Monthly Archive for November, 2010

Michelle Andrews, Kaiser Health News, November 30, 2010

What if, instead of making a $10 insurance copayment for your cholesterol lowering drug, your employer provided it and other drugs to manage chronic conditions for free? What if your company also paid for weight management and smoking cessation classes? You’d probably give your employer high marks for looking out for your health.

Now, what if your employer said that if you want certain procedures that it’s determined are overused, like an MRI or knee surgery, you’ll have to pay up to $500 extra, on top of your other coinsurance charges? Those employer decisions might not be nearly as welcome.

Both, however, are part of an approach to health care that shares a common perspective: The idea that consumers’ out-of-pocket medical costs should be based on the value of a medical service to their health rather than its price.

Although still relatively rare, the model is garnering increasing attention among employers, insurers and policy experts. Mercer, a benefits consulting company, found in a 2008 survey that 19 percent of employers with at least 500 employees were charging workers less for services the companies considered to have a higher value for workers’ health. In addition, more than 80 percent of employers with at least 10,000 workers surveyed by Mercer in 2007 said they were interested in adopting this model in the next five years, according to a paper published in the November issue of Health Affairs. It was one of several on value-based insurance design, as it’s called, in the current issue.

Some health law provisions also embrace value-based insurance principles, including the requirement that new insurance policies provide free recommended preventive services such as mammograms andcolon cancer screenings starting in 2011. “It’s all in keeping with the idea that some things are so valuable to health care that there should be no barriers to their use,” says Dr. Niteesh Choudhry, an assistant professor at Harvard Medical School and lead author of two of the articles in this month’s Health Affairs.

A landmark 1982 study showed that as out-of-pocket costs rise, consumers spend less on health care services. But they scrimp not just on care that’s ineffective or unnecessary but also on care that they need, treatment that’s highly effective at addressing their condition.

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GINA KOLATA, New York Times, November 29, 2010

The very high levels of  vitamin D that are often recommended by doctors and testing laboratories — and can be achieved only by taking supplements — are unnecessary and could be harmful, an expert committee says. It also concludes that calcium supplements are not needed.

The group said most people have adequate amounts of vitamin D in their blood supplied by their diets and natural sources like sunshine, the committee says in a report that is to be released on Tuesday.

“For most people, taking extra calcium and vitamin D supplements is not indicated,” said  Dr. Clifford J. Rosen, a member of the panel and an osteoporosis expert at the Maine Medical Center Research Institute.

Dr. J. Christopher Gallagher, director of the bone metabolism unit at the Creighton University School of Medicine in Omaha, Neb., agreed, adding, “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.”

Over the past few years, the idea that nearly everyone needs extra calcium and vitamin D — especially vitamin D — has swept the nation.

With calcium, adolescent girls may be the only group that is getting too little, the panel found. Older women, on the other hand, may take too much, putting themselves at risk for kidney stones. And there is evidence that excess calcium can increase the risk of heart disease, the group wrote.

As for vitamin D, some prominent doctors have said that most people need supplements or they will be at increased risk for a wide variety of illnesses, including heart disease, cancer and autoimmune diseases.

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KEVIN SACK and ROBERT PEAR, New york Times, November 26, 2010

WASHINGTON — As the Obama administration presses ahead with the health care law, officials are bracing for the possibility that a federal judge in Virginia will soon reject its central provision as unconstitutional and, in the worst case for the White House, halt its enforcement until higher courts can rule.

The judge, Henry E. Hudson of Federal District Court in Richmond, has promised to rule by the end of the year on the constitutionality of the law’s requirement that most Americans obtain insurance, which takes effect in 2014.

Although administration officials remain confident that it is constitutionally valid to compel people to obtain health insurance, they also acknowledge that Judge Hudson’s preliminary opinions and comments could presage the first ruling against the law.

“He’s asked a number of questions that express skepticism,” said one administration official who is examining whether a ruling against part of the law would undermine other provisions. “We have been trying to think through that set of questions,” said the official, who insisted on anonymity because he was not authorized to discuss the case freely.

While many newly empowered Republican lawmakers have vowed to repeal the health care law in Congress, a more immediate threat may rest in the federal courts in cases brought by Republican officials in dozens of states. Not only would an adverse ruling confuse Americans and attack the law’s underpinnings, it could frustrate the steps hospitals, insurers and government agencies are taking to carry out the law.

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Michael Specter, The New Yorker, November 11, 2010

Is it possible to save the millions of people who die from TB?

Every afternoon at about four, a slight woman named Runi slips out of the cramped, airless room that she shares with her husband and their sixteen children. She skirts the drainage ditch in front of the building, then walks toward the pile of hardened dung cakes that people in this slum on the edge of the northeastern Indian city of Patna use for fuel. Dressed in a bright-yellow sari shot with gold threads, Runi is followed by several of her children. Although she can’t remember their ages, or her own, Runi must be about forty, because she dates her life from its first crucial memory: the smallpox epidemic that devastated Patna and much of surrounding Bihar province in 1974.

Runi survived that plague, and several others, but, about a year ago, after developing a persistent cough, she visited one of the private medical clinics that line the streets of Patna. There someone who called himself a doctor stuck a needle in her arm, drew a few drops of blood, examined them, and told her that she had tuberculosis. It is not an uncommon diagnosis. Tuberculosis has always been the signature disease of urban poverty, passed easily in poorly ventilated spaces. India has nearly two million new cases each year, and every day a thousand people die of the disease, the highest number in the world. Tuberculosis is also the leading cause of death among people between fifteen and forty-five—the most productive age group in any country and the key to India’s prospects for continued economic growth.

For most patients, the choices are bleak. Public hospitals are so overcrowded that people are forced to rely on inaccurate tests dispensed at private labs and clinics. They are unregulated enterprises, and peddle blood tests that are responsible for tens of thousands of misdiagnoses every year. “This is deadly,” L. S. Chauhan, the director of the National TB Control Program, told me when we met in New Delhi. “But there are thousands of labs. Shut one down and the next day ten more appear.”

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LESLEY ALDERMAN, New York Times, November 5, 2010

THE lunch menu at my son’s elementary school — Public School 29 in Brooklyn — looked very tempting recently: vegetarian chili, sofrito brown rice, confetti corn salad, pico de gallo, salad bar, milk. Making the menu even more appealing was the price: $1.50.

When a school lunch is nutritious and tasty, it’s one of the best health bargains around. Lunches provided through the National School Lunch Program, which is subsidized by the federal government, cost parents about $1.25 to $2, typically less than it would cost to make the meal at home. For lower-income families, the bill is less, or even free.

P.S. 29 students are lucky; their school participates in Wellness in the Schools, a nonprofit program that places culinary school graduates in New York City public schools to create appealing meals from wholesome ingredients. Across the country, many other school districts are beginning to make healthy food a priority by starting school gardens, using local produce and involving parents in the meal planning.

Still, at many schools, lunches are neither tasty nor nutritious. While more than 70 percent of schools serve lunches that meet the guidelines for nutrients like vitamins, minerals and protein, many serve meals that are high in fat, salt and sugar, according to a School Nutrition Dietary Assessment study.

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