobs is gone. Jobs’ passing and the industry’s mixed response to the recent iPhone 4S model create challenges for Apple in coming quarters,” said Neil Mawston, an analyst with Strategy Analytics.  “Industry eyes will inevitably turn to the iPad 3 launch next year to see whether Apple can continue the company’s impressive legacy of innovation created by Steve Jobs,” he said.  In a sign of deepening competition, Amazon.com recently unveiled its Kindle Fire tablet at an affordable $199 that could pose a serious threat to the iPad.  “Apple is facing a competitive firestorm from not just one company but a coalition of rivals that are trying to beat it, including some of the largest consumer electronics companies on the planet,” said Ben Wood, head of research at British mobile consultancy CCS Insight.

Writing in the Washington Post, Melissa Bell believes that one of Jobs’ longest-standing legacy will be the recognition that his illness and death are bringing to pancreatic cancer.  According to Bell, “Steve Jobs knew the art of keeping your cards close to your chest.  Though  leaks did spring from the closely guarded Apple world, Jobs was a master at unveiling his secrets only when the time was right for him.  As with his business ventures, so it was with his cancer.  Jobs ‘kept his illness behind a firewall,’ the Associated Press reported.  Apple released no more of a statement than that they lost a ‘visionary and creative genius, and the world … lost an amazing human being.’  It was not known whether Jobs died from the rare form of pancreatic cancer that plagued him for seven years, or from complications from a liver transplant two years ago.  Despite the lack of details, Jobs’ role as the very public face of Apple put his illness on display along with his products.”