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You Know Who Else Fails ‘The Jimmy Kimmel Test?’ Hospital Emergency Rooms

(Randy Holmes/ABC via Getty Images)

When Jimmy Kimmel’s child was diagnosed with a serious heart condition, Kimmel realized that people without his wealth (or his generous insurance coverage) would not be able to pay for the life-saving care that his child received, if their children were to be similarly ill. So he gave a moving monologue one evening, explaining why he now believes that healthcare policies should be judged by whether they keep finances from being a barrier to receiving lifesaving care, a view that some now call “The Jimmy Kimmel Test.”

Kimmel’s monologues on this topic have gone viral, but it doesn’t look like hospital ERs have gotten the message. Too often, they charge patients outrageous prices for their services, especially when people don’t have insurance.

Do you think these hospital ER prices are irrelevant for you, because you have insurance? Think again.

Suppose you are on vacation when your diabetes spins out of control. Or you are shopping at a local mall when you have a fainting spell. You are rushed to the nearest hospital by an ambulance crew to an emergency room, where you get an IV, an EKG, and other state-of-the-art care. All is good, until you receive the bill.

According to a recent study, if you happen to receive care in a for-profit hospital emergency department that’s out of your insurance network, you can expect a bill that’s almost six times higher than what Medicare would have paid for those same services. Did you get an EKG? Medicare would have paid $16 for that test. Your bill could be more than $300, a bill that you will have to pay, not your insurance company.

(To read the rest of this article, please visit Forbes.)

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Healthcare Spending and Life Expectancy: in One Stunning Picture

Let me be clear: how long people live in any country of the world is determined by lots of things, not just by the quality of their healthcare system. Nevertheless, one of the things medical care is supposed to do is help us live longer and healthier lives. So you would think that a country which dramatically increases its health spending would gain more in life expectancy than similarly wealthy countries that do not increase such spending.

Your thinking would be wrong.

Here is a picture from The Financial Times, showing that in 1970 the US already lagged behind the UK and Japan in life expectancy by about one year, despite spending a little bit more per capita on healthcare. By 2014, the US spent more than twice as much as those other countries on medical care, with residents of the United States now living five years less than people in those other two countries:

Again, this difference in life expectancy doesn’t arise simply from the quality of medical care in these three countries, but has lots more to do with eating habits, drinking habits, traffic safety, and the like. That said, it points out a real major problem – despite the great wealth of this country, we haven’t figured out how to help Americans live long and healthy lives.

 

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The Life-Expectancy Gap in One Depressing Picture

Here, from the Financial Times, is a picture showing that the lower your income, the less increase you’ve gotten in life-expectancy the last four decades:

Income inequality is one of the largest human problems of this century.

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Your Doctor May Spend More Time with a Computer than with You

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Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients.

What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their desktops than with their patients.

Two recent studies give us quantitative estimates of the stupendous amount of time physicians spend on computers, rather than in direct contact with their patients. In one study, researchers directly observed physicians in outpatient clinics, asking these doctors to document the time they spend on the EHR after hours. The study assessed physicians from four specialties: family medicine, internal medicine, cardiology, and orthopedics. The study found, on average, that doctors spend half their working time on the EHR.

(To read the rest of this article, please visit Forbes.)

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Party First, Ideology Later

We think of political parties as being ideological homes. If you embrace conservative ideas, you gravitate to the Republican party, and so on.

But probably just as often, people have party homes (“My dad was a Dem, and so am I”), in which whatever the party embraces magically fits their ideology. Consider the following picture of people’s attitudes towards free trade. Long a conservative (thus Republican) favorite, now that Trump dislikes free trade, so do many Republicans:

Too often people believe first and think later!

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Burdened by High Medication Costs? Your Boss May Be Able to Help

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Pharmaceutical companies have been charging way too much for way too many of their products. Both Donald Trump and Hillary Clinton complained about drug prices during the election campaign, but neither political party has taken action since November to tackle the problem. Insurance companies aren’t doing much about this problem either, despite having a huge incentive to tackle high prices.

But there is someone who appears to be up to the challenge – employers. According to a recent study in the New England Journal, a consortium of 55 Catholic organizations decided to redesign their employee healthcare benefits in 2013. Before that time, these organizations provided their employees with tiered co-pays for their medications. Under formulary tiers, a patient might pay $10 a month for generic drugs, $25 a month for brand-name drugs, and $100 or more per month for expensive specialty drugs and biologics. Tiered formularies are designed to motivate patients to use less expensive medications, because they carry lower co-pays. But such formularies are usually blunt motivational instruments. They might convince a patient to choose a generic medication rather than a brand-name cholesterol pill, but the patient will have no further incentive to choose the least expensive generic medication. Similarly, a patient with rheumatoid arthritis will face a significant co-pay for a biological therapy, but that co-pay won’t change from one biologic drug to another, even if those drugs have very different price tags.

That’s where reference pricing comes in, a topic I have written about before. The Catholic organizations got together and looked at different categories of medication, and decided how much they would pay for drugs within each category, with the understanding that patients would pick up the rest of the tab. For example, medications for stomach reflux range in price from $26 a month to almost $300 a month. The employers promised to cover $26 of the cost of whichever reflux medications patients chose to take. Similarly, patients who wanted to take $400 nasal inhalers for their allergies could go ahead and do that, but the insurer would only cover $34 of that price, given that an equally effective inhaler was available at that price.

(To read the rest of this article, please visit Forbes.)

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Love This Picture

I had the great pleasure of talking about out-of-pocket healthcare costs at Periodic Tables: Durham’s Science Café, a speaker series run by The Program for Science and Society at Duke University. The crowd was absolutely awesome, and much larger than I expected, given that I was speaking at the same time that Duke’s number one rated men’s basketball team was taking on Michigan state’s number two ranked team.

I also love the advertisement they put together for the program. I wonder if I should use this art on my next book.

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Obesity Nation!

Here is a picture, courtesy of the Financial Times, showing obesity rates among OECD nations. Only 5% of people living in Korea and Japan qualify as obese. Yet obesity rates are drastically higher in the United States; if someone’s in American, there is practically a 4 in 10 chance they are obese.

Not something to be proud of.

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Why Investing in Better Primary Care Failed to Save Money

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We have a huge healthcare problem in the U.S., spending way more than other wealthy countries, expenses that not only burden state and federal governments, but that also take money out of American pockets.

Some people hope that better primary care will reduce U.S. healthcare spending. They point out that a small number of chronically ill patients—super-utilizers—account for half of healthcare spending. The hope is that taking better care of these super-utilizers, with more robust and improved care coordination, will improve their health and reduce healthcare spending.

Or perhaps not. When the Palo Alto VA tested an intensive primary care program for its super-utilizers, healthcare spending and utilization didn’t budge. One iota. Except for primary care utilization which, unsurprisingly, rose significantly among people receiving intensive primary care.

The Palo Alto study was well-designed. The researchers targeted patients who were in the top 5% of healthcare utilization. These patients were typically elderly, and on average had 10 chronic health conditions. Two-thirds carried mental health diagnoses, and a quarter had a history of homelessness. The population included people I am very familiar with from my almost 20 years in the VA: older men with PTSD and anxiety; hypertension, diabetes, coronary artery disease, congestive heart failure, emphysema, and a touch of renal failure; recent hospitalizations for pneumonia, leg wound infections, or maybe a mild stroke.

(To read the rest of this article, please visit Forbes.)

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Generic Doesn‘t Mean Affordable

Generic meds are supposed to be relatively cheap; multiple companies can make the same molecule, leading to price-lowering competition.

But that’s not always what happens in the US market. Look at the prices of these generics, in the US vs Canada:

We need to take regulatory or legislative steps to reduce the price of generic medications.

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