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Sep
28
2006

Insurance preimiums grow faster than wages and inflation

That's not really news to anyone who is paying for health insurance. It confirms what everyone who works for a living already knows. The burning question is: Given how messed up the system is, and how upset people are about access and skyrocketing costs, where is the outcry from the masses? Why are people not insisting on legislative action? There must be a reason why a grassroots demand for change does not seem to exist. Care to speculate?

For fodder, check out a recent article in the Oregonian..."Politicians offer small repairs, not big reform for Oregon's ailing health care system."

And for more fodder, here is the report on rising health insurance premiums. The survey found that premiums have increased 87 percent over the past six years. Family health coverage now costs an average $11,480 annually, with workers paying an average of $2,973 toward those premiums, about $1,354 more than in 2000.

Continue reading They keep growing and growing

Sep
7
2006

A new study suggests that sudden cardiac arrest is linked to poverty. The study validates what many people had assumed. How are such findings to be incorporated into a more just approach to health care? What role does this type of information have in health care reform? In this context, it would have been interesting to know the percentage of these people who had health insurance or access to health care to see if that makes a difference, of course, but such information is not always readily available.

A team of Oregon Health & Science University researchers have found that the incidence of sudden cardiac arrest, one of the nation's most lethal public health problems, was 30 percent to 80 percent higher in the lowest socioeconomic-status neighborhoods in a large urban community than in the high-status areas in that community during the two-year period evaluated. The disparity was most acute for those younger than 65.

The findings were based on a study of 714 cases of sudden cardiac arrest (SCA) in Multnomah County, Ore., reported between February 2002 and January 2004 by the county emergency medical services system, the county medical examiner and 16 area hospitals. At the outset of the study the county had a population of more than 660,000 people.

Ninety-eight percent, or 697, of the SCA cases surveyed had residential addresses in one of the county's 170 census tracts. The tracts were divided into quartiles for each of four measures: median household income, percent of population below the federal poverty level, median home value and percent of population older than 25 with at least a bachelor's degree. For each of the four measures, SCA incidence rates were lowest in the highest socioeconomic status quartiles. Annual incidence of SCAs in census tracts in the lowest versus highest quartiles of median home value was 60.5 versus 35.1 per 100,000. The differential was much more exaggerated for the median home value measure in the younger than 65 population, where it was 34.5 versus 15.1 per 100,000.

Continue reading Sudden Cardiac Arrest Occurs at Higher Rates In Poorer Neighborhoods

Sep
6
2006

by Dan Handel, M.D. and colleagues

An OHSU physician and reseracher, Dr. Handel has submitted an editorial from the Annals of Emergency Medicine for discussion.

It is the end of another busy afternoon in the emergency department (ED). As you finish up your dispositions, a 35-year-old patient with poorly controlled diabetes and hypertension comes in for a medication refill. Reviewing his medical records, you discover he presents often for medication refills. His demographics sheet is marked as “self-pay.”

“Sir, do you have a primary care physician?” you ask.

“No, I don’t have any insurance, and they all ask for the payment up front, which I can’t afford,” he replies.

You have heard this all before. You return to your desk to refill this patient’s prescriptions yet again, knowing that he will soon return to the ED when he runs out or, even worse, will present with an exacerbation of his medical conditions because of his inability to obtain medications.

Residency trains physicians to handle all medical emergencies that present to the ED’s door, but it does not necessarily train physicians to address the ED’s significant social issues. Physicians’ best acute clinical care may be undermined by the social factors that affect the way their patients receive follow-up care. Read the rest of the editorial (PDF).

Continue reading The challenge of patient follow-up in today's health care environment

Jul
27
2006

Guest column
Angela Heider, M.D.

I recently retired from the practice of obstetrics and gynecology at the young age of 32 and after only two years in practice. My reasons are, of course, complex, but they boil down to the impossible logistical, financial, and familial implications of practicing medicine within the confines of the current system. Alarmingly, four of my young female partners have also elected to hang up their stethoscopes – a growing trend. If we are to reverse this trend, we need to reform our health care system.

Some health policy experts believe comprehensive reform is impossible in the absence of a national disaster. I believe we can make a difference but a really important first step is to make insured people understand the necessity of such an endeavor.

True enough, there are millions of uninsured and underinsured Americans who are clearly suffering under our current system. However, there are many more happily insured Americans who are completely unaware of the horrific state of a system they trust whole-heartedly. The fact is, even wealthy Americans are impacted by the looming health care crisis. They just don’t know it yet.

Continue reading The Rise and Fall of Dr. Mom

Jun
21
2006

In health care, the safety net exists to “catch” those who would otherwise fall through the cracks – primarily those without health insurance but also the underinsured, who may have at least some coverage but lack access to health care providers.

OHSU Hospital and other health systems provide significant amounts of uncompensated care for low-income individuals in Oregon each year, and the clinic-based community safety net provides crucial access to primary and preventive care. Comprised largely of Federally Qualified Health Centers, these clinics have traditionally served specific groups – the homeless, migrant workers, low income, temporarily unemployed, and so on.  Generally, safety net clinics use a sliding fee scale tied to income.

In Oregon, our safety net is badly frayed. Demand for free or low-cost services is growing too fast. About 1 in 6 people in Oregon are uninsured, and the numbers continue to rise. There are 210,000 uninsured people in the Portland tri-country area alone. The underinsured, who now include those with Medicaid/Oregon Health Plan coverage, increasingly need the safety net too. According to the Oregon Medical Association, almost 60 percent of our primary care physicians either limit or do not see Medicaid patients at all.

Continue reading Patching Oregon’s frayed safety net

Jun
15
2006

I just read about the new Institute of Medicine report on America's emergency care system being "At The Breaking Point" and while I'm usually a big fan of the IOM's work my first impression is they blew it this time. (Let me first put out the disclaimer that I have not yet read the entire report.)

The report discusses the major problems in our hospital-based EDs, including overcrowding, people using the ED because they cannot access primary care, and the burden of uninsured patients. I'm with them so far. But their recommendation seems to be to throw money at the hospital ED system. Huh?! EDs are widely acknowledged to be the most expensive and least cost effective way to deliver care, especially primary care. So why would we sink more money into building more EDs and paying them to see more people (inefficiently)? Wouldn't it make a heckuva lot more sense to build up the primary care system, especially the Community Health Centers and other safety net providers who specialize in caring for uninsured and disenfranchised individuals, and who provide great care for the lowest cost? Then there'd be more access, so fewer people would seek care in the ED, they'd have less overcrowding and less "burden." I think the IOM needs to try again on this one.

Continue reading IOM got it wrong

Jun
7
2006

The people take to the streets to enact their own solutions.  That is just what has happened with health care this year.  During the 2005 legislative session a myriad of reform proposals were proposed, many passed the Senate, but were ultimately killed in the House.

The legislature’s failure to address the skyrocketing cost of health care left a void advocates are attempting to fill through the initiative process.  Seven ballot measures were proposed this year to address the health care crisis.  They include measures aimed at reducing cost, increasing access and ensuring accountability.  Many of them are modeled after or exact replicas of legislation that failed in 2005.  Four of the seven initiatives are racing toward the July 7 deadline to gather signatures.

To help people learn about the measures and share their ideas for health care reform, Oregonians for Health Security and our allies across the state have been holding a series of health care forums.  In addition to sharing their own experiences, voters discuss proposed solutions and offer their own ideas to make health care more affordable and accessible.  We are holding a Portland Health Care Forum Tuesday, June 13 from 7-9 PM at the St. Andrew’s Catholic Church (806 NE Alberta).  The Portland Forum is sponsored by Oregonians for Health Security, Oregon Action and Jobs with Justice.

Below is a taste of each of the initiatives, more detailed information and links to their websites are available at www.OregoniansForHealthSecurity.org or by contacting Oregonians for Health Security at 503-655-2793.

Continue reading What happens when the legislature fails to act?

May
30
2006

Guest column
Sara R. Collins, senior program officer, The Commonwealth Fund

Dr. Collins and colleagues issued a report this week: "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help.” She has contributed an excerpt here for discussion.

Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health insurance in the United States. Often dropped from their parents’ policies or public insurance programs at age 19 or on graduation day, they are left to find insurance on their own as they make the transition from high school to work or college.

Yet, jobs available to young adults are usually low wage or temporary - the type that generally do not come with health benefits. Young adults who are able to go to college full-time may have some protection through their parents’ policies, but upon graduation usually lose access to family coverage.

The number of uninsured young adults ages 19 to 29 climbed to 13.7 million in 2004, an increase of 2.5 million since 2000. Young adults were the fastest-growing age group among the uninsured over this period, accounting for 40 percent of the increase in the uninsured under age 65. Even though they  comprise just 17 percent of the under-65 population, young adults account for 30 percent of the non-elderly uninsured.

Continue reading Rite of Passage?

Apr
28
2006

The first week of May is Cover the Uninsured Week, which is no easy task in Oregon where we have about 650,000 people without health insurance. But it is an essential task for the health of our community. And it is essential to realize that we are all part of this community that we call Oregon. Some people like to think of themselves as somehow separate, as if there is an “us” and a “them.” But the truth is that we are all “us” and the actions and decisions we make have impacts on the whole community, not just the parts of it that we choose to see.

Continue reading We're all in this together

Apr
20
2006

Kohler_1 Welcome to the health care reform blog. I look forward to sharing ideas and “blogging” with you about health care reform.

I have been privileged to serve as OHSU’s president since 1988 and, during this time, I’ve witnessed huge leaps in medicine. However, extraordinary medical breakthroughs and technology advances lose some of their luster when so many people can’t afford them. As you know, health care for many people is a serious economic challenge. In Oregon alone, over 600,000 people are uninsured. Hundreds of thousands of others are underinsured.

This is an unacceptable situation. I think we can all agree that everyone deserves access to basic health care. The question is: how do we as a society come together to create a health care system to achieve this? The answer to this question is not clear and the problems our current health care system faces are huge. But we must begin the process of change despite how daunting the task.

Continue reading The Computer Will See You Now

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