HEALTH DISPARITIES BLOG

Topic Page for Health Care

Hospitals have the power to deport immigrant patients?

From NYTimes.com:

Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.

What happened next set the stage for a continuing legal battle with nationwide repercussions: Mr. Jiménez was deported — not by the federal government but by the hospital, Martin Memorial. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and “forcibly returned him to his home country,” as one hospital administrator described it.

EXTRA: If you're a researcher or academic and you travel abroad be aware that your laptop (and data) can be confiscated indefinitely.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on August 04, 2008 |
Category: Health Care; Immigrant Health

Money and beauty to the left - skin diseases and insurance to the right

From NYTimes.com:

Like airlines that offer first-class and coach sections, dermatology is fast becoming a two-tier business in which higher-paying customers often receive greater pampering. In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.

A study published last year in The Journal of the American Academy of Dermatology found that dermatologists in 11 American cities and one county offered faster appointments to a person calling about Botox than for someone calling about a changing mole, a possible sign of skin cancer.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 28, 2008 |
Category: Health Care; Health Care; Health Disparities; Healthcare; Heath Inequities; Skin Cancer

Money and beauty to the left - skin diseases and insurance to the right

From NYTimes.com:

Like airlines that offer first-class and coach sections, dermatology is fast becoming a two-tier business in which higher-paying customers often receive greater pampering. In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.

A study published last year in The Journal of the American Academy of Dermatology found that dermatologists in 11 American cities and one county offered faster appointments to a person calling about Botox than for someone calling about a changing mole, a possible sign of skin cancer.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 28, 2008 |
Category: Health Care; Health Care; Health Disparities; Healthcare; Heath Inequities; Skin Cancer

Technical innovation and the rising cost of health care

A recent NYTimes.com article talks about cardiologists buying CT scanners and the cost of using new technology in health care:

CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests.

Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.

Vijay, who is a practicing radiologist in India, wonders why a CT scan cost so much in the US:

An abdomen scan at my department costs Rs. 350 (about $ 9 - yes nine dollars). We most often do not charge anything extra for an abdomen scan that goes on to become a transvaginal scan - as it would in case it turns out to be something like an ovarian cyst. So the lady gets two scans for the price of one.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on June 30, 2008 |
Category: Health Care; Health Care Costs

Cool Whip #7

Wealthy, private health care consultants.

You can find other comics from the series here.

EXTRA: Everyone's a Little Bit Biased (Even Physicians)

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on June 25, 2008 |
Category: Cool Whip; Health Care; Health Care Costs; Patient Navigators

Conflict of interest in most insurance denial claims

From Ohio Health Policy Review:

In a 6-3 decision announced yesterday, the Supreme Court ruled that businesses that administer their own plans or insurance companies that administer a company plan have a financial conflict of interest because they save money virtually every time they reject claims filed by their employees

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on June 23, 2008 |
Category: Conflict of Interest; Health Care; insurance

Congressional Testimony on Health Disparities

Congresswoman Solis testifies before the House Ways and Means Subcommittee on Health regarding health disparites.

Part I

Part II

Transcript at the Congresswoman's website.

BONUS: The Lancet will publish a theme issue devoted to social determinates of health. This special issue will be published on November 8, 2008. More information at The Lancet. Subscription is required.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on June 13, 2008 |
Category: Health Care; Health Disparities; Medicare; interpreter advocates; racial differences

China wants students to exercise eyes

From Reuters:

China's students should exercise their eyes twice a day to ward off nearsightedness that has reached near-epidemic proportions because of their long hours spent hitting the books, the education ministry has urged.

Below is a short clip of some primary school students in Shanghai doing their morning eye exercises.

BONUS: Michael Tomasello writing at NYTimes.com asks, "How are humans unique"?

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on June 09, 2008 |
Category: China; Health Care; eye exercises; eyesight

Pilot program to offer free health care to illegal immigrants

Massachusetts is initiating a pilot program which will provide free health insurance to 50 frequent users of the state's Safety Net Pool. If the program is effective it may be expanded statewide.

You can read the article at the Metro West Daily News. Steer clear of the comment section if you wish to avoid vitriol this morning.

EXTRA: The Seattle Times is reporting that more treatment isn't always better treatment:

When it comes to hospital health care, more isn't necessarily better, says a Consumer Reports analysis of care given at hospitals around the country.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on May 30, 2008 |
Category: Health Care; Health Disparities; immigrants; insurance

Vet commits suicide outside veterans' clinic

On Saturday the Health Disparities Blog celebrated its 2nd birthday. I had planned on posting today the first in a new series of comics focused on the topics of health and healthcare.

Then last night I stumbled upon a terribly sad story at curethis.org that was originally posted at greenvilleonline.com:

Harriett Chapman's eyes filled with tears Sunday as she recalled one of the last conversations she had with her 89-year-old father before he fatally shot himself outside a Greenville veterans' clinic last month.

Grover Cleveland Chapman told his family, "No matter what I apply for at the VA, they turn me down," she recalled.

The next day, the World War II veteran took his own life outside the Veterans Outpatient Clinic at 3510 Augusta Road, said Greenville County Deputy Coroner Mike Ellis.

Somehow posting a comic today just didn't feel right.

EXTRA: GoozNews.com posted an interesting article about the FDA and the Helsinki Declaration.

Last week, the FDA formally declared that it will no longer require that clinical trials submitted to the agency to get regulatory approval for a new drug adhere to the Helsinki Declaration. The new rule, which goes into effect next October, was supported by the drug industry but opposed by numerous public interest, patient advocacy, and consumer groups.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on May 13, 2008 |
Category: Health Care

How the cost of medical school can affect health care quality

Andrew Herstein writing at theNation.com explains how the cost of medical school affects both patient care and health care access.

According to the article, in 2006 graduates of public medical schools owed a median amount of $120,000 in student debt. Their private school counterparts owed $160,000.

Citing 2004 U.S. Census Bureau statistics Mr. Herstein shows that while minorities make up 30% of the U.S. population only 14% of applicants to schools that grant an M.D are minorities. From theNation.com:

According to the Association of American Medical Colleges (AAMC), the primary reason for this discrepancy is that minority students are much more likely to see financing a medical education as an insurmountable problem.

The article continues by showing how race matters with regards to health care providers.

Patients report higher measures of satisfaction and trust when their doctor is of the same race and ethnicity. One study found that race-concordant visits were longer on average and were characterized by more positive physician affect. In addition, minority physicians are more likely than white physicians to practice in geographic areas whose populations face multiple challenges to maintaining good health.

In addition, minority doctors report providing more care for under-served populations.

So what should be done about the low number of minority applicants to medical school? Mr. Herstein offers two possible solutions.

First the U.S. government could work towards reducing the cost of medical school for qualified college graduates. This could be accomplished by increased funding for scholarship programs that reward those who work in under-served areas.

The second possible solution is to provide more money to health professions schools which should increase the number of need based scholarships.

With the rising cost of tuition the article ends with a warning that things could get worse:

If such rapid tuition growth continues, larger and larger numbers of minority students will consider a medical education to be unaffordable. The result would be a workforce that is even less diverse than it is now. Considering the many benefits that a diverse workforce provides, this outcome should be avoided. The federal government has the ability to shape the composition of the physician workforce and ought to do so.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on May 12, 2008 |
Category: Health Care; Healthcare; health care access; medical school; medical school debt

Health care delivery problems in Canada

Often when the issue of health care access is discussed someone will point north and advocate for a Canada-styled heath care system for the U.S.

But there are problems in the Canadian health care system too. From theglobalandmail.com:

Canada, once able to boast about its high rank in the world for low infant-mortality rate – sixth place in 1990 – saw its rank plummet to 25th place in 2005, according to figures published this year by the Organization for Economic Co-operation and Development.

Specifically, Canada's infant mortality rate of 5.4 deaths per 1,000 live births is tied with Estonia's and more than double Sweden's rate of 2.4.

According to the OECD the infant mortality rate for the U.S. was not listed for 2005 but it was 6.8 (deaths per 1000 live births) for 2004.

In addition, the waiting times for many procedures in Canada seems long. In a report titled The Wait Time Strategy (available as a pdf at the health.gov.on.ca website) the number of days between decision to treat and treatment is listed. These are the average number of days waiting for December 2006 and January 2007.

Cancer Surgery 68 days
Angiography 28 days
Angioplasty 17 days
Bypass Surgery 48 days
Cataract Surgery 183 days
Hip Replacement 257 days
Knee Replacement 307 days
MRI 105 days
CT 62 days

If interested, you can navigate the Canadian health care website and check the average waiting times for various hospitals and geographic areas in Ontario.

Bonus: The next lecture in our Works in Progress series will be titled, "“Engaging community members for research purposes: Who benefits?" Check back tomorrow for full details.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on May 05, 2008 |
Category: Canada; Health Care; Health Inequities

Hospital says payment before treatment

From the Health Blog at WSJ.com:

As a front-page article in today’s WSJ reports, hospitals are seeking cash upfront to reduce bad debt they’re experiencing amid a surge in patients who don’t pay their bills. Some are uninsured and other carry coverage that requires high co-payments.

Let us not forget a topic we blogged about earlier - medical credit scores and how they might influence treatment.

BONUS: A new study out reports that blacks have a 5x higher rate of amputations in the Chicago area.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 29, 2008 |
Category: Access to Health Care; Health Care

Low Medicaid reimbursement may lead to disparities

From Health Affairs:

PCPs in high-minority practices rely more heavily on lower-paying Medicaid reimbursements, devote more time to uncompensated charity care, and earn lower incomes. Magnifying these resource disparities, geographic areas with more high-minority practices tend to have lower Medicaid and private insurance reimbursements than those with fewer high-minority practices.

Our results indicate that the minority makeup of physicians' patient panels is associated with greater reports from physicians of difficulties providing high-quality care. At least some of this relationship appears to be explained by the lower resources flowing to high-minority practices. Two of the quality indicators most affected by Medicaid payment levels in our simulations, time spent per patient seen and difficulties getting timely reports from other providers, suggest the possibility that physicians may compensate for the lower revenue flows by increasing the volume of patients they see, reducing the time spent per patient seen, and perhaps devoting less time to coordinating and documenting care. This is despite the more complex psychosocial contexts and the language and cultural barriers that often complicate the treatment of lower-income and minority patients.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 27, 2008 |
Category: Health Care; Health Disparities; Medicaid Reimbursement

Sold her house to open a clinic

CNN.com has a story posted about a doctor who left private practice, sold her house, and opened a clinic focused on providing health care for the poor.

In 2002, these efforts resulted in "The Clinic: Medical Center for the Uninsured," a charitable, sun-filled clinic that has since received more than 40,000 patient visits.

Individuals receive free or low-cost primary medical care across eight specialties, regardless of income or locality.

"Since there's no need to spend a lot of time doing paperwork, we have time to talk to the patient and really hear what they're saying," says Stuart. "So the patients go away feeling they've been heard, that they've been helped."

An arsenal of more than 100 local volunteers, including 20 retired and practicing physicians, assist Stuart in providing expert medical services to more than 800 patients per month from across the southeastern Pennsylvania, New Jersey and Delaware area.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 25, 2008 |
Category: Health Care

Health care around the world

Healthcare-Economist.com has been reviewing many of the national health care systems around the world.

The reviews are based on an article by Michael Tanner that appeared at Cato.org.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 24, 2008 |
Category: Health Care

Health care and the youth in Australia

Australia's Medicare system provides free or low-cost universal care to all individuals.

Australians under the age of 15 can obtain their own Medicare card linked to their parent's account. Because the accounts are linked parents have access to all of their child's medical information.

The Australian newspaper The Age has an article discussing a new proposal that will help young Australians keep their medical details private.

From The Age:

[I]magine for a moment that you are a 14-year-old confused about your sexuality. You're too embarrassed to discuss this with your parents, or perhaps you have unsympathetic parents or come from a dysfunctional family. Wouldn't it be in everyone's best interests if you could talk in confidence to a trusted GP about this?

The proposed solution is the automatic distribution of Medicare cards to all Australian youths when they reach age 13.

This change to the Australian system has two components. First, Medicare cards will be distributed automatically. No longer will teenagers need to enroll in the system. Second, the age for an individual (not linked) Medicare account is lowered from 15 to 13.

Here in the U.S. the debate is focused on whether or not universal health care should exist. In Australia the issue is how young a person should be when they get their own private universal health care account.

For more information on the Australian Medicare system you can visit these links:

Medicare Australia at Wikipedia

Medicare system blamed for GP wage disparity

The Health Care system in Australia

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 18, 2008 |
Category: Health Care; Universal Health Care

What to do with healthcare?

Deane Waldman writing at the Huffington Post.

Imagine you are a doctor walking down the street. You come upon a woman lying on the sidewalk possibly unconscious. Surrounding this woman are four people each loudly suggesting a different way to help. One is urging a candy bar, while another is promoting his unique, patented guaranteed cure for today only: $19.95 plus tax. A third is trying to resuscitate the woman, and the fourth is threatening her with a charge of public drunkenness.

The woman down on the sidewalk is Healthcare. Those offering to help - in essence doctors-without-licenses - are legislators, insurance executives, expert consultants, and regulators. You are the doctor - the person responsible for making the patient (healthcare) better. What should you do?

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 16, 2008 |
Category: Health Care

Separate and unequal health care and the Republican response

The evidence is overwhelming that disparities in health outcomes exist. Nearly every day we post a link to a news story or scholarly article that looks at some aspect of health disparities.

The PBS special Unnatural Causes is helping to further push the discussion.

Given that income and education are huge factors in health outcomes not everyone is ready to accept that health is affected by factors more than just income and education.

Conservative radio talk show host Michael Medved argues that the disparity in life expectancy isn't due racism or social injustice but because those with more income and education make better choices:

Actually, the biggest reasons for wealthier people living longer lives reflect healthier habits: less smoking, better diet, more regular exercise, less divorce, fewer sexually transmitted diseases, and so forth. Educated and privileged people also get more and better information about protecting their own health, as well as more access to preventive care. The “inequalities” in life expectancy don’t indicate some profound injustice – in fact, it would be unjust and illogical if people who had created more wealth were unable to use those resources to secure better health outcomes.

It's unfortunate that Mr. Medved did not watch the PBS series prior to writing his commentary. From Episode 1 of the PBS special Unnatural Causes:

ADEWALE TROUTMAN: I’m clear that on the social gradient, that line that we talked about earlier, that I’m on the top of that line. I’m highly educated. I have a medical degree. I have several other degrees. I make good money. I live in a good neighborhood. But I know that according to the research, if you’re an African American, no matter what your social status, your socioeconomic status, your health outcomes are going to be worse than your white counterpart.

NARRATOR: African Americans die earlier and have higher rates than whites of many chronic diseases across the social gradient.

According to the PBS series, experiencing racism can be stressful. Chronic stress can have an adverse affect on the body's immune system making it more susceptible to illness and disease.

NARRATOR: Racial discrimination can be an added stressor, linked with high blood pressure, increased rates of infant death, coronary artery disease… Troutman knows what this can lead to. He authored a cornerstone study with former Surgeon General David Satcher on excess death among African Americans.

TROUTMAN: It was a national study and we found over 83,000 excess deaths per year in the African American community alone.

NARRATOR: 83,000 excess deaths each year. That’s the equivalent of a major airliner filled with Black passengers falling out of the sky every single day, every year.

It is not as simple as making better choices as Mr. Medved argues. It is about being treated as an equal and having equal access to care.

BONUS: RJ Eskow in an entry at the Huffington Post talks about the Republican response to the issue of unequal health care.

The Republican-dominated Florida State Senate is proposing to cut $803 million in health care financing for the low-income residents, the poor, and senior citizens -- a figure the Orlando Sentinel calls "staggering."

[John McCain] proposes to end tax benefits for employers providing health insurance. That would effectively scrap the current employer-funded system which, however imperfect, provides health coverage to millions of Americans today.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 09, 2008 |
Category: Health Care; Health Disparities

Your vitals: blood pressure, pulse, credit score

The Health Blog has a post about how credit scores are becoming the new vital sign in health care:

To figure out which patients are likely to pay their bills and which ones are best written off as charity cases, hospitals are peering into patients’ financial records.

Some are using traditional credit scores that are used for things like car loans and mortgages. Others are buying reports specially tailored to predict the likelihood that a patient will pay a big medical bill....

The Wall Street Journal has the original story.

The Journal also says that some hospitals are checking credit at the door while others wait for the final bill to be tallied. Also, a new 'health care credit score' is being developed so hospitals can better target collection efforts. From the Journal:

[Orlando Regional Healthcare] figures there's little to be gained from applying more pressure to either low- or high-risk patients. But "we're trying to work with that [medium-risk] population more to try to find some method of payment," says Keith Eggert, Orlando Regional's vice president of revenue management.

How long before non-emergency treatment is denied because of a low 'health care credit score?'

White Coat Rants has a good summary of the issue.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on March 18, 2008 |
Category: Health Care

San Francisco restaurants adding 'tax' to bill to pay for universal healthcare

San Francisco eateries have started adding a surcharge to restaurant meals to help pay for the city's new insurance program:

From latimes.com:

In the hip South of Market neighborhood, the menu at Tres Agaves, a popular Mexican restaurant and tequila bar, has a small message at the bottom of the first page that says, "3.5% service charge will be added to all checks for the San Francisco affordable healthcare legislation."

At issue is the city's new effort, kicked off Jan. 9, to provide healthcare for all residents. Since then, employers with more than 20 workers are required to spend a minimum amount on health insurance, set aside money in health reimbursement accounts or pay a fee to the city's Healthy San Francisco program.

The restaurant surcharges are spreading. Market Street favorite Zuni Cafe charges 4% of the total bill. Others, including Delfina, a trendy Mission District trattoria, collect a flat fee of $1 to $2 per person.

Other restaurants hide the 'fee' in their food costs to not alert patrons to the charge.

A trade association has filed suit in hopes of stopping the mandated tax. Oral arguments will be heard in April.

NPR has an audio report of the San Francisco universal health care plan.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on March 18, 2008 |
Category: Health Care

Ohio television station tests the health care system

A Cincinnati television station decided to test the health care system after getting numerous complaints about Anthem Insurance company. Many of the complaints were about mental health care and how Anthem responded to their claims.

That’s when we [WCPO] first told you that the governor of Ohio was asking for an investigation after we made him aware of complaints about Anthem Insurance company.

Since then, the I-Team’s continued to get complaints that the situation is getting worse. So we decided to test the system ourselves, and to find out what happened to that state investigation the Governor promised.

One person named Kate called over 50 providers that were listed as 'in-network.' Out of those 50 - only 8 still accepted Anthem patients and 5 refused to give her an appointment.

"It does not pay for us to take Anthem. It does not cover our overhead," said an office manager for a local psychiatrist's office who asked us to hide her identity because she fears retaliation from Anthem. She says she hears from patients like Kate every day.

Then WCPO's I-Team called 17 mental health providers at Cincinnati's Children's Hospital. They found only 5 providers willing to see new patients.

The state's Department of Insurance looked into the matter and found no violations of existing Ohio law. However, further investigation by the I-Team discovered that the review by the Department of Insurance was based on information provided from Anthem.

Hamilton County eventually dropped Anthem as an insurer.

The full story at WCPO.com.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on March 17, 2008 |
Category: Health Care

Win the lottery and get insurance

Oregon is conducting a one-of-a-kind lottery, and the prize is health insurance.

Those selected in the lottery will be eligible for a standard benefit program, which was once a heralded highlight of the Oregon Health Plan.

At its peak in 1995, the program covered 132,000 Oregonians. State budget cuts forced the program to close to newcomers by 2004, but it now has several thousand openings.

The program covers their most basic health services, medications and limited dental, hospital and vision services at little or no cost.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on March 05, 2008 |
Category: Health Care

Market Based Health Care

AlterNet has an interesting article on market based health care.

A 2007 paper from the National Bureau of Economic Research looked at retired California public employees on Medicare, and its findings contradict some of the basic assumptions of the consumerist movement.

The study's authors -- from Harvard, MIT, and the University of Oregon -- found that chronically ill patients who are asked to shoulder more of their health care costs deferred, neglected, or opted-out of doctor's visits and drugs when the price got too high. This short-term cost reduction led to long-term catastrophe, as their hospitalization rates were significantly higher than other patients suffering from chronic diseases. Immediate savings ultimately led to a greater -- and otherwise preventable -- use of more expensive care. Oops.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on February 26, 2008 |
Category: Health Care

Cleveland.com offers new Health Pages

Cleveland.com is now publishing several new health related pages.

The main site is cleveland.com/medical and is updated several times per day.

Scalpel is a medical gossip blog that posts about the comings and goings at local hosptials.

They even podcast a medical news roundup every two week or so.

Sadly, it seems they've overlooked the Health Disparities Blog in their links section. Hopefully that's just an oversight ;-)

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on February 19, 2008 |
Category: Health Care

Racial Disparity in Sepsis Rates

From Reuters:

Blacks get severe sepsis -- a rampant infection of the bloodstream that causes organ failure -- at nearly twice the rate of whites, and they are far more likely to die from it, U.S. researchers said on Friday.

The full study can be found in the American Journal of Respiratory and Critical Care Medicine.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on February 04, 2008 |
Category: Health Care; Health Disparities

Eliminating the disparity in medical prices

Ohio Health Policy Review posted yesterday about a Plain Dealer story that reports attorney general Marc Dann wants the state's poor and uninsured to pay the same price for medical care as those with insurance.

From the PD:

[Marc Dann] is concerned about uninsured patients paying high prices for medical procedures because they don't get hefty discounts that insurance companies negotiate.

This is part of the ongoing discussion regarding how 'charity care' is defined.

Again from the PD:

Hospitals throughout Ohio and across the nation define and report charity care differently. Dann and the Ohio Hospital Association said they plan to work together to come up with an Ohio standard.

We blogged about this issue before quoting a Reuters story that said uninsured patients pay 2.5 times more than those with health insurance.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on January 31, 2008 |
Category: Health Care

Longer ER Waits

The major news outlets have been covering a recent study that shows Americans are waiting longer in the emergency room.

The Washington Post reports that in 2006 the Institute of Medicine labeled the countries ER system "overburdened, underfunded and highly fragmented."

In San Diego, ER patients have to wait up to 12 hours in the emergency room.

In 2005 the Boston Globe reported that some ER patients are 'boarded' until a hospital bed becomes available. One patient waited 22 hours before a bed was available.

We even see disparities in the amount of time people wait with blacks and Hispanics waiting seven and nine minutes longer respectively than whites in the ER.

In a blog post, WhiteCoat offers this take:

No emergency physician is going to give someone monthly prescriptions for high blood pressure medications. No ED performs yearly health screenings. “Treat ‘em and street ‘em.” “Move the meat.”

Really what we’re doing is forcing indigent patients to wait until an emergency develops before society believes that it is “OK” to seek emergency care. How much more bass-ackward can we be?

The original study can be found in the journal Health Affairs.

UPDATE- Cleveland's WCPN hosted a show on the topic of emergency services in Cleveland.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on January 18, 2008 |
Category: Health Care

US has highest medical error rate

From the Commonwealth Fund:

Among adults in the seven countries, U.S. adults reported the highest overall error rates, including lab and medication errors. One-third of U.S. patients (32%) with chronic conditions reported a medical, medication, or lab test error in the past two years, compared with 28 percent of patients in Canada, 26 percent in Australia, and fewer patients in the other countries. Patient-reported errors were highest in every country for those seeing multiple doctors or with multiple chronic illnesses.

The surveyed countries were Australia, Canada, Germany, Netherlands, New Zealand, the United Kingdom, and the United States.

Other findings:

Of adults in the U.S., 37% "skipped medications, did not see a doctor when sick, or did not obtain recommended care in the past year because of the cost." This was the highest number of the seven surveyed countries.

19% of U.S. adults had "serious" trouble paying medical bills. This was more than double the rate of the next highest country.

More than one-third (34%) of Americans think their health care system needs to be rebuilt. Again the highest of the seven surveyed countries.

It is interesting to note that the United States in the only country of the seven surveyed to not have a universal health insurance system.

The journal Health Affairs has the complete study.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on November 02, 2007 |
Category: Health Care

Personal Health Records and Disparities

Microsoft made some news last week with the announcement of their HealthVault system.

From Medpagetoday.com:

Information such as blood pressure or weight loss can be uploaded and -- once online -- can be shared with doctors or any other recipients a user chooses, the company said.

The goal is to reduce "unnecessary confusion, paperwork and delays," Microsoft said.

"The launch of HealthVault makes it possible for people to collect their private health information on their terms and for companies across the health industry to deliver compatible tools and services built on the HealthVault platform," Microsoft said in a statement.

Microsoft is not alone in the push towards Personal Health Records (PHRs.)

From NYTimes.com:

[Google] has been developing offerings broadly similar to Microsoft’s — personal health records stored in Google data centers, and enhanced health search.

Google will not discuss the timing of its health plans. Marissa Mayer, the Google vice president now overseeing the health team, said, “We hope the products we’re working on will give people access to better information about health that is more relevant to them and help them manage and control their own information.”

At Cisco, the head of its health care practice, Dr. Jeffrey Rideout, recently left to join a private equity firm, Ziegler HealthVest Management. (Cisco called his departure a “leave of absence.”) And Dossia, a coalition led by Intel to provide employees at several large companies with personal health records, is going more slowly than planned.

The security of the data seems to be one of the major concerns.

From the PointClear Blog:

Microsoft may do a great job securing the HealthVault platform, but what about all the third-party vendors and partners who write applications that use HealthVault? If health information sloshes back and forth between these third parties, and some of the third parties have insufficient security which can potentially lead to data breaches, then how secure is HealthVault in practice?

Aside from the security issues, there may be access issues for underserved populations.

A policy brief from Mathematica Policy Reasearch, Inc (pdf) reviewed 21 software-based PHRs and found that only 2 products were available in Spanish as well as English and all but 2 of the reviewed software packages charges a fee for the PHR. While this fee can be avoided in free web based offerrings such as the those by Microsoft and Google, an individual still needs secure access to a computer.

For insightful discussion read this post at the Health Care Blog.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on October 09, 2007 |
Category: Health Care

Definition of 'Emergency Care'?

NYTimes.com is reporting that the federal government will no longer consider chemotherapy 'emergency care.'

The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.

At issue is the definition of 'emergency care.'

Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment.

Under a limited provision of Medicaid, the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other noncitizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.

Last year the Atlanta Business Chronicle wrote about how this issue is affecting Grady Memorial Hospital.

Grady and other hospitals fear they will end up footing the bill for illegal immigrants in the long run. They say immigrants denied care for chronic illness will only grow sicker, forcing them to return to the emergency room in a worsened condition.

"It's a tremendous burden that Grady must face," said state Sen. Don Thomas, R-Dalton. "They can't simply turn them away because they can't pay, whether they come into the emergency room or for chronic care."

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on September 24, 2007 |
Category: Health Care

Scheduling an appointment. Botox vs. Moles

From NYTimes.com:

Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, a study published online yesterday by The Journal of the American Academy of Dermatology said.

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.

Original research available at the Journal of the American Academy of Dermatology.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on September 06, 2007 |
Category: Health Care

World's Best Medical Care?

From Sunday's New York Times:

With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on August 13, 2007 |
Category: Health Care

Fighting Your Insurance Company to Stay Alive

From NYTimes.com:

Gordon Hendrickson was sick.

Five years ago, when Mr. Hendrickson was 66, routine blood work found something amiss with his liver. One test led to another, and then to an awful diagnosis: pancreatic cancer, one of the deadliest kinds.

But he was lucky. The cancer was caught early enough that perhaps it could be cured with surgery. He needed a Whipple procedure.

However, there were no experts in his hometown.

Albuquerque’s population was less than half a million, and the entire state of New Mexico had fewer than two million people, not enough to give local surgeons much practice with a relatively uncommon operation.

An experienced surgeon and hospital can significantly increase the odds of survival for people with pancreatic cancer, studies have found. Lower complication rates can also minimize the cost.

Mr. Hendrickson found a cancer center in Houston and an internist he was comfortable with. However his insurance, the Presbyterian Health Plan, refused to cover the procedure in Houston.

Mr. Hendrickson decided that his life was the most important thing so using a credit card to pay the deposit (since he would be having the procedure without insurance) he signed the paperwork and had the surgery.

[The surgery] went well. But he was left with more than $80,000 in medical bills, which Presbyterian Health Plan refused to pay.

Two appeals later and a trip to the state appeals board found Mr. Hendrickson acting as his own lawyer. The insurance company was represented by two lawyers.

Mr. Hendrickson won his case by showing that the five doctors recommened by his insurance company had performed this type of surgery only five times in five years. Presbyterian Health Plan paid the total cost of the surgery.

A spokesman for Presbyterian said the case had led the company to allow more patients to be treated at high-volume centers if there was evidence that the results would be better.

Strange, I thought we knew that going in.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 31, 2007 |
Category: Health Care

The Young Invincibles

NYMag.com has an excellent feature on the lives of working but uninsured New York twenty-somethings.

One interesting paragraph shows how one individual conceptualizes health insurance in terms of cell phone cost.

Andrew Kuo, a 29-year-old painter, told me he made a vow to be insured by the time he turned 30. “But that was when 30 seemed like a ways away,” he added. “Now I find myself making all these stupid calculations. Like, it would cost me around $3,000 a year to have insurance, right? Okay, isn’t that about what it would cost out of pocket if I broke my wrist? Chances are I’m not going to break my wrist once a year, so why not save the money for that onetime emergency?” Like many I spoke with, Kuo said he’d happily pay for insurance, if only the cost-benefit analysis tilted more in its favor. “What’s ironic is that I would never live without my cell phone, but I won’t consider buying health insurance. It sounds ridiculous to say that out loud, but the fact is insurance is just too expensive. If it was the same price as my phone”—$150 a month sounded reasonable to him—“I’d buy it in a second.”

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 20, 2007 |
Category: Health Care

New Strategy for Screening Children for Lead Poisoning

WKYC recently covered a press conference given by Ash Sehgal MD. Dr. Sehgal is the Co-Medical Director Physician of the Cleveland Department of Public Health as well as Director of the Center for Reducing Health Disparities.

You can view of video of the WKYC report here. (Note - will open in Windows Media Player.)

Additional background on the issue of lead can be found in this Free Times article.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 19, 2007 |
Category: Health Care

Race in a Bottle

ScientificAmerican.com has a new article about race specific medicine.

The entire article is well worth the read. Here are a few excerpts:

BiDil was also hailed as a means to improve the health of African-Americans, a community woefully underserved by the U.S. medical establishment. Organizations such as the Association of Black Cardiologists and the Congressional Black Caucus strongly supported the drug’s approval.

A close inspection of BiDil’s history, however, shows that the drug is ethnic in name only. First, BiDil is not a new medicine—it is merely a combination into a single pill of two generic drugs, hydralazine and isosorbide dinitrate, both of which have been used for more than a decade to treat heart failure in people of all races.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on July 17, 2007 |
Category: Health Care

Reducing Costs - Improving Quality via Self Managment

From PLoS Medicine:

We propose that the time has come for health systems to support appropriate and appropriately timed shifts from practitioner-based care to patient self-management. The use of toolkits in other fields has demonstrated an improvement in quality, lowering of costs, and more efficient completion of tasks. This trend holds even in very complex fields. We believe that this trend will also be evident in the management of patients with chronic illness.

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on April 17, 2007 |
Category: Health Care; Health Disparities

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.

"

Send news items related to health disparities to ReduceDisparity(AT)case.edu

Posted by: David Porter on March 22, 2007 |
Category: Health Care; Health Disparities

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.

Send news items related to health disparities to