Health Affairs current issue

Health Spending Projections Through 2019: The Recession's Impact Continues [Web First]

Thu, 04 Feb 2010 04:00:03 PST

The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012.

E-Health's Promise For The Developing World [From The Editor-in-Chief]

Dentzer, S. — Mon, 01 Feb 2010 17:14:00 PST

Medicaid Expansion Offers Solutions, Challenges [Entry Point]

Iglehart, J. — Mon, 01 Feb 2010 17:14:00 PST

Health Affairs founding editor John K. Iglehart writes about the expanded role of Medicaid in a post-health care reform landscape.

People & Places [People & Places]

Mon, 01 Feb 2010 17:14:00 PST

An Agenda For Action On Global E-Health [Policies & Potential]

Gerber, T., Olazabal, V., Brown, K., Pablos-Mendez, A. — Mon, 01 Feb 2010 17:14:00 PST

Use of e-health, or electronic information technologies, has spread to cities and remote villages worldwide. Countries such as Rwanda are activating nationwide e-health networks. The Rockefeller Foundation’s month-long 2008 conference Making the eHealth Connection: Global Partners, Local Solutions accelerated this process. Conference participants proposed global partnerships, health technology solutions based on local needs, cross-border interoperability, leveraging current open-source networks, and shared informatics systems; they achieved progress on a shared, cross-border understanding of e-health solutions and policy. Early steps toward furthering these goals include creation of a new organization, the mHealth Alliance, to coordinate efforts, but collaborative investments are needed to usher in the promise of e-health.

Global E-Health Policy: A Work In Progress [Policies & Potential]

Mars, M., Scott, R. E. — Mon, 01 Feb 2010 17:14:00 PST

E-health (information and communication technology that facilitates health and health care) is expanding in developed, developing, and least-developed countries. E-health’s ability to transcend sociopolitical boundaries holds the potential to create a borderless world for health systems and health care delivery. But the policy needed to guide e-health development is limited and just now emerging in developed countries. What’s needed to foster e-health growth in the developing world is thoughtful policy to facilitate patient mobility and data exchange, across both international borders and regional boundaries within countries.

E-Health Technologies Show Promise In Developing Countries [Policies & Potential]

Blaya, J. A., Fraser, H. S.F., Holt, B. — Mon, 01 Feb 2010 17:14:00 PST

Is there any evidence that e-health—using information technology to manage patient care—can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted.

'Mobile' Health Needs And Opportunities In Developing Countries [Cell Phones & M-Health]

Kahn, J. G., Yang, J. S., Kahn, J. S. — Mon, 01 Feb 2010 17:14:00 PST

Developing countries face steady growth in the prevalence of chronic diseases, along with a continued burden from communicable diseases. "Mobile" health, or m-health—the use of mobile technologies such as cellular phones to support public health and clinical care—offers promise in responding to both types of disease burdens. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. We examine various m-health applications and define the risks and benefits of each. We find positive examples but little solid evaluation of clinical or economic performance, which highlights the need for such evaluation.

Cell-Phone Medicine Brings Care To Patients In Developing Nations [Report From The Field]

Feder, J. L. — Mon, 01 Feb 2010 17:14:00 PST

Enhancing 'M-Health' With South-To-South Collaborations [Cell Phones & M-Health]

Curioso, W. H., Mechael, P. N. — Mon, 01 Feb 2010 17:14:00 PST

Partnerships among health care and information technology researchers and designers worldwide are creating mobile health tools tailored to local community needs and resources. Much of the hardware and infrastructure comes from developed countries of the so-called global North. From both these countries as well as developing countries in the global "South" are coming applications that enable health workers to collect and organize data, access diagnostic and treatment support, and promote healthy behavior. Most are still in pilots or demonstration phases, but their use is accelerating.

A Toolkit For E-Health Partnerships In Low-Income Nations [Investment & Innovation]

Tierney, W. M., Kanter, A. S., Fraser, H. S.F., Bailey, C. — Mon, 01 Feb 2010 17:14:00 PST

Collecting, managing, and communicating information is a critical part of delivering high-quality, efficient health care. Low-income countries often lack the information technology that is taking root in developed countries to manage health data and work toward evidence-based practice and culture. Partnerships between academic and government institutions in high- and low-income countries can help establish health informatics programs. These programs, in turn, can capture and manage data that are useful to all parties. Several partnerships among academic institutions and public and private organizations, in areas such as sub-Saharan Africa, Haiti, and Peru, are leading the way.

Building A Health Informatics Workforce In Developing Countries [Investment & Innovation]

Hersh, W., Margolis, A., Quiros, F., Otero, P. — Mon, 01 Feb 2010 17:14:00 PST

Information and communication technology can be used to improve the quality and safety of health care and to lower costs. But in both developed and developing countries, there is an inadequate supply of skilled individuals who have the technical skills to use this technology to improve health care. Some studies project workforce needs of tens of thousands in English-speaking developed countries, but it is not known what size workforce will be required in the developing world. It is important to identify and develop the skills, training, and competencies—consistent with local cultures, languages, and health systems—that will be needed to realize the full benefits of these technologies. We present a framework for answering these questions and for developing estimates of the size and scope of the workforce that may be needed.

Accelerating Innovation In Information And Communication Technology For Health [Investment & Innovation]

Crean, K. W. — Mon, 01 Feb 2010 17:14:00 PST

Around the world, inventors are creating novel information and communication technology applications and systems that can improve health for people in disparate settings. However, it is very difficult to find investment funding needed to create business models to expand and develop the prototype technologies. A comprehensive, long-term investment strategy for e-health and m-health is needed. The field of social entrepreneurship offers an integrated approach to develop needed investment models, so that innovations can reach more patients, more effectively. Specialized financing techniques and sustained support from investors can spur the expansion of mature technologies to larger markets, accelerating global health impacts.

Connecting Information To Improve Health [Investment & Innovation]

Hammond, W. E., Bailey, C., Boucher, P., Spohr, M., Whitaker, P. — Mon, 01 Feb 2010 17:14:00 PST

Effective health information systems require timely access to all health data from all sources, including sites of direct care. In most parts of the world today, these data most likely come from many different and unconnected systems—but must be organized into a composite whole. We use the word interoperability to capture what is required to accomplish this goal. We discuss five priority areas for achieving interoperability in health care applications (patient identifier, semantic interoperability, data interchange standards, core data sets, and data quality), and we contrast differences in developing and developed countries. Important next steps for health policy makers are to define a vision, develop a strategy, identify leadership, assign responsibilities, and harness resources.

Funding Growth Drives Community Health Center Services [DataWatch]

Lo Sasso, A. T., Byck, G. R. — Mon, 01 Feb 2010 17:14:00 PST

Federally qualified health centers play a major role in providing health care to the underserved, and will remain an important part of the health care safety net even under reforms that will increase the number of Americans with health insurance. We show that the investments made in federally qualified health centers during 1996–2006 clearly translated into an increase in services available to patients, including mental health and substance abuse treatment and counseling and staffing. One particularly notable finding is that an additional $500,000 in federal grants translates into 540 more uninsured patients treated.

The Economic Burden Of Diabetes [Chronic Disease]

Dall, T. M., Zhang, Y., Chen, Y. J., Quick, W. W., Yang, W. G., Fogli, J. — Mon, 01 Feb 2010 17:14:00 PST

New research provides revised comprehensive estimates that suggest that the U.S. national economic burden of pre-diabetes and diabetes reached $218 billion in 2007. This estimate includes $153 billion in higher medical costs and $65 billion in reduced productivity. The average annual cost per case is $2,864 for undiagnosed diabetes, $9,975 for diagnosed diabetes ($9,677 for type 2 and $14,856 for type 1), and $443 for pre-diabetes (medical costs only). For each American, regardless of diabetes status, this burden represents a cost of approximately $700 annually. These results underscore the urgency of better understanding how prevention and treatment strategies may or may not help reduce costs.

Workplace Wellness Programs Can Generate Savings [Prevention]

Baicker, K., Cutler, D., Song, Z. — Mon, 01 Feb 2010 17:14:00 PST

Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.

Person-Centered Care For Nursing Home Residents: The Culture-Change Movement [Long-Term Care]

Koren, M. J. — Mon, 01 Feb 2010 17:14:00 PST

The "culture change" movement represents a fundamental shift in thinking about nursing homes. Facilities are viewed not as health care institutions, but as person-centered homes offering long-term care services. Culture-change principles and practices have been shaped by shared concerns among consumers, policy makers, and providers regarding the value and quality of care offered in traditional nursing homes. They have shown promise in improving quality of life as well as quality of care, while alleviating such problems as high staff turnover. Policy makers can encourage culture change and capitalize on its transformational power through regulation, reimbursement, public reporting, and other mechanisms.

Laying The Foundation For Catalytic Change [Interview]

Dentzer, S., Smith, M. D. — Mon, 01 Feb 2010 17:14:01 PST

'Shock Me, Tube Me, Line Me' [Narrative Matters]

Veysman, B. — Mon, 01 Feb 2010 17:14:01 PST

GrantWatch Outcomes [GrantWatch]

Mon, 01 Feb 2010 17:14:01 PST

Rational Drug Policies In The Asia-Pacific [Book Reviews]

Zellmer, W. A. — Mon, 01 Feb 2010 17:14:01 PST

BookMarks [BookMarks]

Mon, 01 Feb 2010 17:14:01 PST

No Mention Of Patient-Safety Legislation [Letters]

Riley, W. — Mon, 01 Feb 2010 17:14:01 PST

Patient Safety: The Author Responds [Letters]

Wachter, R. — Mon, 01 Feb 2010 17:14:01 PST

Need For Open-Source Electronic Health Records [Letters]

Wilder, B. — Mon, 01 Feb 2010 17:14:01 PST

Ethical Funding: The Authors Respond [Letters]

Brock, D., Wikler, D. — Mon, 01 Feb 2010 17:14:01 PST

Sample Size Not Such A Great Limitation [Letters]

Jako, B. — Mon, 01 Feb 2010 17:14:01 PST

Ethical Funding For HIV/AIDS: 3 Caveats [Letters]

Van Puymbroeck, R. V. — Mon, 01 Feb 2010 17:14:01 PST