Tag: healthcare
Medical debt was cut nearly in half in states that expanded Medicaid
“The Affordable Care Act offered states a huge infusion of federal money to expand Medicaid eligibility to low-income adults, and about 30 states took that deal right away in 2014. Since then, new medical debt in those states has fallen 44 percent, a dramatically bigger drop than was seen in the states that refused to expand the program over the same period. Those states showed only a 10 percent decline.”
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“nonmedical debt had fallen by similar amounts in expansion and non-expansion states over the time period they studied, 2009 to 2020, strengthening the case that Medicaid expansion was the difference with medical debt.”
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“In states that expanded Medicaid, both the lowest- and highest-income groups saw their medical debt drop after expansion, but the amount of medical debt added annually decreased much more for the former (by $180, from $458 to $278) than the latter (by $35, from $95 to $60).
In non-expansion states, on the other hand, the lowest-income group averaged a $206 average increase in new medical debt, from $630 to $836. But the highest-income bracket still saw a small decline in new debt for medical care.”
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“Those states are concentrated in the South. Eight of the 12 non-expansion states are in the region. Nearly one in four Southerners have some medical debt in collections listed on their credit report, compared to 10.8 percent of people in the Northeast and 12.7 percent in the West.”
Alabama’s Dumb Health Care Regulations Helped Create a Shortage of ICU Beds
“An insufficient supply of ICU beds is one of the acute crisis points of the pandemic. When hospitals run out of room to treat patients who need the most help, doctors and hospital administrators must make difficult triage decisions. This affects not just COVID patients but anyone else who might be in urgent need of medical care—car crash victims or those who’ve had heart attacks—and it almost certainly means that some people will die who otherwise may have survived.
It’s a crisis that has been made worse by outdated and ineffective government regulations—known as “Certificate of Need” (CON) laws—that actually reduce the number of available hospital beds by requiring that hospitals get permission from the state before adding capacity.
In Alabama, which is one of 27 states that subjects the supply of hospital beds to CON oversight by the state, we’re now seeing some of the consequences of these rarely thought-of policies. While the surging number of serious COVID cases there and elsewhere across the country is largely the result of unvaccinated Americans being hit by the highly contagious delta variant, a restricted supply of hospital beds is not helping.
Since March 2020, states that use CON laws to regulate the supply of hospital beds have seen an average of 14.99 days per month where ICU capacity has exceeded 70 percent, according to Matthew Mitchell, a senior research fellow at the Mercatus Center who crunched Department of Health and Human Services (HHS) data and shared his findings with Reason. Meanwhile, states that do not have CON laws governing the supply of hospital beds have seen an average of just 8.65 days per month with ICU capacity exceeding 70 percent, according to Mitchell.”
Covid-19 isn’t the reason that US life expectancy is stagnating
“The stagnation in life expectancy isn’t due to some natural limit of human lifespans. In 2019, life expectancy was 84.4 in Japan, 83 in France, and 81 in the United Kingdom and Germany. The US, with its life expectancy of 78.8 years, was already lagging before the pandemic.”
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“The relatively poor health of the US is rooted in “fundamental causes,” according to epidemiologists Bruce Link and Jo Phelan. These are the social conditions like economic inequality and racial segregation that worsen some illnesses and reduce access to health care. In the US, solutions could also include policies that replace jobs in towns and cities that have been hollowed out by globalization and deindustrialization. The dignity of meaningful work can improve health.
Of course, we should not ignore the gains that can be made within medicine. I don’t mean high-profile technological advances that will make headlines or boost the bottom line of new biotech startups. I mean routine and preventive care that can detect disease early, help get patients into treatment, and provide a trusted source of medical advice.
Rather than wringing our hands about the Covid-19 life-expectancy dip, the US should be passing laws and expanding programs that draw medical workers into primary and preventive care, not least by paying them more. This is especially true in rural areas with aging populations and a shortage of doctors. Training more Black doctors, especially in obstetrics and gynecology, may lead to dramatic improvements in the shamefully bad maternal health outcomes among Black women in the US.
By focusing on one historical measure of years lost to the pandemic, we run the risk of dwelling on what we can’t change and ignoring what we can improve. If you want the next generation to live longer and healthier lives, one of the best things you can do is push for economic and health care policies that reduce economic and racial inequality, and help ensure that every person has access to the kind of world-class, routine health care that saves lives. Let’s give the demographers of 2110 something to celebrate.”
Will the Taliban roll back two decades of public health progress in Afghanistan?
“relatively little attention has been paid to what the Taliban victory will mean for one of the nation’s biggest accomplishments: the sharp decline in child and maternal mortality over the past two decades.
A study in The Lancet Global Health found that between 2003 and 2015, child mortality in Afghanistan fell by 29 percent. While maternal mortality is difficult to estimate, one data set found that deaths in childbirth fell from 1,140 per 100,000 in 2005 to 638 per 100,000 in 2017, or nearly in half.
This progress was not necessarily all generated by the US-led occupation, with aid from international organizations and Afghan-led initiatives contributing heavily; and these estimates rely on household surveys that are difficult to conduct well, especially in poor, war-torn countries with large nomadic populations, meaning they are likely off to some degree.”
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“The best-case scenario would be a continued emphasis on the health of women and children, expansion of the developing public health sector — including nutrition, water, sanitation, and housing — and attention to the emerging problem with chronic or noncommunicable diseases.
The health workforce needs continuing support. Things can go bad if restriction of women, both as a health focus and in the workforce, occurs and ideology starts getting in the way of health programming. The health of Afghanistan cannot move forward without continuing external support, and this is likely to be required for some years to come, regardless of who is the government. A plunge back into war and instability is the very worst case imaginable for the health of the country”
States gripped by Delta variant face case surge with fewer health workers
“Hospitals and lawmakers in states gripped by the Delta variant are offering nurses tens of thousands of dollars in signing bonuses, rewriting job descriptions so paramedics can care for patients and pleading for federal help to beef up their crisis-fatigued health care workforces.
The alarming spread of new cases is draining the pool of available health workers in ways not seen since the pandemic’s winter peak, forcing officials to improvise and tear up rules dictating who cares for whom. Governors and hospital directors warn that the staffing crisis is so acute that patients, whether suffering from Covid-19, a heart attack or the effects of a car accident, can no longer expect the level of care that might have been available six weeks ago.”
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” Hospitals can respond by adding beds and ordering more protective gear. But they’re stuck fighting over the same finite pool of nurses, lab techs, nurse assistants and front desk workers, whose ranks have already been depleted by retirements and resignations. The Delta variant’s transmissibility — the U.S. is averaging 140,000 cases per day, up from 12,000 six weeks ago — is leaving few regions untouched, making it harder to call for reinforcements.”
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“Some nurses say hospitals facing surges are paying more to recruit new nurses, or hire temps from a staffing agency, than to retain the current staff. Some new hires can receive $20,000 signing bonuses while current staff get a $500 retention bonus, said Jamie Lucas, the executive director of the Wisconsin Federation of Nurses and Health Professionals, which is bargaining with multiple hospitals for bigger retention bonuses.”
Health insurers are threatening not to cover some patients’ ER bills
https://www.vox.com/2021/7/1/22557401/united-healthcare-emergency-room-visits-medical-bills
The US health system was already falling short. Then Covid-19 happened.
https://www.vox.com/policy-and-politics/22555949/us-health-care-system-ranking-covid-19-pandemic
Covid-19 made America’s long-term care crisis impossible to ignore
“The vast majority of Americans want to age in their home and community, spending their twilight years in a familiar and comfortable setting. But the choice is not always their own.
The US long-term care system — such as it is — is broken. Hundreds of thousands of Americans are on waiting lists for home-based care. More than 40 million people report that they have cared for a loved one over 50 without any pay in the last year. The United States ranks near the bottom of developed economies in the number of older adults who receive long-term care at home. Meanwhile, America’s nursing homes are staffed by overwhelmed and underpaid workers, and for-profit takeovers of those facilities have led to worse care for patients.
Covid-19 has made this long-term care crisis impossible to ignore. More than 130,000 nursing home residents have died in the pandemic, accounting for nearly one in four US deaths. Residents of large institutions died at higher rates than those who live in the community.
In America, aging people who need care — in a nursing facility or at home — either must be wealthy enough to pay for it themselves or must deplete their income and assets enough that they qualify for Medicaid. Almost by accident, the health insurance program for low-income Americans has become the main payer for nursing home and home-based care. Experts describe long-term care in the US with a sense of disbelief.
“If you were starting from scratch, you would never design a system this way,” David Grabowski, a Harvard professor who studies the economics of long-term care, told me.
Tricia Neuman, who studies long-term care at the Kaiser Family Foundation, put it even more baldly: “We do not have a system of long-term care in our country.”
America has been struggling for decades to figure out a balance between having people age in long-term care facilities and age at home. President Joe Biden has proposed a massive infusion of federal spending on home-based care. Experts say it should start to address these structural problems — but it’s only a start.”
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“More than three in four people over the age of 50 said in a 2018 AARP survey they want to stay in their community as long they can. But fewer than half thought that would be possible — and many of them may end up being right, as the long waiting lists for home- and community-based services attest. As of February 2020, more than 820,000 Americans were stuck on their state Medicaid program’s waiting list for home- and community-based services, according to the Kaiser Family Foundation, and their average wait time is longer than three years.
Even for those lucky enough to be able to afford in-home care, the US long-term care system hasn’t done them any favors. Virginia Veliz, a 70-year-old in Santa Clarita, California, has been coordinating care for her 90-year-old mother, who has Lewy body dementia and Parkison’s disease, for the past five years.
“You really have to treat it like a job,” she said.”
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“There are some people for whom institutional care makes sense — those with severe cognitive decline, for example. Others might simply prefer to live in a nursing home with other people instead of living alone at home.
But the idea is that it should be the patient’s choice. The US still has not found a way to put that decision entirely in the patient’s hands.”
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“Prioritizing home-based care appears to be the preferred solution for both patients and policymakers. But it will cost money. The Netherlands, Norway, and Sweden are considered global leaders in providing community-based services, but they also spend a substantially higher share of their GDPs on long-term care (around 3 percent) than the US (0.5 percent).”