“So now you know why economists are useless: when they actually do understand something, people don’t want to hear about it”
I am generally skeptical of broad, top-down approaches to improve health. For instance, soda taxes are one example. While soda is clearly not got for you, should unhealthy drinks like Red Bull be taxed? Why single out soda? What about cheesecake? Thus, these efforts–while well intentioned–can seem arbitrary and paternalistic.
On the other hand, posting calorie counts I would regard as somewhat different. While there are clear costs to businesses, providing information to consumers and allowing consumers to make their own decisions seems like a more reasonable approach. The question is whether the cost of the regulation outweight the benefits…and more specifically, whether there are any benenfits. Specifically, does posting calories lead to reduction in body mass index (BMI)?
That is exactly the question that Restrepo (2017) attempts to answer using data from New York City. They find that:
…the point-of-purchase provision of calorie information on chain restaurant menus reduced body mass index (BMI) by 1.5% and lowered the risk of obesity by 12%. Quantile regression results indicate that calorie labeling has similar impacts across the BMI distribution. An analysis of heterogeneity suggests that calorie labeling has a larger impact on the body weight of lower income individuals, especially lower income minorities. The estimated impacts of calorie labeling on physical activity, smoking, and the consumption of alcoholic beverages, fruits, and vegetables are small in magnitude, which suggests that other margins of adjustment drive the body-weight impacts estimated here.
A very interesting piece of evidence that will be useful for this debate on whether to extend the calorie information more broadly.
Health consumers have become savvy about the role of technology in their healthcare, according to a survey from Ambra, a company that is in the health cloud business.
The survey paints a picture of health consumers hungry for digital health connections.
The most popular activities patients do online for health were:
To meet patients where they want to be — increasingly, online — Ambra recommends that healthcare providers increase their digital presence, welcome online reviews, and create digital self-service tools.
Given patients’ keenness to manage healthcare activities online, there is still frustration about personal medical record access and ease of scheduling. 1 in 3 consumers surveyed said they could not easily access their medical records. Among those who said they could, only 50% could do this via online access offered by providers. 39% maintained their own records systems.
When people do keep track of their own records for themselves and the family, the most common areas managed are:
Healthcare stakeholders should note that most consumers consider medical access and ease of scheduling when shopping for healthcare, across the age groups.
The survey was conducted in Q2-2017 among 1,136 U.S. adults over 18 who have received medical imaging services. This is a unique lens for a health consumer sample: note that Ambra Health is in the medical imaging cloud business.
Health Populi’s Hot Points: The mainstream U.S. health consumer is increasingly tech-savvy and -trusting, engaged with shopping for and taking on more self-care, the Ambra poll shows.
But Ambra uncovered an ongoing challenge: more consumers found it easier to track maintenance and service records for their vehicles than for their dependents — a particular vexing problem for more women in the study. Ambra recommended looking at models of Netflix and Verizon for family-share options with easy online access.
This is sound advice: consumers want enrolling in health insurance plans to feel more like an Amazon ecommerce experience than a typical, painful, hassle-ful insurance sign-up, Aflac recently found in their own consumer survey.
We’ll be discussing health care shopping and patient engagement on Tuesday at Health 2.0, when I’ll have the joy of speaking on the main stage with David Vivero, CEO of Amino Health. That’s one company looking to light up the un-transparent space between healthcare providers and consumers looking to make rational economic and clinical decisions about health services for themselves and their loved ones.
The post To Meet Health Consumers’ Digital Demands, Think Netflix and Verizon appeared first on HealthPopuli.com.
The answer to this question must be ‘yes’. Everyone wants to see a good doctor compared to a bad doctor. However, what defines a “good” doctor? Patients perception of what makes a doctor good (e.g., bedside manner, clinic amenities) may not correspond to what technocrats or policmakers think (e.g., process of care measures). Even if patient and payer/policymaker/provider ideas of quality are aligned, non-technical patients may not be good judges of physician quality.
An interesting paper by Fe, Powell-Jackson and Yip (2017) use data from rural China (Ningxia province in Northwest China) to answer this question.
We have sufficiently tight confidence intervals to rule out reasonably small effect sizes. The results…suggest that a one standard deviation increase in doctor competence has an insignificant effect of 1.7 percentage points on the probability of visiting a village doctor, relative to a mean of 18%. The confidence intervals imply that we can rule out a positive effect size of 4.7 percentage points. Taken together, the findings suggest that healthcare-seeking behaviour is unresponsive to changes in doctor competence at the village level.
However, perceptions matter:
A one standard deviation increase in perceptions of quality is associated with 6 percentage point increase in use of village doctors.
Interesting, patient perceptions of value and technical competence are not well correlated.
The obvious conclusion from this paper is that patients do not know anything and top down government programs could solve these problems. However, the technical measures of quality are very limited and often focus on doing the obvious right thing for many patients rather than making more complicated decisions for complicated patients. If the market functions well, well-informed physicians would refer patients to high quality (technical) doctors and these referral would increase practice funding to allow those practices to increase patient perceptions of quality (e.g., by improving amenities). Patients may perceive bedside manner and amenities as luxuries that are not only valued in and of themselves but also for their signaling value that the physician is high quality. Of course, physicians could take out a loan, build a nice clinic and attract new patients. However, this approach is risky–particularly in a system with well-informed physician referrals–because they may not get many patients if physicians are not fooled by these amenities. The resulting dynamic equilibrium is likely to be market-specific.
Source:
“So now you know why economists are useless: when they actually do understand something, people don’t want to hear about it”
I am generally skeptical of broad, top-down approaches to improve health. For instance, soda taxes are one example. While soda is clearly not got for you, should unhealthy drinks like Red Bull be taxed? Why single out soda? What about cheesecake? Thus, these efforts–while well intentioned–can seem arbitrary and paternalistic.
On the other hand, posting calorie counts I would regard as somewhat different. While there are clear costs to businesses, providing information to consumers and allowing consumers to make their own decisions seems like a more reasonable approach. The question is whether the cost of the regulation outweight the benefits…and more specifically, whether there are any benenfits. Specifically, does posting calories lead to reduction in body mass index (BMI)?
That is exactly the question that Restrepo (2017) attempts to answer using data from New York City. They find that:
…the point-of-purchase provision of calorie information on chain restaurant menus reduced body mass index (BMI) by 1.5% and lowered the risk of obesity by 12%. Quantile regression results indicate that calorie labeling has similar impacts across the BMI distribution. An analysis of heterogeneity suggests that calorie labeling has a larger impact on the body weight of lower income individuals, especially lower income minorities. The estimated impacts of calorie labeling on physical activity, smoking, and the consumption of alcoholic beverages, fruits, and vegetables are small in magnitude, which suggests that other margins of adjustment drive the body-weight impacts estimated here.
A very interesting piece of evidence that will be useful for this debate on whether to extend the calorie information more broadly.
The Republican’s latest health care bill is the Graham-Cassidy-Heller-Johnson (GCHJ) proposal or Graham Cassidy for short. Below is my super short summary of the bill.
What does it propose?
The Washington Post has a nice summary which shows that the bill would:
In short, there is no mandate and although there are some protections for individuals (e.g., mandatory coverage of pre-existing, and lifetime limits) states can get around these provisions if they so choose.
The bill would also result in a transfer of funds from blue states to red states as many blue states expanded Medicaid.
What does this mean for you?
The answer to this question likely depends a lot on what state you live in. Some states may opt to have higher taxes and provide more generous insurance. Other states may opt for lower taxes and less generous insurance support. Some may increase insurance coverage of less generous coverage (e.g., a Medicaid for all plan) and others may use their block funding to support existing insurance programs (e.g., reinsurance subsidies) but not support people who don’t have access to these plans. Thus, Graham-Cassidy is a way to reduce federal government spending, repeal individual and employer mandates, and let states decide whether or not to provide broad based coverage approaches to their residents.
“Wellness is a way to cope with the demands and rigors of new modern lifestyles,” according to Ogilvy in their latest report, The Wellness Movement Pioneers: New Global Research Findings.
The report makes the case that the mass public are project-managing life adopting mental health, nutrition, physical activity and sleep to boost personal wellness. There is a big business model underneath this, which has inspired Ogilvy to start up the company’s Health & Wellness Practice. Think of this report as the group’s own business case to address the $3.7 trillion global wellness economy, illustrated by the first image.
The report synthesizes interviews the team undertook with so-called wellness pioneers, folks active in various aspects and geographies for healthy lifestyles.
In the section called “A sick planet,” the Ogilvy team points out that non-communicable diseases (NCDs) account for a growing share of mortality in both wealthy and developing nations. Once upon a time, infectious diseases killed most people on the planet; today, it’s NCDs like diabetes, heart disease, and lifestyle-influenced cancers (especially due to the risks of tobacco) that will kill most of us. Note the bar chart and dramatic growth of NCD mortality in South Asia and Sub-Saharan Africa.
How to address this? Ogilvy responds by pointing to the wellness movement and “salutogenesis:” moving from a mindset of what causes disease to what boosts health; from a reactive healthcare response to a proactive health input paradigm; and, from guarding against pain or loss to promoting for gain and growth.
There are several dozen pages of research to mine, but among the most overlooked topics in the social determinants of health literature is the section on social fitness. “We can’t all be gurus, but we can take part,” the authors assert. “Taking part” brings people together to support social fitness. Isolation kills; connectedness heals, research has proven.
“Homo Sapiens know how to adapt and change….Now we realize the impact modern life has on our health. We must make better choices if we want to get and stay well,” Ogilvy concludes.
This is the opportunity for Ogilvy, their wellness industry clients, and health consumers the world over.
Health Populi’s Hot Points: Ogilvy’s report re-confirms my latest work and learnings in the growth of retail health, which for morphing health consumers is a preferred way to “consume” healthcare: via self-directed value-based products and services that people curate in the context of their own health values.
“Values” here has a two-fold meaning: first, in terms of an individual’s own value-set of preferences, tastes, and cultural norms; and, “value,” a person’s definition of quality vs. price vs. personal utility for a good or service. As people in the U.S. face first-dollar coverage paying for healthcare in high-deductible plans and via health savings accounts, health spending is done with “their” money. That means that healthcare should look and feel like retail service experiences to gain loyalty and retain customers on an annuity basis. Health is not a one-off purchase but a lifelong continuum of personal investing.
In today’s health/wellness marketplace, the first area consumers are turning to is food, and increasingly a food-as-medicine paradigm. There is growing evidence on the role of (good, clean) food in health: the DASH diet, for example, has hard clinical evidence that the eating regime can reverse heart disease and help manage or fend off Type 2 Diabetes. Grocery stores continue to hire retail dietitians and nutritionists, coupling up with store pharmacies and continuing to blur food/health/healthcare adjacencies.
Each wellness area identified by the first graphic has at least a few savvy marketers who know how to reach, motivate, and successfully sell to health consumers. The healthcare industry’s legacy stakeholders — hospitals, physicians, health insurers and pharma — must get skilled in this increasingly consumer-driven health market to stay relevant in the growing world of wellness.
The post The Mainstreaming of Wellness appeared first on HealthPopuli.com.
For each dollar spent on healthcare in the United States, families paid 28 cents, according to the U.S. National Health Expenditure Accounts for 2015. Welcome to the new era of Americans and medical banking, with new insights provided by the largest of banks, JP Morgan Chase, in Paying Out-of-Pocket: The Healthcare Spending of 2 Million U.S. Families, from JP Morgan Chase.
Chase is the largest bank in America based on its assets. They’ve mined 2.3 million de-identified records of Chase consumers in their banking network to learn about customers’ healthcare spending. These data represent spending between 2013 and 2016, detailed in this report. Consumers were between 18 and 64 years of age, and therefore do not include people enrolled in Medicare.
In 2016, out-of-pocket costs (OOPs) for Chase customers reached $714, growing by 4.3% year-on-year between 2013 and 2016.
The second chart illustrates OOP spending differences between different demographic groups. Note that women have greater OOP spending than men, very low income people more than more affluent consumers, and older versus younger people.
Women’s OOP expenses were 20% greater than men’s as a percent of take-home income in 2016.
Most OOP spending was for doctor, dental and hospital payments which accounted for over one-half of the observed healthcare spending. The largest single OOP healthcare expense, on average, was for dental care.
The top 10% of families with the greatest OOPs accounted for 49% of all OOP spending. This spending averaged 9% of family take-home income, and about one-half of these families spent another 9% of income the following year. This 9% is how much one family spends on cell phone and utility bills in one year, Chase calculated.
Health Populi’s Hot Points: Chase concludes that health care reform it he U.S. should recognize that out of pocket spending is a strain for American families and reforms should account for this situation for those households who are more financially burdened. These are older, lower-income, and female health citizens.
Chase isn’t the only entity who believes out-of-pocket costs should be a health reform priority. So do 93% of American adults, polled in last December’s Kaiser Family Foundation Health Tracking Poll, who called it a top or important priority to “lower the amount individuals pay for healthcare.” Nearly as many Americans said lowering the cost of prescription drugs was the next highest priority for health reform — specifically, for “things Donald Trump and the next Congress might do when it comes to health care.”
The post Out-Of-Pocket Healthcare Costs Grow in the Family Budget appeared first on HealthPopuli.com.
The answer to this question must be ‘yes’. Everyone wants to see a good doctor compared to a bad doctor. However, what defines a “good” doctor? Patients perception of what makes a doctor good (e.g., bedside manner, clinic amenities) may not correspond to what technocrats or policmakers think (e.g., process of care measures). Even if patient and payer/policymaker/provider ideas of quality are aligned, non-technical patients may not be good judges of physician quality.
An interesting paper by Fe, Powell-Jackson and Yip (2017) use data from rural China (Ningxia province in Northwest China) to answer this question.
We have sufficiently tight confidence intervals to rule out reasonably small effect sizes. The results…suggest that a one standard deviation increase in doctor competence has an insignificant effect of 1.7 percentage points on the probability of visiting a village doctor, relative to a mean of 18%. The confidence intervals imply that we can rule out a positive effect size of 4.7 percentage points. Taken together, the findings suggest that healthcare-seeking behaviour is unresponsive to changes in doctor competence at the village level.
However, perceptions matter:
A one standard deviation increase in perceptions of quality is associated with 6 percentage point increase in use of village doctors.
Interesting, patient perceptions of value and technical competence are not well correlated.
The obvious conclusion from this paper is that patients do not know anything and top down government programs could solve these problems. However, the technical measures of quality are very limited and often focus on doing the obvious right thing for many patients rather than making more complicated decisions for complicated patients. If the market functions well, well-informed physicians would refer patients to high quality (technical) doctors and these referral would increase practice funding to allow those practices to increase patient perceptions of quality (e.g., by improving amenities). Patients may perceive bedside manner and amenities as luxuries that are not only valued in and of themselves but also for their signaling value that the physician is high quality. Of course, physicians could take out a loan, build a nice clinic and attract new patients. However, this approach is risky–particularly in a system with well-informed physician referrals–because they may not get many patients if physicians are not fooled by these amenities. The resulting dynamic equilibrium is likely to be market-specific.
Source:
Morning Consult has an interesting piece from Mark Linthicum, the Director of Scientific Communication at the Innovation and Value Initiative (IVI) titled “Why Understanding Value Is Central to True Health Care Reform“. In the piece he argues:
The true problem is that dollars are poured into a system without any clear understanding of how worthwhile one dollar spent is, relative to another. The remedy lies in making spending and coverage decisions based on the value – not just the price tag – of health care treatments and services.
Value-based spending is a simple notion that amounts to prioritizing spending on services where the benefits outweigh cost – spend less on recognized areas of low-value care, like unnecessary tests and procedures, and more on high-value areas like vaccines.
Implementing value-based spending in practice, however, is more complicated because health care system stakeholders each have disparate, and sometimes conflicting, definitions of value.
Interesting throughout. Do read the whole piece.
With Labor Day in the rear-view mirror and pumpkin spice EVERYTHING hitting the shelves, it can mean only one thing: fall is here. There is something about fall that makes you want to get outside and embrace the cooler weather (or at least the not-blisteringly-hot weather). While Halloween is still weeks away, it doesn’t mean that you can’t start to embrace the season.
Hitting a pumpkin patch with your family is a tradition that many north Texans embrace year after year. With a multitude of venues featuring pumpkins, corn mazes and petting zoos, there’s always something the whole family can enjoy. Pull out your jeans and boots and let us show you the best places to find your pumpkin patch spirit this year!
Autumn at the Arboretum
If you prefer sunflowers over scary, then the Dallas Arboretum is the place for you. From September 23-November 22, the Arboretum has transformed to the Land of Oz featuring hundreds of thousands of blooming plants and flowers. You’ll think you followed the yellow brick road straight out of downtown. In addition, the Pumpkin Village is a must-see with more than 90,000 pumpkins, squashes and gourds. Pumpkins will be available to purchase, too. Be sure to check out their calendar of special fall events, including opportunities for the little ones to show off their costumes. There will be so many adorable photo ops you’ll hardly be able to keep up!
Pumpkins on the Prairie
Pumpkins on the Prairie in Frisco is designed for those with children who are looking for a way to add some outdoor, energy-expending fun into their family outing. Featuring both a hay maze and bounce houses, Pumpkins on the Prairie is sure to wear out even the most active kids. Open from September 30-October 31, the pumpkins are ready to be picked, so come on by! This event is free and open to the whole community.
Elves Farm
While the name of the farm may have you thinking it’s Christmas come early, don’t let the name deceive you. Yes, you can get a Christmas tree here, but you’ll have to come back later for that. For the month of October, the Elves farm is also where your family can purchase all your fall decorations and take a tour of the farm on a hay ride. There’s also a farm zoo featuring chickens, goats, rabbits and a pot belly pig. If you’re looking for more farm fun, check out the sack races and the Dress the Scarecrow activity. Elves Farm is open every weekend in October.
Hall’s Pumpkin Farm
Looking for a challenge that stimulates your brain and your body? Head to Hall’s Pumpkin Farm in Grapevine to get lost in a corn maze that stretches over two acres. For the brave, bring your flashlight and come after dark when spooky shadows are cast over the stalks. For the pumpkin lovers, bring your wagon because these pumpkins come in all shapes and sizes. Hayrides are also available for the young (and young at heart) to have the opportunity to view the whole farm. The farm is open daily from September 29. Please note, this is a cash only farm, so prepare accordingly.
Looking for more pumpkin patches? Many local churches, schools, and troops create “pop-up patches” across the metroplex. Be on the lookout for one on your next drive around town!!
The post Dallas/Ft Worth Pumpkin Patch Festivities appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
With Labor Day in the rear-view mirror and pumpkin spice EVERYTHING hitting the shelves, it can mean only one thing: fall is here. There is something about fall that makes you want to get outside and embrace the cooler weather (or at least the not-blisteringly-hot weather). While Halloween is still weeks away, it doesn’t mean that you can’t start to embrace the season.
Hitting a pumpkin patch with your family is a tradition that many north Texans embrace year after year. With a multitude of venues featuring pumpkins, corn mazes and petting zoos, there’s always something the whole family can enjoy. Pull out your jeans and boots and let us show you the best places to find your pumpkin patch spirit this year!
Autumn at the Arboretum
If you prefer sunflowers over scary, then the Dallas Arboretum is the place for you. From September 23-November 22, the Arboretum has transformed to the Land of Oz featuring hundreds of thousands of blooming plants and flowers. You’ll think you followed the yellow brick road straight out of downtown. In addition, the Pumpkin Village is a must-see with more than 90,000 pumpkins, squashes and gourds. Pumpkins will be available to purchase, too. Be sure to check out their calendar of special fall events, including opportunities for the little ones to show off their costumes. There will be so many adorable photo ops you’ll hardly be able to keep up!
Pumpkins on the Prairie
Pumpkins on the Prairie in Frisco is designed for those with children who are looking for a way to add some outdoor, energy-expending fun into their family outing. Featuring both a hay maze and bounce houses, Pumpkins on the Prairie is sure to wear out even the most active kids. Open from September 30-October 31, the pumpkins are ready to be picked, so come on by! This event is free and open to the whole community.
Elves Farm
While the name of the farm may have you thinking it’s Christmas come early, don’t let the name deceive you. Yes, you can get a Christmas tree here, but you’ll have to come back later for that. For the month of October, the Elves farm is also where your family can purchase all your fall decorations and take a tour of the farm on a hay ride. There’s also a farm zoo featuring chickens, goats, rabbits and a pot belly pig. If you’re looking for more farm fun, check out the sack races and the Dress the Scarecrow activity. Elves Farm is open every weekend in October.
Hall’s Pumpkin Farm
Looking for a challenge that stimulates your brain and your body? Head to Hall’s Pumpkin Farm in Grapevine to get lost in a corn maze that stretches over two acres. For the brave, bring your flashlight and come after dark when spooky shadows are cast over the stalks. For the pumpkin lovers, bring your wagon because these pumpkins come in all shapes and sizes. Hayrides are also available for the young (and young at heart) to have the opportunity to view the whole farm. The farm is open daily from September 29. Please note, this is a cash only farm, so prepare accordingly.
Looking for more pumpkin patches? Many local churches, schools, and troops create “pop-up patches” across the metroplex. Be on the lookout for one on your next drive around town!!
The post Dallas/Ft Worth Pumpkin Patch Festivities appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
The average cost of an employer=sponsored health plan for a family reached $18,764 in 2017. While this premium grew overall by a historically relative low of 3.4%, employees covered under that plan faced an increase of 8.3% over what their plan share cost them in 2016, according to the 2017 Employer Health Benefit Survey published today by the Kaiser Family Foundation. [Here’s a link to the 2016 KFF report, which provided the baseline for this 8.3% calculation].
Average family premiums at the workplace rose 19% since 2012, a slowdown from the two previous five-year periods — 30% between 2007 and 2012, and 51% between 2002 and 2007, KFF calculated.
This annual study details every aspect of health insurance provided by U.S. companies to workers, and provides important benchmarks year after year on health plan premiums, worker contributions, prescription drug coverage, wellness, and other key issues in employer-sponsored health benefits.
There are significant differences between health benefits provided by small (with 3 to 199 workers) versus large firms (covering 200 or more employees). One-half of firms with fewer than 50 workers offered health benefits in 2017, compared with virtually all companies with over 100 workers offering health insurance. Just over one-half of workers (55%) were covered by health insurance through the workplace in 2017, illustrating the fact that some workers who are offered health coverage at work do not enroll in the plan, often finding the cost prohibitive relative to the family budget.
To reinforce that point, the second chart illustrates what U.S. families have experienced since 1999: it’s a picture of relatively flat wage increases relative to hockey-stick growth of worker contributions for family health premiums. In 2017, the cumulative increase in the worker’s earnings since 1999 was 64% (while general price inflation was a cumulative 47%). Family premiums rose 224%, and workers’ contributions to those premiums, 270%.
Thus, workers continue to trade off wage increases to receive health insurance at the workplace for the better part of two decades. In 2017, the 8.3% growth in health premium cost sharing was over six times the rate of inflation for the year (at 1.4%).
There are many other trends I’ll cover from the KFF survey over the coming days, especially related to prescription drug coverage and wellness programs.
In the meantime, for historical context, here are links to my previous posts covering this important research:
2016 KFF Employer Health Benefits report in Health Populi, 16 September 2016
2015 KFF Employer Health Benefits report in Health Populi, 23 September 2015
2014 KFF Employer Health Benefits report in Health Populi, 10 September 2014
2013 KFF Employer Health Benefits report in Health Populi, 21 August 2013
2012 KFF Employer Health Benefits report in Health Populi, 3 October 2012
2010 KFF Employer Health Benefits report in Health Populi, 3 September 2010
2009 KFF Employer Health Benefits report in Health Populi, 17 September 2009
The post Employees Continue To Pick Up More Health Insurance Costs, Even As Their Growth Slows appeared first on HealthPopuli.com.
Most U.S. patients want healthcare providers to offer cost information before a procedure, and whether doctors offer financial options to help them extend payments over time.
This is an automotive or home appliance procedure we’re talking about. It’s healthcare services, and American patients are now the third largest payors to providers in the nation. Thus, the title of a new report summarizing a consumer survey from HealthFirst notes, “It’s Never Too Soon to Communicate Pricing and Payment Options.
The study found that two-thirds of U.S. consumers would like healthcare providers to discuss financing options; however, only 18 percent of providers have spoken to patients about such financial plans. Only 8% of patients had used either zero- or low-interest financing to pay off medical bills over time, HealthFirst found.
HealthFirst also quantified that most patients are now behaving more like healthcare consumers: 86% of people check whether a provider will accept their insurance plan, 77% want to receive cost information before a procedure, 63% look for published pricing lists for common procedures, and 57% of patients say it would be important for a provider to offer no-interest financing options enabling payments over time.
Worrying about healthcare costs impacts patients at all income levels. While, clearly, more lower-income people are concerned about their ability to pay out-of-pocket medical expenses, 1 in 4 high-income patients with $100K or more annual income are concerned about meeting their out-of-pocket costs.
Younger people are most keen to pay medical bills over time, as the bar chart illustrates. 71% of Millennials would be interested in a multi-year no interest financial option for a bill under $1,000, and nearly 50% would like that financing option for a bill under $500.
HealthFirst is a healthcare financing company extending long-term financing options to patients receiving services as over 200 U.S. healthcare providers. The company surveyed over 1,000 patients for the study.
Health Populi’s Hot Points: There’s a not-so-sweet spot somewhere between $500 and $1,000 where most U.S. patients would like to finance their out-of-pocket healthcare costs over a period of time, based on these survey results.
I’ve researched and written extensively about this issue, recently noting that healthcare is the #1 pocketbook issue in America above paying rent or a mortgage, for food, or utilities — even for the wealthiest Americans, Kaiser Family Foundation found.
There are several components to out-of-pocket costs, and they vary by person. If you are a young person diagnosed with leukemia, you may face a cost of nearly $500,000 for new CAR-T therapy (see here for my take on this). If you are a Boomer couple weighing the financial implications of retiring sooner-versus-later, you will learn that healthcare costs in retirement could run you, on average, $275,000 (not including long-term care).
If you work for a small company, your health plan deductible would likely be $2,000. In this case, based on HealthFirst’s poll, you would part of the health consumer market seeking longer-term finance of your health cost liability. Welcome to the new era of medical banking.
In the immediate term, if you work in hospital or healthcare finance, Black Book just issued its top revenue-cycle management technology tools and services ratings here. The top five include Optum (now including the Advisory Board) and Navicure among others.
The post Patients Are Looking to Finance Healthcare Over Time appeared first on HealthPopuli.com.
Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation.
There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability).
“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But we’ve been much less motivated to address issues leading to illnesses,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, quoted in Reuters summary of the report.
Let’s dissect the 3 key factors underlying the global disease burden:
Diet and food: Diets low in whole grains, fruit, nuts and seeds, fish oils and high in salt were the most common risk factors, contributing to cases of obesity, high blood pressure, high blood sugar and high cholesterol. Here is Newsweek’s take on eating badly causing death and disability. Men’s Health magazine was more direct, asserting that, “Your crappy diet is literally killing you.”
Conflict: Deaths due to terrorism and war increased by 143% since 2006 to over 150,000 in 2016. These deaths were concentrated in the Middle East and North Africa. Mortality due to gun deaths grew by 5.7% to 161,000 for deaths due to firearm assaults, and 4.3% for suicide-by-gun (67,500 deaths) over the ten years.
Mental illness: 1.1 billion people living with psychological or psychiatric disorders and substance abuse problems in 2016. Major depressive disorders ranked in the top 10 causes of ill health in all but four countries worldwide. Depression is a major cause of non-fatal disease burden, driving substantial morbidity around the world.
Over 2,500 researchers from 130 countries collaborated on this study, led by the IHME.
Health Populi’s Hot Points: In the U.S. and 72% of the world, most deaths are due to non-communicable diseases which can be prevented or postponed through lifestyle choices and behaviors. Diabetes is growing around the world owing to several factors including aging, greater exposure to lifestyle-related risk factors, and high BMI. Treatment improvements are increasing lifespans for people with diabetes, but those increased life-years can often be coupled with other chronic conditions and financial stress on national health systems, leading to people living longer, but with disabilities often preventing folks from their pursuits of happiness — those YLDs are a looming threat for the U.S. healthcare system, public and individual health.
Take diabetes, which is epidemic around the world and, to be sure, in the U.S. New research that will be presented tomorrow at the meeting of the European Association for the Study of Diabetes in Lisbon, Portugal found that millions of Americans with type 2 diabetes and pre-diabetes are at risk for chronic kidney disease, and diabetes-related blindness.
And while cancer death rates are falling due to the use of new and effective treatments, new research learned, there’s more work to be done in preventing cancer’s onset — namely smoking cessation, limiting environmental hazards, and improving nutrition. Note that 7 million people died globally due to tobacco use, the GBD study calculated.
What bolsters health are investments in social determinants and primary care, which are key for both physical and mental health. As health reform discussions continue in the U.S., this GBD research, and the criticality of social determinants and accessible primary care on-ramps, must be considered.
As an example of a wonderful initiative just launched to tackle the GBD, Dr. Tom Frieden, former director of the CDC, and Michael Bloomberg, my favorite ex-healthcare mayor, have come together to fund Resolve, a $225 million program co-sponsored by the Gates Foundation and the Chan Zuckerberg Initiative.
The post How We Live and Die in 2017: Obesity, Conflict and Mental Illness appeared first on HealthPopuli.com.
I am generally skeptical of broad, top-down approaches to improve health. For instance, soda taxes are one example. While soda is clearly not got for you, should unhealthy drinks like Red Bull be taxed? Why single out soda? What about cheesecake? Thus, these efforts–while well intentioned–can seem arbitrary and paternalistic.
On the other hand, posting calorie counts I would regard as somewhat different. While there are clear costs to businesses, providing information to consumers and allowing consumers to make their own decisions seems like a more reasonable approach. The question is whether the cost of the regulation outweight the benefits…and more specifically, whether there are any benenfits. Specifically, does posting calories lead to reduction in body mass index (BMI)?
That is exactly the question that Restrepo (2017) attempts to answer using data from New York City. They find that:
…the point-of-purchase provision of calorie information on chain restaurant menus reduced body mass index (BMI) by 1.5% and lowered the risk of obesity by 12%. Quantile regression results indicate that calorie labeling has similar impacts across the BMI distribution. An analysis of heterogeneity suggests that calorie labeling has a larger impact on the body weight of lower income individuals, especially lower income minorities. The estimated impacts of calorie labeling on physical activity, smoking, and the consumption of alcoholic beverages, fruits, and vegetables are small in magnitude, which suggests that other margins of adjustment drive the body-weight impacts estimated here.
A very interesting piece of evidence that will be useful for this debate on whether to extend the calorie information more broadly.
Fast Company’s October 2017 issue leads with a cover story featuring Microsoft’s CEO Satya Nadella, with the title, Microsoft Rewrites the Code. The issue of Fast.Co is devoted to the theme of innovation by design, and the 8-page story on the company emphasizes the theme of empathy and collaboration.
I lead with this because I’m now in Orlando preparing to participate in Microsoft’s annual meeting called Envision. This conference brings together the company’s clients from around the world, representing major industry segments. I’m grateful to be invited to participate in the first of six sessions devoted to healthcare.
Dr. Simon Kos, Chief Medical Officer at Microsoft, will be interviewing me for a one-on-one conversation on Saving Lives With Digital Transformation in Health. We’ll be mashing up health-tech topics including analytics, artificial intelligence, Internet of Healthy Things, mobile health, virtual and telehealth, population health, and the importance of privacy and security in light of the latest Equifax breach and EU data privacy update — all with people (patients, consumers, caregivers and clinicians) and value at the center.
Simon published a blog post on Envision, AI and Digital Transformation last week here; it’s worth reading through this doctor’s lens on the state of education and schools, creativity, the hospitality industry, and healthcare. Obviously, he is certainly a kindred spirit to my way of trend-weaving health and healthcare.
Here’s a link to the ENVISION meeting agenda, and here’s one for the health-specific sessions.
Health Populi’s Hot Points: It’s fun to get lulled into techno-optimism; after all, we’re in Orlando and the fantasy of Disney and Harry Potter World perfume the air we breathe while we’re in this geographic neck of the theme park woods.
So I’ll also be raising issues and barriers during my conversation with Simon that could limit mass adoption of digital innovations. These might include:
and other challenges to existing health business models, professional turf, and consumer engagement.
Stay tuned for more insights we’re hearing about at Microsoft Envision. We’ll be tweeting using hashtag #MSFTEnvision, @MSFTEnvision and @Health_IT. I’ll also be writing up another blog post highlighting my Envision learnings here on Health Populi to which Microsoft will link.
The post Envisioning Healthcare Innovation and Value with Microsoft appeared first on HealthPopuli.com.
Driven by price increases, costs for the prescription drug benefit carve-out will increase 11.6% this year, based on Segal Consulting’s survey report, High Rx Cost Trends Projected to Be Lower for 2018, published today.
While the Segal team expects prescription drug (Rx) benefit plan cost trends to be “less severe” in 2018, Rx cost increases is a top priority for many sponsors of health plans as their rate of increase far exceeds those for inpatient hospital claims or physician expense. Drug costs continue to be the fastest-growing line item in health plans. This has resulted in greater public scrutiny and criticism of the pharma industry.
It’s price growth, not increased utilization (volume), which is driving this trend.
Specifically, cost growth for outpatient Rx coverage for active workers and retirees under 65 will increase by 10.3% in 2018, lower than the 11.6% of 2017. For specialty drugs, trend growth will be 17.7% in 2018 versus 18.7% in 2017. Segal points to the examples of Alcortin A, Aloquin and Novacort, combination medicines that treat skin conditions like eczema and atopic dermatitis. The price of non-discounted Alcortin A grew from $226 in early 2015 to over $9,500 in today’s market.
The expanded use of generic drugs has worked to tame Rx trend, but the growth of specialty drug costs will mitigate the favorable cost pressures of generics.
As more consumers take up high-deductible health plans, the theory is that people price-shop for health care goods and services. Segal recommends that plans invest more in consumer-facing programs and tools to help connect consumers to helpful, personalized information to bolster smarter prescription drug use, purchasing, and adherence.
Health Populi’s Hot Points: The Segal report mentions Epipen pricing, with a wholesale price of $100 for a two-pack in 2009 rising to $600 in 2016. The photo pictures a protest in front of Mylan’s office in New York City involving an Epipen piñata beat-up.
High-cost drugs are a growing component in overall drug prescriptions in the U.S. While we expect emerging competition from biosimilars and generics to enter the market over time, analysts don’t expect countervailing price pressure downward the way we experienced the era of Generics 1.0.
Pharmacy benefit sponsors’ strategies for moderating drug spending will include specialty pharmacy management, more intense pharmacy management programs, contracting with value-based providers like ACOs and patient-centered medical homes, increasing financial incentives in wellness design, and adopting HDHPs. These tactics are meant to address the demand side, how patients receive services and products.
What about the supply side? That is, how pharma companies calculate prices for products, and whether, say, Medicare might be allowed to negotiate prices with suppliers the way other big payors do in other industrialized nations?
Earlier this week, Anthem, the health plan in California, expected that prescription drug costs would increase by 30% in 2018. As a result, the health insurance company proposes a 35% increase for health insurance rates in the state. This rate increase would be the highest seen in the U.S., so far, for 2018. Whether this rate will be modified, the event reminds us that pharmaceutical companies and their product prices are in the bullseye of regulator, plan purchasers, and consumers alike.
For more on the politics and economics of prescription drugs, see yesterday’s post detailing the findings of Kaiser Family Foundation’s 2017 Employer Health Benefits report, Prescription Drug Coverage at Work: Prices: Common, Complex, and Costly.
The post 2017 Rx Cost Trend Over 5 Times U.S. Inflation, Segal Projects appeared first on HealthPopuli.com.
Getting health insurance at work means also having prescription drug coverage; 99% of covered workers’ companies cover drugs, based on the 2017 Employer Health Benefits Survey released by the Kaiser Family Foundation (KFF).
I covered the top-line of this important annual report in yesterday’s Health Populi post, which found that the health insurance premium for a family of four covered in the workplace has reached $18,764 — approaching the price of a new 2017 small car according to the Kelley Blue Book.
The complexities of prescription drug plans have proliferated, since KFF began monitoring the drug portion of health benefits at the workplace.
As the first chart illustrates, virtually all workers covered by workplace health plans cover medicines, including specialty drugs. Slightly fewer smaller companies (91%), with 200 to 999 workers, provide drug coverage.
83% of covered workers’ plans have three or more tiers for consumers’ cost-sharing. Co-payments are the most common form of cost sharing in the first three tiers, shown in the second chart. Coinsurance is the second type of cost-sharing for Rx drugs.
Tier 1 of prescription medicines generally covers generic drugs, for which there are the lowest co-payments: on average, $11 per prescription. Tier 2 covers so-called preferred drugs, those on a formulary which are often brand-name drugs without generic substitutes or older drugs still on-patent with a proven track record. The average price of second-tier drugs was $33. The average co-payments for third-tier drugs was $59, covering drugs excluded from formularies; these tend to be branded drugs with generic substitutes. Fourth-tier drug co-pays reached $110 in 2017; this category can apply to lifestyle drugs (for, say, dermatology or erectile dysfunction), or biologics. Finally, specialty drugs are cost-sharing quite differently, discussed below. Specialty drugs are the new high-cost drugs to treat arthritis, blood disorders, cancer, and other conditions where the treatment may need special handling or infusion at the doctor’s office. For more on this growing category of therapies and their impact on U.S. health consumers, see my recent post on the rise and rise of specialty drug costs here in Health Populi.
Virtually all covered workers at large companies have specialty drug coverage. (KFF covered this issue for the first time in this year’s study, and did not research specialty drug coverage at smaller companies). Among people with specialty drug coverage, nearly one-half are in a plan with at least one cost-sharing tier to deal with specialty drugs. 45% have a co-payment for specialty drugs (on average, $101 per prescription), and 46% have coinsurance (on average, 27% of the cost).
Health Populi’s Hot Points: Prescription drug spending is the most transparent consumer-facing health care cost aside from the health plan premium. Generic Rxs, accounting for 89% of prescriptions filled in 2016 (3.9 billion prescriptions), have become a beloved component of the consumer-facing health supply side. Generic drugs, covered on Tier 1, save consumers and states money, illustrated by the map. In 2016, generics saved Medicare $1,883 per enrollee, and $512 per Medicaid enrollee.
But consumers’ collective love for the pharmacy is now threatened, J.D. Power learned, as more patient-consumers face higher-cost drugs in the retail setting as I discussed here in Health Populi.
Research published this month in JAMA Internal Medicine details Strategies That Delay Market Entry of Generic Drugs, research sponsored by The Commonwealth Fund. The issue is that, “Manufacturers of brand-name drugs use many strategies to extend the market exclusivity of their products…By delaying the entry of generic products into the marketplace, such tactics can keep prices high and limit the affordability of drugs to patients and payers,” the researchers assert. Some of these tactics include extending market exclusivity on the initial patent by applying for new patents on “secondary aspects” of drugs (like coating or how the treatment is administered); offering compensation to generic companies to stall generic drug entry to the market; restricting generic companies’ distribution for drugs, such as preventing sampling; and, various petitions to the FDA (a boondoggle for lawyers),
Allergan gets the Health Populi Chutzpah Award for Generic-Stall Tactic this month. Allergan transferred ownership of the patent for Restasis to the Saint Regis Mohawk Tribe, to whom Allergan will pay $15 million every year. Restasis, a drug that treats the condition of dry eye, is Allergan’s second-biggest selling drug generating $393.1 million in the fourth quarter of 2016, up 13%.
Prescription drug pricing is a legislative issue that Democrats, Independents, and Republicans converge on in a tri-partisan way, compared with dealing with the ACA. The President and Congress had an opportunity at the start of 2017 to address this healthcare policy convergence. Even Donald Trump said, in his TIME magazine interview, that he would seek to deal with prescription drug pricing once assuming the presidency.
The post Prescription Drug Coverage at Work: Common, Complex, and Costly appeared first on HealthPopuli.com.
Morning Consult has an interesting piece from Mark Linthicum, the Director of Scientific Communication at the Innovation and Value Initiative (IVI) titled “Why Understanding Value Is Central to True Health Care Reform“. In the piece he argues:
The true problem is that dollars are poured into a system without any clear understanding of how worthwhile one dollar spent is, relative to another. The remedy lies in making spending and coverage decisions based on the value – not just the price tag – of health care treatments and services.
Value-based spending is a simple notion that amounts to prioritizing spending on services where the benefits outweigh cost – spend less on recognized areas of low-value care, like unnecessary tests and procedures, and more on high-value areas like vaccines.
Implementing value-based spending in practice, however, is more complicated because health care system stakeholders each have disparate, and sometimes conflicting, definitions of value.
Interesting throughout. Do read the whole piece.
The average cost of an employer=sponsored health plan for a family reached $18,764 in 2017. While this premium grew overall by a historically relative low of 3.4%, employees covered under that plan faced an increase of 8.3% over what their plan share cost them in 2016, according to the 2017 Employer Health Benefit Survey published today by the Kaiser Family Foundation. [Here’s a link to the 2016 KFF report, which provided the baseline for this 8.3% calculation].
Average family premiums at the workplace rose 19% since 2012, a slowdown from the two previous five-year periods — 30% between 2007 and 2012, and 51% between 2002 and 2007, KFF calculated.
This annual study details every aspect of health insurance provided by U.S. companies to workers, and provides important benchmarks year after year on health plan premiums, worker contributions, prescription drug coverage, wellness, and other key issues in employer-sponsored health benefits.
There are significant differences between health benefits provided by small (with 3 to 199 workers) versus large firms (covering 200 or more employees). One-half of firms with fewer than 50 workers offered health benefits in 2017, compared with virtually all companies with over 100 workers offering health insurance. Just over one-half of workers (55%) were covered by health insurance through the workplace in 2017, illustrating the fact that some workers who are offered health coverage at work do not enroll in the plan, often finding the cost prohibitive relative to the family budget.
To reinforce that point, the second chart illustrates what U.S. families have experienced since 1999: it’s a picture of relatively flat wage increases relative to hockey-stick growth of worker contributions for family health premiums. In 2017, the cumulative increase in the worker’s earnings since 1999 was 64% (while general price inflation was a cumulative 47%). Family premiums rose 224%, and workers’ contributions to those premiums, 270%.
Thus, workers continue to trade off wage increases to receive health insurance at the workplace for the better part of two decades. In 2017, the 8.3% growth in health premium cost sharing was over six times the rate of inflation for the year (at 1.4%).
There are many other trends I’ll cover from the KFF survey over the coming days, especially related to prescription drug coverage and wellness programs.
In the meantime, for historical context, here are links to my previous posts covering this important research:
2016 KFF Employer Health Benefits report in Health Populi, 16 September 2016
2015 KFF Employer Health Benefits report in Health Populi, 23 September 2015
2014 KFF Employer Health Benefits report in Health Populi, 10 September 2014
2013 KFF Employer Health Benefits report in Health Populi, 21 August 2013
2012 KFF Employer Health Benefits report in Health Populi, 3 October 2012
2010 KFF Employer Health Benefits report in Health Populi, 3 September 2010
2009 KFF Employer Health Benefits report in Health Populi, 17 September 2009
The post Employees Continue To Pick Up More Health Insurance Costs, Even As Their Growth Slows appeared first on HealthPopuli.com.
Most U.S. patients want healthcare providers to offer cost information before a procedure, and whether doctors offer financial options to help them extend payments over time.
This is an automotive or home appliance procedure we’re talking about. It’s healthcare services, and American patients are now the third largest payors to providers in the nation. Thus, the title of a new report summarizing a consumer survey from HealthFirst notes, “It’s Never Too Soon to Communicate Pricing and Payment Options.
The study found that two-thirds of U.S. consumers would like healthcare providers to discuss financing options; however, only 18 percent of providers have spoken to patients about such financial plans. Only 8% of patients had used either zero- or low-interest financing to pay off medical bills over time, HealthFirst found.
HealthFirst also quantified that most patients are now behaving more like healthcare consumers: 86% of people check whether a provider will accept their insurance plan, 77% want to receive cost information before a procedure, 63% look for published pricing lists for common procedures, and 57% of patients say it would be important for a provider to offer no-interest financing options enabling payments over time.
Worrying about healthcare costs impacts patients at all income levels. While, clearly, more lower-income people are concerned about their ability to pay out-of-pocket medical expenses, 1 in 4 high-income patients with $100K or more annual income are concerned about meeting their out-of-pocket costs.
Younger people are most keen to pay medical bills over time, as the bar chart illustrates. 71% of Millennials would be interested in a multi-year no interest financial option for a bill under $1,000, and nearly 50% would like that financing option for a bill under $500.
HealthFirst is a healthcare financing company extending long-term financing options to patients receiving services as over 200 U.S. healthcare providers. The company surveyed over 1,000 patients for the study.
Health Populi’s Hot Points: There’s a not-so-sweet spot somewhere between $500 and $1,000 where most U.S. patients would like to finance their out-of-pocket healthcare costs over a period of time, based on these survey results.
I’ve researched and written extensively about this issue, recently noting that healthcare is the #1 pocketbook issue in America above paying rent or a mortgage, for food, or utilities — even for the wealthiest Americans, Kaiser Family Foundation found.
There are several components to out-of-pocket costs, and they vary by person. If you are a young person diagnosed with leukemia, you may face a cost of nearly $500,000 for new CAR-T therapy (see here for my take on this). If you are a Boomer couple weighing the financial implications of retiring sooner-versus-later, you will learn that healthcare costs in retirement could run you, on average, $275,000 (not including long-term care).
If you work for a small company, your health plan deductible would likely be $2,000. In this case, based on HealthFirst’s poll, you would part of the health consumer market seeking longer-term finance of your health cost liability. Welcome to the new era of medical banking.
In the immediate term, if you work in hospital or healthcare finance, Black Book just issued its top revenue-cycle management technology tools and services ratings here. The top five include Optum,
The post Patients Are Looking to Finance Healthcare Over Time appeared first on HealthPopuli.com.
Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation.
There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability).
“Death is a powerful motivator, both for individuals and for countries, to address diseases that have been killing us at high rates. But we’ve been much less motivated to address issues leading to illnesses,” said Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, quoted in Reuters summary of the report.
Let’s dissect the 3 key factors underlying the global disease burden:
Diet and food: Diets low in whole grains, fruit, nuts and seeds, fish oils and high in salt were the most common risk factors, contributing to cases of obesity, high blood pressure, high blood sugar and high cholesterol. Here is Newsweek’s take on eating badly causing death and disability. Men’s Health magazine was more direct, asserting that, “Your crappy diet is literally killing you.”
Conflict: Deaths due to terrorism and war increased by 143% since 2006 to over 150,000 in 2016. These deaths were concentrated in the Middle East and North Africa. Mortality due to gun deaths grew by 5.7% to 161,000 for deaths due to firearm assaults, and 4.3% for suicide-by-gun (67,500 deaths) over the ten years.
Mental illness: 1.1 billion people living with psychological or psychiatric disorders and substance abuse problems in 2016. Major depressive disorders ranked in the top 10 causes of ill health in all but four countries worldwide. Depression is a major cause of non-fatal disease burden, driving substantial morbidity around the world.
Over 2,500 researchers from 130 countries collaborated on this study, led by the IHME.
Health Populi’s Hot Points: In the U.S. and 72% of the world, most deaths are due to non-communicable diseases which can be prevented or postponed through lifestyle choices and behaviors. Diabetes is growing around the world owing to several factors including aging, greater exposure to lifestyle-related risk factors, and high BMI. Treatment improvements are increasing lifespans for people with diabetes, but those increased life-years can often be coupled with other chronic conditions and financial stress on national health systems, leading to people living longer, but with disabilities often preventing folks from their pursuits of happiness — those YLDs are a looming threat for the U.S. healthcare system, public and individual health.
Take diabetes, which is epidemic around the world and, to be sure, in the U.S. New research that will be presented tomorrow at the meeting of the European Association for the Study of Diabetes in Lisbon, Portugal found that millions of Americans with type 2 diabetes and pre-diabetes are at risk for chronic kidney disease, and diabetes-related blindness.
And while cancer death rates are falling due to the use of new and effective treatments, new research learned, there’s more work to be done in preventing cancer’s onset — namely smoking cessation, limiting environmental hazards, and improving nutrition. Note that 7 million people died globally due to tobacco use, the GBD study calculated.
What bolsters health are investments in social determinants and primary care, which are key for both physical and mental health. As health reform discussions continue in the U.S., this GBD research, and the criticality of social determinants and accessible primary care on-ramps, must be considered.
The post How We Live and Die in 2017: Obesity, Conflict and Mental Illness appeared first on HealthPopuli.com.
Many people pay little attention to floss. It’s just viewed as another toiletry that’s used infrequently, and otherwise lays at the bottom of your bathroom drawer collecting dust. Aside from the biannual harassment from the dentist to floss daily, this isn’t a product that comes to mind too often. In fact, most people would be hard pressed to identify the basic history and evolution of the product.
The history of floss
In case you’re ever on Jeopardy (or at a trivia night), floss actually dates back to prehistoric times. Archeologists have found grooves in the teeth of prehistoric humans and hypothesized that horse hairs were used to get the tough meat and fibrous plants out of hard-to-reach places of our early ancestors. Through the nineteenth century to present, floss has evolved and changed as a result of several world events. For example, during World War II the traditional silk floss had to be replaced by nylon due to rising costs of materials during the war effort. Today, modern technologies and synthetic materials have once again influenced the development of floss, which is cheaper to make than ever.
If your floss is sitting unused at the bottom of your drawer, start by actually using it. Less than 12% of Americans floss the recommended amount, so by setting this habit you’ll be a ready-made superstar.
It gets better…
Next, if you have copious amounts of unused floss, the good news is that there are numerous ways to use it aside from oral hygiene. Floss has commonly been used as a “household hack.” Need to hang a picture on the wall, but don’t have the wire for the back of the frame? Floss can easily be used to hold the frame on the nail. Out camping and need to cut food, but forgot your silverware? Floss has been used to cut foods like cheese, hard bodied eggs, and even to remove fish from its skin. And another camping perk—floss burns easily thanks to the wax on the outer layer. Simply wrap it around some bark, and light. There are so many uses for floss in the wild that survivalists actually suggest packing it when you venture into the wilderness.
There are plenty of urban legends about other benefits of floss that you can decide if you believe. In 1995, they say a West Virginia inmate crafted and used a floss ladder to escape from prison. His ladder was supposedly eighteen feet long and as thick as a telephone wire. Since that time, inmates in prisons across the world have tried this escape. It is uncertain if others have been successful. And in case you were curious—the prisoner who escaped in 1995 was caught only weeks later.
Finally, if you think flossing is something that only your dentist does, you’d be mistaken. In North America, over three million miles of floss are purchased each year. That amount of floss would wrap around the world over 120 times! While there are many reputable alternatives for unused floss, and some not-so-reputable (cough…prison breaks), using it to get plaque out from between your teeth is the most important. Brushing your teeth without flossing is like bathing only 70% of your body when you shower, so remember—in order to reach the other 30% of your teeth surfaces, floss twice a day, right before brushing.
The post Fun Facts about Floss appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
Many people pay little attention to floss. It’s just viewed as another toiletry that’s used infrequently, and otherwise lays at the bottom of your bathroom drawer collecting dust. Aside from the biannual harassment from the dentist to floss daily, this isn’t a product that comes to mind too often. In fact, most people would be hard pressed to identify the basic history and evolution of the product.
The history of floss
In case you’re ever on Jeopardy (or at a trivia night), floss actually dates back to prehistoric times. Archeologists have found grooves in the teeth of prehistoric humans and hypothesized that horse hairs were used to get the tough meat and fibrous plants out of hard-to-reach places of our early ancestors. Through the nineteenth century to present, floss has evolved and changed as a result of several world events. For example, during World War II the traditional silk floss had to be replaced by nylon due to rising costs of materials during the war effort. Today, modern technologies and synthetic materials have once again influenced the development of floss, which is cheaper to make than ever.
If your floss is sitting unused at the bottom of your drawer, start by actually using it. Less than 12% of Americans floss the recommended amount, so by setting this habit you’ll be a ready-made superstar.
It gets better…
Next, if you have copious amounts of unused floss, the good news is that there are numerous ways to use it aside from oral hygiene. Floss has commonly been used as a “household hack.” Need to hang a picture on the wall, but don’t have the wire for the back of the frame? Floss can easily be used to hold the frame on the nail. Out camping and need to cut food, but forgot your silverware? Floss has been used to cut foods like cheese, hard bodied eggs, and even to remove fish from its skin. And another camping perk—floss burns easily thanks to the wax on the outer layer. Simply wrap it around some bark, and light. There are so many uses for floss in the wild that survivalists actually suggest packing it when you venture into the wilderness.
There are plenty of urban legends about other benefits of floss that you can decide if you believe. In 1995, they say a West Virginia inmate crafted and used a floss ladder to escape from prison. His ladder was supposedly eighteen feet long and as thick as a telephone wire. Since that time, inmates in prisons across the world have tried this escape. It is uncertain if others have been successful. And in case you were curious—the prisoner who escaped in 1995 was caught only weeks later.
Finally, if you think flossing is something that only your dentist does, you’d be mistaken. In North America, over three million miles of floss are purchased each year. That amount of floss would wrap around the world over 120 times! While there are many reputable alternatives for unused floss, and some not-so-reputable (cough…prison breaks), using it to get plaque out from between your teeth is the most important. Brushing your teeth without flossing is like bathing only 70% of your body when you shower, so remember—in order to reach the other 30% of your teeth surfaces, floss twice a day, right before brushing.
The post Fun Facts about Floss appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
Although this Saturday Evening Post article comparing how physicians and patients prefer end of life treatment is from 2013, it is interesting throughout.
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
Why did this renowned surgeon forego medical treatment that could have potentially extended his life?
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
So why don’t physicians treat patients like they would like to be treated? Oftentimes, caregiver preferences may be to extend the patient’s life whereas patients may focus on improved quality of life. Patients themselves may ask to “do everything” to save their life, but without a sense of what everything means. In addition, incentives in the health care system favor more intervention.
Consider the case of a man named Jack who had documented do not resuscitate (DNR) order. When the patient’s primary physician intervened to end the provision of life support, here is what happened.
One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of over-treatment.
An interesting study by Chen et al. (2017) examines the cost of cancer care among Medicare patients. Using SEER-Medicare data of people diagnosed with cancer between 2007 and 2011, they found:
Over the year of diagnosis, mean per-patient annual Medicare spending varied substantially by cancer type: $35,849 for breast cancer, $26,295 for prostate cancer, $55,597 for lung cancer, and $63,063 for colorectal cancer. More advanced stage at diagnosis was associated with higher annual spending for breast, prostate, and colorectal cancer…Over the year of death, mean per-patient annual spending was more consistent across cancer types: Breast cancer patients had an average of $61,429 in annual spending, compared to prostate ($62,351), lung ($59,912), and colorectal ($72,883).
In what care setting did the costs occur?
Over the year of diagnosis, inpatient services accounted for 50 percent of lung and 58 percent of colorectal cancer spending but only 22 percent of breast and 25 percent of prostate cancer spending (Figure 4). Outpatient costs were responsible for the majority of initial spending among patients newly diagnosed with breast and prostate cancer (66 percent for both).
Note that most injectable cancer drugs are included in the outpatient spending category.
Source:
