Americans spent less in 2012 on prescription drugs than the year before. This is the first time such a drop has occurred since sales began being tracked in 1957. The drop was small--1%--to $325.7 billion, and was due to increased use of generics. Such price relief is unlikely to last long; new advanced drugs, called biologicals, are entering the market in great numbers, and drug makers charge hundreds of thousands of dollars a year for these types of pharmaceuticals. (I took one, myself--rituximab--in my treatment of non-Hodgkin's Lymphoma.)
3/18/2013
3/18/2013
An unprecedented slowdown in health care spending in the U.S. has continued for 4 straight years now. The reasons for this easing in spending growth are not yet known. Likely causes include our recent recession, structural changes occurring within health care systems, and reforms put in place by the ACA. Whatever the reason, this is quite good news for all Americans. The news was particularly good for Medicare where spending increased by only .4% per beneficiary.
2/12/2013
2/12/2013
A large study of malpractice trends in the United States shows that while the number of malpractice payments has been decreasing, the size of each individual payment has been rising. Patient outcomes were the strongest predictor of both payment size and likelihood of a large payment.
10/18/2012
10/18/2012
As of Oct. 1, Medicare is now paying for performance at our nation's hospitals. Both processes of care and patient satisfaction will be measured. This is a big breakthrough and continues to align payment structures with patient centered care.
The American College of Surgeons released a study today that showed that 1 in 7 surgeries resulted in complications. They stressed the need for patient education to help reduce this high complication rate.
10/2/12
10/2/12
Researchers publishing in Health Affairs found that adults in 2010 were 66 percent more likely to report unmet medical needs than in 2000, 79 percent more likely to have unmet dental needs, and were also more likely to have delayed treatment for needed medical care.
The deterioration of access was worst among the uninsured. But access deteriorated for insured patients as well. By 2010, 10.2 percent of Americans with private insurance reported having unmet medical needs, vs 5.8 percent in 2000. The number of privately insured who delayed care because of costs also climbed, to 6.8 percent from 3.9 percent. Click link above for abstract.
5/15/12
The deterioration of access was worst among the uninsured. But access deteriorated for insured patients as well. By 2010, 10.2 percent of Americans with private insurance reported having unmet medical needs, vs 5.8 percent in 2000. The number of privately insured who delayed care because of costs also climbed, to 6.8 percent from 3.9 percent. Click link above for abstract.
5/15/12
A new study shows that hospitals are paying greater attention to preventing infections due to Medicare's refusal to pay for certain preventable hospital acquired infections. This has resulted in better efforts to reduce such infections. Pay for performance works.
5/15/12
5/15/12
Is your doctor always honest with you? Apparently not. According to a study in Health Affairs, doctors often don't admit their mistakes, disclose financial arrangements with other providers, or tell the whole truth about patient prognosis and treatment choices. Without full disclosure, patients cannot make informed treatment decisions, and they may not do what is in their best interests.
3/6/2012
3/6/2012
Healthcare spending is once again growing well faster than the growth of the U.S. GDP. Spending on commercially insured patients is rising fastest just when employers are cost shifting onto their employees. This strengthens the vice health costs exert on average Americans.
3/5/2012
3/5/2012
The U.S. Census Bureau is now estimating that 50,000,000 Americans live in poverty. The single biggest factor behind increased numbers is out-of-pocket health care costs. Indeed, if the burden of health-care expenses were not taken into account, then 10 million fewer people would have been classified as poor, and one of the biggest jumps in poverty under the new method is among people with private health insurance. Costs are rising so fast and employers are shifting more costs onto employees that many people with illness or accident simply can't keep up.
11/28/11
11/28/11
The United States Senate and the Justice Department are both reviewing Medtronic's synthetic bone graft, Infuse. It is currently used in about half of the 80,000 anterior lumbar bone fusions performed each year in this country. A report authored by Dr. Eugene Carragee in the Spine Journal (available by subscription) confirmed that some of the 13 Medtronic-sponsored studies of Infuse had failed to properly disclose complications.
In an editorial accompanying the new study, Dr. James Kang of the University of Pittsburgh wrote that industry support was perhaps the best way to explain the different conclusions reached by Dr. Carragee and the Medtronic-sponsored researchers. “There does not seem to be any rational explanation for these observational differences,” Dr. Kang wrote. Of note, the physicians who perform industry studies generally are paid millions of dollars in royalty or consulting fees. One must wonder, what exactly are they paid to do?
6/22/11
In an editorial accompanying the new study, Dr. James Kang of the University of Pittsburgh wrote that industry support was perhaps the best way to explain the different conclusions reached by Dr. Carragee and the Medtronic-sponsored researchers. “There does not seem to be any rational explanation for these observational differences,” Dr. Kang wrote. Of note, the physicians who perform industry studies generally are paid millions of dollars in royalty or consulting fees. One must wonder, what exactly are they paid to do?
6/22/11
Graphic illustration of the problems with America's healthcare system
Taken from UC Santa Cruz's Atlas of Inequality, the US ranks just ahead of Cuba in life expectancy while spending vastly more than any other country. Only large-scale systemic reforms can improve this situation.
A new survey reveals that orthopedic surgery was the most lucrative specialty in American medicine last year. The median income for orthopedists was $515,000. Again, trailing far behind was family practice with a median income of $189,000. Furthermore, orthopedic surgeons generally supplement their practice income with revenue derived from ownership positions in imaging centers, physical therapy, or surgery centers--an opportunity generally not available to primary care physicians. Click here to view report and then open PDF. Looking at these numbers, how can we not have an intractable problem steering new doctors into primary care fields? How can specialists claim that they cannot afford to treat Medicare or Medicaid patients?
6/17/2011
6/17/2011
The CDC has released its first report detailing racial and socioeconomic disparities in Americans' health. Among other findings are these:
1/13/11
- Babies born to black women are up to three times as likely to die in infancy as those born to women of other races.
- Young American Indian adults have the highest suicide rate of any group by far.
- The poor, the uninsured and the less educated tend to live shorter, sicker lives.
- Rates of preventable hospitalizations increase as incomes decrease.
1/13/11
According to a study by the Center for Studying Health System Change, community based, private practice physicians own or lease advanced imaging equipment and in-office invasive surgery equipment as follows:
1/12/11
- 25.2 percent reported owning or leasing equipment for laboratory services
- 17.4 percent reported owning or leasing advanced imaging equipment, such as CT or MRI machines
- 28.9 percent reported owning or leasing equipment for non-invasive procedures
- 11.4 percent reported owning or leasing equipment for for invasive procedures, such as cardiac catherization
1/12/11
Geoffrey Spurling and colleagues have published a study looking at the $57.5 billion that pharmaceutical companies spent on drug promotion in the United States in 2004. Their conclusion: "With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality ..." They recommend that doctors have no contact with pharmaceutical salespeople.
11/01/10
11/01/10
Joblessness and the accompanying loss of health benefits drove an additional 3.7 million people into state Medicaid programs last year according to an annual survey by the Kaiser Family Foundation. Enrollment in the programs grew by 8.2 percent from December 2008 to December 2009, the second-largest rate of increase in the 10 years that Kaiser has conducted the survey. There were 48.5 million people on Medicaid at the end of 2009, or about one of every six Americans.
10/8/10
10/8/10
Researchers publishing in The Archives of Internal Medicine "found a massive, dramatic system failure" when studying orthopedists who were all paid more than $1 million by medical device manufacturers but who then routinely failed to disclose this conflict of interest in their articles in medical journals. The medical journals all promise stricter guidelines concerning conflicts of interest. See this review article in the New York Times if you don't have a subscription to the Archives.
9/16/10
9/16/10
The Organization for Economic Cooperation and Development has released its yearly report on the performance of health systems in OECD countries. The United States most significantly under performs in primary care medicine. For example, we do poorly in preventing costly hospital admissions for chronic conditions, such as asthma or complications from diabetes, which should normally be managed through proper primary care. This leads to excess morbidity, mortality, and unnecessary expense. The culprit? An inadequate primary care network caused by our skew in reimbursement toward procedures. See our page Rescuing Primary Care and Fixing our System.
12/10/09
12/10/09
Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study. The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable. The study appears in the November issue of Archives of Surgery.
11/17/09
11/17/09
Nearly 45,000 people die in the United States each year, or one every 12 minutes, in large part because they lack health insurance and can not get good care according to a well designed study just published in The American Journal of Public Health. Overall, researchers concluded that American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage. Please click link above to view abstract.
9/19/09
9/19/09
The authors of America's first-ever national random-sample survey of bankruptcy filers published their findings in this month's issue of The American Journal of Medicine. The survey found that over 62% of our country's bankruptcies are due to a medical cause. Three quarters of bankruptcy filers had active health insurance and most were members of our middle class. Furthermore, the share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007. 6/13/09
