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, 09 Feb 2012 07:35:52 +0100 http://www.medworm.com/index.php?rid=5671746&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F462%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671746 Wed, 08 Feb 2012 05:00:00 +0100 5671746 http://www.medworm.com/index.php?rid=5671745&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F461-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671745 Wed, 08 Feb 2012 05:00:00 +0100 5671745 http://www.medworm.com/index.php?rid=5671744&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F461%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671744 Wed, 08 Feb 2012 05:00:00 +0100 5671744 http://www.medworm.com/index.php?rid=5671743&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F460-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671743 Wed, 08 Feb 2012 05:00:00 +0100 5671743 http://www.medworm.com/index.php?rid=5671742&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F460-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671742 Wed, 08 Feb 2012 05:00:00 +0100 5671742 http://www.medworm.com/index.php?rid=5671741&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F460%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671741 Wed, 08 Feb 2012 05:00:00 +0100 5671741 http://www.medworm.com/index.php?rid=5671740&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F459%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671740 Wed, 08 Feb 2012 05:00:00 +0100 5671740 http://www.medworm.com/index.php?rid=5671739&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F456%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671739 Wed, 08 Feb 2012 05:00:00 +0100 5671739 http://www.medworm.com/index.php?rid=5671738&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F452%3Frss%3D1 A former home hospice medical director recalls the story of one elderly patient discharged from hospice—and calls for a new approach to better serve those with advanced illnesses. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671738 Wed, 08 Feb 2012 05:00:00 +0100 5671738 http://www.medworm.com/index.php?rid=5671737&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F444%3Frss%3D1 The Massachusetts health reform initiative enacted into law in 2006 continued to fare well in 2010, with uninsurance rates remaining quite low and employer-sponsored insurance still strong. Access to health care also remained strong, and first-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery in the state. There were also improvements in self-reported health status. The affordability of health care, however, remains an issue for many people, as the state, like the nation, continues to struggle with the problem of rising health care costs. And although nearly two-thirds of adults continue to support reform, among nonsupporters there has been a marked shift from a neutral position toward opposition ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671737 Wed, 08 Feb 2012 05:00:00 +0100 5671737 http://www.medworm.com/index.php?rid=5671736&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F434%3Frss%3D1 Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy—a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services’ National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point—that is, poised to make the transition from the margins to the mainstream. If public... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671736 Wed, 08 Feb 2012 05:00:00 +0100 5671736 http://www.medworm.com/index.php?rid=5671735&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F426%3Frss%3D1 In 2010 a bundled payment system for diabetes care, chronic obstructive pulmonary disease care, and vascular risk management was introduced in the Netherlands. Health insurers now pay a single fee to a contracting entity, the care group, to cover all of the primary care needed by patients with these chronic conditions. The initial evaluation of the program indicated that it improved the organization and coordination of care and led to better collaboration among health care providers and better adherence to care protocols. Negative consequences included dominance of the care group by general practitioners, large price variations among care groups that were only partially explained by differences in the amount of care provided, and an administrative burden caused by outdated information and ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671735 Wed, 08 Feb 2012 05:00:00 +0100 5671735 http://www.medworm.com/index.php?rid=5671734&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F417%3Frss%3D1 Donor nations and philanthropic organizations increasingly require that funds provided for a specific health priority such as HIV should supplement domestic spending on that priority—a concept known as "additionality." We investigated the "additionality" concept using data from Honduras, Rwanda, and Thailand, and we found that the three countries increased funding for HIV in response to increased donor funding. In contrast, the study revealed that donors, faced with increased Global Fund resources for HIV in certain countries, tended to decrease their funding for HIV or shift funds for use in non-HIV health areas. More broadly, we found many problems in the measurement and interpretation of additionality. These findings suggest that it would be preferable for donors and countries to ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671734 Wed, 08 Feb 2012 05:00:00 +0100 5671734 http://www.medworm.com/index.php?rid=5671733&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F408%3Frss%3D1 We examined ten years of nationally representative data from the Medical Expenditure Panel Survey and describe trends in two measures of financial burden for prescription drugs: out-of-pocket drug costs as a function of family income and the proportion of all out-of-pocket health care expenses accounted for by drugs. We found that although the percentage of people with high financial burden for prescription drugs increased from 1999 to 2003, it decreased from 2003 to 2007, with a slight increase in 2008. The decline is evidence of the success of strategies to lower drug costs for consumers, including the increased use of generic drugs. However, the financial burden is still high among some groups, notably those with public insurance and those with low incomes. For example, one in four none... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671733 Wed, 08 Feb 2012 05:00:00 +0100 5671733 http://www.medworm.com/index.php?rid=5671732&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F399%3Frss%3D1 Policies that mandate calorie labeling in fast-food and chain restaurants have had little or no observable impact on calorie consumption to date. In three field experiments, we tested an alternative approach: activating consumers’ self-control by having servers ask customers if they wanted to downsize portions of three starchy side dishes at a Chinese fast-food restaurant. We consistently found that 14–33 percent of customers accepted the downsizing offer, and they did so whether or not they were given a nominal twenty-five-cent discount. Overall, those who accepted smaller portions did not compensate by ordering more calories in their entrées, and the total calories served to them were, on average, reduced by more than 200. We also found that accepting the downsizi... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671732 Wed, 08 Feb 2012 05:00:00 +0100 5671732 http://www.medworm.com/index.php?rid=5671731&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F392%3Frss%3D1 The childhood obesity crisis has prompted repeated calls for government action to curb the marketing of unhealthy food to children. Food and entertainment industry groups have asserted that the First Amendment prohibits such regulation. However, case law establishes that the First Amendment does not protect "inherently misleading" commercial speech. Cognitive research indicates that young children cannot effectively recognize the persuasive intent of advertising or apply the critical evaluation required to comprehend commercial messages. Given this combination—that government can prohibit "inherently misleading" advertising and that children cannot adequately understand commercial messages—advertising to children younger than age twelve should be considered beyond the scope of ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671731 Wed, 08 Feb 2012 05:00:00 +0100 5671731 http://www.medworm.com/index.php?rid=5671730&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F383%3Frss%3D1 We present data from a 2009 survey of 1,891 practicing physicians nationwide assessing how widely physicians endorse and follow these principles in communicating with patients. The vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of interventions and should never disclose confidential information to unauthorized persons. Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they h... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671730 Wed, 08 Feb 2012 05:00:00 +0100 5671730 http://www.medworm.com/index.php?rid=5671729&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F376%3Frss%3D1 The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation’s highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation shoul... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671729 Wed, 08 Feb 2012 05:00:00 +0100 5671729 http://www.medworm.com/index.php?rid=5671728&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F367%3Frss%3D1 Fewer than one-third of eligible Medicare beneficiaries enroll in Medicare savings programs, which pay premiums and, in some cases, eliminate out-of-pocket cost sharing for poor and near-poor enrollees. Many beneficiaries don’t participate in savings programs because they must complete a cumbersome application process, including a burdensome asset test. We demonstrate that a streamlined alternative to the asset test—allowing seniors to qualify for Medicare savings programs by providing evidence of limited assets or showing a lack of investment income—would permit 78 percent of currently eligible seniors to bypass the asset test entirely. This simplified approach would increase the number of beneficiaries who qualify for Medicare savings programs from the current 3.6&... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671728 Wed, 08 Feb 2012 05:00:00 +0100 5671728 http://www.medworm.com/index.php?rid=5671727&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F360%3Frss%3D1 This article reports on our study of the effect of premium increases on disenrollment from a health insurance program for low-income immigrant children in Los Angeles County. Two groups of children were compared: those ages 6–18, who were subject to an increase, and those ages 0–5, who were not. Fewer than half of the children in the older group remained enrolled after the premium increase—slightly more than 12,000 children, compared to more than 25,000 at the beginning—and there was a 20 percent decline in overall membership in the program that was attributable to the increase. Although many families paid the higher premium to keep their children enrolled, other families were not able to do so. As programs serving disadvantaged populations contemplate premium ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671727 Wed, 08 Feb 2012 05:00:00 +0100 5671727 http://www.medworm.com/index.php?rid=5671726&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F350%3Frss%3D1 The Affordable Care Act will expand health insurance coverage for an estimated thirty-two million uninsured Americans. Increased access to care is intended to reduce the unnecessary use of services such as emergency department visits and to achieve substantial cost savings. However, there is little evidence for such claims. To determine how the uninsured might respond once coverage becomes available, we studied uninsured low-income adults enrolled in a community-based primary care program at Virginia Commonwealth University Medical Center. For people continuously enrolled in the program, emergency department visits and inpatient admissions declined, while primary care visits increased during the study period. Inpatient costs fell each year for this group. Over three years of enrollment, av... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671726 Wed, 08 Feb 2012 05:00:00 +0100 5671726 http://www.medworm.com/index.php?rid=5671725&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F341%3Frss%3D1 As president and CEO of CareFirst BlueCross BlueShield, Chet Burrell is leading the insurer’s effort to spark delivery system reform in and around the nation’s capital. His main tool: cold hard cash. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671725 Wed, 08 Feb 2012 05:00:00 +0100 5671725 http://www.medworm.com/index.php?rid=5671724&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F340%3Frss%3D1 A leading legal analyst says his Mennonite faith motivates him to support ways to extend coverage to more Americans—including through health insurance exchanges. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671724 Wed, 08 Feb 2012 05:00:00 +0100 5671724 http://www.medworm.com/index.php?rid=5671723&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F332%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671723 Wed, 08 Feb 2012 05:00:00 +0100 5671723 http://www.medworm.com/index.php?rid=5671722&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F324%3Frss%3D1 The Affordable Care Act changed the regulations governing small firms’ health insurance premiums. However, small businesses can avoid many of the new regulations by self-insuring or maintaining grandfathered plans. If small firms with healthy and lower-cost enrollees avoid the regulations, premiums for coverage sold through insurance exchanges could be unaffordable. In this analysis we used the RAND Comprehensive Assessment of Reform Efforts microsimulation model to predict the effects of self-insurance and grandfathering exemptions on coverage and premiums available through the exchanges. We estimate that Affordable Care Act regulations restricting employers’ ability to offer grandfathered plans will result in lower premiums on plans available through the exchanges and will ha... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671722 Wed, 08 Feb 2012 05:00:00 +0100 5671722 http://www.medworm.com/index.php?rid=5671721&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F316%3Frss%3D1 As implementation of the Affordable Care Act reshapes the US health insurance market, state policy makers should be prepared to revisit regulation of stop-loss coverage—a form of reinsurance—for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans might rise to an extent that could seriously impair the regulated market. States can influence small businesses to participate in the regulated market by making it more difficult or costly to obtain stop-loss coverage, which self-funded employers rely on to protect their businesses from catastrophic medical costs inc... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671721 Wed, 08 Feb 2012 05:00:00 +0100 5671721 http://www.medworm.com/index.php?rid=5671720&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F306%3Frss%3D1 This article describes why the Affordable Care Act could lead to favorable or adverse risk selection across plans. It reviews provisions in the act and recent proposed regulations intended to mitigate the problem of risk selection. We performed a simulation that showed that under the premium rating restrictions in the law, large incentives for insurers to attract healthier enrollees will be likely to persist—resulting in substantial overpayment to plans with very healthy enrollees and underpayment to plans with very sick members. We conclude that risk adjustment based on patients’ diagnoses, such as will be in place from 2014 on, will yield payments to insurers that will be more accurate than what will come solely from the age-adjusted and other rating allowed by the act. We al... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671720 Wed, 08 Feb 2012 05:00:00 +0100 5671720 http://www.medworm.com/index.php?rid=5671719&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F299%3Frss%3D1 Large employers are thinking about how they might use the health insurance exchanges created by the Affordable Care Act. In the short term, from 2014 to 2016, many of these employers are giving serious consideration to using the exchanges to help provide coverage for part-time workers and for retirees not yet eligible for Medicare. In the long term, beginning in 2017, some large employers are considering using the exchanges to provide coverage for all of their employees. Costs, human resources strategies, and competitive pressures, as well as state and federal policy, will be the likely drivers of large employers’ decisions about whether—and how—to use the exchanges. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671719 Wed, 08 Feb 2012 05:00:00 +0100 5671719 http://www.medworm.com/index.php?rid=5671718&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F290%3Frss%3D1 The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute’s Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671718 Wed, 08 Feb 2012 05:00:00 +0100 5671718 http://www.medworm.com/index.php?rid=5671717&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F284%3Frss%3D1 The Affordable Care Act calls on states to create health insurance exchanges serving small businesses by 2014. These exchanges will allow small-business owners to pool their buying power, have more choices of health plans, and buy affordable health insurance. However, creating an exchange that appeals to small-business owners poses several challenges. Past and current exchanges provide valuable insights into the role exchanges can play, services they can offer, and design features that can make them successful. For example, states should allow insurance brokers to provide employers with advice and analysis regarding plans offered in the exchanges. Exchanges should also provide services to ease enrollment, such as a single application for all of the plans they offer, and make additional ben... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671717 Wed, 08 Feb 2012 05:00:00 +0100 5671717 http://www.medworm.com/index.php?rid=5671716&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F275%3Frss%3D1 This article frames the challenges that exchanges will encounter in meeting these objectives. In particular, it discusses the advisability of small-business exchanges’ offering an "employee choice" model (which the article describes in detail); of combining the small-business and individual exchanges to broaden product offerings and gain operational efficiencies; and of encouraging low-cost plans to enter the exchange market, perhaps by enabling Medicaid managed care plans to offer comparable commercial products, and in turn affording health plans access to a uniquely motivated market of small firms and their workers who want affordable coverage. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671716 Wed, 08 Feb 2012 05:00:00 +0100 5671716 http://www.medworm.com/index.php?rid=5671715&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F267%3Frss%3D1 The health insurance exchange is the centerpiece of the insurance reforms created by the Affordable Care Act. The Small Business Health Options Program (SHOP) is intended to create a marketplace for small, and perhaps eventually large, employers to purchase health insurance for their employees. This paper introduces a collection of articles that illuminate the need for small-business exchanges and discuss how they will function. The paper also describes the difficulties these exchanges will face, as well as the opportunities they will offer to states, employers, and individuals. The success or failure of small-business exchanges may well hinge on how states choose to address these challenges. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671715 Wed, 08 Feb 2012 05:00:00 +0100 5671715 http://www.medworm.com/index.php?rid=5671714&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F2%2F263%3Frss%3D1 The federal government is trying to shore up supplies of life-saving drugs, but for now, fundamental aspects of the market for specialized generic medications are working against it. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671714 Wed, 08 Feb 2012 05:00:00 +0100 5671714 http://www.medworm.com/index.php?rid=5671713&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F2%2F262%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5671713 Wed, 08 Feb 2012 05:00:00 +0100 5671713 http://www.medworm.com/index.php?rid=5633458&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2011.0653v1%3Frss%3D1 The Massachusetts health reform initiative enacted into law in 2006 continued to fare well in 2010, with uninsurance rates remaining quite low and employer-sponsored insurance still strong. Access to health care also remained strong, and first-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery in the state. There were also improvements in self-reported health status. The affordability of health care, however, remains an issue for many people, as the state, like the nation, continues to struggle with the problem of rising health care costs. And although nearly two-thirds of adults continue to support reform, among nonsupporters there has been a marked shift from a neutral position toward opposition ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5633458 Wed, 25 Jan 2012 05:00:00 +0100 5633458 http://www.medworm.com/index.php?rid=5614743&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2011.1169v1%3Frss%3D1 Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy—a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services’ National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point—that is, poised to make the transition from the margins to the mainstream. If public... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5614743 Wed, 18 Jan 2012 05:00:00 +0100 5614743 http://www.medworm.com/index.php?rid=5589927&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F252%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589927 Mon, 09 Jan 2012 05:00:00 +0100 5589927 http://www.medworm.com/index.php?rid=5589926&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F251-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589926 Mon, 09 Jan 2012 05:00:00 +0100 5589926 http://www.medworm.com/index.php?rid=5589925&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F251%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589925 Mon, 09 Jan 2012 05:00:00 +0100 5589925 http://www.medworm.com/index.php?rid=5589924&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F250-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589924 Mon, 09 Jan 2012 05:00:00 +0100 5589924 http://www.medworm.com/index.php?rid=5589923&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F250%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589923 Mon, 09 Jan 2012 05:00:00 +0100 5589923 http://www.medworm.com/index.php?rid=5589922&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F249-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589922 Mon, 09 Jan 2012 05:00:00 +0100 5589922 http://www.medworm.com/index.php?rid=5589921&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F249-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589921 Mon, 09 Jan 2012 05:00:00 +0100 5589921 http://www.medworm.com/index.php?rid=5589920&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F249%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589920 Mon, 09 Jan 2012 05:00:00 +0100 5589920 http://www.medworm.com/index.php?rid=5589919&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F248%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589919 Mon, 09 Jan 2012 05:00:00 +0100 5589919 http://www.medworm.com/index.php?rid=5589918&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F246%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589918 Mon, 09 Jan 2012 05:00:00 +0100 5589918 http://www.medworm.com/index.php?rid=5589917&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F245%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589917 Mon, 09 Jan 2012 05:00:00 +0100 5589917 http://www.medworm.com/index.php?rid=5589916&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F240%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589916 Mon, 09 Jan 2012 05:00:00 +0100 5589916 http://www.medworm.com/index.php?rid=5589915&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F236%3Frss%3D1 A woman with diabetes points out the shortcomings of a system that blames people with the disease—rather than taking steps to prevent diabetes, diagnose it earlier, and support the best care. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589915 Mon, 09 Jan 2012 05:00:00 +0100 5589915 http://www.medworm.com/index.php?rid=5589914&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F228%3Frss%3D1 How has funding to developing countries for health improvement changed in the wake of the global financial crisis? The question is vital for policy making, planning, and advocacy purposes in donor and recipient countries alike. We measured the total amount of financial and in-kind assistance that flowed from both public and private channels to improve health in developing countries during the period 1990–2011. The data for the years 1990–2009 reflect disbursements, while the numbers for 2010 and 2011 are preliminary estimates. Development assistance for health continued to grow in 2011, but the rate of growth was low. We estimate that assistance for health grew by 4 percent each year from 2009 to 2011, reaching a total of $27.73 billion. This growth was largely driven by t... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589914 Mon, 09 Jan 2012 05:00:00 +0100 5589914 http://www.medworm.com/index.php?rid=5589913&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F220%3Frss%3D1 As health care systems worldwide struggle with rising costs, a consensus is emerging to refocus reform efforts on value, as determined by the evaluation of patient outcomes relative to costs. One method of using outcome data to improve health care value is the disease registry. An international study of thirteen registries in five countries (Australia, Denmark, Sweden, the United Kingdom, and the United States) suggests that by making outcome data transparent to both practitioners and the public, well-managed registries enable medical professionals to engage in continuous learning and to identify and share best clinical practices. The apparent result: improved health outcomes, often at lower cost. For example, we calculate that if the United States had a registry for hip replacement surger... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589913 Mon, 09 Jan 2012 05:00:00 +0100 5589913 http://www.medworm.com/index.php?rid=5589912&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F208%3Frss%3D1 Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010—at rates of 3.8 percent and 3.9 percent, respectively—than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall US gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589912 Mon, 09 Jan 2012 05:00:00 +0100 5589912 http://www.medworm.com/index.php?rid=5589911&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F199%3Frss%3D1 Sugar-sweetened beverages are a major contributor to the US obesity and diabetes epidemics. Using the Coronary Heart Disease Policy Model, we examined the potential impact on health and health spending of a nationwide penny-per-ounce excise tax on these beverages. We found that the tax would reduce consumption of these beverages by 15 percent among adults ages 25–64. Over the period 2010–20, the tax was estimated to prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths, while avoiding more than $17 billion in medical costs. In addition to generating approximately $13 billion in annual tax revenue, a modest tax on sugar-sweetened beverages could reduce the adverse health and cost burdens of obesity... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589911 Mon, 09 Jan 2012 05:00:00 +0100 5589911 http://www.medworm.com/index.php?rid=5589910&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F188%3Frss%3D1 We examined the impact of the Food and Drug Administration’s May 2007 safety warning regarding rosiglitazone (Avandia), a diabetes drug found to raise the risk of heart attacks, on the drug’s availability on state Medicaid preferred drug lists and on the prescribing of diabetes medications more generally for Medicaid beneficiaries. Nearly all state Medicaid programs covered rosiglitazone as a preferred drug, requiring no prior authorization, with minimal change after the safety warning. At the same time, the safety warning was associated with a greater-than-expected decline in rosiglitazone prescribing among states providing coverage as a preferred drug. This suggests that providers reacted to the safety warning by reducing prescriptions. However, Medicaid programs that di... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589910 Mon, 09 Jan 2012 05:00:00 +0100 5589910 http://www.medworm.com/index.php?rid=5589909&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F187%3Frss%3D1 A community collaborative helps residents tackle formidable barriers to healthier behavior: lack of access to exercise, food insecurity, and even Chicago’s bitter winters. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589909 Mon, 09 Jan 2012 05:00:00 +0100 5589909 http://www.medworm.com/index.php?rid=5589908&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F177%3Frss%3D1 We report preliminary findings, such as improved diabetes care and diabetes control, and we discuss lessons learned to date. Our initiative neatly aligns with, and can inform the implementation of, the accountable care organization—a delivery system reform in which groups of providers take responsibility for improving the health of a defined population. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589908 Mon, 09 Jan 2012 05:00:00 +0100 5589908 http://www.medworm.com/index.php?rid=5589907&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F168%3Frss%3D1 We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as "bad" cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and c... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589907 Mon, 09 Jan 2012 05:00:00 +0100 5589907 http://www.medworm.com/index.php?rid=5589906&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F159%3Frss%3D1 Medicaid’s key role in financing diabetes care will grow when many low-income uninsured people with diabetes gain eligibility to the program in 2014 under the Affordable Care Act. Using a national data set to describe current health care use and spending among the nonelderly, low-income adult population, we found that adult Medicaid beneficiaries with diabetes had total annual per capita health expenditures more than three times higher ($14,229 versus $4,568) than those of adult beneficiaries without diabetes. At the same time, Medicaid facilitates financial protection and care access among beneficiaries with diabetes. Low-income adults with diabetes who were uninsured used fewer services, spent more out of pocket, and reported worse access than did their peers who were covered by Me... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589906 Mon, 09 Jan 2012 05:00:00 +0100 5589906 http://www.medworm.com/index.php?rid=5589905&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F150%3Frss%3D1 To ensure that medical residents will be prepared to deliver consistently high-quality care, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists. We found significant quality gaps in process, intermediate outcome, and patient-experience measures. These inadequacies in ambulatory training for internal medicine residents must be addressed by policy makers and educators—for examp... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589905 Mon, 09 Jan 2012 05:00:00 +0100 5589905 http://www.medworm.com/index.php?rid=5589904&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F140%3Frss%3D1 Managing diabetes and preventing its associated morbidities require active partnerships between physicians and patients. Studies to date lack the level of detail to quantify the degree to which interventions that are more controlled by physicians influence outcomes versus those that are more controlled by patients. Using the Archimedes model, we simulated a thirty-year clinical trial and compared the effects of three sets of interventions over which physicians have progressively less control: compliance with process-of-care standards, such as conducting foot and retinal exams and screening for signs of early kidney disease; control of biomarkers, such as hemoglobin A1c and blood pressure; and lifestyle modifications, such as patients’ switching to healthier diets and losing weight. W... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589904 Mon, 09 Jan 2012 05:00:00 +0100 5589904 http://www.medworm.com/index.php?rid=5589903&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F130%3Frss%3D1 Self-management of diabetes is essential to reducing the risks of associated disabilities. But effective self-management is often short-lived. Peers can provide the kind of ongoing support that is needed for sustained self-management of diabetes. In this context, peers are nonprofessionals who have diabetes or close familiarity with its management. Key functions of effective peer support include assistance in daily management, social and emotional support, linkage to clinical care, and ongoing availability of support. Using these four functions as a template of peer support, project teams in Cameroon, South Africa, Thailand, and Uganda developed and then evaluated peer support interventions for adults with diabetes. Our initial assessment found improvements in symptom management, diet, blo... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589903 Mon, 09 Jan 2012 05:00:00 +0100 5589903 http://www.medworm.com/index.php?rid=5589902&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F120%3Frss%3D1 A substantial threat to the overall health of the American public is nonadherence to medications used to treat diabetes, as well as physicians’ failure to initiate patients’ use of those medications. To address this problem, we evaluated an integrated, pharmacy-based program to improve patients’ adherence and physicians’ initiation rates. The study included 5,123 patients with diabetes in the intervention group and 24,124 matched patients with diabetes in the control group. The intervention consisted of outreach from both mail-order and retail pharmacists who had specific information from the pharmacy benefit management company on patients’ adherence to medications and use of concomitant therapies. The interventions improved patients’ medication adherenc... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589902 Mon, 09 Jan 2012 05:00:00 +0100 5589902 http://www.medworm.com/index.php?rid=5589901&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F110%3Frss%3D1 The Affordable Care Act of 2010 authorized the continued availability of Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs). This case study examines the model of care used by the largest such plan, Care Improvement Plus, and compares utilization rates among its diabetes patients with those of other beneficiaries enrolled in fee-for-service Medicare in the same five states. This special-needs plan emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care. The comparative analysis indicates that people with diabetes in the special-needs plan—particularly nonwhite beneficiaries—had lower rates of hospitalization and readmission than their peers in fee-for-service Medicare. For example, risk-adjusted hospit... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589901 Mon, 09 Jan 2012 05:00:00 +0100 5589901 http://www.medworm.com/index.php?rid=5589900&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F103%3Frss%3D1 A diagnosis of diabetes can require multiple changes in a person’s behavior, diet, and lifestyle. Efforts to sustain these changes and manage this complex chronic disease can be difficult. Group visits, in which several patients meet together with a primary care provider and transdisciplinary team, have tremendous potential to improve health care quality, cost, and access. When group-based diabetes self-management education and a primary care visit occur within a single appointment, people with the disease can address multiple needs in one visit and take advantage of peer groups for support and motivation. A review of the literature demonstrates that the efficacy of group visits has a promising evidence base—but more needs to be learned about optimal group size and aspects of t... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589900 Mon, 09 Jan 2012 05:00:00 +0100 5589900 http://www.medworm.com/index.php?rid=5589899&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F93%3Frss%3D1 Many countries have implemented pay-for-performance programs to improve the quality of care. The structure of these programs, however, can have perverse consequences beyond improving care for patients. To investigate this possibility, we studied the pattern of enrollment of patients with diabetes in the first five years of a pay-for-performance program in Taiwan’s National Health Insurance Program from 2001 through 2005. Taiwan’s program did sharply improve quality of care for enrolled patients, producing 100 percent or nearly 100 percent adherence to all process measures. But at the same time, only a minority of the nation’s patients with diabetes were enrolled, because the program’s design encouraged physicians not to enroll their most complicated patien... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589899 Mon, 09 Jan 2012 05:00:00 +0100 5589899 http://www.medworm.com/index.php?rid=5589898&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F84%3Frss%3D1 This article argues that four policy paradigm shifts will be necessary to achieve that specific emphasis on type 2 diabetes: conceptually integrating primary and secondary prevention along a clinical continuum; recognizing the central importance of early detection of prediabetes and undiagnosed diabetes in implementing cost-effective prevention and control; integrating community and clinical expertise, and resources, within organized and affordable service delivery systems; and sharing and adopting evidence-based policies at the global level. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589898 Mon, 09 Jan 2012 05:00:00 +0100 5589898 http://www.medworm.com/index.php?rid=5589897&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F76%3Frss%3D1 Type 2 diabetes prevention studies have shown that the onset of the disease can be delayed or prevented, chiefly by weight loss. But the current efforts to establish community-based lifestyle modification programs will not be very effective in preventing diabetes, largely because most overweight or obese people cannot maintain weight loss over time. A complex environment is driving greater food consumption along with less energy expenditure, making maintenance of weight loss extremely difficult. To improve the likelihood of achieving populationwide success in reducing the obesity pandemic, we need a better understanding of the biological processes that underlie the balance between intake and expenditure of energy. In the meantime, once diabetes develops, we can greatly reduce the likelihoo... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589897 Mon, 09 Jan 2012 05:00:00 +0100 5589897 http://www.medworm.com/index.php?rid=5589896&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F67%3Frss%3D1 We conducted a systematic review and meta-analysis of twenty-eight US-based studies applying the findings of the Diabetes Prevention Program, a clinical trial that tested the effects of a lifestyle intervention for people at high risk for diabetes, in real-world settings. The average weight change at twelve months after the intervention was a loss of about 4 percent from participants’ baseline weight. Change in weight was similar regardless of whether the intervention was delivered by clinically trained professionals or lay educators. Additional analyses limited to seventeen studies with a nine-month or greater follow-up assessment showed similar weight change. With every additional lifestyle session attended, weight loss increased by 0.26 percentage point. We conclude that... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589896 Mon, 09 Jan 2012 05:00:00 +0100 5589896 http://www.medworm.com/index.php?rid=5589895&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F61%3Frss%3D1 This article presents a three-part proposal: expand the Diabetes Prevention Program nationally; build care coordination through health teams into the traditional Medicare program; and use these teams to connect public health, prevention, and treatment. Enrollment in evidence-based lifestyle modification programs—specifically, those focused on excess weight—should be added as a covered benefit under Medicare with no cost sharing. Funding for the Medicare component could be provided through the budget of the Center for Medicare and Medicaid Innovation. The proposal in its totality has the potential for improving health outcomes and reducing costs. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589895 Mon, 09 Jan 2012 05:00:00 +0100 5589895 http://www.medworm.com/index.php?rid=5589894&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F50%3Frss%3D1 The increasing health and economic burden of diabetes has made preventing the disease a public health priority. But investing in such chronic disease prevention programs requires a long-term horizon because many years may be required for the downstream savings to fully offset the up-front intervention cost. Using a simulation model, we projected the costs and benefits of a nationwide community-based lifestyle intervention program for preventing type 2 diabetes. Accounting for all costs to the US health care system, our results indicate that the program would break even in fourteen years. Within twenty-five years, the program would prevent or delay about 885,000 cases of type 2 diabetes in the United States and produce savings of $5.7 billion nationwide. If restricted to people ages 65... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589894 Mon, 09 Jan 2012 05:00:00 +0100 5589894 http://www.medworm.com/index.php?rid=5589893&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F43%3Frss%3D1 Public health measures are required to address the worldwide increase in type 2 diabetes. Proponents of personalized medicine predict a future in which disease treatment and, more important, prevention will be tailored to high-risk individuals rather than populations and will be based on genetic and other new biomarker tests. Accurate biomarker tests to identify people at risk for diabetes could allow more-targeted and perhaps individualized prevention efforts. DNA variants conferring higher risk for type 2 diabetes have been identified. However, these account for only a small fraction of genetic risk, which limits their practical predictive value. Nor has identification of these variants yet led to new, individualized prevention methods. Further research is needed to identify genomic and ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589893 Mon, 09 Jan 2012 05:00:00 +0100 5589893 http://www.medworm.com/index.php?rid=5589892&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F35%3Frss%3D1 We examined evidence supporting screening high-risk adults, including studies using intermediate outcomes and modeling studies. We found a broad range of evidence of practical relevance to diabetes screening that merits consideration in developing new screening guidelines. This evidence could inform recommendations to expand coverage to screening of other high-risk groups and could facilitate the prevention and early treatment of diabetes. We recommend that the US Preventive Services Task Force consider these expanded sources of evidence and revise its recommendations accordingly. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589892 Mon, 09 Jan 2012 05:00:00 +0100 5589892 http://www.medworm.com/index.php?rid=5589891&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F27%3Frss%3D1 Despite a growing diabetes crisis, the nonmedical implications for young adults have gone virtually unexplored. We investigated the effects of diabetes on two key outcomes for this age group—schooling and earnings—and found that it delivers an increasingly common "health shock" to both. We identified effects in several measures of educational attainment, including a high school dropout rate that was six percentage points higher than among young adults without the disease. We also found lower employment and wages: A person with diabetes can conservatively expect to lose more than $160,000 over his or her working life, compared to a peer without the disease. For young adults with diabetes, having a parent with diabetes also leads to poorer outcomes than if one more parents do not... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589891 Mon, 09 Jan 2012 05:00:00 +0100 5589891 http://www.medworm.com/index.php?rid=5589890&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F20%3Frss%3D1 Between a fifth and a third of US adults will have diabetes by midcentury, up from one in ten now, according to a government estimate. We project that over the next decade, around 40 million adults could have diabetes and 100 million could be diagnosed with its clinical precursor, prediabetes. Related health care spending could reach $512 billion annually in 2021. Evidence-based interventions can curb diabetes and its clinical complications, but little has been done to implement them on a wide scale. What’s needed, among other measures, are new risk-assessment methods to identify subpopulations that will benefit most; the enrollment of consumers in new care models that support and encourage lifestyle change; partnerships with pharmacists, nurses, and health coaches; an... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589890 Mon, 09 Jan 2012 05:00:00 +0100 5589890 http://www.medworm.com/index.php?rid=5589889&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F12%3Frss%3D1 The rising tide of diabetes has an unacceptable human and societal toll. Rates of all major forms of diabetes are increasing at enormous individual and societal cost: 8.3 percent of the US population is afflicted today, and financial costs reached $174 billion for 2007. A major cause of blindness, renal failure, amputation, and cardiovascular disease, diabetes also increases the risk of cancer and dementia and more than doubles individual health care costs. Control of glucose, blood pressure, and lipids improves outcomes. Yet diabetes management is nonetheless suboptimal, particularly in disproportionately affected poor and minority populations. Safer, less burdensome, and more personalized approaches to therapy are needed. People at high risk for type 2 diabetes must be identifi... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589889 Mon, 09 Jan 2012 05:00:00 +0100 5589889 http://www.medworm.com/index.php?rid=5589888&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F31%2F1%2F8%3Frss%3D1 Justices could leave the Affordable Care Act intact, in shambles, or somewhere in between—and just months before the 2012 presidential election. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589888 Mon, 09 Jan 2012 05:00:00 +0100 5589888 http://www.medworm.com/index.php?rid=5589887&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F31%2F1%2F6%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5589887 Mon, 09 Jan 2012 05:00:00 +0100 5589887 http://www.medworm.com/index.php?rid=5509871&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2011.1154v1%3Frss%3D1 How has funding to developing countries for health improvement changed in the wake of the global financial crisis? The question is vital for policy making, planning, and advocacy purposes in donor and recipient countries alike. We measured the total amount of financial and in-kind assistance that flowed from both public and private channels to improve health in developing countries during the period 1990–2011. The data for the years 1990–2009 reflect disbursements, while the numbers for 2010 and 2011 are preliminary estimates. Development assistance for health continued to grow in 2011, but the rate of growth was low. We estimate that assistance for health grew by 4 percent each year from 2009 to 2011, reaching a total of $27.73 billion. This growth was largely driven by t... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5509871 Wed, 14 Dec 2011 05:00:00 +0100 5509871 http://www.medworm.com/index.php?rid=5490842&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2011.0762v1%3Frss%3D1 As health care systems worldwide struggle with rising costs, a consensus is emerging to refocus reform efforts on value, as determined by the evaluation of patient outcomes relative to costs. One method of using outcome data to improve health care value is the disease registry. An international study of thirteen registries in five countries (Australia, Denmark, Sweden, the United Kingdom, and the United States) suggests that by making outcome data transparent to both practitioners and the public, well-managed registries enable medical professionals to engage in continuous learning and to identify and share best clinical practices. The apparent result: improved health outcomes, often at lower cost. For example, we calculate that if the United States had a registry for hip replacement surger... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5490842 Wed, 07 Dec 2011 05:00:00 +0100 5490842 http://www.medworm.com/index.php?rid=5481336&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2458-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481336 Mon, 05 Dec 2011 05:00:00 +0100 5481336 http://www.medworm.com/index.php?rid=5481335&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2458%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481335 Mon, 05 Dec 2011 05:00:00 +0100 5481335 http://www.medworm.com/index.php?rid=5481334&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2457-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481334 Mon, 05 Dec 2011 05:00:00 +0100 5481334 http://www.medworm.com/index.php?rid=5481333&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2457-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481333 Mon, 05 Dec 2011 05:00:00 +0100 5481333 http://www.medworm.com/index.php?rid=5481332&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2457%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481332 Mon, 05 Dec 2011 05:00:00 +0100 5481332 http://www.medworm.com/index.php?rid=5481331&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2456%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481331 Mon, 05 Dec 2011 05:00:00 +0100 5481331 http://www.medworm.com/index.php?rid=5481330&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2455%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481330 Mon, 05 Dec 2011 05:00:00 +0100 5481330 http://www.medworm.com/index.php?rid=5481329&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2453%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481329 Mon, 05 Dec 2011 05:00:00 +0100 5481329 http://www.medworm.com/index.php?rid=5481328&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2449%3Frss%3D1 As of 2013, a national physician payment database created under the Affordable Care Act will make such information available to all. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481328 Mon, 05 Dec 2011 05:00:00 +0100 5481328 http://www.medworm.com/index.php?rid=5481327&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2437%3Frss%3D1 Around the world, adults with serious illnesses or chronic conditions account for a disproportionate share of national health care spending. We surveyed patients with complex care needs in eleven countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) and found that in all of them, care is often poorly coordinated. However, adults seen at primary practices with attributes of a patient-centered medical home—where clinicians are accessible, know patients’ medical history, and help coordinate care—gave higher ratings to the care they received and were less likely to experience coordination gaps or report medical errors. Throughout the survey, patients in Switzerland and the United Ki... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481327 Mon, 05 Dec 2011 05:00:00 +0100 5481327 http://www.medworm.com/index.php?rid=5481326&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2427%3Frss%3D1 Inefficiency and low quality of health services are common in many developing countries. To mitigate these problems, we conducted an experiment in rural China in which we changed the existing fee-for-service method of paying village doctors to a mixed payment method that included a salary plus a bonus based on performance. The new payment method also removed a feature that previously allowed doctors to purchase medications to prescribe to patients and earn a markup on each prescription. Changing these payment incentives reduced spending at the village level, curbed unnecessary care for healthier patients, and also decreased the prescribing of unnecessary drugs. However, other features of the arrangement encouraged doctors to refer sicker patients to township and county facilities, where co... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481326 Mon, 05 Dec 2011 05:00:00 +0100 5481326 http://www.medworm.com/index.php?rid=5481325&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2419%3Frss%3D1 We examined the distribution of health insurance in China during 1997–2006, a period when government interventions were implemented to improve access to health care. We analyzed data from a survey that follows households in nine provinces that are home to more than 40 percent of China’s population. The analysis shows that the percentage of individuals with insurance increased from 24 percent in 1997 to 28 percent in 2004 and then rose dramatically, to 49 percent in 2006. Rural and urban levels of insurance coverage became more similar, reflecting a dramatic upswing in coverage in rural areas that is likely to have benefited millions of rural Chinese. At the same time, the analysis suggests that health insurance reimbursement rates to consumers for inpatient ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481325 Mon, 05 Dec 2011 05:00:00 +0100 5481325 http://www.medworm.com/index.php?rid=5481324&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2410%3Frss%3D1 Health impact assessment is a structured decision support tool used to systematically characterize the anticipated health effects, both adverse and beneficial, of societal decisions. In San Francisco, the use of health impact assessments has not only produced evidence to inform health policy decision making but has also contributed to the political conditions needed to achieve optimal population health. Health impact assessments have helped increase public awareness of the determinants of health, routine monitoring of these determinants, cooperation among institutions, health-protective laws and regulations, and organizational networks for health advocacy and accountability. Drawing on more than a decade of local experience, we identify the direct and indirect effects of the assessments on... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481324 Mon, 05 Dec 2011 05:00:00 +0100 5481324 http://www.medworm.com/index.php?rid=5481323&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2400%3Frss%3D1 We describe present and potential costs of environmental exposures and discuss policy options to protect future generations of children in a sustainable development context. Specifically, we describe the principles of sound chemicals management, as follows: precaution, or the use of cost-effective measures to prevent potentially hazardous exposures before scientific understanding is complete; the right to know, or informing the public—especially vulnerable groups—in a timely fashion about the safe use of chemicals and any releases of chemicals into the environment; pollution prevention, or preventing the use of hazardous chemicals and the production of pollutants, rather than focusing on managing wastes; internalization of environmental and health costs, or ensuring that the co... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481323 Mon, 05 Dec 2011 05:00:00 +0100 5481323 http://www.medworm.com/index.php?rid=5481322&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2391%3Frss%3D1 Many human studies have shown a correlation between air pollution and poor health in children. This paper focuses on studies that employ quasi-experimental designs to study the effects of air pollution on specific populations in an effort to isolate the causes and minimize the effect of confounding factors. Human studies of many and varied designs have found that exposure to some pollutants, even at levels below regulatory thresholds, adversely affects health. Our review of quasi-experimental studies adds additional support to these findings. Together, the research suggests that lowering the thresholds for acceptable air pollution levels may be a prudent and necessary step toward improving population health, especially among the most vulnerable members of society: infants and children. Pol... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481322 Mon, 05 Dec 2011 05:00:00 +0100 5481322 http://www.medworm.com/index.php?rid=5481321&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2382%3Frss%3D1 This study demonstrates that continuous and adequate health insurance is vital to the continued well-being of children with special health care needs as they transition to young adulthood. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481321 Mon, 05 Dec 2011 05:00:00 +0100 5481321 http://www.medworm.com/index.php?rid=5481320&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2371%3Frss%3D1 When the Affordable Care Act of 2010 is fully implemented, it will extend health insurance coverage to many adult Americans who currently lack it. It is not known, however, how the health reform legislation will affect children and parents who would otherwise be uninsured. Based on our analysis, the Affordable Care Act has the potential to cut the number of uninsured children by about 40 percent, from 7.4 million to 4.2 million, and the number of uninsured parents by almost 50 percent, from 12.7 million to 6.6 million. However, the actual impact will depend on increasing the share of children and parents who are enrolled in public coverage and on other implementation outcomes. Most strikingly, if the requirement that states continue their Medicaid and Children... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481320 Mon, 05 Dec 2011 05:00:00 +0100 5481320 http://www.medworm.com/index.php?rid=5481319&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2362%3Frss%3D1 Bone imaging known as DXA ("dexa")—dual energy x-ray absorptiometry of the central skeleton—is considered the "gold standard" test for osteoporosis, which affects more than fifty million Americans. The tests are associated with improved clinical outcomes through preventing bone fractures. Cuts in Medicare Part B reimbursement for the provision of this preventive imaging in a physician’s office began in 2007 and reached 56 percent below the 2006 level in January 2010. To encourage the use of DXA testing, the Affordable Care Act of 2010 provided partial relief from the cuts for two years (2010–11). Our study found that after a decade of growth, DXA testing in all Part B settings plateaued in 2007–09, resulting in 800,000 fewer tests than expected for M... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481319 Mon, 05 Dec 2011 05:00:00 +0100 5481319 http://www.medworm.com/index.php?rid=5481318&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2355%3Frss%3D1 Studies have shown that male circumcision greatly reduces the risk for heterosexual transmission of HIV, other sexually transmitted infections, infant urinary tract infections, penile cancer, and other adverse health outcomes. Given recent data regarding these health benefits and the cost-effectiveness of newborn male circumcision, national policy makers are developing new recommendations regarding circumcision for newborn, adolescent, and adult males. To investigate the implications, this study assessed insurance coverage and reimbursement for routine newborn and adult male circumcision in private and public health plans in 2009. We found that coverage varies across private and public payers. Private insurance provides far broader coverage than state Medicaid programs for routine newborn ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481318 Mon, 05 Dec 2011 05:00:00 +0100 5481318 http://www.medworm.com/index.php?rid=5481317&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2346%3Frss%3D1 "Atypical" or second-generation antipsychotics are a class of drug introduced in the 1990s for the treatment of schizophrenia. Given their growing use and rising cost, these and other psychotherapeutic drugs are increasingly subject to prior authorization and other restrictions in state Medicaid programs. To evaluate the effects of these policies, we collected drug-level information on their use and on utilization management strategies—for example, requirements for prior authorization, quantity limits, and so-called step therapy—in thirty state Medicaid programs between 1999 and 2008. In the eleven states that instituted prior authorization during that period, use of atypicals per enrollee rose by 14 percent, versus 19 percent in the other nineteen states. Prior autho... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481317 Mon, 05 Dec 2011 05:00:00 +0100 5481317 http://www.medworm.com/index.php?rid=5481316&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2338%3Frss%3D1 Clinical trial registries are public databases created to prospectively document the methods and measures of prescription drug studies and retrospectively collect a summary of results. In 2007 the US government began requiring that researchers register certain studies and report the results on ClinicalTrials.gov, a public database of federally and privately supported trials conducted in the United States and abroad. We found that although the mandate briefly increased trial registrations, 39 percent of trials were still registered late after the mandate’s deadline, and only 12 percent of completed studies reported results within a year, as required by the mandate. This result is important because there is evidence of selective reporting even among registered trials. Further... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481316 Mon, 05 Dec 2011 05:00:00 +0100 5481316 http://www.medworm.com/index.php?rid=5481315&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2329%3Frss%3D1 Risk-sharing agreements, under which payers and pharmaceutical manufacturers agree to link payment for drugs to health outcomes achieved, rather than the volume of products used, offer an appealing payment model for pharmaceuticals. Although such agreements have been widely touted, the experience to date mainly demonstrates how hard they are to implement. Barriers include high implementation costs, measurement challenges, and the absence of a suitable data infrastructure. Risk-sharing arrangements could gain traction in the United States as payers and product manufacturers acquire experience with the concept and as measurement techniques and information systems improve. For the foreseeable future, they are likely to remain the exception as drug companies pursue payment models unconnected t... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481315 Mon, 05 Dec 2011 05:00:00 +0100 5481315 http://www.medworm.com/index.php?rid=5481314&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2328%3Frss%3D1 Aaron Kesselheim—internist, health services researcher, and patent attorney—works at the intersection of health care and the law. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481314 Mon, 05 Dec 2011 05:00:00 +0100 5481314 http://www.medworm.com/index.php?rid=5481313&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2318%3Frss%3D1 Since 2004 the United States has collected approximately $8 billion from fraud enforcement actions against pharmaceutical manufacturers accused under the federal False Claims Act of illegally promoting drugs for off-label uses. Using the case of gabapentin (Neurontin), a drug approved for epilepsy but prescribed for a variety of conditions, we sought to determine whether the enforcement action also influenced off-label prescribing rates. We conducted a segmented time-series analysis using key legal milestones: the initiation of a sealed investigation, public announcement of the investigation, and settlement of the case. Off-label use grew steadily until settlement, when gabapentin prescriptions declined for both off-label and on-label indications. Because enforcement actions targeting... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481313 Mon, 05 Dec 2011 05:00:00 +0100 5481313 http://www.medworm.com/index.php?rid=5481312&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2310%3Frss%3D1 Clinical decision support systems—interactive computer systems that help doctors make clinical choices—can reduce errors in drug prescribing by offering real-time alerts about possible adverse reactions. But physicians and other users often suffer "alert fatigue" caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems’ effectiveness. Designers and vendors sharply limit the ability to modify alert systems because they fear being exposed to liability if they permit removal of a warning that could have prevented a harmful prescribing error. Our analysis of product liability principles and existing research into the use of clin... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481312 Mon, 05 Dec 2011 05:00:00 +0100 5481312 http://www.medworm.com/index.php?rid=5481311&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2301%3Frss%3D1 A sufficient cardiology workforce is necessary to ensure access to cardiovascular care. Specifically, access to cardiologists is important in the management and treatment of chronic cardiovascular disease. Given this, we examined the supply and distribution of the cardiologist workforce. In doing so, we mapped the ratios of cardiologists, primary care physicians, and total physicians to the population age sixty-five or older within different Hospital Referral Regions from the years 1995 and 2007. We found that within the twelve-year span of our study, the cardiology workforce grew modestly compared with the primary care physician and total physician workforces. Also, despite increases in the number of cardiologists, there was a persistent geographic maldistribution of the workforce. For ex... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481311 Mon, 05 Dec 2011 05:00:00 +0100 5481311 http://www.medworm.com/index.php?rid=5481310&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2293%3Frss%3D1 Little is known about registered nurses’ geographic mobility after they earn their first professional degree and become licensed to practice. Through a cross-sectional mailed survey of newly licensed registered nurses in fifteen states, we found that 52.5 percent work within forty miles of where they attended high school. Our complementary analysis of Census Bureau data shows that next to teaching, nursing is one of the least mobile professions for women, for reasons that remain unclear. To ensure that underserved areas have an adequate workforce of registered nurses, policy makers should expand the number of educational programs in these areas; fund programs that provide incentives to young people from these areas to attend nursing programs; consider supporting extension progra... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481310 Mon, 05 Dec 2011 05:00:00 +0100 5481310 http://www.medworm.com/index.php?rid=5481309&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2286%3Frss%3D1 The vast preponderance of the nation’s registered nurses are women. In the 1980s and 1990s, a decline in the number of women ages 23–26 who were choosing nursing as a career led to concerns that there would be future nurse shortages unless the trend was reversed. Between 2002 and 2009, however, the number of full-time-equivalent registered nurses ages 23–26 increased by 62 percent. If these young nurses follow the same life-cycle employment patterns as those who preceded them—as they appear to be thus far—then they will be the largest cohort of registered nurses ever observed. Because of this surge in the number of young people entering nursing during the past decade, the nurse workforce is projected to grow faster during the next two decades than previou... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481309 Mon, 05 Dec 2011 05:00:00 +0100 5481309 http://www.medworm.com/index.php?rid=5481308&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2277%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481308 Mon, 05 Dec 2011 05:00:00 +0100 5481308 http://www.medworm.com/index.php?rid=5481307&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2269%3Frss%3D1 To attain the anticipated benefits of increased investments in comparative effectiveness research, the results must translate into improved medical practice and policy. In this article we present an analysis of a case study of percutaneous vertebroplasty, a widely used invasive procedure to treat painful vertebral fractures by injecting bone cement into the spine. In August 2009, results from a pair of rigorous double-blind randomized controlled trials were published and reported that vertebroplasty provided no better pain relief than a sham procedure in which needles were introduced into the back without injecting cement. More than two years after publication of the two studies, insurers’ coverage of the procedure continues unchanged. This raises serious questions about the pol... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481307 Mon, 05 Dec 2011 05:00:00 +0100 5481307 http://www.medworm.com/index.php?rid=5481306&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2259%3Frss%3D1 The use of biomarkers to "personalize" cancer treatment—identifying discrete genes, proteins, or other indicators that can differentiate one type of cancer from another and enable the use of highly tailored therapies—offers tremendous potential for improved outcomes and lower treatment costs. However, the rapid development of cancer biomarker, or genomic, tests—combined with a paucity of evidence to support the effectiveness of the tests—presents a challenge for patients, clinicians, and other stakeholders. In this article we propose that comparative effectiveness research be used to strengthen what is now a haphazard process for developing and marketing cancer biomarker tests. We suggest novel funding approaches and a systematic process for moving from regulatory a... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481306 Mon, 05 Dec 2011 05:00:00 +0100 5481306 http://www.medworm.com/index.php?rid=5481305&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2252%3Frss%3D1 Veteran family physician and comparative effectiveness research expert Joe V. Selby is assembling a team and leading efforts to set priorities for patient-focused research. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481305 Mon, 05 Dec 2011 05:00:00 +0100 5481305 http://www.medworm.com/index.php?rid=5481304&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2243%3Frss%3D1 The Affordable Care Act of 2010 created the Patient-Centered Outcomes Research Institute to promote and fund comparative effectiveness research and to ensure that the product of this research improves real-world health care decisions. Notwithstanding limitations imposed by Congress on the institute’s ability to influence federal payers’ coverage and payment policies, the organization now has considerable potential to help standardize and coordinate comparative effectiveness research in the United States. Still, many questions remain about how this important new entity will function—and a central challenge will be to produce comparative effectiveness assessments that can be readily disseminated to, and used by, a wide range of health care stakeholders, especially providers... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481304 Mon, 05 Dec 2011 05:00:00 +0100 5481304 http://www.medworm.com/index.php?rid=5481303&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2235%3Frss%3D1 Medicine’s current evidence base is insufficient for many of the decisions made daily by clinicians, patients, purchasers, and policy makers. The Patient-Centered Outcomes Research Institute represents an effort by the US government to address this shortcoming by funding comparative effectiveness research. Prioritizing that research will be a critical first step. To better understand components of an optimal process, we reviewed the literature and conducted interviews regarding the prioritization efforts of leading public and private health organizations in the United States and abroad. From this review, we propose a framework for prioritization, pose and answer key questions, and make recommendations regarding application of that framework. We also recommend that during the priority... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481303 Mon, 05 Dec 2011 05:00:00 +0100 5481303 http://www.medworm.com/index.php?rid=5481302&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F12%2F2231%3Frss%3D1 The demise of a national voluntary long-term care insurance program has left advocates uncertain where the political and financial support for a similar measure will come from in the future. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481302 Mon, 05 Dec 2011 05:00:00 +0100 5481302 http://www.medworm.com/index.php?rid=5481301&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F12%2F2230%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5481301 Mon, 05 Dec 2011 05:00:00 +0100 5481301 http://www.medworm.com/index.php?rid=5463244&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2Fhlthaff.2011.1243v1%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5463244 Wed, 30 Nov 2011 05:00:00 +0100 5463244 http://www.medworm.com/index.php?rid=5393933&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2Fhlthaff.2011.0923v1%3Frss%3D1 Around the world, adults with serious illnesses or chronic conditions account for a disproportionate share of national health care spending. We surveyed patients with complex care needs in eleven countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States) and found that in all of them, care is often poorly coordinated. However, adults seen at primary practices with attributes of a patient-centered medical home—where clinicians are accessible, know patients’ medical history, and help coordinate care—gave higher ratings to the care they received and were less likely to experience coordination gaps or report medical errors. Throughout the survey, patients in Switzerland and the United Ki... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393933 Wed, 09 Nov 2011 05:00:00 +0100 5393933 http://www.medworm.com/index.php?rid=5393970&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2220%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393970 Mon, 07 Nov 2011 05:00:00 +0100 5393970 http://www.medworm.com/index.php?rid=5393969&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2219-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393969 Mon, 07 Nov 2011 05:00:00 +0100 5393969 http://www.medworm.com/index.php?rid=5393968&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2219-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393968 Mon, 07 Nov 2011 05:00:00 +0100 5393968 http://www.medworm.com/index.php?rid=5393967&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2219%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393967 Mon, 07 Nov 2011 05:00:00 +0100 5393967 http://www.medworm.com/index.php?rid=5393966&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2218-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393966 Mon, 07 Nov 2011 05:00:00 +0100 5393966 http://www.medworm.com/index.php?rid=5393965&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2218%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393965 Mon, 07 Nov 2011 05:00:00 +0100 5393965 http://www.medworm.com/index.php?rid=5393964&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2217-b%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393964 Mon, 07 Nov 2011 05:00:00 +0100 5393964 http://www.medworm.com/index.php?rid=5393963&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2217-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393963 Mon, 07 Nov 2011 05:00:00 +0100 5393963 http://www.medworm.com/index.php?rid=5393962&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2217%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393962 Mon, 07 Nov 2011 05:00:00 +0100 5393962 http://www.medworm.com/index.php?rid=5393961&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2216-a%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393961 Mon, 07 Nov 2011 05:00:00 +0100 5393961 http://www.medworm.com/index.php?rid=5393960&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2216%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393960 Mon, 07 Nov 2011 05:00:00 +0100 5393960 http://www.medworm.com/index.php?rid=5393959&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2215%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393959 Mon, 07 Nov 2011 05:00:00 +0100 5393959 http://www.medworm.com/index.php?rid=5393958&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Ffull%2F30%2F11%2F2214%3Frss%3D1 (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393958 Mon, 07 Nov 2011 05:00:00 +0100 5393958 http://www.medworm.com/index.php?rid=5393957&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2208%3Frss%3D1 Low-income children and adolescents continue to bear a heavy burden of untreated pain and complications from dental disease. To explore why proposals to remediate this problem have not gained traction, the authors interviewed experts involved in efforts to improve the oral health status of low-income and minority children during the past decade. Key informants believe that success requires addressing both consumer demand and provider supply factors. They especially cite the lack of public outcry for more accessible oral health care and the undervaluing of oral health, relative to medical care. Informants were cautiously optimistic that strategies such as health literacy and outreach campaigns, which have helped increase children’s physical activity and improve their diets, offer unex... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393957 Mon, 07 Nov 2011 05:00:00 +0100 5393957 http://www.medworm.com/index.php?rid=5393956&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2204%3Frss%3D1 Productivity at a breast care center is laudable, but not if interactions with scared or vulnerable patients lose the individualized human touch. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393956 Mon, 07 Nov 2011 05:00:00 +0100 5393956 http://www.medworm.com/index.php?rid=5393955&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2194%3Frss%3D1 In 2006 the Department of Veterans Affairs commissioned the Altarum Institute and the RAND Corporation to do an evaluation of its mental health treatment system. We found that veterans with mental illness and substance use disorders represented 15.4 percent of all veterans using Veterans’ Health Administration (VHA) services in 2007 and that they accounted for 32.9 percent ($12 billion) of VHA costs, of which the majority was for non–mental health conditions. The average cost for a veteran with mental illness and substance use in our study was $12,337, or 2.7 times the cost for an average veteran without these conditions. The quality of care for the veterans in our study, although similar to or better than the care given to comparable privately insured patients o... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393955 Mon, 07 Nov 2011 05:00:00 +0100 5393955 http://www.medworm.com/index.php?rid=5393954&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2186%3Frss%3D1 The Affordable Care Act of 2010 will expand Medicaid to millions of Americans by 2014. How many enroll will greatly affect health care access, demand for clinicians, and the federal budget, yet the precision and validity of enrollment estimates made to date is unknown. We created a simulation model using two nationally representative data sets to determine the range of reasonable projections, estimating eligibility, participation, and population growth using prior research and our data. Our model predicted that the number of additional people enrolling in Medicaid under health reform may vary by more than 10 million, with a base-case estimate of 13.4 million and a possible range of 8.5 million to 22.4 million. Estimated federal spending for new Medicaid enrollees ranged... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393954 Mon, 07 Nov 2011 05:00:00 +0100 5393954 http://www.medworm.com/index.php?rid=5393953&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2177%3Frss%3D1 Many policy analysts fear that eliminating the individual health insurance mandate and penalty from the Affordable Care Act of 2010 would lead to a "premium spiral," in which healthy people would drop coverage, premiums would soar, and the number of people with coverage would plummet. However, there are other provisions of the law that would greatly mitigate this effect. For example, the subsidies provided in the law to help people purchase coverage through health insurance exchanges would restrain a premium spiral by absorbing much of the impact of premium increases. We estimate that if the mandate were lifted, premiums in the individual market would increase by 12.6 percent—somewhat less than other estimates—with 7.8 million people losing coverage, versus other esti... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393953 Mon, 07 Nov 2011 05:00:00 +0100 5393953 http://www.medworm.com/index.php?rid=5393952&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2167%3Frss%3D1 This article estimates the health costs associated with six climate change–related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change–related events projected to worsen with continued global warming—ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14 billion, with 95 percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740 million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393952 Mon, 07 Nov 2011 05:00:00 +0100 5393952 http://www.medworm.com/index.php?rid=5393951&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2157%3Frss%3D1 The evolution of pharmaceutical competition since Congress passed the Hatch-Waxman Act in 1984 raises questions about whether the act’s intended balance of incentives for cost savings and continued innovation has been achieved. Generic drug usage and challenges to brand-name drugs’ patents have increased markedly, resulting in greatly increased cost savings but also potentially reduced incentives for innovators. Congress should review whether Hatch-Waxman is achieving its intended purpose of balancing incentives for generics and innovation. It also should consider whether the law should be amended so that some of its provisions are brought more in line with recently enacted legislation governing approval of so-called biosimilars, or the corollary for biologics of generic compet... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393951 Mon, 07 Nov 2011 05:00:00 +0100 5393951 http://www.medworm.com/index.php?rid=5393950&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2149%3Frss%3D1 This article examines these challenges and makes recommendations for how to maximize the positive impact of the council through effective cross-agency collaboration aimed at improving Americans’ health, including framing prevention as a bipartisan cost containment strategy; distancing the work of the council from the implementation of other aspects of the Affordable Care Act; using dollars from the Prevention and Public Health Fund to incentivize ongoing participation by nonhealth agencies; and providing technical assistance and analytic support to nonhealth agencies willing to broaden attention to the health impacts of their nonhealth policies. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393950 Mon, 07 Nov 2011 05:00:00 +0100 5393950 http://www.medworm.com/index.php?rid=5393949&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2142%3Frss%3D1 Many observers have been concerned about a mismatch between the knowledge, skills, and professional values of newly trained physicians and the requirements of current and future medical practice. We surveyed and interviewed Kaiser Permanente’s clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology to ascertain their views of the perceived gaps in the readiness of newly trained physicians. Nearly half of those surveyed reported deficiencies among new physicians in managing routine conditions or performing simple procedures often encountered in office-based practice. A third of the chiefs noted deficiencies in coordinating care for patients. Filling these and other training gaps will require changes at many levels—from residency p... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393949 Mon, 07 Nov 2011 05:00:00 +0100 5393949 http://www.medworm.com/index.php?rid=5393948&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2134%3Frss%3D1 Some health plans have experimented with increasing consumer cost sharing, on the theory that consumers will use less unnecessary health care if they are expected to bear some of the financial responsibility for it. However, it is unclear whether the resulting decrease in use is sustained beyond one or two years. In 2004 Mayo Clinic’s self-funded health plan increased cost sharing for its employees and their dependents for specialty care visits (adding a $25 copayment to the high-premium option) and other services such as imaging, testing, and outpatient procedures (adding 10 or 20 percent coinsurance, depending on the option). The plan also removed all cost sharing for visits to primary care providers and for preventive services such as colorectal screening and mammography. The... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393948 Mon, 07 Nov 2011 05:00:00 +0100 5393948 http://www.medworm.com/index.php?rid=5393947&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2125%3Frss%3D1 In developed nations that rely on multiple, competing health insurers—for example, Switzerland and Germany—the prices for health care services and products are subject to uniform price schedules that are either set by government or negotiated on a regional basis between associations of health insurers and associations of providers of health care. In the United States, some states—notably Maryland—have used such all-payer systems for hospitals only. Elsewhere in the United States, prices are negotiated between individual payers and providers. This situation has resulted in an opaque system in which payers with market power force weaker payers to cover disproportionate shares of providers’ fixed costs—a phenomenon sometimes termed cost shifting—or pr... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393947 Mon, 07 Nov 2011 05:00:00 +0100 5393947 http://www.medworm.com/index.php?rid=5393946&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2116%3Frss%3D1 Fee-for-service payment is blamed for many of the problems observed in the US health care system. One of the leading alternative payment models proposed in the Affordable Care Act of 2010 is bundled payment, which provides payment for all of the care a patient needs over the course of a defined clinical episode, instead of paying for each discrete service. We evaluated the initial "road test" of PROMETHEUS Payment, one of several bundled payment pilot projects. The project has faced substantial implementation challenges, and none of the three pilot sites had executed contracts or made bundled payments as of May 2011. The pilots have taken longer to set up than expected, primarily because of the complexity of the payment model and the fact that it builds on the existing fee-for-service... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393946 Mon, 07 Nov 2011 05:00:00 +0100 5393946 http://www.medworm.com/index.php?rid=5393945&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2107%3Frss%3D1 Payers are considering bundled payments for inpatient surgery, combining provider reimbursements into a single payment for the entire episode. We found that current Medicare episode payments for certain inpatient procedures varied by 49–130 percent across hospitals sorted into five payment groups. Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. But after adjustment for these differences, per episode payments to the highest-cost hospitals were higher than those to the lowest-cost facilities by up to $2,549 for colectomy and $7,759 for back surgery. Postdischarge care accounted for a large proportion of the variation in payments, as did discretionary physician services, which may be driven in turn ... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393945 Mon, 07 Nov 2011 05:00:00 +0100 5393945 http://www.medworm.com/index.php?rid=5393944&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2098%3Frss%3D1 General job training programs, and separate disease prevention or health promotion programs, are usually viewed as two different strategies for reducing poverty and promoting community development. We propose that with better alignment of the strategies, new jobs with the potential to simultaneously improve population health, lower the cost of health care, and reduce unemployment could be created and filled. Initiatives for three types of entry-level positions—in the fields of community health, environmental remediation and protection, and food preparation—show particular promise as vehicles for health and economic improvement at the individual and community levels. Building on current federal programs, new pilot projects financed by federal funding should be created to test an... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393944 Mon, 07 Nov 2011 05:00:00 +0100 5393944 http://www.medworm.com/index.php?rid=5393943&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2090%3Frss%3D1 This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation’s low-income communities. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393943 Mon, 07 Nov 2011 05:00:00 +0100 5393943 http://www.medworm.com/index.php?rid=5393942&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2080%3Frss%3D1 Understanding social determinants of health, such as the social and physical conditions under which children and their families live, work, and play, is essential to reducing disparities and improving the quality of primary care. We studied the relationship between perceptions of neighborhood characteristics such as cohesion, safety, physical environment, and whether children receive care from a patient-centered medical home. We found that place matters. Children were less likely to have access to a medical home if they were from less socially cohesive neighborhoods, less safe neighborhoods, or neighborhoods with fewer amenities. These associations persisted even after adjustment for socioeconomic factors and proved to be more strongly associated than race and income. Our findings undersco... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393942 Mon, 07 Nov 2011 05:00:00 +0100 5393942 http://www.medworm.com/index.php?rid=5393941&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2079%3Frss%3D1 The Bronx has long lagged behind the rest of New York and the nation in a number of health indicators. A community development organization tries to narrow the gap. (Source: Health Affairs) Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393941 Mon, 07 Nov 2011 05:00:00 +0100 5393941 http://www.medworm.com/index.php?rid=5393940&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2072%3Frss%3D1 Tens of billions of dollars—both public and private—flow to low-income communities each year, mostly for affordable housing. However, it is rare for the health effects of these investments to be assessed. In San Francisco, California, a collaborative effort is under way that aims to fill this research gap while helping residents of Sunnydale, the city’s largest public housing project, where poverty, violence, and truancy are entrenched. The collaboration is in its earliest stages—with construction not scheduled to start for at least four years—but some early lessons have emerged. For example, researchers and community developers have found that their data collection needs and timeline expectations often don’t match. Nevertheless, the collaborators intend... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393940 Mon, 07 Nov 2011 05:00:00 +0100 5393940 http://www.medworm.com/index.php?rid=5393939&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2064%3Frss%3D1 The implementation of the Affordable Care Act of 2010 and the Obama administration’s urban policy create an opportunity to link community development with health in new and powerful ways. The administration’s policy emphasizes improved access to and quality of care through coordinated local and regional approaches, expansion of access to healthy food, and the support of environmental health—including clean air, water, and soil—and healthy homes. New federal programs, such as the Affordable Care Act’s Community Transformation Grants, seek to prevent death and disability through policy, environmental, programmatic, and infrastructure changes. But fragmented congressional jurisdiction and budget "scoring" rules pose challenges to needed reform. We argue that gove... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393939 Mon, 07 Nov 2011 05:00:00 +0100 5393939 http://www.medworm.com/index.php?rid=5393938&cid=s_30987_46_f&fid=30987&url=http%3A%2F%2Fcontent.healthaffairs.org%2Fcgi%2Fcontent%2Fabstract%2F30%2F11%2F2056%3Frss%3D1 Safe, vibrant neighborhoods are vital to health. The community development "industry"—a network of nonprofit service providers, real estate developers, financial institutions, foundations, and government—draws on public subsidies and other financing to transform impoverished neighborhoods into better-functioning communities. Although such activity positively affects the "upstream" causes of poor health, the community development industry rarely collaborates with the health sector or even considers health effects in its work. Examples of initiatives—such as the creation of affordable housing that avoids nursing home placement—suggest a strong potential for cross-sector collaborations to reduce health disparities and slow the growth of health care spending, while at t... Health Affairs journals http://www.medworm.com/rss/comments.php?id=5393938 Mon, 07 Nov 2011 05:00:00 +0100 5393938