Sunday, September 03, 2006

What uninsured crisis?

Post lifted from the Locker Room

A slide from the Duke University Center for Health Policy unintentionally offers some perspective on this week's Census report that 15.9% of Americans are without health insurance, the highest level since 1998 when 16.3% were uninsured. Nina Owcharenko thinks the best way to deal with the problem is to eliminate barriers in the individual market.


Despite exploding costs, most Americans got sizable life-extending bang for their medical bucks over recent decades, says one of the most sweeping studies ever of health-care value. That might come as a surprise to anyone who has ever shuddered over a medical bill, and the report itself raises doubts over how quickly costs have escalated. However, the study calculated that Americans of all ages spent an average of $19,900 on medical care for each extra year of life expectancy gained over the last four decades of the 20th century. And that cost is worth it, the study authors say. "On average, the return is very high," concludes study leader David Cutler, a Harvard University health economist. "But it's getting worse for ... in particular, the elderly."

The federally funded study by researchers at Harvard and the University of Michigan was being published Thursday in the New England Journal of Medicine. The researchers measured value by the cost of care that extends the average person's life by one year. The $19,900 spent for each extra year of life - when averaged over 40 years - would be widely considered a reasonable value. Many public and private insurers routinely pay for treatments that cost up to roughly $100,000 for each additional year of life. The researchers attribute this this relatively low cost for longer lifespan to things like cheap blood-pressure drugs that prevent heart attacks.

However, the study also outlines disquieting trends. It finds that inflation-adjusted costs from birth rose fivefold between the 1970s and 1990s, when the cost of an additional year of life span peaked at $36,300. That means each health care dollar of the 1990s, when expensive drugs made modest impact on cancer, bought a fifth as much real value as 20 years before, when cheaper medicines saved many lives.

Values deteriorated seriously for older people, the study finds. By the 1990s, 65-year-olds paid $145,000 for each additional year of life gained - a value that would be challenged for many individual treatments. These higher costs presumably come largely from end-of-life care that doesn't extend life very much.

Health policy chief Kathleen Stoll, of the advocacy group Families USA, said she believes the study suggests real value anyway. "Each increment of gain is more expensive now, but certainly very valuable to the person involved and their family," she said.

Others were troubled. "The fact that someone is writing this paper shows how desperate the health care system is to justify these out-of-control increases in health spending," said consumer advocate Dr. Sidney Wolfe, who heads health research at Public Citizen.

The researchers admit their calculations give only a partial picture of value. They started by calculating average changes in both medical spending and life expectancy for various age groups in each decade. Then they divided changes in spending by changes in life expectancy, yielding the cost per year of life gained. But many factors extend life apart from medical care, like not smoking or keeping extra weight off. So the researchers turned to previous studies suggesting that about half of all gains in lifetime stem from medical care - and adjusted their findings accordingly.

Even the researchers acknowledge this adjustment could be off. Others familiar with their findings said their calculations - while potentially useful for the big picture - had to overlook other important factors, like the impact of care on quality of life and the amount of waste in the medical system. "It really doesn't tell you whether we are spending too much on what doesn't matter and too little on what does," said Dr. Harlan Krumholz, a cost-effectiveness expert at Yale University. Others worried about future costs, though the study makes no projections. "The growth in medical spending is unsustainable over time - both in terms of absolute dollars and the benefit it yields," said health care analyst Steven Findlay at Consumers Union.


A negligent Australian public hospital

This time in the State of New South Wales

A father who lost his son to meningococcal disease is suing a South Coast hospital after it allegedly twice sent him home with his sick child. Nicholas Constantini, 5, died 48 hours after his father first took him to the Shoalhaven Memorial District Hospital in January last year. Yesterday his father, Roy Constantini, of Nowra, sued in the NSW District Court, claiming damages for psychiatric injury he has suffered since his son's death.

In a statement of claim filed with the court, he alleges the hospital was negligent in its treatment of his son, and in the advice given to him about his son's symptoms. Among its alleged failures were a failure to follow public health and NSW guidelines for the early treatment of meningococcal disease, a failure to administer intravenous antibiotics and failure to conduct appropriate tests. "Had Nick been provided with adequate treatment he would have survived," said Mr Constantini's solicitor, Stephen Thornton.

Speaking from his home yesterday, Mr Constantini said he and his sister had first taken Nicholas to the hospital about 10am on a Thursday. He said the hospital administered some tests, and gave him Panadol. They were told they could all go home about 3pm.

Mr Constantini said after leaving hospital his son began to vomit, so he returned to the hospital at 6pm, and was told the boy had an allergy. By the next morning he said his son had difficulty breathing and walking. He took him back to the hospital at 10am where, not long after, he convulsed and went into a coma from which he did not wake.

Mr Constantini said his son was flown to Sydney that night but died on Saturday morning. "I was angry. I was in shock. I had a sick child and I trusted the doctors, too. I believed them," he said. "I want everybody to know about this. I don't want it to happen to another child."



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


No comments: