USA health-care expenditure

The USA has exceptional levels of health-care expenditure, but growth has slowed dramatically in recent years, amidst major efforts to close the coverage gap with other countries of the Organisation for Economic Co-operation and Development (OECD). We reviewed expenditure trends and key policies since 2000 in the USA and five other high-spending OECD countries. Higher health-sector prices explain much of the difference between the USA and other high-spending countries, and price dynamics are largely responsible for the slowdown in expenditure growth. Other high-spending countries did not face the same coverage challenges, and could draw from a broader set of policies to keep expenditure under control, but expenditure growth was similar to the USA. Tightening Medicare and Medicaid price controls on plans and providers, and leveraging the scale of the public programmes to increase efficiency in financing and care delivery, might prevent a future economic recovery from offsetting the slowdown in health sector prices and expenditure growth. 

The Lancet, 01 July 2014 link

Medicaid e as falsas urgências

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems link

Rwanda

In Rwanda, Health Care Coverage That Eludes the U.S. link link

Rwanda is known for its remarkable success story in extending access to health care to its entire population. This process took an important further step in July 2011 with the introduction of measures to improve the health-care system’s financial sustainability.

A pedir meças ao Obamacare.

ACA, Court´s decision

Early Reaction to Supreme Court Decision on the ACA link

Obamacare (2)

Supreme Court Upholds President Obama's Health Care Reform link link
The Real Winners link
Hospitals Celebrate Decision, But Threats Remain link
Competing for Better Outcomes and Lower Costs link
Seven Consequences of the Health Care Ruling link

One Battle in a Long War

In the fight for universal health insurance, affirmation of the Affordable Care Act (A.C.A.) is a small victory that prevented a major rout. But the next big battle is already upon us: the presidential and Congressional elections in November.

The act might reduce the number of uninsured by 30 million (from the about 50 million now). My gut feeling is that it may be closer to 25 million, as Congress is likely to trim the subsidies for families above 300 percent of the federal poverty level.

Depending on the fall election, significant portions of the act -- especially the subsidies for low- income people -- might be severely clipped.

The A.C.A. has provisions for the development of a number of tools that could be used to constrain the future growth of health spending -- among them bundled payments in place of the inflationary fee-for-service payment, clinically integrated health care, greater transparency of the prices and quality of individual providers. But the act itself would not in this decade reduce total national health spending. On the contrary, by itself it will increase spending slightly.

And, of course, if 30 million additional people with health insurance demand more health care, it will put pressure on an already tight supply of physicians -- especially primary-care physicians.

But depending upon the outcome of the fall election, significant portions of the act -- especially the subsidies for health insurance of low- income people -- might be severely clipped or even eliminated. I believe that could be done through a budget reconciliation that cannot be filibustered in the Senate.

So, after today's euphoria and, on the other side, despair, the battle goes on.

A few years ago I wrote a piece in Health Affairs entitled "Is there Hope for the Uninsured?" I answered "No." After today I would modify it to "A little!"   link 
Kaiser Health Tracking Poll link

Uwe E. Reinhardt is a professor of political economy, economics and public affairs at Princeton University. Updated June 29, 2012, 12:36 AM

Obamacare

O Supremo Tribunal norte-americano deu luz verde à reforma da saúde promovida por Obama. A decisão foi tomada por cinco votos a favor e quatro contra. E representa uma importante vitória política para Obama, a quatro meses das Presidenciais de Novembro, porque esta legislação era uma das promessas que permitiram a sua eleição em 2008.link

Health Care Law supreme court decision link

EU, gastos em saúde abrandam

Nos EU, o crescimanto dos gastos em saúde nos últimos dois anos é o mais baixo dos últimos cinquenta. Esta constatação tem servido de motivação ao debate para apurar se este abrandamento é consistente, perdurável, resultante de medidas estruturais introduzidas no sistema ou se, se trata de um efeito temporário resultante da actual crise da economia.

“The projections have gone down, and the main reason for that is that economic growth has been lower than we’d initially thought,” says Medicare’s Keehan. However, he notes, that there are other changes that have factored into the lower their projected spending -- ones that could have a more permanent effect on cost growth. Drug companies haven’t released any blockbuster pharmaceuticals lately, and, as their biggest sellers have gone generic, spending there has dropped. Hospitals are taking some steps to become more efficient. For the first time in a decade, the number of hospital-acquired infections is declining.link

USA health expenditures

Health, United States , annual report on trends in health statistics – 2011 link

USA, one in 10 veterans currently lack health insurance

An estimated 1.3 million veterans and nearly 950,000 members of their families are uninsured, together making up 4.8 percent of the nation’s 47.3 million uninsured in 2010.

Forty-one percent of uninsured veterans report having unmet medical needs, while nearly 34 percent have delayed care due to cost.

Just four states have uninsurance rates below 6 percent—Massachusetts, Hawaii, Vermont, and North Dakota. Meanwhile, four states—Louisiana, Oregon, Idaho, and Montana—have uninsurance rates above 14 percent. link

EUA, baixa produtividade na Saúde

“Synergies at Work: Realizing the Full Value of Health Investments” link

Os norte americanos são mais produtivos por hora que os europeus (16%) e trabalham por ano mais horas (9%), por isso, as conclusões deste estudo são deveras surpreendentes.

Cerca de 51% dos custos totais da Saúde são devidos à perda de produtividade do trabalho, em termos de desempenho e absentismo. Os restantes 49% dizem respeito aos custos médicos directos (27%) e à reposição dos salários (22%). Assim, os "custos" de maior peso dos cuidados de saúde não estão nos cuidados médicos ou nos seguros, mas antes na produtividade.

drfeelgood

US, despesa da saúde

U.S. health care spending growth decelerated in 2008, increasing 4.4 percent compared to 6.0 percent in 2007. Total health expenditures reached $2.3 trillion, which translates to $7,681 per person or 16.2 percent of the nation's Gross Domestic Product. The health spending share of GDP reached 16.2 percent, up from 15.9 percent in 2007. link "Rate of Health Spending Growth Slows" link

Morrer, caro como o caraças

«The study estimated that out-of-pocket health-care spending in the last year of life amounted to $11,618 on average, with the 90th percentile equal to $29,335, the 95th percentile $49,907, and the 99th equal to $94,310. link
Yes, you read that correctly: Health-care spending in the last year of life by the top 1 percent of Americans is nearly twice the annual income of the typical American household. »

Dying Is Expensive, economix 16.07.10

We have to be more like engineers

Discurso de formatura na Faculdade de Medicina de Stanford. Excerto do que Atul Gawande disse à turma. link
…
Why does anyone receive suboptimal care? After all, society could not have given us people with more talent, more dedication, and more training than the people in medical science have—than you have. I think the answer is that we have not grappled with the fact that the complexity of science has changed medicine fundamentally. This can no longer be a profession of craftsmen individually brewing plans for whatever patient comes through the door. We have to be more like engineers building a mechanism whose parts actually fit together, whose workings are ever more finely tuned and tweaked for ever better performance in providing aid and comfort to human beings.
You come into medicine and science at a time of radical transition. You have met the older doctors and scientists who tell the pollsters that they wouldn’t choose their profession if they were given the choice all over again. But you are the generation that was wise enough to ignore them: for what you are hearing is the pain of people experiencing an utter transformation of their world. Doctors and scientists are now being asked to accept a new understanding of what great medicine requires. It is not just the focus of an individual artisan-specialist, however skilled and caring. And it is not just the discovery of a new drug or operation, however effective it may seem in an isolated trial. Great medicine requires the innovation of entire packages of care—with medicines and technologies and clinicians designed to fit together seamlessly, monitored carefully, adjusted perpetually, and shown to produce ever better service and results for people at the lowest possible cost for society.

...

NY 16.06.10

HCR, pressão sobre o Senado

victor
This year, when you're writing holiday cards to your friends and loved ones, there are two more people who need to hear from you: your senators.
With the Senate deep in final negotiations -- and a compromise just introduced that increases choice and drives costs down -- your senators need to understand how urgent reform really is.
So we've come up with a unique way for you to get the message across -- by sending your senators a card with your holiday wish for the season.

Pink Glove Dance

Já imaginou o pessoal do seu HH a dançar, corredores fora, ao som de uma qualquer charangada. Mesmo em prol de uma boa causa... link

Not this time

"Not This Time" link

Debating health care

cartoon, The New Yorker

na blogosfera

Peter Orszag, “Debating Health Care” link responde no seu blogue às críticas feitas por três conservadores: Virgínia Postrel, Mickey Kaus e Richard Posner.
Entre nós (talvez com a excepção do ex-ministro da saúde, Correia de Campos), não vemos nenhum ministro (com pedalada) capaz de semelhante ousadia. O ambiente da blogosfera nos EUA também é outro e os blogues de uma forma geral de elevada qualidade, são levados mais a sério.

SNS, quanto não vale...

EUA: link ● 62.1% of all bankruptcies have a medical cause.
● Most medical debtors were well educated and middle class; three quarters had health insurance.
● The share of bankruptcies attributable to medical problems rose by 50% between 2001 and 2007.

EUA, healthcare reform

A reforma dos cuidados de saúde é actualmente um dos grandes problemas dos EUA. Provavelmente o maior problema. Para quem se interessa por esta matéria, indispensável a leitura do relatório do Council of Economic Advisers, recentemente publicado: “The Economic Case for Healthcare reform” link