Thursday, September 11, 2014

In praise of placebos - Pittsburgh Post-Gazette

 

In alternative treatments, patients are told that “it will take time to regain your health.” Granted sufficient cultural authority, chiropractors and other alternative medicine practitioners could dissuade patients from risky and painful medical tests, dependence on addictive drugs and needless surgeries.

This makes what chiropractors do secondary to what they prevent. True natural healing may involve distracting patients with a good story and avoiding medical interference. Spinal manipulation at least gives patients time, reassurance and permission to recover — without a costly back surgery that often has no greater probability of success than time and encouragement. (Of course, alternative medicine can become the new dependence — and the new form of bloated expenditure — as “regaining health” creeps into ongoing treatment for “maintaining health.”)

The greater theme here is that so much of our health and well-being lies in our connection with others. My study found that people receiving care — even if it was sham therapy in a control group — showed greater improvement over those stuck on a waiting list.

The logical conclusion is that we are more resilient and more likely to recover if we have a plausible explanation of why we hurt and when the pain might end, and if we know that someone cares. How many other conditions might also require just patience, community and time to heal?

In praise of placebos - Pittsburgh Post-Gazette

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Why More, Not Fewer, People Might Start Getting Health Insurance Through Work - NYTimes.com

Why More, Not Fewer, People Might Start Getting Health Insurance Through Work - NYTimes.com: "The law’s best-known and least-liked provision — the “individual mandate” — is probably causing the trend. For the first time, people must buy insurance this year or be subject to a tax penalty. In Massachusetts, a similar requirement changed the employer-sponsored insurance market in two ways, said Sharon Long, a senior fellow at the Urban Institute, who has studied the state’s experience.

First, it encouraged more workers who were already being offered health insurance to take it — an effect roughly analogous to what Walmart is experiencing. Second, it actually induced more employers to offer coverage to their workers — because, Ms. Long believes, workers began to demand insurance once they were required to have it. Over all, the percentage of Massachusetts residents with employer-based insurance went to 65.6 percent in 2008, when the health care law was up and running, up from 61 percent in 2006."



'via Blog this'

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Thursday, August 28, 2014

Expansion of Mental Health Care Hits Obstacles - NYTimes.com

 

LOUISVILLE, Ky. — Terri Hall’s anxiety was back, making her hands shake as she tried to light a cigarette on the stoop of her faded apartment building. She had no appetite, and her mind galloped as she grasped for an answer to her latest setback.

In January, almost immediately after she got Medicaid coverage through the Affordable Care Act, she had called a community mental health agency seeking help for the depression and anxiety that had so often consumed her.

Now she was getting therapy for the first time, and it was helping, no question. She just wished she could go more often. The agency, Seven Counties Services, has been deluged with new Medicaid recipients, and Ms. Hall has had to wait up to seven weeks between appointments with her therapist, Erin Riedel, whose caseload has more than doubled.

“She’s just awesome,” Ms. Hall said. “But she’s busy, very busy.”

The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces.

Expansion of Mental Health Care Hits Obstacles - NYTimes.com

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Thursday, August 21, 2014

Opinion: UPMC’s costly divorce from Highmark - Pittsburgh Post-Gazette


On Jan. 1, UPMC will achieve its long-sought divorce from Highmark. The separation will undoubtedly disrupt care, add untold stress and potentially harm thousands. UPMC, in refusing even to negotiate a renewed contract, has plainly driven the breakup.
UPMC’s grounds for divorcing Highmark are tenuous. In testimony to the Legislature, UPMC complained that Highmark threatens to injure UPMC by “steering” patients to the “now-struggling” Allegheny Health Network, which Highmark has supported to serve as competitive foil to UPMC.
UPMC further explained, “Western Pennsylvania simply has too many hospital beds, and any gain in admissions at one hospital must come at the expense of other hospitals.”
In brief, UPMC believes competition against Highmark is good, but competition against UPMC is bad. UPMC touts creation of the UPMC Health Plan as “a competitive thorn in Highmark’s side,” but derides its own competitors as malevolent meddlers. As once explained by its CEO, UPMC’s goal is to create a “benevolent monopoly.” Unfortunately, monopolies are rarely benevolent, and there is nothing suggesting that UPMC would forgo (untaxed) profits for the public good.
Op Ed Columns - Pittsburgh Post-Gazette

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Monday, August 18, 2014

Assisted suicide debate in United Kingdom: House of Lords on death with dignity.

In spite of their soul-destroying socialism, the Brits engage in a civil, constructive debate over an emotionally charged subject. So that’s how it’s done…

Last month, a spellbinding 10-hour debate to legalize physician-assisted dying took place in Britain’s House of Lords. Since Americans are unfamiliar with this legislative body, it bears mention that most peers in the upper house of Parliament have been appointed for life for their experience in public service or for their outstanding level of achievement in a given field. Accordingly, many of the bills introduced are not shackled by political constraints, as is the case in the U.S. Congress, but instead address urgent social issues that warrant and receive thoughtful consideration.

Assisted suicide debate in United Kingdom: House of Lords on death with dignity.

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Wednesday, August 13, 2014

Non-profit hospital CEOs' compensation rises again | Modern Healthcare

The hutzpah is amazing!

Despite the ongoing public ire aimed at executives at not-for-profit healthcare systems because of their multimillion-dollar pay packages, their salaries and total cash compensation continued to rise at a far faster clip than average worker salaries in 2012—the most recent year with full data available.
Boards and compensation consultants continue to cite market forces—the need to keep up with peers to hold onto skilled healthcare leaders—as the main reason for the increases.
Total cash compensation grew an average of 24.2% from 2011 to 2012 for the 147 chief executives included in Modern Healthcare's analysis of the most recent public information available for not-for-profit compensation. Of those 147 CEOs, 21, or 14.3%, saw their total cash compensation rise by more than 50%.

Non-profit hospital CEOs' compensation rises again | Modern Healthcare

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Sunday, August 3, 2014

Adventures in ‘Prior Authorization’ - NYTimes.com

 

DEAR Doctor,” the letter from the insurance company began. “We are writing to inform you that a prior authorization is required for the medication you prescribed.”

That’s usually where I stop reading. Thousands of these letters arrive daily in doctors’ offices across the country. They are attempts by insurance companies to prod doctors away from more expensive treatments and toward less expensive alternatives. To use the pricier option, you need to provide a compelling clinical reason.

In theory, this is a reasonable way to control costs by making it harder to prescribe costlier medications. In practice, it is a wasteful administrative nightmare, a cavalcade of recurring paperwork, lengthy phone calls and bureaucratic battles.

One study estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice: one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. Other studies have suggested that prior authorizations could cost individual practices tens of thousands of dollars a year.

Adventures in ‘Prior Authorization’ - NYTimes.com

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