A blog covering the health/care ecosystem and people.

95% of Americans want a health care overhaul, according to a new survey released by the AFL-CIO. 95% of people are concerned about being able to afford health insurance in the coming years. The 2008 Health Care for America survey is by no means scientific; the sample of 26,419 was conducted online between January and early March, 2008. But the data do have significance in terms of their veracity and clarity of voice and opinion. Among many important points in the study are that: – 1/3 of people have skipped medical care because of cost – 1/4 of people have

The current generation of medical scientists is at-risk. In 2003, budget increases for the National Institutes of Health stopped. Since then, the NIH has experienced a 13% drop in real purchasing power. A must-read for anyone who envisions a healthy world is world is A Broken Pipeline? Flat Funding of the NIH Puts a Generation of Science at Risk. The report was written by seven prestigious academic institutions concerned about health in America, and the world: Brown, Duke, Harvard, Ohio State, Partners Healthcare, UCLA and Vanderbilt. Their take is that the past five years of flat funding to the National

Among my top 3 HIMSS lightbulb moments was, appropriately, at a roundtable held by GE Healthcare. Of course, I learned in outline form about GE’s strategy for electronic health records and digital imaging and personalized medicine. This, I was prepared for. Then I took a look at a schematic drawing with a patient at the center and GE’s many health touchpoints around the circumference. Ponder for a moment those touchpoints: the Centricity EMR; the huge installed base of digital imaging technologies throughout the US (and the world); personalized medicine and women’s health; and, diagnostics. Then there is NBC Universal. Say,

In 2005 that is, according to the Kaiser Family Foundation’s (KFF) latest research into employer-sponsored health care titled Employer Health Insurance Costs and Worker Compensation. KFF analyzed six years’ worth of employers’ health insurance cost data and found their premiums increased 78% in the six years as wages grew only 19%. It’s useful to dive into these data and learn that employers with higher-wage employees spend more per hour on health insurance than those in lower-wage occupations. However, although technical, executive/managerial, and professional occupations had some of the highest health costs per hour, KFF found that as a share of

The launch of Aetna‘s SmartSource portal is a pioneering effort to provide health plan enrollees with personalized information on costs, health risks, and medical information from electronic health records. The system uses data to generate a personalized profile such as the enrollee’s employer, age, zip code, and specific health plan information. Mash up all these data points, and the consumer confronts a screen with personalized health risks and health-ful suggestions. The portal will also integrate Aetna’s existing online information sources such as DocFind, which helps enrollees find physicians and facilities. A demo of SmartSource can be seen here. Aetna has

The 2008 Edelman Health Engagement Barometer is out alongside the company’s annual Trust Barometer, and more than ever, people are trusting “people like me” more than they do institutions. This is the ninth iteration of the Trust survey. The toplines of the past four years show an important change in peoples’ trust perspectives. In 2005, Edelman found that trust in ‘established institutions’ and figures of authority began shifting to peers. By 2006, “A person like me” was the most credible spokesperson for companies. That year, people trusted employees significantly more than company CEOs. Edelman defines “a person like me” as

Last week, I was fortunate to meet with a group of health providers representing some of the best-and-brightest, most innovative delivery systems in the U.S. The subject was innovation, and as I presented a forecast of scenarios for health reform, the conversation inevitably moved to the subject of how to manage health costs if/when we add the uninsured into the American health insured population. There is a typical response to this question that many of us pull out of our health-econ PowerPoint deck: that “we’re” already paying high costs for this population in the form of emergency room visits and

There is much to report in the area of prescription drugs, not much of which will bring joy to my pharmaceutical phriends. First, following the money (hey, it’s me, the health economist), AARP brings out its latest Watchdog Report which details the rising prices of 220 brand name Rx’s most used by older people covered by Medicare Part D since the plan’s inception two years ago. These prices have risen much faster than the rate of general inflation. The average price increase in 2007 was 7.4%, over 250% of inflation in the period (=2.9%). For people with multiple chronic conditions,

The second meeting of the Health 2.0 Conference kicked off today in San Diego. The weather is pleasant in this town, and so is the crowd. The excitement engendered at the first Health 2.0 Conference held in September 2007 in San Francisco continues to grow at this meeting, which is focused on how consumers-people-patients can connect with providers, payors, and employers using Web 2.0 tools. American Well trated us to a “deep dive” into their new service, which will go live in June 2008. Roy Schoenberg, MD, MPH, the CEO of American Well, demonstrated their concept of the “online health

Welcome to the new health math in America: > education = > life > income = > life less income = less life less income = more chronic illness Got that? A new report from the Robert Wood Johnson Foundation (RWJF), Overcoming Obstacles to Health, codifies the relationship between socioeconomics and health. Health disparities go way beyond simple race and ethnicity categories — the combination of income, education, wealth, and neighborhood conditions could be more useful in explaining differences in Americans’ health status. Based on per capita GDP, Americans should live nearly three years longer than we do. Instead, we

Here’s the story that trumps any HIMSS announcement today because it sets the context for the future health of health care in America: spending on health care could double by 2017. This would calculate to $1 in every $5 in our economy. The story, written by researchers from the Centers for Medicare and Medicaid Services (CMS), was published yesterday in Health Affairs. That’s the macro view; within that spending trajectory, more would shift from the private to the public sector. The burdens will be on Medicare (read: the first phase of Baby Boomer retirements) and Medicaid. At a steady growth

On this eve of the annual meeting of the Healthcare Information and Management Systems Society (HIMSS) in Orlando, I’m meditating and getting myself prepared for the next three days at the Orange County Convention Center. Why? Medicare. Last week, President Bush has already announced a budget cutting hospital funding for fiscal year 2008. The President proposes cuts in Medicare and Medicaid spending by $196 billion over five years, with hospitals in the bulls’-eye of the reductions. Hospitals are a primary target audience attending HIMSS. HIMSS is akin to a shopping mall with stores featuring every conceivable aspect of health IT:

Two-thirds of Americans support state-mandated health insurance, with roughly the same percent supporting a tax increase to cover the uninsured. Welcome to the latest picture of health care consumers, brought to you by those clever researchers at the Center for Health Solutions at Deloitte. Deloitte’s 2008 Survey of Health Care Consumers presents the latest numbers on Americans and how they feel about the US health system, health politics, and innovations in health care delivery. The survey was conducted among people age 18-75 in September 2007. Top-line: 9 in 10 Americans don’t believe they are prepared to meet the costs of

Six of the 7 largest publicly-traded health insurers had profits increasing 10% or more in 2007. However, for many of these plans, medical loss ratios went up, too. The February 25th issue of American Medical News explores this fiscal phenomenon. American Medical News is the weekly newspaper targeted to physicians. AMNews’s mission is to keep doctors apprised of the latest information they need to know for practicing the business of medicine. The story is potentially potent for doctors because Wall Street analysts are focusing in on medical loss ratios — that is, the cost of health services provided by an

Take comfort in this latest study into health benefits derived from social networks: that is that people who participate in larger social networks are better able to manage their pain than people who are not part of networks. In a peer reviewed article in the Journal of the American College of Surgeons, Social Connectedness and Patient Recovery After Major Operations, researchers find that whether a patient has a social network in her life has a direct impact on health outcomes following surgery. In fact, the larger the person’s social network, the better the outcomes. The study assesses social networks and

Health insurance premiums rose 78% between 2001 and 2007, increasing families’ concerns about health care costs in America. Overall inflation grew 17% in this period. A new report from Kaiser Family Foundation (KFF), Wages and Benefits: A Long-Term View, sheds more light on health insurance cost trends, revealing an increasingly difficult scenario for average American families…even affluent ones. The figure on the right illustrates that the total amount spent by employers on group health insurance policies from 1960 to 2006 increased more than 20x from $23 billion in 1960 to $537 billion in 2006. [I note parenthetically that the GDP

Sicko has come to that great time-honored health model of England. I’m heading to London this week, and in preparation received a report to review published for the Parliament’s House of Commons Health Committee on NICE — the National Institute for Health and Clinical Excellence. You can think of this Committee akin to the U.S. Senate Subcommittee on Health. It’s responsible for assessing spending, administrative issues, and policy for the UK’s Department of Health (the peer of the U.S. Department of Health and Human Services), which is responsible for the National Health Service (NHS). NICE was established nearly a decade

Just in case you’re feeling lonely about the state of health care costs in the U.S., note that we’re in good company: medical costs will accelerate around the world over the next five years. Watson Wyatt brings you this news based on the results of a poll conducted among 85 insurers that cover medical for global employers in the Americas, Africa, Asia and Europe. The benefits consulting group found that health cost increases are growing faster than rates of inflation in 80% of countries surveyed. Thus, hyperinflation of health costs isn’t just an American malaise, but a problem for most

Snoopy’s googling for his American Dream. He lost it somewhere in the trajectory of rising energy prices, health costs and personal debt. The American Dream is defined, first and foremost, as financial security, in MetLife‘s second annual American Dream survey. Concerns abound in the American worker’s mindset focused on dropping home values, incrasing energy costs, and rising personal debt. Thus, only one in three Americans believe they’ve achieved the Dream of financial security. Still, three-quarters of Americans believe it’s possible to achieve this Dream in their lifetime. Nearly all Americans see themselves working harder than ever “to get by.” Half

Pundits are focused on the impact on search and ads, but I’ll be quick to point out that the breaking news that Microsoft has bid $44+ billion for Yahoo! has big implications for health. Yahoo! has made a successful mark in health on many fronts. One of many distinctions, for example, is Yahoo! Health & Wellness Groups where countless people convene to meet, share, and debate health issues, from medications and their side effects to what to do when you’re newly diagnosed. It’s all about the stories and the sharing and the wisdom of health crowds over there. If you’re

Democrats are all for expanded access; Republicans dread tax increases to expand access, and are more concerned with managing costs (downard). This rift is described, in some detail, by Bob Blendon et. al. in an important analysis published this week in the New England Journal of Medicine. NEJM feels so strongly about this content that they’ve made it freely available to all comers. I urge all of you who are tracking health politics this year to read this document. Blendon’s politically savvy team analyzed polling surveys from a variety of sources, so this is a sort of meta-analysis of voters’

We’d rather be healthy than wealthy, according to a new survey from Manning Selvage & Lee (MS&L), the PR firm that’s part of the global communications company, Publicis. MS&L polled Americans’ beliefs on health and self-esteem. Three-quarters (72%) of Americans say that being physically healthy is a symbol of personal success. 91% of Americans said they’d rather be described ads “healthy” than “wealthy.” 71% said they’d rather be seen as someone who “looks really healthy” vs. someone who’s nicely “put together or well-dressed.” These will be glad tidings for MS&L’s client base. MS&L serves a global health clientele which includes

In a thoughtful new report, the Committee for Economic Development (CED) suggests that by being open, the U.S. health system could be transformed. The concept of “openness,” as described by CED in Harnessing Openness to Transform American Health Care, goes beyond what we traditionally think of as transparency. Of course, transparency is critical for helping markets freely flow. But CED uses openness as an M.O. for transforming markets. Think: open source computing, where information or intellectual property is generated at some origin, and then others build on that initial idea (that’s the open-source Linux mascot, Tux the Penguin, pictured on

What nations deliver consumer-centric health care? The top five destinations for consumer-friendly health systems would be Austria, the Netherlands, France, Switzerland, and Germany, at least according to the latest iteration of the Euro-Canadian Health Care Index (ECHCI). The US is not part of this analysis. The concept of consumerism in health care has migrated to Europe. The Health Consumer Powerhouse, a self-described “do-tank” (as opposed to “think-tank”) based in Brussels and Stockholm, innovated and perenially updates the ECHCI. This year, the Powerhouse has added sister-nation Canada to the mix, and the results are fascinating. A key objective for the Index

What motivates a consumer to choose one health plan over another, or commit to managing his newly-diagnosed chronic condition, or take on health behaviors to keep her well? It’s their values, stupid. Borrowing from the fields of social psychology and health behavior and education, the Employee Benefit Research Institute (EBRI) has published a provocative paper on how consumer-directed health plans (CDHPs) risk failure when plans and providers ignore consumers’ inner values. Listening to Consumers: Values-Focused Health Benefits and Education offers insights into the current complexion of CDHPs and how consumers make health decisions. Among the reports’ findings are that, Some

Nine years from now, one in every 5 dollars will go to health care for older Americans. This forecast is presented in detailed context in a new report published by the Kaiser Family Foundation. Financing Medicare: An Issue Brief reminds us that Medicare is among the fastest-growing Federal programs in the U.S. By 2016, Medicare spending will exceed that of the forecasted cost of Social Security in 2028. These findings are based on the budget estimates presented by the Congressional Budget Office in August 2007.Simply said, it is escalating health care costs that cause Medicare to consume increasing chunks of

A new brand of clinic is entering the health care market…aligning itself in a public/private partnership with none other than the largest health system in the world, the National Health Service in the UK. Richard Branson is a master brander, having started up Virgin records in 1970 and Virgin airlines in 1984,. When he took on the Old School airlines, he was seen as the enfant terrible of the industry. But he re-imagined the airline business model and made it fun to fly. Can he do the same for health in the United Kingdom? Here’s the deal: Virgin Healthcare will

However you might “Brangelina” up the name — call it Zagthem or Angat — Zagat has met up with Anthem Blue Cross and Blue Shield to create a consumer-oriented guide to physicians. The tool is now live and free to access for members of the Lumenos plan in Cincinnati and Dayton, as well as in California and Connecticut. By the end of 1Q08, the Zagat Health Survey tool will be accessible to Anthem’s enrolleess throughout Ohio. The consumer-generated ratings will include scores on trust, communication, availability, and environment. So the Lumenos member will learn more about a prospective physician’s exam

Health care and security top money when it comes to American workers’ priorities, according to a new survey from The Center for State and Local Government Excellence. The report, Security: what Americans want from a job, examines 15 job characteristics: among them, 84% of Americans rate “the health insurance plan” as the #1 aspect of a job. Coming in second place are job security and working in an environment with clear policies. Retirement security comes in fourth place with 76% of workers ranking pensions as “very important.” Americans rank a family-friendly workplace in fifth place of the 15 job characteristics.

An outstanding commentary in this week’s Journal of the American Medical Association succinctly traces the history of U.S. health care in the context of “market justice.” Peter Budetti, MD, PhD, who teaches health policy at the University of Oklahoma, observes, “Fragmented and struggling to come to terms with externally imposed pressures, medicine is losing both its political force and moral compass.” Those so-called externally imposed pressures come from stakeholders behaving according to their own self-interest in the health market: employers, physicians, hospitals, suppliers, insurers, public officials, and of course, consumers. Dr. Budetti concludes that, “Market justice may have outlived its

I “leave” you for the year with some great, good, and less-than-sanguine expectations for health care in 2008. These are views filtered through my lens on the health care world: the new consumer, health information technology, globalization, politics, and health economics.  Health politics shares the stage with Iraq. Health care is second only to Iraq as the issue that Americans most want the 2008 presidential candidates to talk about, according to the latest Kaiser Health Tracking Poll. Several candidates have responded to the public’s interest with significant health care reform proposals. But major health reform – such as universal access

The annual national hospital bill may reach $1 trillion by 2008. This forecast is brought to you in a new report from the Agency for Healthcare Research and Quality (AHRQ). Hospital charges in 2005 totalled $873 billion in 2005, nearly doubling in ten years. The hospital bill was covered primarily by three payor segments: Medicare, which paid nearly one-half of the total hospital bill; private insurance, covering nearly one-third; and Medicaid, at 14% of the total. What are we spending money on in hospitals? Putting aside pregnancy/childbirth and infant care, the top three conditions are heart-related: coronary artery disease ($46

While many health analysts usually point to California as the state for vanguard health movements, I keep my eye on Minnesota. Once again, I discovered a new-new health project that I expect will be a model that will be replicated. The Health Care Scoop is among the first epinions.com-style websites where patient/consumers can log their opinions about local health care experiences with plans and providers. While many health plans have begun to provide report cards on quality and price lists for services, the Scoop is among the first social media websites provided by a health plan that allows the good,

The National Federal of Independent Business (NFIB) laid out its latest principles for health reform. This “voice of small business” says that universal access to health care is especially important to small businesses in the US. The NFIB believes that the most important issue facing small business for the past twenty years has been access to quality, affordable health care. NFIB cites several reasons for supporting universal access. Access to affordable health insurance options has been a particular problem for small business in the US, which employs so many of the millions of uninsured workers in America. This segment of

Here’s a recipe for starting a vaccine revolution without breaking any eggs: take one Goliath in the health care industry with a disposable fast-tracking manufacturing method, and combine with a David-sized novel biotech company with a speedy way of growing cells. Mix, bake, and wait one-half of the usual time to yield a vaccine. Welcome to a new era in vaccine development, brought to you by GE Healthcare (aka Goliath) and Novavax (aka David). These two partners think they’ve got a speedy way of making a pandemic flu vaccine. The potential for this venture could significantly impact global public health.

A new survey from HarrisInteractive reveals that one in 3 patients don’t think doctors have a complete picture of their medical history. But if the doctor has an electronic medical record (EMR), 9 out of 10 Americans want access to it. Compared to the same survey done in 2006, more consumers have faith in EMRs’ ability to reduce medical errors (57% of consumers thought that the use of EMRs could decrease the frequency of errors in 2006; in 2007, 63% did). On privacy, consumers appear to be trusting EMRs more. Overall, 60% of Americans believe that the benefits of EMRs

A strong FDA is crucial for the health of our country. The benefits of a robust, progressive Agency are enormous; the risks of a debilitated, under-performing organizaiton are incalculable.   These are the findings of the latest critical analysis of the Subcommittee on Science and Technology prepared for the FDA Science Board, FDA Science and Mission at Risk. FDA Commissioner von Eschenbach requested a hard look at the FDA one year ago, and this report is the sobering culmination of that effort. The Subcommittee included leading members of the scientific community familiar with emerging science, the external marketplace, and the

While health has blurred into a score of consumer product categories, here’s the latest crossover from Toyota: the first car to engineer health and wellness into its design, recently unveiled at the 2007 Tokyo Auto Show. The Toyota RiN is a concept car based on comfort and what Toyota’s PR calls, “serene, healthy living.” The RiN was one of 21 cars Toyota showed under the theme, “Harmonious Drive — a New Tomorrow for People and the Planet.” This isn’t high performance; it’s high-minded health by way of Dr. Weil, wrapped up in a golf cart-cum-Popemobile. Toyota’s press says the car’s

Perhaps our collective shopping jones has kicked in, but The Regence Group of Blues plans has found that more consumers are comparison shopping for health services these days. A new survey from the Blues plans that cover the Pacific Northwest Idaho, Oregon, Utah and Washington found that the number of people who comparison shop based on price and quality for medical services has grown to 70%. Note that this study was framed to assess Internet-based shopping habits. That consumers adopt information-seeking behaviors in health care is a sine qua non for consumerism: information availability, access, flow and consumption makes markets

A pack of cigarettes ranges in price from a low of $3.35 in South Carolina to a high of $6.45 in New Jersey. But the real personal costs of cigarettes — per pack smoked — are 66 times greater (in the case of that smoking South Carolinian). The analysis can be found in a new working paper for the National Bureau of Economic Research. W. Kip Viscusi and Joni Hersch calculate this cost in terms of personal health risks: for a man, each pack of cigarettes smoked reduces the value of his life by $222; for a woman, each pack

The double-barreled news of Dennis Quaids’ twins receiving heparin doses 1,000x the prescribed dose while receiving medical treatment at Cedars-Sinai Medical Center, coupled with the tragic death of Kanye West’s mother following cosmetic surgery, focuses this health care paparazzi’s lens squarely on the role of information technology in health care. The Cedars-Sinai Chief Medical Officer has termed the Quaid event a “preventable error.” Donda West’s doctor has been described by the likes of People magazine and the Los Angeles Times as a clinician with at least 2 DUI’s and an assortment of malpractice suits — as well as a recommendation

The Financial Times celebrates the 20th birthday of Prozac in the newspaper’s Nov 17/18th issue. It’s valuable to look at the rise and fall of Prozac, the brand; the rise of its generic equivalent; and how the drug has profoundly impacted one consumer’s life. Prozac Market. Before it treated depression, Prozac was thought to be an anti-hypertensive. When that didn’t seem to work, Eli Lilly considered it for an anti-obesity treatment. Strike two, clinical-wise. Finally, Lilly took the drug to market to fight depression after it was approved by the FDA on December 29, 1987. In two years, Prozac became

Talking to your parents about their future living arrangements is difficult. I’ve been there. Trust me. A new study from AARP, who knows a thing or two about dealing with older people, sheds some light on the challenge. It’s easy for me to say this, but…it’s good to plan ahead and have these conversations before your parent becomes sick, or infirm, or both. According to AARP’s report, Are Americans Talking with Their Parents About Independent Living: A 2007 Study Among Boomer Women, most women 45 and over have had this talk with parents, but most have not made plans ahead

The current issue of The New Republic is devoted to health care. An essay by Jonathan Cohn presents a thoughtful and personal analysis of how universal coverage would not necessarily slow medical innovation. Cohn talks about how his good friend and fellow writer, Michael Kinsley, was diagnosed with Parkinson’s Disease over ten years ago. In the past decade, Kinsley has searched for an effective treatment, and came upon Deep Brain Stimulation (DBS). DBS represents a medical innovation: a new-new treatment that was approved by the FDA only 10 years ago. Cohn is quick to point out that DBS costs a

About 15% of employers who provide health care to employees plan to cut benefits in the next 12 months, according to a survey of U.S. CFOs and comptrollers chief financial officers and senior comptrollers conducted by Grant Thornton. On the other hand, there is a large portfolio of cases where employers are creatively addressing employee health management. A new report from the Business Roundtable has found that Doing Well Through Wellness really pays off. BR surveyed their member companies (which include 160 jumbo and large companies that cover 35 million Americans and collectively generate $4.5 trillion in annual revenues). BR

Is it the maple syrup, the brilliant fall foliage, or those ever-lovin’ teddy bears? Vermont’s been named the healthiest state in the union, due to a complex interplay of social, political, clinical, and behavioral factors. Vermont may have improved its health profile, but speaking top-line, the overall health of the US declined over the past year. While progress has been made in reducing cancers and deaths from heart disease, we’ve miles to go when it comes to obesity, healthy risk behaviors (especially tobacco use and violent crimes), growing uninsured population, and childhood poverty. The 18th annual report on the state

It’s Renal Week, the education meeting of the American Nephrology Society. The latest research on that under-appreciated organ, the kidney, is being presented by the best minds focused on nephrology. The critical headline from the meeting is that, in 2020, there will be a huge rise in the incidence and prevalence of end-stage renal disease (ESRD). The number of Americans wil ESRD in 2020 is expected to be 785,000, an increase of more than 60% from 2005.   The key factor driving the growth of kidney disease is diabetes, in part driven by obesity projections and the aging of baby

Medical tourism is no longer in start-up mode. About 500,000 Americans traveled outside of the US for health care in 2005. For most medical tourists, the decision to leave one’s country for heatlh care is a financial one. That drive has built a $40-60 billion market today, projected to rise as high as $100 billion in 2012. The National Center for Policy Analysis (NCPA) just published a comprehensive look at medical tourism titled, Medical Tourism: Global Competition in Health Care. The report points out that in the earliest phase of medical tourism, Americans tended to travel to Mexico and Latin

Women determine the bulk of health spending in American households. Furthermore, caregiving women can be passionate health care consumers. CVS is tapping into this consumer segment through its ad campaign, For All the Ways You Care. Part of this campaign asks women to share their caregiving stories online. CVS hopes to make this website a viable online community that will support caregivers (and of course, drive traffic into the store). The TV ad plays the sweet song, “Ordinary Miracle,” as a soundtrack to the caregiver’s storyline. (This song was part of the recent remake of Charlotte’s Web. A bit of