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Understanding US Health Care Reform

July 25, 2012 1 comment

US Health Care Reform: A big deal!

As we travelled from Canada to and from Boston around the first week of July, the US Supreme Court ruling on health care reform dominated all media coverage.  Hype and polarizing condemnation of the high court’s decision was rampant, with Republican presidential nominee, Mitt Romney, vowing to undo it if elected.  This is not surprising. What was surprising was that most Americans we spoke to – Democrat or Republican – were also unhappy with the decision.  Concerns ranged from fears that the new health care reform law would result in rationing of health care, to expectations that it would result in lower quality of care, along with increased costs to individuals, small businesses and the government.  Many were skeptical about being required to buy insurance, seeing it as a curb on individual freedom and a step down a slippery slope towards socialism.

Need for reform

The US health care system is an expensive and inefficient system (see the McKinsey Global Institute report: Accounting for the cost of US health care: A new look at why Americans spend more. According to the US Census Bureau report: Income, Poverty, and Health Insurance Coverage in the United States: 2010, 49.9 million people were estimated to be without health insurance (p. 23).  An overhaul of the system seems necessary, but with all the hype and political wrangling, it is difficult to sort out what is being proposed and why.

So what is being proposed?

Illustrating Health Reform: How Health Insurance Coverage Will Work

This 10-minute animated movie, written and produced by the Kaiser Family Foundation, is an excellent, balanced summary of what is being proposed and why.

Kaiser Health Reform Gateway

Statistics, analysis and discussion from the Kaiser Family Foundation web site.

US Health Care Reform

Details on health reform from the White House governmental web site.

New York Times: Health Care Reform

Article and related discussion, debate and news links.

NIH Commissioned Study Results on Race, Ethinicity and NIH Research Awards.

August 19, 2011 Leave a comment

Findings of a US National Institutes of Health (NIH) commissioned study to investigate gaps in NIH grant success rates among various racial and ethnic groups have been published in the Aug 19 issue of Science.  The study reported that even after controlling for education, institution, and other factors that influence the likelihood of success, black investigators were still 10 percentage points less likely than white investigators to receive a new research project grant.

Dr. Lawrence Collins, Director of the NIH, and Lawrence Tabak, NIH Principal Deputy Director, have pledged to remedy that with a thorough investigation of ways to improve the peer review process, encourage greater diversity on review boards, increase technical assistance to applicants in grant preparation, and support innovative ways to increase local mentoring of junior faculty.    As they say in their commentary “Troubling data such as these require substantive action. Compelling evidence supports the view that diversification of the research workforce is an imperative for our nation’s continued success”. They call upon every institution and scientist supported by NIH to join in reinvigorating efforts to diversify the nation’s current and future biomedical research workforce.

The study can be downloaded  here

Lawrence Tabak and Francis Collins Commentary on the study can be downloaded here.

News article about the study can be downloaded here

Google Health PHR is being retired after all

June 27, 2011 6 comments

An official Google Blog post on 24 June announced that  Google Health will be retired in January 2012 as it has not resulted in the broad impact anticipated at its launch three years ago.  Patients will be able to download their data through January 1, 2013. Google Health’s no-cost, secure, online, open source, patient health record made available to health consumers, was expected to improve health care by enabling patients to be partners in the management of their health.

Most health records worldwide are still paper-based, and those in electronic format may be scattered among hospitals, doctor offices and specialists. Technology standards and data ownership issues are yet not clearly defined, so populating personal health record with data can be an onerous task.  Adoption of personal health records involves a fairly steep learning curve and a change in cultural mindset.   Finally, the cost of housing data and creating applications to make the data useable and secure is high.  Though disappointing, it is perhaps not surprising, therefore, that Google has pulled out of the personal health record space.

In Canada, Telus Health Space has moved into personal health record provision, building on the Microsoft Health Vault platform,  partnering with hospitals, health care associations, and academic research initiatives to standardize technologies and encourage development of applications to make PHRs more useful and user-friendly.  Telus Health Space is not free, however; it  is only available to users for a fee, which might make it a more sustainable business model.

Making American Health Care More Efficient

May 12, 2010 2 comments

The United States spent 17.3% of GDP on health in 2009, but ranks on 49th on life expectancy worldwide, patients receive the correct treatment just 55% of the time, and significant variability exists in the quality of care delivered. The contentious Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act, signed into US law on March 23, 2010 and March 30, 2010 respectively, were historic events paving the way to changing the US health care system to make it more equitable, efficient and effective. The challenge lies in bringing about the change needed.

A 21st Century Roadmap for Advancing America’s Health: The Path From Peril to Progress, the 2nd report by the Commission on U.S. Federal Leadership in Health and Medicine, was published this week. Drawing on recommendations from working groups representing key areas in which progress is needed, the Commission put forth a comprehensive strategy:

• Re-engineer America’s health care system: Invest in health technology ($19 billion has already been committed to investment in health information technology with the American Recovery and Reinvestment Act) to maximize value and minimize waste; lower costs by adopting new value-based payment methods, promoting team-based medicine, strengthening primary care and conducting comparative effectiveness and health systems research.

• Advance public health: Focus on public health, prevention of illness, and encouragement of healthy lifestyles: more than 75% of health care costs in the US result from chronic diseases, many of which are preventable.

• Promote global health and health diplomacy: Increase federal investments in global health, as global health has humanitarian, economic and national security implications. Currently federal investments in global health account for less than 1% of the US budget.

• Strengthen US medical and public health research:  Increase the funding base for scientific research in biomedical and public health research, as it is “the foundation for all health and medical interventions, the cornerstone of health care reform efforts, and an engine of economic and societal progress.”

The Commission acknowledged that improvement in health needs much more than investments in health technology, access to care, measures to contain costs or health insurance coverage for all citizens – that commitment to change is needed at every level: from government & policy-makers, to health care and public health workers, to individual citizens. Whether the new legislation, increased investments, and new technology will achieve the goal of advancing America’a health depends greatly on how that change is managed. Developments so far are promising….