A blog covering the health/care ecosystem and people.

The financial toxicity of health care costs in the U.S. takes center stage in Health Populi this week as several events converge to highlight medical debt as a unique feature in American health care. “Medical debt is the most common collection tradeline reported on consumer credit records,” the Consumer Financial Protection Bureau called out in a report published March 1, 2022. CFPB published the report marking two years into the pandemic, discussing concerns about medical debt collections and reporting that grew during the COVID-19 crisis. Let’s connect the dots on: A joint announcement this week from three major credit agencies,

As we mark the second anniversary of the COVID-19 pandemic, the key themes facing health citizens deal with money, inflation, and war — “piled on a nation stuck in COVID-19 survival mode,” according to the latest poll on Stress in America from the American Psychological Association. Financial health is embedded in peoples’ overall sense of well-being and whole health. Many national economies entered the coronavirus pandemic in early 2020 already marked by income inequality. The public health crisis exacerbated that, especially among women who were harder hit financially in the past two years than men were. That situation was even worse

There’s a trifecta cost challenge hitting U.S. household budgets in February 2022, highlighted in a poll from Morning Consult: inflationary spikes for housing, food, and energy, and the COVID-19 Omicron variant forcing health care costs up for some consumers driving medical debt up. This further underscores the reality that medical spending in the U.S. is taking shape as a consumer service or good, competing with — potentially crowding out — other household line items like food and increasingly costly petrol to fill gas tanks. Or taken the other way, gas and food crowding out health care spending, leading to either

This week, public health truths have collided with social media, the infodemic, and health citizenship. First, I read in Becker’s Health IT on February 16 that the peer-reviewed policy journal Health Affairs was prevented by a social media outlet from promoting its February 2022 issue themed “Racism and Health.” The company said the topic was too controversial to feature in this moment. “Google and Twitter are blocking its paid media ads to promote the content, flagging racism as ‘sensitive content,'” Molly Gamble explained in Becker’s. I myself used the blogging platform you’re on now to promote the February ’22 issue of

The Future of Wellness in 2022 is, “shifting from a ‘feel-good’ luxury to survivalism as people seek resilience,” based on the Global Wellness Institute’s forecast on this year’s look into self-care and consumer’s spending on health beyond medical care — looking beyond COVID-19. GWI published two research papers this week on The Future of Wellness and The Global Wellness Economy‘s country rankings as of February 2021. I welcomed the opportunity to spend time for a deep dive into the trends and findings with the GWI community yesterday exploring all of the data, listening through my health economics-consumer-technology lens. First, consider

A new study from CIGNA and its subsidiary MDLive touts the cost-effectiveness of telehealth to improve health outcomes, reducing the need for unnecessary lab work, reducing duplication of care, and connecting patients with  high-performing providers. It is expected that one in three patient visits will be virtual, CIGNA quotes from an Accenture forecast. As more consumers used telehealth channels during the early phase of the COVID-19 pandemic, patients experienced virtual care. For many people, these visits matched or exceeded expectations compared with in-person encounters with clinicians, as well as satisfying on convenience and access values. How will virtual care play

As we enter COVID-19’s “junior year,” one unifying experience shared by most humans are feelings of pandemic fatigue: anxiety, grief, burnout, which together diminish our mental health. There are many signposts pointing to the various flavors of mental and behavioral health challenges, from younger peoples’ greater risk of depression and suicide ideation to increased deaths of despair due to overdose among middle-aged people. And about one-in-three Americans has made a 2022 New Year’s resolution involving some aspect of mental health, the American Psychiatric Association noted approaching the 2021 winter holiday season. Underneath this overall statistic are important differences across various

I cannot recall a season when so many health consumer studies have been launched into my email inbox. While I have believed consumers’ health engagement has been The New Black for the bulk of my career span, the current Zeitgeist for health care consumerism reflects that futurist mantra: “”We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run,” coined by Roy Amara, past president of Institute for the Future. That well-used and timely observation is known as Amara’s Law. This feels especially apt right “now” as we enter 2022,

The pandemic has put health care top-of-mind for health citizens the world over. As the public health crisis continues its up-and-downticks around the globe, people are connecting health care to their national economies and politics, based on a global survey from the Pew Research Center, Citizens in Advanced Economies Want Significant Changes to Their Political Systems. For this analysis, the Pew research team assessed the views of some 2,600 health citizens living in 17 developed countries in February 2021. The study report was published in late October 2021. Shown in the first bar chart, the majority of people in at least

The most effective, engaging, and enchanting digital health innovations speak to patients beyond their role as health consumers and caregivers: digital health is at its best when it addresses peoples’ health citizenship. I had the great experience brainstorming the convergence of digital health, wearable tech, user-centered (UX) design, and health citizenship with João Bocas, @WearablesExpert, in a on his podcast. And if those topics weren’t enough, I wove in the role of LEGO for our well-being, “playing well,” and inspiring STEM- and science-thinking. João and I started our chat first defining health citizenship, which is a phrase I first learned from

“More than a year and a half into the COVID-19 outbreak, the recent spread of the highly transmissible delta variant in the United States has extended severe financial and health problems in the lives of many households across the country — disproportionately impacting people of color and people with low income,” reports Household Experiences in America During the Delta Variant Outbreak, a new analysis from the Robert Wood Johnson Foundation, NPR, and the Harvard Chan School of Public Health. As the HLTH conference convenes over 6,000 digital health innovators live, in person, in Boston in the wake of the delta

In 2020, Genentech launched its first study into health inequities. The company spelled out their rationale to undertake this research very clearly: “Through our work pursuing groundbreaking science and developing medicines for people with life-threatening diseases, we consistently witness an underrepresentation of non-white patients in clinical research. We have understood inequities and disproportionate enrollment in clinical trials existed, but nowhere could we find if patients of color had been directly asked: ‘why?’ So, we undertook a landmark study to elevate the perspectives of these medically disenfranchised individuals and reveal how this long-standing inequity impacts their relationships with the healthcare system

“The simple fact is that the federal and state governments are doing almost nothing to help people who have a broadband service available that partially meets their needs but abuses them with regular price hikes, spotty reliability, and poor customer service. Local governments will continue to step in to build better networks because communities have very few other options.” That “necessity is the mother” motivation to build broadband comes from Christopher Mitchell, Director of the Community Broadband Networks Initiative at the Institute for Local Self-Reliance (ILSR). [FYI, Mitchell’s Twitter handle is @communitynets]. Mitchell is quoted in the story, New data

“Racial and ethnic inequities in the US health care system have been unremitting since the beginning of the country. In the 19th and 20th centuries, segregated black hospitals were emblematic of separate but unequal health care,” begins the editorial introducing an entire issue of JAMA dedicated to racial and ethnic disparities and inequities in medicine and health care, published August 17, 2021. This is not your typical edition of the Journal of the American Medical Association. The coronavirus pandemic has changed so many aspects of American health care for so many people, including doctors. Since the second quarter of 2020,

“We don’t un-learn,” Dr. Amy Abernethy asserted as she shared her pandemic perspectives on a panel with 2 other former U.S. health policy and regulatory leaders. The three spoke about navigating compliance (think: regulations and reimbursement) in an uncertain world. An uncertain world is our workplace in the health/care ecosystem, globally, in this moment. So to give us some comfort in our collective foxhole, my last post for this week of immersion in #HIMSS21 is based on the keynote speech of Michael Dowling, CEO of Northwell Health. Dowling keynoted on the theme of “Leading for the Future,” sharing his lessons

“Most Americans clearly recognize the potential benefits that improved health IT can offer, and they want this transformation of the health care system to continue,” the Pew Charitable Trusts research concludes in Most Americans Want to Share and Access More Digital Health Data. The Pew team surveyed 1,213 adults ages 18 and over in June and July 2020, interviewing in English and Spanish. As digital health industry stakeholders will be convening at the 2021 annual HIMSS conference in Las Vegas and digitally, this report is well-timed to give us a level-set on just “where” U.S. health citizens are with respect to

The level of medical debt in America exceeded debt of other types in 2020. Furthermore, the flow of medical debt was greater among health citizens living in states that did not expand Medicaid as part of the Affordable Care Act, compared with patients who reside in Medicaid expansion states, according to an original research essay, Medical Debt in the US, 2009-2020 published in JAMA on 20 July 2021. The first line chart illustrates the trends in medical debt in collections by state expansion of Medicaid, with the bottom darkest line representing debt in collections in Medicaid expansion states from the

As the COVID-19 pandemic shifts to a more endemic phase — becoming part of peoples’ everyday life for months to come — impacts on peoples’ mental health will persist, according to new research from CVS Health in the company’s annual Health Care Insights Study. CVS conducted the annual Health Care Insights Study among 1,000 U.S. adults in March 2021. To complement the consumer study, an additional survey was undertaken among 400 health care providers including primary care physicians and specialists, nurse practitioners, physician assistants, RNs and pharmacists. CVS has been tracking the growing trend of health care consumerism in the

Some of America’s least-healthy communities are also those that index greater for vaccine hesitancy and other risks for well-being, found in U.S. News & World Report’s 2021 Healthiest Communities Rankings. U.S. News collaborated with the Aetna Foundation, CVS Health’s philanthropic arm, in this fourth annual list of the top geographies for well-being in the U.S. Six of the top ten healthiest towns in America are located in the state of Colorado. But #1 belongs to Los Alamos County, New Mexico, which also ranked first in ___. Beyond Colorado and New Mexico, we find that Virginia fared well for health in

The emergence of the COVID-19 vaccine “infodemic” has slowed the ability for nations around the world to emerge out of the public health crisis. Growing cynicism among some health citizens facing the politicization of public health tactics like vaccines and facial masks is what we’re talking about. At the root is peoples’ lack of trust across a range of information providers, including government, media, business, and even peers. The 2021 Edelman Trust Barometer spotlighted the infodemic and eroding trust in the U.S. in the voices of public health, the public sector, and media. This is a global challenge as well,

In April 2020, the U.S. Centers for Disease Control issued a report featuring evidence that in the month of March 2020, the coronavirus pandemic was not an equal-opportunity killer. Within just a couple of months of COVID-19 emerging in America, it became clear that health disparities were evident in outcomes due to complications from the coronavirus. An update from that early look at differences in COVID-19 diagnoses and mortality rates was published in Health Disparities by Race and Ethnicity During the COVID-19 Pandemic: Current Evidence and Policy Approaches, In this report, the Assistant Secretary for Planning and Evaluation, part of

In the summer of 2020, four months into the pandemic, one-half of people living in the U.S. felt worry or stress related to the coronavirus that had a negative impact on their mental health. Over a year into the COVID-19 in America, nearly one-half of people still have negative mental health impacts due to the coronavirus, based on research from the Kaiser Family Foundation (KFF) published in their April 2021 update on the mental health impact of the COVID-19 pandemic. Note the line in the bar chart from the study has flat-lined and settled at just about 50% of U.S.

The coronavirus pandemic exposed weaknesses in the U.S. health care system that existed before the public health crisis. What lessons can be learned from the COVID-19 stress-test to build American health care back better? The National Academy of Medicine is publishing nine reports addressing health stakeholder segments impacted and re-shaped by COVID-19 — for public health, quality and safety, health care payers, clinicians, research, patients-families-communities, health product manufacturers, digital health, and care systems. The report on health care systems and providers was released this week:  COVID-19 Impact Assessment: Lessons Learned and Compelling Needs was authored by experts on the front-line

One in five people in the U.S. cannot afford to pay for quality health care — an especially acute challenge for Black and Hispanic Americans, according to a West Health-Gallup poll conducted in March 2021, a year into the COVID-19 pandemic. “The cost of healthcare and its potential ramifications continues to serve as a burdensome part of day-to-day life for millions of Americans,” the study summary observed. Furthermore, “These realities can spill over into other health issues, such as delays in diagnoses of new cancer and associated treatments that are due to forgoing needed care,” the researchers expected. The first table

Springtime is finally emerging on the east coast of the U.S. and my local CSA farm is on my mind. It’s timely, then, to re-visit a research paper on subsidizing fruits and vegetables from a March 2019 issue of PLOS as an introduction to a new initiative growing out of The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) on produce prescriptions. Timely, too, that Chef José Andrés has been called to President Biden’s White House to help address food security in America. First, let’s look at the research in PLOS: Cost-effectiveness of financial incentives for

A year into the COVID-19 pandemic, most Americans are still in “survival mode,” according to an update of the 2021 Edelman Trust Barometer, Trust and the Coronavirus in the U.S. Updating the company’s annual Trust Barometer, Edelman conducted a new round of interviews in the U.S. among 2,500 people in early March. [For context, you can read my take on the 2021 Edelman Trust Barometer published during the World Economic Forum in January 2021 here in Health Populi].  The first chart shows that two in three people in the U.S. are still in a pandemic mindset, worried about safety and

After a year of living with and “in” the coronavirus pandemic, younger people in the U.S. have had to deal with over twelve months of quarantine and lockdown, going to school remotely from home, and distancing from friends. For most young people, the public health crisis has been more about that social distancing from friends, a collective sense of isolation, and mental and behavioral health impacts. These dynamics and these young health citizens’ coping mechanisms are captured in the report, Coping with COVID-19: How Young People Use Digital Media to Manage Their Mental Health. Three organizations collaborated to conduct and

“Without a four-year college diploma, it is increasingly difficult to build a meaningful and successful life in the United States,” according to an essay in PNAS, Life expectancy in adulthood is falling for those without a BA degree, but as educational gaps have widened, racial gaps have narrowed by Anne Case and Angus Deaton. Case and Deaton have done extensive research on the phenomenon of Deaths of Despair, the growing epidemic of mortality among people due to accidents, drug overdoses, and suicide. Case and Deaton wrote the book on Deaths of Despair (detailed here in Health Populi),  Case and Deaton

More Americans are happier in March 2021 than they’ve been for a year, based on consumer research from Civic Science polling U.S. adults in early March 2021. For the first time, a larger percent of Americans said they were better off financially since the start of the pandemic. This week, Civic Science shared their latest data on what they’re seeing beyond the coronavirus quarantine era to forecast trends that will shape a post-COVID America. Buoying peoples’ growing optimism was the expectation of the passage of the American Cares Act, which President Biden signed into effect yesterday. The HPA-CS Economic Sentiment Index

Some people remark about 2020 being a “lost year” in the wake of the coronavirus pandemic. That happens to be a true statement, sadly not in jest: in the U.S., life expectancy at birth fell by one full year over the first half of 2020 compared with 2019, to 77.8 years. In 2019, life expectancy at birth was 78.8  years, according to data shared by the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC). Life expectancy at birth declined for both females and males, shown in the first chart. The differences between

By the autumn of 2020, U.S. physicians grew concerned that patients who were avoiding visits to doctor’s offices were missing care for chronic conditions, discussed in in Delayed and Forgone Health Care for Nonelderly Adults during the COVID-19 Pandemic from the Urban Institute. More than three-fourths of people who delayed or forewent care had at least one chronic health condition. The pandemic may have led to excess deaths from diabetes, dementia, hypertension, heart disease, and stroke, as well as record drug overdoses in the 12 months ending in May 2020. In their JAMA editorial on these data, Dr. Bauchner and

The coronavirus pandemic has exposed major weaknesses in the U.S. health care system, especially laying bare inequities and inertia in American health care, explained in The Progress We Need: Ten Health Care Imperatives for the Decade Ahead from Manatt Health. The report details the ten objectives that are central to Manatt’s health care practice, a sort of team manifesto call-to-action and North Star for the next decade. Their ten must-do’s for bending the cost curve while driving constructive change for a better health care system are to: Ensure access Achieve health equity Stability the safety net and rebuild public health

President Biden’s first few days on the job gave us a very clear view on how he sees conquering COVID: through a whole-of-government approach to public policies that bolster directly addressing the virus, along with the many forces shaping how we got here and how to come out of the pandemic era stronger. I cover this first wave of Biden health policy in my latest post for the Medecision Liberation blog titled, “Top Priorities for President Biden: COVID-19, Then Everything Else.” The plotline goes… On the day of inauguration, January 20, 2021, Joseph R. Biden was installed as the 46th

The coronavirus pandemic disrupted and re-shaped the annual CES across so many respects — the meeting of thousands making up the global consumer tech community “met” virtually, both keynote and education sessions were pre-recorded, and the lovely serendipity of learning and meeting new concepts and contacts wasn’t so straightforward. But for those of us working with and innovating solutions for health and health care, #CES2021 was baked with health goodness, in and beyond “digital health” categories. In my consumer-facing health care work, I’ve adopted the mantra that our homes are our health hubs. Reflecting on my many conversations during CES

Citizens around the world unite around the concept that Trust is Dead. This is no truer than in the U.S., where trust in every type of organization and expert has plummeted in the wake of the COVID-19 pandemic, political and social strife, and an economic downturn. Welcome to the sobering 2021 Edelman Trust Barometer, released this week as the world’s technology innovators and analysts are convening at CES 2021, and the annual JP Morgan Healthcare meetup virtually convened. As the World Economic Forum succinctly put the situation, “2020 was the year of two equally destructive viruses: the pandemic and the

The coronavirus pandemic has shifted everything that could “come home,” home. THINK: tele-work, home schooling for both under-18s and college students, home cooking, entertainment, working out, and even prayer. All of this DIY-from-home stuff has been motivated by both mandates to #StayHome and #WorkFromHome by government leaders, as well as consumers seeking refuge from contracting COVID-19. This risk-shift to our homes has led consumers to re-orient their demands for home purchase features. Today, home is ideally defined as a safe place, offering comfort and refuge for families, discovered in the America at Home Study. The Study is a joint project of

The first six months into the coronavirus pandemic shocked the collective system of U.S. consumers for living, learning, laboring, and loving. I absorbed all kinds of data about consumers in the wake of COVID-19 between March and mid-August 2020, culminating in my book, Health Citizenship: How a virus opened hearts and minds, published in September on Kindle and in print in October. In this little primer, I covered the five trends I woven based on all that data-immersion, following up the question I asked at the end of my previous book, HealthConsuming: when and how would Americans claim their health

The coronavirus pandemic has been a shock to people across all aspects of everyday living, for older and younger people, for work and school, for entertainment and travel — all impacting our hearts, minds, and wallets. “As the bedrock of daily life was shaken, uncertainty predictably emerged as the prevailing emotion of our time but this universal problem was eliciting a highly differentiated reaction in different people,” Kern Schireson, CEO of Known, observed. His company has conducted a large quantitative and qualitative research program culminating in a first report, The Human Condition 2020: A Shock To The System. Known’s team of

2020 marked the centennial anniversary of the 19th Amendment to the U.S. Constitution, giving women the right to vote. In this auspicious year for women’s voting rights, as COVID-19 emerged in the U.S. in February, women’s labor force participation rate was 58%. Ironic timing indeed: the coronavirus pandemic has been especially harmful to working women’s lives, the Brookings Institution asserted last week in their report in 19A: The Brookings Gender Equality Series. A new study from Tia, the women’s health services platform, looks deeply into COVID-19’s negative impacts on working-age women and how they would advise the next occupant of

In the pandemic, I’ve been weaving together data to better understand how people as consumers are being re-shaped in daily life across their Maslow Hierarchies of Needs. One of those basic needs has been digital connectivity. People of color have faced many disparities in the wake of the pandemic: the virus itself, exacting greater rates of mortality and morbidity being the most obvious, dramatic inequity. Another has been digital inequity. Black people have had a more difficult time paying for phone and Internet connections during the COVID-19 crisis, we learned in a Morning Consult poll fielded in June 2020. In

In May 2020, the Oxford English Dictionary (OED) re-visited the acronym, “PPE.” As OED evolves the definition of PPE, the wordsmiths could borrow from OSHA’s website, noting that PPE, “is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits.” Perhaps Definition 3 in the OED could be updated by a blog

In terms of income, U.S. households entered 2020 in the best financial shape they’d been in years, based on new Census data released earlier this week. However, the U.S. Census Bureau found that the level of health insurance enrollment fell by 1 million people in 2019, with about 30 million Americans not covered by health insurance. In fact, the number of uninsured Americans rose by 2 million people in 2018, and by 1.9 million people in 2017. The coronavirus pandemic has only exacerbated the erosion of the health insured population. What havoc a pandemic can do to minds, bodies, souls, and wallets. By September 2020,

“This surge of people experiencing acute behavioral health problems…has the potential to further impact the healthcare system for years to come,” a report from McKinsey expects looking at the hidden costs of COVID-19’s impact on U.S. health care. The coronavirus pandemic has taken a toll on Americans’ mental health, with anxiety and depression growing as a side-effect to worries about the virus itself, the long Great Lockdown in much of the country, and the economic recession that has particularly impacted women and people of color. I covered depression impacts due to COVID-19 here in Health Populi yesterday, and wanted to

Along with the life-threatening impact of the coronavirus on physical health, and the accompanying mental health distress activated by self-distancing comes a third unintended consequence with the pandemic: a hard hit on women’s personal economies. The recession of the pandemic is considered by many economists as a “She-Cession,” a downturn in the economy that’s negatively impacting women more acutely than men. This is markedly different than the Great Recession of 2008, the last major financial crisis: that financial decline was coined a “ManCession,” taking a more significant toll out of more typically men’s jobs like construction and manufacturing where fewer

The worse of the coronavirus pandemic is yet to come, most Americans felt in July 2020. That foreboding feeling is shaping U.S. parents’ concerns about their children returning to school, with the calendar just weeks away from educators opening their classrooms to students, from kindergarten to the oldest cohort entering senior year of high school. The Kaiser Family Foundation’s July 2020 Health Tracking Poll focuses on the COVID-19 pandemic, return-to-school, and the governments’ response. KFF polled 1,313 U.S. adults 18 and older between July 14 to 19, 2020. The first line chart illustrates Americans’ growing concerns about the coronavirus, shifting

The core business of hospitals is patient care, often baked with teaching and research. But wait — there’s more, asserts the Lown Institute in their approach to ranking America’s Best Hospitals in 2020. The Institute’s methodology for assessing what’s “best” addresses ten pillars. Several of these are the “stick-to-the-knitting” components of the Webster Dictionary definition of hospital work: patient outcomes, clinical outcomes, avoiding overuse, patient safety, and a recent focus, patient satisfaction. Community benefit has been part of a hospital’s life, especially in the not-for-profit world where hospitals must demonstrate goodwill generated for and provided in the neighborhoods in which

The 21st Century Cures Act emphasizes patients’ control of personal health information. ONC rules issues in March 2020 called for more patient-facing health tools and apps to bolster health consumer engagement and empowerment. But the emergence of the coronavirus in the U.S. revealed many weakness in the American health care system, one of which has been health inequities faced by millions of people — especially black Americans, who have sustained higher rates morbidity and mortality for COVID-19. There have also been digital health divides found in the COVID-19 pandemic, discussed in a timely essay in JAMA, Digital Health Equity as

“The COVID-19 pandemic has altered every aspect of American life, from health and work to education and exercise,” the new Stress in America 2020 study from the American Psychological Association begins. The APA summarizes the impact of these mass changes on the nation: “The negative mental health effects of the coronavirus may be as serious as the physical health implications,” with COVID-19 stressors hitting all health citizens in the U.S. in different ways. Beyond the risk of contracting the virus, the Great Lockdown of the U.S. economy has stressed the U.S. worker and the national economy, with 7 in 10

  Today, 7th May 2020, the U.S. Bureau of Labor Statistics announced that about 3.17 million jobs were lost in the nation in the last week. This calculated to an unemployment rate of 15.5%, an increase of 3.1% points from the previous week. Total jobs lost in the COVID-19 pandemic, starting from the utterance of the “P” word, has been ___ in the I.S. The virus’s global impact has led to what IMF called the Great Lockdown, resulting in economic inertia and contraction since Asia and Europe reported the first patients diagnosed with the coronavirus. The economic impact the world