healthcare Archives - ChangingMedia

Jun 11

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Domo Arigato Mr. Abe

If France can brag that they have the healthiest health care system, Japan can brag that they have the healthiest people. At a life expectancy of 82 years, the Japanese live the longest and have four full years of life on us Americans. Some people may think it’s because of their diet full of fish and low on fried foods but it could be that the Japanese have their hands-on government to thank.

First of all, even if the traditional Japanese diet is lower in fat and sugar than a lot of countries around the world, the Japanese government doesn’t care. They will still make you take nutrition classes if your waistline is over a certain amount of inches because of the Waistline Law. To Americans this may seem strange because the United States has more than three times the amount of obese people. Bloomberg and public health officers are green with envy — they can’t even ban large sodas.

In addition to the government’s heavy hand in public health, they also control most of private health matters. Every two years the Ministry of Health sets the prices for all health care services. Hospital stays cost roughly $10 a night whereas it runs in the thousands for a U.S. patient. Doctors may get paid way less, but they also don’t have to pay for medical school and their malpractice insurance for the whole year is less than what doctors here pay in a month.

Although the Japanese government severely controls prices, the patients have all the freedom of choice. They don’t need a referral to see a specialist and they can see any doctor they please — there’s no in or out of network for insurance. And the Japanese are taking advantage of this freedom too. They see a doctor about three times more than Americans do.

Good for them, as the Japanese will always have health insurance and it doesn’t cost that much either. That’s because all health insurance companies in Japan are not-for-profit and if the company comes in the black one year, they subtract it from your premiums the next. Most Japanese people get health insurance through their employer, which helps pays for the already low-cost premium, or through the government.

So how does our reformed health system compare? Well, soon all Americans will have the opportunity to have health insurance. Though people are grumbling about a rumored increase in insurance premiums, all insurance companies must run them by the government first. And a lot of the speculations of high cost premiums don’t take into account the subsidies for people up to 400% of the Federal Poverty Level (roughly $45,000/yr). For a more realistic estimate of what insurance will cost in the exchanges, Washington D.C. recently released proposed rates. But as far as the other highlights of Japan’s health care system, particularly public health measures and cost control, it’s not looking too good. It would help if states would consider expanding Medicaid to include people making up to 133% the poverty level but so far only 23 states have taken that step.

Perhaps we don’t want our government policing our waistlines, but when it comes to providing a low-cost, equitable healthcare system for all, Japan is, quite literally, years ahead of us.

IMAGE CREDIT. [Ko Sasaki for The New York Times].

Mar 19

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A Brief History of Belt-Tightening

By Leanne Demery | Health | No Comments

When Barack Obama announced health reform as a part of his first presidential campaign, the cost of healthcare was never a major priority. Expanding coverage was always the main intent despite the fact that the United States spends more on health care than any other country in the world, reaching almost three trillion dollars or about 17 percent of the nation’s GDP. So if you’re going to attempt comprehensive health reform, why wouldn’t you have cost control included? If you take a look at other attempts of cost control in the past, you can see how the piece-meal attempts have not gotten close to fixing the problem.

The last time a president directly controlled health care costs was in 1971 under President Nixon with his executive order to freeze wages and prices. His Cost of Living Council allowed physician’s fees to increase by only 2.5 percent a year but its authority expired in 1974. The council however, did spark in interest into looking at how hospitals were paid, which were at that time on a per diem basis. The department of Health, Education and Welfare then came up with a payment system based upon diagnosis, now called the Diagnosis Related Grouping (DRG) system and widely used throughout the world. In 1984 Medicare adopted DRG, which is based upon the average cost of treating a patient per a particular diagnosis. During Nixon’s time in office Medicare also changed to have a regulated room and board cost to all hospitals and limited the per diem cost, which was not regulated. Yet, eight states at that time decided to control the rates that Medicare paid to hospitals, and today Maryland is the only state left standing.

After Nixon sparked the idea of health reform and cost containment, President Ford attempted a unique approach. Under the National Health Planning and Resource Development Act, local planning agencies were created to approve new facilities or buy expensive equipment. The agencies were presented with Certificates of Need (CON) to determine if spending was appropriate. The program was inefficient as CONs sometimes were too hard to get, and was eventually eliminated under President Reagan.

Then we have President Carter who was ambitious with his attempt at cost control. Twice during his presidency his proposals for limiting hospital’s total revenues were defeated. At this time, congress must have been feeling pretty optimistic as they agreed to have hospitals voluntarily contain costs. And that policy is still in use today.

The next attempt at cost control was under the Balanced Budget Act of 1997 that proclaimed physicians’ fees would decrease in the future if they exceeded a targeted amount set the previous year. It was enacted for the first two years, but since 2002 congress has postponed the decrease each year and has even allowed small increases. So much for that!

From past attempts at controlling costs, it was obvious a total re-haul of health care spending would be difficult. Obama knew he had to start (somewhat) small to pass something. Though it was an absolute battle to pass, it was a walk in the park compared to what could have been, or what could have never happened at all.

Nonetheless, Obamacare has a few provisions that will feebly attempt to control costs, mostly through regulation of insurance company administration costs by adopting a set of standards (all effective by January 2016) and through Medicare. Medicare Advantage plans have been greatly subsidized in the past, but will be greatly reduced by 2019. Also, the Independent Payment Advisory Board (IPAB) will establish growth spending rates by 2018 and will decrease funding if Medicare exceeds this target. The other provisions allow for tests or trials to control, such as centering care around primary care physicians, which is why many preventative services are free of cost.

Most of the cost control attempts in Obamacare are experimental. And USA Today claims that in the past three years Obamacare has slowed health care spending growth. Others would strongly disagree. Considering we spend the most on health care in the world, and have the 38^th best health system (it makes me cringe to say this), Obamacare is better than nothing.

IMAGE CREDIT. Emory University.

Mar 13

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On the Record: eHealthRecord

By Jami Dodson | Design | No Comments

Do you remember David, the boy in the bubble? Born with severe combined immunodeficiency (SCID), a primary immuneodeficiency disorder, or PIDD, that causes the immune system not to work, David — portrayed by John Travolta in a 1976 movie — might be the only reference most people have for this type of disease. But for Colin Seal and many other individuals living with them, the ability for the body to heal itself from certain types of infections is severely compromised.

Colin is leading a very productive life helping others who have this type of deficiency. A patient with PIDD himself, Colin became involved with the Immune Deficiency Foundation in Towson as a volunteer before he began working there. The Immune Deficiency Foundation was started in 1980 by Marcia Boyle, the mother of a son with a primary immunodeficiency disease, to help improve the quality of life for patients and their families. I recently spoke with Colin, a Program Manager at IDF, about a new project designed to help patients manage their health record information, and how it both supports IDF’s research about the disease and serves as a clear example of how tech and design can enhance people’s health.

Most PIDDs are genetic disorders. In the United States, more than 250,000 people are diagnosed with primary immune deficiency diseases. Thousands more go undetected. These diseases are chronic illnesses caused by hereditary or genetic defects in the immune system in which part of the body’s immune system is missing or does not function properly. Because of this increased vulnerability, patients are at great risk for prolonged infections and suffer from recurrent health issues.

With early diagnosis, medical advances and consistent monitoring of health, individuals are able to live full and “normal” lives. People with PIDD usually require regular immunoglobulin therapy infusions, many kinds of medications, close monitoring of reactions to medications and diligent maintaining of medical records. By conducting surveys about patient experience, the IDF team discovered a lot of patients were not keeping personal records of pertinent medical information. Seeing the opportunity to make this easier, IDF began an effort to make an electronic notebook. This eventually evolved into the IDF eHealthRecord, an online application that assists in documenting health records and data specifically for the primary immunodeficiency community.

The eHealthRecord helps patients to track diagnosis, infections and symptoms; scan and save important documents; and log doctor’s visits and medications, among other features. I was impressed with Colin’s enthusiasm for the project, and especially the attention to customer service that IDF provides to their eHealthRecord users. Anyone can get assistance via phone or email and get a personal response, along with a screen-share demonstration. CSL Behring, the sponsor of the IDF eHealth Record, even provided funding for a small in-house green screen, where Colin himself stars in “4 minutes or less” YouTube tutorials. Colin regularly attends meetings where he has the opportunity to talk to patients about how to use the program. Not to mention the private Facebook community where patients can reach out to others, ask questions and share stories.

http://youtu.be/67e50dOkyzI

From what I saw pulled up on Colin’s iPad, the module could use a little design love. Turns out they are already redesigning the user interface and overall user experience now and ironing out little quirks. Colin’s team sent out surveys to current users, and armed with information on exactly how the product is being used, can refine the interface to be approachable and intuitive for its users.

Where to go from here? Mobile, for a start. The IDF eHealthRecord is only web-based currently, with a mobile version in the pipeline. With the big push for “mobile first” in the web design community, this app may be an example of when developing the desktop version first made sense. Colin also emphasized how important the data pulled from this system (which is HIPAA-compliant and completely anonymous) will be to mapping the diseases and could possibly contribute to better integration with doctor’s offices.

A development such as the IDF eHealthRecord demonstrates the type of design thinking processes that should be at the core when designing for social change. Colin isn’t a designer, but he and the IDF team knew the right questions to ask and looked at the real needs of the primary immune deficiency community in order to develop a solution. And they chose to partner with developers (an outside firm) who didn’t just say yes to the project, but helped set the scope and made recommendations, applying their expertise. The nonprofit sector seldom affords the ability for mere experimentation, and empathetic designers who see the bigger picture produce better results.

Special thanks to Colin Seal.

IMAGE: By David Gallagher

Mar 01

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You Can’t Slam A Revolving Door

By Jasmine Arnold | Homelessness, The Race to End Homelessness | 5 Comments

I have never stayed overnight in a hospital. My only real surgery was to remove my wisdom teeth. After that, I vaguely remember being walked by my mom to a waiting car, brought home, and allowed to sleep — in my own bed — for the better part of the next 24 hours. Even with the puffy cheeks, it was worlds better than the common post-surgery experiences of someone who doesn’t have someone to pick them up, some way to transport them, and some place to sleep.

Medical recovery for someone who is homeless means taking open wounds, broken bones and compromised immune systems out into the elements. You don’t get to stay an extra night in a hospital bed just because you don’t have another bed to move to. Some Medical Respite Centers do exist, providing a place for those without housing to recover, but only in limited quantities. There are 25 beds for medically fragile homeless people in Baltimore City, 104 in Boston, 30 in Denver, four in Austin, zero in Detroit and zero in New Orleans. Even when beds are available, patients are not always referred to them.

Perhaps busy hospital staff believe that the homeless are the responsibility of shelters, not medical centers. In Los Angeles, a hospital recently got a $125,000 fine for “dumping” as many as 150 patients in homeless shelters. This is hardly a medically sound plan, because shelters cannot even accept patients if their health needs are too great. A person with an oxygen mask, an open wound, or a contagious disease is typically not allowed in a shelter. Even inside the shelter, patients run the risk of having their prescriptions lost or stolen. Not surprisingly, this often lands the recently discharged back in the hospital — this time, in the emergency room — with infection or complications from their treatment. Hospitals can become traps for the people experiencing homelessness — a revolving door of disease and disarray.

What might be the easiest first step to improving recovery — asking an individual if he or she has a place to go — is hardly implemented when talking with patients. One study found that only 44 percent of homeless patients were asked about their housing accommodations for the night after their discharge, and 11 percent spent the first night after leaving the hospital outside.

The right questions and improved resources can change the health outcomes for homeless individuals. In California, hospital discharge procedure for the homeless sometimes includes a bus pass. In Austin, the founder of a city housing program proposed a new policy, in which he suggests patients not be sent away from medical care if they lack a safe and stable place to go. The plan, called Discharge No One Into Homelessness (DNOIH), is only a petition now, but its implementation could help improve health among homeless populations.

Over 200 cities in the United States have developed 10 Year Plans to End Homelessness, yet homeless patients are often discharged without so much as a plan for the next 10 hours. If we cannot ensure short-term health, there is little hope for more long-term change.

IMAGE CREDIT. Courtesy of Global Good Group.

Nov 13

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Obamacare –A Reform that Keeps the Status Quo

By Leanne Demery | Health | No Comments

Since the turn of the 20th century there have been people calling for healthcare reform in the United States. Why did it take over a hundred years? In the United States, the major players would rather keep things the same than make a drastic change. Obama knew that many before him had failed miserably. So Obamacare builds on our current, privatized, for-profit health care system (that’s right, Obamacare is actually the opposite of socialized medicine). Our system has a lot of groups with a lot of benefits and most do not want to sacrifice them for universal care. To reform healthcare, you have to make changes, but not too many or else you won’t keep enough people happy.
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Oct 30

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Obamacare Explained

By Leanne Demery | Health | No Comments

Health policy in the United States is unique, to say the least. We are the only developed economy that does not have nationalized health care and despite popular belief, the United States does not have the best healthcare in the world even though we spend the most on it. According to the World Health Organization, the United States ranks 37^th in health care – just behind Costa Rica and above Slovenia and Cuba. So how did we get into this economic and unhealthy mess? It’s a long story full of scandals, politics, history, economics, and American culture. In this space, I’ll seek to tell that story and explain healthcare policy, and the debates that swirl around it, in accessible terms.

In just a week, Americans will go to the polls to decide whether President Obama will get a second term. Healthcare reform – the president’s signature legislative achievement – hangs in the balance. Read More