By not discussing cost issues, doctors, patients may miss chances to lower out-of-pocket costs

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Twenty-dollar bill in a pill bottleBy Shefali Luthra
Kaiser Health News

Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient’s health can be undermined. 

A study published in Monday’s Health Affairs explores the dynamics that can trigger that scenario.

Patients are increasingly responsible for shouldering more of their own health costs. In theory, that’s supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous services alike.

Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors currently stands in the way, according to the study. Continue reading

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UnitedHealth tries boutique-style health plan

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Harken Health members get free yoga at the clinic. (Phil Galewitz/KHN

By Phil Galewitz
Kaiser Health News

AUSTELL, Ga. — UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes. Services are delivered in stylish clinics with hardwood floors and faux fireplaces in their lobbies.

Harken Health is available only in Chicago and Atlanta, where it covers 35,000 members who signed up this winter on the Affordable Care Act’s insurance exchanges. UnitedHealth still sells traditional plans in those cities, too.

The plan spends twice as much on primary care as the average insurer,

Harken’s lush operation might seem puzzling for a cost-conscious company such as UnitedHealthcare, which said in November it lost hundreds of millions of dollars on its Obamacare plans in 2015 and threatened to drop out of the exchanges in 2017.

But it’s not crazy. Health care analysts say Harken demonstrates the insurer’s search for a better way to provide affordable care and attract more customers. Its mission is to prove that convenient, no-cost primary care, delivered with top-notch customer service, can lower hospitalization rates and overall health costs. Harken spends twice as much on primary care as the average insurer, according to the company.

“At the end of the day, United wants to know if this system can better control costs, as it’s a lot cheaper to prevent disease than treat one,” said Liz Frayer, an employee benefits consultant in Atlanta. Continue reading

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Health care adds 503,000 jobs in just one year – POLITICO

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Health care’s on pace to become the nation’s biggest industry in three years. More than 15.4 million people now work in health care, up about 3 million in the past decade.

The growth has been constant — total health care jobs outpaced manufacturing jobs seven years ago — and if current trendscontinue, the health care industry should overtake retail by 2019.

Source: Health care adds 503,000 jobs in just one year – POLITICO

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As fentanyl deaths spike, states and CDC respond

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DeafentanylBy Christine Vestal
Stateline

ATLANTA — When Ohio tallied what many already knew was an alarming surge in overdose deaths from an opioid known as fentanyl, the state asked the U.S. Centers for Disease Control and Prevention to investigate.

The rash of fatal overdoses in Ohio — a more than fivefold increase in 2014 — was not an isolated outbreak. Fentanyl is killing more people than heroin in many parts of the country. And the death toll will likely keep growing, said CDC investigators Matt Gladden and John Halpin at the fifth annual Rx Drug Abuse and Heroin Summit here.

At least 28,000 people died of opioid overdoses in 2014, the highest number of deaths in U.S. history. Of those, fentanyl was involved in 5,554 fatalities.

Fentanyl, used in its legal pharmaceutical form to treat severe pain, represents the latest evolution of an epidemic of opioid addiction that began with prescription painkillers and moved to heroin, as users demanded cheaper drugs and greater highs.

At least 28,000 people died of opioid overdoses in 2014, the highest number of deaths in U.S. history. Of those, fentanyl was involved in 5,554 fatalities, a 79 percent increase over 2013, according to a December CDC report.

Unpublished data for the first half of 2015 indicate an even steeper spike in fentanyl deaths, Gladden said.

Cheap and Lethal

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Workers’ Desire Grows For Wage Increases Over Health Benefits

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By Michelle Andrews
Kaiser Health News

Twenty-dollar bill in medicine bottleMore wages, less health insurance.

In a recent survey, one in five people with employer-based coverage said they would opt for fewer health benefits if they could get a bump in their wages.

That’s double the percentage who said they would make that choice in 2012.

“I do these surveys all the time, and it’s rare where you see things change that quickly,” said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, which conducted the survey of 1,500 workers with Greenwald & Associates.

Fronstin speculated that worker frustration with low wage growth may be driving the shift in attitudes.

Wage and salary increases have hovered around 2 to 3 percent in recent years, generally rising more slowly than cost increases of annual health care benefits.

Overall, two-thirds of people with employer-sponsored coverage reported that they were satisfied with their health insurance benefits in 2015, the survey found, lower than the 74 percent satisfaction figure in 2012.

Meanwhile, the percentage of people who would accept a smaller paycheck for better health insurance benefits was 14 percent last year, essentially unchanged from 15 percent three years earlier.

The growing willingness to trade health benefits for wages may be linked to some degree to the millennial generation’s growing share of the workforce, Fronstin said, referring to people born between roughly 1980 and 2000.

“The younger you are, the less important health insurance is to you,” Fronstin said.

As baby boomers retire and younger workers move in behind them, it may affect the mix of benefits that employers offer.

But as today’s “young invincibles” age, chances are they’ll see more value in their health insurance and the pendulum will swing back again, according to Fronstin.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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World’s obese population hits 641 million, global study finds | Reuters

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burger-and-friesMore than 640 million people globally now weigh in as obese and the world has more overweight than underweight people, according to an analysis of global trends in body mass index (BMI).

A startling increase in rates of obesity in the past 40 years means the number of people with a BMI of more than 30 has risen from 105 million in 1975 to 641 million in 2014, the study found.

More than one in 10 men and one in seven women are obese.

Source: World’s obese population hits 641 million, global study finds | Reuters

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Researchers determine structure of Zika virus

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From Purdue University

A team led by Purdue University researchers has determined the structure of the Zika virus, which reveals insights critical to the development of effective antiviral treatments and vaccines.

The team also identified regions within the Zika virus structure where it differs from other flaviviruses, the family of viruses to which Zika belongs that includes dengue, West Nile, yellow fever, Japanese encephalitis and tick-borne encephalitic viruses.

A paper detailing the findings was published Thursday (March 31) in the journal Science and is available online.

Any regions within the virus structure unique to Zika have the potential to explain differences in how a virus is transmitted and how it manifests as a disease, said Richard Kuhn, director of the Purdue Institute for Inflammation, Immunology and Infectious Diseases (PI4D) who led the research team with Michael Rossmann, Purdue’s Hanley Distinguished Professor of Biological Sciences.

“The structure of the virus provides a map that shows potential regions of the virus that could be targeted by a therapeutic treatment, used to create an effective vaccine or to improve our ability to diagnose and distinguish Zika infection from that of other related viruses,” said Kuhn, who also is head of Purdue’s Department of Biological Sciences. “Determining the structure greatly advances our understanding of Zika – a virus about which little is known. It illuminates the most promising areas for further testing and research to combat infection.”

The Zika virus, a mosquito-borne disease, has recently been associated with a birth defect called microcephaly that causes brain damage and an abnormally small head in babies born to mothers infected during pregnancy. It also has been associated with the autoimmune disease Guillain-Barré syndrome, which can lead to temporary paralysis. In the majority of infected individuals symptoms are mild and include fever, skin rashes and flulike illness. Continue reading

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World’s older population grows dramatically

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From the National Institutes of Health

The world’s older population continues to grow at an unprecedented rate. Today, 8.5 percent of people worldwide (617 million) are aged 65 and over. According to a new report, “An Aging World: 2015,”  this percentage is projected to jump to nearly 17 percent of the world’s population by 2050 (1.6 billion).

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“Older people are a rapidly growing proportion of the world’s population,” said NIA Director Richard J. Hodes, M.D. “People are living longer, but that does not necessarily mean that they are living healthier. The increase in our aging population presents many opportunities and also several public health challenges that we need to prepare for. NIA has partnered with Census to provide the best possible data so that we can better understand the course and implications of population aging.”

“An Aging World: 2015” contains detailed information about life expectancy, gender balance, health, mortality, disability, health care systems, labor force participation and retirement, pensions and poverty among older people around the world.

America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.

The report was commissioned by the National Institute on Aging (NIA), part of the National Institutes of Health, and produced by the U.S. Census Bureau. The report examines the demographic, health and socioeconomic trends accompanying the growth of the aging population.

“We are seeing population aging in every country in every part of the world,” said John Haaga, Ph.D., acting director of NIA’s Division of Behavioral and Social Research. “Many countries in Europe and Asia are further along in the process, or moving more rapidly, than we are in the United States. Since population aging affects so many aspects of public life — acute and long-term health care needs; pensions, work and retirement; transportation; housing — there is a lot of potential for learning from each other’s experience.”

Highlights of the report include

  • America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.
  • By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.
  • The global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.
  • Among the older population worldwide, noncommunicable diseases are the main health concern. In low-income countries, many in Africa, the older population faces a considerable burden from both noncommunicable and communicable diseases.
  • Risk factors — such as tobacco and alcohol use, insufficient consumption of vegetables and fruit, and low levels of physical activity — directly or indirectly contribute to the global burden of disease. Changes in risk factors have been observed, such as a decline in tobacco use in some high-income countries, with the majority of smokers worldwide now living in low- and middle-income countries.

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Pregnant and addicted: the tough road to a healthy family

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Amanda Hensley holds her daughter Valencia

Amanda Hensley holds her daughter Valencia

By Sarah Jane Tribble, WCPN
Kaiser Health News

Amanda Hensley started abusing prescription painkillers when she was just a teenager. For years, she managed to function and hold down jobs. She even quit opioids for a while when she was pregnant with her now 4-year-old son. But she relapsed.

Hensley says she preferred drugs like Percocet and morphine, but opted for heroin when short on cash.

By the time she discovered she was pregnant last year, she couldn’t quit.

“It was just one thing after another, you know — I was sick with morning sickness or sick from using,” said Hensley, who is 25 and lives in Cleveland. “Either I was puking from morning sickness or I was puking from being high. That’s kind of how I was able to hide it for a while.”

Hensley said she was ashamed and hurt, and she wanted to stop using but didn’t know how. She had friends who would help her find drugs — even after they found out she was pregnant. But finding help to get sober and protect her child proved much more difficult, though.

The number of people dependent on opioids is increasing and that includes women of child-bearing age, like Hensley. Researchers estimated that every 25 minutes a baby was born dependent on opioids in 2012, the most recent year for which data are available.

By the time Hensley was about six months pregnant, she was living on couches, estranged from her mother and her baby’s father, Tyrell Shepherd. Her son went to live with her mother.

That’s when Hensley reached out for help. One moment, she dialed to get her fix. The next, she called hospitals and clinics.

“Nobody wants to touch a pregnant woman with an addiction issue,” she said.

Shepherd wasn’t happy when he realized Hensley was taking opioids while pregnant. “If you don’t care about yourself,” he said, “have enough common decency to care about the baby you’re carrying. Be adult. Own up to what it is you’re doing and take care of business. Regardless of how bad you’re going to feel, there’s a baby that didn’t ask to be there.”

After being rejected by two hospitals and several clinics, Hensley let herself go into withdrawal and then went to the emergency department of MetroHealth System, Cleveland’s safety-net hospital. Continue reading

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President’s task force aims to help end discrimination in mental health coverage

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headacheBy Jenny Gold
Kaiser Health News

Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President  Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”

Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them. Continue reading

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Diabetes link to sitting largely due to obesity and lack of exercise | Reuters

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Too much time spent sitting is associated with an increased risk of developing diabetes, but the effect is primarily seen among those who are also obese or inactive most of the time, a recent Danish study finds.

Overall, the study linked sitting for more than 10 hours a day to a 35 percent higher risk of diabetes compared with sitting for less than 6 hours daily.

But the good news for desk jockeys is that staying slim and getting plenty of exercise appeared to minimize the diabetes risk associated with all that time sitting down.

Source: Diabetes link to sitting largely due to obesity and lack of exercise | Reuters

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FDA Eases Rules for Abortion Pill, Making Access Simpler in U.S. – Bloomberg

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The U.S. Food and Drug Administration simplified the regulations for using pills to induce an abortion, making the procedure more easily available to American women even as several states consider efforts to curtail the practice.The medication, known as Mifeprex, now can be taken by women who are as much as 10 weeks pregnant, up from 7 weeks, according to a new label posted on the agency’s website.

The dose was also cut by two-thirds to 200 milligrams, reducing the risk of side effects.

Source: FDA Eases Rules for Abortion Pill, Making Access Simpler in U.S. – Bloomberg

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Experts warn complacency on Ebola may leave vaccine work unfinished | Reuters

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The number of cases with Ebola, shown here, could double by the end of the month. There is a one in five chance it will reach the U.S. in that same time, researchers predict. Photo: Centers for Disease Control and Prevention

The World Health Organization (WHO) has declared the Ebola emergency over, but action is still needed to fully develop effective vaccines and prepare the world for future outbreaks, experts said on Thursday.

Great progress has been made in Ebola vaccine development in the last two years, according to a report by an international panel of infectious disease experts, but this “could grind to a halt as memories of the outbreak in West Africa begin to fade”.

Source: Experts warn complacency on Ebola may leave vaccine work unfinished | Reuters

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