MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Health Affairs' source. Thu, 18 Mar 2010 15:52:15 +0100 http://www.medworm.com/index.php?rid=3357484&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.1019v1%3Frss%3D1 We examined public perceptions of health care access and quality for the uninsured over time, and we found that Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3357484 Thu, 11 Mar 2010 12:00:22 +0100 3357484 http://www.medworm.com/index.php?rid=3325751&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.1113v1%3Frss%3D1 We have developed a new approach to child obesity that supports the delivery of so-called secondary care—referral-based specialized visits—by primary care teams within community health centers. The Healthy Weight Clinic reorganizes care to provide access to a trained team consisting of a pediatric provider, nutritionist, and case manager during dedicated weight management visits. Our model improves obesity care by promoting local specialization and increasing capacity for specialized care; building multidisciplinary teams within primary care; focusing on health behavior change as a critical determinant of chronic disease outcomes; and using health information technology to promote high-quality care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3325751 Tue, 02 Mar 2010 12:00:38 +0100 3325751 http://www.medworm.com/index.php?rid=3321005&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F567-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321005 Tue, 02 Mar 2010 02:01:32 +0100 3321005 http://www.medworm.com/index.php?rid=3321004&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F567%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321004 Tue, 02 Mar 2010 02:01:32 +0100 3321004 http://www.medworm.com/index.php?rid=3321003&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F566-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321003 Tue, 02 Mar 2010 02:01:32 +0100 3321003 http://www.medworm.com/index.php?rid=3321002&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F566-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321002 Tue, 02 Mar 2010 02:01:32 +0100 3321002 http://www.medworm.com/index.php?rid=3321001&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F566%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321001 Tue, 02 Mar 2010 02:01:32 +0100 3321001 http://www.medworm.com/index.php?rid=3321000&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F565-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3321000 Tue, 02 Mar 2010 02:01:32 +0100 3321000 http://www.medworm.com/index.php?rid=3320999&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F565-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320999 Tue, 02 Mar 2010 02:01:32 +0100 3320999 http://www.medworm.com/index.php?rid=3320998&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F565%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320998 Tue, 02 Mar 2010 02:01:32 +0100 3320998 http://www.medworm.com/index.php?rid=3320997&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F563%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320997 Tue, 02 Mar 2010 02:01:32 +0100 3320997 http://www.medworm.com/index.php?rid=3320996&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F558%3Frss%3D1 For the money spent on health care in the United States, far better quality of care should be expected. The Commonwealth Fund and AcademyHealth have created the State Quality Improvement Institute to assist states in implementing sustainable quality improvement strategies. Lessons have emerged about the role of states in advancing fundamental and systemic changes in the way care is delivered, as well as how providers are organized and compensated. The experiences of states participating in the institute may offer insights for other states seeking to achieve similar goals. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320996 Tue, 02 Mar 2010 02:01:32 +0100 3320996 http://www.medworm.com/index.php?rid=3320995&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F554%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320995 Tue, 02 Mar 2010 02:01:32 +0100 3320995 http://www.medworm.com/index.php?rid=3320994&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F551%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320994 Tue, 02 Mar 2010 02:01:32 +0100 3320994 http://www.medworm.com/index.php?rid=3320993&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F544%3Frss%3D1 The suspected burden that undocumented immigrants may place on the U.S. health care system has been a flashpoint in health care and immigration reform debates. An examination of health care spending during 1999–2006 for adult naturalized citizens and immigrant noncitizens (which includes some undocumented immigrants) finds that the cost of providing health care to immigrants is lower than that of providing care to U.S. natives and that immigrants are not contributing disproportionately to high health care costs in public programs such as Medicaid. However, noncitizen immigrants were found to be more likely than U.S. natives to have a health care visit classified as uncompensated care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320993 Tue, 02 Mar 2010 02:01:31 +0100 3320993 http://www.medworm.com/index.php?rid=3320992&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F537%3Frss%3D1 Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon. How much of these differences can be explained by Medicare’s paying more to compensate for the higher cost of goods and services in such areas? To answer this question, we analyzed Medicare spending after adjusting for local price differences in 306 Hospital Referral Regions. The price-adjustment analysis resulted in less variation in what Medicare pays regionally, but not much. The findings suggest that utilization—not local price differences—drives Medicare regional payment variations, along with special payments for medical education and care for the poor. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320992 Tue, 02 Mar 2010 02:01:31 +0100 3320992 http://www.medworm.com/index.php?rid=3320991&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F530%3Frss%3D1 Value-based insurance design reduces patient copayments to encourage the use of health care services of high clinical value. As employers face constant pressure to control health care costs, this type of coverage has received much attention as a cost-savings device. This paper’s examination of one value-based insurance design program found that the program led to reduced use of nondrug health care services, offsetting the costs associated with additional use of drugs encouraged by the program. The findings suggest that value-based insurance design programs do not increase total systemwide medical spending. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320991 Tue, 02 Mar 2010 02:01:31 +0100 3320991 http://www.medworm.com/index.php?rid=3320990&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F522%3Frss%3D1 The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320990 Tue, 02 Mar 2010 02:01:31 +0100 3320990 http://www.medworm.com/index.php?rid=3320989&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F513%3Frss%3D1 The impact of childhood obesity on the workplace is not well understood. A study conducted for one large employer indicated that average per capita health insurance claims costs were as high as $2,907 in 2008 for an obese child and $10,789 for a child with type II diabetes. The average claims cost for children with type II diabetes actually exceeded the level of the average claims cost for adults with type II diabetes ($8,844). This paper reviews the evidence on the impact of childhood obesity on employers and discusses opportunities for business engagement—including two current examples of activities involving employers. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320989 Tue, 02 Mar 2010 02:01:31 +0100 3320989 http://www.medworm.com/index.php?rid=3320988&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F503%3Frss%3D1 We examine the impact of neighborhood socioeconomic conditions and "built environments" on obesity and overweight prevalence among U.S. children and adolescents using the 2007 National Survey of Children’s Health. The odds of a child’s being obese or overweight were 20–60 percent higher among children in neighborhoods with the most unfavorable social conditions such as unsafe surroundings; poor housing; and no access to sidewalks, parks, and recreation centers than among children not facing such conditions. The effects were much greater for females and younger children; for example, girls ages 10–11 were two to four times more likely than their counterparts from more favorable neighborhoods to be overweight or obese. Our findings can contribute to policy decisi... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320988 Tue, 02 Mar 2010 02:01:31 +0100 3320988 http://www.medworm.com/index.php?rid=3320987&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F498%3Frss%3D1 Geographic information system (GIS) mapping can help communities visualize the health of their neighborhoods and identify opportunities for improvement. In Austin, Texas, Children’s Optimal Health, a nonprofit association, used GIS to map the prevalence of obesity among middle school children and to identify contributory factors. The maps indicated that obesity is a problem in all Austin middle schools. Two neighborhoods outside downtown Austin have particularly high concentrations of overweight and obese students. Maps also showed that the neighborhoods have different proportions of fast-food outlets, grocery stores selling fresh produce, green recreation space, and students failing cardiovascular testing. The mapping exercise spurred community groups to propose obesity intervention... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320987 Tue, 02 Mar 2010 02:01:31 +0100 3320987 http://www.medworm.com/index.php?rid=3320986&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F491%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320986 Tue, 02 Mar 2010 02:01:31 +0100 3320986 http://www.medworm.com/index.php?rid=3320985&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F481%3Frss%3D1 In 2006, approximately 37 percent of Delaware’s children were overweight or obese. To combat Delaware’s childhood obesity epidemic, Nemours, a leading child health care provider, launched a statewide program to improve child health. The "social-ecological" strategy reaches beyond clinical encounters to promote better health and behavior at multiple levels. Early results show that the initiative halted the increase in the prevalence of overweight and obese children, since no statistically significant change occurred during the two-year span between administrations of the Delaware Survey on Children’s Health. The initiative also spurred increased knowledge of healthy eating and awareness of the need for increased physical activity in school, child care, and primary car... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320985 Tue, 02 Mar 2010 02:01:31 +0100 3320985 http://www.medworm.com/index.php?rid=3320984&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F473%3Frss%3D1 In 2001 the Food Trust, a nonprofit organization committed to ensuring access to affordable, nutritious food, focused attention on the lack of access to healthy foods in Philadelphia by creating food access maps and convening a task force. The campaign led to the creation of a statewide initiative that to date has funded seventy-eight fresh food outlets in Pennsylvania, increasing food access for 500,000 children and adults. This success has led to interest from other states and the federal government in expanding the initiative. Here we present the Food Trust’s five-step framework for increasing access to fresh, healthy food in other locales. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320984 Tue, 02 Mar 2010 02:01:31 +0100 3320984 http://www.medworm.com/index.php?rid=3320983&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F463%3Frss%3D1 Data on childhood obesity collected by the Centers for Disease Control and Prevention helped reveal the nation’s epidemic of overweight and obese children. But more information is needed. Collecting body mass index (BMI)—the widely accepted measurement of childhood weight status—at the state and local levels can be instrumental in identifying and tracking obesity trends, designing interventions to help overweight children, and guiding broader policy solutions. Approximately thirty states have enacted or proposed BMI surveillance laws and regulations. Arkansas stands out as the state with the highest-quality surveillance data. Innovative strategies being pursued in a number of other states should be explored for broader dissemination. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320983 Tue, 02 Mar 2010 02:01:31 +0100 3320983 http://www.medworm.com/index.php?rid=3320982&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F454%3Frss%3D1 Head Start provides early childhood education to nearly one million low-income children, through federal grants to more than 2,000 local programs. About one-third of children who enter Head Start are overweight or obese. But program directors face difficulty in implementing policies and practices to address obesity—and in our national survey, they identified the key barriers as lack of time, money, and knowledge. Also, parents and staff sometimes shared cultural beliefs that were inconsistent with preventing obesity, such as the belief that heavier children are healthier. Minimizing those barriers will require federal resources to increase staff training and technical assistance, develop staff wellness programs, and provide healthy meals and snacks. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320982 Tue, 02 Mar 2010 02:01:31 +0100 3320982 http://www.medworm.com/index.php?rid=3320981&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F447%3Frss%3D1 Federal legislation aimed at tackling the nation’s soaring childhood obesity rate through changes to school meals and nutrition and wellness programs has met with mixed results. An examination of Pennsylvania’s response to the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, one of the most comprehensive state responses, found improvements to the nutritional quality of foods offered à la carte in conjunction with school meal programs. However, multiple weaknesses remain. Consistent wellness policy implementation steps were not followed, and there was inadequate statewide enforcement. Despite this, Pennsylvania can offer lessons for other states in moving forward with programs to promote good nutrition and wellness. (Source: Health Affai... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320981 Tue, 02 Mar 2010 02:01:31 +0100 3320981 http://www.medworm.com/index.php?rid=3320980&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F436%3Frss%3D1 We examined whether new policies restricting sales in schools of so-called competitive foods and beverages—those that fall outside of what is served through federally reimbursed school meal programs—influenced increasing rates of overweight children in the Los Angeles Unified School District and the rest of California. After these policies, which set stricter nutrition standards for certain food and beverages sold to students, took effect, the rate of increase in overweight children significantly diminished among fifth graders in Los Angeles and among fifth-grade boys and seventh graders in the rest of California. The extent to which the new nutritional policies contributed to the change is unclear. This is one of the first studies examining the postulated population-level infl... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320980 Tue, 02 Mar 2010 02:01:31 +0100 3320980 http://www.medworm.com/index.php?rid=3320979&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F430%3Frss%3D1 Almost one-third of American children and adolescents are now either overweight or obese. One contributing factor may be the foods and beverages sold outside of the U.S. Department of Agriculture (USDA) school meal programs, which are often called "competitive foods." These foods, such as cookies, chips, and sodas, are often available through vending machines, snack bars, and other outlets on school premises. They are not required to conform to the nutritional standards of the USDA school meal programs. This paper looks at the research into whether these competitive foods may be affecting students’ dietary intake or contributing to their risk of obesity. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320979 Tue, 02 Mar 2010 02:01:31 +0100 3320979 http://www.medworm.com/index.php?rid=3320978&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F425%3Frss%3D1 Proposed regulations targeting food marketing to children typically focus on traditional media, such as television, radio, and print ads. However, the widespread use of the Internet has promulgated novel food marketing strategies such as "advergaming," or the use of online games incorporating advertisements. In addition, the advent of so-called neuromarketing research is also allowing advertisers to appeal to the subconscious and emotional effects of food and beverage products, to which children may be particularly vulnerable. Current and future regulatory efforts should address the ubiquitous but often subtle marketing to which children are exposed and should measure success in terms of children’s consumption of these products. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320978 Tue, 02 Mar 2010 02:01:31 +0100 3320978 http://www.medworm.com/index.php?rid=3320977&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F419%3Frss%3D1 To address the obesity crisis, public health experts recommend major reductions in the marketing of unhealthy food to youth. However, policies to restrict food marketing are not currently viewed as politically feasible. This paper examines attitudes and knowledge about food marketing and support for restricting unhealthy food marketing restrictions among one group of constituents: parents. A survey of 807 parents found that those most likely to support food marketing restrictions were also more likely to have negative views. These findings suggest that increased public education about the harm caused by food marketing may increase public support for policy interventions. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320977 Tue, 02 Mar 2010 02:01:31 +0100 3320977 http://www.medworm.com/index.php?rid=3320976&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F411%3Frss%3D1 Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children’s weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320976 Tue, 02 Mar 2010 02:01:31 +0100 3320976 http://www.medworm.com/index.php?rid=3320975&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F405%3Frss%3D1 For thirty-five years, U.S. agriculture has operated under a "cheap food" policy that spurred production of a few commodity crops, not fruit or vegetables, and thus of the calories from them. A key driver of childhood obesity is the consumption of excess calories, many from inexpensive, nutrient-poor snacks, sweets, and sweetened beverages made with fats and sugars derived from these policy-supported crops. Limiting or eliminating farm subsidies to commodity farmers is wrongly perceived as a quick fix to a complex agricultural system, evolved over decades, that promotes obesity. Yet this paper does set forth a series of policy recommendations that could help, including managing commodity crop oversupply and supporting farmers who produce more fruit and vegetables to build a healthier, more... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320975 Tue, 02 Mar 2010 02:01:31 +0100 3320975 http://www.medworm.com/index.php?rid=3320974&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F398%3Frss%3D1 Nationally representative surveys of food intake in U.S. children show large increases in snacking between the 1989–91 to 1994–98 and 1994–98 to 2003–06 periods. Childhood snacking trends are moving toward three snacks per day, and more than 27 percent of children’s daily calories are coming from snacks. The largest increases have been in salty snacks and candy. Desserts and sweetened beverages remain the major sources of calories from snacks. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320974 Tue, 02 Mar 2010 02:01:31 +0100 3320974 http://www.medworm.com/index.php?rid=3320973&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F393%3Frss%3D1 As scientists currently understand the phenomenon, widespread obesity represents an interaction of genes and the environment. Throughout human history, the ability to gain weight enabled humans to survive food shortages by tapping energy reserves stored in body fat. Today, an overabundance of calorie-rich foods enables calorie intakes that can overwhelm the body’s weight-regulatory system. Genetic variation also makes some people more vulnerable than others to weight gain. Finally, there is a growing understanding of the deleterious biological and physiological consequences of accumulating too much fat. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320973 Tue, 02 Mar 2010 02:01:31 +0100 3320973 http://www.medworm.com/index.php?rid=3320972&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F388%3Frss%3D1 Overcoming the childhood obesity epidemic will require changes on the scale of a social movement similar to the shift in attitudes and regulations toward smoking and tobacco. Tobacco control became a successful public health movement because of shifts in social norms and because cigarette companies came to be perceived by many as a common enemy. In contrast, obesity advocates have not identified a common threat or mobilized grass-roots change, nor have they identified strategies that resonate across diverse settings and constituencies. Framing obesity as a common threat can lead to consensus regarding the interventions needed to achieve healthier children and communities. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320972 Tue, 02 Mar 2010 02:01:31 +0100 3320972 http://www.medworm.com/index.php?rid=3320971&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F379%3Frss%3D1 The concept of personal responsibility has been central to social, legal, and political approaches to obesity. It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. These environmental conditions can override individual physical and psychological regulatory systems that might otherwise stand in the way of weight gain and obesity, hence undermining personal responsibility, narrowing choices, and eroding personal freedoms. Personal responsibility can be embraced as a value by placing priority on legislative and regulatory actions such as improving school nutrition, menu labeling, altering industry marketing practices, and even such controversial measures a... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320971 Tue, 02 Mar 2010 02:01:31 +0100 3320971 http://www.medworm.com/index.php?rid=3320970&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F372%3Frss%3D1 Policy makers generally agree that childhood obesity is a national problem. However, it is not always clear whether enough is being spent to combat it. This paper presents nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups. A mathematical model was then used to project lifetime health and economic gains. Spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point. The analysis also found that childhood obesity has more profound economic consequences than previously documented. Large investments to reduce this major contributor to adult disability may thus be cost-effective by widely accepted criteria. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320970 Tue, 02 Mar 2010 02:01:31 +0100 3320970 http://www.medworm.com/index.php?rid=3320969&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F364%3Frss%3D1 In the past few decades, obesity rates among American children have skyrocketed. Although many factors have played a part in this unhealthy increase, this paper focuses on how economic policies may be contributing to our children’s growing girth and how these policies might be altered to reverse this trend. It examines the economic causes and consequences of obesity, the rationales for government intervention, the cost-effectiveness of various policies, and the need for more research funding. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320969 Tue, 02 Mar 2010 02:01:31 +0100 3320969 http://www.medworm.com/index.php?rid=3320968&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F357%3Frss%3D1 Childhood obesity is epidemic in the United States, and is expected to increase the rates of many chronic diseases. Increasing physical activity and improving nutrition are keys to obesity prevention and control. But changing individual behavior is difficult. A comprehensive, coordinated strategy is needed. Policy interventions that make healthy dietary and activity choices easier are likely to achieve the greatest benefits. There is emerging evidence on how to address childhood obesity, but we must take action now to begin to reverse the epidemic. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320968 Tue, 02 Mar 2010 02:01:31 +0100 3320968 http://www.medworm.com/index.php?rid=3320967&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F347%3Frss%3D1 New data from the 2007 National Survey of Children’s Health show that the percentage of children ages 10–17 who are overweight (body mass index in the eighty-fifth to ninety-fourth percentiles) remained stable, while the national prevalence of obesity (BMI in the ninety-fifth percentile and higher) grew significantly, from 14.8 percent in 2003 to 16.4 percent in 2007. This increase in obesity accounted for the entire increase in the combined prevalence of overweight and obesity between 2003 and 2007 (from 30.6 percent to 31.6 percent). An estimated 10.58 million children, or nearly one in three children ages 10–17, were overweight or obese in 2007. Our findings suggest that the obesity epidemic among children may not yet have reached its plateau f... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320967 Tue, 02 Mar 2010 02:01:31 +0100 3320967 http://www.medworm.com/index.php?rid=3320966&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F346%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320966 Tue, 02 Mar 2010 02:01:31 +0100 3320966 http://www.medworm.com/index.php?rid=3320965&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F3%2F343%3Frss%3D1 Health Affairs founding editor John K. Iglehart writes about federally qualified community health centers and their increasingly important role as safety-net providers. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320965 Tue, 02 Mar 2010 02:01:31 +0100 3320965 http://www.medworm.com/index.php?rid=3320964&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F3%2F342%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3320964 Tue, 02 Mar 2010 02:01:31 +0100 3320964 http://www.medworm.com/index.php?rid=3310175&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0715v1%3Frss%3D1 Faced with declining payment rates, California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout. California’s experience is a cautionary tale for national health reform: It suggests that proposals to promote integrated care through models such as accountable care organizations (ACOs) could lead to higher rates for private payers. Because antitrust policy has proved ineffective in curbing most provider strategies that capitalize on providers’ market power to win higher payments, policy makers need to consider approaches including price caps and all-payer rate setting. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3310175 Thu, 25 Feb 2010 12:00:23 +0100 3310175 http://www.medworm.com/index.php?rid=3286503&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0474v1%3Frss%3D1 Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs. Health reform must address changed health needs through evidence-based community prevention, care coordination, and support for patient self-management. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3286503 Thu, 18 Feb 2010 12:00:30 +0100 3286503 http://www.medworm.com/index.php?rid=3286502&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0609v2%3Frss%3D1 Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon. How much of these differences can be explained by Medicare’s paying more to compensate for the higher cost of goods and services in such areas? To answer this question, we analyzed Medicare spending after adjusting for local price differences in 306 Hospital Referral Regions. The price-adjustment analysis resulted in less variation in what Medicare pays regionally, but not much. The findings suggest that utilization—not local price differences—drives Medicare regional payment variations, along with special payments for medical education and care for the poor. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3286502 Thu, 18 Feb 2010 12:00:27 +0100 3286502 http://www.medworm.com/index.php?rid=3286501&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.1074v2%3Frss%3D1 The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3286501 Thu, 18 Feb 2010 12:00:26 +0100 3286501 http://www.medworm.com/index.php?rid=3286504&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0119v2%3Frss%3D1 Value-based insurance design reduces patient copayments to encourage the use of health care services of high clinical value. As employers face constant pressure to control health care costs, this type of coverage has received much attention as a cost-savings device. This paper’s examination of one value-based insurance design program found that the program led to reduced use of nondrug health care services, offsetting the costs associated with additional use of drugs encouraged by the program. The findings suggest that value-based insurance design programs do not increase total systemwide medical spending. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3286504 Thu, 18 Feb 2010 12:00:23 +0100 3286504 http://www.medworm.com/index.php?rid=3265677&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0400v1%3Frss%3D1 The suspected burden that undocumented immigrants may place on the U.S. health care system has been a flashpoint in health care and immigration reform debates. An examination of health care spending during 1999–2006 for adult naturalized citizens and immigrant noncitizens (which includes some undocumented immigrants) finds that the cost of providing health care to immigrants is lower than that of providing care to U.S. natives and that immigrants are not contributing disproportionately to high health care costs in public programs such as Medicaid. However, noncitizen immigrants were found to be more likely than U.S. natives to have a health care visit classified as uncompensated care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3265677 Thu, 11 Feb 2010 12:00:25 +0100 3265677 http://www.medworm.com/index.php?rid=3242504&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.1074v1%3Frss%3D1 The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3242504 Thu, 04 Feb 2010 12:00:03 +0100 3242504 http://www.medworm.com/index.php?rid=3230310&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F333-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230310 Tue, 02 Feb 2010 01:14:01 +0100 3230310 http://www.medworm.com/index.php?rid=3230309&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F333-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230309 Tue, 02 Feb 2010 01:14:01 +0100 3230309 http://www.medworm.com/index.php?rid=3230308&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F333%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230308 Tue, 02 Feb 2010 01:14:01 +0100 3230308 http://www.medworm.com/index.php?rid=3230307&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F332-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230307 Tue, 02 Feb 2010 01:14:01 +0100 3230307 http://www.medworm.com/index.php?rid=3230306&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F332-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230306 Tue, 02 Feb 2010 01:14:01 +0100 3230306 http://www.medworm.com/index.php?rid=3230305&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F332%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230305 Tue, 02 Feb 2010 01:14:01 +0100 3230305 http://www.medworm.com/index.php?rid=3230304&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F330%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230304 Tue, 02 Feb 2010 01:14:01 +0100 3230304 http://www.medworm.com/index.php?rid=3230303&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F329%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230303 Tue, 02 Feb 2010 01:14:01 +0100 3230303 http://www.medworm.com/index.php?rid=3230302&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F327%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230302 Tue, 02 Feb 2010 01:14:01 +0100 3230302 http://www.medworm.com/index.php?rid=3230301&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F324%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230301 Tue, 02 Feb 2010 01:14:01 +0100 3230301 http://www.medworm.com/index.php?rid=3230300&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F318%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230300 Tue, 02 Feb 2010 01:14:01 +0100 3230300 http://www.medworm.com/index.php?rid=3230299&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F312%3Frss%3D1 The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230299 Tue, 02 Feb 2010 01:14:00 +0100 3230299 http://www.medworm.com/index.php?rid=3230298&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F304%3Frss%3D1 Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230298 Tue, 02 Feb 2010 01:14:00 +0100 3230298 http://www.medworm.com/index.php?rid=3230297&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F297%3Frss%3D1 New research provides revised comprehensive estimates that suggest that the U.S. national economic burden of pre-diabetes and diabetes reached $218 billion in 2007. This estimate includes $153 billion in higher medical costs and $65 billion in reduced productivity. The average annual cost per case is $2,864 for undiagnosed diabetes, $9,975 for diagnosed diabetes ($9,677 for type 2 and $14,856 for type 1), and $443 for pre-diabetes (medical costs only). For each American, regardless of diabetes status, this burden represents a cost of approximately $700 annually. These results underscore the urgency of better understanding how prevention and treatment strategies may or may not help reduce costs. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230297 Tue, 02 Feb 2010 01:14:00 +0100 3230297 http://www.medworm.com/index.php?rid=3230296&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F289%3Frss%3D1 Federally qualified health centers play a major role in providing health care to the underserved, and will remain an important part of the health care safety net even under reforms that will increase the number of Americans with health insurance. We show that the investments made in federally qualified health centers during 1996–2006 clearly translated into an increase in services available to patients, including mental health and substance abuse treatment and counseling and staffing. One particularly notable finding is that an additional $500,000 in federal grants translates into 540 more uninsured patients treated. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230296 Tue, 02 Feb 2010 01:14:00 +0100 3230296 http://www.medworm.com/index.php?rid=3230295&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F284%3Frss%3D1 Effective health information systems require timely access to all health data from all sources, including sites of direct care. In most parts of the world today, these data most likely come from many different and unconnected systems—but must be organized into a composite whole. We use the word interoperability to capture what is required to accomplish this goal. We discuss five priority areas for achieving interoperability in health care applications (patient identifier, semantic interoperability, data interchange standards, core data sets, and data quality), and we contrast differences in developing and developed countries. Important next steps for health policy makers are to define a vision, develop a strategy, identify leadership, assign responsibilities, and harness resources. (... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230295 Tue, 02 Feb 2010 01:14:00 +0100 3230295 http://www.medworm.com/index.php?rid=3230294&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F278%3Frss%3D1 Around the world, inventors are creating novel information and communication technology applications and systems that can improve health for people in disparate settings. However, it is very difficult to find investment funding needed to create business models to expand and develop the prototype technologies. A comprehensive, long-term investment strategy for e-health and m-health is needed. The field of social entrepreneurship offers an integrated approach to develop needed investment models, so that innovations can reach more patients, more effectively. Specialized financing techniques and sustained support from investors can spur the expansion of mature technologies to larger markets, accelerating global health impacts. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230294 Tue, 02 Feb 2010 01:14:00 +0100 3230294 http://www.medworm.com/index.php?rid=3230293&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F274%3Frss%3D1 We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230293 Tue, 02 Feb 2010 01:14:00 +0100 3230293 http://www.medworm.com/index.php?rid=3230292&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F268%3Frss%3D1 Collecting, managing, and communicating information is a critical part of delivering high-quality, efficient health care. Low-income countries often lack the information technology that is taking root in developed countries to manage health data and work toward evidence-based practice and culture. Partnerships between academic and government institutions in high- and low-income countries can help establish health informatics programs. These programs, in turn, can capture and manage data that are useful to all parties. Several partnerships among academic institutions and public and private organizations, in areas such as sub-Saharan Africa, Haiti, and Peru, are leading the way. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230292 Tue, 02 Feb 2010 01:14:00 +0100 3230292 http://www.medworm.com/index.php?rid=3230291&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F264%3Frss%3D1 Partnerships among health care and information technology researchers and designers worldwide are creating mobile health tools tailored to local community needs and resources. Much of the hardware and infrastructure comes from developed countries of the so-called global North. From both these countries as well as developing countries in the global "South" are coming applications that enable health workers to collect and organize data, access diagnostic and treatment support, and promote healthy behavior. Most are still in pilots or demonstration phases, but their use is accelerating. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230291 Tue, 02 Feb 2010 01:14:00 +0100 3230291 http://www.medworm.com/index.php?rid=3230290&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F259%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230290 Tue, 02 Feb 2010 01:14:00 +0100 3230290 http://www.medworm.com/index.php?rid=3230289&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F252%3Frss%3D1 Developing countries face steady growth in the prevalence of chronic diseases, along with a continued burden from communicable diseases. "Mobile" health, or m-health—the use of mobile technologies such as cellular phones to support public health and clinical care—offers promise in responding to both types of disease burdens. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. We examine various m-health applications and define the risks and benefits of each. We find positive examples but little solid evaluation of clinical or economic performance, which highlights the need for such evaluation. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230289 Tue, 02 Feb 2010 01:14:00 +0100 3230289 http://www.medworm.com/index.php?rid=3230288&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F244%3Frss%3D1 Is there any evidence that e-health—using information technology to manage patient care—can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230288 Tue, 02 Feb 2010 01:14:00 +0100 3230288 http://www.medworm.com/index.php?rid=3230287&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F237%3Frss%3D1 E-health (information and communication technology that facilitates health and health care) is expanding in developed, developing, and least-developed countries. E-health’s ability to transcend sociopolitical boundaries holds the potential to create a borderless world for health systems and health care delivery. But the policy needed to guide e-health development is limited and just now emerging in developed countries. What’s needed to foster e-health growth in the developing world is thoughtful policy to facilitate patient mobility and data exchange, across both international borders and regional boundaries within countries. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230287 Tue, 02 Feb 2010 01:14:00 +0100 3230287 http://www.medworm.com/index.php?rid=3230286&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F233%3Frss%3D1 Use of e-health, or electronic information technologies, has spread to cities and remote villages worldwide. Countries such as Rwanda are activating nationwide e-health networks. The Rockefeller Foundation’s month-long 2008 conference Making the eHealth Connection: Global Partners, Local Solutions accelerated this process. Conference participants proposed global partnerships, health technology solutions based on local needs, cross-border interoperability, leveraging current open-source networks, and shared informatics systems; they achieved progress on a shared, cross-border understanding of e-health solutions and policy. Early steps toward furthering these goals include creation of a new organization, the mHealth Alliance, to coordinate efforts, but collaborative investments are nee... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230286 Tue, 02 Feb 2010 01:14:00 +0100 3230286 http://www.medworm.com/index.php?rid=3230285&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F232%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230285 Tue, 02 Feb 2010 01:14:00 +0100 3230285 http://www.medworm.com/index.php?rid=3230284&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F2%2F230%3Frss%3D1 Health Affairs founding editor John K. Iglehart writes about the expanded role of Medicaid in a post-health care reform landscape. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230284 Tue, 02 Feb 2010 01:14:00 +0100 3230284 http://www.medworm.com/index.php?rid=3230283&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F2%2F229%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3230283 Tue, 02 Feb 2010 01:14:00 +0100 3230283 http://www.medworm.com/index.php?rid=3219185&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0609v1%3Frss%3D1 Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon. How much of these differences can be explained by Medicare’s paying more to compensate for the higher cost of goods and services in such areas? To answer this question, we analyzed Medicare spending after adjusting for local price differences in 306 Hospital Referral Regions. The price-adjustment analysis resulted in less variation in what Medicare pays regionally, but not much. The findings suggest that utilization—not local price differences—drives Medicare regional payment variations, along with special payments for medical education and care for the poor. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3219185 Thu, 28 Jan 2010 12:01:04 +0100 3219185 http://www.medworm.com/index.php?rid=3196539&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0119v1%3Frss%3D1 Value-based insurance design reduces patient copayments to encourage the use of health care services of high clinical value. As employers face constant pressure to control health care costs, this type of coverage has received much attention as a cost-savings device. This paper’s examination of one value-based insurance design program found that the program led to reduced use of nondrug health care services, offsetting the costs associated with additional use of drugs encouraged by the program. The findings suggest that value-based insurance design programs do not increase total systemwide medical spending. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3196539 Thu, 21 Jan 2010 12:00:58 +0100 3196539 http://www.medworm.com/index.php?rid=3174579&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0155v1%3Frss%3D1 New research provides revised comprehensive estimates that suggest that the U.S. national economic burden of pre-diabetes and diabetes reached $218 billion in 2007. This estimate includes $153 billion in higher medical costs and $65 billion in reduced productivity. The average annual cost per case is $2,864 for undiagnosed diabetes, $9,975 for diagnosed diabetes ($9,677 for type 2 and $14,856 for type 1), and $443 for pre-diabetes (medical costs only). For each American, regardless of diabetes status, this burden represents a cost of approximately $700 annually. These results underscore the urgency of better understanding how prevention and treatment strategies may or may not help reduce costs. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3174579 Thu, 14 Jan 2010 15:01:21 +0100 3174579 http://www.medworm.com/index.php?rid=3174578&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0626v1%3Frss%3D1 Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3174578 Thu, 14 Jan 2010 15:01:18 +0100 3174578 http://www.medworm.com/index.php?rid=3152056&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0966v1%3Frss%3D1 The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3152056 Thu, 07 Jan 2010 12:01:09 +0100 3152056 http://www.medworm.com/index.php?rid=3141423&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F223%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141423 Tue, 05 Jan 2010 01:16:58 +0100 3141423 http://www.medworm.com/index.php?rid=3141422&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F219%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141422 Tue, 05 Jan 2010 01:16:58 +0100 3141422 http://www.medworm.com/index.php?rid=3141421&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F212%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141421 Tue, 05 Jan 2010 01:16:58 +0100 3141421 http://www.medworm.com/index.php?rid=3141420&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F207%3Frss%3D1 This article describes some of the broad array of approaches they have taken—in such areas as aging in place, assisted living, "culture change" in nursing homes, quality improvement, augmenting the workforce, and paying for care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141420 Tue, 05 Jan 2010 01:16:58 +0100 3141420 http://www.medworm.com/index.php?rid=3141419&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F203%3Frss%3D1 After her mother is diagnosed with gallbladder cancer, a journalist researches how to help find effective therapies for patients who get rare diseases. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141419 Tue, 05 Jan 2010 01:16:58 +0100 3141419 http://www.medworm.com/index.php?rid=3141418&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F196%3Frss%3D1 A national survey of medical oncologists indicates that rising cancer treatment costs are influencing clinical practice, even as oncologists tend not to communicate with patients about costs. The survey shows that 84 percent of oncologists say that patients’ out-of-pocket spending influences treatment recommendations. Only 43 percent always or frequently discuss costs with patients. Among those surveyed, 79 percent favor more comparative effectiveness research; 80 percent support more cost-effectiveness data, although only 42 percent feel well prepared to interpret it. The results suggest that physicians support federally funded comparative effectiveness research but that they wish to retain a central role in making decisions about how and when to use expensi... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141418 Tue, 05 Jan 2010 01:16:58 +0100 3141418 http://www.medworm.com/index.php?rid=3141417&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F189%3Frss%3D1 The utilization rate of advanced diagnostic imaging (magnetic resonance imaging, computed tomography, and nuclear medicine) in Medicare outpatients rose 72.7 percent between 2000 and 2005, sparking concern among policymakers. However, analysis of discretionary use of these exams indicates that their use largely stabilized after 2005. Some have credited the Deficit Reduction Act of 2005, which sharply reduced reimbursements for advanced imaging done in physicians’ offices. But the fact that the leveling was more pronounced in hospital outpatient facilities than in physicians’ offices indicates that the explanation lies elsewhere. More likely, there has been a change in physicians’ ordering patterns, possibly due to the influence of radiology business management compan... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141417 Tue, 05 Jan 2010 01:16:58 +0100 3141417 http://www.medworm.com/index.php?rid=3141416&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F188%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141416 Tue, 05 Jan 2010 01:16:58 +0100 3141416 http://www.medworm.com/index.php?rid=3141415&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F182%3Frss%3D1 Hospitals’ boards may influence the quality of care that hospitals provide, but their engagement in quality-related issues is largely unknown. We surveyed a nationally representative sample of board chairs of 1,000 U.S. hospitals to understand their expertise, perspectives, and activities in clinical quality. We found that fewer than half of the boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality. The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141415 Tue, 05 Jan 2010 01:16:58 +0100 3141415 http://www.medworm.com/index.php?rid=3141414&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F174%3Frss%3D1 It’s often assumed that high-cost health insurance plans—sometimes called "Cadillac" plans—provide rich benefits to plan subscribers. Health reform provisions that treat these plans like luxuries may be misguided. Only 3.7 percent of variation in the cost of family coverage can be explained by benefit design (actuarial value). Benefit design plus plan type (HMO, PPO, POS, or high-deductible plans) explains 6.1 percent of this variation. Industry type and medical costs in the region also play a role. Most variation in premiums, however, remains largely unexplained. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141414 Tue, 05 Jan 2010 01:16:58 +0100 3141414 http://www.medworm.com/index.php?rid=3141413&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F165%3Frss%3D1 December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are finally grappling with balancing "no blame" and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B–, a modest improvement since 2004. (Source: H... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141413 Tue, 05 Jan 2010 01:16:58 +0100 3141413 http://www.medworm.com/index.php?rid=3141412&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F156%3Frss%3D1 This paper compares health plans currently available on the individual market with employer-sponsored plans. Points of comparison include the scope of benefits, cost-sharing provisions, premiums, expected out-of-pocket costs, and actuarial value. We draw from the 2007 KFF/HRET Health Benefits Survey, our own survey of individual-market plans, the MarketScan medical claims database, and a computer simulation of medical claims. We find that in 2007, employment-based plans covered 80 percent of all charges paid by the plan and the member, while individual plans covered 64 percent. For most people, premiums and out-of-pocket costs were more affordable in tax-advantaged employer plans than in individual-market plans. Proposed health reforms would fundamentally alter the plan offerings... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141412 Tue, 05 Jan 2010 01:16:58 +0100 3141412 http://www.medworm.com/index.php?rid=3141411&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F147%3Frss%3D1 In 2008, U.S. health care spending growth slowed to 4.4 percent—the slowest rate of growth over the past forty-eight years. The deceleration was broadly based for nearly all payers and health care goods and services, as growth in both price and nonprice factors slowed amid the recession. Despite the slowdown, national health spending reached $2.3 trillion, or $7,681 per person, and the health care portion of gross domestic product (GDP) grew from 15.9 percent in 2007 to 16.2 percent in 2008. These developments reflect the general pattern that larger increases in the health spending share of GDP generally occur during or just after periods of economic recession. Despite the overall slowdown in national health spending growth, increases in this spending continue to ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141411 Tue, 05 Jan 2010 01:16:58 +0100 3141411 http://www.medworm.com/index.php?rid=3141410&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F141%3Frss%3D1 Many employers have not placed a priority on addressing end-of-life issues. Yet these issues affect their employees who serve as caregivers to ailing parents and siblings, who experience a health crisis for themselves or a partner, or who care for a critically ill child. End-of life issues affect employers’ cost of benefits, workers’ productivity, and absentee and "presenteeism" rates, and they can undermine employees’ effectiveness at work. Some employers have begun to address end-of-life issues with targeted programs and are gathering data to evaluate their impacts. Potential solutions include using existing resources; training managers to assist employees in need; and monitoring the costs of end-of-life challenges. In an environment where end-of-life issues are politic... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141410 Tue, 05 Jan 2010 01:16:58 +0100 3141410 http://www.medworm.com/index.php?rid=3141409&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F136%3Frss%3D1 More than two-thirds of long-stay nursing home residents suffer from dementia. This illness has a variable and unpredictable course that renders it a poor fit for the six-month life-expectancy requirement of the Medicare hospice benefit. Palliative care—a form of treatment that strives to match care to patient goals, relieve pain, and improve quality of life for people with chronic or life-threatening illnesses—should be the standard of practice for all elderly dementia patients in nursing homes, regardless of prognosis. Similar principles could apply to other long-term residents with underlying chronic diseases who would benefit from palliative care. Indeed, we would argue that the growing acceptance of the culture-change movement centered on elder-directed goals in nursing ho... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141409 Tue, 05 Jan 2010 01:16:58 +0100 3141409 http://www.medworm.com/index.php?rid=3141408&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F130%3Frss%3D1 Many elderly people spend their final days in nursing homes. For them, high-quality end-of-life care is an important component of their overall care. Unfortunately, the Medicare hospice benefit—the primary source of palliative care coverage for Medicare beneficiaries—is a poor fit with the nursing home setting. We recommend creating a separate end-of-life Medicare benefit for nursing home residents based on documented need for services that neither requires physicians to certify a person’s prognosis, nor requires beneficiaries to choose it or to agree to forgo curative care. Nursing homes would be paid directly for end-of-life care services and held accountable for their quality. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141408 Tue, 05 Jan 2010 01:16:58 +0100 3141408 http://www.medworm.com/index.php?rid=3141407&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F125%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141407 Tue, 05 Jan 2010 01:16:58 +0100 3141407 http://www.medworm.com/index.php?rid=3141406&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F116%3Frss%3D1 Families are the bedrock of long-term care, but policymakers have traditionally considered them "informal" caregivers, as they are not part of the formal paid caregiving workforce. As chronic and long-term care systems have become more complex and as more demanding tasks have been shifted to families, this view is no longer sustainable. The care transition process offers a critical opportunity to treat family caregivers as important care partners. Enhancing their involvement, training, and support will contribute to reducing unnecessary rehospitalizations and improving patient outcomes. The contributions and experiences of family caregivers should be considered in gathering information to shape policies and practice; training health care professionals; developing programs; and reforming fi... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141406 Tue, 05 Jan 2010 01:16:58 +0100 3141406 http://www.medworm.com/index.php?rid=3141405&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F109%3Frss%3D1 There is a worsening shortage of competent, committed, paid long-term care workers who are able to meet the needs of older adults. Efforts to address the shortage must be informed by a conceptual framework that acknowledges the unique circumstances affecting these workers. These include nontraditional market forces, low compensation and prestige, limited career opportunities, and inadequate preparation for evolving roles and responsibilities. Applying this framework, we identify strategies that can reverse current trends by expanding worker supply; improving education, training, and developmental activities; and making delivery of long-term care services and supports to older people a more attractive alternative to employment in acute and primary care settings. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141405 Tue, 05 Jan 2010 01:16:58 +0100 3141405 http://www.medworm.com/index.php?rid=3141404&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F102%3Frss%3D1 A genetic marker known as apolipoprotein E provides a clear signal of a person’s risk of developing Alzheimer’s disease and thus that person’s future need for long-term care. People who find that they have the variant of the trait that increases Alzheimer’s disease risk are more likely to purchase long-term care insurance after receiving this information. If the information is widely introduced into the insurance market, coverage rates could be affected in different ways, depending on who possesses that information. Policymakers will eventually need to confront the issue of the use of this and other markers in the pricing of long-term care insurance. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141404 Tue, 05 Jan 2010 01:16:58 +0100 3141404 http://www.medworm.com/index.php?rid=3141403&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F96%3Frss%3D1 Discussions about long-term care financing often get mired in the false dichotomy that long-term care should be primarily either a public or a private responsibility. Our starting premise is that public and private long-term care coverage can best serve complementary roles. Therefore, public policy should focus on supporting both mechanisms to achieve efficient and equitable outcomes. The current state of the private long-term care insurance market, and the possible reasons for its modest size, provide a starting point for exploring how public policy might interface more productively with it, in the context of both existing and potential programs, such as the proposed Community Living Assistance Services and Supports (CLASS) Act. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141403 Tue, 05 Jan 2010 01:16:58 +0100 3141403 http://www.medworm.com/index.php?rid=3141402&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F87%3Frss%3D1 The U.S. Congress is considering the Community Living Assistance Services and Supports (CLASS) Act, a voluntary insurance program that would help pay for long-term services and supports to disabled Americans. In Germany and Japan, social insurance programs are universal, support family caregivers, and allow individuals considerable flexibility in securing the services they require. We explored differences between Germany and Japan in program goals, eligibility process, scope, size, and sustainability for possible applications in the United States. Moreover, when we compared public spending on long-term care, we found that spending in the United States is actually higher than in Germany even now, prior to enactment of the CLASS Act, and is only slightly lower than in Japan. (Source: Health ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141402 Tue, 05 Jan 2010 01:16:58 +0100 3141402 http://www.medworm.com/index.php?rid=3141401&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F81%3Frss%3D1 The traditional approaches to improving the quality of care at U.S. nursing homes—regulation, inspection, and accountability through public reporting—have produced modest results. Greater progress could be made by focusing incentives on broader processes related to improving quality. This could foster a culture of upstream identification and solving of problems that would supplement existing downstream requirements to meet specific safety and care standards. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141401 Tue, 05 Jan 2010 01:16:58 +0100 3141401 http://www.medworm.com/index.php?rid=3141400&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F74%3Frss%3D1 Recent trends in U.S. long-term care policy reflect three broad goals Americans have for the quality of long-term care: improving quality of life, reducing fragmentation of delivery and financing, and increasing use of home and community-based care. At the same time, market-based reforms—namely, public reporting and pay-for-performance—have taken on their own momentum, aimed at improving the clinical quality of care among nursing home and home health care providers. The focus of reporting systems should be broadened to include quality of life in addition to clinical quality and to make measures less dependent on the setting in which care is delivered. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141400 Tue, 05 Jan 2010 01:16:58 +0100 3141400 http://www.medworm.com/index.php?rid=3141399&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F65%3Frss%3D1 The proportion of Hispanics age sixty-five and older who are living in nursing homes rose from 5 percent in 2000 to 6.4 percent in 2005. Although segregation in nursing homes seems to have declined slightly, elderly Hispanics are more likely than their non-Hispanic white peers to reside in nursing homes that are characterized by severe deficiencies in performance, understaffing, and poor care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141399 Tue, 05 Jan 2010 01:16:58 +0100 3141399 http://www.medworm.com/index.php?rid=3141398&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F57%3Frss%3D1 Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006. Especially in an elderly population, cycling into and out of hospitals can be emotionally upsetting and can increase the likelihood of medical errors related to care coordination. Payment incentives in Medicare do not encourage providers to coordinate beneficiaries’ care. Revising these incentives could achieve major savings for providers and improved quality of life for beneficiaries. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141398 Tue, 05 Jan 2010 01:16:58 +0100 3141398 http://www.medworm.com/index.php?rid=3141397&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F49%3Frss%3D1 Consumer-directed long-term care service programs give participants the flexibility they want, while reducing unmet need for home and community-based services and supports. States’ efforts to expand such programs under Medicaid, including those supported by federal Cash and Counseling demonstration and evaluation grants, are often hindered by challenges related to costs, staffing and organizational issues, new infrastructure requirements, and resistance from stakeholders. Yet states have developed a number of successful strategies for overcoming these challenges, even in financially trying times. Their experiences offer valuable insights, guidance, and encouragement to other states contemplating consumer-directed service expansions. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141397 Tue, 05 Jan 2010 01:16:57 +0100 3141397 http://www.medworm.com/index.php?rid=3141396&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F44%3Frss%3D1 As millions of Americans age and exercise their preference for long-term care in the least restrictive environment, policymakers search for ways to increase community-based services. A new federal program—Money Follows the Person—is off to a slow but promising start. The program’s "downstream" approach moves residents out of nursing homes and into community care settings. For example, states with mature nursing home transition programs have managed to relocate 25–35 percent of their nursing home residents to assisted living. Other programs successfully using "upstream" strategies to keep people out of nursing homes have not been widely copied. The challenge for policymakers is to maintain funding and flexibility so that nursing homes are no longer the default o... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141396 Tue, 05 Jan 2010 01:16:57 +0100 3141396 http://www.medworm.com/index.php?rid=3141395&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F35%3Frss%3D1 In this study we used primary data that we collected on county-level assisted living supply to gain a fuller understanding of this sector nationally. Reflecting their reliance on private resources, assisted living facilities are located disproportionately in areas with higher educational attainment, income, and housing wealth. As this sector evolves, policymakers will have to contend with issues related to access to services, public financing, quality of care, and regulatory oversight. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141395 Tue, 05 Jan 2010 01:16:57 +0100 3141395 http://www.medworm.com/index.php?rid=3141394&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F29%3Frss%3D1 During the past century, long-term care in the United States has evolved through five cycles of development, each lasting approximately twenty years. Each, focusing on distinct concerns, produced unintended consequences. Each also added a layer to an accumulation of contradictory approaches—a patchwork system now pushed to the breaking point by increasing needs and financial pressures. Future policies must achieve a better synthesis of approaches inherited from the past, while addressing their unintended consequences. Foremost must be assuring access to essential care, delivery of high-quality services in an increasingly deinstitutionalized system, and a reduction in social and economic disparities. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141394 Tue, 05 Jan 2010 01:16:57 +0100 3141394 http://www.medworm.com/index.php?rid=3141393&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F22%3Frss%3D1 Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated. Gaps often exist in some services while there is overlap in others. This can lead to inefficient delivery of services and confusion among program recipients and providers alike. Spending on postacute services in Medicare and long-term care services in Medicaid has grown more rapidly than enrollment in either program since 1999. Although growing numbers of people receive home and community-based services paid for by the two programs, there are wide variations across states and among target groups. The system of long-term care is in need of structural reform. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141393 Tue, 05 Jan 2010 01:16:57 +0100 3141393 http://www.medworm.com/index.php?rid=3141392&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F29%2F1%2F11%3Frss%3D1 Long-term care in the United States is needed by 10.9 million community residents, half of them nonelderly, and 1.8 million nursing home residents, predominantly elderly. Ninety-two percent of community residents receive unpaid help, while 13 percent receive paid help. Paid community-based long-term care services are primarily funded by Medicaid or Medicare, while nursing home stays are primarily paid for by Medicaid plus out-of-pocket copayments. Per person expenditures are five times as high, and national expenditures three times as high, for nursing home residents compared to community residents. This suggests that a redistribution of spending across care settings might produce substantial savings or permit service expansions. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141392 Tue, 05 Jan 2010 01:16:57 +0100 3141392 http://www.medworm.com/index.php?rid=3141391&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F10%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141391 Tue, 05 Jan 2010 01:16:57 +0100 3141391 http://www.medworm.com/index.php?rid=3141390&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F8%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141390 Tue, 05 Jan 2010 01:16:57 +0100 3141390 http://www.medworm.com/index.php?rid=3141389&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F29%2F1%2F6%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3141389 Tue, 05 Jan 2010 01:16:57 +0100 3141389 http://www.medworm.com/index.php?rid=3055273&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2008.0430v1%3Frss%3D1 It’s often assumed that high-cost health insurance plans—sometimes called "Cadillac" plans—provide rich benefits to plan subscribers. Health reform provisions that treat these plans like luxuries may be misguided. Only 3.7 percent of variation in the cost of family coverage can be explained by benefit design (actuarial value). Benefit design plus plan type (HMO, PPO, POS, or high-deductible plans) explains 6.1 percent of this variation. Industry type and medical costs in the region also play a role. Most variation in premiums, however, remains largely unexplained. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=3055273 Thu, 03 Dec 2009 09:44:31 +0100 3055273 http://www.medworm.com/index.php?rid=3055272&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0060v1%3Frss%3D1 This paper compares health plans currently available on the individual market with employer-sponsored plans. Points of comparison include the scope of benefits, cost-sharing provisions, premiums, expected out-of-pocket costs, and actuarial value. We draw from the 2007 KFF/HRET Health Benefits Survey, our own survey of individual-market plans, the MarketScan medical claims database, and a computer simulation of medical claims. We find that in 2007, employment-based plans covered 80 percent of all charges paid by the plan and the member, while individual plans covered 64 percent. For most people, premiums and out-of-pocket costs were more affordable in tax-advantaged employer plans than in individual-market plans. Proposed health reforms would ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3055272 Thu, 03 Dec 2009 09:28:27 +0100 3055272 http://www.medworm.com/index.php?rid=3051076&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0785v2%3Frss%3D1 December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are finally grappling with balancing "no blame" and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B-, a modest improvement since 2004. (Source: Health Affai... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3051076 Wed, 02 Dec 2009 18:25:33 +0100 3051076 http://www.medworm.com/index.php?rid=3047103&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0785v1%3Frss%3D1 December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are finally grappling with balancing "no blame" and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B-, a modest improvement since 2004. (Source: Health Affai... Health Affairs journals http://www.medworm.com/rss/comments.php?id=3047103 Tue, 01 Dec 2009 10:34:54 +0100 3047103 http://www.medworm.com/index.php?rid=2969477&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2009.0297v1%3Frss%3D1 Hospitals' boards may influence the quality of care that hospitals provide, but their engagement in quality-related issues is largely unknown. We surveyed a nationally representative sample of board chairs of 1,000 U.S. hospitals to understand their expertise, perspectives, and activities in clinical quality. We found that fewer than half of the boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality. The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals. [Health Aff (Millwood). 2010;29(1): published online 6 November 2009; 10.1377/hlthaff.2009... Health Affairs journals http://www.medworm.com/rss/comments.php?id=2969477 Fri, 06 Nov 2009 08:55:54 +0100 2969477 http://www.medworm.com/index.php?rid=2953471&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1171%3Frss%3D1 This 2009 survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States finds wide differences in practice systems, incentives, perceptions of access to care, use of health information technology (IT), and programs to improve quality. Response rates exceeded 40 percent except in four countries: Canada, France, the United Kingdom, and the United States. U.S. and Canadian physicians lag in the adoption of IT. U.S. doctors were the most likely to report that there are insurance restrictions on obtaining medication and treatment for their patients and that their patients often have difficulty with costs. We believe that opportunities exist for cross-national learning in disease management, us... Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953471 Tue, 03 Nov 2009 01:03:48 +0100 2953471 http://www.medworm.com/index.php?rid=2953470&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1160%3Frss%3D1 Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953470 Tue, 03 Nov 2009 01:03:48 +0100 2953470 http://www.medworm.com/index.php?rid=2953469&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1151%3Frss%3D1 In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions. Undiagnosed and uncontrolled chronic illness, which is common among insured people, is even more frequent among the uninsured. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953469 Tue, 03 Nov 2009 01:03:48 +0100 2953469 http://www.medworm.com/index.php?rid=2953468&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1141%3Frss%3D1 Among nonelderly U.S. adults (ages 25–61), uninsurance rates increased from 13.7 percent in 2000 to 16.0 percent in 2005. Despite the existence of public insurance programs, rates remained high for low-income people reporting serious health conditions (25 percent across years) or disabilities (15 percent). Residents of southern states had even higher rates (32 percent with health conditions, 22 percent with disabilities). Those who did not belong to a federally mandated Medicaid eligibility category were about twice as likely as others to be uninsured overall, and uninsurance among this group increased more rapidly over time. These regional and categorical differences reflect gaps in current policy that pose challenges for incremental health reform. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953468 Tue, 03 Nov 2009 01:03:48 +0100 2953468 http://www.medworm.com/index.php?rid=2953467&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1133%3Frss%3D1 Magnetic resonance imaging (MRI) is a technology frequently used to evaluate low back pain, despite evidence that challenges the usefulness of routine MRI and the surgical interventions it may trigger. We analyze the relationship between MRI supply and care for fee-for-service Medicare patients with low back pain. We find that increases in MRI supply are related to higher use of both low back MRI and surgery. This is worrisome, and careful attention should be paid to assessing the outcomes for patients. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953467 Tue, 03 Nov 2009 01:03:48 +0100 2953467 http://www.medworm.com/index.php?rid=2953466&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1122%3Frss%3D1 Technology is a major driver of health care costs. Hospitals are rapidly acquiring one new technology in particular: 64-slice computed tomography (CT), which can be used to image coronary arteries in search of blockages. We propose that it is more likely to be adopted by hospitals that treat cardiac patients, function in competitive markets, are reimbursed for the procedure, and have favorable operating margins. We find that early adoption is related to cardiac patient volume but also to operating margins. The paucity of evidence informing this technology’s role in cardiac care suggests that its adoption by cardiac-oriented hospitals is premature. Further, adoption motivated by operating margins reinforces concerns about haphazard technology acquisition. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953466 Tue, 03 Nov 2009 01:03:48 +0100 2953466 http://www.medworm.com/index.php?rid=2953465&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1110%3Frss%3D1 We examined the influence of menu calorie labels on fast food choices in the wake of New York City’s labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953465 Tue, 03 Nov 2009 01:03:48 +0100 2953465 http://www.medworm.com/index.php?rid=2953464&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2Fw1098%3Frss%3D1 In 2006, New York City’s Health Department amended the city Health Code to require the posting of calorie counts by chain restaurants on menus, menu boards, and item tags. This was one element of the city’s response to rising obesity rates. Drafting the rule involved many decisions that affected its impact and its legal viability. The restaurant industry argued against the rule and twice sued to prevent its implementation. An initial version of the rule was found to be preempted by federal law, but a revised version was implemented in January 2008. The experience shows that state and local health departments can use their existing authority over restaurants to combat obesity and, indirectly, chronic diseases. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953464 Tue, 03 Nov 2009 01:03:48 +0100 2953464 http://www.medworm.com/index.php?rid=2953516&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1865%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953516 Tue, 03 Nov 2009 01:03:47 +0100 2953516 http://www.medworm.com/index.php?rid=2953515&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1863-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953515 Tue, 03 Nov 2009 01:03:47 +0100 2953515 http://www.medworm.com/index.php?rid=2953514&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1863%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953514 Tue, 03 Nov 2009 01:03:47 +0100 2953514 http://www.medworm.com/index.php?rid=2953513&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1862-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953513 Tue, 03 Nov 2009 01:03:47 +0100 2953513 http://www.medworm.com/index.php?rid=2953512&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1862%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953512 Tue, 03 Nov 2009 01:03:47 +0100 2953512 http://www.medworm.com/index.php?rid=2953511&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1861-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953511 Tue, 03 Nov 2009 01:03:47 +0100 2953511 http://www.medworm.com/index.php?rid=2953510&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1861%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953510 Tue, 03 Nov 2009 01:03:47 +0100 2953510 http://www.medworm.com/index.php?rid=2953509&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1860-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953509 Tue, 03 Nov 2009 01:03:47 +0100 2953509 http://www.medworm.com/index.php?rid=2953508&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1860%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953508 Tue, 03 Nov 2009 01:03:47 +0100 2953508 http://www.medworm.com/index.php?rid=2953507&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1859-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953507 Tue, 03 Nov 2009 01:03:47 +0100 2953507 http://www.medworm.com/index.php?rid=2953506&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1859%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953506 Tue, 03 Nov 2009 01:03:47 +0100 2953506 http://www.medworm.com/index.php?rid=2953505&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1858-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953505 Tue, 03 Nov 2009 01:03:47 +0100 2953505 http://www.medworm.com/index.php?rid=2953504&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1858%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953504 Tue, 03 Nov 2009 01:03:47 +0100 2953504 http://www.medworm.com/index.php?rid=2953503&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1856%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953503 Tue, 03 Nov 2009 01:03:47 +0100 2953503 http://www.medworm.com/index.php?rid=2953502&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1854%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953502 Tue, 03 Nov 2009 01:03:47 +0100 2953502 http://www.medworm.com/index.php?rid=2953501&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1851%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953501 Tue, 03 Nov 2009 01:03:47 +0100 2953501 http://www.medworm.com/index.php?rid=2953500&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F28%2F6%2F1848%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953500 Tue, 03 Nov 2009 01:03:47 +0100 2953500 http://www.medworm.com/index.php?rid=2953499&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F28%2F6%2F1838%3Frss%3D1 We compare cancer screening rates between the United States and Europe. Many European countries have organized screening programs, whereas the U.S. approach is relatively decentralized. Many European countries, unlike the United States, also impose upper age limits on screening. Overall, European screening rates were 22–88 percent of the corresponding U.S. rates. U.S. residents are more likely to be screened at younger ages, when the expected benefit from early detection is the greatest, but also at older ages, when the expected benefit is declining. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=2953499 Tue, 03 Nov 2009 01:03:47 +0100 2953499