Kim’s public health blog

A study performed at  The University of Rochester Medical School   showed that when adolescents graduate to young adulthood, their preventive care tends to fall by the wayside. A recent study has found that young adults are much less likely to use ambulatory or preventive care, even though their mortality rate is more than twice that of adolescents. COMMENT: I have difficulty understanding why this should surprise anyone when the  various insurance programs, including Medicaid fail to pay for counseling by primary care practitioners. Further once the individual reaches 18 years of age eligibility for Medicaid vanishes.

In the New York Times (9/22) Economic Scene column, according to Harvard economist Amitabh Chandra, “$60 billion a year, or about three percent of overall medical spending, is a reasonable upper-end estimate” of what is spent on defensive medicine in the US. Leonhardt argues that the current “malpractice system does” indeed “affect the morale of doctors,” leaving “them wondering when they will be publicly accused of doing the very thing they’ve sworn not to do: harm patients.”

“The most important healthcare document released this week was not Sen. Max Baucus’s Healthy Future Act. It was the Kaiser Family Foundation’s 2009 Employer Benefits Survey.” The survey, “which polls employers about health benefits to assemble a detailed look at the actual cost of healthcare, fits it squarely in our pocketbooks. The truth is we all pay, and much more than we recognize, for healthcare.” According to Kaiser, “the average healthcare coverage for the average family now costs $13,375.” Over the past decade, “premiums have increased by 138 percent.

ScienceDaily (Sep. 20, 2009) — A person, usually a child, dies of rabies every 20 minutes. However, only one inoculation may be all it takes for rabies vaccination, according to new research published in the Journal of Infectious Diseases by researchers at the Jefferson Vaccine Center.

Also in JAMA [JAMA. 2009;302(11):1223-1224] is a useful article suggesting how to reduce cost while trying to expand access the health care. Disease prevention initiatives aimed at improving nutrition, physical activity, tobacco use, and related lifestyle behaviors are likely to have the greatest effect on slowing the annual increase in health care costs. Evidence suggests that investment in physical activity, nutrition, and smoking cessation yields a 5-fold greater return in cost savings² than that documented for most clinical preventive services, owing to the inability of identifying the specific high-risk populations likely to benefit from such interventions as opposed to across-the-board screening and testing.^{1, 3} Current health reform proposals that would allocate $10 billion for a Prevention and Wellness Fund targeted to promoting healthier lifestyles and communities represents a major step toward slowing the annual increase in health care spending over time, given the current evidence on return on investment.

In the NEJM [V361,pp1131-1133. Sept 17] Is an article worth reading about the failure of current legislation to be serious about cost reduction, or even control. The article references three European countries with multiple payers that require annual collective bargaining with the government to control prices. Comment: The article is worth reading for the other serious options for controlling costs. The biggest barrier is the insurance industry

An excellent paper in JAMA [JAMA. 2009;302(11):1221-1222. ] this week shows how a country can respond to a new virus H1N1) and that all of us can learn how effective methods can be used to maximize participation by everyone in the country.

In this week’s NEJM a team of prominent doctors, scientists and policy makers says ”it could be a powerful weapon in efforts to reduce obesity, in the same way that cigarette taxes have helped curb smoking.” Authors of the report include “the New York City health commissioner, Thomas Farley, and Joseph W. Thompson, Arkansas surgeon general.”  Comment: There is too much of a rush by public health behaviorists to rush into punitive measures to change population behavior.  There seems to be no sense that this leads toward Huxley’s Brave New World.

In an op-ed in the Atlanta Journal-Constitution (9/17), Jim Fortenberry, MD, pediatrician-in-chief at Children’s Healthcare of Atlanta, discusses how, “time after time, parents are bringing children with flu symptoms to the emergency” department “when it’s not an emergency.” Dr. Fortenberry points out that even though the H1N1 “flu is a new strain, at present it is acting just like a mild-to-moderate case of the flu with the same type of outcomes as seasonal influenza.” Therefore, he suggests that “parents take away that H1N1 label and name, and think of this as the flu.” COMMENT: Overkill by the medical politicians overloads the system, time after time.  We saw the same behavior with swine flu in 1976 when the White House insisted everyone be vaccinated, yet evidence for severe outcome was missing.