PNHP

NHS: Section 75 of the health act is an engine for destruction

NHS: Section 75 of the health act is an engine for destruction

Section 75 of the health act is the mechanism that locks in privatisation of the health service: the Lords must amend it

By Kailash Chand 
The Guardian (U.K.), April 22, 2013

Andrew Lansley’s Health and Social Care Act, which came into effect on 1 April, had a troubled passage through parliament, including an unusual legislative “pause”. This was to allow the government time to “listen” to its many critics, including most healthcare professionals and a majority of the public, who believed the plans would create and lock in rights for private providers to make a profit from the NHS. Lansley gave assurances that these voices had been heard, and that clinical commissioning groups would be able to decide “when and how competition should be used”.

However, concerns about privatisation return to centre stage this week, when the regulations governing procurement and competition are debated in the Lords. As Lucy Reynolds, a research fellow at the London School of Hygiene and Tropical Medicine, puts it, if the act itself was the aircraft of privatisation, the structure that gave the idea the potential to fly, section 75 of the regulations is the engine that will allow take off.

The wording of section 75 requires commissioners to put out to tender everything that could be provided by an organisation other than the NHS. Private contractors are more likely to win these tenders than doctors, many of whom will never have even seen a tender notice. The regulations would create rights for commercial providers under rules originally devised by US corporations to promote their commercial interests. If implemented, they will drag the NHS into a competition law regime which creates obligations for governments to compensate private providers in the event of services being brought back into public provision.

The British Medical Association, along with many other health organisations including the Royal College of General Practitioners, are calling for the regulations to be withdrawn, as is the Labour party. The BMA says they must be replaced with new regulations that “unambiguously reflect previous government assurances that commissioners will not be forced to use competition when making their commissioning decisions”, and explicitly state this principle.

As contracts are lost by public sector bidders, the teams that would have delivered them will be made redundant because funds will not be available to pay them. Under the proposed regulations, the government is not permitted to rescue such a service unless all other competitors are equally subsidised, in the interests of non-discrimination.

The competitive tendering forced by the current draft of the regulations requires a large amount of administration, which will divert funds away from frontline care. Thanks to market-driven changes that have already taken place administrative costs have risen to at least 16%, in contrast to the pre-1980 figure of less than 5%.

These regulations will act as the motor of the NHS privatisation by giving companies a mechanism to force their way into NHS service provision for the patients, procedures and places wherever they see profits. The likes of Care UK or Virgin Care will try to cherry-pick easy and profitable services – diagnostics, routine elective surgery, and simple treatments, for example – leaving behind A&E, care of the elderly, mental health services and anything that is unpredictably expensive.

Seeking the withdrawal and replacement of these regulations is not scaremongering; there is plenty of evidence that market-driven health services lead to limited choice, escalating costs, and reduced quality. There is no evidence to support the idea that competition breeds excellence in healthcare. According to Robert Evans, professor of economics at the University of British Columbia, market innovations in the NHS over the last 40 years have led to greater inequity, increased inefficiency, cost inflation and higher levels of public dissatisfaction. It is time to reject the market ideology that has plagued the NHS for more than a quarter of a century, wasting billions of pounds in the process.

http://www.guardian.co.uk/commentisfree/2013/apr/22/section-75-health-act-destruction-engine

1 million hours of psychiatrist time wasted yearly on phone approvals for hospitalization

Harvard researchers find lengthy waits for severely ill psychiatric patients

FOR IMMEDIATE RELEASE
April 23, 2013

A study published today in Annals of Emergency Medicine reports lengthy waits for severely ill psychiatric patients in need of immediate hospitalization in the Boston area, due in part to time-consuming prior authorizations required by insurance companies.

Psychiatrists spent, on average, 38 minutes on the telephone getting authorization. In 10 percent of cases it took more than one hour to obtain insurance authorization; in one case authorization took five hours of psychiatrist time.

Mental health disorders are common, affecting nearly 1 in 4 adults annually, less than a third of whom receive psychiatric care. Better access to care might reduce the harms mental illness imposes on the mentally ill, their families and communities.

For the present study, over a three-month period, researchers tabulated how long psychiatric patients who were deemed in need of inpatient admission stayed in the emergency department (ED) prior to being hospitalized, and the amount of time that the ED psychiatrists spent obtaining authorization from the patient’s insurer. A group of 11 psychiatric residents at Cambridge Health Alliance (CHA) working in the psychiatric ED with acutely ill psychiatric patients collected the data.

Most patients required hospitalization because they were suicidal or, in a few cases, homicidal.

Although obtaining insurance authorization delayed care and took clinicians away from other duties, only 1 of the 53 requests for authorization was denied. Median total time in the ED was 8.5 hours, with the shortest stay lasting 3 hours and the longest recorded stay lasting 20 hours.

These numbers don’t include a handful of patients who boarded in the ED over the weekend while waiting for an inpatient bed to become available for them. They exclude uninsured patients and those with Medicare, which doesn’t require prior authorization.

With approximately 1.6 million psychiatric admissions among people with private insurance nationwide each year, 38 minutes of phone time to obtain authorization translates into about 1 million hours of wasted psychiatrist time.

Lead author Dr. Amy Funkenstein, a child psychiatry fellow at Brown University, led the study while she was a psychiatric resident at CHA and Harvard Medical School. She said: “Society pays for inadequate psychiatric care; more than half of all prison inmates and a third of all homeless people are mentally ill. Massachusetts is considered a model for health reform, yet we found that seriously ill patients routinely spent hours stranded in the ED due to insurance bureaucracy. The hours psychiatrists spend obtaining those authorizations could be far better spent treating our patients.”

Senior author Dr. J. Wesley Boyd, attending psychiatrist at CHA and assistant clinical professor of psychiatry at Harvard Medical School, commented: “Private insurers are obstructing care by requiring authorizations before a qualified psychiatrist can hospitalize a dangerously ill patient. With doctors, nurses and emergency departments already overburdened, adding a time consuming bureaucratic task that doesn’t help patients is unconscionable.

“Insurers hope that clinicians will be so hassled by authorization procedures that they won’t seek admission for their patients, saving insurance companies money,” he said. “Placing profits ahead of the health of patients when mental illness makes them vulnerable is immoral. A single-payer Medicare-for-all health care system would represent a great leap forward for patients and providers alike.”

*****

“Insurance Prior Authorization Approval Does Not Substantially Lengthen the Emergency Department Length of Stay for Patients with Psychiatric Conditions,” Amy Funkenstein, M.D., Monica Malowney, B.A., and J. Wesley Boyd, M.D., Ph.D. Annals of Emergency Medicine, April 23, 2013.

The doi for this article is 10.1016/j.annemergmed.2012.10.033.

A copy of the manuscript of the study, which takes the form of a clinical observations research letter, is available here.

*****

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization of more than 18,000 doctors who advocate for single-payer national health insurance, an improved Medicare for all. PNHP had no role in funding or otherwise supporting the study described above. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Businessman Allan Tweddle responds to Uwe Reinhardt on "one size fits all"

Allan Tweddle responds to Uwe Reinhardt on "one size fits all"

(Quote of the Day for April 16, 2013 https://pnhp.org/news/2013/april/uwe-reinhardt-on-one-size-fits-all):

I am no expert, just a Canadian born US Citizen with family still north of the border.  I have seen the personal value of their system many, many times.  From horrific cancer in children, to heart and cancer in elderly, to total hip replacements, all covered at zero expense to the citizen patient.
 
And even that needs clarification.  In the Canadian Immigration web page, once a person is accepted by their immigration department, a new arrival into Canada will get full coverage within 3 months after arrival.  That is remarkable, considering that that person has not yet contributed one dime to the system.
 
Their system, like in Britain, provides basic health care for all and lets the private insurers pick up the tab for luxury items like fancy hospital suites, Viagra, etc.
 
The Canadian system is controlled, designed and managed by each province.  It has Federal dollars in each plan, so while their experience is NOT “One size fits all”, they have made it work for 30 years or more.  Did we make any attempt to study their success and learn from their mistakes?  I doubt it.
 
However, there are only 10 provinces.
 
Our ACA plan that tries to take into consideration 50 States does look far too complicated. I’ve been in briefings for the West Virginia plan alone, and it’s too complicated.  We need to just lower the eligibility age of Medicare to age zero less 9 months!
 
We need a single payer for the basics so we eliminate bankruptcy due to unexpected and financially catastrophic health care costs to individuals.  It is my understanding that in the U.S., medical debt contributes to 62% of all bankruptcies. In Canada that number is ZERO!
 
Shouldn’t we be protecting the citizens and not the greed-driven insurance industry?

****

Our emerging manufacturing company has been considering a location for our production operations.  We have concluded, like so many automobile companies* have, that Southern Ontario would be financially attractive due, among other reasons, to the differential in payroll burden.  Aerospace payroll burden here is about 36%, whereas it is 15 to 18% in Ontario.  That’s a significant differential…20%!  And from everything we have been able to determine, the difference is health care expense. (*Did you know that the expense of health care is almost always cited as a primary reason for the announcement of new plants in Ontario, so that now more cars are made and assembled in Ontario than Michigan?)
 
The financial/economic value of a universal single payer system is obvious to us.  And when you learn that the system they have there has better health results, then the choice becomes clear.  And if any right-wing free enterprise enthusiast who has an open mind would pay attention to the sheer economic advantages, they would join us on a bandwagon to get it here.
 
But we cannot wait for that to happen, so we will in all probability be locating there.

Allan Tweddle, of Charleston, West Virginia, is Chairman and CEO of an aerospace manufacturing firm. His email address: allantweddle@msn.com

Comment:

By Don McCanne, M.D.

We should listen to this Canadian-born, U.S. businessman who is very familiar with the health-care systems and the business climates in both the United States and Canada. The lure of Canada’s health-care system may be too great for his company to establish production operations here in the United States. That should awaken us all, especially the business community.

Much less important, a comment on “one size fits all” is warranted. That phrase has been used endless times to dismiss single payer reform. Used this way, it implies that there are many “sizes” in health care. In reality, when you need health care, you aren’t checking out “sizes.” You merely want unrestricted access to the health care delivery system that we have.

The “sizes” they speak of usually refer to different insurance products, ranging from almost worthless mini-med plans to comprehensive, integrated HMOs. (For purposes this discussion, integrated health care delivery systems such as Kaiser and Group Health are considered components of our health care delivery system rather than as intermediary insurers.)

When individuals select their own insurance plans, which do they choose most often? They select high-deductible, preferred provider organizations. That is, they select a “size” that works if they stay healthy. Should they develop significant health problems, that particular “size” will prevent them from being able to have free choice of their health care professionals and institutions, and it will leave them with out-of-pocket financial burdens – neither of which is the “size” that they really wanted, especially when they find out too late that it didn’t fit.

Mr. Tweddle points out that Canada’s single payer system is not “one size fits all” since it is separately administered in each of their ten provinces. But, refocusing, the Canada Health Act does pull all of the provinces together into one “size” that is universal, comprehensive, accessible, portable, and publicly administered. Quite clearly, this is not a “size” that is inflexible to varying needs, but rather it is a comprehensive program that fits all.

When you shop for health insurance, it is important to keep in mind that all of the private insurance choices are the wrong size, to varying degrees. The only right size out there is the health care delivery system which can be readily accessed by getting all of the wrong-sized insurers out of the way, except for the one right-sized program that really does fit everyone – a single payer national health program, or improved Medicare for all.

Single-payer plan is best health care solution

By Thomas P. Clairmont, M.D.
Portsmouth (N.H.) Herald, Letters, April 20, 2013

The Chidester (op-ed) correctly identifies the problems in health care today: uncontrolled costs and the rising number of uninsured.

He advocates for a simple solution, but fails to deliver one.

His numbers are absolutely wrong. A review of the Census Bureau Web site clearly states that the uninsured number for 2010 was 49,904,000. His number is one-sixth of that. However, it doesn’t really matter. At Physicians for a National Health Program, we feel that one uninsured person is too many. This is reflected in our motto: Everybody In, Nobody Out.

He then advocates for free markets as the solution, comparing buying health insurance to purchasing cell phones and computers. Free markets have been around for a long time, giving us premium increases multiple times inflation for the past decade. Just this week, the Herald reported the York School Department is facing a 13 percent increase in health care premiums. Health care inflation for 2012 was only 3.7 percent.

Free markets don’t work in health care. Every business wants more customers. In health insurance, however, that isn’t true. They only want the healthy, who won’t hurt their bottom line of excessive profits, inordinate executive compensation and returns to stockholders.

Chidester then says he wants a simple solution. OK, so does everyone else. Let’s look at the Vermont Plan, authored by Harvard economics Professor William Hsiao. He outlined four goals:

(1) Universal health insurance coverage; (2) provision to every Vermont resident of an adequate standard benefits package and equal access to health care; (3) control of the rapidly escalating costs of health care in Vermont; and (4) establishment of a system that prioritizes community-based preventive and primary care, as well as integrated health care delivery.

He accomplishes this with a single-payer plan that dramatically reduces administrative expenses. In fact, his plan will immediately reduce health care costs in Vermont by 8-12 percent and reduce health care costs by an additional 12-14 percent over time. Keep in mind that every resident is covered and they won’t have to decide which policy they want, with what combination of co-payments, deductibles and other out-of-pocket costs that are a deterrent to good health. Now that is a simple plan. Do you want the Chidester plan or complete health care security for you and your family?

Dr. Thomas P. Clairmont resides in Portsmouth, N.H.

http://www.seacoastonline.com/articles/20130420-OPINION-304200304

Hawaii should end Medicaid managed-care model

By Stephen Kemble, M.D.
Honolulu Star-Advertiser, April 21, 2013

Hawaii was recently awarded a $937,691 State Innovation Model grant to plan health care reform for Medicare and Medicaid.

However, no reforms can be effective without good physician participation and good access to care for patients, and we have serious problems with both in our Medicaid managed care program. If we don’t fix these problems, Hawaii will waste almost a million dollars and several years on ineffective reforms.

Hawaii converted our state-run, fee-for-service Medicaid program to managed care via competing private plans, in stages, in 1994 and 2009. This conversion has demonstrably increased the cost of the Medicaid program while reducing patient access to care and quality of care.

Hawaii’s Medicaid costs have been rising around 3 percent faster than the national average since Medicaid managed care was introduced here in the mid-1990s, according to Kaiser Family Foundation State Health Facts. Regardless of what the managed care companies will tell the state, privatization of Medicaid has led to increased cost and declining access and quality of care wherever it has been studied.

The managed-care model relies on restriction and denial of care. Escalating administrative burdens imposed by managed care plans are literally driving doctors out of treating Medicaid patients, and it has become almost impossible to find a private-sector doctor who will accept new Medicaid patients. Access to outpatient care is getting worse, undoubtedly leading to increased preventable hospitalizations.

Competing managed-care plans add substantially higher administrative costs, much of which are misleadingly counted as “health care” for reporting purposes, adding to the total cost that the state must pay for Medicaid.

Failures in care coordination are largely due to fragmentation of Medicaid and excessive managed-care restrictions. Each plan has its own restricted network of doctors and its own formulary and prior authorization policies. This means increased administrative hassles for doctors, fragmentation of the data needed for health information technology and care coordination, declining physician participation, and disruption in care when patients switch plans.

The Medicaid managed-care plans talk about “integrated, coordinated care,” but in practice this is true only for Kaiser, where Medicaid patients have the same access to care as any other Kaiser member, and to some degree for HMSA, which has better acceptance among doctors than the other Medicaid plans.

Payment and delivery system reforms cannot be effective without access to cost-effective care. There is nothing in the governor’s Health Transformation Initiative that addresses the reasons doctors are refusing Medicaid patients. The managed-care policies that obstruct and deter care and associated administrative hassles for doctors are being left in place. Doctors may complain about low fees, but that is not the reason they have been fleeing Medicaid. Medicaid fees relative to commercial rates have not changed significantly in the past 20-30 years, but physician acceptance of Medicaid patients declined only after Medicaid was broken into competing private plans.

The state actually ran Medicaid much more cost-effectively than the private plans do now, but a consolidated Medicaid program could use a single third-party administrator to run the program in lieu of re-creating the administrative structures that were in place before conversion to Medicaid managed care.

Hawaii could markedly reduce Medicaid administrative costs while increasing physician participation and access to care simply by terminating our Medicaid managed-care program when the contracts expire at the end of this year, and go back to fee-for-service Medicaid. Then we could add care coordination programs funded with the State Innovation Model planning grant, including patient-centered medical homes and community care teams, and see if they help improve the cost-effectiveness of care.

Dr. Stephen Kemble is president of the Hawaii Medical Association; he also serves on the Hawaii Health Authority and was on the executive committee of the Hawaii Health Project.

Labor council, plumbers local in Alabama endorse H.R. 676

Actions bring total labor organization endorsements to 600 nationwide

By Kay Tillow

On April 15, the Northeast Alabama Labor Council in Gadsden endorsed H.R. 676, national single-payer health care legislation sponsored by Congressman John Conyers.

President Garry “Gabby” Frost brought the resolution before the council in response to an appeal from the All Unions Committee for Single Payer Health Care – H.R. 676 and from Pippa Abston, M.D., Ph.D., a board member of Physicians for a National Health Program and a Huntsville, Ala., pediatrician.

“Health care is a necessity not a privilege,” said President Frost after the adoption of the resolution for H.R. 676. “Everybody’s got to have it. This is the only industrialized nation that does not have it.”

The Northeast Alabama Labor Council is the 145th Central Labor Council to endorse H.R. 676. The council represents workers in nine counties: Calhoun, Chambers, Cherokee, Cleburne, DeKalb, Etowah, Marshall, Randolph, and St. Clair. The Southwest Alabama Labor Council in Mobile and the Alabama State AFL-CIO had previously endorsed H.R. 676.

President Frost, who is the business manager of Local 498, United Association of Plumbers and Pipefitters, reports that Local 498 has also endorsed H.R. 676. That brings the total of union organizations that have endorsed H.R. 676 to 600.

Dr. Pippa Abston commented on the importance of these union endorsements of H.R. 676. She said, “As an Alabama physician and Physicians for a National Health Program board member, I am thrilled to hear this news! Medicare for All is an achievable, practical way to address our health care needs and would go a long way towards relieving our state’s constant budget struggles. Thank you to our friends in Labor for helping bring H.R. 676 a step closer to success.”

****

H.R. 676, the Expanded and Improved Medicare for All Act, would institute a single-payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S.

H.R. 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care.

H.R. 676 ends deductibles and co-payments. H.R. 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, H.R. 676 has 41 co-sponsors in addition to Conyers.

H.R. 676 has been endorsed by 600 union organizations including 145 Central Labor Councils/Area Labor Federations and 41 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA & RI).

For further information, a list of union endorsers, or a sample endorsement resolution, contact:

Kay Tillow, All Unions Committee for Single Payer Health Care—H.R. 676, c/o Nurses Professional Organization (NPO), 1169 Eastern Parkway, Suite 2218, Louisville KY 40217. Phone: (502) 636 1551; e-mail: nursenpo@aol.com; website: http://unionsforsinglepayer.org

Hospital Head Warns of Racism in U.S. Health Care System

By Jeffrey Hess
Mississippi Public Broadcasting News, April 19, 2013

JACKSON, Miss. — The head of a major U.S. hospital is warning that the health care industry in the U.S. is ignoring embedded racism.
 
Dr. Claudia Fegan is the chief medical officer of a major Chicago hospital.  She talks about what she views as a major problem in the current health care system.
 
“The reality is, in the delivery of health care in this country racism still plays an important role,” says Fegan.
 
She says evidence shows that minority patients have worse health care outcomes in most situations, a disparity that transcends class and education level.
 
“Black women with college degrees whose birth do not have as good an outcome as white women who do not have a high school diploma. It is not as simple as socio-economic status or the notion that you can earn or educate yourself out of these problems,” continues Fegan.
 
For example, In Mississippi black babies are twice as likely to die as infants compared to white babies.
 
Fegan says doctors and patients often have very different perceptions of the quality of a doctor’s visit, which she says contributes to doctors not understanding how race impacts health care.
 
She says doctors and hospitals need to do more to recognize the cultural differences and acknowledge the worse outcomes to begin fixing the issue.

http://mpbonline.org/News/article/hospital_head_warns_of_racism_in_u.s._healthcare_system

Uwe Reinhardt on "one size fits all"

Author Interview

JAMA, April 16, 2013

Uwe E. Reinhardt, PhD, economics professor at Princeton:  On this point, I’m very disappointed that we Americans couldn’t even get the exchanges right. As Atul said, an exchange is really just like the personnel benefit department at General Motors. It’s just an electronic market to buy health insurance. I could show you the Swiss or the German exchanges. We have now made a horrendous mess of these exchanges. It cost close to a billion dollars to implement the California exchange, and heaven knows what’s happening in the other states. I was thinking if this generation of Americans had to plan the Normandy invasion, I think they would never have gotten there, or by the time they got there, the Russians would have been there. It is just unbelievable what an administrative nightmare the Affordable Care Act has become. Americans always tell me – I’m just an immigrant trying to learn about this country – they always tell me, oh, one size doesn’t fit all. Well, tell that to McDonald’s or to the Holiday Inn. In fact, Americans invented the idea that one size fits all, and built great industries on it – the auto companies, the food services, the hotels, the department stores – they’re all one size fits all.

Ed Livingston, deputy editor of JAMA:  You mentioned that companies like McDonald’s and Holiday Inn have been very successful in building large industries with uniformities, but those are private industries. Is the problem that when the government tries to take on something this complex they just can’t seem to get it done?

Uwe Reinhardt:  Well, it’s for the reason that Atul mentioned, that somehow we give enormous respect to regional variations, and, because we do, we make everything enormously complex. Imagine if you ran the U.S. Army that way. Soldiers from every state could pick their own rifles, and so on and so forth. Sometimes you have to do national things. I recently wrote a Health Affairs piece and said, every American is a dual citizen. He has citizenship in the state that they live in and citizens in America. And it really depends when you draft federal legislation, which citizenship do you make supreme. Typically you find Democrats put American citizenship up on top. The idea being that a baby in Mississippi should have the same rights to access to health care as a baby in Massachusetts, because they are both Americans. I think more on the Republican side they would say, no, what happens to a Mississippi baby is up to the people down there, and you can do what you want to a Massachusetts baby up there in Massachusetts. Now, that’s a different conception, neither right or wrong, but I’m saying on some issues we really, in my view, should have national policies because it would be much more easy to administer. After all, that’s what we said in Medicare. We said no matter where the elderly live, they should have the same deal in health care, and we created Medicare. Has Medicare been that much of a disaster?

Audio (April 16,2013): http://jama.jamanetwork.com/multimedia.aspx#AuthorInterviews

Comment:

By Don McCanne, M.D.

Hmmm.

“It is just unbelievable what an administrative nightmare the Affordable Care Act has become.”

“…they always tell me, oh, one size doesn’t fit all. Well, tell that to McDonald’s or to the Holiday Inn.”

“…but I’m saying on some issues we really, in my view, should have national policies because it would be much more easy to administer.”

“We said no matter where the elderly live, they should have the same deal in health care, and we created Medicare. Has Medicare been that much of a disaster?”

So can we draw the conclusion that we should adopt the administrative simplicity of a national, one-size-fits-all Medicare that gives everyone the same deal in health care? Seems like a really good idea.

Upstate New York Greece

By Andrew D. Coates, MD, FACP
WAMC Northeast Public Radio, April 19, 2013

I live in upstate New York. If you’re hearing this, chances are you do too.

One of my great friends at the university once casually remarked that it seemed the whole world came through our community. “Look deeply enough into anyone’s family history and you will find a connection,” she said. “Some part of everyone has been here one way or another.”

Her consciousness about the connectedness of one community to the whole world reminded me of a fragment by Franz Kafka:

“You do not need to leave your room. Remain sitting at your table and listen. Do not even listen, simply wait, be quiet, still and solitary. The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet.”

When the world is busy rolling up at our feet it reveals that upstate New York, like anywhere, has its own distinct and proud culture. From it, our own William Kennedy, Richard Russo, Lauren Groff and many others have spun great literature. Just think, for example, of the extraordinary catalogue of people who have come through Yaddo or Caffe Lena, both in Saratoga, or Bard College, just down the Hudson, and all that these people have shown us, collectively, about life and our world.

In other words, knowing one’s community well can be, as my friend was pointing out, a way to understand the whole world.

We physicians have earned great scientific insight into health and illness in our patients. But we also gain great human insight — how the conditions of everyday life impact the fate of our patients. Ultimately an understanding the culture and the economy of our community is inescapable if we are to serve our patients and our profession. This leads to a sense of connectedness with the whole world.

Lately I’ve been struggling to overcome a sense of shock as I learn about the living conditions and the daily life distress faced by my patients.

I feel a bit like Rip Van Winkle, for after several years away from hospital medicine I returned to full time. In the hospital an entire slice of life, a cross section of all cultures and classes and ages, streams into the building, for we all face a risk of acute medical illness. It has opened my eyes.

The ravages of drug addiction — how it can tear families asunder; the weight of a serious illness upon a spouse — how people forfeit their homes and their jobs because of a family health crisis; how temporary and part-time jobs, always with no sick time, force the postponement of necessary medical care, not only for the person with the difficult job, but for their children, their parents, anyone who depends upon them. These issues arise again and again and in the most personal way. Things have gotten worse in our community over recent decades — and I am a frontline witness.

To illustrate our connectedness to the world, a study published this week in the American Journal of Public Health looked at the adverse health consequences of the economic recession and subsequent austerity measures in Greece over recent years. The team of Greek and American researchers found, for example, that between 2007 and 2009, suicide rates among men rose 22.7 percent.  Homicide mortality rates among men increased by 27.6 percent.

Mental disorders, substance abuse, and infectious diseases showed worsening trends. In turn, the government cut public health spending dramatically.

In short, government austerity is bad for our health.

Meanwhile UNICEF published a study of child well-being in the 29 wealthiest nations. My friend Dr. Don McCanne pointed out that out of 29 nations, Greece was ranked number 25. The United States was behind Greece at 26.

As I read these studies the tears and sobs of my patients and their loved ones leapt to mind. The human stress of illness in the context of difficult economic times has been worsened by austerity here, just like Greece.

The same schemes of privatization, deregulation and cuts to public programs that have happened in Greece can be found in every community in upstate New York.

The people who make the decisions don’t seem to understand the human consequences of austerity policies on top of the difficult economy.  But for those of us who know and love our home communities and our local culture — whether upstate New York or Greece or anywhere — the tragic health effects tear a hole in our hearts and our future.

Andrew D. Coates, M.D., F.A.C.P., practices internal medicine in upstate New York. He is president of Physicians for a National Health Program.

You can listen to Dr. Coates’ radio broadcast, which was titled “The Human Consequences of Austerity” by WAMC, here:
http://www.wamc.org/post/andrew-coates-human-consequences-austerity

Suicides, murders rise as Greek austerity takes health toll

By Kerry Sheridan
Agence France-Presse, April 18, 2013

When Greece’s economy took a plunge, murders and disease rates soared, according to a study published Thursday that suggests the impact of the European nation’s austerity cuts may be worse than expected.

Suicide and murder rates climbed from 2007 to 2009 particularly among men, and unusual outbreaks of malaria, West Nile virus and HIV took clinicians by surprise, said the findings in the American Journal of Public Health.

The decline in health came as Greece’s once robust economy collapsed into recession following the global economic crisis of 2007, with unemployment rising from 7.2 percent in 2008 to 22.6 percent in early 2012.

Greece took out billions in loans to stave off financial collapse and implemented austerity measures that included a major downsizing of the Ministry of Health, where spending fell nearly 24 percent from 2009 to 2011.

For patients, the cuts meant many services that were once free now cost money out of pocket, including higher prices for hospitalization. There were salary freezes and layoffs in the health sector, and many preventive programs were halted.

With debates raging in political and economic circles over the true costs and merits of austerity, a team of Greek clinicians and US researchers set out to document the effects of the policies on the health of people in Greece.

“We were expecting that these austerity policies would negatively affect health services and health outcomes, but the results were much worse than we imagined,” said lead author Elias Kondilis, a researcher at Aristotle University.

Among the general population of some 11 million people on the Mediterranean island, suicide rates rose 16 percent and murders climbed nearly 26 percent from 2007 to 2009, said the findings, which draw on Greek government data.

Meanwhile, deaths in the general population from infectious disease increased 13 percent in those two years.

Among men under 65 who were more likely to face the perils of unemployment, the numbers were higher — a 23 percent higher suicide rate, a 25 percent rise in murder rate and a 27.6 percent rise in deaths from infectious diseases.

Normally, preventive measures in developed nations like Greece are successful at keeping diseases such as malaria and HIV to a relatively low incidence, co-author Howard Waitzkin of the University of New Mexico told AFP.

But when programs like needle-exchanges for drug users and condoms for at-risk groups were slashed, the disease rates ballooned.

Researchers were surprised to see three infectious disease outbreaks in a span of 18 months from July 2010 to December 2011, he said.

They included an spate of West Nile virus that infected 197 and killed 35 people and an outbreak of malaria in southern Greece.

Also, there was a 57 percent spike in newly diagnosed cases of HIV infection, from 607 new HIV cases in 2010 to 954 in 2011.

Among injection drug users, the impact was more dramatic — 15 new cases of HIV documented in 2010 compared to 241 cases in 2011, or a 1,506 percent increase.

“These aren’t small percentage changes,” said Waitzkin, distinguished professor emeritus of sociology and medicine at the University of New Mexico.

The study said Greece initially attributed the outbreaks to environmental risk factors but the fact that public health measures had to be deployed after the fact implies that “the risks of transmission had not been addressed through prevention.”

Mental disorders and substance abuse also climbed.

Waitzkin said similar problems were seen in Argentina a decade ago, and the same issues could loom on the US horizon as the American government implements across-the-board spending cuts known as the sequester.

“The concerns are much broader than simply Greece and these kinds of policies in our view are very dangerous for public health,” he said.

http://www.globalpost.com/dispatch/news/afp/130418/suicides-murders-rise-greek-austerity-takes-health-toll

Austerity in Greece linked to serious mental, physical health decline

Psychiatric Annals, April 19, 2013

The economic recession and subsequent austerity measures in Greece were associated with a significant deterioration in public health services and mental and physical health outcomes, according to a new report by Greek and US researchers.

“We were expecting that these austerity policies would negatively affect health services and health outcomes, but the results were much worse than we imagined,” study researcher Elias Kondilis, PhD, of Aristotle University of Thessaloniki in Greece, said in a press release.

Kondilis and colleagues examined data on economic and social conditions, the utilization of health services, and health outcomes in Greece during the 2008-2012 recession. Between 2009 and 2011, there was a 23.7% reduction in the Ministry of Health’s expenditures, and the overall expenses of public hospitals fell by 12.5% during the same period. To address the growing economic crisis, the government deregulated private health services.

A number of adverse health outcomes coincided with these events, according to the researchers.

The all-cause mortality rate continued to decline during the economic crisis, but suicide, homicide and infectious disease rates increased by 16.2%, 25.5% and 13.2%, respectively.

Specifically, the suicide and homicide rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009. The 1-month prevalence of major depression doubled between 2008 and 2009 from 3.3% to 6.8%, and the number of people with problematic drug use — primarily heroin — increased 11.6% from 2008 to 2010. Among those aged 35 to 64 years, the increase in the prevalence of drug use was even more significant, at 88.2% in 2010.

Greece experienced three outbreaks of infectious disease in a period of less than 18 months. There were 197 reported cases of neuroinvasive disease and 35 related deaths in October 2010; 63 cases of malaria between May and October 2011; and a 57.2% increase in newly diagnosed cases of HIV-1 infection from 2010 to 2011. Among injection drug users, there was a 1,506.7% increase in newly diagnosed HIV-1 infections.

Although the increased prevalence of infectious disease in Greece was initially attributed to environmental risk factors and migrant populations, the researchers said cutbacks in public health services were to blame, as well. Preventive services such as mosquito- and vector-control programs and the distribution of condoms and clean needles had been dismantled.

The recession in Greece and its economic policies to address the crisis also had an effect on the utilization of health care services, the researchers said. The use of private medical facilities decreased, and the use of public inpatient and primary care services increased by 6.2% and 21.9%, respectively, between 2010 and 2011.

Study researcher Howard Waitzkin, PhD, MD, of the University of New Mexico, said severe economic cutbacks in the United States could lead to health outcomes similar to those in Greece.

“Instead of austerity policies, we need increased public health sector spending to stimulate our failing economy and to protect the health of our people,” he said in the press release.

Disclosure: The researchers report no relevant financial disclosures.

Kondilis E. Am J Public Health. 2013;doi:10.2105/AJPH.2012.301126.

http://www.healio.com/psychiatry/suicide/news/online/%7B69483171-C5EB-4FE8-8DF2-D4BA6B5DB576%7D/Austerity-in-Greece-linked-to-serious-mental-physical-health-decline

Deteriorating Public Health Policies? What Greece, U.S. May Have in Common

By Bob Herman
Becker’s Hospital Review, April 18, 2013

For the past several years, the United States has not been the only country to face a recession. Many parts of Europe have also undergone an economic crisis, especially Greece, and an article in today’s American Journal of Public Health said there are lessons to be learned from how Greece has handled its public healthcare over the past several years.

Since 2007, Greece has faced high rates of unemployment, little economic growth and higher risks of poverty, most of which have been mirrored in the United States to varying degrees. To curtail the fiscal spiral, the Greek government implemented several austerity measures, including massive cuts of government-sponsored health programs, which led to worsening layoffs and stagnant wages, according to the article.

Several authors — including four Greek public health experts and Howard Waitzkin, MD, PhD, of the University of New Mexico — compared the situation in Greece to what is occurring in the United States, as the country considers further cuts to Medicare, the largest health program in the country and the biggest payor for hospitals.

The authors found that after Greece made sweeping cuts to public health programs and services, suicide and homicide mortality rates increased by 22.7 percent and 27.6 percent, respectively. In addition, patients decreased use of private medical facilities, such as private outpatient clinics and hospitals, by 18.5 percent, while healthcare drastically increased at public hospitals and health centers.

As U.S. healthcare reform continues to focus on population health management, researchers said reducing the public safety net, which the United States is considering to do further, could be contradictory with that goal.

“Historical evidence suggests that in times of economic downturn, policies of cutbacks and privatization can further jeopardize populations’ health and health services,” the authors wrote. “On the other hand, sustained public spending or creative reorganization and expansion of public sector health services can protect populations’ health status.”

http://www.beckershospitalreview.com/hospital-management-administration/deteriorating-public-health-polices-what-greece-us-may-have-in-common.html