Policy

Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed

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Pharmacies Braced for Cuts to Their Medi-Cal Payments

(Getty Images)

(Getty Images)

Pharmacies across the state are bracing for a blow to their revenues. Starting Friday, Medi-Cal –the state’s health coverage for low-income patients — will start paying 10 percent less for filling certain prescriptions. Though the number of drugs affected is less than originally outlined, pharmacists are still worried.

Many of them say there is a misconception that they make loads of money selling drugs. But after they pay pharmaceutical companies for the medications they stock, there’s little profit left, they say. An additional cut could put them in the red on some drugs.

“The margin in drug products is roughly 2 to 4 percent,” says Jon Roth, CEO of the California Pharmacists’ Association. “If you’re looking at a 10 percent reduction, you’re immediately upside down and dispensing medication at a loss.” Continue reading

How Much Does It Cost to Have a Baby in California?

(Shingo/Flickr)

Did this baby’s hospital charge $3,300 or $33,000 for delivery — or somewhere in between? (Shingo/Flickr)

The most common reason for hospitalization in the United States is childbirth. A new study published Thursday adds to the depth of research on cost variation in the American medical system.

In the study, researchers at U.C. San Francisco looked at 110,000 uncomplicated births across California and found that hospital charges for a vaginal delivery ranged from $3,296 to $37,227 and for a caesarian section the range was $8,312 to $70,908.

For health policy researchers, this is not a big surprise, said lead author Dr. Renee Hsia, an associate professor of emergency medicine at UCSF, but “most people that aren’t familiar with health care variation would be surprised and distressed.” Continue reading

Governor’s Budget Includes $670 Million for Medi-Cal; Preserves Provider Rate Cuts

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

The governor’s budget is out and for the first time in years, California is expecting a multibillion dollar tax surplus. The governor is proposing a $8 billion in increased spending, with $670 million earmarked to expanded benefits under Medi-Cal.

The expanded benefits include mental health, substance use disorder, adult dental, and specialized nutrition services.

In his proposal, Brown noted that Medi-Cal is the “budget’s second largest program.” In keeping with his approach to being fiscally prudent, Brown included a warning about health care inflation and implementation of the Affordable Care Act. From his budget: Continue reading

Long-Fought Medi-Cal Provider Rate Cuts Take Effect

Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)

Health care providers joined in a rally at the state capitol to protest cuts in Medi-Cal reimbursement rates in June, 2013. (California Medical Association/Flickr)

A long-awaited and much-feared ten percent rate cut goes into effect Thursday for doctors and clinics reimbursed through Medi-Cal –- the state’s health insurance for low-income patients. This comes at the same time the federal health overhaul is expanding that program to as many as 2 million Californians.

Provisions of the Affordable Care Act will protect primary care doctors from the cuts for the next two years, but specialty doctors that treat the poor are bracing for the hit. Many physicians in dermatology, neurology, cardiology, and urology will now be losing money on every Medi-Cal patient they see. Some will have no choice but to turn low-income patients away.

“Bottom line, they cannot continue to provide care for below the cost of care,” says Shannon Smith-Crowley, a lobbyist who works closely with the California Medical Association. Continue reading

Shopping for a Doctor or Hospital? Expanded Website Helps You Compare

(Andrea Marutti/Flickr)

(Andrea Marutti/Flickr)

Say you want to buy a car. One of the first places you might think about going for ratings and reviews is Consumer Reports. For decades, the magazine has published reviews of all manner of consumer products.

“We want to level the playing field” for consumers. 
You might not know it, but Consumer Reports also publishes reviews on hospitals and physician groups. Starting Wednesday Californians can access that information — free — on CalQualityCare.org, a website run by the nonprofit California HealthCare Foundation (CHCF). This site already features reviews of hospitals and nursing homes.

Launching just days after Jan. 1, when new insurance took effect for hundreds of thousands of Californians via the Covered California marketplace, the revamped site offers consumers information to help them choose hospitals, nursing homes and doctor groups.

“Making this information easy to digest for the consumer is so key,” said Andy Krackov, senior program officer for CHCF. Previously, the foundation had maintained separate websites for hospitals and long-term care facilities. In this new partnership with Consumer Reports, CHCF has merged its separate websites to create a one-stop resource for comparison data. The site has no advertising. Continue reading

Video: How Survival Rates Are (Very) Different from Mortality Rates

Think the U.S. has the greatest health care system in the world?

Over at The Incidental Economist, pediatrician, blogger and health researcher Aaron Carroll has posted a terrific video explaining why survival rates are not the best way to compare how well the U.S. system is doing against  that of any other country. Check it out:

 

Here’s the takeaway: the mortality rate is the number of people who die every year of a given cause in a specific number of people (often 100,000). The survival rate is how many people are still alive at a specific time after diagnosis.

Continue reading

Blunt, But True: Brain Death Is Death

(Getty Images)

(Getty Images)

It’s been more than three weeks since 13-year-old Jahi McMath was declared brain dead after what appeared to be a tonsillectomy at Children’s Hospital Oakland. In the interim, the family has battled the hospital to keep McMath’s body hooked up to a ventilator while they have searched for a facility willing to accept her. Friday morning, at a hearing in Alameda Superior Court, the two sides seem to have come to an agreement that the family can possibly remove her, as long as they accept full responsibility for her.

“This isn’t a patient with a bad prognosis. This is about someone who died. And what the family is hoping for … is resurrection.”

But none of this changes the sad fact that Jahi McMath is dead, as experts patiently explained on KQED’s Forum earlier this week.

David Magnus, director of Stanford’s Center for Biomedical Ethics, pointed to six separate independent evaluations that have all come to the same conclusion, that McMath is “medically dead, she is legally dead.” Continue reading

Check Your Blood Pressure, (Unwittingly) Sell Your Contact Information

(April Dembosky/KQED)

(April Dembosky/KQED)

Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them. Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.

One of these kiosks sits in aisle ten of a Safeway grocery store in a city near San Francisco. It’s nestled next to the shelves of antacid and cold medicine. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. There’s a big plastic seat and foot rest for measuring weight and body mass index, a window for testing vision, and a blood pressure cuff.

“Make sure the cuff comes up above your elbow,” says an attractive brunette on screen. She is wearing a white lab coat, and her hair is pulled back in a tight bun. She asks a lot of personal questions throughout the session, like “Do you have a blood relative who was told they have a heart problem?” Or, “During the past 30 days, how many days have you felt sad or depressed?” Continue reading

After Years of Budget Cuts, More Psychiatric Resources Coming

(Getty Images)

(Getty Images)

By Elaine Korry

Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”

Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn’t gone away.

On a recent night Fox walked San Francisco’s Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.

He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn’t well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn’t let me stay longer, so they made me leave.” Continue reading

How California’s Mentally Ill Children Suffer — Few Hospital Beds Statewide

 (Debora Bogaerts/Flickr)

(Debora Bogaerts/Flickr)

CORRECTION: Due to a reporting error, the original version of this story incorrectly identified John Muir Medical Center, Concord as the facility where Maria Ramirez’s granddaughter was taken. We regret that error.  The post has been edited so that it no longer contains the incorrect information.

By Elaine Korry

Maria Ramirez began caring for her granddaughter when the girl was just a toddler. Her granddaughter began hurting herself — cutting her arms and swallowing things — before she was 10. Soon, says Ramirez, she couldn’t let the girl out of her sight. “She was running in front of cars, just really impulsive,” says Ramirez. “It was out of control, and I was really scared.”

Ramirez has a job and health insurance, so she did what any parent or guardian would do: she took her granddaughter to her local hospital for treatment. But instead of finding help, she always got the same reply, “No beds, no beds.”

Ramirez, a Bay Area artist who loves gardening, says she knew early on that her granddaughter was going to need help. “She was a hard child to make smile. She was very serious,” says Ramirez. Continue reading