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Editorials and op-eds mark first year of healthcare reform law

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News organizations published multiple opinions marking the anniversary of the health law, here is a selection:

Cincinnati Enquirer: Health Care Law Breaks Promises
We now know that lawmakers who promised that “if you like your plan, you can keep your plan” were wrong. … The president likes to say Americans aren’t interested in revisiting the debates of the past. No one would accept an answer like that from an electronics store manager who refused to offer a refund on a defective television. Why would they accept it when it comes to their health care? (Sen. Mitch McConnell and Rep. John Boehner, 3/22).

The Wall Street Journal: ObamaCare And Carey’s Heart
Some years ago, a little girl was born with a serious heart defect: Her aorta and pulmonary artery were reversed. Without immediate intervention, she would not have survived. … the girl is my daughter, Carey. And my wife and I are incredibly thankful that we had the freedom to seek out the most advanced surgical technique. The procedure that saved her, and has given her a chance at a full life, was available because America has a free-market system that has advanced medicine at a phenomenal pace (Sen. Ron Johnson, 3/23).

USA Today: After One Year, Health Law Already Offers Lifelines
Many of the key features of the controversial new health law — such as the mandate requiring most Americans to buy insurance and subsidies to help some people afford it — don’t go into effect until 2014. Many smaller provisions have kicked in, however, and they have begun doing what the law was designed to do — change a dysfunctional status quo in which too many Americans couldn’t get insurance, and even those with coverage had to worry about losing it just when they needed it most (3/22).

Politico: ‘Obamacare’ Is A Failed Experiment
After a year of learning what is in the law — and seeing its effect on families, small businesses and our economy — it is now clear that Obamacare is a failed experiment. Sadly, this failure was predictable and very expensive. … Rather than fighting reality by trying to persuade the people to love a law that does not live up to its hype, Congress should scrap this failed program and replace it with common-sense reforms that can truly lower costs (Sen. John Thune, 3/23).

Cincinnati Enquirer: Act Has Improved Health Care In U.S.
When you add together all these improvements under the Affordable Care Act, projections based on data from the nonpartisan Congressional Budget Office show that a family of four, making $55,000, could save more than $6,000 a year on health insurance in 2014. For a family making $33,000, those savings will be nearly $10,000 annually. For many American families, this means that health insurance will be within reach for the first time in their lives (Dr. James Galloway, 3/22).

Politico: For Many, Affordable Care Act Repeal Is Dead Wrong
As an African-American man, I can expect my life to be six years shorter than that of the average American. … It took a century for the federal government to meaningfully address the need for a just and equitable health care system that shows respect for the lives of all Americans. We must protect the integrity and continuity of the law (Wade Henderson, 3/23).

Fox News: Gambling With Our Very Lives — A Senior’s Take on ObamaCare One Year Later
To politicians and policy wonks, health care is an ideological issue. And the president’s health care scheme is a grand experiment. But seniors understand the real world impact this experiment will have if the ObamaCare numbers don’t work —and it is now painfully clear that they never will. Inevitably, care and treatment will be rationed because denying access to care and treatment is really the only way government can “reduce its costs.” It’s that simple (Jim Martin 3/22).

The Washington Post: Post Partisan: ObamaCare Is Not ‘Job-Destroying’
The ACA may just be one part of a larger effort to reform entitlement spending. But, too often, the post-passage debate on health-care reform has been about “covering more people” versus “spending more money and punishing business,” when one of the law’s most important elements — cost containment — promises to help do the former while avoiding the latter (Stephen Stromberg, 3/22).

The Wall Street Journal: A Very Bad Year
As of Jan. 1, 2014, unless it is repealed, health care will be run, controlled, and totally supervised by Washington. … Health-care payments in America have changed over time. In the past 40 years people’s out-of-pocket spending has fallen from 50% of medical expenditures to 10%, while the portion picked up by private insurance companies has increased from 25% to 40%. The portion paid by Medicare and Medicaid–that is, by taxpayers–has increased from 25% to 50%. … The Europeanization of America is alive and well. Unless there is significant change, it will be with us forever (Pete DuPont, 3/23).

McClatchy / The Kansas City Star: After One Year, Health Care Law Benefits America
Comprehensive health-care reform has endured a rocky first year. … Fortunately, the Affordable Care Act remains intact and already is changing health care in positive ways. … The Affordable Care Act remains, however, the building block of a fairer, more humane and more efficient system. May it survive and prosper (3/22).

Des Moines Register: Health Care Reform Act Is Constitutional Necessary
[E]xpedited review is a bad idea for two reasons. First is the court’s reputation and legitimacy as an apolitical branch of government. Second, this is essentially a policy debate, not a judicial debate, and as such it is a question that we are doing our best to work out in various political arenas. To short-circuit this quintessentially American process would do a disservice not just to those without adequate health insurance, but also to democracy itself (Ian Bartrum, 3/22).

The Miami Herald: One Year After Healthcare Reform
In Florida, the celebration, like our healthcare outlook, is not a cheerful one. There are more than four million uninsured residents in Florida. … Despite those numbers, our legislative leadership turned down even-bigger numbers: $1 million in federal funds that were to be used for planning to cover the uninsured and another $1 million for a health-insurance exchange to help small businesses access health coverage for their employees. … Let’s get behind this law and tell our officials to do the same (Steven Marcus, 3/23).

USA Today: How To Reform Your Health Care
[L]et’s stipulate that the medical system in the USA is far from perfect. Let’s also agree that what ails medicine in America won’t be fixed quickly and can never be fixed entirely by the federal government, your state, your employer, your union, insurance companies, hospitals, or doctors. … This is a column about what you can do to improve health care and help bring down its soaring costs, no matter what the fate of the reform law is. Way more than you might think, your behavior can make a difference (Steve Findlay, 3/22).

The Houston Chronicle: Texas Needs To Establish Its Own Health Exchange
It has been one year since President Obama signed the Patient Protection and Affordable Care Act into law, and Texas is at a policy crossroads: We can choose to lead with responsible public policy or become supporting actors in a national political sideshow. The reality is that the success of health reform now depends on the states (State Rep. Garnet Coleman, 3/22).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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glucose-monitor

State’s health technology board draws national press scrutiny

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The Washington State program that evaluates treatments to determine whether they are safe and effective has come under harsh attack from the Wall Street Journal and has been the focus of two stories one in the Journal’s news pages and another in today’s New York Times.

The focus of all this attention is the Washington State Health Technology Assessment (HTA) program, which was established in 2006 to determine if treatments are safe and effective, based on the available scientific evidence.

The HTA’s decisions affect whether the treatments will be covered by state-funded health plans that insure about 750,000 Washingtonians, including state employees, Medicaid enrollees and prisoners.

The program is seen by many as a model for the national comparative effectiveness programs created by the new healthcare reform law, the Patient Protection and Affordable Care Act, which will compare treatments to see which are best.

In two editorials, The Wall Street Journal targeted the HTA’s decision to evaluate two methods of monitoring blood sugar levels in children with type 1– insulin-dependent–diabetes: intermittent home blood glucose monitoring with test strips and continuous glucose monitoring with a sensor placed under the skin.

With intermittent blood glucose monitoring, the child’s blood glucose levels are measured from a drop of blood drawn with a prick of the skin.

While this is considered standard practice, the HTA decided to evaluate the practice because there is controversy over how frequently blood levels should be tested and the overall effectiveness of the practice.

The committee also sought to evaluate whether the more costly continuous glucose monitoring device was safe and effective as well.

The committee met last Friday, March 18th to consider the evidence and make a decision.

On the day of the meeting, The Wall Street Journal attacked the program in an editorial entitled “The Pro-Diabetes Board: Washington state targets modern medicine. Coming soon to D.C.”  I

n the editorial, the Journal editors charged that the HTA panel was “targeting the fundamental standard of diabetes care that has been the established medical consensus for at least three decades”

The panel was interested in finding ways to “scrimp” on patient care, the Journal charged.

“…political comparative effectiveness isn’t about informing choices. It’s really about taking away options,” the Journal said.

The next day, Wall Street Journal reporter Shirley S. Wang reported on the HTA’s hearing and decision. Wang wrote:

Washington is one of few states that factors cost into its health-coverage decisions, in addition to effectiveness and safety. Critics say that amounts to rationing because it can limit access for patients who need services but can’t afford them.

Critics of the program fear more cash-strapped states will implement programs similar to Washington’s, Wang wrote.

But some observers say states have little choice but to find ways to curb health costs.

“Washington is a leader in attempting to bend the cost curve while improving quality,” said Anne Gauthier, senior program director at the National Academy for State Health Policy, a nonpartisan think tank that isn’t involved with the Washington program.

Ultimately, the HTA committee decided to give unlimited approval for coverage of home blood glucose monitoring with standard test strips.

But coverage of continuous glucose monitoring devices, the panel decided, would only be covered for children who had experienced a hypoglycemic episode, a serious condition when the blood sugar levels fall dangerously low, or who are enrolled in a research study.

In response, The Wall Street Journal revisited the topic today in an editorial entitled “The Anti-Diabetes Board: The dodged bullet in Washington state“.

“Friday’s decision is a bow to the medical consensus, but the moment shouldn’t pass without noting how extraordinary it was that the board even considered the question,” the Journal editors wrote.

The HTA ” has prohibited coverage for or imposed restrictive conditions on drug-coated cardiac stents, knee replacements for osteoarthritis, ultrasounds for pregnant women, infusion pumps for chronic pain medication, lumbar fusion back surgery, hip resurfacing arthroplasty and others. Merely the spectacle of doctors forced to justify their practices, if not yet their existence, to a government board is troubling enough,” the editors wrote.

If the Washington model is adopted nationwide, the Journal warned, the “Government could create a de facto formulary for procedures and dictate other choices about how doctors are allowed to treat patients.”

In today’s  New York Times reporter Andrew Pollack noted that the HTA saves the state more than $31 million a year.

Leah Hole-Curry, director of the program, defended its actions, saying they did not amount to rationing of health care.

“Rationing is where you know you need something and without it you are going to suffer but there’s not enough to go around,” she offered as a definition. In this case, she said, the program denied coverage for procedures that have simply not been shown to work.

“It’s still pretty astounding that we have individuals who say we don’t want you to look at scientific evidence in deciding how to spend taxpayer dollars,” she said.

To learn more:


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Three red and white capsules

Psychologists seek authority to prescribe drugs

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By Michelle Andrews

In any given year, more than a quarter of U.S. adults have a diagnosable mental health problem — from depression to bipolar disorder — yet  fewer than half get any kind of treatment for it.

The figures are similar for children.Many who do receive care get it through their primary-care physician rather than a mental health professional like a psychiatrist or psychologist.

That’s partly by choice: People prefer to talk to someone they know and trust about medical problems, and for many, there’s still a stigma in seeing a “shrink.”

But part of the reason people turn to their primary-care doctors or go without care is that it can be tough to get an appointment with a mental health expert. Psychiatrists, in particular, are in short supply, especially in rural areas.

A recent survey conducted for the Tennessee Psychological Association, for example, found that the average wait to see a psychiatrist for a non-emergency appointment was 54 days for patients with private health insurance and 90 days for those covered by TennCare, the state’s Medicaid program, says Lance Laurence, director of professional affairs for the TPA.

“It’s a huge access issue,” says Katherine Nordal, executive director for professional practice at the American Psychological Association, a trade group for psychologists.

Psychologists say they have a solution to help address the access problems: Give them more authority to prescribe psychotropic medications.

They can already prescribe in New Mexico and Louisiana, as well as in all branches of the military and the Indian Health Service. A half-dozen other states are considering measures that would give more psychologists prescribing authority.

More From This Series: Insuring Your Health

Some of those states have considered and rejected such legislation before, but Nordal says her group is “cautiously optimistic” that it may succeed in a few states this year.

Psychiatrists are medical doctors with a specialty in psychiatry; psychologists have doctoral degrees, and their training includes coursework in diagnosing and managing mental illness.

Any medical doctor, from dermatologist to surgeon, can prescribe psychotropic drugs; but before psychologists can prescribe drugs — in the jurisdictions that allow it — they must complete work equivalent to an additional master’s degree in clinical psychopharmacology, says Nordal.

With the exception of psychiatrists, she says, no medical professional is as well versed in medication for mental disorders as prescribing psychologists.

In addition, psychologists provide other types of treatment, such as talk therapy and cognitive behavioral therapy, in contrast to psychiatrists, who often only prescribe drugs. A national survey found that only 10.8 percent of psychiatrists offer talk therapy to all their patients. “We have a bigger toolkit than many others do that prescribe,” Nordal says.

Health insurance generally covers prescription drugs to treat mental illness, but coverage for therapy sessions with a mental health provider is less routine.

This has resulted in an over-reliance on drug therapy in recent years, all agree. Experts say this imbalance should change under the Mental Health Parity Act, which took effect last year; it requires mental health benefits, if offered, to be at least as generous as benefits for medical and surgical care. Even if the type of treatment shifts somewhat, however, many patients will still need drug therapy.

Physician groups such as the American Medical Association and some patient advocacy groups, however, are cool to the idea of letting psychologists prescribe drugs. “These are serious drugs with serious side effects,” says Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, a consumer advocacy organization. “We feel strongly that [prescribing] should be handled by someone with medical training.”

The problem is likely to become more acute with an estimated 32 million people expected to gain health insurance under the health-care overhaul law. The Association of American Medical Colleges projects a shortage of 45,000 primary-care physicians alone by 2020.

People with serious mental illness die 25 years sooner, on average, than the rest of the population.

Experts agree that solutions lie in better integration between primary care and mental health care. This makes sense in part because for more than a third of patients with mental health problems, the only practitioner they see is a primary-care provider.

In addition, people with chronic illnesses such as diabetes, heart disease and asthma are significantly more likely to have mental health problems than those without chronic illness. People with serious mental illness, in fact, die 25 years sooner, on average, than the rest of the population.

The health-care overhaul, with its emphasis on medical homes and accountable care organizations that take responsibility for managing a patient’s health rather than just providing medical services, offers promising models for integration, experts agree.

In clinical psychologist Benjamin Miller’s primary care “dream world,” mental health providers work alongside primary-care physicians, in the same office. Miller is an assistant professor of family medicine at the University of Colorado’s school of medicine in Denver. Part of his job is to integrate mental health into the family medicine department’s clinical, education and research functions.

“There’s a range of mental health needs that will be seen in primary care,” he says. “You can’t tease it out from the other conditions that an individual is facing.”

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Japan

Trace levels of radiation from Japan detected in Seattle

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An air monitor in Seattle has detected trace levels of radioactive iodine linked to the damaged nuclear reactors in Japan, the Washington Department of Health reported Monday.

“The minuscule amounts of radioactive iodine are millions of times lower than levels that would be a health concern,” health department officials said.

The Department of Health takes hourly measurements from monitors in four locations throughout the state — Richland, Seattle, Spokane, and Tumwater. The chart above shows radiations measures known as “gross beta,” a term that refers to all radioactive materials that emit beta radiation.

Gross beta measurements are used because they give us the fastest indication of any change in radiation levels. They’re measured in “counts per minute. All four monitoring stations have continually shown normal background levels of radiation, the Department of Health reports.

Despite the arrival of these radioactive particles, the state’s overall background radiation levels have not rise, the officials said.

Readings from U.S. Environmental Protection Agency

Health officials urged people not to take potassium iodide, also known as KI, which can protect the thyroid gland from absorbing radioactive iodide.

Radioactive iodide levels in the state are so low that it poses no risk, while taking KI can cause serious reactions in some people, they warned.

“Only people who work in or around nuclear power plants during an emergency, or who live near such a plant and can’t get away, should take KI,” Department of Health officials said.

To learn more:

  • Read about the uses and potential dangers of potassium iodide from the Centers for Disease Control and Prevention KI information page.
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Baby drinks from bottle

Children should ride rear-facing to age 2, use a booster until at least age 8 — New Guidelines

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Children should ride in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat, according to new guidelines issued today by the American Academy of Pediatrics.

Previous guidelines, advised that infants and toddlers should ride rear-facing up to the limits of the car seat, but they also cited age 12 months and 20 pounds as a minimum.

As a result, the Academy said, many parents turned the seat to face the front of the car when their child celebrated his or her first birthday.

But new research indicates children are safer in rear-facing car seats, including a 2007 study that found that children under age 2 were 75 percent less likely to die or be severely injured in a crash if they are riding rear-facing.

“The ‘age 2’ recommendation is not a deadline, but rather a guideline to help parents decide when to make the transition,” said Dr. Durbin Dennis Durbin, M.D., lead author of the policy statement and accompanying technical report.

“Smaller children will benefit from remaining rear-facing longer, while other children may reach the maximum height or weight before 2 years of age,” he said.

Once children have reached the maximum height and weight of their rear-facing car seats, they should transition to a forward-facing seat with a harness, the guidelines say.

Then, when they have reached the maximum size for that seat, children should then switch to a “belt-positioning” booster seat so their lap and shoulder belts fit properly.

Most children will need to ride in a belt-positioning booster seat until they have reached 4 feet 9 inches tall and are between 8 and 12 years of age, the guidelines say.

“A rear-facing child safety seat does a better job of supporting the head, neck and spine of infants and toddlers in a crash, because it distributes the force of the collision over the entire body,” Dr. Durbin said. “For larger children, a forward-facing seat with a harness is safer than a booster, and a belt-positioning booster seat provides better protection than a seat belt alone until the seat belt fits correctly.”

A properly positioned shoulder belt should lie across the middle of the chest and shoulder, not near the neck or face, and the lap belt should fit low and snug on the hips and upper thighs, not across the belly, the guidelines advise.

To learn more:

  • Read about infant and child car seats and their proper installation and use on the Academy’s Healthy Children website.
  • Read the new guidelines in the journal Pediatrics.

 

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Umbrella Thumb

Insurers respond to reform by snapping up less-regulated businesses

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By Christopher Weaver
This story was produced in collaboration with wapo

llustration by Ellen Weinstein

Here’s one change few were talking about when the health overhaul law passed: It’s sent insurers – worried the law could stunt profits and growth – looking for new types of business.

Where are they investing? In less-regulated companies that could yield strong profits and make the main business – insurance – more lucrative. The purchases also could increase insurers’ control over more parts of the health system.

Insurers have moved into technology, health-care delivery, physician management, workplace wellness, financial services and overseas ventures in wide-ranging efforts to mitigate the new rules imposed by the law.

Since June 2009, seven of the nation’s largest insurers have made 25 major deals, and only six of those acquisitions run health plans, according to an analysis of data collected by FactSet Research Systems, a private company.

At an investors meeting in February, Rick Jelinek, UnitedHealth Group’s top executive for emerging businesses, said the company’s future growth would be in services that are “much less regulated” than insurance plans.

UnitedHealth Group LogoIn 2010, UnitedHealth Group bought ChinaGate, which helps bring medical treatments to market in China; Picis, a technology vendor specializing in clinical and financial management systems for hospital emergency departments and intensive care units; the medical screening company Wellness; and six other firms.

Aetna LogoIn December, Aetna acquired Medicity, a business that helps hospitals share patient information. The federal government will reward hospitals and doctors with more than $30 billion in increased Medicaid and Medicare payments by 2015 for adopting electronic medical records, but only if they can share their data.

Also in December, Humana bought Concentra, a Texas-based urgent- and occupational-care provider with clinics in 40 states. More than one-third of Humana members live within 10 miles of a Concentra clinic, making its services convenient for the insurer’s members. Last year it also bought a health coaching firm that helps employers keep workers healthy, and in February it partnered with a South African company to launch new wellness services in the United States.

Those moves represent only big-ticket buys that require regulatory approval or that companies chose to announce. Insurers can buy smaller firms or create businesses from scratch without disclosing details.

For instance, OptumHealth, a UnitedHealth subsidiary, has quietly taken control of Memorial Healthcare IPA, a Los Angeles company that manages more than 400 doctors, according to a document filed with the California Secretary of State’s office. OptumHealth declined to discuss details of the deal. A Memorial Healthcare executive, Patty Page LaPenn, said in a statement that relationships with patients and other businesses “will continue as usual.”

The trend shifts

Insurers have been on buying binges before – in the past decade, the seven large firms publicly acquired 137 companies. However — with the exception of UnitedHealth, which has been building its technology arm, Ingenix, since 1997 — they focused on acquiring rival health plans and insurance services firms. For instance, 10 of 13 deals Humana struck before 2010 involved health plans.

The current trend is largely driven by the health law, said Ana Gupte, an analyst with Sanford C. Bernstein & Co.

The newer ventures will not replace the core business of selling health coverage.

“They’re very synergistic with the health-insurance [product],” Gupte said, giving insurers more tools to control medical costs while potentially increasing earnings.

In the past, buying health plans “was a really good meat-and-potatoes strategy,” said Paul Kusserow, Humana’s chief strategy officer. But the looming threat of new regulations means “that we have to get much more engaged in managing health for our members.”

With its recent acquisitions, Humana is dipping its hand directly into patient care, gaining more control over doctors. That’s what makes acquisitions such as Concentra a “two-for-one deal,” Kusserow said. Concentra will continue to generate “great margins” for the company as a stand-alone business, he said, but also will give Humana a workforce of physician gatekeepers controlling access to costly services.

Doctors’ orders initiate almost all medical spending. If insurers can push physicians to more effectively manage chronic diseases such as diabetes and judiciously prescribe expensive services such as MRIs, they stand to profit.

“The ultimate goal,” Kusserow said, “is going to be to teach these folks at Concentra to deal with risk” by making doctors responsible for the cost and quality of care.

The flurry of acquisitions underscores the pressures facing insurers. Years of rapidly rising prices have made it difficult to raise rates further.

“Companies have to continue to grow, and they can’t keep raising rates at 20 percent a year,” said Eric Coburn, a health-sector investment banker at Shattuck Hammond Partners.

Last year, rates increased 7 percent, on average, for employer-sponsored plans and as much as 20 percent for individuals, according to reports by Hewitt Associates and the Kaiser Family Foundation. (Kaiser Health News is part of the foundation.)

The overhaul’s effect

Now comes the health law. As more people receive insurance under the law, insurers would welcome 15 million new customers, according to the Congressional Budget Office. But the companies worry that the rules requiring most Americans to obtain coverage will prove too weak and allow many to go uncovered, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

That could leave insurers with slim gains, even as they face regulations that could limit profits, prohibit the practice of charging sick people higher rates, and funnel individuals and small businesses into government-created exchanges to buy policies.

Under the law, insurers must spend at least 80 percent of the premiums they collect on medical care. The final regulation, known as the medical-loss ratio rule, has turned out to be less painful for insurers than initially anticipated, because it will not count taxes and quality improvement as administrative costs.

“If you’re a health plan, you either become a care delivery system or an information services company . . . . The traditional business is dead.”

Still, the medical-loss rules and meteoric growth in health spending make getting a better grip on costs essential for insurers.

“I’ve seen a big trend in getting further down the supply chain towards the point of care,” said Sarah James, an insurance industry analyst at Los Angeles-based Wedbush Securities. “Everybody’s looking to add on staff physicians and clinics” that can help control medical spending.

Analysts view technology investments as another way to control medical costs. Medicity and other technology investments put Aetna “closer to the actual delivery of care,” said Lonny Reisman, Aetna’s chief medical officer.

“Without practicing medicine,” Reisman said, “we are facilitating the relationship between the doctor and the patient with the technology and services,” such as a wealth of information gathered by Medicity and on-the-spot clinical guidance for doctors using ActiveHealth Management, a company Aetna bought in 2005.

Medicity has also opened a new revenue stream for Aetna, with 800 fee-paying hospital clients. Reisman said demand for those services will only increase as the health law threatens hospitals with large Medicare pay cuts if they cannot track and prove that they are providing quality services.

In a sign of Aetna’s interest in future acquisitions, the company hired Charles Saunders, a physician and recent veteran of the private equity firm Warburg Pincus, in January to oversee “strategic diversification.”

Other insurers are pursuing different strategies. Cigna is looking overseas and plans to begin selling comprehensive health insurance plans to individuals in China in hopes of capitalizing on a burgeoning middle class, Bill Atwell, an executive in charge of international operations, told investors March 11. The operation will roll out by the year’s end, Gloria Barone Rosanio, a spokeswoman, said in an e-mail.

At home, though, the options are limited, in part because of the health law. Some analysts do not see much of a future for companies that just stick with the business of selling insurance policies.

“If you’re a health plan, you either become a care delivery system or an information services company,” said David Brailer, a former George W. Bush administration health official who now leads an investment firm. “The traditional business is dead.”

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Damaged Fukushima reactor - Photo: Courtesy of Digital Globe

Even in worst case, Japan’s nuclear disaster should have limited reach–experts

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By Abrahm Lustgarten
ProPublica

For more than a week the world has watched the escalating crisis at Japan’s Fukushima Daiichi nuclear power plant slide from one catastrophic episode to a seemingly graver one, often upending assurances from the Japanese and adding to the fear and confusion about how it all might end.

Are we on a slow-motion path to a six-reactor meltdown? Or will Fukushima stop short of being the worst nuclear power disaster ever, and squeeze somewhere behind Chernobyl and alongside Three Mile Island in infamy?

While there can be no definitive answers amid a still-unfolding disaster, ProPublica spoke with seven top nuclear engineers and scientists to at least establish some boundaries for the disaster’s potential health and environmental impacts.

Fukushima Daiichi reactor complex from the air

Fukushima Daiichi Reactor Complex

The rough consensus: The long-term and most severe effects from radiation at the plant, where four of six reactors are in crisis and hundreds of tons of spent fuel is a risk, will be largely contained to the area around the plant, affect a relatively limited population and will likely not spread outside Japan.

Even in the worst case, the crisis should not lead to the level of health and environmental destruction that followed the 1986 Chernobyl disaster, the experts say. Unlike Chernobyl, the potential for an explosion large enough to carry contaminants high into the atmosphere and to far away areas appears remote.

A complete loss of control of the Fukushima plant, followed by total meltdowns at multiple reactors and fires in the spent fuel stocks, would be an extraordinary development leading to very high radioactive emissions and contamination of the surrounding landscape that could last for decades.

Such a scenario is now less probable, in part because the fuel rods in the reactors are expected to continue to cool each day. Even a sustained fire in the spent fuel that sits on the top level of the reactors is unlikely to result in “criticality,” or a new nuclear chain reaction and reheating of that spent fuel.

Damaged Fukushima reactor - Photo: Digital Globe

The New York Times reported that Japanese officials remain concerned that criticality is possible in some of the troubled reactors or spent fuel. But even if it were to happen, the process can eventually be interrupted.

Experts interviewed by ProPublica said that even if a meltdown scenario unfolded unabated, the contamination would likely remain localized and would not affect a large population because evacuations have already been ordered. There remains uncertainty about whether worst-case contamination could reach as far as Tokyo, about 150 miles from the Fukushima plant, but few believe there is any chance of dangerous levels of contamination spreading offshore.

“The events that have happened, and the speculation for what could happen is not on the same scale as the release from Chernobyl,” said Peter Caracappa, a nuclear engineer at Rensselaer Polytechnic Institute, in Troy, N.Y. “Based on all the available information, the risk to any of the places far from the plant … would be too small to calculate with any confidence. We’re not talking intercontinental effects.”

Odds of Total Meltdown Diminish

There are two aspects to the ongoing risk at the Fukushima Daiichi plant in Japan: the fate of the reactors themselves, and the condition of the millions of pounds of spent fuel rods stored in open pools atop the reactor structures.

A total meltdown would occur if the fuel rods inside a reactor continue to overheat and break down, spilling the uranium or uranium-plutonium pellets inside them into a heap on the reactor floor. The core of the reactor containing the fuel rods is encased in a steel vessel that is then surrounded by a huge reinforced concrete containment structure.

As the fuel consolidates, there is less space for cooling water to circulate among the pellets, which can heat into a molten substance. The hotter that molten slurry gets, the greater the possibility that it can burn through the fortified steel containment vessel meant to isolate whatever happens inside the reactor.

Local radiation levels

To view radiation levels detected by the U.S. Environmental Protection Agency in the Seattle area go here. To view radiation levels detected by Washington State Department of Health monitoring stations for Seattle, Tumwater, Richland and Spokane go here.

A breach of the reactor vessel would normally be the most critical danger. If a meltdown did happen, experts say the fuel could leak out and spread through cracks in the concrete containment, sear through a second metal liner, and then flow out in the open air towards the perimeter of the plant.

“That’s the event that changes this situation from a horrible situation to a nightmare of unprecedented proportion,” said Kenneth Bergeron, a physicist who worked on nuclear reactor accident simulations at Sandia National Laboratories.

Officials have said they believe there has been a partial meltdown at least two of the four troubled reactors. But it has now been seven days since the reactors were shut down following a 9.0 earthquake that rocked the islands of Japan and triggered the devastating tsunami that swamped the power plant.

Tokyo Electric Power Company, which runs the plant, continues to work to control the temperature inside the reactors and has been injecting sea water laced with boron, which short-circuits the nuclear reaction, into the reactors to maintain cooling. Experts believe that by now, the reactors should have cooled substantially. And with each day that passes, they say, the temperature drops further and the possibility of a full meltdown diminishes.

That doesn’t seem very likely now,” said Louis Lanese, a nuclear engineer who worked on the Three Mile Island crisis in 1979 and now is a partner with Panlyon Technologies, a nuclear energy services firm in Flanders, N.J. “It’s cooled down. They have water over the core. Every day makes the consequences a little bit better.”

For those cores to melt now, Lanese said, there would have to be a complete loss of water and fuel rods would have to sit for some time – days or even weeks. Even then, he said, “I don’t know if there is enough energy in that fuel to even get out of the reactor vessel.”

Spent Fuel Is Less Potent

The greater risk may now lie with the spent fuel sitting in storage pools on top of the reactors. Those pools contain very large quantities of old fuel, at least some of which still contains significant amounts of uranium, and they are not in containment like the reactor cores.

The spent fuel rods generate residual heat and must to be cooled by water, but water levels have been precariously low in at least one pool – Unit 3 – and may have dried up altogether in the pool at Unit 4. The danger is that the zirconium cladding that contains the fuel pellets, when exposed to the air, can catch fire and burn intensely and leave the fuel pellets exposed.

Twice, reports have emerged of smoke and a possible fire in the pool atop Unit 4, but it has been difficult to confirm exactly what is taking place. Those reports have also stoked concerns that spent fuel could also melt down, and because it is not contained, release large amounts of radioactivity.

But much of the most dangerous material has already been spent, or has begun to degrade. Lanese said that if the cooling water has already evaporated from the pool in Unit 4 without a significant fire erupting, it is a sign that convection cooling from exposure to the air is enough to keep the rods stable.

Explosions remain a risk at the site. When nuclear fuel is hot enough, it can split the water molecules, releasing hydrogen, a flammable gas. Should spent fuel become molten, it could melt through the floor of the pool. When doused again with water, it could create hydrogen and an explosion that released radioactive contaminants. If reactor fuel were to melt down, it could fall into an area that contains water.

There have already been three hydrogen explosions at the Fukushima Daiichi plant – a gas buildup in the reactor buildings of Units 1, 2 and 3 destroyed the exterior walls. But unlike Chernobyl, the worst explosion believed possible at the Japanese plant would not push tens of thousands of feet into the atmosphere and would be a momentary event.

That explosive power is the key difference.

In Chernobyl, the reactor burst in a fiery ball while running at full capacity. The Chernobyl plant was also an entirely different design. It did not have a containment vessel to hold the fuel inside, and the core of the reactor contained graphite. The graphite burned like coal and sustained a roaring fire for two weeks, pushing radioactive particles miles into the atmosphere. That is how some of Chernobyl’s radioactive fallout ended up in Northern Europe.

Radiation risk mostly local

If there is open-air exposure of molten fuel at Fukushima Daiichi, there does not appear to be a mechanism for carrying large quantities of radioactive byproducts over wide areas or great distances. A fire or hydrogen blast could carry contaminants into the lower atmosphere, but only for a relatively short way, scientists say.

The exposed fuel rods or molten slurry emit large amounts of radiation and present a serious health risk to workers inside the plant. But the radiation itself doesn’t extend very far. To affect people outside the Fukushima facility, radioactive material has to be spread around.

Long-term radiation risks result from people swallowing or breathing in tiny particles that continue to be radioactive inside the human body, and continue to emit radiation as they break down over time. The radionuclides of most concern include cesium 137 – which has been detected around the Fukushima Daiichi plant – as well as strontium 90 and plutonium 239.

“A fuel melt doesn’t necessarily lead to a big disaster, any more than what we have,” said Gilbert Brown, a professor in the nuclear engineering program at the University of Massachussetts in Lowell. “Even if it’s a fuel melt, you have to have a mechanism to get all that radiation to people, to get hurt by it.”

Bergeron estimates that even after the worst kind of explosion at the Fukushima Daiichi plant, contamination might be detectable 200 miles away, with the most serious contamination within a 100 mile radius.

“That, although striking and horrible, is something described as manageable,” Bergeron said.

An evacuation has cleared out part of the area around the plant. Experts say the largest environmental impact, outside the facility, is potential contamination of the surrounding landscape. Fallout could affect groundwater and surface water supplies, as well as render much of the nearby farmland too dangerous for use.

Some of that environmental contamination can be cleaned up, but agriculture and food supplies could be affected for decades. Human health exposure can be limited by both evacuations and other precautions.

“I don’t think we are going to kill a lot of people,” said Victor Gilinsky, a former commissioner of the U.S. Nuclear Regulatory Commission and a former head of the physical sciences department at the Rand Corporation. “But you could have a tremendous amount of land contamination. Depending on the half life, it could be many time more than 30 years before you could go there.”

Much uncertainty remains about what will happen next at the Fukushima Daiichi plant. Experts caution that if there has been any lesson thus far, it is that assumptions can be easily proved wrong. But with every day that Japanese responders hold wholesale deterioration at bay – however tenuously – the health and environmental impacts should be less severe.

“I’ve worked almost 40 years in this business to keep anything even remotely like this from happening,” said Lanese. “But strange as it is, these situations tell me that these plants have even more resilience than I had expected.

“This is what an 9.0 earthquake and an eight-foot Tsunami does?” he asked. “It’s unprecedented. And those nuclear reactors are still there and still hanging in there.”

Michael Grabell and Nick Kusnetz of ProPublica contributed to this report.

Inform our investigations: Do you have information or expertise relevant to this story? Help us and journalists around the country by sharing your stories and experiences.

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State officials seek to calm fears over fallout from Japan reactor accidents

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Seeking to reassure Washington State residents concerned that radioactive material from the damaged reactors in Japan might reach our shores, state health officials are posting the radioactivity measurements from the state’s four monitoring stations online.

The measurements, taken in Richland, Seattle, Spokane, and Tumwater, will be updated daily here.

 

The chart shows radiations measures known as “gross beta,” a term that refers to all radioactive materials that emit beta radiation. Gross beta measurements are used because they give us the fastest indication of any change in radiation levels. They’re measured in “counts per minute.”

Health officials said because of the great distance between Japan and the U.S., radiation from the Japanese reactors should pose no public health risk here and that the air monitoring was being conducted as a precaution.

“Dangerous levels of radiation are not expected to reach Washington,” said Secretary of Health Mary Selecky.

Sec. Selecky also warned Washington State residents not take potassium iodide, which some people have been taking to protect their thyroid from radioactive iodide, one of the radioactive particles being released from the damaged reactors.

Potassium iodide, also known as KI, is only needed by people who must work in or around nuclear power plants during an emergency, or who live nearby and cannot evacuate, officials said.

Potassium iodide can have harmful side effects, Sec. Selecky warned, and should not be taken unless needed.

“We urge people not to take potassium iodide or iodine pills; it’s unnecessary and could be harmful to some people,” Selecky said.

The Department of Health has also issued a fact sheet addressing concerns:

Why the Japanese nuclear incidents are not a health threat in Washington

Radiation from the nuclear power plants in Japan is not a health risk for Washington. Since the failure of the power plants in Japan, radiation levels in Washington have not climbed above normal background levels and we do not expect they will.

Several factors play a role in protecting us from the release of radiation occurring at the damaged reactors in Japan:

  • Most of the radioactive material is contained at the damaged plants; even if radioactive material reaches the upper atmosphere, it would not reach Washington in concentrations high enough to cause a health risk.
  • The radioactive material that was released did not reach the upper atmosphere where it could be carried toward North America by the jet stream in amounts that would cause public health impact.
  • The fires and explosions at the Japanese reactors have not been as intense as the Chernobyl accident. Radioactive material ejected into the jet stream from Chernobyl did reach Washington in small amounts. Even after the Chernobyl disaster, protective action was not needed in our state, and the Japan incident is much smaller than Chernobyl.
  • Even if radioactive material is released in Japan and reaches the jet stream, it would take several days to get here because the nuclear plants are about 5,000 miles from our state. In the time it would take to cross the Pacific, it would mix with lots of air as it’s blown in the wind (thus diluted); rain would wash some of the material from the air into the ocean.
  • Radioactive decay, especially for short half-life radioactive materials such as iodine-131, would substantially reduce the amount of the radioactive material that could reach here.

For these reasons, it’s unlikely that we will see an increase in background levels of radiation in Washington. Even if a small amount of radiation did reach us, it would be well below levels that would pose public health concerns.

–Washington State Department of Health

To learn more:

  • Read about the uses and potential dangers of potassium iodide from the Centers for Disease Control and Prevention KI information page.

 

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Americans remain divided, confused about health reform law

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By Phil Galewitz
KHN Staff Writer

A year after Democrats in Congress pushed through the law overhauling U.S. health care, Americans remain as split as ever about it, according to a poll released today.

A survey this month by the Kaiser Family Foundation found 42 percent of Americans support the health law while 46 percent are opposed.

Kaiser Family Foundation

 

Although both figures were down slightly from February, overall they have changed little since President Barack Obama signed the landmark bill into law on March 23, 2010. (KHN is an editorially independent program of the foundation.)

The law, which will extend coverage to 32 million Americans, has come under a blistering attack from Republicans in Congress who are trying to repeal it and Republican governors who have filed suit seeking the Supreme Court to declare it unconstitutional.

The survey found last April that 46 percent of Americans favored the law and 40 percent opposed it. But both sides have been up and down since then, although neither side has been able to move beyond 50 percent over the course of the year.

Not surprisingly, public opinion of the law varies along partisan lines, with 71 percent of Democrats supporting the law while 82 percent of Republicans oppose it in the latest survey.

Of those who oppose the law, 20 percent say they are most concerned about its costs, 19 percent are worried about the government’s role and 18 percent don’t like the law’s mandate that individuals get coverage.

The public also remains as confused about the law today as it was a year ago: About 53 percent of Americans said they are confused, the survey found.

Kaiser Family Foundation

 

That is even more widespread among the uninsured and low-income Americans – the groups who have the most to gain from the law, particularly when most coverage expansions take effect in 2014. About six in 10 in these groups report a lack of understand.

Senior citizens, the vital voting bloc that gained several new benefits in the Medicare program from the law, remains the most skeptical age group, with 52 percent opposing the law.

That’s down 7 percentage points from the February survey. About 39 percent of seniors believe Medicare will be worse off under the law, compared to 19 percent who think it will be better off.

21 percent of Americans would like to keep the law intact, while another 30 percent favor expanding it.

The health law extends the solvency of the Medicare Trust Fund by 12 years, gradually closes the gap in coverage in the Medicare prescription drug benefit and eliminates Medicare co-payments for many preventive services.

Republicans have raised concerns about cuts in the growth of Medicare payments to hospitals and other providers that finance the law’s coverage expansions and reductions in payments to Medicare health plans under the law that could result in reduced benefits.

The poll also delivers some bad news for Republicans pushing for repeal of the law. Less than 40 percent of Americans favor repeal, with about 21 percent of respondents favor repealing the law and not returning to the issue, while 18 percent want the law repealed and replaced by a Republican alternative plan, the survey found.

The poll found that 21 percent of Americans would like to keep the law intact, while another 30 percent favor expanding it.

The Obama administration has said that it would favor allowing states to implement their own programs if those plans met the same standards for coverage and cost that the federal law demands.

The poll found that two-thirds of Americans favor that option, but only if the states don’t offer insurance that is less generous than the federal plan.

The foundation conducted the telephone survey of 1,202 adults between March 8 and March 13. The margin of error was +/- 3 percentage points.

To learn more:

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Smoking, alcohol use down among Washington youth

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There has been a substantial drop in both smoking and alcohol use among Washington youth, according to a survey of more than 212,000 students in the state’s public schools.

The survey, conducted last year, found that among the 6th, 8th, 10th and 12th grade students participating in the study, the rate of smoking has dropped by half since 2000.

Among 12th grade students the percentage who had smoked in the preceding 30 days, had fallen to 19 percent in 2010 from  27.7 percent in 2000, to 12.7 percent from 19.8 percent among 1oth graders, to 6.4 percent from 15.2 percent among 8th graders, and to 1.7 percent from 4.7 percent among 6th greaders.

While these reductions were heartening, officials expressed concern that the rate of decline in smoking had flattened out in recent years, with smoking rates among 10th grade students remaining at about 13 percent since 2004.

The survey also found that alcohol use was down. Compared to 20 years ago, the percentage of 8th graders who reported they had drunk alcohol in the past 30 days has fallen from 39 to 14 percent last year, and for 10th graders the rate fell from 44 to 28 percent.

For the first time, the survey asked questions about sexual activity and found that 31 percent of 10th graders and 53 percent of 12 graders report having had sexual intercourse.

About 6 percent of 10th graders and 17 percent of 12th graders reported they had had sexual intercourse before age 13.

And about 8 percent of 10th graders and 17 percent of 12th graders reported having had sexual intercourse with more than four or more partners in their lifetime.

For comparison, a national survey conducted by the U.S. Centers for Disease Control and Prevention found that nationally about 41 percent of 10th graders and 62 percent of 12th graders reported having had sexual intercourse, higher rates than seen in Washington, and 7 percent of 10th graders and 4 percent of 12th graders reported having intercourse before age 13, rates similar to those seen here.

The Health Youth Survey, which is conducted every two years, also looks at such issues as depression, violence, suicide and bullying. Participation is voluntary.

Statewide 12th grade students reported:

  • Smoking cigarettes in the past 30 days — 19.6%
  • Drinking alcohol in the past 30 days — 40.0%
  • Using marijuana or hashish in the past 30 days — 26.3%
  • Carrying a weapon at school in the past 30 days — 7.3%
  • Being bullied in the past 30 days — 17.0%
  • Feeling safe at school — 88.4%
  • Enjoyed being in school over the past year — 41.6%

To learn more:

 

 

 

 

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Doctors prescribed lethal doses to 87 patients in 2010 under state’s Death with Dignity Act

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Doctors prescribed lethal doses to 87 Washington State residents last year under the state’s Death with Dignity Act, according to the Washington State Department of Health.

Under the Act, physicians can prescribe–but not administer–lethal doses of medications to adult Washington State residents with terminal illnesses who are expected to have no more than six months to live.

The Act was passed by a ballot initiative in 2008 but did not come into effect until 2009.

Of the 87 who received the prescriptions last year,  72 have died — 51 after taking the prescribed medications, the department reports.

Those who died were between the ages of 52 and 99 — most, 78 percent, had been diagnosed with terminal cancer; 10 percent had degenerative neurological conditions, such as amyotrophic lateral sclerosis or Lou Gerhig’s disease; and 12 percent had heart disease or some other illness.

Almost all were white, 95 percent, and lived west of the Cascades, 94 percent.

Of those who died after taking the prescriptions, 90 percent were at home and 84 percent were enrolled in a hospice program at the time.

The most common end-of-life concerns were: concern about a loss of autonomy (90 percent); concern about the loss of dignity (64 percent); and concern about an inability to participate in activities that made life enjoyable (87 percent), the department reports.

To learn more:

End of life resources

 

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hippocraticmyth

Do medicine’s rising costs put Hippocratic Oath at risk?

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By NPR Staff
This story comes from KaiserHealthNews partner NPR

Bust of Hippocrates

Hippocrates

In most medical schools, students recite the Hippocratic Oath together to mark the start of their professional careers. The soon-to-be physicians swear to uphold the ethical standards of the medical profession and promise to stand for their patients without compromise.

Though the oath has been rewritten over the centuries, the essence of it has remained the same: “In each house I go, I go only for the good of my patients.”

But the principles of the oath, says Dr. Gregg Bloche, are under an “unprecedented threat.” In The Hippocratic Myth, Bloche details how doctors are under constant pressure to compromise or ration their care in order to please lawmakers, lawyers and insurance companies.

Bloche says that doctors are increasingly expected to decide which expensive tests and treatments they can and cannot provide for their patients. Their dual role as examiner and cost-cutter can then potentially compromise patients’ care, he says, particularly when insurers and hospital administrators urge physicians to only perform “medically necessary” treatment.

The Hippocratic Myth: Why Doctors Have to Ration Care, Practice Politics, and Compromise their Promise to Heal
By M. Gregg Bloche M.D., Hardcover, 272 pages, Palgrave Macmillan
List Price: $27

“The average person thinks that ‘medically necessary’ care means all care that might potentially be beneficial,” he says. “But the reality is that it’s a wide-open term.”

Care may be denied, says Bloche, for a variety of reasons, including whether patients have consented to cheaper treatment options through their health insurance plans. What that means, he says, is that doctors who ration care on behalf of insurance providers may simply be following their patients’ wishes — even if patients are not aware that they’re receiving subpar treatment.

“In the real world, the choices aren’t made clear in the employee benefits office,” he says. “In the real world, the cheap health plan and the expensive health plan both promise you ‘medically necessary’ care and you don’t really know what that means. So you sign up for this care and you think, ‘Aha! This one’s cheaper than the other. And it’s promising medically necessary care. You don’t really know that one car is a Lexus and one car is a Chevy. These two plans are being presented to you as Lexuses. And so you say, ‘I’ll buy it.’ But in fact, in terms of the care it makes available, it’s cheap because it’s a Chevy, not a Lexus.”

Click to lsten to the story on Fresh Air from WHYY

Talking about potential tradeoffs in care is a conversation that doctors and policymakers need to have, says Bloche, because it’s inevitable that our health care system will need to find ways to set limits on care.

“We cannot afford anything like what we’re spending on health care today, and we’re certainly not going to be able to afford what we’re projected to spend in the future,” he says. “We spend almost a fifth of our national income today on medical care. And within 25 years, unless we change dramatically, we’re going to be spending a third of our national income on medical care. And we’re doing that by borrowing from our kids.”

Interview Highlights

On the rationale of withholding care:

“The rationale there is that the doctor who stints on care three years later when you get really sick is acting in accordance with your preferences as you expressed them in the employee benefits office three years before,” says Bloche. “And therefore, the doctor is not violating the Hippocratic Oath. The doctor is merely complying with your preferences when you rolled the dice in the employee benefits office.”

On insurers not being required to reveal their criteria to providers for what claims they’ll pay:

“This is a walk on the wild side. I’ve taken on some of these cases for people that I know, and one thing about it, if you know the system’s hypocrisies, then you can beat the system. One of the hypocrisies is that the companies take the position that their guidelines for what they will and will not pay for are trade secrets — that they’re proprietary. Now imagine a legal system in which the laws were considered trade secrets and their lawyers weren’t allowed to know the laws in advance because that would mean they could game the system. That doesn’t fit with our legal values, our due-process values — but that is what happens for many, not all, health plans. They take the position that they’re not going to reveal in advance the rules for what they’ll pay for and won’t pay for because that would enable doctors and patients to game the system.”

On randomized clinical trials:

“What’s amazing is that probably only 10 to 20 percent of the treatments that doctors use today have been tested [in] randomized clinical trials. Even when a treatment is shown to work really well for the sample that’s studied in the clinical trial, in the real world patients are all different. [They] vary hugely. So we’re never going to be able to have solid science that can tell us for sure whether the treatment is going to work or not. So let’s do the research but let’s be realistic and pragmatic about the limits of that research.”

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Online follow-up helps depressed patients cope, Group Health study

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A new study by researchers at Seattle’s Group Health Research Institute indicates that following up on patients with depression through online messages can improve their treatment at relatively low cost.

The researchers found that compared to patients receiving standard follow-up care patients who received follow-up support through online messages from a psychiatric nurse were more likely to feel less depressed, take their antidepressant medication, and report they were “very satisfied” with their treatment.

The researchers conducted the study because, despite the development of effective antidepressant drugs, the quality of care for depression remains poor.

Studies have shown that often the best medicines are not chosen, doses are not properly adjusted, and follow-up care spotty. And, in many cases, patients stop taking their medicines altogether.

A number of programs have sought to improve the quality of care by setting up systematic programs to follow-up on patients and make sure they are getting the best treatment.

But these programs usually rely on regular telephone follow-up, which is costly and time-consuming. Patients may not be available when the provider calls, and telephone tag is common. Indeed, almost half the time providers spend trying to reach patients is wasted. As a result, even though such programs have been shown to improve care, many providers are reluctant to adopt them.

Dr. Simon

In the new study, a research team led by Dr. Gregory Simon, a Group Health psychiatrist, set out to see whether following up with patients online would work as well as by telephone.

With such an approach providers could send messages–and patients could respond–whenever it was most convenient.

Group Health already has an electronic health records system that allows patients and providers to exchange messages as part of their routine care, but would, the Group Health researchers wanted to know, such online contacts be as effective–or as acceptable to patients with depression–as a personal phone call?

To find out, the research team enrolled 208 Group Health patients who had recently been prescribed antidepressants by their primary care provider for depression.

These patients were randomly assigned to two groups. In one group, the “usual care” group, the patients were provided the usual services such patients receive, including follow-up in primary care or, if need be, referral to a specialist.

Patients in the second group, on the other hand, were enrolled in a systematic management program using online messages.

Patients in this group were first contacted by psychiatric nurse with an outreach message that included advice on the importance of taking their medication and on how to cope with depression.

Then two, six and ten weeks later, the patients received a follow up message with links to an online questionnaire to assess their level depression as well as questions about whether they were taking their medicines, if they were experiencing side effects and, if they had stopped taking their medicine, why.

The researchers report that compared to patients receiving usual care those enrolled in the online outreach program were more likely to be taking their antidepressant medicines (81 percent compared to 61 percent) after 90 days, more likely to express they were “very satisfied” with their depression treatment (53 percent vs. 33 percent) and generally rate their level of depression less severe.

The results were as good or better than those seen with similar programs that relied on telephone contacts, but required half the staff time required by telephone programs, the researchers write.

This online approach “helped these patients, even though they never met the trained psychiatric nurse in person or talked to her on the phone,” says  Dr. Simon. “And because she spent only one hour per patient to deliver this intervention, it promises to make high-quality depression care more affordable.”

The paper “Randomized trial of depression follow-up care by online messaging” was published online by the Journal of General Internal Medicine.

The National Institute of Mental Health funded the trial. Dr. Simon’s coauthors were James D. Ralston, MD, MPH; James Savarino, PhD; Chester Pabiniak, MS; Christine Wentzel, RN; and Belinda H. Operskalski, MPH, of Group Health.

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Health data breach may affect thousands in Washington State

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Health Net, Inc., a health insurance company, reports that it is missing data servers that contain health and financial information for nearly 40,000 Washington residents, the Washington State Office of the Attorney General reports.

“The missing data includes information about current and past customers, employees and heath care providers. Social Security numbers were included for some individuals,”  the Attorney General’s office posted on its consumer alert blog.

More from the blog post:

The company is contacting affected individuals this week by mail and offering them two years of free credit monitoring through Debix Identity Protection Network. The service includes $1 million in identity theft insurance coverage. Health Net will also reimburse affected individuals for any fees associated with applying or thawing a credit freeze, the company said in its letter.

Washington residents affected by the breach should watch their mail for a letter from Health Net that includes instructions on how to register for the identity protection program and an activation code. They may also wish to freeze access to their credit reports. Information about obtaining a security freeze can be found on our Web site athttp://atg.wa.gov/freeze.aspx.

To learn more:

  • Read the full blog post at the Washington State Office of the Attorney General’s website.
  • Read the news release from Health Net.
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Four in ten Americans struggle to pay medical bills, study

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By Aimee Miles
KaiserHealthNews

A recession-driven spike in unemployment levels, rising treatment costs and unaffordable insurance coverage caused four in 10 Americans to struggle to pay their medical bills last year, according to a report by the Commonwealth Fund.

The Commonwealth survey also found that more than 40 percent of the respondents said that high costs had compelled them to forgo the care they needed—up from 29 percent in 2001.

Karen Davis, president of Commonwealth, a N.Y.-based foundation that advocates for health care access, said the trends will ease with the implementation of the new health law, which is set to mark its first anniversary next week amid Republican efforts to choke off federal funding.

The Commonwealth report, she says, “tells the story of a continuing deterioration of health care accessibility, efficiency, security and affordability over the past decade.”

Among those who lost their health benefits along with their jobs, 57 percent reported they could not get new insurance.

The fund conducts the national survey on health insurance every two years, and this poll of more than 3,000 working age adults reflects the recent recession that threw millions of Americans out of work. For many of them, unemployment also meant the end of employer-provided health insurance.

Nearly a quarter of respondents said they or their spouses had experienced a job loss in the past two years. Among those who lost their health benefits along with their jobs, 57 percent reported they could not get new insurance.

A quarter of those losing jobs and health benefits said they were able to get coverage through their spouse or some other method and about 14 percent turned to COBRA, which allows workers to continue their insurance for 18 months after losing their job.

Usually the worker has to pay the entire cost of the program, but as part of the federal stimulus package, the government subsidized part of that cost for most workers. But enrollment in that program ended last May.

The Commonwealth Fund survey comes on the heels of two Gallup polls released earlier this month. One reported an overall decline in employer-based health care, the other noted a rise in uninsured levels in almost every state.

The analysis with the state poll suggested that the new health law could “fill the voids in care” created by state budget problems and rising unemployment rates. But such relief wouldn’t come until after 2014, when the law will extend Medicaid coverage to anyone whose income falls within 133 percent of the federal poverty level, and the federal government will subsidize part of the cost of private coverage for families earning up to 399 percent of the poverty level.

The health law will also standardize the benefits that health insurers offer in plans they sell on the individual and small group markets, bringing them in line with the benefits available to those offered by large employers; and prohibit insurers from denying coverage because of an individual’s medical history.

“It eliminates some of the unpleasant surprises in the fine print in insurance policies,” Davis said.

But conservative groups like the Heritage Foundation, a D.C.-based think tank, have criticized the health law. The foundation has called for changes in the health care system to make it less reliant on government and to have individuals “own and control their own health care policies.” They also say the health law will increase government spending.

“Of course there’s some people who will benefit from the law, but just focusing on individuals with benefits is misleading,” said Brian Blase, a policy analyst in health studies at Heritage. “You have to look at the law in its totality.”

Contact Aimee Miles at amiles@kff.org.

We want to hear from you: Contact Kaiser Health News

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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