How the era of travel nursing has changed health care
https://www.vox.com/22936455/travel-nurses-health-care-covid
Tag: health
The hidden epidemic
“the overuse of antibiotics, whether in human patients or in livestock, results in bacteria adapting to the drugs, leading them to become less effective over time. If the pace of resistance isn’t halted — whether through more judicious use of the drugs or through the development of new classes of antibiotics — it will likely lead to soaring deaths from common infections and surgical complications, sending us back to a world where a minor cut could potentially once again be lethal.
We can avoid this fate, but it will require coordinating a global response before it’s too late.”
We’ll never have a normal flu season again
“Before the pandemic, the flu alone could sometimes push hospital systems into crisis mode, where they cancel elective procedures and limit other kinds of care. Now there’s Covid-19, which has done the same thing on its own.
Suddenly conjuring more hospital capacity every winter to handle the expected surges of flu and Covid-19 is not going to happen. Thousands of additional hospital beds are not coming in the next few years, and the US would not have the doctors and nurses to staff them anyway. It will take much longer — years or maybe decades — to improve the gaps in America’s health care infrastructure and workforce that have been exposed during Covid-19.
This means the imperative to “flatten the curve,” to limit the spread of these viruses to stop hospitals from being overwhelmed, will be with us for a long time. But the makeup of the curve will change, measuring multiple diseases instead of one.”
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“Vaccination is the best way to stop a bad Covid-and-flu season before it starts.”
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“Surveillance is critical, starting with early-warning systems. Public health institutions have long monitored the flu and they are already tracking Covid-19 in a similar manner. Monitoring the amount of virus detected in local wastewater has proven to be a reliable leading indicator of new Covid-19 waves during the pandemic. And widespread, reliable testing will be essential — including at-home tests for both Covid-19 and the flu.”
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“Frequent testing lets people know that they should isolate. If they are at higher risk of severe illness, they can get on antivirals quickly. The current therapies are most effective at stopping serious symptoms that could require hospitalization if they are taken within the first few days of an illness. Research in the last decade has found that flu antivirals are too often underprescribed for patients who would benefit most; improving prescription rates is only more critical now that the health system will be contending with both the flu and Covid-19 going forward.”
Congress is on the brink of an immense health policy failure
“The coronavirus pandemic has fully exposed the flaws in the US health care system and deepened many of its disparities. Yet there is a serious possibility, now that Sen. Joe Manchin (D-WV) has rendered the current version of the Build Back Better Act dead, that the current Congress will not pass any long-term provisions to cover more people, make health care more affordable, or better prepare the nation for the next pandemic.
Though they have not attracted as much attention as other parts of the legislation, Democrats had written a wide-ranging health care section in Build Back Better. They were planning to patch up holes in the Affordable Care Act, extending assistance to middle-class families as well as people in poverty; to reduce drug costs for millions of Americans; and to make investments in the country’s health care infrastructure, with the goal of better preparing the US for the inevitable next pandemic.”
Mexico’s ‘Junk Food’ Warning Labels Are Junk
“Mexico’s controversial, year-old, mandatory, front-of-package food warning label law was supposed to help Mexicans make healthier food choices and slash sky-high obesity rates in the country.
The law, which took effect one year ago this week, “requires black informational octagons to be placed on packaged foods that are high in saturated fat, trans fat, sugar, sodium[,] or calories.” Other requirements include that any food which must bear the dreaded black octagon “cannot include children’s characters, animations, cartoons, or images of celebrities, athletes[,] or pets on their packaging.”
Many food producers inside and outside Mexico opposed the labeling law, arguing it’s misleading, burdensome, and paternalistic. The Mexican government, though, claimed the law would lead Mexicans to eat 37 fewer calories per day, which would theoretically result in an average Mexican losing nearly four pounds per year. Some outside Mexico supported the labeling scheme, too. Last year, for example, a World Health Organization (WHO) regional office gushed over the black octagons and gave the Mexican government an award, calling the labels a “public health innovation” that is the “most advanced and comprehensive regulation worldwide.”
But early returns suggest the law’s impact has been negligible at best.
“More than a year after Mexico’s food warning label law took effect, sales of junk food and sugary beverages have not declined significantly, according to a market research firm and a business group,” Mexico News Daily reported last week. “In fact, sales of unhealthy products have increased in some cases, data shows.”
That’s the conclusion of a Mexico-based market research group, Kantar México, which tracks food purchases made by thousands of Mexican households each week. Mexico News Daily also notes that a Mexican government agency says purchases of treats such as candy, chocolates, and soda were higher this past September than they were in September 2020—the same month the WHO rewarded the Mexican government for its purportedly innovative efforts.
Despite the fact the law’s not working as advocates hoped and claimed it would, last week’s Mexico News Daily report notes a Mexican government official praised the labeling scheme as a success because “[c]onsumers are now more informed and empowered to make better choices.””
More And More Americans Are Smoking Pot. What Does That Mean For Their Health?
“Many of pot’s effects are tangled in contradictory research, but there are a few clear health risks to consuming the drug. Smoking cannabis regularly can cause bronchitis-like symptoms, and research published last month found that chronic cannabis users, defined as people who used pot at least four times a week for more than three years, had impaired pancreatic function. There have also been cases of daily cannabis users developing pancreatitis without having any other obvious risk factors.
Regular pot use has also been associated with higher rates of depression, anxiety and poorer life outcomes like being unemployed, but causality has not been established because other factors could predispose someone both to using cannabis and having a mental illness or not having a job.
There’s also evidence that cannabis can be dangerous when used in certain situations, like during pregnancy or while driving a vehicle. A recent study linked increasing rates of childhood leukemia to an increase in cannabis use, and a separate study found a correlation between women using cannabis while pregnant and their children having higher rates of anxiety. There’s also evidence that using pot while pregnant can lead to lower birth weights, although that evidence is still considered limited. And driving a car while high has been shown to moderately increase the risk of getting into a motor vehicle accident.
Addiction can be an issue as well. Some people who smoke pot develop what’s called cannabis use disorder (CUD), a clinical diagnosis of problematic and uncontrollable cannabis use. There’s evidence that CUD rates have increased since 2008, but Dr. Kevin Hill, an addiction psychiatrist and professor at Harvard Medical School, told FiveThirtyEight in an email that “it is still important to point out that most people who use cannabis don’t have a problem with it.”
The 2020 NSDUH found that 4.1 percent of people ages 12-17 met the criteria for CUD,1 13.5 percent of people ages 18 to 25 had the disorder, and 4 percent of people over age 26 had the disorder. Yet those numbers were below rates of alcohol use disorder across all age groups in 2020’s survey.
Deborah Hasin, an epidemiologist at Columbia University, said she is very concerned about adults’ increasing use of cannabis because CUD is associated with poorer quality of life, cognitive decline and impaired educational and occupational employment. Hasin’s research has found that 19.5 percent of people who use cannabis met the criteria of CUD in their lifetimes.
“It’s clear that not everybody who smokes marijuana has all of these problems, but the risk is there, and it’s a greater risk than people assume,” Hasin said.
Using cannabis frequently increases the risks of developing CUD, and frequent pot use is growing among adults. Monthly use for 26-to-34-year-olds has more than doubled since 2008, and the share of people getting at least five days a week increased from 5.8 to 13.8 percent between 2008 and 2019, according to NSDUH survey results.”
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“A 2016 study that followed a group of New Zealand adults for 20 years found that cannabis use was associated with worse gum health, but better cholesterol levels, lower BMI and reduced waist circumference.
Those results were further substantiated in a 2020 study that looked at cannabis use among people over the age of 60. Cannabis users in the study exercised more often and had a significantly lower BMI than non-users.
While there’s evidence that BMI, which measures only weight and height, is not the best way to gauge health for people who are normal weight or are slightly overweight, very high BMI scores are significantly associated with mortality.”
The US is about to make the same pandemic preparedness mistakes — again
“Outside experts have estimated that as much as $75 billion should be spent over 10 years on public health infrastructure, preparedness, and prevention.
The revised Build Back Better legislation totals roughly $10 billion in public health infrastructure and pandemic preparedness funding over the next few years — a down payment on better readiness, in Democrats’ view, but one without assurance of future installations.
“All too often, when there’s a crisis, the reaction is to put money into public health. Once the crisis subsides, the funding tends to dry up,” Ron Bialek, president of the Public Health Foundation, told me. “This is not a recipe for success.””
Can Health Regulation Move Beyond Markets?
“I document a large and mounting body of empirical research that shows that key market-based policies in health care have failed. Even if well intended, these policies have often not helped people make meaningful choices of medical care or insurance plans. And neither have they controlled spending, as experts promised.
In fact, they are doing exactly the opposite. They are setting people up to make poor choices and are scaffolding a massive, ineffective market bureaucracy.
One-third of people said they would rather file their taxes than read the terms of a health plan. And reams of studies summarized in my article affirm that people do not choose well among health insurance plan options, and these errors are hard to remedy with anything short of a strong default plan—in which case, one must ask whether “choice” even matters.
Likewise, even when people have to pay a large share of their own medical care and have easy access to price information, they still do not compare prices or choose the lowest-price options, even for services with little variation in quality. One partial explanation is that health care patients look to doctors—not price lists—to steer their care. Patients lack the desire, time, knowledge, and skills to navigate medical decisions as “consumers.”
The focus of the last several decades of health regulation has been to try to fix broken markets and flawed consumers through constant regulatory, technocratic tinkering—either to spur competition or to nudge consumers toward better choices. This tinkering has fallen short, and it has produced a massive market-based bureaucracy.
Thick layers of government regulations and regulators attempt to scaffold failing market-based policies. Plus, this scaffolding has deeply embedded private health care enterprises—with high profits and salaries—into the bureaucracy. As one example, the 2018 salary for the CEO of Blue Cross and Blue Shield of Michigan was recently reported to be $19 million, which is not an unusual sum among health care executives.
Because markets do not meaningfully enhance choice, do not avoid bureaucracy, and have certainly not solved cost problems, it is time to stop tinkering and to seek a better foundation for the next era of health policy and regulation.”
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“It is time to give up the false hope that health care markets and individual purchase decisions will produce a health care system that Americans want and, in the process, drive down spending. Policymakers have spent a half-century avoiding the hard questions about what values, objectives, and tradeoffs should guide health policy, by hoping that markets would magically answer these questions.
The reality is that the only way to build effective health policy—and, in turn, health regulation—is by engaging deeply in these hard questions and the challenging political battles they necessarily provoke.”
It Took More Than 15 Years for a South Carolina Hospital To Get Permission To Be Built
“Before being able to break ground on a new hospital there, Piedmont Medical Center had to navigate the state’s Certificate-of-Need (CON) process, which in this case required going all the way to the state Supreme Court to fend off a legal challenge from a competitor. All that to build a 100-bed facility that the South Carolina Department of Health and Environmental Control had determined, all the way back in 2004, was indeed needed in the region.
Unfortunately, “need” is not enough in many cases. Like how zoning laws and mandatory environmental reviews might be well-intentioned policies but are frequently wielded by “not in my backyard” (NIMBY) activists as a way to tangle new development in costly piles of red tape, the CON laws on the books in many states can be used by existing hospitals to delay or prevent new facilities from opening.
That’s exactly what happened in Fort Mill. A hospital chain based in Charlotte challenged Piedmont Medical Center’s plans for a new facility, then sued to block the state’s decision to give Piedmont permission to build the hospital. The litigation cost thousands of dollars and delayed construction by several years. Researchers at the Americans for Prosperity Foundation, a free market think tank, argue that even the threat of such lengthy, expensive reviews ends up deterring investments that would otherwise take place.”
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“Artificially limiting the supply of health care services can be a major issue when a pandemic or other emergency strikes, of course, but CON laws harm public health even without the help of a novel coronavirus. States with CON laws have higher mortality rates for patients with pneumonia, heart failure, and heart attacks, according to research published in 2016 by the Mercatus Center, a free market think tank that argues for repealing CON laws. Other studies show that CON laws contribute to health care shortages in rural areas because they force medical providers to focus on wealthier, more populated areas in order to make up for the added costs imposed by the CON process.”
Video Sources: Do high deductibles lower healthcare prices? Price Controls VS Managed Market Healthcare.
High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services Rajender Agarwal et al. 10 2017. HealthAffairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0610 Does High Cost-Sharing Slow the Long-term Growth Rate of Health Spending? Evidence from the States Molly Frean and Mark