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Uninsured get poor care for migraine: Harvard study

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Uninsured get poor care for migraine: Harvard study

U.S. health system causes headaches in more ways than one, researchers say

EMBARGOED until     
Monday, April 12, 2010

Contacts:
Rachel Nardin, M.D.
Andrew P. Wilper, M.D., M.P.H
Steffie Woolhandler, M.D., M.P.H.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Migraines, often characterized by excruciating headache and nausea, are much worse for the uninsured, a new Harvard Medical School study shows.

Researchers say migraine sufferers who lack private health insurance get poor care for their condition. They are about twice as likely to get inadequate treatment for their headaches as their privately insured counterparts. People with Medicaid also get substandard care.

Because migraine is common in the United States, affecting about 18 percent of women and 6 percent of men, and because so many Americans lack health insurance, a startling 5.5 million people are at risk of getting substandard care for their often painful and disabling headaches, the researchers say.

The study, titled “The impact of insurance status on migraine care in the United States: a population based study,” was published today [Tuesday, April 13] in Neurology, the world’s leading clinical neurology journal.

Study senior author Dr. Rachel Nardin, assistant professor of neurology at Harvard and chief of neurology at the Cambridge Health Alliance in Massachusetts, said: “The tragedy is that we know how to treat this disabling condition. But because they are uninsured or inadequately insured, millions of Americans suffer needlessly.

“Unfortunately,” she said, “the new health law doesn’t fully address this problem. At least 23 million people will remain uninsured nine years out.

“Optimizing migraine care requires improvement in our health care systems as well as educating physicians to prescribe the best available drug and behavioral treatments.”

The researchers analyzed data from two federal surveys, the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey, which together provide a nationally representative sample of all U.S. visits to doctors’ offices, hospital clinics and emergency rooms. They analyzed the 6,814 visits for migraine between 1997 and 2007, representing 68.6 million visits nationwide.

Neurologists recommend two types of drugs when a moderate-to-severe migraine strikes: “triptans” (such as sumatriptan) or dihydroergotamine (DHE). For the majority of migraine sufferers whose headaches are frequent or severe, neurologists also recommend a daily dose of one of several preventive medications.

The researchers used these recommendations from the American Academy of Neurology to define standard migraine treatment and found that the uninsured were nearly twice as likely as the privately insured to receive substandard treatment.

Medicaid enrollees were 50 percent more likely to receive substandard treatment, suggesting that “access to some forms of insurance is not the same as access to adequate care,” the researchers wrote.

Care in doctors’ offices was substantially better than in emergency departments. The fact that the uninsured are less likely to get care in doctors’ offices explained some, though not all, of their substandard care.

Most people with migraine are impaired by their headaches and the accompanying nausea, and lose an average of four to six days of work annually.

Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: “Lack of insurance clearly takes a heavy toll on our patients and the economy. Regrettably, the health bill just signed into law will leave tens of millions of Americans uninsured or poorly insured and thus unable to get the care they need.”

Dr. Andrew Wilper, lead author of the study, said: “We showed that the uninsured have a higher risk of death when compared to those with insurance. Lack of insurance also puts patients with migraine at risk for needless suffering due to lack of access to standard medical therapy.”

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“The Impact of Insurance Status on Migraine Care in the United States: A Population Based Study,” Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., David U. Himmelstein, M.D. and Rachel Nardin, M.D. Neurology, April 13, 2010.

A limited number of patient stories are available upon request from Mark Almberg, (312) 782-6006, mark@pnhp.org.

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Mutual fund managers are relieved

Health Care Overhaul May Help a Fund Sector

By Geraldine Fabrikant
The New York Times
April 9, 2010

Now that President Obama has finally gotten his sweeping health overhaul passed, mutual fund managers can breathe a sign of relief. Finally, there is some certainty about the changes, and most of them appear to be beneficial for health care stocks.

“There does not seem to be any onerous cost control,” said Les Funtleyder, a heath care analyst at Miller Tabak, an insititutional brokerage firm and asset manager.

In the wake of the new bill, the only negative he sees is a potential problem for insurance companies, like WellPoint, the UnitedHealthGroup and Aetna, because at some point they will have to cover all potential clients. “Then the question is, will they price these things so that they can avoid losing money?” he asked.

http://www.nytimes.com/2010/04/11/business/mutfund/11health.html?hpw

Comment: 

By Don McCanne, MD

For those of us who continue to express concerns about the failure of the reform legislation to adequately control the excess growth in health care spending, this news is no surprise. Mutual fund managers are relieved that there are no onerous cost controls, allowing them to continue to include health care stocks as an important part of their portfolios. The only concern they’ve expressed is that health insurers now are going to have pay for health care for high-cost patients that they’ve been successful in excluding from their plans.

Expanding our expensive dysfunctional health care financing system works well for Wall Street, but it doesn’t work for the rest of us. It is absolutely inevitable that we will have to adopt a program of social insurance, preferably an improved Medicare for all.  The sooner, the better.

Bill to design new health care model approved

By DANIEL BARLOW
Times Argus (Vt.), April 8, 2010

MONTPELIER – Senators voted 28-2 Wednesday to hire consultants to design a new health care model for Vermont, one of which would include a single-payer system.

Approval of the bill is a victory for Sen. Doug Racine, D-Chittenden, the chair of the Senate Health and Welfare Committee, who made it his goal this year to set Vermont on a path to a new health care system.

Racine, a gubernatorial candidate, said the state’s health care spending is on an unsustainable path and is now expected to hit almost $6 billion by the year 2012. His proposal would fully design several new options for the state.

“This is an essential next step for the state of Vermont,” Racine told his colleagues on the Senate floor Wednesday afternoon. “We need to get our costs under control and provide what we have promised … that all Vermonters have access to high-quality and affordable health care.”

Racine said his goal with the bill was to move the discussion over the future of health care beyond the abstract and instead begin looking at the specific details of various proposals. His bill allocates about $300,000 to a newly-revamped Health Care Reform Commission to hire consultants and fully design up to three new health care models.

The bill states that at least one of those models must be a single-payer system, one where all Vermonters are included in a single pool run by the state government. That has some advocates – such as Burlington’s Vermont Workers’ Center – cheering Racine on.

“We know that this bill has changed a little since when it was first introduced, but we’re still strongly supporting it,” said James Haslam, the director of the Center. “It puts Vermont on the right path.”

Racine conceded that he preferred his original bill, which envisioned setting up a new independent committee to study health care and help design the new systems. Under changes made to the bill by the Senate Appropriations Committee, that format was scrapped and the plans handed to the Reform Commission, a body of legislators and citizens who debate health care policy.

“The commission can still do the work,” Racine said.

Racine’s bill changed in other ways too. The Senate Appropriations Committee also successfully added an amendment to the bill – in a 21-9 vote on the floor – language that would give the Vermont government more authority over regulating hospital budgets.

That provision, sponsored by Sen. Susan Bartlett, D-Lamoille, the Appropriations Committee chairwoman and another gubernatorial candidate, places a 4 percent statewide cap on hospital budget increases over the next two years. There are provisions in the bill for certain financial exemptions from that cap.

Several senators worried that their hospitals would be shortchanged. Sen. Kevin Mullin, R-Rutland, said his county’s main hospital would be hurt more than others because 72 percent of the patients they see are on Medicaid or Medicare. The 4 percent cap would effectively be a 1 percent cap, he said.

“I want to be on record supporting my local hospital,” Mullin said.

Bartlett responded that the state government and school districts have been making tough budget decisions. She said “this isn’t even the beginning of the hard stuff” when it comes to bring budgets in line.

“They should be scared,” Bartlett said. “We’re almost out of money. But there are protections in here. There are plenty of outs for a hospital that is in an extreme financial situation.”

Only two senators – Sen. Randy Brock, R-Franklin, and Sen. Margaret “Peg” Flory, R-Rutland, voted against Racine’s health care bill. Brock said he was worried that a single-payer system in Vermont would be a “magnet for those from elsewhere.” Flory said the commission’s mission would cost too much in a tight budget year.

“We’re talking about a quarter million to a half million here,” she said. “This is just another proposal that we probably wouldn’t be able to do anything with for six more years.”

Daniel.Barlow@timesargus.com

http://www.timesargus.com/article/20100408/NEWS01/4080374/1002/NEWS01