Tag Archives: gao

New GAO report reveals trends in coverage, use of dental services

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

In 2011, 4 million children did not obtain needed dental care because their families could not afford it, according to a new Government Accountability Office report. In 2008, more than 40 percent of adults with tooth or mouth problems did not see a dentist because they lacked dental coverage or the money to pay for care. Roughly 62 percent of Americans carry private or public dental coverage, a rate that is about the same as it was in 1996, according to the report, “Dental Services: Information on Coverage, Payments, and Fee Variation.”

“Unfortunately … not much has changed in this arena,” said Kathleen Iritani, explaining the findings in an interview on the GAO’s Watchdog report.

Most people know that they need to go to the dentist often. Having dental coverage is strongly associated with the use of dental services. Americans often say that the cost of dental care and the lack of dental coverage are reasons they don’t get needed dental care,” Irritani said.

The GAO report revealed a shift away from private coverage and toward public coverage when 1996 and 2010 rates were compared. The percentage of Americans with private dental coverage decreased from 53 percent to 50 percent, while coverage through Medicaid or the State Children’s Health Insurance Program (SCHIP) increased from 9 percent to 13 percent.

Individuals with no dental coverage decreased from 28 percent to 25 percent, and coverage for 10 percent to 12 percent of the population was unknown, according to the study. Continue reading

GAO reports give journalists a starting place for local assessments

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Ready or not, here they come – maybe.

The Government  Accountability Office has released two lengthy reports (and handy one-page summaries) on preparedness of both the individual and SHOP, or small business, exchanges.

In both cases the assessment was mixed – much has been done, but there’s still a big hill to climb between now and Oct. 1, when enrollment begins. The GAO had more concern about the preparedness of the small business exchanges. As we’ve noted before, one key feature has already been postponed a year, the ability of small business employees to choose their own plan, rather than have their employer choose it.

The reports are a good guide to where things stand – and can help you assess progress in your states:

GAO evaluates FDA’s overseas inspectors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

A couple of new GAO reports are seeking to shed some light on the FDA’s overseas regulatory efforts. The first is part overview, part progress report (52-page PDF). It’ll answer your basic questions.

September 18, 2007: An FDA chemist is shown conducting a rapid screening using an automated immunoassay instrument to detect cell surface antigens of Salmonella on food products. Photo by Black Star/Michael Falco for FDA

An FDA chemist tests food for antigens of Salmonella. (Photo: Black Star/Michael Falco for FDA)

In 2008 and 2009, the FDA sent 42 staffers overseas to establish foreign offices. The staff are on two-year overseas rotations, though it’s been difficult to find qualified workers for certain locations, especially since some of them had to take a pay cut. There’s a map of all 11 offices on the 12th page of the PDF.

According to the GAO, what do FDA overseas offices do?

  • Build relationships with foreign regulators and stakeholders, and with other U.S. agencies that are overseas
  • Gather information about regulated products
  • Inspect overseas facilities which are exporting to the U.S. (China and India only)
  • Train foreign stakeholders to better understand FDA regulations and systems

The second report is focused specifically upon inspections of overseas drug manufacturers producing for the U.S. market. The FDA has prioritized a list of such facilities that it would like its inspectors to visit, and the overseas agents managed to check off 11 percent of that list last year. At that rate, it will take about nine years for them to cover everything. For domestic facilities, that turnover rate is about 2.5 years.

GAO examines competition in hospital purchasing

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Group purchasing organizations are intermediaries which theoretically group hospitals together to give them more leverage in purchasing negotiations. In 2009, they accounted for an average of 73 percent of hospitals’ non-labor purchases and were used by 98 percent of American hospitals. There are more than 600 of them in the United States, but the six largest account for 90 percent of the business.

In 2002, they came under fire for anti-competitive practices such as product bundling, excessive administrative fees and sole-source contracting. These practices also may limit access to innovative devices, a problem Washington Monthly‘s Mariah Blake investigated earlier this year.

medical-supplies

Photo by House of Sims via Flickr

At the time, the GPOs promised to institute codes of conduct to prevent such practices. A new GAO report (24-page PDF) aimed to see how much of a difference such codes had made, among other things (pages 18-22, all page numbers are based on the PDF). It also sought to answer questions like “what exactly do GPOs do, anyway?” (page 12), and “how do they make money?” (page 13).

The report relies heavily on interviews and self-reporting, all of which seem to indicate that the industry has voluntarily made progress toward curbing exclusive contracts and conflicts of interest, though a deeper independent investigation would be needed to produce any truly conclusive answers.

The industry’s primary trade group, the Health Industry Group Purchasing Association (HIGPA), heralded the GAO’s findings.

“The GAO report clearly demonstrates the group purchasing industry’s firm commitment to remaining the most transparent industry in health care. The report affirms that our aggressive efforts have yielded increased transparency and low administrative fees in health care contracting, the second largest expense for hospitals after the cost of labor,” HIGPA President Curtis Rooney said in a press release.

HIGPA, which cooperated with the GAO investigation and says it has helped review codes of conduct across the industry, has a membership list that might come in handy for reporters looking to localize this story.

GAO sting spotlights sketchy herbal meds

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Undercover sting operation reports may not be the meatiest documents released by the Government Accountability Office, but they’re almost always the most entertaining.

This time, the target was herbal supplements marketed to elderly patients. In addition to reviewing marketing materials and chemical compositions, investigators posing as elderly customers called supplement companies and received all sorts of bad advice. Check the highlights page for a nifty table of the most common and egregious errors, all of which involved garlic, gingko biloba or ginseng. You can also hear recordings of sellers peddling these treatments here.

All claims were deceptive, but two were also potentially dangerous. They are reproduced, along with GAO commentary, below.

Claim: Ginseng cures diseases, including cancer.

Comment: NIH specifically recommends that breast and uterine cancer patients avoid this product, as it may have an adverse interaction with some cancer drugs.

Claim: Ginkgo biloba can be taken with a daily aspirin prescription.

Comment: Taking this product with aspirin may increase the risk of bleeding.

And, of course, there’s also the matter of toxic substances lurking in the supplements.

GAO also found trace amounts of at least one potentially hazardous contaminant in 37 of the 40 herbal dietary supplement products tested, though none in amounts considered to pose an acute toxicity hazard. All 37 supplements tested positive for trace amounts of lead; of those, 32 also contained mercury, 28 cadmium, 21 arsenic, and 18 residues from at least one pesticide. The levels of heavy metals found do not exceed any FDA or Environmental Protection Agency (EPA) regulations governing dietary supplements or their raw ingredients.

GAO: FDA designation doesn’t ensure safety

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

gras
Ammonium Hydroxide and Phosphoric Acid, both GRAS. Photo by Benny BNut via Flickr.

On his blog Cold Truth (and on AOL News), Andrew Schneider brought our attention to the GAO’s recent investigation into the well-known FDA loophole created by the “generally regarded as safe” or GRAS designation.

The GRAS designation is meant to spare manufacturers lengthy and expensive testing that might otherwise slow the flow of new products to market. It’s conferred, Schneider writes, as long as a “scientific panel selected by the manufacturer can rule that no harm will result from the intended use of an additive.”

Schneider’s version of the highlights of the GAO report:

  • The FDA generally doesn’t know about most of these determinations of “generally regarded as safe,” or GRAS, because companies are not required to inform the agency.
  • The FDA has not taken steps that could help ensure the safety of additives listed as GRAS.
  • Food products may contain numerous ingredients, including GRAS substances, making it difficult, if not impossible, for public health authorities to attribute a food safety problem to a specific GRAS additive.
  • The FDA does not systematically reconsider the safety of GRAS substances as new information or new methods for evaluating safety become available.

The GAO said nanomaterials and imported additives were of particular concern.

(Hat tip to OMB Watch in general and Matthew Madia in particular)