Policy

Health policy is much more than health care reform

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May 21, 2013 | 4:41 AM | By

Where You Live Affects What Kind of Surgery You’ll Have: Look It Up

(Getty Images)

(Getty Images)

Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you’re having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.

In health policy, “elective” does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered “elective” because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its “All Over the Map” project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.

PIcking out eyebrow-raising numbers was no problem:

  • Men in Indio (Riverside County) receive brachytherapy, known commonly as radiation seeds, to treat prostate cancer at almost five times the statewide average.
  • Women in Healdsburg (Sonoma County) receive lumpectomy without radiation for early stage breast cancer at 270 percent of the statewide average.
  • People in Brawley (Imperial County) are nearly three times as likely to receive cervical fusion, where two vertebrae in the neck are fused together, for neck problems compared to statewide.

CHCF_AllOverTheMap_Banner2_200513_R1SingleLow rates are easy to find, too. To name just one: women in Lancaster, northeast of Los Angeles, with early stage breast cancer receive lumpectomy with radiation at just 26 percent of the statewide average.

The question is why. Maribeth Shannon with the foundation says the variation is “just puzzling to us.” She stressed that the statewide average is not necessarily the “right” rate, but the state average is an estimate that’s easy to use as a benchmark.

In its analysis, the foundation accounted and adjusted for a host of patient characteristics that might skew the numbers. Still, the broad variation is there. Shannon pointed out that it would be “unusual” that patients would differ so significantly in what treatments they wanted, simply according to where they lived.

“It’s much more likely,” Shannon said, “that physicians practicing in that area tend to rely on that course of treatment over others. … It does seem to be more the physician preference than the patient preference.” Continue reading →

FILED UNDER: Policy, You're the Boss, Geographic Variation
May 16, 2013 | 11:38 AM | By

Alameda County Details How Transit Cuts Harm Health

By Rachel Dornhelm

(Getty Images)

(Getty Images)

At first glance, you might not think that cuts to public transportation might affect someone’s health. But Devilla Ervin understands the impact firsthand. The 23-year-old lives in West Oakland and a few years ago worked the graveyard shift at McDonald’s.

“I got off work at 4 a.m. and there was no bus service,” he describes. “And so I was walking in my community of West Oakland, with shootings and violence, 45 minutes to an hour to get home.”

Yet, in addition to the threat of violence, Ervin also described a sense of social isolation that he’s felt as a result of recent cuts to bus service in his area.

“It’s not good for physical and mental health,” he says. “It wasn’t good for my spiritual health too, because I couldn’t get to church. A lot of the bus cuts were around International Boulevard where my church is.”

Access to public transportation is what policy types call a “social determinant of health” or SDOH. Health is about much more than health care, than simply seeing a doctor.

Now, in a new study, the Alameda County Public Health Department documents the link Ervin has experienced between health and access to reliable public transportation. Continue reading →

FILED UNDER: Place Matters, Policy, Public Transportation, SDOH, Social Determinants of Health
May 15, 2013 | 5:00 AM | By

Brown Backs State-Run Medi-Cal Expansion

By Mina Kim

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials.

Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system.

But Brown anticipates recouping more than $300 million from the counties next fiscal year – money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms.

Farrah McDaid Ting with the California State Association of Counties says Brown’s proposal makes no sense. She says plenty of people will still rely on county services in 2014.

They are “people who qualify for Medi-Cal but don’t sign up, people who have a hard time signing up or staying on programs, the undocumented in our communities and those who are in between private health plans,” McDaid Ting said. “We need to retain enough funds to serve those people.” Continue reading →

FILED UNDER: Money, Policy, Reform, Affordable Care Act, California Budget, Medi-Cal
May 13, 2013 | 8:40 AM | By

Valley Fever Cases Soar in West, Yet ‘Off The Radar’ of East Coast Policymakers

By Rebecca Plevin, NPR

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

(Daniel Casarez/Vida en el Valle/Reporting on Health Collaborative)

When she was just 6, Emily Gorospe became very tired and sick. The spunky girl, now 8, developed a fever that wouldn’t go away, and red blotches appeared across her body.

“She’s got so much energy usually,” says Emily’s mother, Valerie Gorospe. “Just walking from one part of the house … she was drained.” The little girl was also very pale. “She just didn’t look like herself,” Valerie recalls.

Emily, who lives in the Central Valley town of Delano, was eventually diagnosed with valley fever, also known as coccidioidomycosis. She’s one of an estimated 150,000 people nationwide who get the fungal disease every year. There is no cure and no vaccine.

Valley fever has afflicted about four times more people than West Nile virus, with thousands more going undiagnosed.

Valley fever is well known in the Central Valley and other areas of California and Arizona. Tiny fungal spores live in the soil throughout much of this arid region. When the spores are disturbed, they can be inhaled into the lungs.

James McCarty, the medical director of infectious diseases at Children’s Hospital Central California, says most people feel nothing, or experience symptoms similar to the flu. Common symptoms include fever, night sweats, weight loss, chest pain, cough and sometimes skin rashes.

Valley fever can be a very serious disease for some people, McCarty says. It can spread from the lungs to other parts of the body, like the central nervous system, bones or skin. It can be life-altering or even fatal. Continue reading →

FILED UNDER: Policy, Science, Valley Fever
May 9, 2013 | 11:22 AM | By

Open-Campus Policies Eat Away at School Nutrition

By Katharine Mieszkowski, Center for Investigative Reporting

Scott Sowko, a sophomore at Berkeley High School, leaves Bongo Burger after lunching off-campus. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

Berkeley High School students have lunch off-campus at Bongo Burger. School officials say one-tenth of the students take advantage of the healthy lunch served in the school cafeteria. (Noah Berger/Center for Investigative Reporting)

At lunchtime, hundreds of Berkeley High School students rush off campus, leaving behind healthy meals served in the cafeteria. Many of them head to Bongo Burger, Top Dog and other joints selling high-fat, high-sugar alternatives.

Six miles away at Oakland High School, the cafeteria is mobbed. There are not enough seats for everyone, so some students eat lunch outside on picnic tables while others eat in classrooms. No one goes off campus to pick up food from Wingstop or the AMPM convenience store.

The difference? The Oakland High students are no longer allowed to leave campus during lunch.

At Berkeley High, where famed chef Alice Waters’ nonprofit, the Edible Schoolyard Project, has consulted on the menu, school officials say one-tenth of the students take advantage of the healthy lunch on campus.

“Kids could be eating a good meal for free, or they could be running off campus, and in a hurry … they’re going to buy the Flamin’ Hot Cheetos and a Coke.”

In recent years, lawmakers, regulators and school districts have tried to improve students’ health by curbing the sale of junk food and tightening nutritional standards for school food. But those efforts are undermined when students can leave campus to eat whatever they want, as they can at dozens of Bay Area high schools. Based on the experience in Oakland, closing campuses while offering free lunches can be an effective strategy.  

First lady Michelle Obama has made improving what students eat a signature cause. Just this school year, cafeterias nationwide have been implementing new nutritional standards for the lunches they serve. The U.S. Department of Agriculture is working on new regulations for all other foods sold in schools, including from vending machines. But the idea of keeping kids on campus so that they eat healthy lunches is not part of the national debate.

The Oakland Unified School District closed the Oakland High campus last fall to cut down on absenteeism after lunch and reduce break-ins, drug use and trespassing in surrounding neighborhoods, said then-Principal Jeffrey Rogers.

Continue reading →

FILED UNDER: Policy, School Lunches, Science
May 8, 2013 | 6:12 PM | By

How Much Would You Rather Pay For That Procedure? $170,000 or $43,000?

(Getty Images)

(Getty Images)

It’s nearly unbelievable to average consumers, but well known to wonks: health care prices are impossible to come by. Even calling and asking about a specific procedure, as researchers recently reported, led to an “I dunno” from the hospital itself more than half the time.

But now, a little bit of light is being shed on this dark area of health care. Wednesday morning, the federal government released a massive amount of data: the prices that hospitals across the country charge for 100 of the most common inpatient treatments.

Skipping over the wonk for now, let’s dive in to some numbers right here in the Bay Area. They cast a spotlight on how random and wildly variable health care prices are.

I picked one procedure, a hip or knee replacement (“lower extremity major joint replacement”) without major complications.

A joint replacement is generally a procedure you would schedule in advance, not a race-to-the-hospital-life-or-death-spare-no-cost situation. You might think the range of prices would be somewhat narrow.

You would be wrong. Continue reading →

FILED UNDER: Policy, Health Care Costs, Variation
May 7, 2013 | 12:04 PM | By

Rarely Mentioned Medical Mistake: Patients Harmed by High Rates of Misdiagnosis

By Sandra G. Boodman, Kaiser Health News

(Getty Images)

(Getty Images)

Until it happened to him, Dr. Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn’t think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor  –  the size of a peach pit  –  using a simple procedure. The experienced head and neck surgeons who regularly examined Brook had never tried it. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

Misdiagnosis “happens all the time … This is an enormous problem.”

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. To cite just two examples: Continue reading →

FILED UNDER: Policy, Medical Error, Patient Safety, Science
May 6, 2013 | 11:14 AM | By

New Factors in Play for Legislators Considering Statewide Soda Tax

(Getty Images)

(Getty Images)

A soda tax failed at the ballot at two California cities last November. Before that, a statewide soda tax failed two years ago. But advocates and legislators are trying again. A bill that would require a penny-per-ounce tax on any sugary beverage is back in front of legislators and, so far, has passed out of two Senate committees.

The bill by Sen. Bill Monning (D-Carmel) has two explicit goals: to “discourage excessive consumption” by increasing the price of sugary drinks and to create a Children’s Health Promotion Fund.

“We’re in the midst of a public health crisis fueled by childhood obesity,” CaliforniaHealthline reports Monning said to the Senate Committee on Health last week. “This legislation sets an alternative path toward health and wellness.”

The health committee approved the bill. Next stop is the Senate appropriations committee.

While the soda industry is expected to be back in force for this bill, as it was for the other soda-tax efforts, this time there are new forces in play. Continue reading →

FILED UNDER: Policy, Science, Soda Tax, Sugar-Sweetend Beverages
May 3, 2013 | 3:26 PM | By

Oregonian Describes Life — and Health — After Winning Medicaid Lottery

(Fred/Flickr)

(Fred/Flickr)

For you wonks out there, Kaiser Health News has a fascinating Friday afternoon read for you.

In a piece titled “Bloggers See Own Reflections in Oregon Medicaid Study,” reporter Jordan Rau describes how this week’s news about Oregon’s Medicaid Experiment quickly became “a Rorschach test for how partisans and health policy wonks view the health care law.”

With no money for better food, no money for good shoes to go on walks, no rain gear, no walkman for listening to music as a distraction while walking, change is harder.

To quickly recap, in a New England Journal of Medicine study researchers analyzed how 10,000 people who won Medicaid coverage have fared since they gained insurance. The highlights were: no apparent affect on physical health; rates of depression 30 percent lower than those without coverage; catastrophic out-of-pocket medical expenses essentially eliminated.

In his piece, Rau publishes excerpts from seven blogs, each with a different take on the study’s highly nuanced results. But he closes with something I hadn’t seen elsewhere: a view of the experiment by someone who says he was one of the winners of the Medicaid coverage. Rau found the post on the blog Robert’s Stochastic thoughts.

Here’s the post in its entirety:

I am one of the winners in the Oregon lottery [winners could get Medicaid]. Going from no insurance to insurance is very confusing. When you have no money every health question starts with “would I rather live with this problem and have electricity, or treat this problem and keep my milk in a cooler for a month or so?” Stepping back into healthcare was like Continue reading →

FILED UNDER: Policy, Affordable Care Act, Medicaid, Obamacare, Science
April 29, 2013 | 9:27 AM | By

School-Based Health Centers Serve More Than Just Students

By Chris Richard

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew's great-grandmother, Yvonne Lee (right) says Andrew's entire family relies on the center for medical care.(Photo/Chris Richard)

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew’s great-grandmother, Yvonne Lee (right) says Andrew’s entire family relies on the center for medical care.(Photo/Chris Richard)

When Compton’s Dominguez High School celebrated the opening of a new campus wellness center last month, it was a timeless moment.

The marching band blared and thundered. Drill teams members pranced and whirled, just as they’ve been dancing and high-kicking on high school campuses for generations.

But the scene in the wellness center itself offered a glimpse of what the future could be for school medical services in California.

There was a student in for routine blood work. In the next cubicle, a mother had brought her young son, who had the flu. And neighborhood resident Jonetta Stewart, 76, had come seeking relief from frequent vertigo and headaches.

Physician’s assistant Rachel Damicali checked Stewart’s blood pressure. It was very high.

Some campus-based wellness centers offer free and low-cost services not just to students, but to entire neighborhoods, to people of any age.
Dimacali says she sees a lot of variety in her fast-paced days.

“My last patient was a 4-year-old kid, and now I’m seeing Jonetta for her blood pressure management,” she said. “So, we see a whole range: from chronic disease to urgent care visits to just physical exams.”

Just in time for the implementation of President Obama’s health care overhaul coming Jan. 1, a handful of California schools are starting to open campus-based wellness centers like the one at Dominguez, offering free and low-cost services not just to students, but to entire neighborhoods, to people of any age. Continue reading →

FILED UNDER: Place Matters, Policy, School Health Centers, Science