Cute Baby Boy Isolated on White

Thousands enter Swedish Hospital’s baby-photo contest — Seattle Times

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Swedish Medical Center’s marketing team has begun sifting through 2,226 digital pictures entered online for the Swedish baby-photo contest marking the hospital’s 100th anniversary, writes Seattle Times staff reporter Sonia Krishnan in today’s paper.

Employees came up with the idea:

“But in recent years, employees noticed that wherever they went, everyone and their brother — and sister, and cousin and mom and dad, it seemed — had a story to tell about how they were born at Swedish or how their children were born at Swedish.”

The idea caught on:

Tweets went out. An “I’m A Swedish Baby” Facebook page was created, racking up more than 2,700 fans. People uploaded photos at www.swedish100.org.

The contest has six categories:

  • Craziest Hair Day
  • Trick-or-Treat
  • Most Adorable Moment
  • Biggest Sports Fan
  • My First Birthday
  • I ♥ My Pet

To learn more:

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What we mean when we talk about women & children’s health

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The Gates Foundation on Monday announced that it planned to give $300 million every year over the next five years, a total of $1.5 billion, to programs that are devoted to improving the health of women and children worldwide. This now becomes one of the foundation’s largest initiatives.

“Women and children have finally moved up on the global agenda and I’m here to tell you that’s where they’re going to stay,” said Melinda Gates, speaking on the same day at a star-studded conference in Washington D.C. called Women Deliver. “Policymakers have treated women and children, quite frankly, as if they matter less than men.”

PHOTO CREDIT: The Humanitarian and Development Partnership Team

My friend Kristi Heim at the Seattle Times wrote a good story that tells you all about the grant announcement so I won’t repeat it.

I had noted earlier that the philanthropy was shifting in this direction – which they claim is not a shift but merely an expansion of an existing priority.

Putting aside the question about whether the Gates Foundation can, in fact, guarantee what will be high on the global agenda (is there a global agenda?), it’s perhaps worth considering if women and children’s health issues really have been neglected as a matter of policy and agenda-setting. And if so, how?

Most global health initiatives that battle diseases like AIDS, tuberculosis and malaria benefit both genders and all ages since the bugs don’t discriminate.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

I can’t think of any global initiatives devoted to men’s health but we have a number of organizations like CARE, Planned Parenthood and the Global Fund for Women focused on women’s health issues worldwide.

We have even more organizations devoted solely or mostly to children’s health such as Save the Children, World Vision or the United Nation’s Children Fund (aka UNICEF).

The Gates Foundation’s biggest project, GAVI, gets vaccines out to children worldwide.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

We’re mostly talking about childbirth.

“When people talk about women’s health, they are often talking about maternal health,” said Emmanuela Gakidou, professor of global health at the UW’s Institute for Health Metrics and Evaluation. Women who survive childbirth may or may not live longer than men generally, Gakidou said, but the number of young mothers and children in poor countries who die from complications associated with childbirth is hugely disproportionate when compared to developed countries.

“. . . the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.” — Amy Hagopian, UW professor of global health

For example, she said, Italy sees an average of four mothers die in childbirth for every 100,000 live births while in places like Afghanistan or Malawi it is more like one maternal death out of every 100 births.

“These deaths are entirely preventable,” Gakidou said, adding that the new momentum on this front is because more people recognize “that women should not be dying while they are trying to have a child.”

Amy Hagopian, also a UW professor of global health, said she welcomed the Gates Foundation’s increased interest and investments in maternal health. But the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.

“Women are dying because of the lack of these health services,” said Hagopian, adding that the Gates Foundation has so far shown little interest in funding efforts aimed at improving health services. “We already have lots of NGOs working on women and children’s health. Adding more people running around Africa claiming they have come to improve women’s health won’t solve the fundamental problem.”

Hagopian was among a number of people who recently advocated for and won passage of a resolution at the World Health Assembly in Geneva aimed at improving health worker retention in poor countries.

PHOTO CREDIT: The Humanitarian and Development Partnership Team (HDPT) under a Creative Commons Attribution 2.0 Generic License.

The Humanitarian and Development Partnership Team unites all organizations working to alleviate the humanitarian and development crisis in the Central African Republic: United Nations agencies, the Red Cross Movement, NGOs and other organizations. For more information, visit About HDPT CAR or email us at info@hdptcar.net

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Health law provides benefits for pregnant women, new mothers

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Photo: Daquella manera

By Michelle Andrews

By the time women reach 44 years old, roughly 85 percent have given birth.

Yet even though pregnancy and childbirth are such commonplace events, health insurance coverage and support services to keep mothers and babies healthy are often seriously deficient.

Some private insurers, for example, treat pregnancy as a preexisting condition and charge pregnant women higher premiums, or refuse to cover costs associated with childbirth.

Low-income women can get Medicaid coverage while they’re pregnant, but they generally lose it 60 days after giving birth unless they’re very poor.

The health-care overhaul greatly improves this situation. Some of the biggest changes don’t kick in until 2014, but here’s what to look for this year and next:

More From This Series:Insuring Your Health

Starting in the fall, all new health plans must cover certain preventive screenings and other services for pregnant women at no additional cost to the patient.

Those include folic acid supplements, which reduce the risk of neural tube defects in developing fetuses, and counseling to help pregnant women stop smoking.

Medicaid will also begin to cover smoking cessation counseling and drug therapy for pregnant women.

The law requires employers to provide paid time off for new mothers to express breast milk, as well as a place to do so that’s not a bathroom. It also authorizes funding for research and treatment of postpartum depression.

Additional support services will include a pregnancy assistance fund, which will provide $25 million annually for 10 years for housing, child care and other needs.

A much bigger chunk of money – $1.5 billion over five years – will be dedicated to expanding home-visiting programs in which nurses and other providers visit pregnant teenagers and young mothers.

Among other things, the practitioners suggest ways to cope with the stress that inevitably comes with being a parent.

“Every mom wants to do the right thing for her kids, but so many don’t know how.”

Studies of this model have shown that it results in better health for both mother and child, more stable relationships and lower rates of child abuse and delinquency.

“Every mom wants to do the right thing for her kids, but so many don’t know how,” says Miriam Rollin, national director for Fight Crime: Invest in Kids, a nonprofit anti-crime organization based in Washington.

One such mother was Stephenie Rounds, who today is a 26-year-old preschool teacher in Aurora, Colo. But at 14, she says, she was “crazy” – a repeat runaway who drank and did drugs and got pregnant by her 19-year-old boyfriend.

She credits a program called the Nurse-Family Partnership with helping her get ready for the birth of her son. A visiting nurse helped Rounds quit smoking and enroll in a high school for pregnant teens.

The nurse taught Rounds how to decipher what babies try to communicate when they cry, and gave her emotional support when her ex-boyfriend returned to town and started dropping by.

“She gave me the tools I needed to succeed,” says Rounds, whose son Michael is now 11 years old.

The bigger changes coming in 2014 include an expansion of Medicaid to cover adults with incomes up to 133 percent of the federal poverty level.

Forty percent of pregnant women are covered by Medicaid, but many don’t have health insurance before they become pregnant or after they give birth.

Increasing the number of low-income women on Medicaid raises the odds they’ll be healthier overall and have successful pregnancies, says Jocelyn Guyer, co-executive director of Georgetown University’s Center for Children and Families.

Also in 2014, many health plans will be required to cover maternity and childbirth services as part of an “essential health benefits” package detailed by the federal government.

And insurers won’t be allowed to charge women who are pregnant higher rates, or refuse to cover them or their childbirth costs.

Some of the new and expanded initiatives, such as the funding for postpartum depression and break time for new mothers to express breast milk, have been on the wish lists of advocates and lawmakers for some time. But another factor may have played a role during the debate that preceded the new law.

“The dynamic around abortion was so controversial,” says Guyer, “people working on the issue wanted to be sure that pregnancy and maternal support services were ensured.”

This is a weekly column covering consumer questions about the new health law. If you have questions or ideas for future topics, please email us:questions@kaiserhealthnews.org

PHOTO CREDIT: Daquella manera via Flickr under a Creative Commons license

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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Newborn preemie baby hand NICU

Quitting smoking before pregnancy could save babies’ lives

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By Katherine Kahn, Contributing Writer
Health Behavior News Service

If more women quit smoking before they became pregnant, it would save infant lives, concludes a new study from the Centers for Disease Control and Prevention (CDC).

Despite a decline over the past decade in the number of women who smoke during pregnancy, smoking is still a major cause of newborn deaths, early births and babies born with low birth weight.

“We know about half of women quit when they find out that they are pregnant, but a lot of women are still smoking during pregnancy,” said Patricia Dietz, DrPh, lead study investigator.

The study appears online and in the July issue of the American Journal of Preventive Medicine.

Dietz and co-investigators examined data from the US Linked Birth/Infant Death Data Set, which included all 3.3 million births of single babies that occurred in the United States (with the exception of California) during 2002.

About 11.5 percent of babies, or 386,000, had mothers who smoked during pregnancy.

Researchers determined that prenatal smoking caused 5 percent to 8 percent of premature births and 13 percent to 19 percent of cases of low birth weight in babies carried to full term.

“For women who smoke and are considering pregnancy, we strongly recommend that they get preconception counseling for smoking cessation.”

Of infants who died, 5 percent to 7 percent of preterm-related deaths and 23 percent to 34 percent of deaths caused by sudden infant death syndrome (SIDS) might have been preventable if the mother had not smoked before pregnancy.

In addition, the researchers wrote that if all women quit smoking during pregnancy, it could cut health care costs by about $232 million every year — and improve overall health for both mothers and children.

“The percentage of SIDS deaths that might be avoided with smoking cessation is a significant number,” said Diane Ashton, M.D., deputy medical director of the March of Dimes. “For women who smoke and are considering pregnancy, we strongly recommend that they get preconception counseling for smoking cessation.”

Given these sobering statistics, why do some women continue to smoke during pregnancy?

“Studies have shown that these women may be dealing with a lot of stress, such as economic hardship, or they might be dealing with depression or other mental health issues,” Dietz said. “Most of them are living with other smokers that make it difficult to quit. They may be living in communities where it’s acceptable to smoke — where everyone is smoking. So it’s really complex.”

“This is an addiction,” Ashton said. “If pregnancy could cure addiction then none of these issues would be a problem. During pregnancy, women tend to be a little more highly motivated to address their addictions, but a lot of it depends on the level of readiness of the individual.”

To learn more:

  • Free smoking cessation counseling is available by phone in all 50 states at 1(800) QUIT-NOW or 1(800) 784-8669 or online at www.smokefree.gov.

Local Resources:


Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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VM logo

VM adds nine new physicians to staff

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Seattle’s Virginia Mason Medical Center has announced the hiring of nine new physicians in a variety of specialities.

Anesthesiology

Carli Hoaglan

Carli Hoaglan, MD, joined Virginia Mason in the Department of Anesthesiology.

Hoaglan received her medical school training from University of Washington in Seattle.

She completed her internship and categorical anesthesiology residency at Baylor College of Medicine in Houston.

She also completed a cardiothoracic anesthesiology fellowship at Texas Heart Institute in Houston.

Gynecology

Kirsten Wolff

Kirsten Wolff

Kirsten Wolff, MD, joined Virginia Mason in the Section of Gynecology.

Wolff received her medical school training at University of Vermont College of Medicine in Burlington.

She completed her obstetrics and gynecology residency at University of North Carolina in Chapel Hill.

Emergency Medicine

Janda Stevens, MD, joined Virginia Mason in the Section of Emergency Medicine.

Stevens received her medical school training from Southern Illinois University in Springfield.

She completed her obstetrics and gynecology internship and emergency medicine residency at Grand Rapids Medical Education and Research Center at Michigan State University.

Lisa Wilson, MD, joined Virginia Mason in the Section of Emergency Medicine.

Wilson received her medical school training at Eastern Virginia Medical School in Norfolk.

She completed her emergency medicine residency at Drexel University (formerly MCP-Hahnemann) in Philadelphia.

Hospitalist Service

Geetha Easwaran

Geetha Easwaran, MD, joined Virginia Mason in the Section of Hospitalist Service.

Easwaran received her medical school training from Thanjavur Medical College in India.

She completed her internal medicine residency at the University of Washington School of Medicine Spokane affiliate.

Therese Franco

Therese Franco, MD, joined Virginia Mason in the Section of Hospitalist Service.

Franco received her medical school training from Wayne State University. She completed her primary care internal medicine residency at University of

Connecticut Health Center.

Mark Sullivan, MD, joined Virginia Mason in the Section of Hospitalist Service.

Sullivan received his medical school training and completed his internal medicine residency at the University of Washington.

Ophthalmology

Janet Chieh

Janet Chieh, MD, joined Virginia Mason in the Section of Ophthalmology.

Chieh received a bachelor of science degree from Massachusetts Institute of Technology in Cambridge and received her medical school training from University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School in New Brunswick.

She completed her ophthalmology residency at Duke University Medical Center in Durham, N.C.

She also completed a vitreoretinal fellowship at Tufts Medical Center and Ophthalmic Consultants of Boston, Inc.

Orthopedics

Alvin Ngan

Alvin Ngan, DPM, joined Virginia Mason in the Section of Orthopedic Surgery and is practicing at VM Issaquah.

Ngan received his medical school training at Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Health Sciences in Chicago.

He completed his foot and ankle trauma and reconstructive surgery fellowship at Legacy and Kaiser Permanente Foundation Hospitals in Portland, Ore.

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Twenty-dollar bill in a pill bottle

COBRA subsidy starts running out for some laid-off workers

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COBRA Subsidy Starts Running Out For Some As Congress Grapples With Extension

By Andrew Villegas
KHN Staff Writer

Howard Kornblum has been watching every penny for the past 15 months and it’s about to get worse.

After being laid off from his job as a consulting director in Michigan, he took advantage in March 2009 of a federal subsidy to help pay for health insurance.

With the government picking up 65 percent of the tab, Kornblum’s share of the premiums was $236 a month.

But starting on June 1, the subsidy expired for the first people who got it, and Kornblum’s benefits end tomorrow.

Under the federal COBRA law, a laid-off worker can stay on his employer’s plan a total of 18 months, but the employee must pay the entire cost of the coverage.

The COBRA subsidy – initially part of the 2009 stimulus package – provided the funding for 15 months for people who lost their jobs.

U.S. Treasury study found that up to a third of eligible unemployed workers took advantage of the benefit. The average cost of a family plan is more than $13,000 annually – not affordable on an unemployment check.

The Obama administration estimates that about 500,000 workers who lost their jobs each month were eligible for the COBRA subsidy, said Sandra Salstrom, a Treasury spokeswoman.

“I have to, I don’t have a choice right now.”

Although he is losing his subsidy, Kornblum, 54, still has the option to continue COBRA health insurance for three months. With shoulder surgery looming, he’ll now be paying the nearly $700-a-month premium to continue the coverage.

“I have to, I don’t have a choice right now,” Kornblum said. After that, he hopes to have found a job, he said, but if he doesn’t, he’ll buy health insurance on the individual market, even though the cost is higher.

Some might consider Kornblum one of the lucky ones. Starting this month, the newly unemployed aren’t eligible to get the subsidy at all. The proposal to extend subsidies to those laid off through the end of the year is languishing in Congress, a casualty of worries about the deficit in an election year.

So the unemployed may soon pay more to remain on COBRA without a subsidy, look for insurance on the individual market, go 

Congress extended the subsidies four times since February 2009, but the latest effort stalled before the Memorial Day recess. Congress may again consider extending the subsidy when members return next week, but it’s unclear how long such a proposal would take to make its way through Congress and what support there would be for it.

So the unemployed may soon pay more to remain on COBRA without a subsidy, look for insurance on the individual market, go on Medicaid if they qualify or lose coverage altogether.

And that could further tax a health care system that’s already struggling to keep up with the number of uninsured. Some who have expiring COBRA coverage or did not get the benefit could be eligible to join existing state high-risk pools or soon-to-be-launched federal high risk pools.

But the federal pools require participants to have preexisting conditions and to have been uninsured for six months.

Karyn Schwartz, a senior policy analyst with the Kaiser Family Foundation, said some people who continue their COBRA coverage may have another option: a state “HIPAA-eligible” plan. (KHN is a program of the foundation.)

Each state offers one for people with the pre-existing conditions whose coverage on COBRA has expired, but the premiums are often very expensive, and in order to qualify people must meet exacting criteria: They must have had COBRA for 18 months, have been covered the entire time, have a pre-existing condition that would preclude them from getting other coverage and must be able to pay the higher premium such a plan would charge. In the end, many may not be able to meet such a high threshold.

Additionally, 40 states offer so-called “mini”-COBRA laws to supplement federal COBRA that can provide additional benefits for as long as 36 months. The cost, however, is often higher than other coverage, such as an individual policy.

The bulk of people losing insurance may simply decide to drop their coverage altogether, joining the ranks of the uninsured, Schwartz says.

“It can be hard to keep their health insurance. Often the quality of what people can get on the individual market may not be as great,” she said, adding that individual plans are often more expensive and don’t cover things their employers’ plans used to cover. Additionally, people may make a conscious decision to pay other bills like rent instead of paying for health insurance. “They may decide it’s better.”

But Carrie McLean, a consumer specialist with ehealthinsurance, said that people should price the plans on the individual market to see if one is affordable for them.

Consumers should also see if they are eligible for premium help under their state’s Health Insurance Premium Payment programs, which cover people under the Medicaid program if such coverage is deemed “cost-effective,” or if mixing and matching coverage for different family members could help them save money.

For example – children may be eligible for coverage under the Children’s Health Insurance Program while other family members have individual plans. “Going with no insurance at all, you’re putting yourself at so much risk,” McLean said.

Katie Kemple, who was laid off last year from her job as public relations professional, said she will buy individual coverage for her family after her COBRA subsidy ends in August.

Right now, she’s paying $450 a month for coverage for herself, her husband and her 2-year-old with the subsidy, which is similar to what she says she’ll pay for a high-deductible plan on the individual market after August.

But the coverage is not as good as the COBRA subsidized plan she has right now and the deductible is $5,000, she says. “That’s before anything kicks in.”

Nonetheless, for Kemple, the choice is easy: “I would have gotten rid of anything else other than health insurance,” she said. “Other things come and go.”

Earlier, related KHN story: Democrats Scale Back Medicare ‘Doc Fix,’ COBRA Subsidy Extension In Jobs Bill (Villegas, 5/27).

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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Pills-red-and-white

Healthcare reform whiplash

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Jonathan Cohn, Senior Editor of The New Republic

This column is a collaboration between KHN and The New Republic.

Will health care reform reduce spending on health care too little?

Or too much?

Over the last several days, one respected authority made a version of the former argument while another made a version of the latter–offering a reminder of why reform is so complicated and why the new law, for all its imperfections, is still an important step forward.

The first argument about spending came from Douglas Elmendorf.  Elmendorf is director of the Congressional Budget Office, making him Washington’s official accountant and among the most influential voices on all matters relating the federal budget.

During a conference presentation, he announced that the Patient Protection and Affordable Care Act won’t significantly reduce what the government spends on Medicare and Medicaid.

This wasn’t exactly news. Elmendorf and his staff had produced official cost estimates for the new health overhaul bill in the spring, just before the final debate and vote. Those projections showed that the initiative would reduce net government spending by only a modest amount.

Of course, the fact that reform would reduce net government spending at all represents a major achievement. The new health law includes expansions of Medicaid, additional drug assistance for seniors on Medicare and new subsidies for poor and middle-class people that buy private health insurance-that’s how it makes sure all Americans (or most of them, anyway) can actually afford their own medical care.

But those efforts require the federal government to spend large sums of new money. Only by coming up with an even larger set of cuts to existing programs, along with new revenues, could the law result in actual savings.

And yet Elmendorf was right about the long-term picture: The projected reduction in health care spending is small relative to what the government is likely to spend over the next few decades, given the aging population and the development of expensive new medical technologies.

Or, to put it more simply, even with the reform law’s projected reductions in government spending, Washington remains on the hook for spending more on Medicare and Medicaid than it is currently prepared to take in.

So the government needs to find even more savings. And there are savings to be had, Elmendorf suggested, since the best available evidence suggest a lot of what the government spends on Medicare and Medicaid doesn’t actually leave beneficiaries better off.

That evidence includes, first and foremost, a famous series of studies that researchers at Dartmouth have produced over the last 30 years.

Their research shows that spending on medical care varies wildly from community to community-with no apparent effect on the quality of care people receive.

Seniors in Miami, for example, get way more treatment than seniors in Minneapolis. But they don’t seem to end up healthier afterward.

To say that reformers have read and been influenced by the Dartmouth research is an understatement. President Barack Obama and his supporters cited it repeatedly over the last year.

But a front-page story in the New York Times—the type of story that, by design, gets Washington’s attention—suggested the Dartmouth research is full of ambiguity

One implication of the story was that overly severe cuts in medical spending would deprive people of necessary and appropriate medical treatments.

Sources for the Times story, including one of the Dartmouth researchers, claim (persuasively, from what I can tell) that the Times reporters either took quotes out of context or made errors. But the idea that cutting health care spending too crudely or severely will harm patients is credible.

The question isn’t so much whether the waste exists. The question, rather, is whether reform can pinpoint and excise that waste-whether it can cut out the bad medical care without removing the good.

Go back to that Miami versus Minneapolis contrast: To what extent are the Miami seniors getting too much care and the Minneapolis ones getting too little? To what extent does the disparity reflect other factors for which the Dartmouth studies and other related research may not fully account?

Different people will give you different answers to those questions.

My own view is that over-treatment (i.e., too much care in Miami) is more of a problem than under-treatment (too little care in Minneapolis) and that, in an ideal world, the health overhaul law would have reduced spending more severely.

It would have implemented many of the same reforms it does already-like applying scrutiny to new drugs, imposing penalties on hospitals with high rates of infection and so on. But it would have done so more quickly and more severely.

Still, providers and producers of medical care—all of them well represented in Washington—don’t like anything that might reduce their incomes.

And, as a recent survey in Health Affairs showed, the public continues to equate more care with better care. The reform law includes as many, or close to as many, cuts as these groups would tolerate.

And it enacts reforms that can be strengthened over time, through some combination of administrative rulings, congressional action and intervention from a new advisory board whose sole purpose is to control Medicare spending.

Over time, we can see which cuts reduce spending without harming quality–and which ones don’t. We can then double-down on the former while minimizing or eliminating the latter.

It’s not an ideal solution or even an elegant one. But given how health care costs are projected to rise, it’s what we have to work with.

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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Yes-No-Maybe

Patient Survey: more health care Is better, despite what experts say

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By Julie Rovner, NPR news

This article also appeared in NPR’s health blog, Shots.

However inartfully articulated, it’s been a central theme of the Obama administration’s push on health care and on the lips of health experts for years: More health care is not necessarily better health care.

But patients are far from convinced.

The journal Health Affairs just surveyed more than 1,500 patients with employer-provided insurance, including dozens in focus groups and one-on-one interviews.

The “pervasive themes” from respondents, according to the authors, were “more is better, newer is better, you get what you pay for, (and) guidelines limit my doctor’s ability to provide me with the care I need and deserve.”

Such findings are frustrating for experts who have spent years trying to communicate that those things are not true. And they actually imperil efforts to alter hospital and doctor payments to reward quality.

They also discourage consumers from seeking higher quality and more cost-effective care, the researchers say.

“For those who believe that all medical care meets minimum standards and that more care is better, differentiating among physicians, hospitals, or other providers based on quality and efficiency profiles is likely to meet with resistance,” they write.

Their own survey shows that only 41 percent of respondents agree that employees should pay less if they use doctors who rank highly in quality measures. Also, only 47 percent thought that employees should pay less for treatment that’s been shown to work better.

Of course, it doesn’t help their education efforts that Republicans have been hammering at the new health law’s “comparative effectiveness” provisions, calling them Democratic efforts to ration health care.

Still, those pushing the use of evidence-based medicine aren’t giving up.

The study’s authors have developed a communication toolkit to help employers and unions better explain the concepts behind health care quality and cost-effectiveness to patients. It’s available on the National Business Group on Health’s website.

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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India

India rises, leaving the poor behind

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Unlike in China, a leading physician activist says, India’s rising economic tide is not floating many boats to lift the poor up and out of poverty.

India’s rich and middle-class sectors are riding higher, getting richer, says Dr. Jonathan Fine, founder of the Nobel Peace Prize-winning group Physicians for Human Rights, while India’s hundreds of millions of poor people remain firmly anchored to the bottom.

“Things are actually getting worse in many of India’s rural villages,” Fine said on a recent visit to Seattle. The Boston physician spoke Tuesday at the UW to the student-run Global Health Group. Fine was in Seattle to meet with — and recruit volunteers for — a local branch of an organization devoted to assisting India’s poor, Association for India’s Development.

Dr. Jonathan Fine, speaking to UW students

Malnutrition rates tell the story of inequity in India, Fine said. Hundreds of millions of Indians continue to live on semi-starvation diets, he said, despite there being enough food in India to feed everyone and despite India’s overall economic progress.

According to UNICEF, China has reduced its rate of child malnutrition to 7 percent while in India today more than 40 percent of young children are malnourished – a rate worse than in many sub-Saharan African countries.

“Initiatives aimed at improving health and welfare won’t have much effect if malnutrition is not dealt with first,” Fine contended. Hungry people are more prone to illness, he said, and malnourished children don’t learn or develop properly. “The Indian government continues to largely neglect this massive problem.”

Tapoja Chaudhuri, who teaches at the UW’s South Asia Center, and her soon-to-be-doctor husband Sunil Aggarwal (he gets his MD in a week), agreed with Fine’s comments and are, for the same reasons, planning to become more active in efforts to assist India’s poor. Both said the gap between rich and poor in India is growing.

Chaudhuri, who grew up in Calcutta, said there are terrible conflicts raging across many parts of India today due to these entrenched inequities. Though the government portrays the fight as against communist terrorists, Chaudhuri said the conflicts are fueled not so much by ideology but by the disenfranchisement of many poor communities. Government economic policies, she said, tend to focus on large-scale development projects rather than on anything that directly benefits the rural poor.

“It is not at all paradoxical to me that India’s rapid economic growth is accompanied by high rates of malnutrition,” Chaudhuri said. The way India is achieving its overall growth, she said, is by often bulldozing over – figuratively and literally — already impoverished communities.

Chaudhuri plans to work on social justice issues in India next fall while Aggarwal, who plans to someday go there as a doctor, completes his residency at Virginia Mason Medical Center.

MAP CREDIT: Ssolbergj under a Creative Commons License.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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HealthLawSquare

What the new health law means for you

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By Phil Galewitz
KaiserHealthNews Staff Writer

The new health law signed by President Obama this spring contains the most sweeping changes to the American health system in a generation.

The law will extend health insurance to 32 million currently uninsured Americans by 2019, and will also have an impact on how nearly every American buys insurance and what insurance must cover.

Here’s how you might be affected:

Q: I don’t have health insurance. Will I have to get it, and what happens if I don’t?

A: Under the legislation, most Americans will have to have insurance by 2014 or pay a penalty. The penalty would start at $95, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016. This is an individual penalty; families have a maximum penalty of $2,085. Some people are exempted from the insurance requirement because of financial hardship or religious beliefs or if they are American Indians.

Q: I want health insurance, but I can’t afford it. What do I do?

A: Depending on your income, you might be eligible for Medicaid. Medicaid is the state-federal program for the poor and disabled, which will be expanded sharply beginning in 2014. For the first time nationwide, low-income adults without children will be eligible, as long as their incomes don’t exceed 133 percent of the federal poverty level, or $14,404, according to current poverty guidelines.

Q: What if I make too much for Medicaid but still can’t afford coverage?

A: You might be eligible for government subsidies to help you pay for private insurance that would be sold in the new state-based insurance marketplaces, called exchanges. These will start operating in 2014.

Individuals and families can get help to pay premiums if their incomes are between 133 percent and 400 percent of the poverty level. That’s $14,404 to $43,320 for individuals and $29,326 to $88,200 for a family of four.

The subsidies will be granted on a sliding scale. For example, a family of four earning 150 percent of the poverty level, or $33,075 a year, will have to pay up to 4 percent of its income on premiums. A family with income of 400 percent of the poverty level could pay up to 9.5 percent.

Q: Will the law make it easier for me to get coverage, even if I have health problems?

A: If you have a medical condition, the law will make it easier for you to get coverage. Health insurers will be barred from rejecting applicants based on health status in 2014.

“. . .starting Sept. 23, 2010 insurers can no longer deny coverage to children with pre-existing conditions and insurers will be banned from setting lifetime coverage limits for adults and kids.”

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Until the new exchanges are up and running in 2014, the law created temporary high-risk insurance pools for people with medical problems who have been uninsured at least six months. The new risk pools – which will be run by the states and the federal government – are scheduled to start accepting members in September.

Also, starting Sept. 23, 2010 insurers can no longer deny coverage to children with pre-existing conditions and insurers will be banned from setting lifetime coverage limits for adults and kids.

In 2014, annual limits on coverage will be banned.

Also in 2014, new health insurance policies sold on the exchanges will be required to cover a minimum range of benefits, including hospitalizations, doctor visits, prescription drugs, maternity care and certain preventive tests.

Q: How will the new law affect young adults?

A: If you’re an unmarried adult younger than 26, you can stay on your parent’s insurance coverage as long as you are not offered health coverage at work.

This benefit will begin Sept. 23 or whenever the new plan year begins – January 2011 for many health plans. Some insurers, including Aetna and UnitedHealthcare, have decided to offer this benefit immediately, but many employers have deferred.

Q: I own a small business. Will I have to buy insurance for my workers? What help can I get?

A: It depends on the size of your firm. Companies with fewer than 50 workers won’t face any penalties if they don’t offer insurance.

Companies can get tax credits to help buy insurance if they have 25 or fewer employees and a workforce with an average wage of up to $50,000.

These tax credits of up to 35 percent of the cost of premiums have already been made available.

Firms with more than 50 employees that do not offer coverage will have to pay a fee of up to $2,000 per full-time employee if any of their workers get government-subsidized insurance coverage in the exchanges. The first 30 workers will be excluded from the assessment.

Q: I’m over 65. How will the legislation affect seniors?

A: The Medicare prescription-drug benefit will be improved substantially. This year, seniors who reach a certain threshold of out of pocket drug expenses known as the “donut hole” will get $250 to help pay for their medications.

“Beginning this year, the law will make all Medicare preventive services, such as screenings for colon, prostate and breast cancer, free to beneficiaries.”

Beyond that, drug company discounts on brand-name drugs and federal subsidies and discounts for all drugs will gradually reduce the gap, eliminating it by 2020.

Meanwhile, government payments to Medicare Advantage, the private-plan part of Medicare, will be frozen starting in 2011, and cut in the following years. If you’re one of the 10 million enrollees, you could lose “extra” benefits that many of the plans offer, such as free eyeglasses, hearing aids and gym memberships.

To cushion the blow to beneficiaries, the cuts to health plans in high-cost areas of the country such as New York City and South Florida — where seniors have enjoyed the richest benefits — will be phased in over as many as seven years.

Beginning this year, the law will make all Medicare preventive services, such as screenings for colon, prostate and breast cancer, free to beneficiaries.

Q: How much is all this going to cost?

A: The package is estimated to cost $938 billion over a decade. But because of higher taxes and fees and billions of dollars in Medicare payment cuts to providers, the law is actually projected to narrow the federal budget deficit by $143 billion over 10 years, according to the Congressional Budget Office. Still, the cost of the bill could rise another $115 billion if Congress approves additional spending, the CBO said.

If you have a high income, you face higher taxes. Starting in 2013, individuals who earn more than $200,000 a year and couples who earn more than $250,000 will pay a Medicare payroll tax of 2.35 percent. That’s up from the current 1.45 percent they pay.

Also, people at these income levels face an additional 3.8 percent tax on unearned income like dividends.

Starting in 2018, the law will also impose a 40 percent excise tax on employers who offer insurance that exceeds $10,200 a year for individuals and $27,500 for families. The tax is often called the “Cadillac” tax.

The law will also limit the amount of money you can put in a flexible spending account to pay medical expenses to $2,500 starting in 2013.

Want a tan without going outdoors? Tanning booths will add a 10 percent tax to your bill starting Sept. 23.

Q: What will happen to my premiums?

A: That’s hard to predict and the subject of much debate. People who are sick might face lower premiums than otherwise because insurers won’t be permitted to charge sick people more. Healthier people might pay more. Older people could still be charged more than younger people, but the gap couldn’t be as large as it is now.

The bigger question is what happens to rising medical costs, which drive up premiums. Efforts in the legislation to control health costs won’t have much of an effect for several years.

This is an updated version of a story that was last published on April 13.

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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With Congress on recess, health reform politics emerge on homefront

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A KaiserHealthNews round up of health policy news:


The Associated Press:

While Americans remain divided over the new health reform law, “they aren’t clamoring for its repeal. … Instead, the public seems willing to listen to candidates who would give the overhaul a chance and fix or improve it as needed. That’s the signal from some surveys and a congressional race in a bellwether Pennsylvania district.”

Such surveys and races could spell a break for Democrats in the upcoming midterm elections as some Republicans continue to appeal for votes by calling for a repeal.

“Americans’ nuanced outlook is reflected in some recent polls. For example, an NBC News/Wall Street Journal survey found the public tilting against the law 44-38, with 36 percent saying the quality of their health care would get worse, and only 17 percent believing it would improve. Not exactly a vote of confidence. But when asked if they would be more likely to vote for a congressional candidate willing to give the law a chance to work and make changes as needed, or one who would repeal it entirely and start over, respondents picked the one who would give it a chance by 55-42. Political independents favored giving the law a chance 57-40 in the poll, taken in early May” (Alonso-Zaldivar, 6/1).

Politico: Meanwhile,

“Senate Republicans are vowing to press their case against Obama’s sweeping new health care law by challenging (Dr. Donald) Berwick’s nomination (to run Medicare and Medicaid) — just in time to resurrect the brutal yearlong health reform battle ahead of the midterm elections. … The Republican campaign has grown so alarming to Democratic senators and health care activists that the White House is facing fresh demands to launch a more vigorous defense of Berwick, who is considered an American pioneer in helping doctors and hospitals provide improved care at a lower cost.”

The GOP is objecting to Berwick’s “self-professed ‘love’ of the British system,” according to Politico  (Budoff Brown, 6/1).

The Hill:

“Senate Democrats, wary of losing an important constituency, are using their week-long Memorial Day recess to reach out to senior citizens,” especially on issues related to scheduled Medicare cuts and elements of health reform’s implementation. “Senate Democratic leaders want members to hold town hall forums at senior centers …”

“‘Health insurance reform, particularly as it relates to seniors, is one of the most important things for senators to discuss when they are home for recess,’ reads a packet distributed to Democratic members. ‘In order to get the message out ahead of talk of health reform repeal, senators should talk with seniors about the benefits they are going to see immediately and those they will be seeing over the coming months and years.’”

A similar Republican packet also “zeroes in on health care, calling it ‘Exhibit A’ of a ‘Runaway Washington Government’” (Rushing, 5/30).

CQ Politics:

“Democrats will also continue their efforts to turn public perception of their health care reform legislation. For instance, Senate Majority Leader Harry Reid (D-Nev.) sent his Members home with recess materials stressing immediate effects of the law – such as expanding coverage of adult children” (Kucinich and Stanton, 5/30).

The Washington Post: In North Carolina,

“[a] defiant move by one of the nation’s most powerful unions to help oust Democrats who voted against the health care bill by establishing a third political party in North Carolina has failed because organizers did not collect enough signatures to qualify for the November midterm elections.”

The Service Employees International Union there failed to gather 85,000 signatures to get a third-party candidate on the general election ballot to challenge Rep. Larry Kissell, a first-term Democrats who voted no on health care. “But organizers said they are drafting an independent candidate to challenge [Kissell] … Frustrated that Democratic lawmakers they deem too centrist are not pursuing a more liberal agenda, the SEIU and other labor unions and progressive advocacy groups have been taking on Democratic incumbents across the country, including in Arkansas. But while most of these family feuds have been confined to Democratic primaries, the North Carolina effort will play out in the general election” (Rucker, 5/31).

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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Crash Test Dummies

King County traffic deaths tumble

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Traffic deaths in King County fell from an average of 188 per year from 2002 to 2006 to an average of 94 per year in 2007 and 2008, and, according the preliminary data, traffic deaths appear to have fallen again last year to 76, Public Health – Seattle & King County officials report.

Officials attribute the decline in deaths to strong enforcement of driving under the influence (DUI) laws, safer car design, road improvements, better driving habits, and seatbelt use.

King County’s traffic fatality rate is the lowest in the state, nevertheless, from 2004 to 2008, 568 people were killed in traffic accidents including drivers, passengers, pedestrians and cyclists. Another 98,000 were injured.

DUI-related accidents are the leading cause of local traffic deaths, and for their efforts in curtailing drunk driving, King County is honoring DUI patrol officers from 28 local law enforcement agencies.

Since 1999, officers working on DUI patrols have made over 22,500 stops and arrested more than 6,100 impaired drivers.

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Numbers on wooden type block

Health care tax credit comes with benefits, strings for small businesses

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Insuring Your Health

By Michelle Andrews

If you own a small business and are struggling to pay for employees’ health insurance, the new health-care law could provide quick financial help. The smallest businesses could get temporary tax credits that effectively pay for up to 35 percent of their premium contributions. Slightly larger businesses could get smaller credits.

But the tax credit comes with several strings, and not everyone thinks it will do enough.

Blake Anderson, owner of a small construction company in Durham, N.C., is one of the optimists. When he started Innovative Renovation three years ago, he explored buying coverage for himself, his business partner and the seven workers he had at the time. But when a broker told Anderson that his heart condition, which will require a valve replacement at some point, would make the insurance prohibitively expensive, “the conversation ended there,” he says. Now he’s taking another look.

Here’s what he’ll see: Starting this year, businesses with 10 or fewer employees (or equivalent part-time workers) and average annual wages of less than $25,000 will be eligible for the full 35 percent credit. (The owner’s salary is not included.) Above those thresholds, the credit gradually decreases until it’s completely phased out for companies with at least 25 full-time workers and average wages of $50,000 or more.

More From This Series:Insuring Your Health

Between 1.8 million and 4 million businesses are estimated to be eligible for the credit. Companies have to pay at least 50 percent of the premiums for their employees’ health insurance to qualify. Nonprofit enterprises are eligible for tax credits of up to 25 percent.

Critics say the credit is too complicated and doesn’t solve the underlying problem for small business owners: the rising cost of insurance.

To figure out how big a tax credit your company might qualify for, use the calculator at the website of the Small Business Majority, an advocacy group that supports the new law. You claim the tax credit on your federal income tax return.

That’s the system you’ll use until 2014, when the state-based insurance exchanges, or marketplaces, will begin to sell coverage. From then on, the credit will be available only to small businesses that buy insurance on the exchanges. But it will also increase – to a maximum of 50 percent for small private companies and 35 percent for nonprofits. Because the new law is supposed to make insurance generally more accessible by this time, the benefit will be time-limited: Each small business will be able to take the credit for only two years.

Marsha Geist hopes to take advantage of the credit. Geist and her husband own a landscaping business in Dayton, Md. Two of their eight employees get health insurance through the company, and the Geists pay 100 percent of the premiums, or about $9,300 annually.

Critics say the credit is too complicated and doesn’t solve the underlying problem for small business owners: the rising cost of insurance. “As long as costs keep going up, the credit is going to become less valuable,” says Bill Rys, tax counsel for the National Federation of Independent Business.

“Employer health insurance will always be important, but we’re moving into a world where there will be other options,” Gruber says.

Alan Sayler, who owns a water-treatment equipment business in Florida, views the tax credit as just a way to “buy off small businesses like me so we won’t complain about the shortcomings of this bill.” That said, Sayler figures he’ll qualify for a $1,700 credit against the roughly $7,000 he pays annually to insure two of his employees. “I’d be foolish not to take it,” he says.

John Arensmeyer, founder and chief executive of the Small Business Majority, calls the tax credit a huge step, and Jonathan Gruber, an MIT economics professor who has been a technical consultant for the Department of Health and Human Services, agrees. If a 35 or 50 percent discount doesn’t make insurance affordable, “I don’t know what you could do besides provide it for free,” Gruber says. “That’s a really big discount.”

And if the insurance is still too expensive for some small businesses, even with the tax credit, they don’t have to offer it. Employers with 50 or fewer employees are exempt from penalties for not offering coverage. Once the exchanges open in 2014, employees will be able to start buying coverage there if their employer doesn’t provide it. “Employer health insurance will always be important, but we’re moving into a world where there will be other options,” Gruber says.

This is a weekly column covering consumer questions about the new health law. If you have questions or ideas for future topics, please email us:questions@kaiserhealthnews.org

This column 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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Hospital Hallway

How to avoid the round-trip visit to the hospital

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By Carolyn M. Clancy, M.D.

June 1, 2010

When patients get out of the hospital, it’s usually a sign that their health is getting better and they’re ready to recover at home.

Unfortunately, millions of patients each year end up back in the hospital.

In fact, 1 in 5 Medicare patients go back within 1 month of being released.

Even more people face unexpected medical problems within weeks of leaving the hospital.

Many of the medical problems that send patients back to the hospital could have been avoided in the first place. What causes these problems to happen?

Often it’s because patients and caregivers don’t understand what they need to do to take care of themselves or their loved one after a hospital stay. No one at the hospital told them exactly what they should and shouldn’t do at home or answered questions on taking medicines, making followup appointments, or arranging for followup tests. Research sponsored by my agency, the Agency for Healthcare Research and Quality (AHRQ), found that more than one-third of the patients who leave the hospital don’t get the followup care they need like lab tests or a referral to see a doctor who specializes in their condition.

Sometimes problems occur because patients are excited about leaving the hospital and don’t take time to ask questions about the information they get as they’re leaving.

The good news is that efforts are being made to make sure that patients—and family members—get and understand the information they need before they leave the hospital.

Educating patients about their medicines before they leave the hospital is a 2010 patient safety goal from the Joint Commission, a national group that accredits hospitals (PDF File; PDF Help). Medicare has also stopped paying hospitals for additional costs that result when certain preventable conditions cause patients to end up back in the hospital. Recently, AHRQ developed a new resource to get patients better prepared to leave the hospital. Taking Care of Myself: A Guide for When I Leave the Hospital is a guide that highlights what patients need to know when they leave the hospital.

The guide is based on pioneering work done at Boston University Medical Center. Through a program called Project RED, doctors and nurses at the facility changed the way patients are discharged from the hospital. Funded by AHRQ, Project RED uses trained nurses to help patients understand their condition, make followup appointments, and confirm which medicines they should take.

Dr. Carolyn Clancy

A pharmacist also contacts patients 2 to 4 days after they leave the hospital to answer any questions they may have about their medicines.

Patients who took part in the program were 30 percent less likely to have a second hospital stay or go to the emergency department than patients who did not participate.

The same simple, but important, steps that helped these patients can help you or your loved one. These steps, outlined in the new guide, include:

  • Making an appointment to see your doctor or a specialist who treats your condition.
  • Taking your medicines correctly.
  • Making sure you aren’t allergic to any of your medicines.
  • Asking your doctor about your test results.
  • Getting the right kind of exercise.
  • Knowing who to call with questions or problems.

The easy-to-understand guide helps you keep track of this information and gives you space to write down any questions you want to ask during future appointments.

Of course, this information won’t prevent you from going back to the hospital if you have a bad reaction to a medicine or if you need more treatment. But it does increase the chance that you’ll be better prepared to take care of yourself when you leave the hospital. This can help prevent a return visit and save you time, money, and stress.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

More Information

AHRQ Podcast
podcastCare Transitions—What You Need to Know (Transcript)  Podcast Help

Agency for Healthcare Research and Quality
Taking Care of Myself: A Guide for When I Leave the Hospital
http://www.ahrq.gov/qual/goinghomeguide.htm

Boston Medical Center
Project RED (Re-Engineered Discharge)
http://www.bu.edu/fammed/projectred/index.html Exit Disclaimer

Current as of June 2010


Internet Citation:

How to Avoid the Round-Trip Visit to the Hospital. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, June 1, 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc060110.htm

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Whisky

Relationships can lower substance use in young people, UW study

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By Randy Dotinga, Contributing Writer
Health Behavior News Service

A new study of young people in the two years after high school finds that those in romantic relationships are less likely than their peers to report heavy drinking and marijuana use.

Researchers have known that marriage lowers the odds that people will get drunk frequently or smoke pot, said study lead author Charles Fleming, a research scientist at the University of Washington.

The new findings, he said, reveal that other kinds of romantic relationships have the same effect.

“I’m not saying that we should set up dating services,” he said. “But it’s something for parents to know and it’s something for other people who are working with young adults of this age to know.”

The study findings appear in the June issue of the Journal of Health and Social Behavior.

Fleming and colleagues examined surveys of 909 young people followed from first or second grade in the early 1990s through adolescence and the two years after high school.

More than 80 percent of the participants, from a school district outside Seattle, were white, and 54 percent were male.

The researchers found that those who were not in romantic relationships at ages 19 and 20 smoked less and drank less than other students back when they were in high school. The situation changed when they got older: “They catch up and maybe surpass their peers,” Fleming said.

One possibility is that when people are in relationships, they are “happier and getting social support from their partner,” Fleming said. “They’re spending less time hanging out with their substance-using friends, spending less time at parties and in bars.”

After adjusting their statistics so they would not be thrown off by factors like employment status, the researchers found the typical person who was not in a relationship was 40 percent more likely to use marijuana than a person in a dating relationship but without a live-in girlfriend or boyfriend.

What is going on? One possibility is that when people are in relationships, they are “happier and getting social support from their partner,” Fleming said. “They’re spending less time hanging out with their substance-using friends, spending less time at parties and in bars.”

In the big picture, the findings matter because they provide insight into the influences on people during a time of life “when you see peak rates of alcohol abuse and development of dependency on cigarettes and marijuana,” Fleming said. “You worry about people being disengaged from influences that might curb their risk of drinking and substance abuse.”

Kenneth Leonard, a researcher with the Research Institute on Addictions at the University of Buffalo, said the findings add a couple new things to existing research. For one, they provide evidence that marriages among young people reduce the risk of substance use just as marriages of older people do.

But he said there is an exception: The study shows that when someone’s spouse or boyfriend or girlfriend is a heavy drinker or marijuana user, that actually raises the odds that the person will smoke and drink.

Overall, the findings show that “intimate partners, even those who are cohabiting or dating, can have an important influence on another’s substance use,” he said.

To learn more:

  • Read Fleming C, White HR, Catalano RF. Romantic relationships and substance use in early adulthood: an examination of the influences of relationship type, partner substance use, and relationship quality. J Health Social Behav 51(2), 2010.

Health Behavior News Service, part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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