Posts Tagged ‘public health’

Foreclosure Is Hazardous to Your Health

Monday, November 14th, 2011

Falling behind on mortgage payments harms more than just finances; the stress and strain can negatively impact physical and psychological health.  In 2009, 2.2 percent of all American homes — more than 2.8 million — were in some stage of delinquency.  Researchers examined data collected in 2006 and 2008 on nearly 2,500 Americans who took part in the Health and Retirement Study, a nationally representative sample of Americans aged 50 and older.  The data included information about general health, psychological health, income and whether the person had fallen behind on paying their mortgage.  People who were behind between 2006 and 2008 reported more depressive symptoms, increased food insecurity and were more likely to not take prescription medications as prescribed because of the cost.

“People are making unhealthy trade-offs when they’re trying to make their mortgage,” said Dawn Alley, an assistant professor of epidemiology and public health at the University of Maryland School of Medicine.  “We think it’s a very serious issue.”  The study was published in the American Journal of Public Health.

Nearly 32 percent of people who were having difficulty paying their mortgages didn’t take medications as prescribed because of costs, compared to the five percent who were able to make their mortgage payments.  “Depression, not taking medications and not spending enough money on nutritious food can exacerbate conditions you already have,” Alley said.

Nearly one-third of the people who were mortgage-delinquent reported fair or poor health compared to 19 percent who were able to pay their mortgages on time.  “The rise in mortgage defaults may have important public health implications that could ultimately prove costly to affected individuals, employers, the healthcare system, and society,” according to the study’s authors.

More than a quarter of people in mortgage default or foreclosure are over 50,” Alley said. For an older person with chronic conditions like diabetes or hypertension, the types of health problems we saw are short-term consequences of falling behind on a mortgage that could have long-run implications for that person’s health,” Alley said.

“This study has pinpointed an issue that until now has been somewhat under the radar, but which threatens to become a major public health crisis if not addressed,” said E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.  “Through research such as this, faculty epidemiologists and public health specialists provide valuable information and perspectives that are useful for government and private policy makers as they work to meet the health and economic needs of Americans.”

This study was co-sponsored by the National Institutes of Health and was conducted with support, resources and use of facilities from the Philadelphia Veterans Affairs Medical Center.

Another study by Janet Currie of Princeton University and Erdal Tekin of Georgia State University shows a direct relation between foreclosure rates and the health of residents in Arizona, California, Florida and New Jersey.  The researchers concluded in a paper published by the National Bureau of Economic Research that an increase of 100 foreclosures related to a 7.2 percent increase in emergency room visits and hospitalizations for hypertension, and an 8.1 percent increase for diabetes, among people in the 20 to 49 age group.

Writing in the Wall Street Journal, S. Mitra Kalita says that “Each rise of 100 foreclosures was also associated with 12 percent more visits related to anxiety in the same age category.  And the same rise in foreclosures was associated with 39 percent more visits for suicide attempts among the same group, though this still represents a small number of patients, the researchers say.  Teasing out cause and effect can be delicate, and correlation doesn’t necessarily mean foreclosures directly cause health problems.  Financial duress, among other issues, could lead to health problems — and cause foreclosures, too.  The economists didn’t find similar patterns with diseases such as cancer or elective surgeries such as hip replacement, leading them to conclude that areas with high foreclosures are seeing mostly an increase of stress-related ailments.”

Healthcare Reform May Not End Medical Bankruptcies

Monday, March 21st, 2011

Is healthcare reform a cure-all for the issue of medical bankruptcy?  Depends.  Bankruptcies occur when a person has a serious illness and cannot keep up with paying the bills.  Since RomneyCare became law n Massachusetts, the number of medical-related bankruptcies fell from 59.3 percent to 52.9 percent between 2007 and 2009, according to a recent study.

“Health costs in the state have risen sharply since reform was enacted.  Even before the changes in health care laws, most medical bankruptcies in Massachusetts — as in other states — afflicted middle-class families with health insurance.  High premium costs and gaps in coverage — co-payments, deductibles and uncovered services — often left insured families liable for substantial out-of-pocket costs.  None of that changed.  For example, under Massachusetts’ reform, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616, a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs for covered services,” according to the researchers.  According to the authors, an insured couple earning more than $44,000 a year – a level that is higher than the eligibility requirement for subsidies – might pay as much as $20,512 a year for medical services.  “Massachusetts’ health reform, like the national law modeled after it, takes many of the uninsured and makes them underinsured, typically giving them a skimpy, defective private policy that’s like an umbrella that melts in the rain: the protection’s not there when you need it,” lead author Dr. David Himmelstein said in a Physicians for National Health Reform news release.  The organization’s goal is a national single-payer healthcare system.

The study’s results, which were published in the American Journal of Medicine, suggest “that reducing medical bankruptcy rates in the United States will require substantially improved – not just expanded – insurance.” http://www.latimes.com/health/boostershots/la-heb-obamacare-insurance-costs-03082011,0,7832154.story To determine if RomneyCare had cut the number of bankruptcies, the research team examined a random sample of Massachusetts bankruptcy filings from July of 2009.  After sending surveys to 500 households, they compared the results to national and Massachusetts data assembled during 2007.  The Massachusetts healthcare law went into effect in 2008. According to Dr. Steffie Woolhandler, one of the study’s authors, health insurance in Massachusetts has risen since RomneyCare was implemented.  “It’s really too much money for the average family – especially if the breadwinner is the one who gets sick,” she said.  “We need to reduce limits on deductibles and out-of-pocket costs.”

“People think they have reasonable insurance until they try and use it,” said Dr. David Himmelstein, another study author.  “You are carrying an umbrella and it starts to rain and you put it up and it’s full of holes.  For most people, it just hasn’t rained yet.”  High premiums, large co-payments and deductibles mean that even families with insurance have to pay substantial out-of-pocket costs, said Himmelstein, a professor of public health at City University of New York.  Himmelstein said his survey’s findings suggest that the national health overhaul — which was modeled on the Massachusetts law and takes full effect in 2014 – is unlikely to ease the number of medical bankruptcies, either.

Sally Pipes, a conservative healthcare expert, is a long-time critic of the Massachusetts healthcare law.  “In fact, a substantial portion of Massachusetts’ newly insured still can’t afford to purchase even basic medical services, and are effectively no better off than before the law’s passage. Meanwhile, government health spending is spiraling out of control, adding to the state’s already massive public debt.  Nearly 30 percent of Massachusetts residents report that their medical costs have increased since MassCare’s implementation.”

Lame-Duck Senate Approves Food-Safety Legislation

Wednesday, December 8th, 2010

The Senate recently passed landmark legislation to make food safer and prevent deadly outbreaks of E. coli and salmonella.   The law – if the House of Representatives also gives its blessing – gives the federal government broad powers to step up inspections of food processing facilities and compel firms to recall bad food.  The $1.4 billion legislation – which will impose stricter standards on imported foods – sailed through the Senate on a bipartisan 73 – 25 vote.  Outbreaks of food-related diseases have strained the Food and Drug Administration’s (FDA) resources in its efforts to trace the contaminated products and take them off the market.

The legislation emphasizes prevention so the FDA can halt outbreaks before they start.  Farmers and food processors will be required to tell the FDA how they are working to keep food safe throughout every stage of production.  President Barack Obama hailed the bill’s passage, noting that “We are one step closer to having critically important new tools to protect our nation’s food supply and keep consumers safe.”  Despite broad support, the bill had stalled in the Senate because some feared it would harm small-scale farmers.  Senator Jon Tester (R-MT) added an amendment that will exempt some of those operations from expensive food safety plans required by bigger producers.

Although the House of Representatives approved the legislation in July of 2009, that bill does not include the same exemption.  With little time left in the current lame-duck session of Congress, the question is whether the Senate and House can reconcile the two versions of the bill.  Senator Tom Harkin (D-IA), a sponsor of the legislation, said there is support in the House to pass the Senate version of the bill.  If Senator Harkin is correct, the bill could be on its way to the White House for President Obama’s signature before the 111th Congress goes into recess.

HHS Awards $100 Million to Public Health Initiatives

Monday, October 11th, 2010

Affordable Care Act sends $100 million to public health agencies.Thanks to the Patient Protection and Affordable Care Act, the Department of Health and Human Services is awarding nearly $100 million in grants to support locally based public health and prevention services. The money will support several public health initiatives, including substance abuse; mental health; stop-smoking hotlines; HIV testing and prevention; and obesity treatment and prevention.  According to Department of Health and Human Services Secretary Kathleen Sebelius, some of the funding also will be spent on health information technology.

“From providing tools to help people stop smoking to new HIV testing and prevention programs to a critical investment in mental health, these Affordable Care Act prevention grants will help people get what they need to stay healthy and live longer,” Sebelius said.  The Centers for Disease Control and Prevention http://www.cdc.gov/ will receive $75 million of the funding for its state and local public health programs.  Approximately $26 million of the CDC money will fund epidemiology, lab and health information systems in the health departments of all 50 states, two territories and the nation’s six biggest cities.

The funding is intended to help public health departments participate in “meaningful use” of electronic health records by implementing high-tech reporting.  Another $21.7 million in CDC funds will promote HIV testing and prevention.

Preparing for the Next Pandemic

Thursday, September 2nd, 2010

Department of Health and Human Services plans to ramp up vaccine production to stem next flu pandemic. Now that the H1N1 swine flu pandemic has officially come to an end, the federal government is planning to change the way it works with companies to counteract new disease threats. Proposed actions include reforming the Food and Drug Administration (FDA) and creating centers that will make vaccines available more quickly than was possible previously. According to a Department of Health and Human Services (HHS) report, the nation’s ability to respond to pandemics is too slow and that changes must be made. The report also contains a plan to help researchers and biotech firms bring new drugs and vaccines to the market in record time.

“At a moment when the greatest danger we face may be a virus we have never seen before…we don’t have the flexibility to adapt,” said HHS Secretary Kathleen Sebelius. The report promotes clearer guidance to industry regarding the kinds of tests need to achieve regulatory approval of new drugs and vaccines, something the pharmaceutical industry has requested. The FDA plans to establish teams to expedite this process. Additionally, HHS and the Department of Defense plan to establish the Centers for Innovation in Advanced Development and Manufacturing, according to the report.

“These centers will provide assistance to industry and government by advancing state-of-the-art, disposable, modular manufacturing process technologies,” the report says. “Finally, in public health emergencies, these centers may augment existing United States manufacturing surge capacity against emerging infectious diseases or unknown threats, including pandemic influenza.”

Dr. Harold Varmus, who wrote a separate report from the Presidential Council of Advisors on Science and Technology, said “Accelerated delivery of vaccines by even a few weeks can mean saving tens of thousands of lives. Sebelius noted that the government has not invested adequately in “regulatory science” – studying the optimal means to test new products. “Because of this under-investment, we are often testing and producing cutting-edge products using science that is decades old. We are also going to reach out to product developers earlier in the process so they know what to expect,” Sebelius said.

Switzerland-Style Healthcare System Could be the Solution

Monday, September 28th, 2009

One instructive lesson in reforming American healthcare may be to adopt the Swiss model, which is regulated by the Federal Health Insurance Act of 1994,  and made health insurance compulsory for all residents.  Previously, Switzerland had an American-style system, which became a national outrage when studies revealed that five percent of the population lacked any coverage.

165298519_12e65e294bToday, 99.5 percent of the Swiss people are insured with coverage funded by the individual who generally pays the full cost of premiums. Government subsidies are provided for the poor, with approximately one-third of all Swiss citizens receiving the subsidy.  “These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance.”  All insurance is private and physician compensation is negotiated between the insurance companies and doctors on a canton-by-canton basis.

The down side is that Swiss healthcare is expensive, with costs rising 10 to 20 percent every year.  Monthly health insurance costs for a family with one child can amount to CHF 1,000 ($944).  Deductibles can be adjusted, though, from CHF 300 ($283) to CHF 2,500 ($2,360).  The state will help with the costs if income (married/without children) is around CHF 30,000 ($28,920) or (married/with children) around CHF 60,000 ($56,581).  In those circumstances, the government pays half the cost of insurance.  Options are available that will lower the monthly costs, similar to the American HMO model.  In these plans, the person must consult with their physician prior to seeing a specialist.

“The mix that Switzerland represents between private enterprise and general state regulations that make healthcare accessible to everyone is really an interesting example for the United States,” said Felix Gutzwiller, a Radical Party senator and head of Zurich University’s department of public health.  In Switzerland, administrative costs consume on average five percent of health insurance revenue.  In the United States, it’s closer to 20 percent.

In terms of satisfaction, the World Health Organization puts Switzerland in 20th place in its rankings of healthcare systems around the world.  The United States ranks 37th, sandwiched between Costa Rica and Slovenia.