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March 22, 2007
A pharmacy in this neighborhood
From Reuters:
The nation's first not-for-profit pharmacy is located in Over-the-Rhine, Cincinnati's most notorious neighborhood -- one that is more blighted by boarded-up buildings than blessed with brand new businesses.
"I used to have to go all the way uptown to get my medicine," said Roberts, who lives off government disability payments due to seizures and asthma. "Sometimes I wouldn't have money to catch the bus. I just had to walk."
Neighborhoods like Over-the-Rhine underscore the plight of millions of poor people in the United States.
and later in the article:
"The clinic gets funds from local government, the University of Cincinnati, church groups and even a local billionaire philanthropist. Many of the medications are paid for by Medicaid, a government program that provides health care for the very poor.
Nursing homes donate unused medications, and drug companies give discounts.
Any profit the pharmacy makes will be poured back into the business or used for education programs.
Linda Elam, principal policy analyst at the Kaiser Family Foundation, a nonprofit group that funds research on health care, said it is a great model for communities -- inner-city neighborhoods and rural areas alike -- where a lack of a pharmacy has left a gap in health care.
"There is sort of a space between a physician writing and a patient filling a prescription, where you can lose a lot of people, whether they don't have money to fill it or don't have access to a pharmacy," Elam said.
"The poorest communities often have the largest illness burden, and they are the ones with the least means to deal with it.
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Posted by: David Porter on March 22, 2007
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Category: Health Care; Health Disparities
March 19, 2007
Disparity in Prescription Drug Prices
Stephen J. Dubner blogging about the disparity in prescription drug prices.
Several weeks ago, I was talking to a physician in Houston, the sort of older gentleman family doctor you don’t see much of anymore. His name is Cyril Wolf. He’s originally from South Africa, but other than that, he struck me as the quintessential American general practitioner of decades past.
I’d asked him a variety of questions — what’s changed in recent years in his practice, how managed care has affected him, etc. — when suddenly his eyes fired up, his jaw set tight, and his voice took on a tone of great exasperation. He began to describe a simple but huge problem in his practice: a lot of generic medications are still too expensive for his patients to afford. Many of his patients, he explained, must pay for their drugs out-of-pocket, and yet even the generic drugs at pharmacy chains like Walgreens, Eckerd, and CVS could cost them dearly.
So Wolf began snooping around and found that two chains, Costco and Sam’s Club, sold generics at prices far, far below the other chains. Even once you factor in the cost of buying a membership at Costco and Sam’s Club, the price differences were astounding. Here are the prices he found at Houston stores for 90 tablets of generic Prozac:
Walgreens: $117
Eckerd: $115
CVS: $115
Sam’s Club: $15
Costco: $12
Those aren’t typos. Walgreens charges $117 for a bottle of the same pills for which Costco charges $12.
This disparity in the cost of prescription drugs is interesting when you look at maps of these four retailers in the Cleveland area.
Map of CVS locations with a pharmacy in the Cleveland area.
Map of Walgreens locations with a pharmacy in the Cleveland area.
Map of Costco locations with a pharmacy in the Cleveland area.
Map of Sam's Club locations with a pharmacy in the Cleveland area.
The question becomes, "Where can one buy affordable prescription generic drugs in the city of Cleveland?"
WXYZ.com (Detroit) has a more exhaustive analysis of generic drug prices for the Detroit area.
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Posted by: David Porter on March 19, 2007
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Category: Health Care; Health Disparities
March 14, 2007
JAMA and Health Disparities
The current issue of JAMA has several articles that address the issue of health disparities.
One study concluded that financial barriers to health care are associated with worse outcomes after an acute myocardial infarction. To determine if a financial barrier existed researchers asked questions to patients such as, "In the past year, have you avoided obtaining health care services because of cost?" Among their findings:
Individuals who reported financial barriers had significantly higher unadjusted rehospitalization rates. Reported financial barriers to health care services were associated with an 11.2% higher all-cause rehospitalization rate (P <.001) and an 8.0% higher cardiac rehospitalization rate at 1-year follow-up (P<.001).
In another article, researchers state that those who experienced a unexpected health injury or chronic condition and did not have insurance received less medical care and "poorer short-term changes in health." One of their findings said:
Uninsured individuals were significantly less likely to see a clinician following an unintentional injury or a new chronic condition. However, if an individual did see a clinician, he/she was equally likely to have further care recommended regardless of insurance status. Despite the equal recommendations for further care, uninsured individuals in the unintentional injury sample were significantly more likely to have received none of the recommended follow-up care and significantly less likely to have received all of the recommended follow-up care. In the new chronic condition sample, uninsured individuals also were significantly more likely to have received none of the recommended follow-up care and were significantly less likely to still be receiving treatment for their chronic condition.
Also, in a commentary titled, "Health Disparities and Access to Care" the authors explain that "availability of health insurance does not guarantee access to care—and certainly does not guarantee access to high quality of care."
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Posted by: David Porter on March 14, 2007
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Category: Health Disparities
Organ Donation in Prisons
From CBSNews.com:
Inmates in South Carolina could soon find that a kidney is worth 180 days.
Lawmakers are considering legislation that would allow prisoners to donate organs or bone marrow in exchange for time off their sentences. A state Senate panel gave the nod to an inmate organ and tissue donation program Thursday; debate was postponed on whether the incentive could be added because legislators worried it may not be allowed under federal law.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on March 14, 2007
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Category: Health Care; Health Disparities
March 12, 2007
Boston Treats 1,000 In Health Disparites Project
From the Boston Globe:
More than 1,000 patients in Boston who previously did not have consistent medical care received services during the first year of the city's campaign to address racial and ethnic health disparities, according to a report released today.
Click on the above link for the complete article. You can also read an executive summary here or the complete report here.
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Posted by: David Porter on March 12, 2007
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Category: Health Disparities
March 07, 2007
Chinese children die due to lack of medical care
Put this in the 'thinking globally' category.
From Reuters:
About 400,000 toddlers die every year in China mainly because of a lack of medical care, a member of a government advisory group said on Wednesday, urging greater investment in the health system.
The public in China is very dissatisfied with the current status of health care. This antipathy has increased since the trend towards privitization of health care in the 1980's.
From the New England Journal of Medicine:
From 1978 to 1999, [China's] central government's share of national health care spending fell from 32 percent to 15 percent. At the same time, the central government transferred much of the responsibility for funding health care services to provincial and local authorities and required them to provide that support through local taxation. That had the immediate effect of favoring wealthy coastal provinces over less wealthy rural provinces and laid the basis for major and growing disparities between investments in urban and rural health care.
Again from Reuters:
[Zhu Zonghan] estimated that the lives of 240,000 children could be saved if the government spent an extra 26 billion yuan ($3.36 billion) a year.
The government's spending on health accounted for 3.4 percent of its overall expenditure in 2006, but that figure would climb by only 0.1 percent to 3.5 this year, he told a meeting on the sidelines of China's annual meeting of parliament.
He labeled such an increase "useless".
"If you have money you live. If you don't, you are left to die," Zhu said, speaking about the disparity in health care between China's rich and poor.
Here are a few links to more information on health disparities and China.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on March 07, 2007
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Category: China; China; Health Disparities
March 06, 2007
Dennis Raphael Seminar
Dennis Raphael, PhD, former guest speaker of the Case Center for Reducing Health Disparities, will be in the Cleveland area again speaking for the Center for Health Equity.
The topic is, 'The Materialist and Neo-Materialist Explanations for Health Inequalities: Implications for Understanding the US Scene'
Mather Mansion
Thursday, March 22, 2007
noon to 1:30 p.m.
RSVPs should be sent to bahi@csuohio.edu.
You can read more by viewing this pdf file.
You can view Dr. Raphael's earlier presentation here.
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Posted by: David Porter on March 06, 2007
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Category: Health Disparities; Health Disparities
March 05, 2007
Lack of Insurance Leads to Boys Death
A lack of dental insurance lead to the death of a twelve year old boy.
From the Washington Post (Registration Required):
Twelve-year-old Deamonte Driver died of a toothache Sunday.
A routine, $80 tooth extraction might have saved him.
If his mother had been insured.
If his family had not lost its Medicaid.
If Medicaid dentists weren't so hard to find.
If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.
By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.
The story goes on to say only about 30% of children on Medicaid get dental care.
A little over a month ago we blogged about dental care and insurance but the story of this Prince Charles boy is picking up momentum.
You can watch a high quality NBC video of the story here.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on March 05, 2007
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Category: Health Disparities