Healthy Policy

Medical bankruptcy

A new report was released today found that only 17%, not 46%, of bankruptcies are caused by medical bills.

What's the deal?  Is this just another case of the CW being very wrong?

It appears that the discrepancy comes from quibbling over the source behind the "cause".  The first study, done by Harvard researchers, surveyed over 1,700 people asking them if "medical bills or illness caused their bankruptcy".

Unfortunately, they didn't make much of a distinction between whether illness made them lose money or whether it was the bills themselves.  The new research flushed these groups out.

"It is insufficient to show that medical problems are associated with bankruptcy," Dranove and Millenson write, adding, "one must determine whether, and to what extent, medical spending causes bankruptcies." Dranove and Millenson note that for the 17% whose bankruptcy could be tied to medical expenditure, it could not be determined whether medical costs were the primary cause of those bankruptcies.

They're right; it does matter if the actual bills were the direct cause of bankruptcy.  Even so, no one should be in a position that medical bills (an actual necessity unlike a bigger house or more expensive car) cause their bankruptcy.  Especially 17% of  bankruptcies. 

Personal Anecdote Time

Re: Dr. Andy's post about compulsory vaccination, I have a couple anecdotes.

When I spent a summer in DC I had the opportunity to attend a congressional hearing on Hormone Replacement Therapy.  At one point the committee chairman went on a diatribe about vaccines and autism, and how his grandson is autistic and clearly it's the vaccine's fault.  Then he said asked the chairwoman of the heart, lung, and blood institute why the NIH wasn't doing anything about this (gee -- I don't know, because it's the FDA's jurisdiction??).  Keep in mind this has nothing to do with Hormone Replacement Therapy, which is for menopausal women.

Next in Kate's special anecdote file is the girl who got measles in one of my classes at Santa Cruz.  Now, being Santa Cruz and all, this wasn't too terribly surprising (not because there's lots of measles going around, but because there's a lot of ultra-natural people).  But a 20 year-old got measles!  It's ridiculous.

The main issue I have with "conscientious objections" to immunization is the person who it really affects isn't choosing at all.  They could get something terrible like, say, measles (or heaven forbid, Hepatitis B), down the road because of their parent's scientifically unfounded beliefs. 

Fortunately we're fine as long as the vast majority are vaccinated.  Who knows where my classmate got measles from, but she didn't spread it to anyone else. 

Grand Rounds volume whatever

The latest Grand Rounds is up at A Chance to Cut is a Chance to Cure (hmm...think the host is a surgeon?). 

Pad your resume!

A reader pointed me to this unbelievably comprehensive list of health policy/health care internships and fellowships compiled by Kaiser.  So if you're looking for an enriching experience (or perhaps some resume padding) this is the place to go.

Doctors, start your tablets

When I talk with people (even health policy people) about ways to implement more technology into health care, like doctors using computers during appointments, I get some interesting answers.  Like computing while seeing patients will destroy the doctor-patient relationship.  This answer is quite puzzling, as the doctor-patient relationship is pretty mutilated already, and the benefits of direct computing by physicians (cost, time, efficiency, and most important: reduction of error), seem to outweigh the discomfort of your doctor occasionally typing things in.

But (via the Health Business Blog), Microsoft is introducing a new product that can quiet this debate with one fell swoop:

The Microsoft Origami Project seems to be a nice little tablet-style PC along the lines of the Motion Computing LS800 that I have described before. It's the kind of hardware that makes electronic medical records, e-prescribing and decision support tools all the more practical for physicians by making it possible to carry a full-featured device in a lab coat pocket.

And I'd add, without a big screen that apparently perverts the essential nature of physician care.

The VA tackles obesity and diabetes

The Veterans Affairs health system is rolling out a new program to combat obesity and diabetes among veterans:

As part of the new program, VA doctors will give out "prescriptions for health" to patients after measuring their body mass index, a measure of body fat. The prescriptions will list exercises and nutritional information that match patients' health needs.

Their excellent HIT infrastructure will provide easy assistance in implementing this program.  We're desperately in need of solid public health and prevention programs; success here could indicate a model for other practitioners to adopt. 

Further, VA members actually have a problem with obesity and diabetes.  70% are obese, compared to 31% of the general population.  An astounding 20% have diabetes, compared with 7% of non-vets.  So there's real room for improvement. 

Let Them Eat Mangoes

This is just infuriating.

How to entertain yourself while being an invalid

This is a little out of the blue, and I'm not quite done with my convalesence yet, but you might be just starting your surgery/etc, so here goes:

How to entertain yourself when it's difficult to leave your house:

1. Start a blog.  Convince yourself that people are reading it, so you must write something in it everyday.  By a certain time (like 10 am).  That will give you a sense of accomplishment and reason to get up before one in the afternoon.  Otherwise the days become long and aimless (surprisingly so since you're sleeping in the afternoon).

2.  Find some favorite shows.  I've been watching Project Runway -- there's a new episode every week and I honestly look forward to it.

3.  Avoid message boards unless you have a major dilemma.  A lot of the people on message boards have serious complications and they will inevitably scare you to death.  You don't need to be scared like that (bad for the heart) -- continue on in ignorant bliss.

4.  Fiction, fiction, fiction.  Non-fiction is great and all, but if you only to make out to read non-fiction, you won't finish anything.  So far I've read: Jonathan Strange and Mr Norrell (Susanna Clarke), White Teeth (Zadie Smith), A Heart Breaking Work of Staggering Genuis (David Eggers), The History of Love (Nicole Krauss), and I just started The Red Tent.  All fabulous books.

5.  Don't watch too many sports with super muscled people running around.   The Olympics almost made me throw off my crutches watching all those ridiculously active atheletes.  Remind yourself that the Olympic mogul skier will probably be in your position down the road anyways.  And who really wants their thighs to be as big as Apollo Ono?

6.  Try and make little traditions or appointments.  Again, this helps pass the time and keeps you from feeling like you're stuck in purgatory.  Make a coffee appointment with a friend every Thursday, or go see a movie every Tuesday.

7.  Always be thankful, but don't feel bad about needing/asking for help.  Don't be stubborn.  Don't wear yourself out doing things by yourself that others can help you with.*

Hope that helps someone.

*my bad

Hagel's health commission

From the News Bin:

Sen. Chuck Hagel (R-Neb.) has formed a commission of health care experts to develop health care reform recommendations for federal legislation, the Omaha World-Herald reports. The commission comprises 10 members who will examine health care access and quality, cost control, the roles of medical science and technology to improve care, and the effect that baby boomers will have on future costs, according to the World-Herald (Thompson, Omaha World-Herald, 2/23). Part of the commission's mandate is identifying "more effective financing vehicles for American health care than current public and private plans." Hagel said that the goal will be to ensure sustainable health care for all families.

Smart move.  Methinks someone is getting ready for '08.

Frustrations

I think the thing that frustrates me the most, after 10 and half weeks on crutches, is that I can't make peace with the fact that it takes me a lot longer to do things. 

Today I'm going to attempt cleaning my room.  Instead of being leisurely, taking my time to slowly crutch around while trying to balance things in one of my hands, I will hop like a madwoman all over my room.  When you hop on one leg, you get a fair amount of momentum going, so I'm sure these hops will be tempered by running into/collapsing onto my bed.  I will lay there staring at the ceiling for a minute, cursing my bum leg, then recommence the hopping.

It's quite a spectacle really.