A blog covering the health/care ecosystem and people.

The recession around the world is having a negative impact on health citizens’ purchases of over-the-counter drugs. The economy is changing the way they will use non-prescription drugs, as well as the kind of drugs they will use. To the first point, OTC consumption will decline for some; for people who continue to demand OTC meds, they will increasingly seek lower-priced products. Globally, 46% of the world’s citizens believe that economic decline will have an impact on their demand for over-the-counter drugs. The chart illustrates that, from China (CN) down to Belgium and the US, the world’s citizens feel negatively

In the emerging era of participatory health, fanned by the fiscal flames of the recession and increasing out-of-pocket costs, there’s an important communications component to consider: participatory health economics. The chart illustrates why. Out-of-pocket health costs are steadily increasing for households. Thus, it is reasonable for health citizens to want to know how much health goods and services will cost them before they partake of the service — whether a prescription drug, a stay in rehab, a surgical procedure, or a course of chemo. For some time, providers have had a difficult time effectively fulfilling this role. Thanks to the

Insured workers in the U.S. are cost-sensitive to health care. The recession has been negatively impacting workers’ health: physically, emotionally, financially. However, there may be a silver lining here: that workers are making health improvement a greater priority than they did in 2008. The National Business Group on Health’s report on The Recession’s Toll on Employees’ Health presents results of a survey among workers age 22 to 64, finding good news amidst the not-so-good: that while some employees choose not to receive health treatment to save money on out-of-pocket costs, large percentages of workers are trying to lose weight and

Ten years later, a million lives lost, billions of dollars wasted, is the tag line of a report looking back at the decade since IOM‘s seminal report, To Err is Human, was published in November 1999. Consumers Union has asked, what progress has been made since IOM calculated that 98,000 lives are lost each year due to medical errors committed in the U.S. health system? CU’s finding: To Err is Human – To Delay is Deadly — the title of the report. In the report, CU asserts that preventable medical harm still accounts for over 100,000 deaths a year in

1 in 2 family physicians is seeing fewer patients since the recession began in January 2008. At the same time, 3 in 4 physicians have seen an increase in the number of uninsured patients. Patients who are covered by employer-sponsored insurance and private health plans are in short supply. Welcome to the new health economics for family physicians, where there are more patients without health insurance, more Medicaid patients, and more Medicare patients. As a result, patients are: – Telling family physicians about concerns over ability to pay for health care– Cutting prescription dosages– Cancelling appointments– Forgoing needed preventive care.

Them thats got shall get Them thats not shall lose So the Bible said and it still is news Mama may have, papa may have But God bless the child that’s got his own. So wrote and sang Billie Holiday in 1939. Seventy years later, you can take this classic blues tune as the anthem for the perceptual chasm between people who have and don’t have health insurance in the U.S. Uninsured people tend not to like their health care very much. If you’re insured, you’re pretty happy about your health care coverage. In a national survey of 1,000 U.S.

Generic drug dispensing reached 2 in 3 prescriptions (64.1%) in 2008 from 59.7% in 2007. Drug trend, defined as growth in prescription drug spending, increased 3.3%. What’s driving spending up? Diabetes therapies, rheumatological drugs, seizure drugs, antiviral drugs, and cancer and transplant drugs. What’s pushing spending down? Generic drugs for lowering lipids and OTCs for allergy meds. Welcome to Medco’s Drug Trend Report, unveiled at the company’s Symposium this week. The report analyzes trends, up and down, in prescription drug spending and utilization. This year, one of the key upward trend drivers is stunning: that the obesity epidemic is a

Here’s a riddle that appeared in today’s Wall Street Journal and The New York Times:“It’s the most valuable thing on earth. All the money in the world can’t buy it. Those who have it don’t always appreciate it. Those who’ve lost it will do anything to get it back. What is it?” Readers of Health Populi should well know the answer to this riddle: it’s health. And what’s healthymagination? It’s GE’s new strategy to reinvent itself in health care. The three-legged strategic stool of healthymagination are: To lower the costs of health care To increase peoples’ access to health services

In an era where employers and benefit plans are embracing consumer-driven health plans and health reimbursement accounts, enrollees have seen their out-of-pocket costs for health care increase. Higher cost burdens have led to many health consumers to behave as, well, consumers — self-rationing themselves off of various health services to conserve health spending. Most Americans believe that lowering cost sharing would increase health engagement — that is, better health behaviors — for people who are participating in wellness and health programs as well as for people on drug regimens managing chronic conditions. These findings come from the Employee Benefits Research

This chart appeared in Sunday’s New York Times in an opinion piece called, “American Epidemics, a Brief History” by Howard Markel and Sam Potts. Markel is a professor at my alma mater, the University of Michgian School of Public Health, and Potts is a graphic designer. Their point is neatly captured in this exquisite, simple diagram: that all epidemics in the U.S. share a few themes: 1. Epidemics lead to scapegoating of those thought to have caused the problem; the H1N1’s scapegoat du jour is immigrants. 2. Epidemics are often blamed on living “unclean” lives. 3. Epidemic literacy among people

The recession is shaping a new consumer segment, coined the Downturn Generation by Information Resources (IRI). Members of the Downturn Generation are transforming the ways they shop, eat, and care for their homes and themselves. 2 in 3 consumers believe their financial condition is worse than it was one year ago, and 71% say they have less wealth than they did. IRI identifies 3 segments: Optimists, who agree that “things will get better during the next 12 months” and have selectively cut back purchases; for them, sacrifices are a last resort. Maintainers, who agree that “the economy won’t get worse,

I have seen the future of Health 2.0, and it is Medzio. It’s flexible, it’s consumer-facing and -friendly, it integrates into the activities of daily living, it makes accessing health information easier and integrateable, and it’s fun. As an observer of health information tools for over two decades, the company known as A.D.A.M. has always been in my radar. I have respected their work in medical images from the early days of the firm’s inception, and when the Internet arrived in health care, A.D.A.M. smartly figured out where to play in that new media environment. Of all the offerings I

There’s a new target in town when it comes to Americans’ blame-game for their economic woes: advertising. In a fascinating new Harris Poll, cleverly timed for publication on 2009 Tax Day, the Poll found that most Americans blame various media outlets for persuading them to buy things they didn’t need or couldn’t afford. It’s not just the big bad banks who pushed irrationally-modeled mortgages on us unsuspecting home buyers. And those greedy auto companies building big, bad oil-guzzling SUVs. It’s the Mad Men Who Made Us Do It. That is, spend too much money. There are variations across age groups

Mobile technologies will be more important to health organizations in 2009 than they were in 2008, for 8 in 10 health executives. Motorola has published the 2009 Enterprise Mobility Barometer for the health care industry, and the top line message is health mobility is in demand. Underlying mobility in health are the key investment areas for health providers in 2009: electronic health records (EHR), computerized physician order entry (CPOE), and medication administration to both streamline processes and reduce medication errors. Mobility in health apps relates to three aspects of health care: mobilizing the enterprise itself; freeing workers from immobile techs

You’re not so happy with your health plan if you purchase it as an individual or receive it through a small employer. That’s the top-line finding of J.D. Power‘s 2009 National Health Insurance Plan Study. What’s driving down health plan satisfaction is consumers’ lack of understanding of the benefit. “Members still tend to be least satisfied with the information and communications they receive from their health plan—the third-most-important factor in overall satisfaction,” said David Stefan, executive director of J.D. Power’s health practice. Consumers rate seven factors in J.D. Powers’ study: Coverage and benefits Provider choice Information and communication Claims processing

Is Clayton Christensen right? On April 8, 2009, the Disruptive Harvard Professor was interviewed in Harvard Business School’s Working Knowledge saying that Personal Electronic Health Records (PEHRs) can, “help us manage our own health care” and be “transformative in lots of unexpected ways.” By his definition in The Innovator’s Prescription, a disruptive innovation transforms a product or service that historically has been very complicated and expensive into something that is affordable and simple to use. Health care us certainly complex and expensive, particularly as it’s delivered in the U.S. Can PEHRs help move American health care towards affordability and simplicity?

If it’s April in Chicago and it’s snowing it must be HIMSS. Say, what? Usually the annual meeting of the Healthcare Information and Management Systems Society (HIMSS) is held in February in some lovely southern climate, like Florida, Georgia or Southern California. This year, the HIMSS organizers thought they’d try out the association’s home base in the Windy City and the gargantuan McCormick Place. On purpose, the HIMSS exec’s postponed the Chicago meeting to April to avoid the usual February climate and Lake effects. Sounds like good planning, no? We expect 2-4 inches of snow overnight, and it’s the week

The ‘official’ US unemployment stats for March will be published on April 3, but several data sources assert that the US labor market worsened again in March. One from ADP, the company that processes one in six payments for US workers, calculates a loss of 668,000 jobs in March ’09. Dow Jones Newswires’ survey predicts that private-sector jobs in the US fell 742,000 in March. There is ‘no recovery in sight’ when it comes to health coverage for workers in America, according to the title of a report by Ken Jacobs and Dave Graham-Squire from the UC Berkeley Center for

Thomson published its Top 100 Hospitals list this week, which felt like a déjà vu all over again. Didn’t I just see AARP’s top hospitals, along with similar rankings from US News and HealthGrades in recent months?Is this an embarrassment of riches? Or just more heavy-lifting for confused American health citizens?The Thomson Reuters 100 Top Hospitals National Benchmarks study is based on the company’s “National Balanced Scorecard” which focuses on nine measures: mortality, medical complications, patient safety, average length of stay, expenses, profitability, cash-to-debt ratio, patient satisfaction, and adherence to clinical standards of care. Thomson has conducted this study since

In 2009, the cost of health care for a 65-year old couple entering retirement is 50% more than it was in 2002, according to Fidelity Investments. The nest-egg required for retirement health is $240,000, give or take tens of thousands depending on your health risks. In just the past year, this cost increased 6.7%, from $225K. Fidelity has measured the cost of health care in retirement since 2002, when the cost was $160,000. Note the assumptions behind this number: Fidelity assumes that retirees will not have employer-sponsored retiree health benefits, but will take up Medicare. Thus the $240K takes into

The economy is re-shaping both employers’ and employee’s views on workplace benefits. Most employers continue to value their most important asset: the human capital that is inherent in their employees. This is good news. Retaining employees is the #1 benefits objective for American employers, according to MetLife’s 7th annual Employee Benefits Trends Study. Now, for the #2 and #3 objectives for employers as revealed by MetLife’s survey: due to the economic downturn, employers are looking for more productivity out of their employees, while controlling costs. At the same time, employees are concerned about their financial security. MetLife has found that

As the Internet disrupted health care information in the late 1990s through the 2000s, watch out for the phone to make the health world flat, taking off from Tom Friedman’s phrasing about The World. There are parts of the world using simple SMS text messaging in public health: to enable peoples’ positive health behaviors. In parts of Africa, safe-sex messaging and medication reminders help people prevent the spread of HIV/AIDS. In Europe, Nokia has tested a wide range of these applications, and Vodafone has been successful in getting teenage diabetics to respond to text messages via phones in an NHS

Even though profitability for American business will be elusive in 2009, many employers are increasing employee wellness programs — and not cutting budgets for these programs. According to Buck Consultants’ survey, employers can find that wellness programs actually help employees deal with the very issues that the economic downturn creates. Since the beginning of the economic downturn in the U.S., Buck’s survey found that employees’ use of wellness programs increased for over one-half of employers. The key metrics for measuring success of thesee programs are cost-effectiveness, changing employee behavior, and measuring health status. Nearly one-half of employers said they were

Don’t assume that State Medicaid programs will cover the vulnerable populations this and next year. Even with the stimulus funding provided in ARRA, Governors will be hard-pressed to cover all of the growing demands for health care among citizens in their states. Governors’ budgets are severely constrained due to declining tax receipts and increasing financial obligations, especially for education and health care. According to the Center for Budget and Policy Priorities (CBPP), the American Recovery and Reinvestment Act (ARRA) includes about $140 billion in fiscal relief to the States. However, this funding will cover only about 40% of the $350

“The problem with the U.S. health care market is that it doesn’t really function as a market – it leaves major consumer needs unmet, costs unchecked by competition and basic practices untouched by the productivity revolution that has transformed every other sector of the economy.” That quote isn’t from a Marxist-leaning, left-wing political operative — it was spoken by Ivan Seidenberg, the Chairman and CEO of Verizon, the telecommunications firm that sits as #17 on the 2008 Fortune 100 list. As one of the largest companies in the world, and certainly in telecomms, Seidenberg has to compete in a global

2 in 3 Americans are concerned about being able to afford health care and prescription drugs. While middle-aged Americans aged 45-54 are the most concerned (76% of the cohort), even 54% of younger people between 18 and 34 years of age are worried about health care costs.HarrisInteractive/HealthDay’s latest suvey into personal health economics finds that people are delaying or avoiding consuming care due to cost. The most common health encounters Americans are avoiding due to cost include:– Dental visits (34%) – Physician visits (28%)– Not receiving a medical test, treatment or follow-up recommended by a doctor (23%)– Prescription drug fills

Most people who receive email messages from pharmaceutical companies tend to like it. 9 in 10 believe it’s a good way to learn about new products entering the market — nearly as many people as those who like receiving travel offers via email. This finding comes from Epsilon‘s Email Branding Study, released in early March 2009. Consumers see a very valuable aspect of email from pharma companies is receiving coupons to use in paying for prescription drugs, as well as learning about products. A third value of email from drug companies is receiving a source of support in personal medical

American consumer sentiment over the past year feels and looks like a rollercoaster ride in freefall, ever driving downward as the chart shows. It’s jobs and health costs forcing the downward trajectory. More than stock market declines and saving for retirement, Americans fear two things most in this recession: losing their job, and the costs of health care. 38% of Americans cite unemployment as their biggest concern in early February 2009. Unemployment fears are shared by both men and women. Younger Americans are more concerned about losing a job (50%) than older people (22%) — who are more concerned about

Americans skipped recommended medical tests and procedures, cut pills, and skipped dental care due to cost in the past year. Welcome to the world of rationing, borne not from a government program, but of private sector market forces. With all due respect to Adam Smith, market forces don’t always work in the best interests of public health. The latest iteration of Kaiser Family Foundation‘s Health Tracking Poll published February 25, 2009, found that 53% of Americans did at least one self-rationing health behavior because of cost in the past year (roughly February 2008 to February 2009). The most common health

4 in 10 cancer patients sought information via the Internet, according to a new study to be published in the April 1, 2009, issue of the peer-reviewed journal, Cancer. The downside of information-seeking cancer patients, according to the study, is that 1 in 4 of these patients received the drugs off-label — that is, for a use not approved by the FDA. In these cases, the cancer drugs have been used for patients in both late and early stages of cancer– the latter for which a drug might not be approved for use. The study looked at the relationship between

In the top 100 most social brands determined by Vitrue, not a single one is directly related to health or health care.Among the most visible industry sectors in top 100 are: Automobile manufacturers (Ford, Honda, Lincoln, GM and Mercedes rank highest among the autos). All-things-Apple including the #1 socially-ranking iPhone, #3 Apple corporate, #7 iPod, and the Mac itself at #16. Broadcasters including #2 ranked CNN, MTV, Turner, Fox News, and ABC all in the top 25. Food is very social, with Starbucks, Coke, Pepsi, McDonalds, Subway, Red Bull, Wendy’s, Burger King, Sprite, Chili’s, KFC and Taco Bell in the

Federal negotiations on prescription drug prices, covering kids’ health care, and requiring insurance companies to accept people with pre-existing health conditions are among the most popular elements of President Obama’s health reform platform among all Americans. However, tempering the public’s majority support for these health plan ideas, Americans don’t have much confidence in Congress these days. Based on a poll taken by Rasmussen Reports on the stimulus package, two in three Americans say they trust their own judgment on economnic matters ore than they trust the average member of Congress. According to Rasmussen, “voters believe that no matter how bad

Peter Orszag, the Director of the Office of Management and Budget, has said that Medicare will be the long-term driver of a U.S. economic deficit. Underneath that forecast, it’s the cost of managing chronic disease for Medicare enrollees that’s the main fiscal challenge. Quality of Care, and Health Expenditures Among Medicare Beneficiaries, published in the February 11 2009 Journal of the American Medical Association (JAMA), analyzes the patient outcomes and costs gathered in 15 Medicare disease management pilots conducted between April 2002 and June 2005. Dr. Deborah Peikes and colleagues looked at DM programs targeting heart disease, diabetes, and chronic

Observing the growth in Internet web site traffic is a perfect reflection of what’s going on in the economy. In 2008, the greatest growth in site-types was in job search, women’s-oriented content, coupons, and politics. Online gaming and gambling also gained a lot of eyes in 2008. And, visitors to online classified ads grew by 27%, while traditional print channels – notably newspapers – took a direct hit. In classifieds, it’s about people trying to save and make money through the purchase and sale of used items, according to comScore‘s report, “The comScore 2008 Digital Year in Review.” The big

Americans’ purchases at the grocery store are shifting based on the economic downturn. The headline from NielsenHealth is that consumers are searching for quality and value when shopping. And, people are cooking more at home and purchasing staple goods to have in the pantry. Americans are also buying more wine and vitamins. Dried vegetables and grains along with salads are also up. Could it be that the recession is driving consumers toward some healthy food habits? Perhaps, at least for some. At the beginning of each year, there’s an upward blip driven by New Year’s weight loss resolutions in the

“The performance of consumer-driven health care has fallen short of both the aspirations of its proponents and the fears of its critics,” according to a review of the state of consumer-directed health care published in Health Affairs. Jamie Robinson of UC-Berkeley and Paul Ginsburg of the Center for Studying Health System Change examine the first decade of consumer-driven health care (CDH). Early in the paper, the authors assert that there isn’t a Grand Unified Theory of CDH: it can be viewed through the various lenses of “philosophical advocates,” business entrepreneurs with profit motives, and policy change agents looking to incorporate

Drugs are becoming a luxury product in the U.S. for a growing number of citizens. The Center for Studying Health System Change (CSHSC) found that the proportion of Americans under age 65 who are having problems paying for prescription drugs grew from 10.3% in 2003 to 13.9% in 2007. This is a 35% increase.This finding comes from the Center’s tracking report, More Nonelderly Americans Face Problems Affording Prescription Drugs.CSHSC dug into data from the Center’s 2007 Health Tracking Household Survey to come up with this finding. The survey data reveals that, in 2007, 36.1 million Americans did not get prescription

The affordability gap — that is, the difference between workers’ earnings and active employee health care costs — continues to increase. Health care costs have increased more than 150% over the past eight years, while employee wages have risen only 37%.For two decades, Towers Perrin has been tracking health costs in the U.S. On this 20th anniversary of its health cost survey, the benefits consulting firm finds that an individual retiring at age 60 will need $250,000 saved to pay health care premiums and out-of-pocket costs. 20 years ago, that same retiree needed $40,000 in savings to fund health care

“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 –

The rate of growth of health spending is the single greatest threat to balancing the U.S. budget in the long term. That’s the key message in The Budget and Economic Outlook: Fiscal Years 2009 to 2019, the latest forecast from the Congressional Budget Office released on January 7, 2008. The report states that the three largest mandatory spending programs in America — Social Security, Medicare, and Medicaid — will grow by at least 8% in 2009. At the same time, the U.S. economy is expected to decline by 2.2% (this does not take into account any potential stimulus spending to

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

Over 8 million American children under the age of 18 didn’t have health insurance in 2005. More than 2 million of these kids had parents who had health insurance through their employers. The growth of child poverty will inevitably increase during the economic recession in the U.S. What’s your hunch on how many more kids will lose access to health insurance — even if their parents keep their jobs? The study, Uninsured Children and Adolescents With Insured Parents, debunked the myth that kids of parents with health insurance have health coverage was published in October 22/29, 2008, in the Journal

Gallup‘s latest poll of Americans’ top health concerns survey are firmly focused on access and cost. This has been true for each of the last seven years that Gallup has conducted this survey. These data echo the findings of Kaiser Family Foundation‘s last health tracking poll for the 2008 election season from October 2008.But there are are differences in the role that government should play in the system: while most Americans see that government’s role should expand in health care, 49% would still like to keep the current, private health insurance-based system. 49% of Americans prefer a “government-run system.”The continuum

In this season of thanks, I am thankful to my wonderful parents, Chuck and Polly Sarasohn. They both had challenging end-of-life struggles — Dad in 2007, and Mom in 1979. I highlighted Dad’s unfortunate experience with an overlooked DNR order while in a congestive heart failure inpatient unit in an iHealthBeat column, Digital Diretives Could Aid End-of-Life Care, in June 2007. This post comes to you as part of a “blog rally,” as described in today’s Boston Globe. Several dozen bloggers in and beyond health are simultaneously posting this message to encourage dialogue around the dinner table about a topic