Health Affairs current issue

Hospital Governance And The Quality Of Care [Web Exclusives]

Jha, A. K., Epstein, A. M. — Fri, 06 Nov 2009 00:55:54 PST

Hospitals' boards may influence the quality of care that hospitals provide, but their engagement in quality-related issues is largely unknown. We surveyed a nationally representative sample of board chairs of 1,000 U.S. hospitals to understand their expertise, perspectives, and activities in clinical quality. We found that fewer than half of the boards rated quality of care as one of their two top priorities, and only a minority reported receiving training in quality. The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals. [Health Aff (Millwood). 2010;29(1): published online 6 November 2009; 10.1377/hlthaff.2009.0297]

Understanding The Current Population Survey's Insurance Estimates And The Medicaid 'Undercount' [Web Exclusives]

Klerman, J. A., Davern, M., Call, K. T., Lynch, V., Ringel, J. D. — Mon, 02 Nov 2009 17:03:47 PST

The widely cited Census Bureau estimates of the number of uninsured people, based on the Current Population Survey, probably overstate the number of uninsured people. This is because of a Medicaid "undercount": Fewer people report to survey takers that they’re covered by Medicaid than program administrative data show are enrolled. Our study finds that the undercount can be explained by the inability of people to recall their insurance status accurately from the previous year. We suggest that other data sources, such as Census’s American Community Survey, should be studied to determine whether they would provide better estimates of the uninsured.

Job-Based Health Insurance: Costs Climb At A Moderate Pace [Web Exclusives]

Mon, 02 Nov 2009 17:03:47 PST

Each year the Kaiser/HRET Survey of Employer Health Benefits takes a snapshot of the state of employee benefits in the United States, based on interviews with public and private employers. Our findings for 2009 show that families continue to face higher premiums, up about 5 percent from last year, and that cost sharing in the form of deductibles and copayments for office visits is greater as well. Average annual premiums in 2009 were $4,824 for single coverage and $13,375 for family coverage. Enrollment in high-deductible health plans held steady. We offer new insights about health risk assessments and how firms responded to the economic downturn.

How A New 'Public Plan' Could Affect Hospitals' Finances And Private Insurance Premiums [Web Exclusives]

Dobson, A., DaVanzo, J. E., El-Gamil, A. M., Berger, G. — Mon, 02 Nov 2009 17:03:47 PST

Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums.

Containing Costs And Improving Care For Children In Medicaid And CHIP [Web Exclusives]

Kenney, G. M., Ruhter, J., Selden, T. M. — Mon, 02 Nov 2009 17:03:47 PST

The current health reform debate is greatly concerned with "bending the curve" of cost growth and containing costs, particularly in public programs. Our research demonstrates that spending in Medicaid and the Children’s Health Insurance Program (CHIP) is highly concentrated, particularly among children with chronic health problems. Ten percent of enrollees (two-thirds of whom have a chronic condition) account for 72 percent of the spending; 30 percent of enrolled children receive little or no care. These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children.

Portrait Of A Policy And Political Entrepreneur [Web Exclusives]

Blumenthal, D. — Mon, 02 Nov 2009 17:03:47 PST

Senator Edward M. Kennedy: The Master Legislative Craftsman [Web Exclusives]

Nexon, D. — Mon, 02 Nov 2009 17:03:47 PST

Senator Edward M. Kennedy: Making Common Cause With Adversaries While Committed To Health Reform [Web Exclusives]

Marmor, T. R. — Mon, 02 Nov 2009 17:03:47 PST

The Dangerous Shortage Of Domestic Violence Services [Web Exclusives]

Iyengar, R., Sabik, L. — Mon, 02 Nov 2009 17:03:47 PST

Domestic violence is a serious, preventable health problem affecting more than thirty million Americans annually, yet little is known about federally funded service provision. We used the National Census of Domestic Violence Services, an innovative victim-safety focused survey, to count services provided by more than 2,000 programs. During the twenty-four-hour survey period, 48,350 people used these services. The results show substantial unmet demand for services (10 percent of requests) because of resource constraints, particularly in rural, economically disadvantaged, and minority communities. Greater funding of domestic violence programs, particularly housing support, is likely to be a cost-effective public health investment.

Closing The Schools: Lessons From The 1918-19 U.S. Influenza Pandemic [Web Exclusives]

Stern, A. M., Cetron, M. S., Markel, H. — Mon, 02 Nov 2009 17:03:47 PST

When the novel strain of A/H1N1 influenza first appeared in spring 2009, closing schools was initially a common and often challenging strategy implemented in many communities. Arguments for and against closing schools are likely to arise anew if influenza spikes in the fall of 2009. Policymakers and community officials considering this and other nonpharmaceutical responses can learn from the experiences of ninety-one years ago, during the 1918–19 influenza pandemic that killed thousands of Americans. Analysis of the school closure policies of forty-three U.S. cities during that pandemic shows that smooth implementation was associated with clear lines of authority among agencies and with transparent communication between health officials and the public.

Massachusetts Health Reform: Employer Coverage From Employees' Perspective [Web Exclusives]

Long, S. K., Stockley, K. — Mon, 02 Nov 2009 17:03:47 PST

The national health reform debate continues to draw on Massachusetts’ 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers’ responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers’ dropping coverage or scaling back benefits under health reform have not been realized. Access to employer coverage has increased, as has the scope and quality of their coverage as assessed by workers. However, premiums and out-of-pocket costs have become more of an issue for employees in small firms.

Zoning For Health? The Year-Old Ban On New Fast-Food Restaurants In South LA [Web Exclusives]

Sturm, R., Cohen, D. A. — Mon, 02 Nov 2009 17:03:47 PST

A regulation banning new fast-food establishments for one year in Los Angeles, California, was passed unanimously by the city council in July 2008. It was motivated by health concerns and excessive obesity rates in South Los Angeles. However, it might not have had the impact that was intended. This paper reviews the empirical evidence for the regulation and whether it is likely to target the primary levers of obesity. We argue that the premises for the ban were questionable. For example, the density of fast-food chain restaurants per capita is actually higher in other parts of Los Angeles than in South LA. Other changes, such as menu calorie labeling, are likely to have a bigger impact on overweight and obesity.

New York City's Fight Over Calorie Labeling [Web Exclusives]

Farley, T. A., Caffarelli, A., Bassett, M. T., Silver, L., Frieden, T. R. — Mon, 02 Nov 2009 17:03:48 PST

In 2006, New York City’s Health Department amended the city Health Code to require the posting of calorie counts by chain restaurants on menus, menu boards, and item tags. This was one element of the city’s response to rising obesity rates. Drafting the rule involved many decisions that affected its impact and its legal viability. The restaurant industry argued against the rule and twice sued to prevent its implementation. An initial version of the rule was found to be preempted by federal law, but a revised version was implemented in January 2008. The experience shows that state and local health departments can use their existing authority over restaurants to combat obesity and, indirectly, chronic diseases.

Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City [Web Exclusives]

Elbel, B., Kersh, R., Brescoll, V. L., Dixon, L. B. — Mon, 02 Nov 2009 17:03:48 PST

We examined the influence of menu calorie labels on fast food choices in the wake of New York City’s labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.

Adoption And Spread Of New Imaging Technology: A Case Study [Web Exclusives]

Ladapo, J. A., Horwitz, J. R., Weinstein, M. C., Gazelle, G. S., Cutler, D. M. — Mon, 02 Nov 2009 17:03:48 PST

Technology is a major driver of health care costs. Hospitals are rapidly acquiring one new technology in particular: 64-slice computed tomography (CT), which can be used to image coronary arteries in search of blockages. We propose that it is more likely to be adopted by hospitals that treat cardiac patients, function in competitive markets, are reimbursed for the procedure, and have favorable operating margins. We find that early adoption is related to cardiac patient volume but also to operating margins. The paucity of evidence informing this technology’s role in cardiac care suggests that its adoption by cardiac-oriented hospitals is premature. Further, adoption motivated by operating margins reinforces concerns about haphazard technology acquisition.

Magnetic Resonance Imaging And Low Back Pain Care For Medicare Patients [Web Exclusives]

Baras, J. D., Baker, L. C. — Mon, 02 Nov 2009 17:03:48 PST

Magnetic resonance imaging (MRI) is a technology frequently used to evaluate low back pain, despite evidence that challenges the usefulness of routine MRI and the surgical interventions it may trigger. We analyze the relationship between MRI supply and care for fee-for-service Medicare patients with low back pain. We find that increases in MRI supply are related to higher use of both low back MRI and surgery. This is worrisome, and careful attention should be paid to assessing the outcomes for patients.

Uninsured Adults With Chronic Conditions Or Disabilities: Gaps In Public Insurance Programs [Web Exclusives]

Pizer, S. D., Frakt, A. B., Iezzoni, L. I. — Mon, 02 Nov 2009 17:03:48 PST

Among nonelderly U.S. adults (ages 25–61), uninsurance rates increased from 13.7 percent in 2000 to 16.0 percent in 2005. Despite the existence of public insurance programs, rates remained high for low-income people reporting serious health conditions (25 percent across years) or disabilities (15 percent). Residents of southern states had even higher rates (32 percent with health conditions, 22 percent with disabilities). Those who did not belong to a federally mandated Medicaid eligibility category were about twice as likely as others to be uninsured overall, and uninsurance among this group increased more rapidly over time. These regional and categorical differences reflect gaps in current policy that pose challenges for incremental health reform.

Hypertension, Diabetes, And Elevated Cholesterol Among Insured And Uninsured U.S. Adults [Web Exclusives]

Mon, 02 Nov 2009 17:03:48 PST

In this paper we explore whether uninsured Americans with three chronic conditions were less likely than the insured to be aware of their illness or to have it controlled. Among those with diabetes and elevated cholesterol, the uninsured were more often undiagnosed. Among hypertensives and people with elevated cholesterol, the uninsured more often had uncontrolled conditions. Undiagnosed and uncontrolled chronic illness, which is common among insured people, is even more frequent among the uninsured.

Evidence Of An Emerging Digital Divide Among Hospitals That Care For The Poor [Web Exclusives]

Mon, 02 Nov 2009 17:03:48 PST

Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.

A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences [Web Exclusives]

Schoen, C., Osborn, R., Doty, M. M., Squires, D., Peugh, J., Applebaum, S. — Mon, 02 Nov 2009 17:03:48 PST

This 2009 survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States finds wide differences in practice systems, incentives, perceptions of access to care, use of health information technology (IT), and programs to improve quality. Response rates exceeded 40 percent except in four countries: Canada, France, the United Kingdom, and the United States. U.S. and Canadian physicians lag in the adoption of IT. U.S. doctors were the most likely to report that there are insurance restrictions on obtaining medication and treatment for their patients and that their patients often have difficulty with costs. We believe that opportunities exist for cross-national learning in disease management, use of teams, and performance feedback to improve primary care globally.

Stretching To Meet Global Health Needs [From the Editor]

Dentzer, S. — Mon, 02 Nov 2009 17:03:46 PST

The Difficult But Necessary Choices In Fighting HIV/AIDS [Fighting HIV/AIDS]

Mon, 02 Nov 2009 17:03:46 PST

The Evolving HIV/AIDS Response And The Urgent Tasks Ahead [Fighting HIV/AIDS]

Bertozzi, S. M., Martz, T. E., Piot, P. — Mon, 02 Nov 2009 17:03:46 PST

AIDS continues to outpace the science, financing, prevention, and treatment efforts of the past quarter-century. There have been different epochs along the evolutionary timeline of the global AIDS response, from the discovery of HIV to the threat posed by the current economic crisis. This timeline serves as a reference to how we have arrived where we are today, in the hope that understanding our past will help us set the course for a more efficient and effective future response.

Critical Choices In Financing The Response To The Global HIV/AIDS Pandemic [Fighting HIV/AIDS]

Mon, 02 Nov 2009 17:03:46 PST

The AIDS pandemic will enter its fiftieth year in 2031. Despite much progress, there are thirty-three million infected people worldwide, and 2.3 million adults were newly infected in 2007. Without a change in approach, a major pandemic will still be with us in 2031. Modeling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach $35 billion annually by 2031—three times the current level. Even then, more than a million people will still be newly infected each year. However, wise policy choices focusing on high-impact prevention and efficient treatment could cut costs by half. Investments in new prevention tools and major behavior-change efforts are needed to spur more rapid advances. Existing donors, middle-income countries with contained epidemics, philanthropists, and innovative financing could help bridge the likely funding gap.

Financing HIV/AIDS Programs In Sub-Saharan Africa [Fighting HIV/AIDS]

Haacker, M. — Mon, 02 Nov 2009 17:03:46 PST

This paper offers an analysis of the costs and the financing of HIV/AIDS programs for countries in sub-Saharan Africa. The rate of external financing varies with gross domestic product (GDP) per capita, but not much at all with HIV prevalence. In six of the thirty-four countries examined, the costs of HIV/AIDS programs will exceed 3 percent of GDP by 2015. Most of these are low-income countries. Considerable external support at current rates in these countries would help contain the fiscal costs to around 1 percent of GDP. But if that support dwindles, countries would have to borrow money or cut back on their own spending for HIV/AIDS.

Bridging The Resource Gap: Improving Value For Money In HIV/AIDS Treatment [Fighting HIV/AIDS]

Soni, A., Gupta, R. — Mon, 02 Nov 2009 17:03:46 PST

The world faces both near-term and potentially long-term shortfalls in funding for HIV/AIDS care and treatment. We review the current funding environment, then discuss a range of opportunities to optimize spending on HIV/AIDS. These include (but are not limited to) more use of specific technologies, such as fixed-dose combination drugs or new diagnostics, as well as investments that strengthen underlying health systems, such as expanding training enrollment of health care providers. We also examine the potential cost impact of these opportunities in a hypothetical country. Combined, these approaches can reduce the cost of treatment while preserving and in some cases improving quality.

Investing To Meet The Scientific Challenges Of HIV/AIDS [Fighting HIV/AIDS]

Fauci, A. S., Folkers, G. K. — Mon, 02 Nov 2009 17:03:46 PST

Despite extraordinary scientific advances over more than twenty-five years, the human immunodeficiency virus (HIV) continues to exact an enormous toll worldwide. Given the limitations of current HIV treatment and prevention interventions and the financial and logistical impediments to delivering them, new and potentially transforming interventions are needed if the HIV/AIDS pandemic is to be significantly slowed. Serious scientific challenges remain in the realm of developing potentially curative therapies and a safe and effective HIV vaccine, and in developing, assessing, and validating other new prevention modalities. Substantial funding of the research enterprise must be maintained.

Why We Don't Have An HIV Vaccine, And How We Can Develop One [Fighting HIV/AIDS]

Harris, J. E. — Mon, 02 Nov 2009 17:03:46 PST

Confronted with the recent high-profile failures of several clinical trials of promising candidate vaccines against HIV, many scientists have all but given up hope of producing a human-ready vaccine within the next decade. In this review I contend that although the scientific obstacles remain formidable, the economic challenges are just as real. The groundwork will be laid for a major scientific breakthrough in vaccine development only when there are new contractual structures that enhance private incentives for vaccine development; when we have clearly specified the rights to the profitable North American market; when we have established a system of liability protection for vaccine side effects; and when our clinical trials also test the behavioral consequences of vaccination.

Transforming Social Structures And Environments To Help In HIV Prevention [Fighting HIV/AIDS]

Auerbach, J. — Mon, 02 Nov 2009 17:03:46 PST

Interest in social and structural interventions for HIV prevention is growing. Such approaches modify social norms, institutions, laws, and policies to reduce vulnerability and create environments in which individuals can protect themselves against HIV infection. Examples include expanding access to sterile syringes for injecting drug users and subsidizing stable housing for low-income people. Evidence of the effectiveness of such interventions is emerging despite scientific and political obstacles to their development, implementation, and evaluation. The U.S. government can help build the evidence base for such interventions. It can also implement those with demonstrated or promising results as part of a cost-effective HIV prevention strategy domestically and globally.

Ethical Challenges In Long-Term Funding For HIV/AIDS [Fighting HIV/AIDS]

Brock, D. W., Wikler, D. — Mon, 02 Nov 2009 17:03:46 PST

The global response to the AIDS pandemic aims for universal access to treatment and for pursuing every possible avenue to prevention. Skeptics, doubting that the huge increases in current funding levels needed for universal treatment will ever happen, would scale back antiretroviral treatment in favor of more cost-effective preventive interventions. Economics, politics, and science figure in this debate. But there is also a question of ethical principle: Is there a moral imperative to emphasize treatment, even if emphasizing prevention would save more lives? The authors examine moral arguments that address this question, and come down on the side of saving the most lives via prevention.

Fighting HIV/AIDS In Washington, D.C. [Fighting HIV/AIDS]

Mon, 02 Nov 2009 17:03:46 PST

Washington, D.C., is the capital of the United States and is a major center for public health and health policy expertise. Yet the District of Columbia has an HIV prevalence rate among adults of 3 percent, on par with some sub-Saharan African countries. To date, the local public health response has not controlled the epidemic. The ways in which that response has been galvanized in recent years—through collaboration among the capital’s public health agencies, community and faith organizations, and research institutions—may be instructive to other jurisdictions combating HIV/AIDS.

Tropical Diseases: The Price Of Neglect [Neglected Diseases]

Mon, 02 Nov 2009 17:03:46 PST

Turning Neglected Tropical Diseases Into Forgotten Maladies [Neglected Diseases]

Musgrove, P., Hotez, P. J. — Mon, 02 Nov 2009 17:03:46 PST

Because they afflict mostly poor people in poor countries, killing relatively few compared to the many who suffer from severe chronic disabilities, a large cluster of infections deserve the label of neglected tropical diseases (NTDs). That is changing as these diseases’ enormous health, educational, and economic toll is better understood, including how they interact with HIV/AIDS, malaria, and other illnesses. Several NTDs could be controlled or even eliminated within a decade, using integrated, highly cost-effective mass drug administration programs together with nondrug interventions. Research is needed to provide additional means of control for these conditions and make elimination feasible for still others.

Controlling And Eliminating Neglected Diseases In Latin America And The Caribbean [Neglected Diseases]

Bitran, R., Martorell, B., Escobar, L., Munoz, R., Glassman, A. — Mon, 02 Nov 2009 17:03:46 PST

This paper analyzes the rationale for, and costs associated with, the control and elimination of neglected tropical diseases (NTDs) in Latin America and the Caribbean. It also estimates the magnitude of potential health gains. The results suggest that lymphatic filiariasis, onchocerciasis, and trachoma can be feasibly and affordably eliminated by 2020, at a total cost of US$128 million. Control of other NTDs could produce important reductions in prevalence and incidence, along with other social and economic benefits. In particular, controlling soil-transmitted helminths (roundworm and hookworm, for example) would produce total costs of $41 million between now and 2020.

Neglected Diseases Amid Wealth In The United States And Europe [Neglected Diseases]

Hotez, P. — Mon, 02 Nov 2009 17:03:46 PST

Neglected tropical diseases are not exclusive to low-income countries. In the United States, such infections account for a sizable but largely hidden disease burden among minority populations living in poverty and among people of African descent in particular. Similar infections also occur in Europe. As efforts to control neglected tropical diseases expand throughout Africa, parallel efforts should also target poor and forgotten people in wealthy nations.

Neglected Tropical Diseases: Moving Beyond Mass Drug Treatment To Understanding The Science [Neglected Diseases]

Mahmoud, A., Zerhouni, E. — Mon, 02 Nov 2009 17:03:46 PST

Neglected tropical diseases (NTDs) represent a major health burden in many developing countries. To date, global efforts to control thirteen parasitic and bacterial infections that affect more than 1.4 billion people have relied on mass drug administration. This singular approach should now be expanded to a more comprehensive suite of tools including coordinated community-based programs, vector control, local training, education, and environmental change. In addition, an intensive basic research agenda is urgently needed to develop effective diagnostic, preventive, and therapeutic interventions to stay one step ahead of the evolutionary adaptation tactics of disease-causing microbes and parasites.

How Four Once Common Diseases Were Eliminated From The American South [Neglected Diseases]

Humphreys, M. — Mon, 02 Nov 2009 17:03:47 PST

Four major diseases stigmatized the American South in the nineteenth and twentieth centuries: yellow fever, malaria, hookworm, and pellagra. Each disease contributed to the inhibition of economic growth in the South, and the latter three severely affected children’s development and adult workers’ productivity. However, all four had largely disappeared from the region by 1950. This paper analyzes the reasons for this disappearance. It describes the direct effects of public health interventions and the indirect effects of prosperity and other facets of economic development. It also offers insights into the invaluable benefits that could be gained if today’s neglected diseases were also eliminated.

Progress In Public-Private Partnerships To Fight Neglected Diseases [Perspective]

Gustavsen, K., Hanson, C. — Mon, 02 Nov 2009 17:03:47 PST

In the global fight against neglected tropical diseases (NTDs), public health partnerships involving donations of medicines by pharmaceutical companies are enabling access to treatment for millions of people worldwide. These partnerships collaborate with other disease programs and a range of key stakeholders to develop and improve programs to control and eliminate NTDs. Although progress is being made against NTDs, continued success depends on a policy environment that supports appropriate levels of engagement and collaboration from all participants.

Spurring New Research For Neglected Diseases [Neglected Diseases]

Anderson, G. F. — Mon, 02 Nov 2009 17:03:47 PST

A very small proportion of global spending for biomedical research is for neglected diseases. However, neglected diseases account for a sizable percentage of the global burden of disease, especially in low-income countries. For-profit pharmaceutical and biotech companies are unlikely to conduct significant additional research on neglected diseases without financial incentives. This paper examines the benefits of providing a tax credit to encourage companies to conduct preclinical research on neglected diseases in the laboratory or in animals. This strategy could lead to a new generation of treatment options for the people in low-income countries who are susceptible to neglected diseases.

A Business Plan To Help The 'Global South' In Its Fight Against Neglected Diseases [Neglected Diseases]

Frew, S. E., Liu, V. Y., Singer, P. A. — Mon, 02 Nov 2009 17:03:47 PST

Although neglected tropical diseases (NTDs) threaten the health of those living in the developing world, innovation directed toward addressing NTDs is comparatively meager. Health biotechnology firms in rapidly growing economies in the global South are developing and selling vaccines, diagnostics, and therapeutics for these diseases to local markets. In this paper we identify a pipeline of sixty-two NTD products from seventy-eight "Southern" companies. We also propose creation of a Global Health Accelerator—a new nonprofit organization whose mission would be to support and help grow this Southern source of affordable innovation for NTDs.

Expanding The Biopharmaceutical Industry's Involvement In Fighting Neglected Diseases [Perspective]

Geraghty, J. A. — Mon, 02 Nov 2009 17:03:47 PST

The increasingly recognized need for new products for so-called neglected diseases, which afflict large numbers of people but have received relatively little industry investment, presents a clear example of a "strategic" corporate responsibility. Addressing neglected diseases can be important to "health diplomacy" and other national interests as well. Because industrial capabilities are essential to the development of new drugs and vaccines for these diseases, specific policy initiatives to attract more companies to do such work should also be further developed.

How Private, Voluntary Health Insurance Can Work In Developing Countries [MarketWatch]

Pauly, M. V., Blavin, F. E., Meghan, S. — Mon, 02 Nov 2009 17:03:47 PST

Could voluntary insurance markets exist in developing countries? We used data from the World Health Survey for eleven countries to estimate, at different income levels, variation in total medical spending and spending for hospitals, physicians, and outpatient drugs. The goal was to generate estimates of risk premiums that consumers might pay for insurance coverage and to calculate likely insurance administrative costs. We conclude that insurance covering either hospital spending or total spending is feasible for much of the population, but not insurance for physician services or medicines. Spending varies by income, so insurance markets should be segmented by income.

Microinsurance: Innovations In Low-Cost Health Insurance [MarketWatch]

Mon, 02 Nov 2009 17:03:47 PST

Microinsurance—low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements—can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits—both designed to keep these arrangements in business—perversely limited these schemes’ ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest.

Innovation In Namibia: Preserving Private Health Insurance And HIV/AIDS Treatment [MarketWatch]

Mon, 02 Nov 2009 17:03:47 PST

Namibia, a lower-middle-income country in sub-Saharan Africa, suffers from a huge HIV/AIDS burden. An influx of donor funding in 2004–2007 increased support for publicly provided HIV care and treatment. This raised concern that private funding would be "crowded out," thereby leading to a reduction in the overall resources used to treat patients. In 2006 the Namibian medical aid industry, with donor support, created a special fund to subsidize private health insurance, including HIV/AIDS services. The program allowed both low- and higher-income people to be covered. Crowding out valuable private resources was avoided and the quality of HIV/AIDS services improved.

Dying Of A Treatable Disease [Narrative Matters]

Keirns, C. C. — Mon, 02 Nov 2009 17:03:47 PST

Participation Of Academic Scientists In Relationships With Industry [DataWatch]

Zinner, D. E., Bjankovic, D., Clarridge, B., Blumenthal, D., Campbell, E. G. — Mon, 02 Nov 2009 17:03:47 PST

Relationships between academic researchers and industry have received considerable attention in the past twenty years. However, current data on the prevalence, magnitude, and trends in such relationships are rare. In a mailed survey of 3,080 academic life science researchers conducted in 2007, we found that 52.8 percent have some form of relationship with industry. Life science faculty with industry research support were more productive than faculty without such support on virtually every measure. However, we also found a significant decrease in industry support of university research, which could have major consequences for the academic life science research sector.

Adverse Selection In The Medicare Prescription Drug Program [DataWatch]

Riley, G. F., Levy, J. M., Montgomery, M. A. — Mon, 02 Nov 2009 17:03:47 PST

The Medicare Part D drug benefit created choices for beneficiaries among many prescription drug plans with varying levels of coverage. As a result, Medicare enrollees with high prescription drug costs have strong incentives to enroll in Part D, especially in plans with more comprehensive coverage. To measure this potential problem of "adverse selection," which could threaten plans’ finances, we compared baseline characteristics among groups of beneficiaries with various drug coverage arrangements in 2006. We found some significant differences. For example, enrollees in stand-alone prescription drug plans, especially in plans offering benefits in the coverage gap, or "doughnut hole," had higher baseline drug costs and worse health than enrollees in Medicare Advantage prescription drug plans. Although risk-adjusted payments and other measures have been put in place to account for selection, these patterns could adversely affect future Medicare costs and should be watched carefully.

Cancer Screening And Age In The United States And Europe [DataWatch]

Howard, D. H., Richardson, L. C., Thorpe, K. E. — Mon, 02 Nov 2009 17:03:47 PST

We compare cancer screening rates between the United States and Europe. Many European countries have organized screening programs, whereas the U.S. approach is relatively decentralized. Many European countries, unlike the United States, also impose upper age limits on screening. Overall, European screening rates were 22–88 percent of the corresponding U.S. rates. U.S. residents are more likely to be screened at younger ages, when the expected benefit from early detection is the greatest, but also at older ages, when the expected benefit is declining.

GrantWatch: Outcomes [GrantWatch]

Mon, 02 Nov 2009 17:03:47 PST

Boundary Politics And AIDS Policy [Book Reviews]

Weinreb, A. — Mon, 02 Nov 2009 17:03:47 PST

Killing The Greatest Killer--Smallpox [Book Reviews]

Musgrove, P. — Mon, 02 Nov 2009 17:03:47 PST

Deconstructing Medical Hype [Book Reviews]

Goozner, M. — Mon, 02 Nov 2009 17:03:47 PST

Tele-ICU: Much-Needed Evidence [Letters]

Everett, W. — Mon, 02 Nov 2009 17:03:47 PST

Tele-ICU And Clinical Quality [Letters]

Miller, M. D. — Mon, 02 Nov 2009 17:03:47 PST

eICU: More Data Are Now Available [Letters]

Rosenfeld, B. — Mon, 02 Nov 2009 17:03:47 PST

Tele-ICU: Positive Return On Investment [Letters]

Rufo, B. — Mon, 02 Nov 2009 17:03:47 PST

Tele-ICU: The Authors Respond [Letters]

Berenson, R. — Mon, 02 Nov 2009 17:03:47 PST

Major Reason For Nigerian Boycott Of Polio Vaccine [Letters]

Frishman, A. — Mon, 02 Nov 2009 17:03:47 PST

Polio Vaccine: The Authors Respond [Letters]

Kaufmann, J. R., Feldbaum, H. — Mon, 02 Nov 2009 17:03:47 PST

Ethical Prescribing [Letters]

Carrera, P. M. — Mon, 02 Nov 2009 17:03:47 PST

Ethical Prescribing: The Authors Respond [Letters]

James, C. D. — Mon, 02 Nov 2009 17:03:47 PST

Private Insurance In Taiwan [Letters]

Yu, S., Lin, A. — Mon, 02 Nov 2009 17:03:47 PST

Private Insurance In Taiwan: An Author Responds [Letters]

Cheng, T.-M. — Mon, 02 Nov 2009 17:03:47 PST

Weakest Links In Polio Vaccination [Letters]

Arya, S. C., Agarwal, N. — Mon, 02 Nov 2009 17:03:47 PST

Ownership Statement [Letters]

Tucker, J. — Mon, 02 Nov 2009 17:03:47 PST