Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England. What’s more, over the age of 85, ICU usage among terminal patients is eight times higher in the US than in England, according to new research that compared the two countries’ use of intensive care services during final hospitalizations.
In an op-ed in The Hill (10/8), former FDA commissioner Andrew C. von Eschenbach, now a senior adviser at the Center for Health Transformation, and Wayne W. Oliver, a CHT vice president, write that despite A plan to spend $5 billion of stimulus funds on government grants to increase medical research, “not one dollar of stimulus money will be used to enhance the capacity and capability of the FDA.” Despite “decades of neglect” the agency continues to have “a diminished capacity to embrace new scientific technologies and meet the demands needed to protect the public health.” Von Eschenbach and Oliver call for new resources and “the design and implementation of a 21st century regulatory framework” that will help the FDA “drive innovation, dramatically shorten the time between discovery and delivery, and allow Americans everywhere to have access to safe, effective and miraculous discoveries” Comment: In previous Blogs I have said the FDA was severely restricted by funds yet Congress keeps adding duties, including the most recent tobacco responsibilities.
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.
In this week’s BMJ we find that despite all the medical, public health, social, economic, and political changes over the 20th century, patterns of poverty and mortality and the relations between them remain firmly entrenched. There is a strong relation between the mortality levels of a century ago and those of today. This goes beyond what would have been expected from the continuing relation between deprivation and mortality and holds true for most major modern causes of death. Comment. Most of these deaths are related to chronic diseases and individual behaviors, which have always had an adverse impact on low income groups that have had poorer education
Premiums for employer-sponsored health insurance rose to $13,375 annually for family coverage this year — with employees on average paying $3,515 and employers paying $9,860, according to the benchmark 2009 Employer Health Benefits Survey released today by the Kaiser Family Foundation and the Health Research & Educational Trust (HRET).
USA Today reports, “Uninsured patients aren’t the only ones using the [emergency department (ED)] for non-urgent care. With too few primary-care doctors to go around, many patients turn to the [ED] when they can’t get an appointment with their regular physician, says Sandra Schneider, president of the American College of Emergency Physicians.” Ted Epperly, president of the American Academy of Family Physicians, pointed out that “in some ways, insurance payments contribute to the shortage…by discouraging physicians from going into primary care.” Medicare “pays doctors far more to perform procedures than to monitor a patient’s overall health, Epperly says. In the past decade, only 10 percent of new doctors — who graduate from medical school with an average of $140,000 in student loans — have gone into primary care,” according to Epperly.
Everyone who has an interest on the Congressional approaches to health care reform should read the current issue of ‘Health Affairs’ and note the monetary costs of the various approaches. In the papers we find the expectation that the reforms would consume more than 50% of GDP, while others show that in 75 years the reforms would cost more than the entire GDP. It is clear that the various activists have never taken economics 101. The financial projections indicate totally unrealistic expectations for reform. There have to be limits to new expenditures. Anyway you wish to make changes there has to be some form of rationing. There also has to be some reduction in money devoted to research. Too much research money funneled to medical schools results in too little immediate benefit to the public but solves much of the fiscal problems of the teaching hospitals.
From Marcia Angell MD. It’s not just the right-wing crazies who oppose health reform. In addition, there are many sane Americans who worry about committing a trillion dollars to it. They have a point. We already spend more than twice as much per person on health care as other advanced countries, and our costs are rising faster. How much is enough? Read the whlw post. Dr Angell is a past editor of the NEJM.
