Health Affairs, 26, no. 3 (2007): 877-879 doi: 10.1377/hlthaff.26.3.877 © 2007 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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GrantWatch

EDITOR’S NOTE: Some parts of the GrantWatch section are published on the Web only. The online-only material includes selective coverage of both recently announced grants and publications about or funded by foundations. (Reporting of selected grant outcomes and key personnel changes at foundations, as well as GrantWatch essays, reports, and interviews, continue to be published in both print and online form.)

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GrantWatch is funded in part by the Robert Wood Johnson Foundation and The California Wellness Foundation.

California Health Policy

Recent report:

Tracking the Supply of Health Professions Education Programs in California, Timothy Bates and Susan A. Chapman of the University of California, San Francisco (UCSF), Center for the Health Professions, April 2007, 53 pp., http://futurehealth.ucsf.edu/pdf_files/HWTC%20Tracking%20the%20Supply%204-16-07.pdf. Funded by the California Endowment (TCE), the California Wellness Foundation (TCWF), and the California HealthCare Foundation (CHCF). “Educational institutions in the state that produce graduates of specific professional/vocational programs are an important link in identifying the total number of available workers in each health profession,” this report says. This effort aimed “to map the ‘education link’ in California’s supply chain” for certain professions. The report projects that over the period 2004–2014, the registered nurse, physical therapy, and diagnostic medical sonographer professions in California would grow “much faster than average.” The report points out that “changes in the regulatory environment, or actions undertaken by professional associations or other stakeholder groups, play a significant role in shaping the supply of graduates from health professions education programs.” Also, the researchers found that “for almost all” of the professions they studied, “median wages are higher for professionals in California” compared with the comparable figures for the United States “as a whole.”

Resources on California health policy: immigrant health care:

“Immigrants and the Cost of Medical Care,” Dana P. Goldman, James P. Smith, and Neeraj Sood, Health Affairs Nov/Dec 06, http://content.healthaffairs.org/cgi/content/abstract/25/6/1700. This DataWatch uses data from the Los Angeles Family and Neighborhood Survey (LAFANS), which includes “detailed information on immigrants’ legal or visa status.” Such information is “frequently missing” in surveys, the authors note. Exhibit 4 in this paper contains estimates of “total annual medical spending” in 2000 “for native- and foreign-born nonelderly adults” in Los Angeles County and in the United States. The research for this paper was supported by the Robert Wood Johnson Foundation (RWJF).

“Legal Status and Health Insurance among Immigrants,” Dana P. Goldman, James P. Smith, and Neeraj Sood, Health Affairs Nov/Dec 05, http://content.healthaffairs.org/cgi/content/abstract/24/6/1640. This DataWatch also uses data from LAFANS. The RWJF also supported this research.

“Mexico’s Health Czar Seeks Better Care for Mexicans in California: ‘We Can Build a New Model’ for Insurance,” Tyche Hendricks, San Francisco Chronicle, 24 April 2007, http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/04/24/BAGA7PE9SB1.DTL&hw=Mexico+health+czar&sn=001&sc=1000. This article discusses a 23 April 2007 visit to the San Francisco Bay area by Mexico’s new secretary of health, Jose Angel Cordova Villalobos. The Chronicle reports that Cordova “plans to meet every six months with U.S. health officials and Mexican immigrant communities” to discuss health care for Mexicans in the United States. The article paraphrases a comment by Mario Gutierrez of TCE: “Californians should care about the health of immigrant workers because the state’s economy relies on their labor.” He reminds readers that “if we can provide basic essential services to keep people healthy, we’re not going to be paying for more catastrophic issues later on.” Gutierrez also suggested that this visit by Cordova, early in the administration of new Mexican president Felipe Calderon, means that Mexico will continue to seek ways to share the responsibility of health care for Mexican immigrants working in the United States. The article also notes that TCE “is trying to help craft a basic health insurance policy for Mexican immigrants.”

In a May 2007 follow-up interview with Health Affairs to update the situation, Gutierrez said that Cordova plans to attend the next Binational Health Week Policy Summit, which is expected to be held at TCE in Los Angeles in October 2007. Binational Health Week is a project of the Health Initiative of the Americas (formerly called the California-Mexico Health Initiative), which has received funding from the endowment, the CHCF, TCWF, and others. Gutierrez explained that President Calderon “has embraced” the comprehensive health plan “for all Mexican citizens in Mexico,” called Seguro Popular, created by the previous health minister, Julio Frenk (who now works for the Bill and Melinda Gates Foundation). The plan “has been evolving slowly for the last three years, but it’s only been in the last year that enrollment has reached significant levels,” Gutierrez said. Mexican workers in the United States can buy into the plan for their families “back home and for themselves, if and when they return to Mexico.”

Gutierrez told the journal that TCE’s goal “is to find the common ground between employers, workers, providers (in particular, community clinics), private health plans, Mexico,” and maybe county governments and the state and federal governments “to cobble together a more seamless health plan [for Mexican workers in the United States] with everyone sharing some cost.” He said that making this “a reality is a challenge” in today’s political climate. However, “despite this, we’re moving the agenda along and hope to be closer to reality” later in 2007 once all “the politics” of immigration and California health care reform “play out,” Gutierrez commented.

Prescription Drugs

Recent grant:

Alzheimer’s Drug Discovery Foundation (ADDF), New York, NY. The ADDF, a public charity founded by the Estee Lauder family, will allocate this “lead contribution” for a new Fund for Alzheimer’s Drug Discovery, according to a 10 May 2007 press release. This fund’s purpose is to be “a catalyst” for early-stage drug discovery research for Alzheimer’s disease by “making venture philanthropy grants to biotechnology companies and academic research centers.” Aetna’s chairman and chief executive officer, Ronald A. Williams, noted in the release that “this represents an innovative approach to spurring [on] meaningful research that will expedite finding a cure for Alzheimer’s.” According to a grantee fact sheet, 40 percent of people over age eighty suffer from Alzheimer’s disease.

$1 million. Funded by the Aetna Foundation. This funding is based on the Fund for Alzheimer’s Drug Discovery’s “success in fundraising and identification of research through April 2011,” according to an ADDF spokesperson.

Recent reports:

Extending the Cure: Policy Responses to the Growing Threat of Antibiotic Resistance, Ramanan Laxminarayan of Resources for the Future and Anup Malani of the University of Chicago, with David Howard of Emory University and David L. Smith of the National Institutes of Health (NIH), released March 2007, 192 pp., http://www.extendingthecure.org/research_and_downloads.html. Partially funded by the RWJF. A bound copy of the report can be purchased for $23.95 from Resources for the Future Press.

This “inaugural report” is an outcome of the Extending the Cure project, “a research and consultative effort that frames the growing problem of antibiotic resistance as a challenge in managing a shared societal resource”; that resource is antibiotic effectiveness. The authors “examine the problem of antibiotic resistance from a natural resources perspective and propose solutions from an incentive-based perspective.” Incentives are needed “for patients, physicians, hospitals, and pharmaceutical companies.” The authors “evaluate policy options that will enable society to make the best use of existing antibiotics, sensibly encourage the discovery of new antibiotics, and give drug companies a greater incentive to sell these new drugs responsibly.” However, they note that “the information needed to evaluate each option fully” is lacking, such as “the ability to rank” options by “cost-effectiveness or economic efficiency.” (Research leading to the report “did not explicitly address the problem of antibiotic overuse in agriculture,” although that is also an important topic, the authors note; the focus here is “on antibiotic use in medicine.”)

Among the five components of the “comprehensive strategy” described in the report are “discouraging inappropriate antibiotic use by changing how patients are reimbursed for antibiotic prescriptions and how physicians are paid for prescribing them”; reducing “the need for some uses of antibiotics” by improving hospital infection control “and vaccinating against common infections”; and “encouraging research and development into new antibiotics.” Here is one good example, from the report, of the highlighted “tension between individual good and collective good” in the antibiotic debate. “The average patient” with a cold “wants immediate relief” and views an antibiotic prescription “as the ticket to recovery,” and the physician, unfortunately, “may be only too happy to oblige if writing it benefits her practice.” The problem here is that neither the patient nor doctor “may consider that antibiotic use by one patient eventually reduces the drug’s effectiveness for everyone,” the authors explain. They specifically suggest that “a national requirement for childhood pneumococcal vaccinations and a lower vaccine price could greatly reduce” the demand for antibiotics for children under age five. Also, the report comments that “investment in antibiotics appears to be declining”—development of such drugs lately “has been limited mainly” to addressing methicillin-resistant Staphylococcus aureus (MRSA). Laxminarayan explained to Health Affairs that “more work is needed on some of the [policy] options (such as incentives for lowering prescribing), but we have pretty good evidence on others,” such as vaccinations to lower the need for antibiotics.

Beyond the five components, the authors also say in the report that “comprehensive antibiotic effectiveness legislation may be needed to protect a long-term sustainable future for antibiotic use.” Explicit recognition of the resistance problem in the federal budget “and naming a lead [federal] agency would allow a coordinated government strategy to implement demand-side (antibiotic use) and supply-side (new antibiotic development) efforts.”

Now, early in the twenty-first century, “the rapid rate of emergence and spread of bacterial pathogens resistant to antibiotics threatens to return us to an era when common infections were untreatable,” the report solemnly warns. Citing statistics from a 2003 report chapter written by Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC), the authors say that “more than 63,000 patients in the United States die every year from hospital-acquired bacterial infections that are resistant to at least one common antibiotic.” Antibiotic-resistant infections also exact “a significant financial cost on patients, health care systems, and society.” The report maintains that despite calls for action in the past, “policymakers have taken astonishingly little action.”

The RWJF awarded a grant in 2005 for the Extending the Cure project and the Phase I report described above as part of its Pioneer Portfolio, “which supports innovative projects that may lead to breakthrough improvements in health and health care,” explains the foundation’s April 2007 Advances e-newsletter. Paul Tarini, who manages that portfolio at the RWJF, commented in the funder’s “Pioneering Ideas” blog that the foundation was “intrigued” by Laxminarayan’s “original proposal” for a paper on antibiotic resistance and even “worked with him to use the paper concept as a platform to build a bigger project.” Tarini says that one result is the report; “another is a core group of stakeholders and advisors . . . who can help refine and promote” the “new approach” described in the report. The RWJF considers the project “a near-term success,” he says, while understanding that the policy options are “well-realized but untested and unimplemented.”

Medication Use by Aged and Disabled Medicare Beneficiaries across the Spectrum of Morbidity: A Chartbook, Bruce Stuart, Linda Simoni-Wastila, Ilene Zuckerman, Jalpa Doshi, Dennis Shea, Thomas Shaffer, and Lirong Zhao, 9 May 2007, 264 pp., including appendices, http://www.pharmacy.umaryland.edu/lamy/Chartbook.html. Funded by the Commonwealth Fund. This chartbook was published by the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy; most of the authors are affiliated with the Lamy Center. This publication, which can be ordered in hard-copy format by e-mailing cweaver{at}rx.umaryland.edu, “examines patterns of prescription drug utilization among Medicare beneficiaries” before the implementation of Part D, according to a 30 May 2007 Commonwealth e-alert. “The research provides a baseline comparison for researchers and policymakers to use in efforts to improve Part D, the Medicare program, and the effectiveness of health care for Medicare beneficiaries.” The researchers used data from the Medicare Current Beneficiary Survey.

Related resources:

“TB Patient: Quarantine Conditions ‘Insane”: Feds Frantically Search for 80 Passengers, 27 Crew on Flights with Infected Man,” CBS News/Associated Press, 31 May 2007, 2:15 p.m., http://www.cbsnews.com/stories/2007/05/30/health/main2866105.shtml. The man in question is infected with extensively drug-resistant tuberculosis (XDR TB), a “rare, dangerous strain” of TB. A link to a helpful Tuberculosis Fact Sheet is included. Using information from the CDC, AP, and CBS, it notes that TB “is a disease caused by bacteria called Mycobacterium tuberculosis” and that “the increasing occurrence of drug-resistant TB presents significant challenges to treatment and control of the disease both in the U.S. and abroad.” Also, the CDC’s Web site contains a section on XDR TB. The agency says that XDR TB “is resistant to almost all drugs used to treat TB, including the two best first-line drugs: isoniazid and rifampin,” as well as “the best second-line medications.” Rifampin is an antibiotic.

“Doctors, Legislators Resist Drugmakers’ Prying Eyes,” Christopher Lee, Washington Post, 22 May 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/05/21/AR2007052101701.html. This article examines “drugmakers’ common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities.” Many physicians object to the practice, Lee writes, but the pharmaceutical “industry defends [it] as a way of better educating physicians about new drugs.” New Hampshire tried “to curtail the practice,” but a federal district judge ruled that its law was unconstitutional. The article says that according to the National Conference of State Legislatures, “more than a dozen states have considered" legislation “similar” to that passed in New Hampshire.