Latest Blog Posts & Articles


Medicare, Schmedicare

For more than half a century now, the United States has stood out among its peers in the developed world for having the largest percent of its citizens living without health insurance. But once you turn 65-years-old in America, the government has you covered. Right?

Maybe not so much. Because even after people enroll in, they still end up with lots of out-of-pocket costs, costs that often burden them to the point where they can’t afford to receive care. Take these data from the Commonwealth Fund, which show the percent of people who have difficulty obtaining medical care because of cost:

Medicare Schmedicare

Once again, the U.S. stands as an outlier nation. Sometimes it’s not good being number one!

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Are You Overweight If Your Mom Thinks You Look Fine?

None of us view our children objectively. To a parent, Junior is always smarter, more talented and more attractive than objective evidence would indicate. But look at just how skewed parents’ views of their children are, when it comes to deciding whether their children are overweight. Not until a child gets near the top three or four percentile in body mass index do most parents begin to recognize that Junior has a problem.
Are You Overweight If Your Mom

 

 

Thanks to Pierre Chandon for this image. And thanks to my mom and dad, for convincing me that I was special.

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Free: Boxed Set!

Photo Credit: OrganJet

Photo Credit: OrganJet

Back in June, I published a series of essays about efforts to fly people around the country to give them better access to life-saving organ transplants. For your convenience, I have pulled the three essays together into one PDF. As a teaser, I will remind you of the first few paragraphs of the essay. But if you click on this link, you can get access to the PDF: Your New Liver Is Only a Learjet Away by Peter Ubel.

The forty million dollar Gulfstream jet landed at Memphis International airport in the early morning hours, its schedule hastily arranged earlier that day from Northern California, where the flight originated. Waiting on the tarmac was Dr. James Eason, head of transplant surgery at Methodist University Hospital, who planned on whisking the passenger to the operating room for a liver transplant. The passenger rushed to Memphis not because he lived in Memphis and happened to be out of town when an organ became available, but rather because he knew that flying from his home in Northern California to Tennessee would give him his best chance of receiving a life-saving organ.

You see, the demand for transplantable livers in Northern California far outstrips the supply, meaning there is a decent chance a patient with end-stage liver disease will die before a replacement organ becomes available. But in Tennessee, the number of people waiting for a liver transplants is significantly smaller, per capita, than California, and as a result the supply of transplanted livers is much better matched to the demand for such organs. As a result of these geographic variations in supply and demand, patients in Northern California wait more than six years, on average, for a liver transplant, whereas the majority of patients in Tennessee receive new livers in less than three months.

That’s right: six years versus three months!

The passenger on the Gulfstream that morning was Apple co-founder and CEO, Steve Jobs. After being told he needed a liver transplant, Jobs had learned about the huge disparity in waiting time between California and Tennessee, and arranged to get placed on the transplant waiting list in both locales, knowing he could fly to whichever location came up with the first available organ. So when he got a call from Memphis explaining that a 20 year old man with a compatible blood type had died in a car crash earlier that day, he summoned his flight crew and made his way to Tennessee.

Steve Jobs walked out of the plane that morning a frail shadow of his former self. Pancreatic cancer had spread to his liver and, without a transplant, he had only weeks or months to live. Thanks to that early morning flight and the talents of his surgeon, Jobs received a transplant later that day and would survive two and a half more years, a time in which he introduced the world to the iPad and to a talking phone assistant named Siri.

It was wonderful for Jobs and his loved ones that he was able to receive a transplant that day. But was it fair that Jobs could afford to charter a jet from California to Tennessee to undergo a transplant, while thousands of equally sick Californians waited at home for livers that didn’t always come in time?

To read the rest of this article, please click on the PDF: Your New Liver Is Only a Learjet Away by Peter Ubel

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Insured But Not Covered

Under the Affordable Care Act, the percent of Americans who lack any health insurance has declined significantly. Put another way – more Americans have health insurance than ever. But having insurance coverage is different than being well covered by insurance. Sometimes a person can enroll in a health insurance plan, and still face the kind of out-of-pocket healthcare costs that lead to significant financial distress. That is certainly one of the findings of a recent Commonwealth Fund study, with the main results illustrated below:

Insured But Not Covered

Face out-of-pocket expenses equal to 10% or more of your income? You are officially underinsured. By this measure, almost a quarter of Americans were underinsured in 2014. Not a figure we should be proud of!

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How Much Sugar Is in Your Beverage?

Here’s a display from an elementary school science fair, cleverly showing how much sugar various beverages contain:How Much Sugar Is in Your Beverage

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Is the Government Trying to Make Us Fat?

Photo Credit: Huffington Post

Photo Credit: Huffington Post

The FDA has proposed new labels on grocery store food products, that adjust serving sizes to more accurately capture what Americans eat. Research I conducted with Steven Dallas and Peggy Liu suggests these labels could be a problem. Here is a great media story on our findings:

Last year, the Food and Drug Administration announced it would be overhauling its Nutrition Facts label for the first time in more than 20 years. Among proposed changes to the chart, which is found on most food packaging, is a more realistic assessment of serving size, which reflects the amount of the product people actually eat at one sitting.

This shift has been widely praised by public health advocates, who consider many of the current serving sizes (one-half cup of ice cream?) unrealistically small. This way, they argue, people will have a better sense of the number of calories and grams of fat they are actually consuming.

But newly published research suggests there’s just one small problem with this initiative: It appears to prompt people to eat even more.

“We found that people misinterpret serving size information, with the vast majority of consumers incorrectly believing that the serving size refers to how much can/should be consumed,” a research team led by Steven Dallas of New York University writes in the journal Appetite.

To read the rest of the article, please click here.

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Sleepless in the Hospital

 

Photo Credit: CNN

Photo Credit: CNN

A while back, I wrote a piece on the problems caused when hospitals don’t coordinate care in a way that promotes patient sleep. Now Shefali Luthra, a reporter at Kaiser Health News, has written a great piece, delving deeper into this issue. Here is the beginning of that story:

Hospitals are reviewing their patient-sleep policies and starting to make changes.

It’s a common complaint — if you spend a night in the hospital, you probably won’t get much sleep. There’s the noise. There’s the bright fluorescent hallway light. And there’s the unending barrage of nighttime interruptions: vitals checks, medication administration, blood draws and the rest.

Peter Ubel, a physician and a professor at Duke University’s business school, has studied the rational and irrational forces that affect health. But he was surprised when hospitalized at Duke — in 2013 to get a small tumor removed — at how difficult it was to sleep. “There was no coordination,” he said. “One person would be in charge of measuring my blood pressure. Another would come in when the alarm went off, and they never thought, ‘Gee if the alarm goes off, I should also do blood pressure.’”

“From a patient perspective,” he added, “you’re sitting there going, ‘What the heck?’”

As hospitals chase better patient ratings and health outcomes, an increasing number are rethinking how they function at night — in some cases reducing nighttime check-ins or trying to better coordinate medicines — so that more patients can sleep relatively uninterrupted.

The American Hospital Association doesn’t formally track how many hospitals are reviewing their patient-sleep policies, though it’s aware a number are trying to do better, said Jennifer Schleman, an AHA spokeswoman.

And, though few studies specifically link quality of shut-eye and patient outcomes, doctors interviewed said the connection is obvious: patients need sleep. If they get more of it, they’re likely to recover faster.

Traditionally, hospitals have scheduled a number of nighttime activities around health professionals’ needs — aligning them with shift changes, or updating patient’s vital signs so the information is available when doctors make early morning rounds. Both the sickest patients and those in less serious condition might get the same number of check-ins. In some cases, that can mean patients are being disturbed almost every hour, whether medically necessary or not.

(To read the rest of this article, please click here.)

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Disliking Obamacare despite Benefiting from It

No surprise to learn that the majority of Republicans dislike Obamacare. But did you know that the majority of Republicans, who SIGNED UP FOR INSURANCE through Obamacare, still dislike the law? That’s one finding from a recent Kaiser survey:

Disliking Obamacare

Notably, they dislike the law even though they LIKE THEIR INSURANCE:

I look forward to the day when we can get beyond our attitudes towards this law, and join together to improve our nation’s healthcare system.

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Which Cancers Do We Spend Most of Our Money On?

There has been lots written lately about the soaring cost of cancer care. You’re spending a lot on cancer recently in part because of many wonderful new treatments that come with a substantial price tag.

But there has been less chatter about which cancers we are spending money on. Here’s a nice picture illustrating that information. I came across it courtesy of Ryan Nipp:

Cancers Spend Most On

I’d love to see a breakdown of this information as cost per patient. Please let me know if you have access to those data.

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Priceline for Healthcare Services?

Photo credit: americanlibrariesmagazine.org

Photo credit: americanlibrariesmagazine.org

Here is a link to a story from one of my favorite reporters, Rebecca Plevin from KPCC radio in California. She uncovered a startup company that tries to help people shop for healthcare services, by letting them name their price and seeing if any healthcare providers are game:

Shopping for things like hotel reservations is pretty easy these days.

There are a lot of websites that allow you to compare options by price and other factors. Some sites – like Priceline - even let you do the online version of haggling: You name the price you’re willing to pay and the site matches you with a hotel willing to accept your bid.

Some entrepreneurs are now trying to adapt this approach to the health care field, where it’s been notoriously difficult to shop around. It’s a development that’s being welcomed – with some caution – by people who advocate for transparency in the health care marketplace.

“This approach is the type of thing that the health care market needs,” says Dr. Peter Ubel, a professor at Duke University. “With more and more people in the U.S. paying more and more out of pocket for their health care, they need to be more like regular consumers, where they’re looking around for price and quality.”

Overall, these new sites that bill themselves as being like Priceline for health care “give consumers more power,” Ubel says. But, he and others warn, with more power comes more responsibility on the part of the consumer.

A win-win?

Take the Los Angeles-based start-up company ZendyHealth.

The site allows you to choose a procedure from a list of medical services, like CT or MRI scans. It will tell you the average price for that procedure. You can then suggest the price that you’re willing to pay, and providers can choose whether to accept the bid. If you undergo the procedure, you can either pay in cash or use funds from your health savings account, if you have a high-deductible health plan.

To read the rest of this article, please click here.

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