Posts Tagged ‘Harvard School of Public Health’

Sick Americans Worry About the Cost of Their Healthcare

Tuesday, June 5th, 2012

Many Americans who have been sick or injured over the last year worry about the high cost of healthcare, and struggle to ensure that their care is appropriate, according to a new poll by the Robert Wood Johnson Foundation (RWJF), National Public Radio (NPR) and Harvard School of Public Health.  RWJF commissioned the poll to enhance understanding of Americans’ experiences and attitudes towards the cost and quality of medical care.

Fully 87 percent think the cost of care is a serious problem.  Approximately two-thirds – 65 percent — believe the cost of care has soared over the last five years.  In addition to the general public, the poll studied sick Americans’ experiences with and perceptions of the costs and quality of medical care.  “Sick Americans” (27 percent of adults surveyed) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring significant medical care or who had been hospitalized overnight in the past year.

Many sick Americans had problems with the cost of their own medical care.  More than 40 percent reported that the cost of their medical care has caused a “very serious” (20 percent) or “somewhat serious” (23 percent) problem for their finances.  They also reported that expensive healthcare costs affected their ability to access care.  One in six sick Americans could not get the medical care they needed (17 percent).  Among the sick Americans who could not receive care, 52 percent report that it was because they could not afford the needed care, and 24 percent say it was because their insurers refused to pay for it.  Finally, 11 percent of sick Americans said they had been turned away by a doctor or hospital for financial or insurance reasons when they tried to receive care.

One of those people is Fresno, CA resident Amber Cooper, who has health insurance from her job in the accounting department of a small manufacturing company.  Then the company changed their insurance plan.  According to Cooper, “We were in a conference room…and I had heard rumors but didn’t know if it was true, and I started crying in front of everyone and actually had to excuse myself to gather myself together and go back in.  Unfortunately, the rumors had come true with potentially devastating consequences for Cooper, who had a liver transplant at the age of 10 and takes a medication twice a day so her body won’t reject her liver.

Every year my company changes the insurance.  And instead of giving us three different choices for insurance plans, they were changing to one, which was a high-deductible plan with no prescription coverage,” she said.  Cooper was devastated.  Her anti-rejection medicine costs more than $1,000 a month, a price that she could not afford to pay on her own.

Cooper found help at the HealthWell Foundation, which pays for her medication.  Still, she can’t afford the $300 monthly blood test to make sure she’s not rejecting her liver.  “It is scary because the only way to tell if you’re going to go into rejection is by the blood work.  Your numbers will be a little bit crazy, and then the doctors will be like, ‘OK, you need to get in and we need to check you out and make sure you’re OK.’  So I really took a risk not getting that blood work done.  But I couldn’t afford to get it done. I really couldn’t,” she said.

Cooper isn’t alone.  Health insurance has been changing noticeably “beneath the surface,” said Drew Altman, president and CEO of the Kaiser Family Foundation, a private, nonprofit, nonpartisan research group. “In plain language, it’s becoming skimpier and skimpier and less and less comprehensive.  This affects not only how people seek healthcare — they’re more reluctant to get it if they can put it off.  But it also affects family budgets in a very real way, especially as we’re still coming out of recession and families are still crunched by a weak economy,” Altman said.

Paul Fronstin of the Employee Benefit Research Institute says this is a national trend.  “Deductibles have gone up. Co-pays have gone up.  You see cost-sharing for out-of-network services have gone up,” Fronstin said.  “It seems to have accelerated in the last few years.  Healthcare is just continuing to take a bigger bite out of take-home pay.”  According to Fronstin, the economy is causing more companies to cut back on coverage because of the math: It’s the only way they can keep up with rising healthcare costs.  “Employers are trying to manage those costs.  They’re trying to keep those cost increases as close to inflation as possible.  And they’re doing everything they can to get their workers to think twice about the healthcare that they are using,” Fronstin said.

Drinking Coffee Can Make You Live Longer

Wednesday, May 30th, 2012

A recent study of the link between drinking coffee and mortality suggests that latte lovers have a lower risk of death. “I would say it offers some reassurance to coffee drinkers,” said Neal Freedman, a nutritional epidemiology researcher at the National Cancer Institute (NCI).  “Other studies have suggested a higher risk of mortality with coffee drinking and we didn’t see that in our study.”

Men whose coffee intake was at least six cups a day had a 10 percent lower chance of dying during the 14-year study period than those who drank none.  For women, the risk was reduced by 15 percent, according to Freedman’s work, published in the New England Journal of Medicine.  Approximately 64 percent of American adults drink coffee every day, according to Joe DeRupo, spokesman for the National Coffee Association.  At an average of 3.2 cups each, that amounts to 479 million cups a day.  Coffee lovers can take the new results seriously.  The mortality reduction is modest but solid, Freedman said.

Freedman and his team in NCI’s Division of Cancer Epidemiology and Genetics examined the coffee habits of more than 402,000 people between 1995 and 2008, including more than 52,000 who died.  They included approximately 229,000 men and 173,000 women ages 50 to 71 who participated in the NIH-AARP Diet and Health Study, which tracked comprehensive lifestyle questionnaires.  Freedman’s analysis centered on healthy people; anyone with cancer, heart disease or who had suffered a stroke was excluded from the review.  “We didn’t know what to expect,” said Freedman.  “There have been a lot of studies and the results have been mixed.”

There’s been concerns for a long time that coffee might be a risky behavior,”  said Freedman, who drinks coffee ‘here and there.’ “The results offer some reassurance that it’s not a risk factor for future disease.”

Writing in Time, Marilynn Marchione said that “No one knows why.  Coffee contains a thousand things that can affect health, from helpful antioxidants to tiny amounts of substances linked to cancer.  The most widely studied ingredient — caffeine — didn’t play a role in the new study’s results.  It’s not that earlier studies were wrong.  There is evidence that coffee can raise LDL, or bad cholesterol, and blood pressure at least short-term, and those in turn can raise the risk of heart disease.  Even in the new study, it first seemed that coffee drinkers were more likely to die at any given time.  But they also tended to smoke, drink more alcohol, eat more red meat and exercise less than non-coffee-drinkers.  Once researchers took those things into account, a clear pattern emerged: Each cup of coffee per day nudged up the chances of living longer.  Careful, though — this doesn’t prove that coffee makes people live longer, only that the two seem related.  Like most studies on diet and health, this one was based strictly on observing people’s habits and resulting health.  So it can’t prove cause and effect.  But with so many people, more than a decade of follow-up and enough deaths to compare, ‘this is probably the best evidence we have’ and are likely to get, said Dr. Frank Hu of the Harvard School of Public Health.  He had no role in this study but helped lead a previous one that also found coffee beneficial.”

The study’s findings should be viewed with caution.  “For those who do drink coffee, there’s no reason to stop.  Periodically someone will say it’s bad, but I think this strengthens the view that it’s not harmful,” said Dr. Lawrence Krakoff, a cardiologist from the Mount Sinai School of Medicine in New York, who wasn’t involved in the new research.  “Whether it’s beneficial — without knowing the cause, it’s hard to say,” he said.  “I wouldn’t encourage people to suddenly drink a lot of coffee with the expectation of benefit.”

Not so fast, according to cardiologist Steve Nissen of the Cleveland Clinic, who wasn’t involved in the study.  Asking people about their coffee consumption just one time in a 13-year timeframe can be misleading, since drinking habits change.  Nissen pointed out that the study didn’t include vital medical information that affects longevity, such as cholesterol or blood pressure levels.  “This study is not scientifically sound,” Nissen said.  “The public should ignore these findings.”

The study determined that men who drank two to three cups a day had a 14 percent lower risk of dying from heart disease, 17 percent lower risk of dying from respiratory disease, 16 percent decreased chance of dying from stroke and a 25 percent lower risk of dying from diabetes than those who drank no coffee.  Women who consumed two to three cups a day had a 15 percent lower chance of dying from heart disease, 21 percent lower risk of dying from respiratory disease, seven percent decreased chance of dying from stroke and a 23 percent lower risk of dying from diabetes.

Rest of the World Beats the U.S. on Healthcare Reform

Tuesday, May 22nd, 2012

As Americans debate whether the Patient Protection and Affordable Care Act (ACA) and its promise of guaranteed healthcare coverage should be overturned, a surprising number of less affluent nations are moving to provide medical insurance to all citizens.  Many political leaders globally have concluded that creating a system of universal healthcare is essential to remaining competitive and supporting economic growth.

After years of underfunding healthcare, China is completing a three-year, $124 billion initiative that will cover more than 90 percent of its population.  Mexico, which 10 years ago covered less than 50 percent of its population, just completed an eight-year drive for universal coverage that has noticeably expanded access to lifesaving treatments for diseases.  In Thailand, where the GDP per person is 20 percent of America’s, just one percent of the population doesn’t have health insurance.  Rwanda and Ghana — among the world’s poorest nations — are creating networks of insurance plans to cover their citizens.

“This is truly a global movement,” said Dr. Julio Frenk, a former health minister in Mexico and dean of the Harvard School of Public Health.  “As countries advance, they are realizing that creating universal health-care systems is a necessity for long-term economic development.”  Many countries are still struggling to improve the quality of their medical care.  And making health care affordable remains a challenge for most countries, as it does for the U.S., where about 15 percent of the population lacks coverage.

Today, the United States is the only one of the world’s richest nations that does not provide healthcare coverage for all citizens.  The Supreme Court is expected to hand down a ruling on a legal challenge to the ACA in June.

Some countries established public systems similar to those in Great Britain and Canada.  Others rely on a mix of government and commercial insurance, similarly to the ACA.  The Thai system, set up a decade ago, has survived years of political upheaval and a military coup.  “No party dares touch it,” said Dr. Suit Wibulpolprasert, a senior adviser to the Ministry of Public Health.

We are really an outlier,” said David de Ferranti, a former World Bank vice president who heads the Results for Development Institute, an international non-profit organization based in Washington.  That stands in sharp contrast to the United States’ leadership in education, he said.  Long before most European nations, the United States assured access to public schooling.

People are demanding responses from their governments,”  said Cristian Baeza, the World Bank’s director for health, nutrition and population.  In countries such as India, political leaders know that one of the surest ways to get votes is to promise better access to healthcare.

Survey: Massachusetts Residents Like Their Healthcare Coverage

Tuesday, February 28th, 2012

Despite GOP presidential hopeful Mitt Romney’s wish to distance himself from the law he passed, an overwhelming majority of Massachusetts residents support their state’s landmark universal health insurance program. Even though backing for its central feature — the mandate that most residents have coverage – is not quite as popular, nearly 75 percent of respondents to the Harvard School of Public Health and the Boston Globe poll said they supported the law.  When asked if they wanted changes, more than 50 percent said they did.  Another 24 percent support continuing the law as it is.

Support for the law has risen from the last time Bay Staters were asked their opinion by the Harvard researchers in 2009.  At that time, overall support was 53 percent.  Since then, it has risen to 63 percent.  That will likely come as a surprise to those who have called the state’s law, which served as a model for the federal Patient Protection and Affordable Care Act (ACA), an abject failure.

“The picture of how the Massachusetts healthcare law is working out is different than many national commentators suggest,” said Harvard’s Robert Blendon.  “Most people in Massachusetts approve of this law, and it hasn’t negatively affected them.  A large share of the audience (outside of Massachusetts) believes that something is terribly wrong because they’ve heard stories about how expensive it is…and people who live in the state just have a very different view of what’s going on here,” he said.

“Even with all the attention the Massachusetts law has gotten nationally, it really hasn’t driven down support among voters here in Massachusetts,” said Steve Koczela, president of the MassINC Polling Group, which conducted the poll.  “Taking that in concert with the level of influence people thought the state law had on the national law, at least it suggests there’s some difficulty distancing yourself from what happened nationally to what happened here at home,” Koczela said.

The myth is that the Massachusetts law failed to significantly reduce the ranks of the uninsured in the state. The fact is that the Massachusetts law dramatically increased the state’s insurance rate over a period when the national health coverage rate declined.  At the end of 2010, 98.1 percent of the state’s residents were insured compared to 87.5 percent in 2006 when the law went into effect.  Almost all children in the state were insured in 2010 (99.8 percent).  By comparison, at the national level the health insurance rate dropped from 85.2 percent in 2006 to 84.6 percent in 2010.

Approximately 77 percent of private companies are providing health insurance to their employees, compared to 70 percent before the law, according to Governor Deval Patrick’s office.  The law requires all employers with more than 11 full-time employees to make a “fair and reasonable” contribution toward their workers’ health plans or face penalties.  The mandate that requires all state residents to carry health insurance has also proved to be effective, with nearly 97 percent of taxpayers in compliance.

The problematic part of the law is its failure to curb rising costs.  Although implementation of the law itself didn’t damage the state’s budget – according to an analysis by the independent Massachusetts Taxpayer Foundation, the increase in net spending for the law was just one percent in 2010 – it hasn’t reduced overall costs for policyholders.  Private spending per member grew an average of 15.5 percent between 2006 and 2008.  Meanwhile, average premiums for full insurance increased 12.2 percent from 2006 to 2008, according to the Massachusetts Division of Health Care Finance and Policy.

Still, two-thirds of adults in the state support the law, while 88 percent of doctors say it improved, or did not affect, the quality of care.

Do Corporate Healthcare Incentives Work?

Tuesday, January 11th, 2011

Healthcare insurance incentives are somewhat successful, according to the National Business Group on Health, which says approximately 68 percent of its members either offer their employees discounts on premiums if they quit smoking or start eating more healthfully or begin exercise programs.  The companies have a vested interest in these programs because they keep healthcare costs down and add up to fewer sick days.

The impetus for healthcare incentives is the Safeway Amendment that is one part of President Barack Obama’s healthcare reform legislation.  The amendment lets companies reimburse employees as much as 20 percent of their insurance premiums if they take part in wellness programs.  This percentage rises to 30 percent in 2014 and to 50 percent with special governmental approval.  The amendment is so named because of the support of Safeway CEO Steve Burd, who wrote an op-ed piece in the Wall Street Journal in 2009 about how his company’s Healthy Measures program proved that incentives can slash healthcare costs by as much as 40 percent.

According to Harald Schmidt, a health policy expert and Harkness Fellow at the Harvard School of Public Health, “In principle, I think wellness incentives are a good idea.  But it all depends on how they are implemented.  If the focus is on just reducing the cost of healthcare rather than improving health, then you may have a problem.  The second issue is, we must make sure everybody has a reasonable chance of benefiting from incentive programs.  We really have a problem if some find it much harder than others, and especially if we hold people responsible for things that are in fact beyond their control.”

Kevin Volpp, a physician and director of the Center for Health Incentives at the University of Pennsylvania School of Medicine, offers a slightly different perspective.  “The reality is that we have a healthcare financing system that pays to treat people once they are sick.  There’s a growing recognition that health behaviors are a major driver of premature mortality and healthcare costs.  We need to rigorously test approaches that can better align incentives for patients with other interests of the health system, such as employers and insurers, so that resources go to keep people healthy.  Wellness incentives are a piece of that and can be used in ways that provide positive feedback to patients.”

Healthcare Consumption Shows Systemic Waste

Monday, September 27th, 2010

More than half of America’s 354 million annual acute-care visits – for fevers, stomach aches or coughs – typically take place in a hospital emergency room rather than in a primary-care physician’s office. This statistic was revealed in a study of systemic waste published in the journal Health Affairs. According to the study’s authors, their findings underscore a valid question about the healthcare reform law – how can a system that is already overwhelmed provide care to an additional 32 million newly insured patients?

The study, led by Dr. Stephen R. Pitts, an associate professor of emergency medicine at Emory University, examined acute-care visit records from 2001 to 2004 and found that 28 percent were to the emergency room.  This was particularly true for weekend and after-hours visits.  More than 50 percent of acute-care visits by patients who lacked health insurance were to emergency rooms, which are required by federal law to threat anyone with a serious condition.  This places a heavy financial burden on hospitals, which are compelled to provide basic care in what is admittedly an expensive environment.  Often, there is little or no follow-up to determine progress or secure follow-up care.

“More and more patients regard the emergency room as an acceptable or even proper place to go when they get sick,” according to Dr. Pitts.  “And the reality is that the E.R. is frequently the only option.  Too often, patients can’t get the care they need, when they need it, from their family doctor.”  The Affordable Care and Patient Protection Act is anticipated to boost primary care by increasing reimbursements for physicians, attracting students to the field with incentives; expanding community health facilities; and encouraging accountable-care organizations and medical homes.  “If history is any guide, things might not go as planned,” Dr. Pitts wrote.  “If primary care lags behind rising demand, patients will seek care elsewhere.”

Healthcare: Saving Lives or Prolonging Suffering?

Thursday, August 12th, 2010

There is a cacophony of voices in the media talking about healthcare reform, but it’s more heat than light.  That why Atul Gawande’s most recent article in The New Yorker is so important. Boston-based Brigham and Women’s Hospital general and endocrine surgeon Gawande examines how the trend to prolonging life is one of the reasons behind soaring healthcare costs.Is healthcare saving lives or prolonging suffering?  Everyone needs to read this.

According to Dr. Gawande in Letting Go, “Twenty-five percent of all Medicare spending is for the five percent of patients who are in the final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.  Medical spending for a breast-cancer survivor, for example, averaged an estimated $54,000 in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy.  For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end – to an average of $63,000 during the last six months of life with incurable breast cancer.

The big question Gawande poses is thus:  What are we getting in return?  “Patients who were put on a mechanical ventilator,” Dr. Gawande continues, “given electrical defibrillation or chest compressions, or admitted, near death, to intensive care, had a substantially worse quality of life in their last week than those who received no such interventions.  And, six months after their death, their caregivers were three times as likely to suffer major depression.”

Dr. Gawande notes that in one study, “Researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure.  Surprisingly, they found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer.  Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months.  The lesson seems almost Zen:  you live longer only when you stop trying to live longer.”

In one case Dr. Gawande describes, “Aetna decided to let a group of policy-holders with a life expectancy of less than one year receive hospice services without forgoing other treatments.  A patient like Sara Monopoli (who was diagnosed with terminal lung cancer at the age of 34) could continue to try chemotherapy and radiation, and go to the hospital when she wished – but also have a hospice team at home focusing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe.  A two-year study of this ‘concurrent care’ program found that enrolled patients were more likely to use hospice:  the figure leaped from 26 percent to 70 percent.  That was no surprise, since they weren’t forced to give up anything.  The surprising result was that they did give up things.  They visited the emergency room almost half as often as the control patients did.  Their use of hospitals and I.C.U.s dropped by more than two-thirds.  Overall costs fell by almost a quarter.”

Study Finds Need for More Operating Rooms Globally

Wednesday, July 28th, 2010

Poorest two billion only get four percent of OR time.  The richest two billion people in the world undergo 75 percent of all surgeries performed every year; by contrast, the poorest two billion have only four percent. This is one finding of a study published recently in the medical journal Lancet.  The study, performed by researchers from the Harvard School of Public Health, New Zealand, Canada and the World Health Organization, points out a need for additional ambulatory surgery facilities in the United States and across the globe.

The study found that many countries do not have enough surgeons to handle the simplest surgical procedures that improve lives – cataracts, tumors, auto accidents and the like.  Additionally, the researchers found instances of surgeons who lack access to usable operating rooms.  Throughout Africa, the study found that there was just a single operating room for every 100,000 people.  In the poorer Latin American nations, there were four to 10 operating rooms per 100,000.  That number rose to 15 in Western Europe, North America, Australia and New Zealand.  Eastern Europe and the wealthier Asian nations reported approximately 25 ORs for every 100,000 people.

“Conservative estimates suggest that 11 percent of the world’s disability-adjusted life years are attributable to diseases that are often treated with surgery,” such as heart and cerebrovascular disease, cancer, and injuries resulting from traffic accidents, according to the authors, who were led by Luke M. Funk, MD, of the Harvard School of Public Health.

At the same time, “the findings are consistent with other studies, and, for those familiar with overseas health work, believable,” Paul S. Myles, from Monash University, Melbourne, Australia, and Guy Haller, from the University of Geneva, Switzerland, wrote in an editorial accompanying the study. “The extent of the problem is now clearer: the solution is what needs much more work.”

Women Need to Take a Hike

Thursday, April 22nd, 2010

Brisk walks can help prevent strokes in women.A new study suggests that women who walk for two or more hours every week or who walk at a rapid pace can significantly reduce their risk of suffering a stroke.  The results are based on a study of the exercising routines of 39,315 women health experts with an average age of 54.  The study found that women who walked at a pace of three miles per hour or faster had a 37 percent lesser risk of experiencing any kind of stroke.  Additionally, women who walked for two or more hours a week had a 30 percent less risk of suffering a stroke.

Jacob R. Sattelmair, MSc, of the Harvard School of Public Health, said, “Physical activity, including regular walking, is an important modifiable behavior for stroke prevention”.  Physical activity is essential to promoting good cardiovascular health.  Walking is just one easy way of achieving that goal.  Earlier research showed that people who are physically active typically have a smaller risk of stroke than couch potatoes.  According to Sattelmair, strokes are the third leading cause of death and the leading cause of disability in adults in the United States.

Dr. Michael Hill, a neurologist and spokesman for the Heart and Stroke Foundation in Canada, said the study’s findings are not surprising because exercise is good for the heart.  “If you walk, you do well, and if you don’t walk, you don’t do so well,” said Hill.

Hill noted that the study relied on “self-described” exercise and that is likely why conclusive data regarding vigorous exercise cannot be determined.  “If you look at people who take care of themselves and exercise, they also tend to eat well, and they tend to have a good work/life balance.”

H1N1 Flu Pandemic a Case of Overreaction?

Wednesday, December 16th, 2009

Even though federal health agencies are launching a major campaign to make certain that more Americans get flu shots, a new study from the Centers for Disease Control and Prevention acknowledges that the H1N1 swine flu pandemic is not as bad as originally feared.Was the H1N1 flu panic really necessary

“It’s probably going to be the mildest pandemic on record – compared to the three that happened in the 20th century,” according to Marc Lipsitch, a professor of epidemiology at the Harvard School of Public Health and co-author of an article in the journal Public Library of Science.

Although the flu season is far from over – and a third wave of H1N1 could still occur – only eight percent of Americans have been infected so far.  By contrast, the Spanish Influenza of 1918 – 1920 infected approximately 28 percent of all Americans.  According to Lipsitch, if the H1N1 virus doesn’t alter, it’s fair to expect that between 10 and 20 percent of Americans will become infected. “That’s toward the upper end of a typical flu season,” he said.

If 15 percent of the population is stricken with H1N1, hospitalizations could range from approximately 70,000 to 600,000.  Lipsitch expects hospitalizations will fall in the middle of that range, which is what happens in a typical flu season.  The H1N1 death rate has been less than during a normal flu season.  The difference is that most of the deaths have been children, teenagers and adults under the age of 50.  In a typical year, flu tends to kill people over age 65.  The reason is that younger people are getting H1N1 flu, while older people are not.