- Real-world effects of Brexit.
- Cost of Obamacare = an election?
- Civil rights laws and health inequality.
- Chinese economic history as seen through eyeglasses.
- CHIP at risk?
- Last days of empire edition of HWR
Links posted first on http://ift.tt/2sNcj5z
DFW is an acronym we all identify by to a degree…but for those of us who are proud to live in Fort Worth, we’re grateful for a lot of what makes our community unique. We were so pleased with the additional comments to last week’s blog, Things We’re Thankful For In Fort Worth, that we felt like it was worth celebrating with another post.
And at this time of year, we find it all too easy to narrow in on why we’ve chosen Fort Worth over all other places in the world. Here’s a list of more items we and our patients are grateful for here in Fort Worth.
Take a look at the comments others have left us!
With the population of Fort Worth becoming more and more diverse, we have the whole spread of Mexican-inspired cuisine, from Tex-Mex to mom-and-pop shops with traditional Mexican dishes. Think imported salsas, family recipes, and fresh cotija cheese and corn. You’ll never go home hungry.
It’s that time of year…you know, those holidays that are all about the food on the table. We can’t help but feel appreciative that our dining options in Fort Worth are as about diverse as they come. From Indian to Hawaiian, Asian, Japanese, Italian, Greek, Salvadorian, traditional American, Columbian and more – Fort Worth satiates all our worldly desires.
Often considered the museum capital of the Southwest, Fort Worth boasts multiple visit-worth museums. Fort Worth itself is on the map as a “culturally astute place for modern and historical art,” with no less than five internationally recognized museums. Not to mention the architecture that stands out throughout the city!
With places like Billy Bob’s Honky Tonk Bar, the National Cowgirl Museum and the only place in the world with twice-daily cattle drives, there’s clear evidence we are not trying to forget what makes us Texans—yet we are moving forward in the future like the rest of the world, naturally, with our world recognized character.
They say everything is bigger in Texas, but that doesn’t quite correlate to the cost of living. Living in Fort Worth boasts a 4% lower-than-national-average cost for residents, and home prices are 31% lower than the national average1, too.
Known for our aviation and aerospace sector, plus corporate and professional operations, life sciences, logistics, manufacturing and natural gas, Fort Worth’s central location and diverse economy make for a skilled workforce that continues to draw interest from all industry clusters2, providing opportunities for all skillsets and ages.
Nobody likes to sit in traffic. And the best way to peak efficiency, whether you’re a business or just a normal person trying to make things happen in life, you need to be able to get places quickly. Fort Worth’s four airports, substantial rail network, and extensive highway system ensure that accessibility to any location3 in FW takes 30 minutes or less.
Did you know in this lovely city of ours there are 200 parks? Yes, you read that right—200, all beautifully maintained by our Parks and Recreation Department. From parks and trails, to community centers, athletic programs, pools and aquatics, fishing, golf, tennis, botanical Garden, dog parks, log cabin village, Nature Center and Refuge, to the Water Gardens and more – there never has to be a dull moment!
With its history of gambling joints and brothels that was later developed by the billionaire Bass family, the Sundance Square (named after the infamous Sundance Kid) was turned into a community goldmine filled with things to do (like the Water Gardens), places to go (like the Sid Richardson Museum), and people to see (at the Bass Performance Hall).
How many places can say they make paper currency? Only five sites in the whole of America, as a matter of fact. And it’s always gratifying to have coins jangling in your pocket, even more so when they have the FW stamp. So yep, we’re grateful for that too.
The post MORE Things We’re Thankful For In Fort Worth appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
More consumers are seeking health-making opportunities everywhere, both within and outside of traditional healthcare touch-points. That includes peoples’ consumption of beer.
We learned from the Edelman Health Engagement Barometer that consumers seek to engage for health beyond healthcare organizations – namely, hospitals, providers, over-the-counter medicines, pharma and insurance.
What was perhaps the most surprising industry segment consumers called on for personal health engagement was brewing and alcohol.
Fully 8 in 10 consumers expect brewing and spirits companies to engage in health. The bar chart shows this finding, arraying beer and liquor producers on par with retail and consumer technology, along with insurance.
Since these survey results were published in 2010, I’ve used this chart in meeting and brainstorming with both traditional healthcare industry stakeholders along with new entrants seeking to address consumers’ interests in self-care and making health for themselves and with their families and communities.
As patients are growing into healthcare consumers with the adoption of high-deductible health insurance plans and more DIY-demands for self-care and choice, the supply-side landscape is expanding for these individual industries along with collaborative opportunities to both develop products and services and educate people for self-health.
Here’s a great video example, called “The Cart Crash,” which is an ad for Golden Brau 0.0% alcohol launched in Romania speaking to drunk driving and the role of non-alcoholic beer for people who want to drink and drive this holiday season. The ad developer explained the background for this campaign: “Beer is very popular in Romania. We like to drink beer when going out, at home, pretty much on every occasion. And this is good for Golden Brau, since it is a well-established brand. But this can easily backfire in a country with lots of car accidents caused by drinking and driving – and here comes the ‘extension’ of the brand, Golden Brau 0.0% Alcohol. Its main mission is to educate and increase responsibility by ‘activating’ its consumers in a very sharp way, close to their drinking occasions, in what we call ‘The Pivotal Moment’.
Health Populi’s Hot Points: Earlier this year, Heineken, the brewer of Golden Brau 0.0%, launched a non-alcoholic beer in its own name which has one-half the calories of a classic Heineken or single service of Coca-Cola. Consumers’ search for healthier lifestyles, wellness, and chronic care self-management offer consumer goods, food, technology, retail and financial services companies to meet-up and engage with people to support their personal health-making objectives. The Edelman Health Barometer bar chart bolsters the evidence on that demand side.
The opportunities to collaborate are many, and should motivate healthcare industry stakeholders to forge new, creative relationships that meet their patients where people want to make health – at home, school, on-the-go in a smart(er) car, at the bank, at work, at the gym or grocery store.
Food is a low-hanging fruit opportunity for healthcare and industry partnerships. Evidence published in JAMA Internal Medicine that SNAP benefit participation can reduce health care costs for people with lower incomes is but one scenario that should spur partnerships between healthcare providers, pharma, and food industry players. Another example is Geisinger Health System’s Fresh Food Farmacy, providing food to patients managing Type 2 Diabetes; Geisinger is partnering with The Central Pennsylvania Food Bank, the Degenstein Foundation, The Luzerne Foundation Logos Fund, and Weis Markets, a grocery chain.
Such partnerships can help realize that elusive, noble Triple Aim: reduce per capita health care costs, drive better health outcomes, and improve (even delight) the healthcare experience for people.
The post Consumers Seek Health Engagement Everywhere: the Case for Alcohol and Breweries appeared first on HealthPopuli.com.
Along with my co-authors Jeff Sullivan, Jacki Chou, Michael Neely, Justin Doan, and Ross Maclean I am happy to announce to publication our paper “The effect of medication nonadherence on progression-free survival among patients with renal cell carcinoma” in Cancer Management and Research. The abstract is below.
Objective: To examine how observed medication nonadherence to 2 second-line, oral anticancer medications (axitinib and everolimus) affects progression-free survival (PFS) among patients with renal cell carcinoma.
Methods: We used an adherence–exposure–outcome model to simulate the impact of adherence on PFS. Using a pharmacokinetic/pharmacodynamic (PK/PD) population model, we simulated drug exposure measured by area under the plasma concentration–time curve (AUC) and minimum blood or trough concentration (Cmin) under 2 scenarios: 1) optimal adherence and 2) real-world adherence. Real-world adherence was measured using the medication possession ratios as calculated from health insurance claims data. A population PK/PD model was simulated on individuals drawn from the Medical Expenditure Panel Survey (MEPS), a large survey broadly representative of the US population. Finally, we used previously published PK/PD models to estimate the effect of drug exposure (i.e., Cmin and AUC) on PFS outcomes under optimal and real-world adherence scenarios.
Results: Average adherence measured using medication possession ratios was 76%. After applying our simulation model to 2164 individuals in MEPS, drug exposure was significantly higher among adherent patients compared with nonadherent patients for axitinib (AUC: 249.5 vs. 159.8 ng×h/mL, P<0.001) and everolimus (AUC: 185.4 vs. 118.0 µg×h/L, P<0.001). Patient nonadherence in the real world decreased the expected PFS from an optimally adherent population by 29% for axitinib (8.4 months with optimal adherence vs. 6.0 months using real-world adherence, P<0.001) and by 5% (5.5 vs. 5.2 months, P<0.001) for everolimus.
Conclusion: Nonadherence by renal cell carcinoma patients to second-line oral therapies significantly decreased the expected PFS.
Do read the whole article as it is published on an open access journal.
It takes more than enrolling in a high-deductible health plan (HDHP) for someone to immediately morph into an effective health care “consumer.”
Research from Dr. Jeffrey Kullgren and his team from the University of Michigan found that enrollees in HDHPs could garner more benefits from these plans were people better informed about how to use them, including how to save for them and spend money once enrolled in them. The team’s research letter was published in JAMA Internal Medicine on 27 November 2017.
The discussion details results of a survey conducted among 1,637 people 18 to 64 years of age who have been enrolled in an HDHP for at least one year. The study over-sampled for people diagnosed with chronic health conditions (who, theoretically, are more experienced and savvy users of healthcare services).
The survey looked into HDHP health plan members’ consumer behaviors such as:
The most common healthcare consumer behavior was to save for future healthcare services, among 4 in 10 HDHP plan members. Discussing costs was the second most popular behavior, for 25% of HDHP enrollees.
The study assessed six types of healthcare services: lab tests, imaging tests, prescription medications, procedures, outpatient visits, and inpatient care. Above all, prescription medications were the top-ranked type of healthcare service/product with which consumers dealt versus the other five line items. Specifically,
The most common health engagement tactics adopted by HDHP members were to save for future health care, discuss the cost of services with a clinician, and comparing prices for a service. The most prevalent results of these actions were that:
Comparing quality ratings for services ranked relatively low among HDHP enrollees, with 14% of people doing so.
Health Populi’s Hot Points: It is important to note that consumers were least likely to wrestle with cost issues when it came to inpatient care — which is the most expensive component of the overall healthcare bill, accounting for about 40% of all healthcare spending. However, the hospital bill for a bed and associated services is among the least transparent line items to the consumer. Buying prescription drugs has a more transparent patient-consumer experience at the point-of-purchase in the pharmacy (in the form of a co-pay, coinsurance percentage, or retail price). This has opened patients-as-consumers up to understanding healthcare in terms of retail experiences and expectations.
Kullgren and team recommend that health systems make prices for services available at the point of care to inspire patient-clinician conversations about cost; and, that employers and insurance plans help patients learn how to use pricing information in their health care decision making. There’s a new project announced by Cerner, Epic, and other health IT companies who hold large market shares of the electronic health records market (EHRs), collaborating with Surescripts to channel patients’ prescription drug costs at the point-of-prescribing. Working with the PBMs Caremark (owned by CVS) and Express Scripts, this network would cover nearly two-thirds of U.S. patients. The ultimate objective will be, at the point-of-care, to deliver personalized information about the patient’s financial responsibility for a medication and therapeutic alternatives that could be appropriately prescribed as lower-cost substitutes. “Particularly for our members in a high-deductible plan, clarity around prescription drug costs is vital,” Dr. Lynne Nowak, VP of Clinical and Provider Solutions for Express Scripts, said in the press release.
Here is CVS’s news about real-time prescription drug benefits information, announced today.
This project is but one approach to channeling relevant information to patients building healthcare consumer muscles, and it’s a welcome one that helps to boost health IT interoperability — still a challenge for EHRs in support of patient engagement. But people will expect and need more complete and personalized health care cost and quality information in their own hands to support their consumerism.
The post High-Deductibles Do Not Automatically Inspire Healthcare Consumerism appeared first on HealthPopuli.com.
How frequently are pharmaceuticals used off label? Perhaps more than you think. Although these figures are a bit dated, Tabarrok (2000) details the extent of off-label prescribing in the U.S. as follows:
According to a study by the U.S. General Accounting Office, 56 percent of cancer patients have been given non-FDA-approved prescriptions, and 33 percent of all prescriptions in cancer treatment were off-label (General Accounting Office [GAO] 1991). Another survey, of AIDS patients, found that 81 percent of patients received at least one drug off-label, and 40 percent of all reported drug use was off-label (Brosgart and others 1996). Experts have estimated that nearly all pediatric patients (80 to 90 percent) are prescribed drugs off-label (Jaffe 1994; Kauffman 1996; Goldberg 1996).
If on-label prescribing has the best available evidence, why would a physician use off-label prescribing? Tabarrok gives three reasons:
Tabarrok’s article also highlights the important need to trade off Type 1 and Type 2 errors when regulating pharmaceuticals. He posits that FDA is likely biased towards avoiding Type 2 errors (the approval of drugs that are actually harmful) and is less concerned with Type 1 errors (not approving drugs that are helpful). However, Type 1 errors are clearly costly although receive less attention.
If the FDA approved a drug that killed thousands of people, that story would make the front page of every newspaper in the nation. Congressional hearings would certainly he held, the head of the FDA would probably lose his or her job, and the agency would be reorganized. But if the FDA rejected a drug that could save thousands of people, who would complain? When a drug kills a patient, that person is identifiable, and family and friends may learn the cause of the death. In contrast, the patient who would have lived, had new drugs been available, is identifiable only in a statistical sense.
Clearly, off-label prescribing is helpful in some cases and harmful in others. The key is to maximize the frequency of the former and decreases the frequency of the latter; which is easier said than done.
If you’re thinking about adding a pet to your family this holiday season, then you have probably done your research on proper food, training, and living conditions. While most pet owners diligently take their pet to their yearly exam at the vet, some forget the importance of a pet’s oral health between scheduled appointments! Just like their human counterparts, dental disease can strike our furry friends as well. Oral hygiene is a vital component to an animal’s overall wellness and comfort level. To keep your pet’s mouth in good condition, we have outlined easy steps to take to ensure their needs are taken care of.
Brushing teeth
Veterinarians agree that brushing your pet’s teeth is the single most effective way to maintain good oral health between regular dental exams. Just like in humans, plaque can from in the gum lines of pets and lead to periodontal diseases that can result in pain and tooth loss. For the dogs in our life, toothpastes come in flavors that are appealing to them, such as seafood and poultry. Not quite the minty fresh feeling we’re accustomed to, but Fido will be thrilled!
It’s important to avoid using human toothpaste on pets, since the ingredients can be harmful if ingested—and most of our pets will be inclined to do just that. Additionally, be sure to purchase a pet-specific toothbrush that will help you reach the odd angles of their mouth. If your pet seems to experience pain while you brush, they might already be suffering from a dental disease, and it’s important you get them into the vet as soon as you can.
Regular dental exam
Dental exams for dogs and cats are generally performed under full anesthesia and are recommended every year for small breeds and every two years for larger breed dogs. It’s recommended that pets be fully put under anesthesia in order to have a full, comprehensive cleaning. In order to remove all the plaque from the gum line without causing your pet undue stress or pain, it’s essential that they be asleep. Anesthesia-free exams simply clean the surface of the tooth. The scraping done in the exam leaves grooves, also, which are susceptible to bacteria build up and future dental issues. While under anesthesia, your pet will be closely monitored, and you’ll be given instructions on their post-appointment care. So, there will be nothing to worry about in the hands of your pet’s vet!
Products to promote oral health
While the old adage is that a dog’s mouth is cleaner than a toilet bowl, it is still best to do anything you can to promote good oral health in your pet. Consider giving your dog chew treats or rawhide products that contain anti-tartar ingredients. Ideally, you would create a daily “chew toy” routine which can help protect your pet’s mouth. In addition, massage your pet’s gums to help keep them clean. By getting them comfortable with you touching their mouth, will lead to easier toothbrushing sessions, too.
We often forget that our pets are susceptible to the same dental diseases that we are. While we can easily identify a problem, our pets are not always able to show exactly where their pain is located. By ensuring your pet is receiving regular dental exams, coupled with a daily brushing routine, you will be able to avoid problematic dental diseases. Your animals are a member of your family, so make sure they have good oral health routine, too!
The post How About Fido’s Teeth? appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
Below are some excerpts from seminal papers examining how changes in reimbursement or market size affect pharmaceutical innovation.
Our estimates suggest that a 1 percent increase in the size of the potential market for a drug category leads to a 6 percent increase in the total number of new drugs entering the U.S. market. Much of this response comes from the entry of generics, which are drugs that are identical or bioequivalent to an existing drug no longer under patent protection.
More important, there is a statistically significant response of the entry of nongeneric drugs, which more closely correspond to new products and “innovation”: a 1 percent increase in potential market size leads to approximately a 4 percent increase in the entry of new nongeneric drugs.
…we estimated effects of Part D on each stage of clinical R&D, Phase I through Phase III…we estimate the number of drugs entering Phase I trials in 2004–2005 increased by 27% versus expected trends. By 2006–2007, for the average drug class, the number of drugs entering Phase I trials had increased by about 34% versus expected trends, and by 2008–2010 Phase I trials had increased by a little over 50%. At the means, this translates to about 2–3 additional drugs reported as entering Phase I trials, per drug class…
In a Poisson regression with class-specific time trends, we do find a significant effect of Part D beginning in 2008, with a MedicareShare*(Year>2007) coefficient estimate of 0.74 (p=.013), corresponding to an elasticity of new drug approvals with respect to market size of about 2.8….
Our results indicate that the increase in outpatient prescription drug coverage provided through Medicare Part D has had a significant impact on pharmaceutical R&D. We observe evidence of a structural break in established R&D trends after passage and implementation of Part D, with greater percentage increases in drug trials for therapeutic classes that are most used by Medicare beneficiaries. In addition, we find stronger effects of Part D for protected classes,
Dubois, de Mouzon, Scott-Morton, Seabright (2015):
This article quantifies the relationship between market size and innovation in the pharmaceutical industry using improved, and newer, methods and data. We find significant elasticities of innovation to expected market size with a point estimate under our preferred specification of 0.23. This suggests that, on average, $2.5 billion is required in additional revenue to support the invention of one new chemical entity. This magnitude is plausible given recent accounting estimates of the cost of innovation of $800 million to $1 billion per drug, and marginal costs of manufacture and distribution near 50%.
Dranove, Garthwaite, Hermosilla (2014):
In this paper, we use a novel data set to explore the impact of the introduction of Medicare Part D on the development of new biotechnology products. We find that the law spurred development of products targeting illnesses that affect the elderly, but most of this effect is concentrated among products aimed at diseases that already have multiple existing treatments. Moreover, we find no increase in products targeting orphan disease or those receiving either fast track or priority review status from the FDA. This suggests that marginal changes in demand may have little effect on the development of products with large welfare benefits.
We examine the relationship between patent protection for pharmaceuticals and investment in development of new drugs. Patent protection has increased around the world as a consequence of the TRIPS Agreement, which specifies minimum levels of intellectual property protection for members of the World Trade Organization…We find that patent protection is associated with increases in research and development (R&D) effort when adopted in high income countries. However, the introduction of patents in developing countries has not been followed by greater investment. Particularly for diseases that primarily affect the poorest countries, our results suggest that alternative mechanisms for inducing R&D may be more appropriate than patents.
These articles were identified by a recent Health Affairs blog post by Frank and Ginsburg.
Despite the Trump administration’s efforts to scale back the health law, about 300,000 more people have signed up for health insurance in the Affordable Care Act marketplaces in the first weeks of this enrollment period than last year.
This is about a 25% increase from last year at this time. However, it may not be good news.
Because the Trump administration cut the enrollment periodin half this year, to 45 days from three months, weekly sign-ups would need to double to match the number of sign-ups in previous years.
Thus, this surge in enrollment may or may not be enough to make up for the shorter enrollment period and likely overall enrollment will fall in 2018.
“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness.
We each have our stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma.
Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” bit unwanted, futile care.
When you’re already in the situation of making tough health decisions toward the end-of-life, it’s tough, it’s emotional, it’s irrational, it’s energy-draining…and, it’s the wrong time.
The right time is to have that sensitive, considered, intimate dialogue now, before that inevitable time comes for decision-making.
The questions at Engage in Grace dot org, shown in the chart, are a helpful roadmap for inspiring that conversation. Alexandra Drane, Co-Founder of the Eliza Corporation and Seduce Health, knows all about how to have conversations in health: she’s leveraged technology to innovate such conversations. Engage with Grace is Alex’s long-time mission to inspire these conversations within extended families and tight social networks.
The Thanksgiving meal in America is a time where we are surrounded by the people we love most: family, friends, our close-in communities and social networks. Check out these five simple questions; if you haven’t yet covered these with your tribe, Thanksgiving is a wonderful time to do so.
Remember Merriam-Webster’s definition of the noun and holiday we celebrate in America ever fourth Thursday of November, every year.
If you can’t have this conversation during Thanksgiving week, anytime is the right time to Engage with Grace.
Health Populi’s Hot Points: The American Thanksgiving occurs on the last Thursday of November each year. This year, the Eve of Thanksgiving coincides with the 54th anniversary of the assassination of President John F. Kennedy. As I meditate today on JFK, whom my parents held in very high esteem, I ponder his words shown in the photo: that, “As we express our gratitude, we must never forget that the highest appreciation, is not to utter words, but to live by them.”
Heeding JFK’s wisdom and recommendation, let us be grateful on this great American holiday. And let us endeavor to be the best citizens we can be, mindful of and helpful to our national and global community of brothers and sisters.
The post Engage With Grace and Your Family on Thanksgiving: Have an End-Of-Life Chat at the End-Of-the-Feast appeared first on HealthPopuli.com.
More than once, we’ve been asked why we chose to set up our practice in Fort Worth. Those that are new to the area might wonder, “Why here instead of Dallas? Or, instead of a smaller, quieter area a little further north?”
The truth of the matter is that there is no place we’d rather be. While some may view Fort Worth as the cowboy cousin to posh Dallas, the western charm rooted in the Stockyards is one of the best features of our city. It breeds a hardworking community that looks out for one another.
In Dr. Ku’s 20 years of practice, he’s met some of the most inspiring, down-to-earth and diverse folks in this area. And in addition to the people, Fort Worth is chocked full of family friendly activities, opportunities, and adventure.
Follow along as we highlight some of the reasons that we’re thankful for Fort Worth!
The Fort Worth cultural district boasts an array of world-class museums and galleries featuring renowned works of art. From the Kimbell to the Modern Art Museum, art enthusiasts and museum buffs can wander around works of art from Picasso to Matisse. For a stunning architectural treat, as well as to hear some of the best musicians in Texas, head to downtown Fort Worth to attend a performance at the Bass Performance Hall. From Broadway to holiday, country, or opera, the Bass Performance Hall hosts performances that will delight any music lover.
For weekend warriors looking to get the most out of their days off, there are countless activities in Fort Worth to enjoy with friends and family. First, head to the Fort Worth zoo to see the more than 7,000 different animals they have on display. Featuring hands-on activities and a petting zoo, you might need more than a weekend to see everything! And while the Fort Worth Museum of Science and History might not sound as fun as Saturday cartoon, the truth is that this interactive museum is a fun learning experience for everyone. From the planetarium to unearthing fossils, everyone will rediscover their love for learning. Or, throw on your cowboy boots and head downtown to the stockyards to watch the twice-daily cattle drive, or plan a trip to the weekly rodeo. Bring your appetite as well to eat at the legendary steak houses that are found in the same area.
It would be a loss if we didn’t include those favorite holiday activities as well. Although the weather is rarely “frightful” in Texas, that doesn’t mean you have to miss out on the opportunity to enjoy the winter’s magic, like with ice skating in an outdoor park. Beginning on November 17, skaters can take to the ice at the Coyote Drive-In. While you might not need jackets, don’t forget your gloves—the air might be warm, but the ice is cold! Another local holiday favorite is the annual parade of lights through downtown Fort Worth. As the parade celebrates its 35th anniversary, you won’t want to miss out on never-before seen floats, balloons, and performing groups. Finally, ring in the season with the lighting of the Sundance Square Christmas tree on November 18. Fort Worth always hosts the best holiday activities—make sure to not miss out on any of them!
From the symphony to steer, Fort Worth is a small town within a city. While the population continues to grow, the local charm hasn’t disappeared. We at Dr. Ku’s office are thankful for the diversity, the culture, the activities, and each of our patients in this city we call home. This holiday season, we are definitely thankful for Fort Worth.
The post Things In Fort Worth Our Office Is Thankful For appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
John Ioannidis has an interesting article in the L.A. Times titled “Economics isn’t a bogus science — we just don’t use it correctly.” Some excerpts are below:
Most published studies use limited data. By a conservative estimate, the average study has 18% power to detect a modest association if one exists. Due to this low power of prediction, researchers could easily miss a genuine association. Or, they could declare a spurious, non-existing association, having been led astray by small amounts of bias.
Not all the news is bad, however.
Thankfully, economists are increasingly turning to experimental methods, which have the best reproducibility record. According to one evaluation, two-thirds of experimental studies were fully reproducible when other researchers tried to repeat them.
Several economics journals, moreover, are now employing standards that are likely to enhance transparency and reproducibility. These journals require researchers to share all of their protocols, raw data, software and code.
Do read the whole article.
The premise is simple. Create markets, let consumers choose the products that fit them best, and the competition will lead to higher quality and lower prices. That is the premise behind the Affordable Care Act’s health insurance exchanges. A necessary condition for this to work, however, is that patients have visibility into the quality and cost of each health plan.
Austin Frakt makes the important point that shopping for health plans in an exchange is not so easy due to the lack of visibility into which doctors are considered in-network and which are considered out-of-network. He writs
It’s virtually impossible to thoroughly check the quality of doctors in each insurance plan. A typical plan, even a narrow one, may have a network of hundreds or thousands of physicians… A study of 2016 marketplace offerings in 13 states found that only two provided indications of network size. Eight of them, as well as HealthCare.gov, provided a way to look up whether a doctor was in a plan’s network, but only two could filter plans to show only those with providers a consumer selects.
“To our surprise, we also found that few marketplaces could indicate which hospitals were in plans’ networks,” said Charlene Wong, a pediatrician and researcher at the Margolis Center for Health Policy at Duke University and lead author of the study…
Researchers at the University of Pennsylvania found that plans with more narrow networks systematically excluded oncologists affiliated with higher-quality cancer centers. In part, this is how the plans offer lower premiums, because higher-quality cancer centers may demand higher payments. But it’s pretty likely consumers don’t know that they may be trading quality for price.
Consumers may wish to trade off price for quality. That is a fine decision to make. What is not acceptable, however, is failing to provide the necessary information to consumers for them to make this decision for themselves.
Health permeates a plethora of TIME magazine’s 25 Best Inventions of 2017. From head to foot, health is the mother of invention, based on TIME’s curation of “the best” things launched to market in the past year.
Starting with “the head,” the Oculus Go virtual reality (VR) headset from Facebook. While the first function with which VR is associated is fun and games, Dr. Brennan Spiegel at UCLA Geffen School of Medicine has been proving out VR‘s value in helping patients deal with pain and medical management. Keep your eye on his and others’ research into VR’s use in healthcare. The device will sell for $199 expected on the market in early 2018.
Another headset innovation is the eSight 3, promoted as glasses that give sight to people who are legally blind. They use high-def video plus magnification and algorithms that boost peoples’ eyesight — sufficiently well to, say, enable people to engage in their desired sport. The device has been tested in over 1,000 patients with researchers at Johns Hopkins, the University of Michigan, and Université de Montreal among others. eSight 3 carries a retail price of $9,995.
Now, down to the foot: the adidas Futurecraft 4D shoe is, “a shoe that lets you run faster, pivot better and jump higher.” The soles are made via a 3-D printing process that basically fine-tune/personalize the product in as little as two hours — possibly, in the future, in retail stores. In the meantime, adidas’s plan is to leverage 17 years’ worth of runners’ data it has before the end of the year, and make a mass market standard pair of running shoes.
On the healthcare delivery front, TIME looks at Forward, a clinic that “reboots” primary care, according to the company’s website. Forward’s founder and CEO came from Google, creating a medical model that’s concierge-style – priced at $149 a month, to cover testings and screenings, weight-loss plans, doctors’ visits, and generic meds without co-payments. The clinic is currently operating and refining its business model in San Francisco, and plans to expand to other U.S. cities.
Now to women’s and children’s health: the Willow breast pump is portable and wearable, for on-the-go moms, TIME notes. This pump can slide into a bra (thus, the wearable aspect) and pump whenever, wherever mom wants to do so. “You can take a conference call,” Naomi Kelman, Willow CEO and President, is quoted. The beta version is being tested, with a planned launch for 2018.
BabyTech will be a hot growth area at CES 2018 in Las Vegas, so on the baby front TIME selected Bempu, a wristband for babies. Bempu is essentially a thermometer for baby’s wrist, especially useful for infants born premature or low-weight. The band activates an alarm when baby is too cold, signalling mom to warm them up via hug or swaddling. The device has been launched in India where some 10,000 newborns have tried out Bempu and made a positive impact on neonatal mortality. [I can’t get enough of this Bempu baby, pictured here].
A key social determinant of health is a safe home, and the Nest secure home security system seeks to address that need. Nest is part of Alphabet, Google’s parent company. This system works with a fob, not a pass code, and the app can schedule accessibility so that, say, a babysitter or a housekeeper can only access the home at certain specified times.
On the nutrition front, there’s the so-called “guilt-free” ice cream from Halo Top. The pint has a maximum of 360 calories – which is about what you’d consume with way less than one-half of a pint of, say, Ben & Jerry’s Cherry Garcia (800 calories) or Haagen-Dazs Vanilla (1,080 calories). Halo Top CEO calls its product “healthy.” TIME notes there’s a debate on that but this ice does have a higher percent of protein and uses Stevia to sweeten the flavors. This doesn’t come cheap, at $5 a pint, but sales are fast-growing. [I especially like the transparent big-font calorie count clearly shown on the front of the package and not just on the Nutrition Facts label on the back].
The Tasty One Top induction cooktop and app-linked cooking channel could also address the nutrition and healthy eating front. This development comes out of BuzzFeed’s Tasty video feed which serves up recipes through which the cooktop’s app coaches the cook. Last January, Tasty featured this “one-pan chicken and veggie meal” to coincide with healthy food New Year’s Resolutions.
Tesla’s Model 3 electric car also made it on TIME’s list of best inventions of the year. I select this for the social determinant of health for a clean environment (among other benefits). Respiratory health is compromised by pollutants and effluents, and the adoption of electric cars can be part of the solution.
Furthering environmental and human health, the Molekule air filter has a nanofilter that reacts with light to zap toxins, mold and bacteria, in their tracks. Like many of TIME’s “best inventions” of the year, this device doesn’t come cheap at $800 plus $99 a year for new filters.
In the interest of readers’ short attention spans, I’ll stop the descriptions here, but note other health-potential devices on the list, including the Zero1 stronger, safer football helmet; Norton Core Wi-Fi router to keep homes safe from hacking; the 3D Ocean Farm for sustainable seafood farming; the JIBO robot for personal home care; and, the iPhone X next-generation phone from Apple.
Health Populi’s Hot Points: It’s exciting to get caught up in the potential for health/care everywhere, especially enabled through the Internet of Things to which so many of TIME’s inventions connect. Apps are tethered to many of these devices, which collect and track data that aren’t covered by HIPAA privacy laws (with the exception, I assume, for the Forward clinic patient data).
Last week, the FDA approved the Abilify MyCite, linking a medication for schizophrenia in “smart pill” form with a sensor and app enabling doctors, caregivers, or others to observe the patient’s medication adherence. I wrote about this event here in Health Populi, and have been tracking subsequent discussions about the new-new medical thing.
A key and keen observer of this space is Dr. Eric Topol, who urged us to keep a critical eye on the so-called Big Brother potential of this development.
As consumers adopt new things, like personal digital assistants, smart home devices, and baby tech that can be life-saving and convenient, people should be mindful of the reality of personal health information collection — even when those data may not seem health-related. Social determinants and lifestyle choices are powerful forces in our health-making, and data are the new currency.
So remember, even though ice cream pints don’t yet have health sensors in the packaging: your retail grocery receipts can get mashed up into your personal data profile. So watch your calories, caveat emptor, caveat eater.
For more on health data privacy challenges that fall outside of HIPAA protections, you can read my paper, Here’s Looking at You, written for the California Healthcare Foundation. The paper discusses how personal health information is getting tracked and used in the growing “new currency” data brokering environment.
The post TIME Magazine’s Best Inventions – Health-y Things and Privacy Questions appeared first on HealthPopuli.com.
Choosing Wisely aims to identify low value services and advise physicians to avoid or at least be more conservative in the use of these services. The ability to implement these changes, however, depends on physician awareness of these initiatives. A paper by Colla and Mainor (2017) examines trends in awareness of the Choosing Wisely initiative:
Despite continued publicity and physician outreach efforts, there were no significant changes between 2014 and 2017 in awareness of the campaign among physicians (awareness increased from 21 percent to 25 percent) or physician-reported difficulty in talking to patients about avoiding a low-value service (42 percent reported that such conversations had gotten harder in 2014, and 46 percent did so in 2017). Barriers to the adoption of recommendations included malpractice concerns, patient demand and satisfaction, and physicians’ desire for more information to reduce uncertainty.
To pay for tax cuts, take money from foreign aid if you must, 1 in 2 Americans say. But do not touch my Medicaid, Medicare, or Social Security, insist the majority of U.S. adults gauged by the November 2017 Kaiser Health Tracking Poll.
This month’s survey looks at Americans’ priorities for President Trump and the Congress in light of the GOP tax reforms emerging from Capitol Hill.
While reforming taxes is considered a top priority for the President and Congress by 3 in 10 people, two healthcare policy issues are more important to U.S. adults: first, 62% of U.S. adults want Congress to reauthorize CHIP, the Children’s Health Insurance Program; and second, 48% want legislators to stabilize the ACA health insurance marketplaces, shown in the second graph.
Another “don’t touch this” issue among a plurality of all Americans addresses the tax deduction for health citizens with high health care costs. Across all 3 party affiliations (Democrat, Independent, and Republican), most people are against eliminating the medical expense tax deduction (opposing views among 77% of Democrats, 66% of Independents, and 61% of Republicans).
An underlying survey question asked whether people believe eliminating this would directly impact their families: 44% of people said, “yes.”
The Poll was conducted among 1,201 U.S. adults via phone between 8-13th November 2017.
Health Populi’s Hot Points: Healthcare is personal, and health care costs comprise an integral part of American family budgets. Today, the typical American family allocates $1 in every $5 of household spending to health care. Healthcare spending is Americans’ top “pocketbook issue,” so health care costs and insurance coverage is inextricably linked to tax policy and what peoples’ take home pay from work nets out to be.
Interestingly, financial wellness is a top consideration for employer benefits teams looking to 2018. It may surprise Health Populi readers to know that the fastest-growing holder of student loan debt is…Baby Boomers according to the Federal Reserve Bank of New York.
Most Boomers are also evaluating retirement prospects in the coming decade. So “not touching” Medicare and Social Security will be top priorities for this group of U.S. voters, who are increasingly health care cost-conscious.
The post Don’t Touch My Entitlements to Pay For Tax Reform, Most Americans Say to Congress appeared first on HealthPopuli.com.
According to a paper from Harris et al. (2017), the country from which a study takes place greatly influences the academic community’s perception of that study. The authors used a unique study design approach:
In our randomized, controlled, and blinded crossover experiment, participants rated the same abstracts on two separate occasions, one month apart, with the source of these abstracts changing, without their knowledge, between high- and low-income countries.
The high-income countries in the study were the U.S. and Germany and the low-income countries were Ethiopia and Malawi. Author affiliations also came from high-quality universities within each country [e.g., Harvard University (US), Freiburg University (Germany), University of Addis Ababa (Ethiopia), and University of Mzuzu (Malawi)]. Using this methodology, the authors surveyed 347 English physicians and found that:
…changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents’ ratings of relevance and recommendation to a peer.
The study detailed results are perhaps more interesting than the top-line findings. In 3 of 4 sample abstracts, there was no statistically significant difference between the scientific strength of the article depended on where the study took place and the combined results were not statistically significant either. However, in 3 of 4 cases (and in the combined results) the study in the first-world countries were seen as more relevant; overall peer-reviewers were more likely to recommend papers from high-income counties to their peers.
Thus, it appears there is little scientific bias against the quality of research from low-income countries, but researchers may claim that that research is less relevant to their own or the academic community’s greatest interest.
Interesting throughout.
Source:
Harris, Matthew, Joachim Marti, Hillary Watt, Yasser Bhatti, James Macinko, and Ara W. Darzi. “Explicit Bias Toward High-Income-Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians.” Health Affairs36, no. 11 (2017): 1997-2004.
Value-based insurance design (VBID) is a simple concept. In short, interventions that provide high-value should be covered with little cost sharing; treatments with low-value should be covered with higher rates of cost sharing or in some cases perhaps not even covered at all.
A paper by Cohen et al. (2017) aims to see how far we have come on VBID. Their study asks a more specific question of whether drugs’ excluded versus recommended status on pharmacy benefit manager (PBM) exclusion lists corresponds to evidence from cost-effectiveness analyses, lack of evidence, or rebates. The authors use formulary data from Express Scripts and CVS Caremark. In particular they examine these two PBM’s use of exclusion lists, which are lists of pharmaceuticals that are excluded from coverage, but are combined with other drugs within the same therapeutic class that the PBM recommends.
In 2016, Express Scripts placed 87 products on its exclusion list, while CVS Caremark put 124 drugs on its exclusion list. This represents a 65 percent increase since 2014. The lists for 2017 indicate CVS has increased the number of excluded products to 154, while Express Scripts have increased its number to 85 (Toich 2017).
The authors aim to examine whether treatments included on the exclusion list had lower estimated coste effectiveness than treatments the were covered (i.e., not on the exclusion list). The study measures treatment cost effectiveness using data from the Tufts University Cost-Effectiveness Analysis Registry (CEAR).
Using this approach, they find the following:
The mean cost-per-QALY for excluded drugs was higher ($51,611) than the cost-per-QALY for recommended drugs ($49,474), but not statistically significant. We could find no cost-effectiveness evidence in the Registry or peer-reviewed literature for 23 of the excluded drugs, and no evidence for 5 of the recommended drugs.
Source:
In 2016, most consultations between patients and Kaiser-Permanente Health Plan were virtual — that is, between consumers and clinicians who were not in the same room when the exam or conversation took place.
Virtual healthcare may be the new black for healthcare providers. Mercy Health System in St. Louis launched a virtual hospital in 2016, covered here in the Health Populi post, “Love, Mercy, and Virtual Healthcare.” Intermountain Healthcare announced plans to build a virtual hospital in 2018. And, earlier this month, UPMC’s CEO, Jeffrey Romoff, made healthcare headlines saying, “UPMC desires to be the Amazon of healthcare.”
UPMC, aka University of Pittsburgh Medical Center, is thus far the most ambitious virtual hospital plan, earmarking $2 billion to build three digital hospitals that will serve patients with healthcare needs for heart/transplantation, vision/rehabilitation, and cancer. The plan will be to bolster UPMC and Pittsburgh as an “exporter” of healthcare services, which would further consolidate the region as an economic healthcare center and UPMC as a Center of Excellence and specialty magnet.
When I learned this news, I contacted Dr. Rasu Shrestha, Chief Innovation Officer of UPMC and EVP, UPMC Enterprises. [In full disclosure, Rasu and I are members of the 2017 HIMSS Social Media Ambassador community, so I’m grateful for his collegiality through that tight-knit #HCSM {healthcare social media} tribe]. Rasu and I exchanged email messages about virtual hospital plans, and I share them with you here along with my commentary in the Health Populi Hot Points below the 3 Q&As.
JSK: Why “digital hospitals?” Why “now?” Why “3” of them?
DrRS: UPMC is capitalizing on the massive digitalization happening in healthcare by leveraging the power of data to derive actionable intelligence and augment care in ways never before imagined. The vision to build 3 digitally based specialty hospitals is a bold bet on the future, based on innovations in technology, science and medicine.
The 3 new specialty “hospitals within hospitals” will be the UPMC Heart and Transplant Hospital, UPMC Hillman Cancer Hospital and UPMC Vision and Rehabilitation Hospital – and these will perfectly complement the 3 UPMC specialty hospitals already in the city, Magee-Womens Hospital, Western Psychiatric Institute and Clinic, and Children’s Hospital of Pittsburgh. The 3 new specialty hospitals will offer next-generation treatments in patient-focused, technology-enhanced settings – and will set the stage for the innovative, digitally enhanced approaches to care in cancer, heart disease, transplantation, diseases of aging, vision restoration and rehabilitation, among many others.
JSK: What is it about UPMC’s DNA that supports this bold, innovative venture?
DrRS: The $2 billion investment for these 3 digitally based specialty hospitals is in addition to UPMC’s annual capital commitments of nearly $1 billion and will result in no increase in inpatient beds. Bold moves such as these historically built UPMC to be the organization it is today.
In 1973, a comprehensive reorganization of Western Psychiatric Institute and Clinic and the University of Pittsburgh’s Department of Psychiatry, under the leadership of Dr. Thomas Detre and Jeffrey A. Romoff, began a new era of research-based medicine in Pittsburgh — and set the stage for UPMC’s mission of outstanding clinical care, research, and teaching. Remarkable advancements in medicine, science and technology defined the path forward for UPMC. UPMC is home of Thomas E. Starzl, M.D., the “father of transplantation”. UPMC created one of the largest integrated community cancer networks in the U.S., providing world-class care and clinical research to more than 110,000 patients a year at over 60 locations. Additionally, we’re building on the DNA of UPMC as one of the top-ranked ophthalmology programs in the U.S. with world-renowned experts in vision therapies and interventions such as stem cell implantation, gene therapy, innovative pharmacologic approaches and the artificial retina. UPMC also has the largest rehabilitation network in western Pennsylvania, and one of the largest in the U.S.
Never content to rest on past accomplishments, UPMC continues to anticipate and prepare for the challenges facing academic and nonprofit medicine, and continues to push the envelope of innovative and entrepreneurial approaches to advance the science and art of health and care.
JSK: If we look through your tea leaves for what a medical center might look like 10 years from now, what do you see?
DrRS: The medical center a decade from today will use the power of data and algorithms to push the boundaries of cutting edge translational science, creating treatments and cures for the most devastating diseases; care pathways for personalized, effective and compassionate care – and newer care models that that will treat the person holistically – focusing not just on survival, but on thriving. The experience in the medical center will be profoundly human, with technology playing the crucial role of silently and elegantly being an enabler to better care. Health consumers will use the medical center only when needed, and the focus will be on maintaining health and wellbeing outside of the hospital walls, backed by algorithms that will track, predict and augment care, while incentivizing healthy behavior.
Health Populi’s Hot Points: I began my career as a young health economist advising hospitals and doctors in the 1980s, when same-day and outpatient surgery was a new-new thing. That was the start of the hospital inpatient migrating to outpatient, and the growth of services that could take advantage of medical devices and digital health technologies beyond big-iron MRI and CT imaging.
We observed how services could be performed, both safely and efficiently for patient and clinician, and at the same time, lower per patient/per capita costs. (This didn’t mean we were always saving money for the overall healthcare system, as health care reimbursement under volume-based payment has been a game of “whac-a-mole,” explained in this Health Populi post from January 2010. But that’s another topic for another day).
A later wave of service delivery innovation took advantage of the online world, after the walled gardens of AOL, Compuserve and Prodigy were felled, leading to the more open Internet. Healthcare and hospitals created e-business units, piloting and then proving out digital business tools and scaling productivity solutions across the enterprise. We moved healthcare e-business into, well, just healthcare business.
Now we can weave that outpatient phenomenon with “e,” to go virtual in healthcare. And as important, we can go virtual for “health,” as Rasu points out in his response to my Q3 on the future of the hospital. He asserts, and I repeat verbatim, “Health consumers will use the medical center only when needed, and the focus will be on maintaining health and wellbeing outside of the hospital walls, backed by algorithms that will track, predict and augment care, while incentivizing healthy behavior.”
So we look forward to this next-gen innovation, baking Big and small D(d)ata into the convergence of outpatient and digital/virtual health, to inform and empower patients and clinicians. And, I daresay, help to forge a more sustainable, cost-effective U.S. healthcare system.
The post Movin’ Out(patient) – The Future of the Hospital is Out and Virtual at UPMC appeared first on HealthPopuli.com.
Yesterday, the FDA approved a “digital ingestion tracking system,” the first drug in the U.S. that has an ingestible (in other words, safely edible) sensor built into the pill. That sensor tracks that the medication was taken, which helps with adherence, meant to help ensure that patients who are prescribed the medicine do indeed take the regimen as prescribed. Once ingested, the sensor in the pill communicates to a wearable patch on the patient that then communicates information to a mobile health app that tracks the pill-taking via smartphone. Patients can allow their family and clinicians access to that information via a web portal.
This digital therapeutic product covers Abilify MyCite, a medication that treats schizophrenia and episodes associates with bipolar I disorder, along with being used as a complementary treatment for depression in adults.
It took two organizations in partnership to bring this innovation to market. Proteus is the developer of the MyCite platform technology — the patch and the app. Otsuka markets Abilify, which according to its label is an add-on treatment for adults with depression when an antidepressant is not enough; treats manic or mixed episodes associated with bipolar I disorder in adults and some pediatric patients; treats schizophrenia in adults and some adolescents; and, treats irritability associated with certain patients on the autism spectrum.
This alliance expands the digital health landscape beyond mobile apps, medical devices, and remote health monitors. In fact, this technology system encompasses all three of these aspects.
Here’s a link to Otsuka and Proteus’s combined press release on this historic event for a “digital medical system,” as the announcement calls it.
Health Populi’s Hot Points: Think of the Abilify-MyCite approval as a milestone in moving up the adoption S-curve of digital therapeutics, now that the U.S. federal regulator, the FDA, has approved the technology for human medical use.
Furthermore, given the form factor of a pill+sensor, we can consider this part of the larger Internet of Things for healthcare, with a pill being “the Thing” that is connected to the Internet via the ingestible sensor, coupled to the externally-wearable patch.
Our THINK-Health 2018 consumer health/tech forecast is in the works, and #IOThealth will be on it. Early news out of CES Unveiled has shown us that digital health is certainly a growing category for #CES2018, and I’ll be on-the-Vegas-ground to explore the phenomenon. Expect the connected home and connected car to continue their blur toward the home-as-medical-home. FDA approval of Abilify MyCite is one point on this trajectory.
The post The Internet of Things via Medicines – FDA Approves Digital Pill appeared first on HealthPopuli.com.
Nobody values bread according to the quantity of it which is to be found in his country or in the world, but everybody measures the utility of it according to the amount that he has himself…
No matter how much we try to deny it, every day we are judged on our looks.
Though, to the luck of those of us who aren’t currently getting paid to model the cover of Vogue, this judgment is not based solely on conventional beauty. Rather, our minds view a person’s appearance holistically, and use available data to form an opinion. This could include body language, accents, and overall appearance.
To fill in the holes, our subconscious makes assumptions based on past experiences. The assumptions our mind creates are sometimes helpful, but sometimes entirely inaccurate. Past experiences have cemented that correlation in our minds, and this can be almost impossible to break.
And, even if we’re able to break free of these associations, how many people in the world around us are trying to look at us just as objectively?
Let’s look at an example
One common example of this phenomenon is with the overweight and obese population. Although nearly two-thirds of Americans qualify as either overweight or obese, studies show the average person still assumes that being overweight means someone is lazy, awkward or unmotivated. These assumptions are made in the first millisecond that someone lays eyes on someone else.
These same assumptions are made about people with poor oral health, or with teeth that appear to not be taken care of. Research has shown that 70% of people with “bad teeth” say it has negatively impacted their lives.
Individuals with broken teeth, bleeding gums, or abscesses have reported difficulty finding long-term employment after in-person interviews. With so many jobs that involve directly helping clients, poor oral health can serve as a deterrent for hiring managers.
Even if it’s unfair, even if it’s discriminatory, and even if a patient was just dealt a bad hand with their teeth by “conventional” standards, this problem resonates with millions of Americans.
Happiness and your personal life
Those with dental problems also admit to not smiling often to avoid showing off the problems in their mouth. This lack of smiling has further contributed to the inability to secure a job. Many businesses need people at the front of the office or in a checkout line to be personable and friendly. While not smiling does not equate to unfriendliness, assumptions are made. Studies have shown that those who are self-conscious about their teeth in interviews tend to try to hide their mouth with one hand. This leads to difficulty interacting with the hiring manager, and even muffled interview answers…All of which lead to a decreased likelihood of a job offer.
Going out with friends—or “more than friends”
Poor oral health does not only affect employment prospects, but it also has a negative effect on social lives. This issue is not something that is just affecting older Americans, either. In fact, 33% of young adults have admitted cutting back on socializing due to bad teeth. An underlying lack of confidence is another contributing factor to a decreased desire to socialize. With the increased reliance on social media, images are an important component of modern day social constructs.
And feeling good about yourself
Finally, poor oral health also adversely affects your mental health. It is well known that poor oral health can affect many of the body’s systems, including the heart and kidneys. What is not as well known is that gum disease is linked to mental health problems like stress, anxiety and depression. These conditions cause the body to release a hormone called cortisol which, in large qualities, can cause periodontal disease. In addition, chronic inflammation in the gums has been shown to increase your likelihood of developing Alzheimer’s disease.
If you find yourself struggling with poor oral health, the good news is that the #1 dentist here in Ft. Worth is ready to take your call. All it takes is a phone call to begin the conversation. Don’t let any worry prevent you taking the first step to ultimately transform your life. The caring experts in Dr. Ku’s office are excited to help you take the first step in rejuvenating your teeth, your professional health, your personal life, and your mental health!
The post How Your Smile Affects Your Life appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
“Spend more. Get less.” If a retailer advertised using these four words, how many consumers would buy that product or service?
This is the American reality of healthcare spending in 2016, told in the OECD report, Health at a Glance 2017.
I present four charts from the study in this post, which together take the current snapshot health-economic lesson for the U.S.
First, look at health expenditures as a share of gross domestic product: we’re number one! in the U.S., above Switzerland, France, and the UK, and about two times the OECD average. Note, too, the proportion of out-of-pocket and so-called “voluntary” spending versus what other countries’ health citizens pay. In the U.S. it’s more than one-half of spending. That voluntary aspect is the non-governmental, non-mandated portion: namely, employer-based healthcare spending and consumers’ out-of-pocket contributions to their own healthcare for self and family.
Where does the U.S. fall in per capita healthcare spending compared with other developed countries? America is number one again, spending about 2.5 times more than the average OECD country: that’s nearly $10,000 per person versus $4,000 in other countries.
Switzerland once again comes in at second place, spending nearly $2,000 less than the U.S., and Luxembourg, spending over $2,400 less than the U.S. Italy and Spain, both with a national health service, spend around $3,300 per capita.
What is the return-on-investment for the super-sized healthcare spending in the U.S.? Based on life expectancy at birth, it’s an epic fail.
If the U.S. healthcare system were a company, no rational investor would put a buck into it based on these statistics.
The third chart shows that the U.S. ranks below the OECD average, behind Costa Rica and Chile. Top life expectancies are found in Japan, Spain, Switzerland, Italy, France, Luxembourg, Norway, Sweden, Israel, Korea, New Zealand, Finland, the Netherlands, Canada, Ireland, Austria, Portugal, Belgium, Greece, the U.K., Slovenia, Denmark and Germany.
In line with this U.S. are the Czech Republic, Turkey, Estonia, and Poland.
Look back at the previous chart, which shows that the Czech Republic spends $2,544 per capita on healthcare; Turkey, $1,088; Estonia, $1,989; and, Poland, $1,798.
Next, consider obesity in OECD nations. Obesity has been rising in many countries in the community, with about 25% of children overweight across all OECD countries. The U.S. ranks second to last, just before Chile, among OECD peers, with nearly 4 in 10 kids overweight or obese.
It is not a shock, then, to check out chart number four here, ranking mortality via heart disease. The good news is that deaths due to heart disease have dropped across the OECD, but for the U.S., the decline was significantly lower compared with fellow nations — and below OECD average.
Health Populi’s Hot Points: The last chart summarizes some of the key OECD findings in one picture, with the vertical red lines indicating negative performance relative to the OECD averages for:
The U.S. life expectancy has worsened since the last OECD study when U.S. was one year above the OECD average. Now, it is nearly two years below the OECD average.
On the risk factor front, there are two important successes to point to: smoking, which is quite low compared with the OECD average, and air pollution.
Both of these factors have improved over time through a national focus on public health promotion and smoking cessation efforts, and environmental regulations supporting air quality. Sustaining these efforts are important if U.S. health citizens and health spending are to benefit from managing social determinants of health – smoking and air quality which directly relate to heart disease, respiratory disease, and cancer.
The fact that the U.S. ranks high on people self-rationing care due to cost speaks to healthcare access barriers, as well as risk factors that impact people in daily life beyond health system access. Implementing the Affordable Care Act began to positively impact those access barriers, though not so much the “affordability” issue promised by the legislation’s name. Further work must be done to address both access and cost barriers.
The fact that sign-ups for Obamacare plans over the past few weeks have been brisk and in high-demand illustrate that Americans value health insurance benefits even in the midst of various efforts to stifle the supply and demand sides of the health insurance market.
This glance at the OECD data shows a picture of a financially unsustainable health system at a fork-in-the-road moment: will American health citizens who lack the means to pay out-of-pocket be able to access healthcare services? And will the Federal government support health baked into public policy that boosts health and lowers healthcare spending through cleaner air (namely, through the Environmental Protection Agency), public health programs for healthy food and smoking cessation, and social supports for people at-risk of opioid and other substance dependence (which tie to job and economic security, social isolation, violence and adverse childhood events)? These dots all directly connect to health and healthcare spending.
The post U.S. Healthcare Spending & Outcomes in Five Charts: #EpicFail in the 2017 OECD Statistics appeared first on HealthPopuli.com.