A blog covering the health/care ecosystem and people.

“A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual doom.” So spoke Martin Luther King, Jr. on April 4, 1967 — one year before his assassination.   In this week that’s sure to be inspirational and aspirational, I ponder Dr. King and the state of health care in America.   Health disparities continue to mar the State of American Health Care. “Race remains a significant factor in determining whether an individual receives care, whether an individual receives high quality care, and in determining health outcomes,” according

“People who are underinsured end up facing almost identical problems as the uninsured. The difference is, they paid for the privilege.”This observation by Karen Pollitz, director of the Health Policy Institute at Georgetown University, is a harbinger of what will happen very quickly among workers in the U.S. in 2009 — employed and laid-off.Three pieces of data are the dots to connect that get you to Pollitz’s Maxim: – The pace of job losses and depth of the recession – COBRA costs. – $1,000 — the new deductible. The Federal Reserve of Minneapolis analyzed 10 post-war recessions since 1948 and

About 60% of Americans receive health insurance through their employers. Employers should continue to be the platform on which health benefits are provided in America, according to the American Benefits Council. In its report, Condition Critical: Ten Prescriptions for Reforming Health Care Quality, Cost and Coverage, the Council offers ten maxims it believes will bolster a sustainable health system. ABC is an association of Fortune 500 companies and others that sponsor or provide services to health plans. Together, they represent over 100 million Americans. The 10 “prescriptions” include: Building on existing, voluntary employer-based health coverage. Maintain a Federal framework –

‘Tis the season for free antibiotics. Retail health is not only promoting convenience; the sector is promoting ‘free’ health care in the form of antibiotics (at least until March 31st, 2009). The cheap/free drug trend began with Wal-Mart’s $4 generic program, which launched in 2006. Like proverbial dominoes falling, Target quickly joined Walmart. Then Kmart and food chains began to offer variations on the theme of cheap drugs. The latest retailer to join the free drug trend is Wegmans, the 72-store family-owned chain headquartered in upstate New York. I’m fortunate to have a Wegmans in my community, and I’m a

Anxiety about health care costs tops American citizens’ concerns about health care in the U.S. Rich, poor, insured or un-, 2 in 3 Americans worry about the affordability of health care in America.   So it follows, then, that among those without health insurance, 57% blame their uninsured state on the fact that they simply cannot afford it, as shown in the table on the right. Beyond this group, 30% of the uninsured cite the employer’s role in health insurance: 14% aren’t employed, 9% have employers who don’t offer coverage, and 7% are “between jobs.”   These findings come from

When it comes to health information, online trumps print. Online is the #1 source for health information among 83% of consumers; print attracts only 11% of people as the go-to source for health information. Broadcast is preferred by only 5% as the primary preferred health information source. Once online, it’s health-focused websites that get the lions’ share of search: 1 in 2 American adults use general health-focused Web sites 43% research specific conditions on ailment-focused sites 5% go to online communities 3% go to pharmaceutical companies’ branded drug sites. Prospectiv conducted this survey into Internet health habits in October 2008.

Regular readers of Health Populi know that I’m an avowed foodie (and a champagne-y, too), a longtime member of Slow Food, and adherent to the locavore movement as much as possible.When I mentioned making self-created carrot/zucchini/potato latkes on Twitter on Chanukah Eve this past Sunday afternoon, I received a request for this recipe from one of my favorite Tweeters – Cheryl Greene of DrGreene.com. For those of you who don’t ‘get’ why Jews eat latkes at Chanukah, it’s to do with the miracle behind the holiday. Chanukah (alternatively spelled “Hanukkah”) is known as the Festival of Lights, celebrated for eight

1 in 2 older Americans use prescription drugs and over-the-counter products together. 4% of them are at-risk of adverse drug interaction.The potential for adverse reactions is substantial; nearly 30% of older adults take at least 5 Rx medications on a regular basis. Older people are the biggest consumers of prescription meds and thus are more at-risk for adverse events in combining these drugs with other drugs, and with OTCs and supplements.These warnings come out of a study that will be published in the 24/31 December issue of JAMA. The researchers analyzed drug/OTC use among adults 57 years of age and

There is very little cushion in family budgets for health care costs — even for families with insurance coverage. So says the Center for Studying Health System Change (CSHSC), which regular Health Populi readers know is one of my most valued sources on information on the microeconomy of health in the U.S.CSHSC’s latest Issue Brief is succinctly titled, Living on the Edge: Health Care Expenses Strain Family Budgets. Simply put, American families’ budgets are strained in the economic downturn; if you’re sick, managing chronic conditions, and fall into the middle to lower income earning groups, your budget for health care

There is good news and bad news in the rich data mine that is the latest version of Manhattan Research’s Cybercitizen Health survey. On the positive side of eHealth, the number of Americans who are seeking health information online has more than doubled since 2002. On the downside, nearly 40 million Americans did not fill a prescription due to cost. This isn’t just for preparations that are available over-the-counter or those for nasal allergies. The top ten conditions that people not filling prescriptions haven’t filled cover a great many mental health conditions, along with pain and assorted other maladies that

  This is open enrollment season for those workers fortunate enough to (1) still be employed and (2) still be offered a health benefit. It’s also the season of economic decline. According to Watson Wyatt, these workers are making different health and benefit decisions in this fiscally-constrained era. Watson Wyatt has released its 2008 version of the report, Employee Perspective on Health Care. Some of the most dramatic health behavior changes this year include: Only 19% of employees are willing to pay higher premiums to keep deductibles and copayments lower. In 2007, 38% were willing to do so. 66% of

1 in 2 people over 45 say they’ve taken a generic drug or over-the-counter (OTC) medication instead of a prescription drug due to the current economic situation. The AARP‘s report, Impact of the Economy on Health Behaviors, analyzes the survey responses of 820 Americans 45 years of age and older polled in October 2008. Asked what health behaviors they may done as a result of the declining economy, the most common reactions among 45+ Americans were: Taking a generic or OTC medication, 51% Delaying seeing a doctor, 22% Cutting back on other expenses, 21% Seeking assistance in getting prescription drugs

With all of our (including my) talk about Health 2.0 and consumerism in American health care, the fact remains that most Americans rely on family and friends to find a primary care physician (PCP). That would be known as “word-of-mouth.” 27% of people rely solely on their friends’ and relatives’ opinions about PCPs. On the other hand, 2 in 5 people use multiple sources to find a PCP.When it comes to selecting a specialist, it’s a different picture. 2 in 3 Americans take their PCPs’ referral advice. Sicker people tend to go with their PCP’s recommendations. But 1 in 5

Nearly 1 in 2 women put off seeking health care because the cost was too high. The kinds of services delayed included visits to the doctor, medical procedures, and filling prescription medications. The fourth annual T.A.L.K. Survey was released this week by the National Women’s Health Resource Center (NWHRC), focusing on the declining economy and its impact on women and three dimensions of their health — physical, emotional, and fiscal. 40% of women say that their health has worsened in the past five years due to increasing stress and gaining weight, according to the survey. One of the most interesting

The concept of “cyberchondria” is not new. My first exposure to the term was through a study by Harris Interactive in 2002 which conducted a global cyberchondria study comparing health citizens online in the France, Germany, Japan and the U.S. The study defined cyberchrondriacs as “people who use the Internet for health purposes.” Harris’s poll found that these citizens tended to find health information online to be trustworthy, of good quality, easy to understand and easy to find. In 2002, 93% of cyberchondriacs in the U.S. and France found online health information to be trustworthy. The term cyberchrondria was used

Moms represent a $2.1 trillion market, according to the Marketing to Moms Coalition. “Dear Marketers, Recession is the mother of invention,” begins a full-page ad in the November 17, 2008, Advertising Age magazine. The ad promotes Cookie magazine, a monthly targeted to mothers with the tag-line, “Life. Style. Family.” I’ve thought a lot about Moms in the past two weeks in the context of marketing and health. The State of the American Mom report from the Marketing to Moms Coalition was released. This quantitative study examines the impact of mothers’ choices on retail preferences and household decision making. Two in

40% of American hospitals have seen drops in inpatient admissions, according to the American Hospital Association.In the AHA’s survey, Report on the Economic Crisis: Initial Impact on Hospitals, it’s clear that hospitals are already experiencing the effects of the economic downturn. CEOs are considering several cost-cutting tactics in dealing with this financial crisis: 56% of CEOs are postponing renovations or plans to increase capacity 45% are delaying purchase of clinical technology or equipment 39% are postponing investments in new information technology. The AHA polled 736 hospital CEOs, concluding the survey in November 2008. Additional data was available from AHA’s DATABANK

While the front pages of U.S. and business newspapers are featuring the story of the health-cost hampered Big (and increasingly smaller) 3 automakers looking for a mega-loan, most employers still want to play a key role in the U.S. health system. It’s the legacy of providing health care benefits to the ever-growing list of retirees from GM, Ford and Chrysler that’s crippling the industry. That, and a few other issues — among them, drivers’ preferences for gas-efficient, stylish and high performing cars. Simply put, lots of Americans prefer autos built overseas. Beyond the auto manufacturers, though, a new survey from

It all started with a baby, a baby carrier, and Motrin. Oh, and an advertising agency who probably got their Mommy-messaging more than a little bit wrong. Twitter, the social networking software, helped fuel this uproar in a matter of hours.   In what is to-date among the fastest viral campaigns in consumer health — that backfired –well over a hundred of mommy blogs and countless Twitter messages expressed emotions on a continuum from outrage to insult about a new campaign targeted to Moms who carry their babies in on-the-body carriers. The ad begins, “Wearing your baby seems to be

A very smart doctor told me, “there’s been a realization that the exam room is wherever the patient is.”   That simple, elegant and insightful remark was offered by Dr. Jay Sanders, one of the godfathers of telehealth. I quote him here from my report published this week by the California Health Care Foundation. It’s called Right Here Right Now: Ten Telehealth Pioneers Make It Work.   This report is coupled with another by Forrester, Delivering Care Anytime, Anywhere: Telehealth Alters the Medical Ecosystem. My colleagues at Forrester, Carlton Doty and Katie Thompson, have assembled a very current look into

The buyers of medical devices aren’t very good shoppers: they lack the kind of information about technologies that would help them make value-based purchasing decisions. So says James Robinson in the November/December 2008 issue of Health Affairs in his essay, Value-Based Purchasing for Medical Devices.   This issue is so important because medical technology is the #1 factor driving up health spending in the U.S., according to the Center for Studying Health System Change in their recent report, High and Rising Health Care Costs: Demystifying U.S. Health Care Spending. What are medical devices? they’re the hardware used by surgeons and

71% of Americans have cut household expenses as a result of the financial crisis in the U.S.,according to a new poll from BearingPoint, conducted by Zogby International. Here is more evidence that personal and family health decisions aren’t made in a vacuum separate from other household financial decisions: they’re part and parcel of the kitchen table conversation in our homes. The financial impacts have hit women relatively harder than men, and blacks and Hispanics somewhat harder than whites, according to BearingPoint’s data. How the economic downturn impacts health behaviors varies by health issue, and who the treatment is for: Nearly

We know the name of the 44th President of the United States: Barack Obama. As the next President’s supporter Oprah Winfrey is known to ask, “What do you know for sure?” When it comes to health, there are a few things we know about a President Obama.First and foremost, addressing challenges in U.S. health care will require a multi-pronged strategy which brings stakeholders together. The key health-aches to address will be:– Covering the uninsured– Stemming rising health care costs– Wiring the health information infrastructure and getting electronic health records into medical practice– Funding what works, and de-funding what doesn’t– Ensuring

While the economy ranks as the #1 issue on American voters’ minds, it means way more to Obama voters (56%) than it does to McCain voters (40%).Health care, too, is a higher priority issue to Obama voters (14%) than to McCain voters (9%).The poll by Kaiser Family Foundation and Harvard School of Public Health, conducted in September 2008, was released by the sponsors in the October 30 issue of the New England Journal of Medicine.McCain and Obama voters share some sympathies with each other when it comes to making health care and insurance more affordable, with 44% of McCain voters

The U.S. pharmaceutical market is slow-growth for 2009, according to IMS Health. The company forecasts a tiny 1-2% growth rate for the next year. The data point comes from IMS’s annual Global Pharmaceutical and Therapy Forecast.   The U.S. market for pharmaceuticals will be worth about $300 bn in 2009.   What’s slowing growth prospects for the U.S. are the overall declining macroeconomy, and its impact on visits to physicians and, ultimately, drug sales. Other factors slowing down drug sales in the U.S. are loss of patent protection on former big-name drugs and the influence of payers in drug coverage

“The health care buffet is over,” according to Christopher Parks of change:healthcare, who spoke at last week’s Health 2.0 Conference. There’s evidence that Americans have been adapting to an à la carte health world. While there actually is a company called à la carte health care, part of Allianz, the global insurance company, I’m not talking about them here. Consider the term, à la carte. It comes from the French, meaning ‘from the card.’ Where in health is there a ‘card’ from which to order services? A kind of à la carte menu can be found at, say, Minute Clinic,

I’ve returned from a week of Health 2.0 immersion on the west coast. The top-line finding: we’ve entered the period we can call Participatory Medicine. For some, like the pioneering Gilles Friedman of ACOR, this is nothing new. Other people have never heard of it. It’s global. It’s local. It’s a movement and a verb, as I pointed out thirteen months ago following the inaugural Health 2.0 conference.Some reflections…On Tuesday, I appeared on a panel on Health 2.0 at the Commonwealth Club in San Francisco for KQED public radio, sponsored by the California HealthCare Foundation. The Club’s motto by founder

Employee wellness is a growth business: 57% of large employers provide wellness programs to employees, increasing from 49% of large employers in 2006. According MetLife’s Sixth Annual Employee Benefits Trends Study, nine of ten companies that offer wellness believe these programs are effective in reducing medical costs. For the average employer, MetLife found, 58% of the total benefits spend goes to medical coverage — an even higher percentage for smaller employers. The most popular wellness programs include smoking cessation, weight management, an exercise regimen and cancer screening among others. While 4 in 5 employers provide incentives to “nudge” people into

Each year, actuaries in the Centers for Medicare and Medicaid Services (CMS) issue projections on Medicare spending. For the first time, the CMS Office of the Actuary has published a fiscal report on Medicaid…and the projections are fiscally chilling. Spending on Medicaid will grow 7.3% between 2007 and 2008, hitting $339 billion. Thereafter, the average annual growth rate will be 7.9% in the next decade, reaching $674 billion in 2017. The overall U.S. macroeconomy is expected to grow 4.8% per annum between now and 2017. Thus Medicaid costs are growing much, much faster than the general economy. Combined, Medicare and

Globally, people are looking to engage with health providers, plans, and product suppliers — up-close and very personal.That’s the top-line finding from the first Health Trust Barometer survey sponsored by Edelman, the global communications company that launched the influential Trust Barometer inEdelman’s researchers talked to citizens in five countries — the US, UK, Russia, China, and Germany — to measure their demand for “health engagement.”Edelman defines health engagement as the interaction among stakeholders in health – on the topics that matter, and through the channels and sources where information and opinions gathered, formed and shared. The most health-engaged are called

The top reasons that physicians believe patients don’t take medicines as prescribed are (1) affordability and (2) patients believing they don’t need the meds. AstraZeneca has surveyed 200 physicians about patients and prescription adherence and found the following given as reasons for not taking meds: Affordability (20%) Patient does not feel they need the medication (20%) Side effects (17%) Forgetfulness (16%) Lack of concern for their condition (5%) Lack of information on disease or treatment (5%) Lack of information on the drug they are prescribed (5%) Lack of family/social support (5%) Low satisfaction with the drug they are prescribed (3%)

The National Health Service wants to launch a program in the UK that would provide cash payments to citizens to incentivize them to see their primary care doctors to deal with health problems such as diabetes, heart disease and obesity. National Health Service managers are looking to get higher-risk patients into the system sooner for prevention. As in the US, the UK suffers from health disparities between urban and rural populations, and between people from different socioeconomic classes. The idea is being promoted by the North-East Essex primary care trust. This area covers about 315,000 citizens of Colchester and Tendring.

2 in 3 Americans want the US health care system to change. Most don’t believe that change will come any time soon. In fact, most Americans don’t think they’ll see much change in American health care by the time the next-next Presidential election will be held — by 2012. Jon Berry knows buzz: he’s the author of The Influentials, and last year he re-joined the market research firm GfK Roper. Berry is an expert on word-of-mouth marketing and the power of buzz. And his latest look into American buzz has led him to the conclusion that only 23% of Americans

Stress due to the economic downturn is causing more of us to be irritable, angry, sleepless, and self-medicating through food.   And stress in the workplace is costing business $300 billion a year, according to the American Psychological Association (APA), due to the loss of productivity, absenteeism, turnover and increased medical costs.   The APA completed its survey, Stress in America, in August 2008 — more than a month ago, well before yesterday’s biggest stock market fall in 4 years. The APA warns that the levels of stress felt by Americans due to the financial downturn can wreak significant havoc

“When normal Americans know who the Secretary of the Treasury is, that’s notgood.”— Will Durst comedian Do Americans know who the Secretary of Health and Human Services is yet?*It’s been an intense week of on-again, off-again Congressional votes to rescue financial markets. Two remarks this week generated that Oprah lightbulb moment for me. First, I listened to Laura D’Andrea Tyson, former chair of the Council of Economic Advisors under President Clinton, and currently Dean of the Haas School of Business at UC-Berkeley (and an advisor to Barack Obama). Tyson spoke with Rachel Maddow on MSNBC on 29th September about the

  George Washington ate and drank here. Now, there’s a Walmart Supercenter in that spot. There’s an important crossroads in my vicinity where four major highways meet; it’s called King of Prussia, which is the intersection of the Schuylkill Expressway (I-76), the Pennsylvania Turnpike, US 422, and US 202. A new Walmart Supercenter opens at this intersection today. Across-the-street from the new Supercenter are Neiman-Marcus, Bloomingdales, and Nordstrom, along with hundreds of other retail chains in the shopping mecca known as the King of Prussia Mall. So Walmart’s on my mind. Walmart has become a sort of touchstone for me

The sixth leading cause of death in the United States is the lack of health insurance, according to Critical Condition, a new documentary on the perils of being uninsured in the U.S. Being uninsured beats diabetes and HIV/AIDS on the Top Ten List of causes of death in America, according ot the Institute of Medicine. The PBS series POV features the chilling documentary, Critical Condition, on Tuesday, 30th September 2008. You can check your local listings here for broadcast times on your local PBS station.Critical Condition highlights the stories of four uninsured Americans with advanced stages of diabetes, cancer, liver

Just in case you haven’t had enough bad consumer financing news of late, along comes more news about consumers’ trouble paying medical bills. In Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007, researchers at the Center for Studying Health System Change have found that 57 million Americans had problems paying medical bills in 2007. This represents a 14 million person increase from 2003: in percentage terms, a 32.6% rise in Americans with health financing trouble in four years. The Center found that the biggest increase in consumer health financing trouble was among people who had insurance.

“Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation,” writes John McCain in an article in Contingencies magazine, dated September/October 2008. His article is entitled, Better Care at Lower Cost for Every American. This isn’t a Photo-shopped, made-up comment. See page 30 of the publication, the last paragraph in the left hand-column which continues into the right side. Contingencies is the magazine of the American Academy of Actuaries. These are those sober

If employers got their collective hands on Aladdin’s lamp, they’d wish for: Increased employee accountability Reduced health risks Tailored health management programs that account for risk Health data and measurement tools that feed into analytics and outcomes measures, and Integrated and well-managed benefits and programs. These wishes are brought to you by Hewitt Associates’ 2008 survey, The Road Ahead: Driving Productivity by Investing in Health.   38% of employers plan to develop strategies for employee health and productivity in the next 1 to 2 years; 21% plan to do so within 3 to 5 years. 1 in 5 (19%) aren’t

Corporate executives are concerned about three main issues when it comes to health care: 1. Maintaining ERISA’s national standards, 2. Focusing on health care quality and cost, and3. Worrying about negative impacts of changing tax treatment for employer health benefits.The Miller & Chevalier/American Benefits Council Corporate Health Care Policy Forecast surveyed American employers in August 2008. The key findings of the survey are:…87% of respondents think employees would prefer to get health insurance through employers even if similarly priced options were available through other sources. …Support for maintaining ERISA is solid at 91%. 84% of corporate execs are against state-level

Over the past couple of weeks, the eHealth world learned that RevolutionHealth engaged Morgan Stanley, the investment bank, to help assess the company’s ‘alternatives.’ The early talk was to raise capital, but the tenor seems to have switched to sales or merging. One talked-about suitor for Steve Case’s start-up is Everyday Health. This news comes on the heels of a new comScore report that reports 21% growth in the ‘health information’ site category, from 57 million visitors in July 2007 to 69 million in July 2008. #1 in health search portals continues to be WebMD, which grew by 3% year

As more costs are being charged to consumers by hospitals and other providers, bad debts are growing. More debt is being racked up by people with insurance than those without coverage. Over two-thirds of bad debt are generated by insured patients. This is the finding of nTelagent, Inc., a company that markets retail point-of-service technology. I spent some time on the phone with Earl Winter, the CEO and founder of the company, this week. He told me about nTelagent’s analysis of 50 providers with multiple service points, located throughout the U.S. in urban and rural areas. “What’s happening is that

Major national health reform between 2008 and 2012, the next Presidential election, may take a back seat to many issues: The Economy, financial services bailouts, oil prices, wars in Iraq and Afghanistan (and as a wild card, Georgia?), among other front-burner challenges facing the U.S. Based on the latest Kaiser Family Foundation tracking poll into voters’ top election issues, health has slipped to the #4 issue on voters’ minds, which I wrote about in Health Populi here. Nonetheless, a colleague-mentor in health sector market research, Richard Vanderveer, asked me to think about some scenarios about health care to 2012. Dick

We live in the era of sound-bites and attention-deficit (and I speak for myself as well as for my fellow citizens). That’s a bad thing for our health. Two news stories illustrate the challenge of health literacy and health outcomes: for kids, and for older adults. Parents and those who care for kids make lots of errors when giving medicines to children. As much as 50% of the time, parents and caregivers misdiagnose kids’ conditions. In Randomized Controlled Trial of a Pictogram-Based Intervention to Reduce Liquid Medication Dosing Errors and Improve Adherence Among Caregivers of Young Children, researchers found that

The healthworld is flat. Every day, health and health care evolve based on new technologies, learnings, and people getting smarter. Health events are among the most frequently published stories in the news. There’s so much that impacts health that isn’t health care, per se. Gas prices do impact everyday life, including health choices. And, health consumerism is a work-in-process. This weekend marked the first anniversary of the Health Populi blog. These statements are some of the lessons I’ve learned from blogging about health in the past 365 days. The healthworld is flat. Within a week of launching Health Populi, I

The lower one’s socioeconomic position, the worse the person’s health. This is the sobering finding in a landmark report published but the World Health Organization (WHO), Closing the gap in a generation: Health equity through action on the social determinants of health. While children born in Japan can live beyond 80 years, and newborns in Africa less than 50 years, there are also huge lifespan differentials within these countries. Within every nation, socioeconomics determine health outcomes.What are the social determinants of health? They’re a host of ‘inputs’ into our daily lives, from education to clean water and healthy food, clean

Americans trust pharmacies and drug stores a whole lot more than they do health plans, according to a survey from the Better Business Bureau and Gallup.However, the percentage of people with lots of trust in pharmacies and drug stores fell by 9 points between September 2007 and April 2008. The proportion of Americans trusting health care insurers stayed the same in that seven-month period.What factors affected Americans’ trust in businesses in the spring of 2008? 77% of consumers cited that increasing prices for food, health care and energy had negative impacts.What would strengthen trust in business? 86% of Americans said

The Internet rivals books, magazines and newspapers is the #1 source for Americans seeking health information. Friends and family come a very, very close second. TV and radio rank lower, with only 15% of people relying on these media for personal health information. The tracking report from the Center for Studying Health System Change (CSHSC), Striking Jump in Consumers Seeking Health Care Information, finds that 56% of Americans looked for health information in 2007. Use of the Internet doubled, from 16% in 2001 to 32% in 2007. While all Americans increased their health information seeking behavior, it’s highly correlated to