Minggu, 13 Januari 2013
although this seems like a huge amount of money, the rise actually represents the third consecutive year of "relatively slow growth," the researchers said. whether spending will pick up again as the economy improves, as it has in the past, isn't known, they added.
"the stable growth in national health spending in 2011 is the result of mixed trends," micah hartman, a statistician in the office of the actuary at the centers for medicare and medicaid services, said during a monday afternoon press conference.
those slowdowns, however, were "offset by faster growth in personal health care goods and services," hartman noted. "the main drivers of the spending trends were medicare, private health insurance and consumer out-of-pocket payments," he said.
health care reform has had little effect on spending numbers so far, the researchers said. although some provisions of the obama administration's affordable care act were in place in 2011, their effect on spending was minimal, hartman said. it won't be until 2014 and beyond that the full benefits of the law will be seen, he said.
the report, which is issued annually, was published in the january issue of the journal health affairs.
among other findings in the report:
- health care spending as a part of the country's gross domestic product (gdp) has remained steady at 17.9 percent from 2009 to 2011.
- americans' personal health care spending increased briskly -- from 3.7 percent in 2010 to 4.1 percent in 2011 -- in part due to higher prescription-drug prices and higher costs for doctor and clinical services, the researchers found. personal health care includes all goods and services used to treat diseases in individual people, and excludes expenditures such as government administration and the net cost of health insurance.
- cost of doctor and clinical services jumped 4.3 percent in 2011, compared to about 3 percent in 2010, hartman said.
- spending on prescription drugs increased 2.9 percent in 2011, a big rise compared to the historically low annual increase of 0.4 percent in 2010. this growth is due primarily to the rise in brand-name prescribing and the introduction of new drugs.
the steep growth in drug costs, however, "was partly offset by slower growth for hospital services," hartman said. spending for these services was slowed by 4.2 percent, due to cuts in medicaid and hospital use, he said.
and although the growth in spending for medicaid slowed in 2011, spending for medicare, private insurance and out-of-pocket costs sped up, the researchers noted.
"medicare spending grew 6.2 percent in 2011, accelerating the growth from 4.3 percent in 2010," hartman said. the growth was largely due to one-time spending for skilled nursing facilities, he said.
medicaid spending increased 2.5 percent in 2011, down from 5.9 percent in 2010. the slower growth was due to states spending less on the program as matching federal grants ran out, hartman noted.
private insurance costs also grew as some 1 million more people enrolled. most of these new members were children of current policy-holders recently covered by the affordable care act, he said.
out-of-pocket spending for health care among consumers grew 2.8 percent in 2011, accelerating from 2.1 percent growth in 2010, hartman said.
as for the future, the researchers said they are concerned that spending on health care will only gain speed as the u.s. economy rebounds, something that has happened after past recessions.
Rabu, 02 Januari 2013
Minggu, 30 Desember 2012
states had until friday, dec. 14, to submit blueprints for creating their state-based insurance exchanges.
by default, the federal government will implement health insurance exchanges in the 25 states that are not moving forward, helping the uninsured gain coverage. another seven states, according to the kaiser foundation's count, will operate exchanges in federal-state partnerships. these arrangements will allow states to share the administrative burden of exchange implementation with the federal government.
"i'm sure it's a disappointment because the overall hope and plan from the beginning was to have as many states as possible to go ahead and implement their own exchanges," said frank mcardle, an independent health policy and benefits consultant in bethesda, md.
on monday, u.s. health and human services secretary kathleen sebelius said in a blog posting that the federal government had received 10 state applications to run an exchange. last week, the federal government granted conditional approval of insurance exchanges in another eight states and the district of columbia, where significant progress has been made in setting up those health insurance marketplaces. in all, 18 states and the district of columbia intend to run their own exchanges.
"we're looking forward to jan. 1, 2014, when consumers and small businesses will be enrolled through the exchanges in private health insurance plans and millions more americans will have the coverage they need and deserve," sebelius wrote.
state-based health insurance exchanges are a key element of the patient protection and affordable care act, the controversial health reform legislation championed by president barack obama. each exchange will operate a website where uninsured residents of the state and small employers can compare various health-plan options offered by insurance companies, much in the same way that consumers shop online for hotel rooms and airplane tickets that suit them best.
the health reform law is designed to help some 30 million uninsured americans by expanding medicaid, the publicly run program that helps the poor obtain medical care; creating subsidies for lower-income people to buy private coverage; and establishing the state exchanges.
with enrollment for the exchanges set to begin oct. 1, 2013, the obama administration and its contractors face the mammoth task of building a federal exchange that can be rolled out in states that have no insurance exchange and creating a central data hub where states can verify a person's eligibility for tax credits, premium subsidies and other health programs, such as medicaid and the children's health insurance program.
dr. daniel derksen, chair of public health policy and management at the university of arizona in tucson and former director of the new mexico office of health care reform, expects the federal government to "work hard" to get those systems in place but anticipates "hitches" along the way.
"i think it would be irresponsible to say a switch is going to be flipped and come january 1st  this thing will work perfectly. there's just a lot of moving pieces with this thing," noted derksen, who led efforts to build new mexico's health insurance exchange.
many gop governors not setting up state-run exchanges
although the affordable care act, derided as obamacare by its critics, became law in march 2010, many opponents at the state level dragged their heels on exchange activities pending the u.s. supreme court's decision last june on the law's constitutionality and the outcome of the november presidential election. some states nixed the exchanges, citing anticipated costs, lack of federal guidance and outright opposition to the law.
responding to a request from republican governors, sebelius last month extended the deadline for submitting a letter of intent and application to operate an exchange to dec. 14. states falling behind on exchange-building activities can still request help. the deadline to apply to operate an exchange in partnership with the federal government is feb. 15, 2013.
for the most part, states with republican governors opted to default to a federal exchange. just five republican-led states will run their own exchanges, and two will partner with the federal government.
"the great irony of this whole thing is you have the majority of the republican governors really allowing the federal takeover of health care when they could choose to have a state exchange," derksen said.
but will people care whether their state is the face behind the exchange?
"from a consumer perspective, whether you have a state-run exchange or a federal exchange doesn't make a huge difference," said caroline pearson, a director at avalere health llc, a washington, d.c.-based consulting firm. in either case, she noted, people will get coverage.
where it begins to matter is in the details, pearson explained. states can customize health plan options to accommodate the particular needs of their residents, she said. and because medicaid eligibility rules are state-specific, states may be able to do a better job of helping lower income people who apply through the exchange to coordinate coverage with the state medicaid program, she added.
avalere health predicts that roughly two-thirds of the 8.2 million people expected to buy coverage through the exchanges in 2014 will do so through a federally administered or partnership exchange.
"consumers also need to watch the debate over the fiscal cliff," mcardle cautioned. to offset scheduled tax increases and spending cuts slated to take effect in the new year, congress could reduce health insurance subsidies under the affordable care act, making health coverage less affordable.
"if the fiscal cliff and deficit reduction negotiations were to result in a reduction in federal subsidies available under the aca [affordable care act] starting in 2014, that could make coverage in the health insurance exchanges less affordable for some people," he said.
Kamis, 31 Mei 2012
1 in 5 Americans Has Untreated Cavities: CDC (5/31/2012)1 in 5 Americans Has Untreated Cavities: CDC
Most kids get dental care, regardless of income, because of federal health programs, researcher says
By Steven ReinbergHealthDay Reporter
THURSDAY, May 31 (HealthDay News) -- More than one in every five Americans has untreated cavities, a new government report shows.
"Untreated tooth decay is prevalent in the U.S.," said report co-author Dr. Bruce Dye, an epidemiologist at the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics. "It appears that we haven't been able to make any significant strides during the last decade to reduce untreated cavities."
One expert was not surprised by the findings.
"This is information that has been known for a while," said Dr. Lindsay Robinson, a spokeswoman for the American Dental Association. "More people are on Medicaid and more and more states, in an attempt to balance their budgets, have eliminated dental benefits."
There needs to be more investment in dental care to cover those who rely on Medicaid, Robinson said. "Only about 2 percent of Medicaid dollars go to dental care. In the private system it's triple that," she explained.
"Even people with dental benefits are afraid of any extra out-of-pocket costs," Robinson added.
The report authors found that the rate of cavities was pretty steady among all age groups, with teenagers having the lowest prevalence, Dye said. Among kids aged 5 to 11, 20 percent had untreated cavities, while 13 percent of those aged 12 to 19 had untreated cavities. People aged 20 to 44 had the highest rate of untreated cavities, at 25 percent.
Usually there is a difference in income when it comes to health care, but in this case children were getting about the same dental care regardless of family income, Dye noted.
For poorer children, this is most likely due to government programs such as Medicaid and CHIP (Children's Health Insurance Program), Dye said. Among adults, the poor have a rate of untreated dental problems twice that of others, he noted.
In addition to having cavities that were not treated, 75 percent of Americans have had some sort of dental work.
Other findings in the report include:
Among children and adolescents, 27 percent had at least one dental sealant. In that age group, 30 percent of whites had sealants, compared to 23 percent of Mexican-Americans and 17 percent of blacks.
Among blacks, 38 percent had all of their teeth, compared with 51 percent of whites and 52 percent of Mexican-Americans.
Among those aged 65 and older, 23 percent had no teeth, but most likely had dentures.
To reduce the odds of developing cavities, Dye recommended brushing and flossing daily and going to the dentist at least once a year. In addition, cutting down on sweets and surgery drinks and eating a healthy diet can also help, he said.
Going to the dentist is important, Robinson agreed. When problems are caught and treated early, it saves money, and for people with chronic diseases such as diabetes it can help avoid hospitalizations, she added.
"It is possible to not get cavities," Robinson said. "It's amazing how many people think it's just going to happen."
Kamis, 17 Mei 2012
Everyone has a movie or two that they love to watch at least once a year. A classic that you can spend one rainy evening, two bowls of popcorn and three glasses of chardonnay with. My sentimental favourite is High Society (above).
Yes, it's based on The Philadelphia Story which was made 20 years earlier but it features Frank Sinatra, Grace Kelly and Bing Crosby falling in and out of love while Louis Armstrong plays trumpet. What's not to like?
In the rom-coms of this era, the men and women talk and act like equals, economically and intellectually. That's how movies worked back then. It started with the screwball comedies of Spencer Tracey, Katharine Hepburn, Cary Grant and Rosalind Russell in the 1930s and 40s.
Recently I watched a very different rom-com: Pretty Woman. I did so because I have a whip smart PhD student, Chloe Angyal, who is writing her thesis on rom-coms and how they've become increasingly conservative.
But even reading her clever analysis of the worst of the genre hadn't prepared me for Pretty Woman (above) – a movie from 1990 that sets the feminist movement back by – oh, I don't know – about 400 years.
In case you're one of the lucky ones who has forgotten the plot, a lonely billionaire industrialist pays a prostitute with a heart of gold $3000 to spend the week with him in LA. He buys her expensive clothes and beautiful jewelry and takes her to the opera and French restaurants.
And you'll never guess the ending – they fall in love. How totally plausible.
Pretty Woman is grounded in the Pygmalion myth – originally the story of a sculptor who rejects real women and falls in love with an ideal ivory sculpture he carves.
The story has been reworked many times – the best known being George Bernard Shaw's Pygmalion in which a professor of phonetics bets he can teach a poor girl to speak like duchess. At least Shaw's play mocks Henry Higgins' misogyny and pomposity.
Not Pretty Woman. Richard Gere rides in on a white limo like Prince Charming with a platinum Amex and teaches Julia Roberts to enunciate "the rain in Spain stays mainly on the plain of Rodeo Drive" while she's giving him oral pleasure.
'Fish Pedicure' a Recipe for Bacterial Infection, Researchers Warn (5/17/2012)'Fish Pedicure' a Recipe for Bacterial Infection, Researchers Warn
Health spa practice is highly unhealthy, study reports.
By Alan MozesHealthDay Reporter
THURSDAY, May 17 (HealthDay News) -- "Fish pedicures" in health spas can expose recipients to a host of pathogens and bacterial infections, a team of researchers warns.
The practice of exposing your feet to live freshwater fish that eat away dead or damaged skin for mainly cosmetic reasons has been banned in many (but not all) American states, but it is apparently a hot trend in Britain.
So much so that the British researchers sent their warning in a letter published in the June issue of Emerging Infectious Diseases, a publication from the U.S. Centers for Disease Control and Prevention.
Officially known as "ichthyotherapy," the procedure typically involves the importation of what are called "doctor fish," a Eurasian river basin species known as "Garra rufa." The fish are placed in a spa tub, the foot (or even whole body) joins it, and the nautical feeding on dead or unwanted skin begins.
The problem: such fish may play host to a wide array of organisms and disease, some of which can provoke invasive soft-tissue infection in exposed humans and many of which are antibiotic-resistant, according to the scientists from the Center for Environment, Fisheries & Aquaculture Science (CEFAS) in Weymouth.
In the letter, CEFAS team leader David W. Verner-Jeffreys referenced a 2011 survey that suggested the U.K. is now home to 279-plus "fish spas," with an estimated 15,000 to 20,000 fish coming into the country every week from a host of Asian countries.
Verner-Jeffreys noted that in April 2011, 6,000 fish imported from Indonesia for U.K. fish spas were affected by a disease outbreak that caused hemorrhaging of their gills, mouth and abdomen, resulting in the death of nearly all the specimens.
In turn, U.K. scientists uncovered signs of bacterial infection (caused by a pathogen called "S agalactiae") in the fishes' livers, kidneys and spleen.
Following this discovery, Verner-Jeffreys said, his team conducted five raids on imported fish batches coming through Heathrow Airport, which uncovered further signs of infection with a number of additional pathogens. Many of those were found to be resistant to such standard antimicrobial drugs as tetracycline, fluoroquinolone and aminoglycoside.
"To date, there are only a limited number of reports of patients who might have been infected by this exposure route," Verner-Jeffreys said in his letter. "However, our study raises some concerns over the extent that these fish, or their transport water, might harbor potential zoonotic disease pathogens of clinical relevance."
At particularly high risk, the scientists said, were people already struggling with diabetes, liver disease and/or immune disorders.
Verner-Jeffreys suggested that spas offering fish pedicures use disease-free fish raised in controlled environments.
George A. O'Toole, a professor in the department of microbiology and immunology at the Geisel School of Medicine at Dartmouth in Hanover, N.H., added his own concern.
" I would stay away from this experience," he said. "It's probably not feasible to sterilize these fish. And as for the water itself, even if you dump it between patients, these organisms will form rings of biofilm communities attached to the surface of the tubs themselves. It's like a contact lens case that you never disinfect. Simply wiping them down is not good enough. Unless you're incredibly responsible about sterilizing those tubs you're not going to kill them, and they will reseed the next batch of water. The whole thing is a bad idea."
Dr. Philip Tierno, director of clinical microbiology and pathology at New York University Medical Center in New York City, agreed.
"It's a bad idea in several ways," he said. "Because these pathogens can give you a serious wound infection. Or blood-borne infection. Or diarrhea. Or even pose a threat to a pregnant woman's fetus or newborn."
"Really, you have the potential for multiple types of infection," Tierno added. "Because theoretically when you're touching the area that has been nibbled on by these fish, you can still have the organisms there. And then you can inadvertently touch your mouth and introduce them into your system."