From World War to Class War: The Rebound of the Rich

Longwoods Publishing :: Healthcare Policy / Politiques de Santé :: Vol. 2 No. 1 2006 ::
From World War to Class War: The Rebound of the Rich: "Incomes in Canada, as in many other countries, are becoming increasingly unequal. In North America this process has several notable features. First, after 40 years of stability, income has since 1980 been increasingly concentrated in the hands of the top 0.01% of earners. Second, this concentration correlates with an explosion in the relative earnings of corporate CEOs, a sort of 'corporate kleptocracy.' Third, the top earners have appropriated most of the productivity gains over this period. The resources and political influence of the super-rich underlie the growing prominence of the 'elite' agenda: lower taxes, smaller government and privatization or shrinkage of social programs. The marketing of this agenda may explain much of the nonsense that contaminates health policy debates. "

The Value of Medical Spending in the United States, 1960-2000:

NEJM -- The Value of Medical Spending in the United States, 1960-2000: "

Background The increased use of medical therapies has led to increased medical costs. To provide insight into the value of this increased spending, we compared gains in life expectancy with the increased costs of care from 1960 through 2000.

Methods We estimated life expectancy in 1960, 1970, 1980, 1990, and 2000 for four age groups. To control for the influence of nonmedical factors on survival, we assumed in our base-case analysis that 50 percent of the gains were due to medical care. We compared the adjusted increases in life expectancy with the lifetime cost of medical care in the same years.

Results From 1960 through 2000, the life expectancy for newborns increased by 6.97 years, lifetime medical spending adjusted for inflation increased by approximately $69,000, and the cost per year of life gained was $19,900. The cost increased from $7,400 per year of life gained in the 1970s to $36,300 in the 1990s. The average cost per year of life gained in 1960–2000 was approximately $31,600 at 15 years of age, $53,700 at 45 years of age, and $84,700 at 65 years of age. At 65 years of age, costs rose more rapidly than did life expectancy: the cost per year of life gained was $121,000 between 1980 and 1990 and $145,000 between 1990 and 2000.

Conclusions On average, the increases in medical spending since 1960 have provided reasonable value. However, the spending increases in medical care for the elderly since 1980 are associated with a high cost per year of life gained. The national focus on the rise in medical spending should be balanced by attention to the health benefits of this increased spending.

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Socioeconomic inequalities in cardiovascular disease in Australia

Media release (AIHW): "
A report released today by the Australian Institute of Health and Welfare (AIHW) says thousands of hospitalisations and deaths from cardiovascular disease, particularly coronary heart disease and stroke, could be avoided if rates among the least advantaged were the same as those from the more socioeconomically advantages areas of Australia.
The report, Socioeconomic inequalities in cardiovascular disease in Australia: Current patterns and trends since 1992, shows that in 2002, adults from the most disadvantaged areas of Australia (areas characterised by low income, low educational attainment and unemployment) had significantly higher death rates from cardiovascular disease (CVD), coronary heart disease (CHD) and stroke than adults from the least disadvantaged areas-between 1.6 and 1.9 times as high.
Ms Lynelle Moon, of the Institute's Cardiovascular Disease and Diabetes Unit said, 'If everyone experienced the same death rates as those in the more socioeconomically advantaged areas, around 28% of deaths from cardiovascular disease, 32% of deaths from coronary heart disease and 24% of deaths from stroke might have been avoided in 2002. This translates to over 3,400 deaths which may be regarded as being due to socioeconomic inequality.'
Despite falls in CVD death rates between 1992 and 2002 for all socioeconomic groups, the proportion of those deaths due to socioeconomic inequality has increased over the same period.
Compared with those in more socioeconomically advantaged areas, in 2003-04, adults living in the most disadvantaged areas of Australia also had significantly higher hospitalisation rates for all types of cardiovascular disease, including coronary emergencies and stroke.
'Again, if everyone experienced the same hospitalisation rates as those in the most advantaged areas, around 16% of all CVD hospitalisations, and 38% of emergency coronary heart disease and 24% of stroke hospitalisations, might have been avoided in 2003-04. This translates to almost 45,400 CVD hospitalisations,' Ms Moon said.
Despite falls in hospitalisation rates for all socioeconomic groups between 1996-97 and 2003-04 the proportion of hospitalisations due to socioeconomic inequality increased substantially for acute coronary syndrome, from 19% to 32% for males and from 28% to 41% for females.
Further information: Ms Lynelle Moon AIHW, tel. 02 6244 1235.
For media copies of the report: Publications Officer, AIHW, tel. 61 2 6244 1032.
Availability: Check the AIHW Publications Catalogue for availability of Socioeconomic inequalities in cardiovascular disease in Australia: Current patterns and trends since 1992.
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Personal Responsibility and Physician Responsibility

NEJM -- Personal Responsibility and Physician Responsibility -- West Virginia's Medicaid Plan: "It is unclear what steps will be taken if physicians do not comply with reporting requirements. The four indicators require data collection from physicians' offices. This requirement for additional documentation is an unfunded administrative mandate that could actually decrease physician participation in the Medicaid program.
In the face of both increasing health care costs and numbers of uninsured persons, states will continue to seek ways to control Medicaid costs. Clinicians often abstain from policy discussions until it is too late for them to have an impact. But who is better able to provide evidence of the misguided nature of such plans? What physician would recommend that a person with diabetes who misses appointments lose the ability to attend diabetes education classes? What physician wants to be faced with a child with asthma whose benefits have been reduced to four prescriptions per month when she gets pneumonia and an antibiotic makes five? In an era of 'personal responsibility,' physicians must assume the responsibility of speaking out about how such policies affect their practices and their patients' health. "

Imposing Personal Responsibility for Health

NEJM -- Imposing Personal Responsibility for Health: "The concept of personal responsibility in health care is that if we follow healthy lifestyles (exercising, maintaining a healthy weight, and not smoking) and are good patients (keeping our appointments, heeding our physicians' advice, and using a hospital emergency department only for emergencies), we will be rewarded by feeling better and spending less money. The details of programs that emphasize personal responsibility, however, are often sketchy, and many difficult questions related to individual freedom and patients' autonomy remain unanswered. For instance, which well-meaning measures to promote responsible behavior actually make a difference, and which are primarily coercive and potentially counterproductive? Which measures may actually improve health or save money, and which may merely shift costs from government, private insurers, or employers to patients?
There are many examples of initiatives that are meant to promote personal responsibility. The World Health Organization will no longer hire persons who smoke, suck, chew, or snuff any tobacco product, although it will still recruit people 'who do not have a healthy lifestyle.' In the United States, some employers target smokers, some even going so far as to fire workers who smoke when they are not at work. At some companies, health insurance may cost less for nonsmokers or for people who complete weight-loss programs, and employees may receive financial incentives to participate in health screenings, fitness programs, or tobacco-cessation programs. Wal-Mart has considered discouraging unhealthy people from applying for work by including some physical activity in all jobs. A national survey conducted in July 2006 estimated that 53 percent of Americans think it is 'fair' to ask people with unheal" /.../

Policy Challenges in Modern Health Care

RWJF - Newsroom - Features - Download Chapters from "Policy Challenges in Modern Health Care": "'Policy Challenges in Modern Health Care'
Chapter titles lead to article summaries and full text of the chapters.
Table of contents, preface and acknowledgements
Introduction
David Mechanic, Lynn B. Rogut, David C. Colby and James R. Knickman
Part I: The Context of Health and Health Care Policy
Morality, Politics, and Health Policy
James A. Morone
Cross Pressures: The Contemporary Politics of Health Reform
Theda Skocpol and Patricia Seliger Keenan
The Employer-Based Health Insurance System: Mistake or Cornerstone?
Sherry A. Glied
Entrepreneurial Challenges to Integrated Care
James C. Robinson"/.../

More Wealth = Better Health In U.S., Report: Even Upper-Middle-Class At Big Disadvantage Compared To Richer People

More Wealth = Better Health In U.S., Report: Even Upper-Middle-Class At Big Disadvantage Compared To Richer People - CBS News:
(Referred by Maria Ines Reinert Azambuja and Henry Greenberg)
"(WebMD) In the U.S., your health depends on your wealth — even if you're not poor. That finding comes from a study showing that after age 55, even people with upper-middle-class incomes suffer more disability than those with even higher earnings. Meredith Minkler, DrPH, and colleagues at the University of California, Berkeley, analyzed data from the 2000 U.S. Census. People below the poverty line for that year — $17,761 for a family of four — were six times more likely to suffer from a disability than those making seven times that much or more. That's really no surprise. Poor people in the U.S. have limited access to health care. And they live and work in less healthy environments than wealthier Americans. But Minkler and colleagues also found that people whose income was 600 percent of the poverty level were more likely to be disabled than those at 700 percent or higher. The researchers defined disability as a condition lasting at least six months that made it difficult to dress, bathe, or get around the home. "What was unusual was that we found that people in the middle class were still at a disadvantage compared with those at just a slightly higher income," Minkler said in a news release. "The fact that there's a significant difference between people at 600 percent and 700 percent above the poverty level was a striking finding of this study." A four-person household at 600 percent of the year 2000 poverty level would have an income of $106,566 a year. The same household at 700 percent of the poverty level would earn $124,327 per year. Men age 65-74 who earned between six and seven times the poverty level were 44 percent more likely to be disabled than those who earned seven or more times the poverty level. "With almost 85 percent of Americans who are 55 years of age or older living at an income level under 700 percent of the poverty line, this is not simply an issue of very poor people having a disadvantage in health outcomes," Minkler and colleagues conclude. "Rather, higher risk is demonstrated across a very large proportion of the older population, as compared with the most advantaged." The study appears in the Aug. 17 issue of The New England Journal of Medicine. SOURCES: Minkler, M. The New England Journal of Medicine, Aug. 17, 2006; vol 355: pp 695-703. News release, University of California, Berkeley.By Daniel J. DeNoonReviewed by Louise Chang, M.D.© 2006, WebMD Inc. All rights reserved."

"Estimativa do Impacto Econômico das Doenças Cardoivasculares no Brasil"

Caros companheiros do GT Investindo em Saúde,

É com grande satisfação que desejamos convidá-los para uma apresentação sobre "Estimativa do Impacto Econômico das Doenças Cardoivasculares no Brasil" a se realizar durante a reunião ordinária do Serviço de Cardiologia, no Anfiteatro do Centro de Imagem (HMV), no próximo dia 10 de agosto, na quinta feira da próxima semana, das 7:30 às 8:30 da manhã.Tratam-se de resultados de uma pesquisa realizada em 4 países (Brasil, Africa do Sul, India e China) na qual a Dra. Maria Inês Reinert Azambuja, o apresentador Dr. Murilo Foppa e eu estamos envolvidos, parcialmente apoiados pela Instituição "IC-Health", e sediado - o componente de nosso país - no Instituto de Educação e Pesquisa.
Como já foi informado anteriormente este trabalho pretende ser um passo inicial de fundamentação para um novo projeto de prevenção de Doenças Cardiovasculares e promoção da saúde.
Discussão e sugestões serão benvidos. Seguindo-se imediatamente à reunião poderemos dispor de alguns poucos minutos para trocar idéias sobre nossos próximos passos.
Um abraço a todos e até lá. AA