George Halvorsen | Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care: George C. Halvorson: Books

George C. Halvorson. Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care (Hardcover), Productivity Press; 1 edition (May 27, 2009)

Written by one of the leading authorities in the industry, this book provides a basic primer on the American health care system. Using simple-to-understand language supplemented by insightful anecdotes and examples, the author cuts through the thicket of health care reform rhetoric to offer a step-by-step blueprint for achieving real improvements in health care delivery, as well as putting curbs on growing health care costs. He explains how health insurance works in the U.S. compared with the rest of the world and outlines the barriers to American reform. He also discusses why health care costs are going up so rapidly and sets realistic goals for care improvement.

via Amazon.com: Health Care Will Not Reform Itself: A User’s Guide to Refocusing and Reforming American Health Care: George C. Halvorson: Books.

Illness, medical bills linked to nearly two-thirds of bankruptcies

Medical bankruptcy in the United States, 2007: Results of a national study,” David U. Himmelstein, M.D; Deborah Thorne, Ph.D.; Elizabeth Warren, J.D.; Steffie Woolhandler, M.D., M.P.H. American Journal of Medicine, June 4, 2009 (online). [Full text] [Fact Sheet] [Q&A]

Medical problems contributed to nearly two-thirds (62.1 percent) of all bankruptcies in 2007, according to a study in the August issue of the American Journal of Medicine that will be published online Thursday. The data were collected prior to the current economic downturn and hence likely understate the current burden of financial suffering. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The authors’ previous 2001 findings have been widely cited by policy leaders, including President Obama.

Surprisingly, most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness, including 60.3 percent who had private coverage. Most of the medically bankrupt were solidly middle class before financial disaster hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance. More…

Full text of the study is on-line or through the American Journal of Medicine, ajmmedia@elsevier.com , (212) 633-3944.

The Commonwealth Fund | Issue Brief: The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions

Amy M. Lischko, Sara S. Bachman, and Alyssa Vangeli, The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions, The Commonwealth Fund, May 28, 2009. Full text of issue brief.

The Commonwealth Health Insurance Connector Authority is the centerpiece of Massachusetts’ ambitious health care reforms, which were implemented beginning in 2006. The Connector is an independent quasi-governmental agency created by the Massachusetts legislature to facilitate the purchase of affordable, high-quality health insurance by small businesses and individuals without access to employer-sponsored coverage. This issue brief describes the structure and functions of the Connector, providing a primer to policymakers interested in exploring similar reforms at the state and national level. The authors describe how the Connector works to promote administrative ease, eliminate paperwork, offer portability of coverage, and provide some standardization and choice of plans. National policymakers looking to achieve similar policy goals may find some of the structural components and functions of the Connector to be transferable to a national health reform model, say the authors. More at: The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions – The Commonwealth Fund.

Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 – The Commonwealth Fund

Sharon K. Long, Ph.D., and Paul B. Masi, Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008, Health Affairs Web Exclusive, May 28, 2009, w578–w587. Full text.

More than two years after implementation of its landmark health insurance reforms, Massachusetts had achieved historically high levels of coverage and widespread improvements in access to care, according to this study—the latest in a series of updates, funded by the Blue Cross Blue Shield of Massachusetts Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation, on implementation of the state’s reforms. The authors find, however, that constraints on provider capacity and rising health care costs—trends that predate reform—have eroded some of the gains. Massachusetts is now seeking ways to contain costs and expand provider capacity, including a proposal to shift from fee-for-service provider payments to global fees that emphasize care coordination and collaboration. More at: Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 – The Commonwealth Fund.

Book | Ethical Issues in Rural Health Care

Ethical Issues in Rural Health Care. Edited by Craig M. Klugman and Pamela M. Dalinis. Baltimore, MD, Johns Hopkins University Press, 2008. 224 pp, $50. ISBN-13: 978-0-8018-9045-1

Are ethics different in rural areas than in the big city? This collection of 12 essays provides a careful look at how ethical issues are perceived, noticed, ignored, or dealt with in rural health care. The contributors make clear that perceptions of ethics that come from urban and academic health care centers may need to be adjusted in dealing with the rural environment.

The book is divided into 3 sections. The first provides an overview of what is meant by rural and general ethical issues in rural health care. The second section consists of 3 essays by rural health practitioners. The third and final section examines specific ethical issues in the rural setting. The book provides an illuminating look at questions of culture, character, regulation, social justice, and organizational response. As a reader who has predominantly practiced medicine and taught ethics in urban medical environments, I found the book fascinating . . . [Full Text of this Article]

Myles N. Sheehan, SJ, MD, Reviewer
Leischner Institute for Medical Education
Stritch School of Medicine
Loyola University Chicago
Maywood, Illinois
msheeh1@lumc.edu

Source:  JAMA — Ethical Issues in Rural Health Care, May 27, 2009, Sheehan 301 (20): 2162.

CBO Brief: Budgetary Treatment of Health Reform Proposals

The Congress is currently considering various approaches for instituting major changes in the nation’s system of health insurance. Some of those proposals would significantly expand the federal government’s role in that system, thus raising the question of how such changes might be reflected in the federal budget. CBO has just released a brief describing the approach that CBO will take in judging the appropriate budgetary treatment.

Source: Director’s Blog » Blog Archive » Budgetary Treatment of Health Reform Proposals.

Study: Lower legal drinking age increases likelihood of poor birth outcomes

Amid renewed calls to consider reducing the legal drinking age, a new University of Georgia study finds that lower drinking ages increase unplanned pregnancies and pre-term births among young people. “Our findings suggest that a lower drinking age increases risky sexual behavior among young people, and that leads to more unplanned pregnancies that result in premature birth and low birth weight,” said study author Angela Fertig, assistant professor in the UGA College of Public Health. “The take-home message is that when it’s easier for young people to get alcohol, birth outcomes are worse.”

via College of Public Health: Health Policy and Management News.

JAMA | Regulating the Safety of Pharmaceuticals: The FDA, Preemption, and the Public’s Health, May 20, 2009, Gostin 301 (19): 2036

Lawrence O. Gostin, JD. Regulating the Safety of Pharmaceuticals:  The FDA, Preemption, and the Public’s Health. JAMA. 2009;301(19):2036-2037.

In 2008, the US Supreme Court held that the Medical Device Amendments (MDA) bar common law claims challenging the safety or effectiveness of a medical device approved by the US Food and Drug Administration (FDA).1 Riegel v Medtronic Inc2 had broad implications for patient safety because it removed all means of judicial recourse for most consumers injured by defective medical devices. At that time, the Supreme Court agreed to hear Wyeth v Levine,3 which consumer safety advocates feared would similarly preempt pharmaceutical lawsuits with far-reaching effects. There are 11 000 FDA-regulated drugs, with nearly 100 more approved each year,4 and patients would have no safety net in the event the FDA fails to detect and correct safety hazards. In a recent 6-3 decision, the Supreme Court ruled that the FDA’s approval of a drug label does not preempt a state law product liability claim charging the . . . [Full Text].  Source: JAMA — Regulating the Safety of Pharmaceuticals: The FDA, Preemption, and the Public’s Health, May 20, 2009, Gostin 301 (19): 2036.

The Commonwealth Fund | Policy Brief: Extra Payments to Medicare Advantage Plans to Total $11.4 Billion in 2009, or More Than $1,100 Per Enrollee –

B. Biles, J. Pozen, and S. Guterman, The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009, The Commonwealth Fund, May 2009.  [Full text]

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, MA plans have, for the past six years, been paid more for their enrollees than they would be expected to cost in traditional fee-for-service Medicare. Payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee, for a total of $11.4 billion. Although the extra payments are used to provide enrollees additional benefits, those benefits are not available to all beneficiaries—but they are financed by general program funds. If payments to MA plans were instead equal to the spending level under traditional Medicare, the more than $150 billion in savings over 10 years could be used to finance improved benefits for the low-income elderly and disabled, or for expanding health-insurance coverage. More at The Commonwealth Fund.

Urban Institute | Health Reform: The Cost of Failure

John Holahan, Bowen Garrett, Irene Headen, Aaron Lucas. Health Reform: The Cost of Failure. Washington, DC: Urban Institute, May 21, 2009.  Summary. Full Text.

This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.