Health Disparities – The Moral Healthcare Blog

Fertile ground for Medicaid pitch- The Washington Post

Remote Area Medical back in western Virginia, as the battle to expand Medicaid rolls on…

The three-day clinic, which relies on more than 1,000 volunteers, will serve as many as 3,000 people before it ends Sunday. The vast majority of patients — more than 70 percent — come for dental care, Brock said.

Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

Medicaid expansion would not fully alleviate the dental situation. Medicaid does not cover routine dental care for adults or dentures. But Medicaid does pay for emergency tooth extractions, so patients would not have to wait a year to have a bad one pulled.

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

– The Washington Post

Medicaid Expansion Reduces Mortality, Study Finds – Capsules – The KHN Blog

As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move.

The research published in the New England Journal of Medicine found a 6.1 percent reduction in mortality among low-income adults between the ages of 20 and 64 in Maine, New York and Arizona — three states that expanded coverage since 2000, compared with similar adults in New Hampshire, Pennsylvania, Nevada and New Mexico, neighboring states that did not do so.

The decline in mortality, by an overall 19.6 deaths per 100,000 adults, was especially pronounced among older individuals, minorities and residents of the poorest counties. The researchers analyzed data spanning five-year periods before and after the three states extended their Medicaid coverage to poor, childless adults.

The study also found “improved coverage, access to care and self-reported health” among the newly covered adults.

Flaws And All, Medicaid Can Improve Adults’ Health : Shots – Health Blog : NPR

But a study just published online by the New England Journal of Medicine adds to a growing body of evidence that Medicaid, in fact, does improve the health of those it covers.

The study, whose Harvard-affiliated authors include one currently advising the Obama administration and one who worked for President George W. Bush, compared three states (New York, Maine, and Arizona) that expanded Medicaid coverage to childless, non-disabled adults in recent years to three neighboring states that did not. Those adults will be the primary beneficiaries of the expansion envisioned under the Affordable Care Act.

It found that Medicaid expansions were associated with “a significant reduction in adjusted all-cause mortality,” as well as decreased rates of care being delayed due to cost, and more people reporting themselves to be in “excellent” or “very good” health.

Now if that sounds obvious, it’s not. “Prior to Oregon, we didn’t have very good data for adults” and Medicaid, lead author Benjamin Sommers told Shots.

By Oregon, he’s referring to a landmark study from last year that was able to compare adults who got Medicaid coverage through a lottery with those who didn’t. Such a randomized trial is almost unheard of in health policy research because it most cases it would be unethical. The Oregon study was facilitated by state budget considerations.

One reason critics of Medicaid have been able to maintain the debate is that some earlier studies have, indeed, found that people with Medicaid, particularly adults, sometimes had worse medical outcomes than those who didn’t.

Sommers says that should hardly come as a shock. “We know Medicaid is designed to cover the sickest of the sick” he says. “So it’s not surprising that people who have Medicaid do worse than those who don’t.”

Sommers says this new study, which includes some of the same team working on the Oregon data, complements that one. “While it’s not a randomized study,” he said, it has a larger sample (more than 68,000 people) and examines a longer period of time (five years before and after the Medicaid expansion).

Fair Enough? Inviting Inequities in State Health Benefits — NEJM

Fair Enough? Inviting Inequities in State Health Benefits — NEJM:

How much leeway should HHS allow in benefits programs?

I believe that the HHS proposal reflects an inadequate view of equality. A better approach would be to establish uniform standards so that all Americans would have access to the same high-quality goods and services.5 Such a policy could mean the difference between life and death, and it has been well tested and long debated. Indeed, this solution is grounded in the Aristotelian principles of vertical and horizontal equity. Vertical equity calls for different quantities and intensities of goods and services for persons with different needs. For example, patients with conjunctivitis and those with glaucoma need different treatments to restore normal ocular function. Horizontal equity demands that persons with the same needs receive the same treatment. Providing such persons disparate care — as might well happen under the flexible system established by HHS — represents horizontal inequity.

Those who object to the uniform-standards solution will counter that it idealistically and naively seeks, as measures of fairness, the same health outcomes and the same amounts of care for everyone. In fact, however, it is based on the principle of proportionality — the notion that similar cases should be treated similarly and different cases differently, in proportion to their differences. Medical cases in which the health needs are the same are deemed alike; those in which the health needs are different are considered unalike. Such a solution would also require that health care be provided in keeping with medical necessity and medical appropriateness and that patients and their doctors — not state insurance exchanges, state governments, or private health plans — be the ones to make such assessments, within the scope of national standards.

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Report: Breast Cancer Death Rates Decline, but More Slowly Among Poor

Report: Breast Cancer Death Rates Decline, but More Slowly Among Poor:

A new report from the American Cancer Society finds that deaths from breast cancer in the United States continue to decline steadily. However, the decline has been faster for women who live in more affluent areas. Women from poor areas now have the highest rates of death from breast cancer.

“In general, progress in reducing breast cancer death rates is being seen across races/ethnicities, socioeconomic status, and across the U.S.,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “However, not all women have benefitted equally. Poor women are now at greater risk for breast cancer death because of less access to screening and better treatments. This continued disparity is impeding real progress against breast cancer, and will require renewed efforts to ensure that all women have access to high-quality prevention, detection, and treatment services.”

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To Fix Health Care, Help the Poor – NYTimes.com

To Fix Health Care, Help the Poor – NYTimes.com:

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

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To Fix Health Care, Help the Poor – NYTimes.com

To Fix Health Care, Help the Poor – NYTimes.com:

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

What’s more, America is one of only three industrialized countries to spend the majority of its health and social services budget on health care itself. For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries, for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care.

Our study found that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending. While the stagnating life expectancy in the United States remains at 78 years, in many European countries it has leapt to well over 80 years, and several countries boast infant mortality rates approximately half of ours. In a national survey conducted by the Robert Wood Johnson Foundation, four out of five physicians agreed that unmet social needs led directly to worse health.

It is also well understood in the public health communities that health has far more to do with overall poverty than access to health care, per se. But we have this hard headed approach in America to “punish” the “undeserving” poor. Therefore we shoot ourselves in the foot economically in order to feel better about our “values.”
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