“Health is very addictive,” Michaela Deeley told me. “The way you feel once you start to feel good… you don’t want to stop.”
Michaela is the manager at the Mandara Spa on the Norwegian Cruise Line’s ship, the Breakaway, which sails weekly from New York City to Bermuda. I appreciated the opportunity to interview Michaela about how medical tourism is a growth business for the cruise industry, and a welcome on-ramp to health and wellness for passengers.
“Health on a cruise ship?” you ask. In fact, this area of the146,000 ton ship [which accommodates 3,963 passengers and 1,657 crew is hiring more staff in response to cruising clients’ growing demand for health and wellness services on-board. When it comes to consumers and medical tourism, you must think beyond bingo, binge eating, and bar-hopping.
“More passengers are flowing into the spa area looking for services,” Michaela told me. The primary demand prompting cruise ship passengers may be seeking a week of vacation of sun-tanning (using high-powered SPF to prevent sun damage, of course), dining 24×7, and casino gambling. But more people choosing to cruise are growing more health conscious, seeking opportunities to make personal health throughout the ship: from the kitchen and dining room to the fitness center and through experiencing dozens of health education classes available throughout the seven day ride on the Atlantic Ocean.
What is prompting people to come into the Spa area of the ship, when there are so many other activity options? I asked Michaela. The simple answer is that our interest in health, vitality and wellness is growing, and particularly among people over 50 who want to age well.
While some repeat passengers may know what they want after boarding the ship, most people need time to review the lengthy, descriptive spa menu. Staff are trained to ask clients about what’s motivated them to approach the spa in the first place. The client complaints and concerns cover the gamut: to relax more, to deal with pain, to boost wellness, and to be sure, to lose weight. While this may seem ironic given cruise ships’ stereotypical reputation for 24-hour buffets, unlimited drinks packages and 3 am room service, it is the case that many cruisers seek balance, participate in daily yoga classes, and order nutritious, clean food from restaurant menus. There are vegetarian and gluten-free options for people who want them among the nearly 20 dining venues.
The spa service list is split into categories, some of which are the more typical salon and spa services available on land such as facials, massages, and mani/pedicures. The Medi-Spa services are less familiar to consumers new to the concept: body correction, acupuncture, and several branded dermatological treatments. These are generally available from dermatologists working on terra firma, but rarely under one roof with all the other services offered here – including the GOSMiLE branded tooth whitening procedure.
The demographics of the passengers are important to call out: remember that this ship’s particular route travels from New York City to Bermuda. Michaela noted that the NYC clientele lead busy lives. If people can take advantage of several services over a week in one place, and while on a relaxing holiday, it optimizes peoples’ time.
Convenience is king. A diverse portfolio of services is offered in one place. And for “patients” used to being responsible for one bill for every encounter, here, it’s one bill at the end of the cruise with no sticker shock. Prices for each service are transparently shown. There are even discounts offered, Uber-style, at low-peak times such as in port in Bermuda.
The thermal suite in the spa is equipped with modern amenities that speak to techniques used long-ago in Europe. Medical tourism goes way back to the era where patients were prescribed spas in Bath, England, and Baden Baden, Germany, to take in steam baths and salts. Here on the Breakaway, there is a Salt Room, a Sauna and Sanarium, and a thalassotherapy pool of seawater, salt, and other therapeutic ingredients.
The demand for acupuncture services afloat is growing. Acupuncture has dozens of applications, most notably for pain – a topic getting appropriately more attention in mass media owing to the opioid crisis. Another health issue for which acupuncture gets growing application is for sleep. “People get used to a lack of sleep and lack of energy and they don’t know the difference,” Michaela observed.
I shared with Michaela research I’ve used in my work and discussed here in Health Populi and in the Huffington Post on the Stress in America survey from the American Psychological Association. The most recent poll, published in the midst of the autumn 2016 election season, found that 52% of Americans said the 2016 Presidential election was a significant source of stress, compromising sleep and other health issues.
Of course, exercise has been found to be a stress-reliever and sleep-enhancer, and there is no shortage of fitness classes to be found on the NCL Breakaway. Each day, the ship’s calendar (the “Freestyle Daily”) lists all the day’s activities, including fitness and health meet-ups. On Day 3, for example, there were classes meeting for “stretch & abs,” fun cardio dance, Ryde indoor cycling, body sculpt boot camp, relieving back pain with good feet, a salsa dance class, and many sporting choices from basketball and shuffleboard to scaling a rock climbing wall and doing an evening stretch.
I’ll give a special shout-out for the Ryde indoor cycling class, which is akin to Soul-Cycle-At-Sea. Indoor cycling for fitness has gained great traction on land, and so as a fan of cycling, I’m glad to see this fitness trend reach cruising so that consumers who want to try it out can do so in a relaxed, non-intimidating environment. What’s intriguing about the Ryde class is that riders wear a heart monitor so they can viscerally feel what it’s like to push their personal fitness: the monitor communicates an exerciser’s real-time activity which is digitally posted to a wall graphic, and a personal trainer can educate the rider on how hard to push. At $20, it’s a fair deal compared with prices on land.
At the end of the day (or cruise week), the big remaining question and wild card is whether a passenger on a holiday will continue keeping up a health regimen on-land, day-to-day, once normal workdays, workflows, and stressors enter back into our normal lives.
“We are realistic,” Michaela said, “not to tell someone, for example, to change their diet. On board, people have our support. When you go home, you must have your partner or friends support you. On-board, personal trainers show people how to do new exercises, weight lift routines, yoga poses, and good posture form in a relaxing, supportive environment. But behavior change is hard, so seeing repeat customers throughout the year (especially accessible for health consumers living around the New York metro area) is one way the spa staff knows they are impacting peoples’ lives.
Health Populi’s Hot Points: In the past year, since I first met up in the Breakaway’s Mandara Spa for an interview, I see the breadth of services offered expanding, and health consuming cruisers getting more savvy and demanding.
Several market forces are driving this phenomenon:
1. For American passengers boarding the ship, the growth of high-deductible health plans and out-of-pocket costs are dramatically reshaping US patients into healthcare consumers.
2. As consumers, people are seeking convenient care in formats, places, and at prices they find representing value – value, on their personal terms based on taste, culture, respect, and indeed, price.
3. Healthcare consumers are morphing into health/care consumers, re-defining what inputs are useful for their lifestyles, lives, and medical conditions. If dealing with pain, learning about and accessing acupuncture, posture, or massage may be of interest. If managing weight, a re-set over the course of a week of pampering and meditation could help one re-focus and re-commit to the objective. Ditto for sleep issues.
Michaela, who hails from the United Kingdom, has observed that American patients appear quick to get medications and surgical procedures. “Guests we see now want to look for alternatives. Today, they are more knowledgeable about options and availability” via, for example, watching TV programs like The Biggest Loser, YouTube videos featuring doctors and nutritionists, or reading blogs by health experts and would-be ones (a current example is the brewing controversy between Gwyneth Paltrow’s Goop and Dr. Jen Gunter, an OB-GYN).
As in all healthcare providers and suppliers going direct-to-consumer, people need to be educated and aware of their health risks as well as the quality of the services they choose to purchase. Caveat emptor is always advised, and a lot of research can be done ahead of time before any medical tourism choice, whether on a ship or to a foreign country.
As people look to slow age, enjoy vitality and more energy, and get good sleep, we’ll keep searching for services and experiences that bring those benefits. For thousands of cruise passengers boarding ships every week, these services will be available. Consumers looking to take advantage of these – especially medical procedures – can review these online in advance, and also check with health insurance plans to see if they can be covered by insurance or claimable in medical or health savings accounts.
Our THINK-Health forecasts expect more, and more diverse, opportunities in the retail health landscape for medical tourism and spas morphing closer and closer to health/care.
The post Health on the High Seas – Mandara Spa on the NCL Breakaway appeared first on HealthPopuli.com.
That is the question that Lakdawalla et al. (2017) attempt to answer in the latest edition of the American Journal of Managed Care (AJMC). The long-run average cost (LAC) of a pharmaceutical includes not only initial branded drug price, but also subsequent prices increases and decreases, especially those that occur after a treatment’s patent has expired and generics enter the market. Further, the authors measure the LAC net of any medical cost offsets.
To measure the LAC, the authors rely on data from the 1996-2013 Medicare Expenditure Panel Survey (MEPS). They find that:
Accounting for patent expiration, the loss of exclusivity price and the launch price overstate the LAC by 39% and 11%, respectively, and the LAC net of medical cost offsets by 75% and 40%, respectively.
Overstating long-run prices could be problematic for patients if it results in reduced treatment coverage and decreased incentives for innovation. The authors write:
Branded prices, generic prices, and the LAC all play important roles in economic decisions, which are made on the margin. Prices at a point in time matter to payers, who must decide if the benefit of treating 1 more patient outweighs the cost. The LAC and the LAC net, however, should matter to regulators, policy makers, and payers assessing whether a new drug can be marketed or reimbursed. In this context, overstating the eventual cost of a drug may lead to fewer drugs being made available, weaker incentives to innovate, and ultimately, fewer new drugs discovered
Source:
That is the question that the Outcome Measures in Rheumatology (OMERACT) Working Group attempted to answer. Specifically, the working group aimed to determine the core set of outcome domains for measuring the effectiveness of shared decision-making (SDM) interventions within clinical trials used to treat rheumatic diseases. These diseases included osteoarthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA).
This is not the first effort in SDM. For instance, for more general
The International Patient Decision Aid Standards (IPDAS) has identified a set of 8 outcome domains for evaluating the effectiveness of patient decision aids: (1) recognize the decision to be made, (2) know the options, (3) their features, (4) understand that values that affect the decision, (5) clarify values, (6) discuss values with health providers, (7) participate in decision making in preferred ways, and (8) make an informed value-based choice.
However, the authors wanted to tailor the general SDM approach to rheumatic diseases. The authors used an online Delphi Panel methodology as well as a follow-up in person workshop. About half of Delphi panelists were patients, and just over a third were clinicians, with policymakers, members of industry, consumer groups, and caregivers making up the remainder. The draft set of domains included:
The top-rated domains in the OMERACT breakout groups were: understanding information (2), clarifying patient values (3), and making the decision (5), with the least necessary domain being deliberating (4). In the plenary session, the top domains were: effect of decision (7), understanding information (2), clarifying patient values (3) with the leas necessary domain being deliberating (4).
There was some disagreement, however, with respect to the degree to which participants felt that each domain was necessary. Forums with more researchers/clinicians and fewer patients felt that many of these domains were less necessary than forums where patients made up a large share of respondents.
The authors conclude with the following quotation:
“Patients must be involved in their care and treatment decisions not just to ensure patient-centered care, but also so that patients understand and take responsibility for these decisions. SDM is the wave of the future; we can’t run away from it, we have to tackle it together.”
Source:
The importance of trust in healthcare cannot be overestimated. Trust underpins peoples’ health engagement. Trust eroded repels people from seeking necessary health care services.
So what do we make of Aetna’s appalling breach of patient privacy when the health insurer, whose 23 million members sign HIPAA agreements, sent a letter to some 12,000 members who are managing HIV….and the envelope in which these letters were mailed had a glassine window that exhibited the advisory showing the words, “The purpose of this letter is to advise you of the options…Aetna health plan when filling prescriptions for HIV Medic….members can use a retail pharmacy or a mail order pharma….”
Who needs a cyberattack on digitized electronci health recvords when a health plan discloses such information naked to the eye of an apartment super, a postal delivery person, a family member or friend bringing in the mail, or any other onlooker other than the patient-person herself?
The Legal Action Center in New York City and the AIDS Law Prodjec tof Pennsylvania sent a cease-and-desist letter to Aetna a report in NPR said. People living in Arizona, California, Georgia, Illinois, New Jersey, New York, Ohio, Pennsylvania, and Washington, DC, had complained about the letters, which were sent to people currently taking medications for HIV treatment as well as for PrEP (Pre-exposure Prophylaxis) which is a preventive therapy for people at risk for contracting HIV.
Aetna told the Center and Project that its mailing vendor had indeed been using a window envelope and that contents inside could have shifted int he envelope which may have revealed the confidential information. The letters were mailed on July 28 and July 31.
The story’s been covered massively across media outlets, well beyond health care and insurance. USA Today, the Wall Street Journal, US News & World Report, Philadelphia Inquirer, and many other mainstream news sources have covered this story.
Here’s NPR’s take, well worth reading.
Health Populi’s Hot Points: Trust and authenticity underpin a consumer’s willingness to engage with healthcare stakeholders, we learned in the Edelman Health Engagement Barometer.
We can go all the way to the Tuskegee Experiments for justifiable roots of distrust within the African-American community vis-a-vis the medical and healthcare industry. A timely essay in JAMA last week on the Nuremberg Code 70 Years Later focuses in on the primary role of trust between patient and health care providers, researchers, and other industry touchpoints. The result of the trial had direct import for “human rights, individual autonomy, and informed consent.”
History has scores of examples of how the healthcare system has eroded goodwill between the industry and patients and their families. We don’t need another example like the Aetna scenario, which is a #fail on simple HIPAA 101 policy and procedural basics.
The post A Lesson in Healthcare Data Distrust, Brought to Us By Aetna appeared first on HealthPopuli.com.
An award, in virtually any context, is an honor. Having just been named the 2017 Best Dentist in Fort Worth by the Star-Telegram, we feel that this award is a resounding endorsement for everything our office works to demonstrate. But, better yet, this award has been a definitive show of confidence and trust by our patients.
Yes, an award is an honor. We feel strongly about the quality of care we give, and are proud to have it recognized. It’s the social proof behind this particular award, however, that leaves us humbled.
The Fort Worthy Awards from the Star-Telegram were started several years ago, and the 2017 awards were announced at the end of last week. We had our names in the hat, and watched as likes and shares on our Facebook ticked up on our link to the voting page. The award was granted to us as a product of the phenomenal number of patients who turned up to vote. We cannot thank you enough!
We want to congratulate all the other winners of the Fort Worthy Awards as well, and we encourage everyone to keep voting in years to come. This is an opportunity for our community to high-light the “Best Of” in many care and service fields, and shed light on the places people are proud to support here in the Fort Worth area.
What’s next?
Winning this award has been an honor, and a public show of confidence our patients have given us. We’re thankful, but also excited. What comes after an award like this? After receiving such a show of trust and support, our whole office has a publicly-accoladed standard to live up to. We already took pride in our work, but now we have an added sense of accountability to live up to this standard.
It was the combined effort of our staff, and not just Dr. Ku, who helped win this award. The sense of shared ownership was felt all around the office when the award was announced last week. Doubtless, the next time you’re in, you’ll see how happy we are to keep doing what we love with this award to validate it.
If you haven’t met all of our phenomenal staff members yet, see our pages on the website that introduce our staff and doctors. This is an incredible team to work on, and—as awarded by the Star-Telegram last week—the best of dental care here in Fort Worth!
About the award
Dr. H. Peter Ku was awarded the Star-Telegram Fort Worthy Best Dentist Award for 2017, announced late last week. We feel our entire office earned this award, and want to thank everyone who voted. The trust you’ve placed in us is our greatest reward of all, and we are humbled and grateful by your public show of support.
We’re proud to keep your smiles healthy, but we are overjoyed when we inspire those smiles through the work we do, and the care we give. We look forward to seeing you each in the office the next time you visit!
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Cables and Sensors, a patient monitoring website, named the Healthcare Economist as one of the Top 50 medical blogs.
Three-quarters of patients’ decisions on whether to seek services from healthcare providers are impacted by high deductible health plans. This impacts the finances of both patients and providers: 56% of patients’ payments to healthcare providers are delayed some of the time, noted in Optimizing Revenue: Solving Healthcare’s Revenue Cycle Challenges Using Technology Enabled Communications, published today by West.
Underneath that 56% of patients delaying payments, 12% say they “always delay” payment, and 16% say they “frequently delay” payment.
West engaged Kelton Global to survey 1,010 U.S. adults 18 and over along with 236 healthcare providers to gauge their experiences with healthcare costs and patient payments. More Millennials and younger people delay payments than older patients (70% versus 50%).
8 in 10 patients say affordability is the biggest problem with U.S. healthcare, shown in the first chart. 93% of U.S. adults say healthcare in America is too expensive, and two-thirds say it’s difficult to pay medical bills on time.
Other key findings impacting healthcare providers’ bottom lines are that:
Discussing healthcare costs can help reduce delayed payments. West, which is in the technology-based communications business, offers advice on how to improve this challenge. Healthcare providers have found various communications tactics to be useful to stem late or non-payments, such as sending reminder notifications via automated voice messaging, email or text message appointment reminders. Currently, only 15% of providers send messages using any of these methods. Furthermore, only 31% of providers make phone calls to patients who have missed payments, and fewer use automated communications (such as voice messages, texts and emails) to do so.
West concludes that providers can better manage their risk by prioritizing chronic disease management. Two-thirds of patients dealing with chronic conditions say they want support and are willing to pay for services that help them manage chronic conditions — up to $10 per month out-of-pocket for between-visit support from their medical team. This is an important finding because nearly one-half of chronically ill patients say high deductibles impact how often they go to see their healthcare provider, West found.
Health Populi’s Hot Points: Health literacy in American in 2017 goes beyond clinical instructions; in the current healthcare environment, patients are consumers, taking on both clinical and financial roles. When we’re sick, dealing with an acute onset of, say, cancer, or learning to manage a chronic condition, we can face the issue of financial toxicity — for an oncology therapy that may require an out-of-pocket cost in the six-figures, or for ongoing testing and maintaining a healthy lifestyle for managing diabetes.
The conversation between provider and patient that enables shared decision making is also the one that boosts health literacy, clinical and financial. The traditional bedside manner gives way here to more digital approaches that can scale, and also reinforce, learnings and advice between doctors, other clinicians, and patients and caregivers.
One approach was discussed in the New York Times last week: the use of recording interactions between patients and doctors. While there are some legal issues, state by state, which may impede or be a barrier to this happening, more research and evidence is building making the case for taping or otherwise digitally recording (via smartphones) encounters in real time. This allows patients and those that care for them to re-listen to instructions, diagnostic and prognostic information, and share it in a team-based way.
Lest you call me a techno-optimist in health care, let’s not forget the importance of trust and empathy in our healthcare, as well. Without these, health engagement won’t happen much. There’s evidence for this, too.
The post Patients’ Healthcare Payment Problems Are Providers’, Too appeared first on HealthPopuli.com.
Are Democrats or Republicans more likely to argue against vaccination? A recent article by Charles McCoy in The Conversation reveals that the answer is not so clean cut.
What I found is that the more political someone is, the more likely he or she is to believe that vaccines are unsafe. Those who are “very conservative” are one-and-a-half times more likely to believe this than moderates.
Yet, the same is true for those on the left: compared to moderates, those who are very liberal are also one-and-a-half times more likely to believe vaccines are unsafe. It seems that it does not matter what your politics are, the more partisan, the more likely you believe vaccines are harmful.
To stereotype, both left wing liberals into “natural” health care and right wing libertarians interested in freedom of choice both are more likely to oppose vaccination compared to individuals with more moderate political affiliations.
A 65-year-old couple in America, retiring in 2017, will need to have saved $275,000 to cover their health and medical costs in retirement. This represents a $15,000 (5.8%) increase from last year’s number of $260,000, according to the annual retirement healthcare cost study from Fidelity Investments. This number does not include long-term care costs — only medical and health care spending.
Here’s a link to my take on last year’s Fidelity healthcare retirement cost study: Health Care Costs in Retirement Will Run $260K If You’re Retiring This Year. Note that the 2016 cost was also $15,000 greater than the retirement healthcare costs calculated for the year before in 2015. Fidelity notes that this year’s increase at nearly 6% has culminated in over 70% increase since Fidelity first began to calculate retirement health care costs in 2002.
Medical and health expenses in retirement cover monthly Medicare premiums, Medicare copayments and deductibles, and prescription drug out-of-pocket spending as shown in the diagram (from Fidelity’s retirement calculator website).
Fidelity points to employers’ opportunity to bolster health-insured employees’ health financial literacy and access to tools that can help bolster workers’ financial wellness: in particular, health savings accounts (HSAs). Fidelity notes that the number of HSA clients on the company’s platform grew 38% over the year, and HSA holders increased 46%. The key financial wellness aspect of HSAs is that they have a triple-tax advantage, avoiding taxation at the initial investment, during the interest-growth period over time, and finally when taken out for use in retirement.
Health Populi’s Hot Points: A new report from MedPAC, the Medicare Payment Advisory Commission, segments Medicare spending by enrollee line-item, shown in the third chart. By 2015, Medicare reached $638 billion in spending, split between Medicare plan premiums, hospital, Part D prescriptions, physicians, outpatient hospital costs, and other services.
From 2006 to 2015, there was a shift in shares among these spending categories. Prescription drugs increased as a proportion of total Medicare costs from 11% to 14%; and, outpatient hospital services grew from 5% to 7% of total Medicare costs. Medicare premiums also garner more Medicare spending, from a share of 16% of spending to 27% of the total.
Payments to hospitals (inpatient) and physicians fell as a proportion of Medicare spend, from 2006-2015.
The cost of prescription drugs is on my mind this week as I learned that, per this story in USA Today, the estimated price for a new-new therapy targeting leukemia (known as CAR T-cell therapy) will cost $649,000 for a course of treatment. I’ve written about financial toxicity in the context of patients dealing with cancer therapies here in Health Populi. The magnitude of financial toxicity takes on a new scope here as this therapy is priced more than ten times the median family income in America in 2017. The clinical miracle for patients and families is that 83% of those treated with CAR T-cell therapy have gone into remission.
So it’s no surprise in this era of $500 EpiPens that more Americans are relying on “handouts” for affordable medication, as the title of an article in Britain’s Financial Times wrote in June 2017. “For Americans unable to afford prescription medicines, patient assistance programs – run by charities and drug companies to provide free or low-cost medication to poor or uninsured patients — offer a lifeline,” the column reads. But drug company execs agree that this is an unsustainable model.
Most patients in the U.S. love lower costs and “free” stuff in healthcare (and in everyday life); but as David Howard of Emory University pointed out in the New England Journal of Medicine in 2014 (at the moment of the Hep C pricing crisis and two years before the EpiPen price uproar), as patients become less sensitive to costs, companies often mark up medication costs.
It won’t be only drug companies who face scrutiny as restraining health care costs is the one aspect of U.S. reform that has bipartisan agreement (which I discussed here in Health Populi). Doctors and hospitals already garner lower shares of the Medicare bill and MedPAC learned, and the GOP’s American Health Care Act (AHCA) called for a 50% reduction in federal contributions to Medicaid would have hard-hit providers serving the program.
Retirees, be forewarned: save your cash. You’ll be spending more out-of-pocket for access to health care services. But politicians, be mindful: healthcare costs are top-of-mind for consumers as well, as 2018 looms closer.
The post A Couple Retiring Today Will Need $275,000 For Health Care Expenses appeared first on HealthPopuli.com.
The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016.
The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month.
The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA.
It’s especially noteworthy that women with low incomes made gains in coverage across racial and ethnic groups. In 2010,
The ACA made it easier for women to buy health plans on their own, The Fund found. In 2010, one-third of women who had health insurance or tried to buy it in the individual market in the past three years had either been turned down by an insurance company, charged a higher premium due to pre-existing conditions, or been excluded due to a specific health problem. Fewer than half of the women (46%) who tried to buy health insurance finally enrolled in one.
By 2016, 67^ of women shopped for a plan in the individual market and finally enrolled in one, with the percentage of women having difficulty finding an affordable plan dropping by half. Women with existing health problems made especially large gains, The Fund learned.
The proportion of women skipping or delaying medical care because of cost also fell. These self-rationing issues included not filling a prescription for medicine, not seeing a specialist when needed, skipping a recommended test or treatment, and not seeing a doctor when sick. The share of women reporting a cost-related problem getting care fell from 48% in 2010 to 38% in 2016, shown in the second chart.
Health Populi’s Hot Points: It’s very good news that women’s access to healthcare has significantly improved since the implementation of the Affordable Care Act. But the costs of health care services continue to motivate self-rationing of care due to costs, with 4 in 10 women reporting problems with medical bills and mounting medical debt in 2016, the third chart attests.
Not filling prescriptions, skipping needed lab and diagnostic tests, and avoiding seeing the doctor to avoid the out-of-pocket costs feel like short-term rational fiscal decisions. However, these can lead to downstream negative physical outcomes and resulting greater medical costs. This can then perpetuate a cycle of downward financial health, on top of sub-optimal health outcomes.
Women are more likely than men to say they are paying off medical debt over time, Kaiser Family Foundation found in a 2016 survey.
The societal cost is greater burden on social and public sector safety net budgets (e.g., SNAP benefits, Medicaid, disability payments, and so on). For women, who play the role as caregiver for children, parents, and self, the burden is heavy especially for those managing chronic conditions like heart disease, diabetes, and the mental health impacts of everyday stress.
What would a day in America without women’s economic contributions look like? The Center for American Progress asked that question this year on International Women’s Day, March 8. The fourth chart quantifies the answer, by U.S. state, for how much money each state would lose if women took off work for one day.
These calculations are under-estimates, however. The methodology here doesn’t take into account that women tend to take on unpaid labor, spending 150% more time on housework than men and more than twice the time men spend on caregiving. These skills are vital to the macroeconomy.
Access to health care services is a social determinant of health, and of a healthy national economy.
The post Women’s Access to Health Care Improved Under the Affordable Care Act appeared first on HealthPopuli.com.
In the U.S., one-third of people age 65 and over have difficulty walking 3 city blocks.
Hold that thought, and consider the role of purpose in life: purpose drives well-being, inoculating one’s life with meaning, direction, and goals, as the On Purpose guru Victor Strecher explains in his amazing graphic manifesto.
Having a higher sense of purpose in life is associated with higher probability of people engaging in healthier behaviors, such as greater physical activity and seeking preventive healthcare; better biological functioning; and, lower risk of disease.
Four researchers from the Harvard School of Public Health connected the dots between those hard-to-walk city blocks, aging, and purpose in their original research published in JAMA Psychiatry this month in Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults.
This is the first study published that evaluates associations between purpose in life and physical function. This study confirms others that have associated psychological factors (such as mastery and optimism) with enhanced physical function based on objective measures.
The table included here shares some of the study data showing correlations between older people over 50 feeling increased purpose in life and lower risk of slowed walking and weakening grip strength. Statistically, each 1-SD (standard deviation) increase in one’s purpose in life was associated with a 13% decreased risk of developing weak grip strength and 14% decreased risk of developing slow walking speeds 4 years later.
“Purpose in life may be one promising and novel upstream factor that serves as a target for improving not only mental health but physical function as well,” the researchers conclude.
They point to recent research demonstrating that a sense of purpose can be improved, such as this meta-analysis by Weiss et. al. asking whether we can increase psychological well-being? The answer is “yes,” and points to the promise of investing more in mental and behavioral health for the betterment of peoples’ sense of purpose.
Health Populi’s Hot Points: Many of you saw this triangle diagram in your high school or college Psychology 101 classes: it’s Maslow’s Hierarchy of Needs. Depending on whether you were paying attention, you may recall that “belongingness and love needs” are in the belly of the hierarchy. Belongingness and love — intimate relationships and friends — are central to our well-being and basic needs, like clean water and safe shelter.
These are the social determinants of health beyond the healthcare system. And this one featured in the study, purpose, speaks to basic psychological needs in the hierarchy — self-actualization, esteem, security, in addition to the physiological needs of food, water, warmth, and rest (read “sleep” for most of you Health Populi readers).
The opioid epidemic in the States is but one manifestation of the association of purpose in life and mental/physical function. The findings in the research published in JAMA Psychiatry can extend beyond older people to younger people.
Mother Teresa recognized that, “loneliness and he feeling of being unwanted, is the most terrible poverty.” She also said that, “loneliness is the leprosy of the modern world.”
When we who work in health and healthcare utter the words “connected health,” we should be mindful of the phrase’s two meanings and bake social connections into policy and practice.
The post Loneliness and Isolation Kill: Health Depends on Purpose appeared first on HealthPopuli.com.
In 2015, poor and low-income people in America had worse health care than high-income households; care for nearly half of the middle-class was also worse than for wealthier families.
Welcome to the 2016 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ). The report assesses many measures quantifying peoples’ access to health care, such as uninsurance rates (which improved between 2010 and 2016), and quality of health care — including person-centered care, patient safety, healthy living, effective treatment, care coordination, and care affordability.
While some disparities lessened between 2000 and 2015, disparities persist for poor and uninsured people: 80% of the health disparity measures did not significantly change over the 15 years for any racial and ethnic groups vis-Ã -vis whites. For uninsured people, two-thirds of the measures were lower than for privately-insured Americans.
States in the Midwest and Northeast tend to have lower levels of healthcare disparities compared with the Central South, Southwest, and parts of the west — notably, Arizona and California.
Three key measures that did not improve were:
The major gain noted by the study was the growth in health-insured people — especially among Hispanics, American Indians and Alaska Natives, and Blacks, versus Whites.
Health Populi’s Hot Points: Geography is healthcare disparity destiny in the U.S., illustrated in the map. This shows the overall health care quality and disparity score of each state based on the measures AHRQ studied for the report.
One specific quality component stood out for me in reviewing the data details: trends in effective treatment, which quantify timely treatment of acute illness and injury and management of chronic disease which can positively — or negatively — impact mortality, morbidity and quality of life.
While one-half of measures improved, several areas had not statistically significant changes: namely, diabetes care, treatment for illicit drug use, and treatment of alcohol problems for people age 12 and over who needed that treatment.
The two American public health epidemics of diabetes and opioid addiction are the poster children for this data point.
Another stand-out is trends in care affordability: while the growing health insured population is a positive development, high premiums and out-of-pocket (OOP) payments can deter people from accessing healthcare services. AHRQ found that 70% of the care affordability measures did not statistically improve, such as the percent of people under 65 years of age whose family’s health insurance premiums and OOP spending exceeded 10% of family income. This measure is particularly burdensome for lower-income people, who had a greater likelihood to delay needed medical care due to financial or insurance reasons. (Here at THINK-Health and the Health Populi blog, we look at that phenomenon as self-rationing by patient due to cost).
The first “A” in “Affordable Care Act” also persists for virtually all health citizens in the U.S. As the U.S. Congress soon re-convenes in Washington, DC, they have the opportunity to address the stability of health insurance exchanges as a start to helping make healthcare more affordable for the mass market of Americans. An important essay sponsored by the Commonwealth Fund was published last week in the American Journal of Public Health, calling for bipartisan health reform. The bottom-line is that reducing costs for individuals and payers is a shared priority for both Republicans and Democrats, above all other healthcare reform priorities.
The post Healthcare Quality and Access Disparities Persist in the U.S. appeared first on HealthPopuli.com.
That’s the title of my article released today in U.S. News and World Report. Here is an excerpt.
A number of health care industry leaders are making big bets that the future of health care lies in precision medicine. This July, Dr. Priscilla Chan and Mark Zuckerberg donated $10 million to the University of California-San Francisco’s precision medicine lab. Back in 2016, President Obama launched the Precision Medicine Institute with a $215 million investment from the federal government. In addition, the All of Us program is a National Institute of Health-funded initiative to collect genetic and environmental information to create precision medicines.
All of this money flowing into precision medicine may leave you with only one question left to answer: What is precision medicine?
The rest of the article answers this question. Do read the whole thing.
A 65-year-old couple in America, retiring in 2017, will need to have saved $275,000 to cover their health and medical costs in retirement. This represents a $15,000 (5.8%) increase from last year’s number of $260,000, according to the annual retirement healthcare cost study from Fidelity Investments. This number does not include long-term care costs — only medical and health care spending.
Here’s a link to my take on last year’s Fidelity healthcare retirement cost study: Health Care Costs in Retirement Will Run $260K If You’re Retiring This Year. Note that the 2016 cost was also $15,000 greater than the retirement healthcare costs calculated for the year before in 2015. Fidelity notes that this year’s increase at nearly 6% has culminated in over 70% increase since Fidelity first began to calculate retirement health care costs in 2002.
Medical and health expenses in retirement cover monthly Medicare premiums, Medicare copayments and deductibles, and prescription drug out-of-pocket spending as shown in the diagram (from Fidelity’s retirement calculator website).
Fidelity points to employers’ opportunity to bolster health-insured employees’ health financial literacy and access to tools that can help bolster workers’ financial wellness: in particular, health savings accounts (HSAs). Fidelity notes that the number of HSA clients on the company’s platform grew 38% over the year, and HSA holders increased 46%. The key financial wellness aspect of HSAs is that they have a triple-tax advantage, avoiding taxation at the initial investment, during the interest-growth period over time, and finally when taken out for use in retirement.
Health Populi’s Hot Points: A new report from MedPAC, the Medicare Payment Advisory Commission, segments Medicare spending by enrollee line-item, shown in the third chart. By 2015, Medicare reached $638 billion in spending, split between Medicare plan premiums, hospital, Part D prescriptions, physicians, outpatient hospital costs, and other services.
From 2006 to 2015, there was a shift in shares among these spending categories. Prescription drugs increased as a proportion of total Medicare costs from 11% to 14%; and, outpatient hospital services grew from 5% to 7% of total Medicare costs. Medicare premiums also garner more Medicare spending, from a share of 16% of spending to 27% of the total.
Payments to hospitals (inpatient) and physicians fell as a proportion of Medicare spend, from 2006-2015.
The cost of prescription drugs is on my mind this week as I learned that, per this story in USA Today, the estimated price for a new-new therapy targeting leukemia (known as CAR T-cell therapy) will cost $649,000 for a course of treatment. I’ve written about financial toxicity in the context of patients dealing with cancer therapies here in Health Populi. The magnitude of financial toxicity takes on a new scope here as this therapy is priced more than ten times the median family income in America in 2017. The clinical miracle for patients and families is that 83% of those treated with CAR T-cell therapy have gone into remission.
So it’s no surprise in this era of $500 EpiPens that more Americans are relying on “handouts” for affordable medication, as the title of an article in Britain’s Financial Times wrote in June 2017. “For Americans unable to afford prescription medicines, patient assistance programs – run by charities and drug companies to provide free or low-cost medication to poor or uninsured patients — offer a lifeline,” the column reads. But drug company execs agree that this is an unsustainable model.
Most patients in the U.S. love lower costs and “free” stuff in healthcare (and in everyday life); but as David Howard of Emory University pointed out in the New England Journal of Medicine in 2014 (at the moment of the Hep C pricing crisis and two years before the EpiPen price uproar), as patients become less sensitive to costs, companies often mark up medication costs.
It won’t be only drug companies who face scrutiny as restraining health care costs is the one aspect of U.S. reform that has bipartisan agreement (which I discussed here in Health Populi). Doctors and hospitals already garner lower shares of the Medicare bill and MedPAC learned, and the GOP’s American Health Care Act (AHCA) called for a 50% reduction in federal contributions to Medicaid would have hard-hit providers serving the program.
Retirees, be forewarned: save your cash. You’ll be spending more out-of-pocket for access to health care services. But politicians, be mindful: healthcare costs are top-of-mind for consumers as well, as 2018 looms closer.
The post A Couple Retiring Today Will Need $275,000 For Health Care Expenses appeared first on HealthPopuli.com.
The answer appears to be ‘yes’ according to a study by Narr et al. (2017). They find that:
Close friendship strength in midadolescence predicted relative increases in self-worth and decreases in anxiety and depressive symptoms by early adulthood. Affiliation preference by the broader peer group, in contrast, predicted higher social anxiety by early adulthood. Results are interpreted as suggesting that adolescents who prioritize forming close friendships are better situated to manage key social developmental tasks going forward than adolescents who prioritize attaining preference with many others in their peer milieu.
In short, cultivating close friendships are a way towards less anxiety and more social support. Attempts to be ‘popular’ by increasing the likelihood of more but weaker friendship and pursing friendships for the sake of social status is bad for mental health as the quest for social status is likely to produce anxiety. A press release for the article can be found here.
Source:
In a recent paper with Jeff Sullivan, Dana P. Goldman, and Thomas M. Gill in PLOS One, we try to answer this question. The paper’s abstract is below.
Chronic diseases associated with aging, such as arthritis, frequently cause reduced mobility, pain and diminished quality of life. To date, research on the association between mobility and quality of life has primarily focused in the elderly; hence, much less is known about this association in the near elderly. This cross-sectional study aimed to assess the association between mobility and quality of life measures in the near elderly.
A prospective observational study of persons aged 50–69 years was conducted. The primary endpoint was quality of life measured by EQ-5D-5L, and the primary explanatory variable was observed mobility assessed using the 6-minute walk distance (6MWD). We applied regression models controlling for demographic, health status and other factors to evaluate the association between 6MWD and EQ-5D-5L.
Of the 183 participants analyzed in the study, 37% were male and the average age was 59.8 years. After adjusting for differences in demographic characteristics and health status, EQ-5D-5L-based utility values were 0.046 points (p<0.001), or 5.2% (95% CI: 2.7% to 7.8%), higher on average for individuals with 100 meters longer 6MWD. Holding constant the mobility-specific component of EQ-5D-5L, we still found that walking an additional 100 meters was associated with an EQ-5D-5L utility value that was 0.029 points (p<0.001), or 3.5% (95% CI: 1.7% to 5.5%), higher than the average participant. Among persons with arthritis, the association between 6MWD and EQ-5D-5L was slightly stronger.
Near elderly persons with better mobility had higher quality of life. Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life.
Source:
Initiatives such as high-deductible health plans (HDHPs) aim to transfer risk form insurers to patients. The rationale behind this risk transfer is that when patients are in control of more funds, there will be less moral hazard and patients will use health care resources more efficiently. That is the theory, but does it bear out in reality? A paper by Mehrotra et al. (2017) aims to answer this question. Using a survey of almost 3,000 non-elderly adults in the U.S., they find that:
The majority of respondents believed that price shopping for care is important and did not believe that higher-cost providers were of higher quality. Common barriers to shopping included difficulty obtaining price information and a desire not to disrupt existing provider relationships.
It will be interesting to see whether social norms around price shopping change if HDHPs continue to grab more market share. In addition, patients often have limited information on provider quality, and because they often rely on these same physicians for referrals based on quality, price shopping may be counter-productive in the long-run if it decreases the chance that your current physician gives you a high quality referral. However, tools that provide patients with information on provider prices did not have a measurable effect on health care spending.
The answer appears to be ‘yes’ according to a study by Narr et al. (2017). They find that:
Close friendship strength in midadolescence predicted relative increases in self-worth and decreases in anxiety and depressive symptoms by early adulthood. Affiliation preference by the broader peer group, in contrast, predicted higher social anxiety by early adulthood. Results are interpreted as suggesting that adolescents who prioritize forming close friendships are better situated to manage key social developmental tasks going forward than adolescents who prioritize attaining preference with many others in their peer milieu.
In short, cultivating close friendships are a way towards less anxiety and more social support. Attempts to be ‘popular’ by increasing the likelihood of more but weaker friendship and pursing friendships for the sake of social status is bad for mental health as the quest for social status is likely to produce anxiety. A press release for the article can be found here.
Source:
In a recent paper with Jeff Sullivan, Dana P. Goldman, and Thomas M. Gill in PLOS One, we try to answer this question. The paper’s abstract is below.
Chronic diseases associated with aging, such as arthritis, frequently cause reduced mobility, pain and diminished quality of life. To date, research on the association between mobility and quality of life has primarily focused in the elderly; hence, much less is known about this association in the near elderly. This cross-sectional study aimed to assess the association between mobility and quality of life measures in the near elderly.
A prospective observational study of persons aged 50–69 years was conducted. The primary endpoint was quality of life measured by EQ-5D-5L, and the primary explanatory variable was observed mobility assessed using the 6-minute walk distance (6MWD). We applied regression models controlling for demographic, health status and other factors to evaluate the association between 6MWD and EQ-5D-5L.
Of the 183 participants analyzed in the study, 37% were male and the average age was 59.8 years. After adjusting for differences in demographic characteristics and health status, EQ-5D-5L-based utility values were 0.046 points (p<0.001), or 5.2% (95% CI: 2.7% to 7.8%), higher on average for individuals with 100 meters longer 6MWD. Holding constant the mobility-specific component of EQ-5D-5L, we still found that walking an additional 100 meters was associated with an EQ-5D-5L utility value that was 0.029 points (p<0.001), or 3.5% (95% CI: 1.7% to 5.5%), higher than the average participant. Among persons with arthritis, the association between 6MWD and EQ-5D-5L was slightly stronger.
Near elderly persons with better mobility had higher quality of life. Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life.
Source:
Initiatives such as high-deductible health plans (HDHPs) aim to transfer risk form insurers to patients. The rationale behind this risk transfer is that when patients are in control of more funds, there will be less moral hazard and patients will use health care resources more efficiently. That is the theory, but does it bear out in reality? A paper by Mehrotra et al. (2017) aims to answer this question. Using a survey of almost 3,000 non-elderly adults in the U.S., they find that:
The majority of respondents believed that price shopping for care is important and did not believe that higher-cost providers were of higher quality. Common barriers to shopping included difficulty obtaining price information and a desire not to disrupt existing provider relationships.
It will be interesting to see whether social norms around price shopping change if HDHPs continue to grab more market share. In addition, patients often have limited information on provider quality, and because they often rely on these same physicians for referrals based on quality, price shopping may be counter-productive in the long-run if it decreases the chance that your current physician gives you a high quality referral. However, tools that provide patients with information on provider prices did not have a measurable effect on health care spending.
In 2011, CMS created a demonstration to have competitive bidding for durable medical equipment (DME). Prior to the implementation of this program, CMS used an administrative fee schedule, similar to how physicians are currently reimbursed. How did this market-based solution fare? A paper by Newman, Barrette, and McGraves-Lloyd (2017) answers this question.
We compared prices from Round 1 of the Medicare competitive bidding program, which were established for the periods 2011–13 and 2014–16, to prices paid by national commercial insurers for the same types of items in 2011–14. Our results suggest that the initial years of the program produced prices comparable to those obtained, on average, by large commercial insurers—sophisticated purchasers that presumably were able to negotiate prices with suppliers of durable medical equipment and similar items.
The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016.
The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month.
The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA.
It’s especially noteworthy that women with low incomes made gains in coverage across racial and ethnic groups. In 2010,
The ACA made it easier for women to buy health plans on their own, The Fund found. In 2010, one-third of women who had health insurance or tried to buy it in the individual market in the past three years had either been turned down by an insurance company, charged a higher premium due to pre-existing conditoins, or been exdlued due to a specific health problem. Fewer than half of the women (46%) who tried to buy health insurance finally enrolled in one.
By 2016, 67^ of women shopped for a plan in the individual market and finally enrolled in one, with the percentage of women having difficult finding an affordable plan dropping by half. Women with existing health problems made especially large gains, The Fund learned.
The proportion of women skipping or delaying medical care because of cost also fell. These self-rationing issues included not filling a prescription for medicine, not seeing a specialist when needed, skippign a recommended test or treatment, and not seeing a doctor when sick. The share of women reporting a cost-related problem getting care fell from 48% in 2010 to 38% in 2016, shown in the second chart.
Health Populi’s Hot Points: It’s very good news that women’s access to healthcare has significantly improved since the implementation of the Affordable Care Act. But the costs of health care services continue to motivate self-rationing of care due to costs, with 4 in 10 women reporting problems with medical bills and mounting medical debt in 2016, the third chart attests.
Not filling prescriptions, skipping needed lab and diagnostic tests, and avoiding seeing the doctor to avoid the out-of-pocket costs feel like short-term rational fiscal decisions. However, these can lead to downstream negative physical outcomes and resulting greater medical costs. This can then perpetuate a cycle of downward financial health, on top of sub-optimal health outcomes.
Women are more likely than men to say they are paying off medical debt over time, Kaiser Family Foundation found in a 2016 survey.
The societal cost is greater burden on social and public sector safety net budgets (e.g., SNAP benefits, Medicaid, disability payments, and so on). For women, who play the role as caregiver for children, parents, and self, the burden is heavy especially for those managing chronic conditions like heart disease, diabetes, and the mental health impacts of everyday stress.
What would a day in America without women’s economic contributions look like? The Center for American Progress asked that question this year on International Women’s Day, March 8. The foruth chart quantifies the answer, by U.S. state, for how much money each state would lose if women took off work for one day.
These calculations are under-estimates, however. The methodology here doesn’t take into account that women tend to take on unpaid labor, spending 150% more time on housework than men and more than twice the time men spend on caregiving. These skills are vital to the macroeconomy.
Access to health care services is a social determinant of health, and of a healthy national economy.
The post Women’s Access to Health Care Improved Under the Affordable Care Act appeared first on HealthPopuli.com.
In the U.S., one-third of people age 65 and over have difficulty walking 3 city blocks.
Hold that thought, and consider the role of purpose in life: purpose drives well-being, inoculating one’s life with meaning, direction, and goals, as the On Purpose guru Victor Strecher explains in his amazing graphic manifesto.
Having a higher sense of purpose in life is associated with higher probability of people engaging in healthier behaviors, such as greater physical activity and seeking preventive healthcare; better biological functioning; and, lower risk of disease.
Four researchers from the Harvard School of Public Health connected the dots between those hard-to-walk city blocks, aging, and purpose in their original research published in JAMA Psychiatry this month in Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults.
This is the first study published that evaluates associations between purpose in life and physical function. This study confirms others that have associated psychological factors (such as mastery and optimism) with enhanced physical function based on objective measures.
The table included here shares some of the study data showing correlations between older people over 50 feeling increased purpose in life and lower risk of slowed walking and weakening grip strength. Statistically, each 1-SD (standard deviation) increase in one’s purpose in life was associated with a 13% decreased risk of developing weak grip strength and 14% decreased risk of developing slow walking speeds 4 years later.
“Purpose in life may be one promising and novel upstream factor that serves as a target for improving not only mental health but physical function as well,” the researchers conclude.
They point to recent research demonstrating that a sense of purpose can be improved, such as this meta-analysis by Weiss et. al. asking whether we can increase psychological well-being? The answer is “yes,” and points to the promise of investing more in mental and behavioral health for the betterment of peoples’ sense of purpose.
Health Populi’s Hot Points: Many of you saw this triangle diagram in your high school or college Psychology 101 classes: it’s Maslow’s Hierarchy of Needs. Depending on whether you were paying attention, you may recall that “belongingness and love needs” are in the belly of the hierarchy. Belongingness and love — intimate relationships and friends — are central to our well-being and basic needs, like clean water and safe shelter.
These are the social determinants of health beyond the healthcare system. And this one featured in the study, purpose, speaks to basic psychological needs in the hierarchy — self-actualization, esteem, security, in addition to the physiological needs of food, water, warmth, and rest (read “sleep” for most of you Health Populi readers).
The opioid epidemic in the States is but one manifestation of the association of purpose in life and mental/physical function. The findings in the research published in JAMA Psychiatry can extend beyond older people to younger people.
Mother Teresa recognized that, “loneliness and he feeling of being unwanted, is the most terrible poverty.” She also said that, “loneliness is the leprosy of the modern world.”
When we who work in health and healthcare utter the words “connected health,” we should be mindful of the phrase’s two meanings and bake social connections into policy and practice.
The post Loneliness and Isolation Kill: Health Depends on Purpose appeared first on HealthPopuli.com.
Being a teenager has its hurdles—socially, emotionally and physically. There’s strong social pressure to appear perfect, and so often this is manifested in high anxieties around how kids look. As teenagers’ bodies rapidly change, they often try to manipulate these changes into something perceived as beneficial. It’s not unheard of for a teenager to even think about teeth whitening, even though as adults we associate it with aging teeth, coffee and smoke stains.
Teenagers often find themselves desperate to feel better about their appearances, and with an increasing focus on straight, white and brilliantly shiny teeth, tooth whitening has become a question of parenting and dental interest.
While teeth bleaching is more popular than ever before among teenagers, it’s natural for parents to feel concerned about the safety of these products and treatments. No matter how much your high-schooler might be convinced that it’s harmless, or within their right to make the decision, or something that positively “everyone else is doing,” we have a few tidbits you can reflect on before giving your teenager full support.
Potential side effects of whitening treatments
It is not recommended to let children bleach their teeth, particularly before the age of 16. Tooth bleaching gels used during the whitening procedure may damage the not yet fully-developed nerves of teeth roots, causing lasting hypersensitivity of teeth and slow-to-heal pain in the mouth.
If you’re dealing with stubborn high-schooler who is determined to make their smile as white as can be, discuss options with your dentist to avoid bleaching agents that have high concentrations of carbamide peroxide. The higher the concentration of this bleaching element, the higher the risk of nerve shrinking.
Home tooth whitening versus professional treatments
Educate your high-schooler about risks to over-the-counter tooth whitening products, particularly the ones that are uncertified. The availability of products with adverse side effects is the biggest threat to your teenager’s oral health. Most of the whitening products that your teenager can easily find online will not compare to the professional teeth bleaching treatments available through your dentist. Your teenager should know that ordering teeth whitening products over the internet does not guarantee the desired result, and can lead to side-effects. In extreme cases, your high-schooler even risks swallowing bleaching agents that can severely irritate the throat.
How often should your kid bleach his or her teeth?
No matter the type of teeth bleaching method you give your teenager the green light on, be sure that they don’t overdo it. A helpful reminder is that, within time, your teenagers will be of age to make the decision for themselves.
The post Should I let my high-schooler get tooth whitening done? appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
In a recent paper with Jeff Sullivan, Dana P. Goldman, and Thomas M. Gill in PLOS One, we try to answer this question. The paper’s abstract is below.
Chronic diseases associated with aging, such as arthritis, frequently cause reduced mobility, pain and diminished quality of life. To date, research on the association between mobility and quality of life has primarily focused in the elderly; hence, much less is known about this association in the near elderly. This cross-sectional study aimed to assess the association between mobility and quality of life measures in the near elderly.
A prospective observational study of persons aged 50–69 years was conducted. The primary endpoint was quality of life measured by EQ-5D-5L, and the primary explanatory variable was observed mobility assessed using the 6-minute walk distance (6MWD). We applied regression models controlling for demographic, health status and other factors to evaluate the association between 6MWD and EQ-5D-5L.
Of the 183 participants analyzed in the study, 37% were male and the average age was 59.8 years. After adjusting for differences in demographic characteristics and health status, EQ-5D-5L-based utility values were 0.046 points (p<0.001), or 5.2% (95% CI: 2.7% to 7.8%), higher on average for individuals with 100 meters longer 6MWD. Holding constant the mobility-specific component of EQ-5D-5L, we still found that walking an additional 100 meters was associated with an EQ-5D-5L utility value that was 0.029 points (p<0.001), or 3.5% (95% CI: 1.7% to 5.5%), higher than the average participant. Among persons with arthritis, the association between 6MWD and EQ-5D-5L was slightly stronger.
Near elderly persons with better mobility had higher quality of life. Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life.
Source:
Summer is ticking down to a close, and school is suddenly upon us. While homework might not yet be on kids’ minds, there are some tasks they should check off at the start of every new school year. In fact, the task we’re focused on—you children’s routine dental checks—are typically done at the start of each semester.
Regular dental check-ups might be a “to-do,” but they don’t have to be seen like “homework,” either. Healthy teeth (and a healthy attitude toward dental hygiene) make for happier, more comfortable, and higher-performing kids during the school year.
Prevention is the best teacher of oral health. So, let’s learn what your school-aged kids gain with twice-a-year dentist check-ups.
Let’s get real: there’s a possibility your children rush off to school some mornings without brushing their teeth. Even if your son or your daughter is highly disciplined in their brushing routine, those sneaky bacteria will find a way to harm teeth, particularly with school-time snacks. If bacteria were a student, he or she would be that student who always cheats on exams. Biannual dentist visits are crucial to catch bacteria before it leads to a loss of tooth integrity.
Treating cavities as soon as they’re found means saving time on school absences, and discomfort during classes. Your child won’t be subject to distracting or unmanageable discomfort with the regular dental check-ups to address problems before they become disruptive.
And did you know that cavities can spread? If one tooth develops severe decay, it can affect other teeth, and cause soft tissue or nerve damage. This can lead to horrendous discomfort and far more absences from school. This shouldn’t be a reality for any growing student.
Not only do regular dental appointments for your kids reinforce the care routine to keep their teeth healthy as adults, but these regular, twice-per-year reminders can keep the daily dental routine front-of-mind even while they’re young. Dental visits also make your children accountable to a professional outside of the home—it’s not just about what Mom or Dad says, it’s about what the dentist expects of your kids, too.
Dental professionals emphasize how regular dentist check-ups are just as important as your children’s general physical exams. By inspecting kids’ teeth, dentists sometimes connect dental issues with other underlying issues, for example with signs of digestive issues or dehydration.
Don’t forget that these dental checks are also your child’s chance to get teeth cleaned professionally. Starting off each semester with brilliant, shiny whites without any tartar or plaque build-up will make those school year smiles all that much more dazzling.
Give your children the opportunity to start school with a fresh smile, and with the positive dental habits to teach how important—and rewarding—good oral hygiene can be!
The post Twice-a-Year Dental Check-ups appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
