Category Archives: Access to Health Care
In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:
- Health insurance and exchanges;
- Health care safety net;
- Workforce support and diversity;
- Data, research and quality; and
- Public health and prevention.
To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.
NewPublicHealth: How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?
Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?
The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.
NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?
Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.
FDA’s ‘The Real Cost’ Multimedia Campaign to Graphically Depict the Health Consequences of Smoking
The U.S. Food and Drug Administration (FDA) has launched a new national public education campaign combating youth tobacco use. “The Real Cost” multimedia campaign—with television, radio, print, online and out-of-home advertising—brings together vivid imagery and compelling facts to graphically depict the health consequences of smoking, such as tooth loss and skin damage. The new campaign, which will run in 200 U.S. markets for at least 12 months, targets the 10 million kids ages 12 to 17 who have never smoked, but are at risk, as well as kids who have experimented with smoking. “We know that early intervention is critical, with almost nine out of every ten regular adult smokers picking up their first cigarette by age 18,” said FDA Commissioner Margaret A. Hamburg, MD. Each day, more than 3,200 youth under ages and younger try their first cigarette and more than 700 become daily smokers. Read more on tobacco.
HHS Expands Patient Access to Lab Records
The U.S. Department of Health and Human Services (HHS) is expanding patient access to health records by allowing patients, or their designated “personal representative,” access complete test reports from laboratories. The final rule also eliminates the exception under the Health Insurance Portability and Accountability Act of 1996 Privacy Rule to a patient’s right to access protected health information when it is held by a CLIA-certified or CLIA-exempt laboratory. “The right to access personal health information is a cornerstone of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule,” said HHS Secretary Kathleen Sebelius. “Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and adhere to important treatment plans.” Read more on access to health care.
Study: Climate Change Could Mean Significantly More Heat-related Summer Deaths
The combination of climate change and the growing elderly population could mean a dramatic increase in the number of heat-related summer deaths over the next decades, according to a new study in the Journal of Epidemiology and Community Health. Using data on weather patterns and death rates from 1993 to 2006, researchers at the London School of Hygiene and Tropical Medicine, and Public Health England, concluded that if no preventive measures are taken then the number of 2,000 annual heat-related deaths in England and Wales will climb 257 percent by the 2050s, while the number of 41,000 deaths related to cold will fall two percent. People ages 75 and older are at the greatest risk. Preventive measures could air conditioning, as well as more sustainable options such as shading and changes in building insulation and construction materials. Read more on the environment.
Tips on a Healthy Super Bowl Sunday
Super Bowl Sunday usually also means super-sized portions of unhealthy foods. Knowing this side of the annual event, gastroenterology experts from NewYork-Presbyterian are offering advice on how to get through game day as healthy as possible. "Fats, spices and carbonated beverages are likely to wreak havoc on the gastrointestinal tract, if not at the time of ingestion, then in the hours that follow," said Christine Frissora, MD, a gastroenterologist at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City. "Pass on the junk food at the Super Bowl party and your body will thank you later.” Among the “do” and “don’t” tips:
- Avoid spicy foods, which can trigger irritable bowel syndrome, indigestion and acid reflux.
- Reduce dairy intake, or try cheeses that are low in lactose, including brie, parmesan and aged cheddar.
- Beans are challenging to digest, so limit intake.
- Avoid "high fiber" snacks, which can leave you feeling bloated.
- Reduce fat intake, which can lead to indigestion.
- Make sure you provide your guests with nutritional options, such as yogurt dip, nuts, fruits, multigrain or whole-grain crackers and chips, non-spicy guacamole, baked chicken or fish, salads, fresh vegetables, and water with lemon or citrus garnishes.
Read more on nutrition.
Study: One-third of Adults with Chronic Diseases Have Trouble Paying for Both Food and Medicine
One in three U.S. adults living with chronic diseases such as diabetes, arthritis or high blood pressure have difficulty paying for both food and their needed medications—and sometimes both—according to a new study in The American Journal of Medicine. Using data collected by the 2011 National Health Interview Survey, which covered almost 10,000 people ages 20 and older, researchers determined that people who had difficult affording food were also four times more likely to skip medications because of their cost. They also found that 23 percent took their medication less often than prescribed because of the cost, 19 percent reported difficulty affording food and 11 percent said they were having trouble paying for both food and medications. "This leads to an obvious tension between 'milk' or 'med,'" said Niteesh Choudhry, MD, who worked on the study at Brigham and Women's Hospital in Boston. "If you have a fixed income, should you treat or should you eat?" The researchers recommend that patients speak to their doctors about difficulties affording medications and look food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), as well as food banks, for help with food. Read more on access to health care.
Exercise Can Help Relieve Stress of Work/Home Conflict
Increased exercise can help relieve stress over the conflict between balancing work and family life, according to a new study in the journal Human Resource Management. Utilizing a survey of 476 working adults who were asked about their exercise behavior and their confidence in handling work-family conflicts, researchers determined that people who engaged in regular exercise were also more confident in both their home and work environments. "If, for example, you go for a two-mile jog or walk 10 flights of steps at work and feel good about yourself for doing that, it will translate and carry over into other areas of life," said study author Russell Clayton, an assistant professor of management at Saint Leo University in Florida. "We found that [participants] who exercised felt good about themselves, that they felt that they could accomplish tough tasks, and that carried over into work and family life," Clayton added. Read more on physical activity.
NIDA Releases Resources on Identifying, Treating Teen Drug Abuse
As part of the annual National Drug Facts Week, the National Institute on Drug Abuse (NIDA) has released a collection of resources to help parents, health care providers and substance abuse treatment specialists identify teens at risk and help those struggling with drug abuse. The new resources include:
- Thirteen principles to consider in treating adolescent substance use disorders
- Frequently asked questions about adolescent drug use
- Settings in which adolescent drug abuse treatment most often occurs
- Evidence-based approaches to treating adolescent substance use disorders
- The role of the family and medical professionals in identifying teen substance use and supporting treatment and recovery.
“Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” said NIDA Director Nora D. Volkow, MD. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.” Currently only 10 percent of adolescents ages 12 to 17 who need substance abuse treatment receive it, according to the 2012 National Survey on Drug Use and Health. Read more on substance abuse.
Study: Public Transit Drivers Distracted an Estimated 39 Percent of their Time on the Road
Public transit bus drivers spend an estimated 39 percent of their time on the road distracted, according to a new study in the journal Traffic Injury Prevention. Researchers in the Department of Epidemiology at the University of Alabama at Birmingham observed and recorded distraction behaviors for three months, then compared them by route characteristics. Interactions with other passengers are the most common source of distraction. Drivers younger than 30 or older than 50, on city streets or highways, or who were driving more than 20 passengers were the most likely to be distracted. Researchers concluded that more needs to be done to educate drivers on the hazards of distracted driving and ways to avoid distractions. Read more on transportation.
Improved Education on Subsidies, Medicaid Could Reduce Number of Uninsured U.S. Adults
The number of U.S. adults who are uninsured could be significantly reduced with improved education on available subsidies and Medicaid expansion, according to the new quarterly Health Reform Monitoring Survey, conducted by Urban Institute researchers with funding from the Robert Wood Johnson Foundation and the Ford Foundation. The survey found that 39.3 percent of uninsured adults expect to have health insurance in 2014, and that four in 10 adults who expect to remain uninsured also think they will have to pay some sort of penalty. Read more on access to health care.
USDA: Americans Are Eating Healthier
A new report from the U.S. Department of Agriculture finds that American diets improved between 2005 and 2010. The report, which relied on responses to the National Health Examination and Nutrition Survey, found that American adults are making better use of available nutrition information; consuming fewer calories coming from fat and saturated fat; consuming less cholesterol; and eating more fiber. Daily calorie intake declined by 78 calories per day between 2005 and 2010. The report also found declines in calories from total fat (3.3 percent), saturated fat (5.9 percent), and intake of cholesterol (7.9 percent). Overall fiber intake increased by 1.2 grams per day (7.5 percent). Read more on nutrition.
ACEP Emergency Care Report Card Gives Public Health a ‘C’
Public health and injury prevention received a “C” grade in the new "America's Emergency Care Environment: A State-by-State Report Card." The nation overall received a “D” in the American College of Emergency Physicians report, which looks at the conditions and policies under which emergency care is being delivered, not the quality of the care. Public health and prevention was one of five categories of 136 total measures used to grade the quality of emergency care, along with access to emergency care; quality and patient safety; medical liability and environment; and disaster preparedness. Read more on access to health care.
Mental Health Problems in Middle Aged and Older Adults May be Underreported
A new study by researchers at the Johns Hopkins School of Public Health and published in JAMA Psychiatry finds than the number of people in middle and old age with mental health disorders may be higher than previously thought. The study was based on a survey of just over 1,000 adults who were part of a long-term longitudinal study. The participants were asked questions about mental health disorders and then were also given an assessment for the disorders by health professionals. The survey found that while the responders underreported mental health issues, they were fairly accurate when reporting physical health problems. Read more on mental health.
New Interventions Needed to Reduce Underage Drinking
Strategies recommended by the Surgeon General to reduce underage drinking have shown promise when put into practice, according to scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The approaches include nighttime restrictions on young drivers and strict license suspension policies; partnerships between college campuses and the community; and routine screening by doctors to identify and counsel underage drinkers. However, Ralph Hingson, SCD, director of NIAAA's Division of Epidemiology and Prevention Research says that “while progress has been made in addressing underage drinking, the consequences still remain unacceptably high. We must continue research to develop new interventions and implement existing strategies that have been shown to be effective.” According to Hingson, new research areas could include more studies of the effects of alcohol on the developing brain, legal penalties for providing alcohol to minors and parent-family alcohol interventions. Preliminary NIAAA research also shows that interventions aimed at strengthening family relationships in the middle-school years can have a lasting effect on students’ drinking behavior. Underage drinking is linked to 5,000 injury deaths per year, poor academic performance, potential damage to the developing brain, and risky sexual behavior. Read more on alcohol.
Study: Newly Insured Visit Emergency Departments More Often
While some experts have speculated that expanded insurance under the Affordable Care Act would decrease the rate of emergency department visits, a new study in the journal Science indicates that newly insured people actually visit the departments significantly more than people who were uninsured. The study of 25,000 Medicaid lottery participants in Oregon in 2008 found that people who received expanded coverage increased their visits by 40 percent—or 0.41 visits—over a period of 18 months. The visits encompassed all manner of health issues, included issues that could have been treated by a primary care physician and would have been covered by the insurance. Read more on access to health care.
Electronic Media Use During Family Meals Tied to Poorer Nutrition and Communication
The use of electronic devices—including television, music with headphones and texting—by teens during meals is linked to less nutritious food and poorer family communication, according to a new study in the Journal of the Academy of Nutrition and Dietetics. In a survey of more than 1,800 parents, researchers asked how often adolescent children used a variety of electronics during family meals, whether they had any rules regarding their use and whether they felt family meals were important; the children were asked questions about family communication, such as how often they discussed their problems with their parents. The study found that two thirds of the teens watched television or movies some of the time, with one quarter watching frequently. Other electronic activities were less common, occurring 18 to 28 percent of the time. About 75 percent of the families had limits on mealtime media. "There is no magic number of how many (family meals) to have, not all food at meals has to be 100% healthy and having electronic media at meals is not all bad (e.g., an occasional movie night with dinner) if it facilitates family time," said lead author Jayne A. Fulkerson. "But, parents can take small steps to have quality time with their children by reducing media use at mealtimes." Read more on nutrition.
Smoking Adds $17 Billion to Post-Surgery Costs Each Year
Smoking-related complications following surgery—for both current and former smokers—add an estimated $17 billion in direct U.S. medical costs each year, according to a new study in JAMA Surgery. The study, led by David Warner, MD, of the Mayo Clinic, looked at surgical patients between April 2008 and December 2009. While the costs for initial hospitalizations was relatively consistent for current smokers, former smokers and people who never smoked, post-surgery costs were an estimated $400 higher for current smokers and $273 higher for former smokers. Read more on tobacco.
More Than One Million People Now Enrolled for Health Insurance Coverage under the Affordable Care Act
The Centers for Medicare and Medicaid Services (CMS), which administers the health insurance provisions of the Affordable Care Act (ACA) reported late last week that more than one million people have now enrolled for coverage under the ACA.
CMS also reported that December enrollment as of December 27 was seven times that of October and November. Open enrollment will continue through March, with rolling dates for first day of coverage. Read more on the Affordable Care Act.
U.S. Flu Cases on the Rise
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported last week that rates of flu are on the rise in the United States, with the 2009 H1N1 virus the predominant strain. The good news is that this year’s flu vaccine is protective against H1N1.
According to CIDRAP, officials from the Centers for Disease Control and Prevention have said that the 2009 H1N1 virus has a greater impact on younger adults and older children than seasonal flu strains typically do.
The numbers of U.S. flu cases are usually highest January through March, which means that people who have not had flu shots yet still have time to protect themselves. Full immunity from the vaccine can take up to two weeks from the time of the injection. Use the CDC’s Flu Vaccine Finder to find a flu shot in your neighborhood. Read more on outbreaks.
New Orleans Health Commissioner to become Federal Health IT Administrator
New Orleans Health Commissioner Karen DeSalvo, MD, has been appointed the new National Coordinator for Health Information Technology (IT), replacing Farzad Mostashari, who left the position earlier this year. In a memo to employees of the U.S. Department of Health and Human Services (HHS), which oversees the office of the National Coordinator, HHS Secretary Kathleen Sebelius noted that Dr. DeSalvo boosted the use of health IT as "a cornerstone of [New Orleans’s] primary care efforts and a key part of the city's policy development, public health initiatives and emergency preparedness." Dr. DeSalvo will begin her post in mid-January. Under Dr. DeSalvo's leadership, New Orleans also received the inaugural Robert Wood Johnson Foundation Roadmaps to Health Prize.
New Infographic, Premium Payment Extension Will Help People Signing up for Health Insurance Coverage
Americans Health Insurance Plans, the trade association of many of the U.S. health insurance companies, has released a very easy to understand new infographic that helps simplify the steps for buying health insurance on the federal or state exchanges under the Affordable Care Act.
The new infographic is not the only bonus from the trade association this season. Last week the group announced that most insurers are extending the deadline for people purchasing coverage to pay their premiums to January 10, so long as signup for the plan is before January 1. Coverage for those signups will be retroactive to January 1.
Telehealth Technology Could Help Obese Youth Get Better Treatment, Lose Weight
Telehealth technology—a secure computer system that enables patients to speak “face-to-face” with doctors who are far away—could be an effective strategy to help obese youth who are trying to lose weight, according to new research from UCLA. With a multidisciplinary approach often the prescribed for treating obesity, telehealth services would reduce travel time while giving patients access to expertise that might not be available in their area. This would be especially helpful for low-income families. The UCLA study linked UCLA health care providers with patients at their local health clinics, finding that 80 percent of the 45 study subjects were happy with the technology and would use it again. "One surprise was how natural it was to talk with each other through the telehealth system, even though we never met the patients in person," said lead author Wendy Slusser, MD, medical director of the Fit for Healthy Weight program at Mattel Children's Hospital UCLA and director of pediatric wellness programs at the Venice Family Clinic. "The interaction was very much like being in the same room together. Some kids even thought it was fun to see themselves on the screen." Read more on access to health care.
Study: Psychiatrists Less Likely than Other Doctors to Accept Insurance
Psychiatrists are less likely than other doctors to accept private insurance, according to a new study in JAMA Psychiatry. Researchers analyzed government data from 2005 to 2010, which surveyed approximately 1,250 doctors each year, finding that from 2005 to 2010 the percentage of psychiatrists who accepted private insurance dropped from 72 percent to 55 percent. In comparison, over that same time the rate for doctors in other areas only dropped from 93 percent to 89 percent. While the study does not explain the vast difference, Jeffrey Lieberman, MD, president of the American Psychiatric Association, said reimbursement is a major concern, according to Reuters. "Many doctors can't afford to accept insurance because (insurance companies) don't pay them for the time," he said. "It involves taking more time with the patient and often treating them with psychotherapy.” Read more on mental health.
Even Mild Hits to the Head Can Cause Brain Damage
Even mild hits to the head that don’t cause concussion can still lead to problems with memory and thinking, according to a new study in the journal Neurology. Researchers equipped 80 football and ice hockey players with special helmets that gathered data on mild hits; while none of the players were diagnosed with a concussion, they still showed signs of deficits in thinking after the season. "This suggests that concussion is not the only thing we need to pay attention to," said Tom McAllister, MD, chairman of the department of psychiatry at the Indiana University School of Medicine. "These athletes didn't have a concussion diagnosis in the year we studied them ... and there is a subsample of them who are perhaps more vulnerable to impact. We need to learn more about how long these changes last and whether the changes are permanent." Read more on injury prevention.
Study: U.S. Graphic Warning Labels Could Get 8.6M Smokers to Quit
A new study out of Canada indicates that the U.S. Food and Drug Administration may have underestimated the potential impact of graphic warning labels on tobacco products. From 2000 to 2009, the warning labels cut Canada's smoking rate somewhere between 12 and 20 percent, which would be the equivalent of between 5.3 million and 8.6 million U.S. smokers. That's also 33 to 53 times larger than the FDA's estimates when they pushed for the warning labels--and when the tobacco industry successfully challenged the measure, with the court pointing to the low impact as one of the reasons for the ruling. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found," said Jidong Huang, MD, the study's author. "Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future." Read more on tobacco.
Expanding Nurse Practitioner Abilities Could Save Patients $472M by 2015
Expanding which health services nurse practitioners at retail health clinics can provide could save at least $34 per visit, or as much as $472 million in health costs by 2015, according to a new study in the journal Health Affairs. The estimated 6,000 retail health clinics, often found in chain pharmacies or "big box" stores, provide walk-in care for minor health problems. The rules for nurse practitioners vary from state to state, with some allowing them to prescribe medications and practice independently of a doctor's supervision. Researchers looked at insurance claims from 2004 through 2007, finding that the state's that grant wider latitude also tend to see lower costs for the patients:
- $704 -- Average cost of treatment in the 14 days after a traditional doctor's office visit
- $543 -- Average cost of care during and after a retail visit in states where nurse practitioners had no independence and could not prescribe medication
- $484 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without the supervision of a doctor
- $509 -- Average cost of care during and after a retail visit in states where nurse practitioners were allowed to practice without supervision and prescribe medication
Read more on access to health care.
New Estimate Puts 2009 Swine Flu Global Death Toll at More than 200K
The death toll from the 2009 swine flu epidemic was likely far higher than previously believed, according to a new study in the journal PLoS Medicine. Previously, the total stood at about 18,500 laboratory-confirmed deaths, though experts considered that to be a low estimate because it only factored in confirmed cases of H1N1. A new study, bringing together 60 researchers in 26 countries, now places the toll at as many as 203,000 global deaths--or 11 times higher than the previous estimate. "This study confirms that the H1N1 virus killed many more people globally than originally believed," study lead author Lone Simonsen, a research professor in the department of global health at the George Washington University School of Public Health and Health Services. "We also found that the mortality burden of this pandemic fell most heavily on younger people and those living in certain parts of the Americas." Read more on global health.