Kim’s public health blog

“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.

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.

• Advancing Technology, Demographics and Declining Health Status
• Lack of Productivity Growth
• Inappropriate Utilization
• Payment System Distortions
• Consumer Price Insensitivity
• Medical Errors and Inefficiency
• Medical Malpractice
• Defensive Medicine
• Higher Prices
• Administrative Costs

Two new studies from Canada and the Netherlands found that home births were as safe as hospital births among low-risk women,” USA Today reports that a spokeswoman for the American College of Obstetricians and Gynecologists, “argues that the findings can’t be extrapolated to the USA.” She points out that in those countries, “midwives who attend home births must have at least a bachelor’s degree, which is not the case for all US midwives.” In fact, “they have varied educational backgrounds, ranging from self-study to college- and university-based midwifery programs.” Still, “ACOG shouldn’t confuse the site of a birth with the qualifications of the midwife attending it,” says Lorrie Kaplan, of the American College of Nurse-Midwives. Comment: When in medical school in London in the early 1950s I was taught deliveries at homer by a nurse midwife (what today would be a master’s level MWF).  It is the training rather than the site that makes most home deliveries safe.

From the  Institute of Medicine: Local governments play a crucial role in the fight against childhood obesity by creating environments that make it either easy or hard for children to eat healthier diets and move more. A new report from the Institute of Medicine and National Research Council provides local officials with action steps that hold the greatest potential to reduce obesity rates among children, such as zoning restrictions on fast-food restaurants near schools, community policing to improve safety around public recreational sites, and publicly run after-school programs that limit video game and TV time.

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.