Image by mrrobertwade via flickr.
The piece that aired recently on WSYX-Columbus, Ohio, struck an ominous tone. It featured images of a shadowy basement workshop, cluttered with cooking pans and trays of artificial teeth.
The reporter, Tom Sussi, explained the place was a dental lab. The small operation certainly did not fit the spic-and-span image that might first come to mind when one hears the word “laboratory.” But under Ohio law, it was a perfectly legal place to manufacture dentures, Sussi learned as he did his interviews.
While Ohio beauticians, manicurists and masseuses are all “required to be licensed and properly trained,” the story concluded, the people who “who make things that go into your mouth, like crowns and dentures, are not.”
The situation is similar in a number of other states, as Kiera Butler of Mother Jones pointed out, in her own take on the issue, inspired by Sussi’s story. Continue reading
Dozens of news stories over the past year have reported on the disturbing data showing that Americans are dying younger than people in other wealthy countries and falling behind in many other measures of population health.
But much of the reporting I’ve seen shies away from covering a crucial part of the story: How social inequality may be the most important reason why the health status of Americans is failing to keep up with progress elsewhere.
Being born into poverty, growing up with curtailed opportunities for education and employment, living in a disadvantaged neighborhood – these social determinants of health are like the cards you’re dealt in a game of poker. It’s hard to win if the deck is stacked against you.
Researchers in sociology and public health have developed a fair amount of evidence that social status (typically measured by income or education) may be the most significant shaper of health, disability and lifespan at the population level. In the picture that is emerging, social status acts through a complicated chain of cause-and-effect. Education equips people with knowledge and skills to adopt healthy behaviors. It improves the chances of securing a job with healthy working conditions, higher wages, and being able to afford housing in a neighborhood secure from violence and pollution. The job security and higher income that tend to come with more education provide a buffer from chronic stress – a corrosive force that undermines health among lesser educated, lower income people. Research consistently shows that more education gives people a greater sense of personal control. Positive beliefs about personal control have a profound impact on how people approach life, make decisions about risky behavior, and cope with illness. Continue reading
Image by Judy Baxter via flickr.
What is “successful” aging? According to experts at this week’s Gerontological Society of America Annual Scientific Conference, it depends on the lens through which it’s viewed. “Most of our current definitions are applicable to non-Latino white individuals,” said Linda Phillips, Ph.D., R.N., F.A.A.N., from the School of Nursing at the University of California, Los Angeles. “But these definitions may be inappropriate for elders in other ethnic and racial groups.”
For African-Americans, successful aging is directly connected to the life course process, said Kia Skrine Jeffers. “Health is either built or diminished based on social, economic and environmental experiences, that occur throughout life.” Stressors which occur during sensitive periods have significant impact on disease risk, and the cumulative effect, known as weathering, may also affect health-seeking behaviors. “Many racial and ethnic health disparities can be attributed to weathering, to the accumulated experiences of economic and social adversities.” Continue reading
Three reports – all on various aspects of health care costs – caught my eye today:
The State of the Art of Price Transparency Tools and Solutions
A report released today by Catalyst for Payment Reform examines the price transparency tools and solutions. A summary can be found in the Health Affairs blog. An AHCJ webcast on Dec. 12 will feature CPR’s executive director and Katherine Hempstead of the Robert Wood Johnson Foundation for a discussion about transparency in health care costs. Continue reading
Medicare reform is a hot topic on the agenda for the bipartisan congressional budget committee whose Dec. 13 deadline for a compromise deal on a federal spending plan is looming. Both political parties have proposed raising the Medicare eligibility age and premiums on older adults, among other changes.
In the midst of this debate, two policy experts will join AHCJ’s topic leader on aging, Liz Seegert, to help members understand: Continue reading
You have all probably gotten some emails about this website or that app that can give costs of various health plans in the new insurance exchanges. I’ve seen some that list plans county by county. People may be tempted by these easy tools because, on the surface, they look like a way around that pesky HealthCare.gov or some of the balkier state exchanges.
But there’s a problem. (There’s also a solution that I’ll get to, but keep reading.) The information on most of these plans is very general. And it’s “sticker” prices. Some don’t take into account the subsidies or other particular family circumstances. And that sticker price may produce enough “sticker shock” that people are scared off and don’t find out what they would actually pay, particularly if they are eligible for subsidies. Some of the calculators don’t include age, either, and that does affect what people will pay.
Nor do the calculators always produce the same estimated cost. I tried two different ones using the same information about a family I had spoken to in California. I got very different results – thousands of dollars different. Neither was close to what the family found when they did get on the California exchange. (In this case, the family’s costs did go up.)
The Arizona Republic did a consumer-focused story about the calculators in which they urged consumers to get on the real sites (which are – slowly – improving) and find out what the precise costs are for their unique family circumstances. Continue reading
On Jan. 1, many formerly uninsured Americans will have health insurance coverage and thus will be prepared to engage with the health care system.
But the newly insured will be like most Americans using the health care system today: They will lack the information they need about the cost of health care services and about how much of the total cost is their responsibility.
And, like most Americans, many of the newly insured will have high-deductible health plans and thus may face sticker shock when they visit and physician or hospital and learn how much they have to pay out of pocket until they reach their deductible.
This lack of price transparency is widespread in the U.S. health care system. Yet, for years, health insurers and employers have been shifting the responsibility to pay for care to consumers and employees. Clearly there is a pressing need for information on the cost of care.
AHCJ will explore these issues during a one-hour webcast on price transparency on Dec. 12 at 1 p.m. Eastern (10 a.m. Pacific). Continue reading
A new data brief from the National Center for Health Statistics compares residential care communities with and without special dementia care units in 2010. About four in 10 residents (42 percent) living in residential care communities had Alzheimer’s disease or another dementia. Some states have specific requirements for residential care for these patients such as locked doors and specially trained staff.
Among the major findings:
- 17 percent of residential care communities in the U.S. Had special dementia care units in 2010
- Beds in these special units accounted for 13 percent of all residential care beds
- Facilities with special dementia care units were more likely to be chain-affiliated and built specifically as a residential care community, and less likely to be certified or to participate in Medicaid.
- At least seven out of 10 residential care communities with dementia special care units had features such as specially trained staff (88 percent), an enclosed courtyard (82 percent), doors with keypads or electronic keys (79 percent), and locked exit doors (76 percent).
- More residential communities with dementia care units were located in the Northeast or a metropolitan statistical area and less likely to be situated in the western U.S.
There are some helpful charts to put the data in visual perspective. Reporters may want to see how local residential facilities compare to the national data, or use these figures in combination with a story like this one from KSWB-San Diego – on how a daughter decided her parents needed to move to a care facility.
Image by U.S. Pacific Air Forces via flickr.
Judi Kanne, a registered nurse and freelance writer for Georgia Health News took a look at dental care for seniors and found that her state, and many others, have been coming up short.
She interviewed elderly patients who sought care at Mercy Care, a downtown Atlanta charity clinic.
One of them was 71-year-old Johnnie Collier who told her he went there to get a tooth extracted that had been hurting him for years.
Despite the work of such charity clinics, Kanne wrote, millions of older adults are unable to get the dental services they need.
Then she offered a good summary of the predicament. Continue reading
Michael Hiltzik (@hiltzikm) of the Los Angeles Times has done some fine reporting about the bottom line on the health insurance cancellations.
In this piece, he reminds us that, until this wave of headlines about people losing their beloved individual health policies, people hated their individual health policies. Prices rose every year, benefits were skimpier than employer-sponsored coverage, there were lots of out-of-pocket costs, people got dropped from plans – and people who had pre-existing conditions couldn’t get plans.
“It’s time to retire the threadbare meme that the cancellation notices are depriving people of something they love, as though their health plans are as much as part of the family as the dog,” he wrote in what may be my single favorite sentence in a health care story of the past few weeks. Continue reading