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| CENTER
FOR THE ADVANCEMENT OF HEALTH |
FEBRUARY
2006
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Pedestrian
Solution to Health Care
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The
Center for the Advancement of Health translates
to the public the latest research on prevention,
chronic disease management and health care, with
an emphasis on how social, behavioral and economic
factors affect illness and well-being. The Center
is an independent nonprofit corporation that
receives core funding from the John D. and Catherine
T. MacArthur Foundation and The Annenberg Foundation.
D
I S C O N N E C T
When
you are in the hospital,
the seemingly routine trip to the radiology department
for an X-ray could be the most dangerous part of your
stay. A report by United States Pharmacopeia found that
patients are seven times more likely to be treated erroneously
in the radiology department than anywhere else in the
hospital. Most mistakes involve wrong medications, wrong
dosing and incorrect administration of drugs. But 5 percent
of the mistakes involve working on the wrong patient.
The data came from voluntary reporting.
T
O P_M E D I A_H
I T S
An
HBNS story on a progressive association
between tooth loss and heart disease won
coverage in the New York Times, Detroit
Free Press, HealthDay News, the popular
federal “healthfinder” site and Web
sites in the Dominican Republic, Italy, Switzerland
and the United Kingdom. The study, by Catherine
Okoro, was published in the American Journal
of Preventive Medicine.
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Recently
in Washington, an elderly pedestrian crossed a busy
street at mid-block and was run over by a car. As he
lay dying, the city’s emergency response system
worked as it was designed to do. A policeman called
to the scene placed a $5 jaywalking ticket on the man.
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Jessie
Gruman
President
and Executive Director, Center
for the Advancement
of Health
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This
sad story of what happens when risky behavior meets
a finger-pointing bureaucracy occurs daily all across
America, only we know it as “consumer-driven
health care.”
It
is a notion central to the “ownership society” preached
from the pulpit of the free market just a few blocks
away at the White House; a concept under which people
with money use their own pre-tax dollars to “choose” and
pay for only the care they think they need, which is
supposed to reduce the 16 percent share of the national
economy devoted to health.
It
puts the responsibility on individuals to take care
of themselves and allows employers to use a variety
of strategies to shift the risk - and the cost of good
health – to their employees by raising insurance
premiums, establishing tax-free use of salary for health
care or simply denying coverage.
Consumers
do have a role to play in their health and need to
be involved in the decisions about their care. But
even in a world of perfect information, it is unlikely
they are going to be able to gather and analyze data
from multiple sources to choose the best or cheapest
option.
This
reliance on consumer-driven health care to tame the
world’s most complicated health system is fraught
with mixed messages.
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Consumer-driven
health care tells you it will pay 100 percent for
your screening and early detection costs because
you can’t be trusted to go to the doctor
on your own when you feel healthy. But when you
are sick and least able to make a rational decision,
it tells you to make your own call on which expensive
drug to take or whether to opt for surgery.
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It
tells you to spend only when necessary and
only on the best treatments. But it gives
you no real information on which measures
are the best.
The
incentives in consumer-driven health care are backwards,
akin to the imperative that made a policeman ticket a
dying man so that fault could be assigned. The cop was
doing his job, just as the health care system is doing
its job by refusing to pay for a diabetic person’s
$150 checkup but will gladly pay the $10,000 to amputate
his leg.
The
belief that the consumer is at fault for excessive health
care spending will just lead to solutions that not only
don’t work but also result in more cases of preventable
illness. It adds insult to injury - it’s your own
damn fault you are in the hospital or grave, and here’s
the jaywalking ticket to prove it.
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HealthBehaviorBlog: The
Center’s Web site, which now features the incisive HealthBehaviorBlog and
information for the Kellogg Scholars programs, continued
to grow in 2005, at a 67 percent increase over 2004.
HBNS The
Health Behavior News Service reached new heights in 2005,
producing more than 170 news stories, a majority of them
based on systematic evidence reviews. Those stories received
print, broadcast or Internet placements more than 3,500
times. With a mission of expanding coverage globally, the
News Service placed stories in media or on Web sites in
37 countries. For the first time, a majority of stories
appeared on Internet sites, and more than one-third of
all stories were attributed to the Health Behavior News
Service or the Center.
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HEALTH AND BEHAVIOR INFORMATION TRANSFER
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The totals are in for federal
research spending for fiscal year 2006. Congressional
action in late December cut the Centers for Disease Control
and Prevention budget by 4 percent, kept Agency for Healthcare
Research and Quality spending flat and provided the National
Institutes of Health with its smallest increase in 30 years.
Since another bill mandated a 1 percent across the board
cut in all domestic programs, funding for NIH will actually
be lower than the previous year’s.
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AHRQ issued reports
in January on health care quality http://www.ahrq.gov/qual/nhqr05/nhqr05.pdf and
health care disparities http://www.ahrq.gov/qual/nhdr05/nhdr05.pdf in
America, finding that overall quality of care improved
at a rate of 2.8 percent but disparities in both quality
and access to health care are growing wider for Hispanics.
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The Women’s
Health Initiative is sponsoring a 2-day conference
on “A Legacy to Future Generations” Feb.
28-March 1 at the NIH campus in Bethesda, Md. The conference
features opening remarks from the nation’s scientific
leaders, including NIH Director Elias Zerhouni, M.D.;
Vivian W. Pinn, M.D.; Elizabeth G. Nabel, M.D.; William
R. Harlan, M.D.; and Bernadine Healy, M.D. Register
online at https://www.peopleware.net/secure/index.cfm?siteCode=2843i&&siteID=682
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The
Institute on Medicine as a Profession, an
organization committed to educating the public about
medical professionalism as both a field and a force
for positive change, has launched a new Web site, http://www.imapny.org/
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