JustCare

Tag: Data

  • People with Medicare spend an average of $5,500 on health care annually

    People with Medicare spend an average of $5,500 on health care annually

    Medicare works to ensure people access to quality affordable health care, but average out-of-pocket health care costs are still considerable. A new report from the Kaiser Family Foundation finds that individuals typically spend more than $3,200 a year just on Medicare premiums, deductibles and coinsurance. When you add in costs for services Medicare does not pay for, people spend an average of $5,500 a year out of pocket on health care or, put differently, more than 40 percent of their Social Security benefits.

    Juliet Cubanski and Tricia Neuman analyzed data from 2013 to determine the amount people with Medicare spend on health care. All in, they found that spending on health care eats up about 41 percent of the average monthly Social Security check, $1,115. Average annual Social Security benefits were $13,375 in 2013 and average total income for a person with Medicare was $35,317.  Their report establishes that people with Medicare have far higher annual average out-of-pocket health care costs than the Center for Retirement Research found based on 2014 data, 41 percent of their Social Security benefits as compared to 33 percent.

    To be sure, the percentage of income spent on health care is far higher for people who rely exclusively or almost exclusively on Social Security for their retirement income. And, a notable portion of the 62 million people receiving Social Security benefits rely almost exclusively on Social Security for their income. More than one in five married couples and more than four in ten individuals rely on Social Security for more than 90 percent of their income, according to the Social Security Administration.

    When the Kaiser Family Foundation researchers dug deeper, they found that people over 85 and women typically spent an even higher share of their Social Security income on health care than men and people under 85. People 85 and older spent on average 74 percent of their Social Security benefits on health care costs Medicare does not cover. Women over 85 spent more than men, 83 percent of their Social Security benefits as compared to 58 percent. Because Medicare does not pay for custodial nursing home care or most other long-term care services and supports, the oldest cohort of people with Medicare have especially high out-of-pocket costs.

    Out-of-pocket costs for people in poor health and people with lower incomes were also higher than other people. People in fair or poor health spent an average of $6,128 on health care as compared to $5,246 for people in excellent, very good or good health. Put differently, people who could perform all the activities of daily living–bathing, feeding, toiletting, dressing and transferring–spent on average $4,673 out of pocket a year on health care, whereas people who needed help with activities of daily living spent on average $6,946.

    The researchers found that one in four people with traditional Medicare spent almost 30 percent of their total income on health care costs Medicare does not cover. And, one in ten people spent just under 60 percent of their total income.

    We need to increase Social Security benefits if we want to ensure retirees can make ends meet and keep older adults from falling into poverty. Their situation is projected to get even worse as health care costs continue to grow.

    If you want Congress to expand Social Security benefits, please sign this petition.

    Here’s more from Just Care:

  • Beware of medical advice from the mainstream media

    Beware of medical advice from the mainstream media

    Kevin Lomangino of Health News Review explains how you and the rest of America may end up duped by medical advice from the mainstream media. Even the medical correspondents in the big media outlets are often not delivering evidence-based advice. And, while they may be spinning an interesting story based on a study of one sort or another, question what you learn before taking action.

    Medical studies abound to support the value of all kinds of treatments. And, it seems worthwhile to let people know when a study shows that a treatment works. What’s the downside, especially when the treatment sounds benign. Unfortunately, if the sample of people studied is small, the length of the study is short, or the design of the study is flawed, the value of the study is questionable. And, in some cases, the proposed treatment may have harmful side effects.

    At Just Care, where possible, before reporting on a study, in addition to speaking with medical experts, we check with Cochrane, an independent non-profit that does meta-studies, before we offer health advice. Cochrane’s meta-studies dig deep into as much of the research as possible to determine whether a particular finding can be trusted; and, if so, to what degree. But, Cochrane does not always have an answer, so what to do?

    If the proposed treatment is based on independent peer-reviewed evidence and there is no harm in trying it–such as “exercise” or “eat green leafy vegetables”–there are likely only benefits to trying it. And, Just Care might write about it as we did with one study on exercise and memory. It could be another reason to take a brisk walk or eat a Mediterranean diet or not eat foods with processed sugar.

    But, if the proposed treatment is any type of supplement or complementary medicine, it is potentially unsafe. And, you should likely avoid it. You certainly should not take it without first consulting with your doctor. Much like new drugs and medical devices approved by the FDA, the treatment may not be worth the risks, as less in known about it.

    Health News Review reports, for example, that ABC News’ Good Morning America’s medical correspondent advised viewers to take “complementary natural” remedies for the flu without any compelling evidence that they work. Without evidence on benefits and toxicities, the ABC News medical correspondent has no business recommending to viewers a cocktail of supplements to treat the flu and how to take them. The medical correspondent even acknowledges that there is no evidence that these “remedies” work and no data on their toxicity. What is she and ABC’s Good Morning America thinking?

    Similarly, Sharon Begley at StatNews writes about a rash of media reports on the value of aerobics and other exercise to help the brain. But, as Begley explains, experts disagree on the value of the studies underlying these reports. Even when advice is evidence-based, there is generally more to the story.

    The American College of Neurology recently began recommending aerobics to patients with mild cognitive impairments as a way to help their memory, thinking and judgment and to prevent dementia as they age. And, there is evidence to support this recommendation. But, the National Academy of Sciences (NAS) has completed a meta-study of 262 studies, and it did not find a link between exercise and dementia prevention.

    Interestingly, the studies showing a link between exercise and dementia prevention were randomized-controlled studies that were peer-reviewed. But, the NAS found that many of them were flawed in one way or another.

    Of course, lots of us want to learn about ways to stave off the flu, forestall dementia and live longer healthier lives. So, we are sure to continue to read and hear about new findings as to what we can do. If the recommendations are exercise and good nutrition, following them will most likely help you. But before buying and taking a pill, an oil or some complementary medicine remedy, look deeper into the research and talk to your doctor.

    Here’s more from Just Care:

  • FDA approves first digital pill

    FDA approves first digital pill

    The New York Times reports that the FDA has approved the first digital pill, a pill that allows doctors to know whether you took your medicines and when. This latest health technology embeds a sensor in a prescription drug that captures and transmits data. The digital pill is designed to help with ensuring that people comply with their medication regimens.

    Digital pills will be especially helpful to older people and others who might otherwise forget to take their medications. Researchers have found that patients typically take only half of the doses of their prescribed medications. People who do not take their medications as prescribed may jeopardize their health.  They may end up hospitalized and in need of otherwise avoidable health care. The health care spending implications of medication noncompliance in the US is estimated by one population health management company at between $100 billion and $289 billion a year.

    The first digital pill, Abilify MyCite, is a new version of Abilify, an antipsychotic medicine. Patients must sign a written document consenting to give their doctors, and up to four other caregivers, access to the digital data. Abilify MyCite’s sensor is no bigger than a grain of salt. It is made of magnesium, copper and silicon. Once ingested, stomach acid activates the sensor.

    The data from the pill’s sensor is transmitted through a patch that patients wear. It indicates whether they took their medicine and when.  Patients can protect their privacy through a digital app that allows them to control who has access to their data.

    The FDA requires Abilify MyCite to have a warning that older patients with dementia-related psychosis, who are treated with antipsychotic drugs, are at increased risk of death. “Abilify MyCite is not approved to treat patients with dementia-related psychosis.” The drug poses serious risks of harm, including nausea, vomiting, anxiety, and uncontrollable limb and body movements.

    It may not be long before all medicines will be embedded with sensors to allow doctors and caregivers to monitor patients and help ensure medication compliance. At a minimum, sensors will be able to indicate whether a patient has taken a medicine. The public health benefits are significant.

    But, we also need to protect people from the big risks posed by this new health technology. Privacy and security issues abound. The data could be used by insurers against patients who fail to comply with their medication regimens. And, if the data is not stored securely or it is hacked, patients may have no control over the people who can access it.

    Here’s more from Just Care:

  • One in four insured Americans go without care, struggle to pay high deductibles

    One in four insured Americans go without care, struggle to pay high deductibles

    A new Kaiser Family Foundation report finds that fewer than half of single people have the money to pay $2,000 in deductibles and other cost-sharing requirements in most commercial health plans. In sharp contrast to wealthy Americans who can afford high deductibles and copays, high cost-sharing too often keeps working people from getting needed care. With health plan deductibles and copays rising more quickly than people’s income, more Americans are unable to afford their care.

    Commercial health plans for people under 65 typically have out-of-pocket limits of $6,850 for an individual and $13,700 for a family, far more than most Americans can afford. Only about half of people living alone have $2,500 in cash or other liquid assets. And, only about half of larger households have $5,000 in liquid assets. Slightly more than one in three households could pay $6,000 in cost sharing.

    More than forty percent of people with incomes between 150% and 400% of the federal poverty level are at risk of going without care if they get sick, without the money to pay even a $1,500 deductible ($3,000 for families), the average deductible for people with employer coverage. About sixty percent of people in this income range could not afford a $3,000 deductible ($6,000 for families), which are typical in the state exchanges.

    Access to care for working families in the US has declined in the last couple of years as health plans increasingly ration care based on people’s ability to pay. In 2015, Families USA reported that one in four Americans with non-group coverage—insured either through the health insurance exchanges or outside the health insurance exchanges—could not afford their medical care. They were unable to pay the high deductibles (which, according to the Kaiser report, averaged over $3,000 in 2016 and 2017) or out-of-pocket costs their policies require. As a result, they went without care they need.

    In 2013 and 2014, 25.2 percent of people in non-group plans went without care because they were not able to pay for it. Not surprisingly, people with incomes between 139 and 249 percent of the federal poverty level had more trouble affording care (32.3%) than people with incomes between 250 and 399 percent of poverty (22.2%).

    And almost three in ten people with deductibles of $1,500 or more (29.8%) went without medical care as compared with about two in ten people with deductibles under $1500 (19.6%). A somewhat smaller percentage of people who got their coverage through the state exchanges had deductibles of $1500 or more (42.8%) than people who got their coverage outside the exchanges (58.3%).

    According to a September 2016 CDC report, in the first quarter of 2016, 40 percent of Americans were enrolled in high-deductible health plans, up from 36.7 percent in 2015 and from 25.3 percent in 2010.

    The Families USA report found that the most common procedures people skipped were medical tests, treatments and follow-up visits (15.3%) and filling prescriptions (14.2%). Many prescription drugs have become prohibitively expensive even with insurance. Not only have prices on brand-name drugs gone up, but copays on brand-name drugs have risen signficantly, to as much as 30 percent of the cost. It’s no wonder that government drug price negotiation is a top policy issue for democrats and republicans alike.

    If you support improved Medicare for all, please sign this petition.

    Here’s more from Just Care:

  • Long-term care at a glance; many of us will need it

    Long-term care at a glance; many of us will need it

    Because we don’t live forever, it’s important to be prepared in the event that you or a loved one needs long-term care.  In 2010, 12 million people needed long-term care. As the baby boomers near 65, the number of people needing long-term care only grows. By 2050, 27 million people are projected to need long-term care.

    Only 35% of Americans say that they have set aside any money to meet long-term care needs. Most people rely on family, friends and other unpaid care for their care. Paid long-term care supports and services can cost a lot. So, a recent Commonwealth Fund study finds that two out of five older adults and people with disabilities needing long term care do not receive it.

    An expansion of community and institutional programs could be the first step in reducing the cost burden of long-term care, according to The Robert Wood Johnson Foundation. Lack of awareness of this pressing issue is a major factor in the lack of resources for long-term care. Greater awareness might help foster change to help those who are faced with long-term care costs in their later years.

    Fact: Seven out of ten older adults will need long-term care at some point in their lives, typically for about three years. As the baby boomers near 65, the number of people needing long-term care only grows. In 2010, it was 12 million people. By 2050, it is projected to be 27 million people.

    Fact: 11 million people needed paid long-term care services in 2013.

    Fact: Four in ten older adults will need long-term care for two or more years.

    Click here and here to learn more about long-term care from JAMA and RWJ Foundation.

  • If you want easy health care access and good quality care, you probably want traditional Medicare

    If you want easy health care access and good quality care, you probably want traditional Medicare

    When you’re considering your Medicare health plan options, if you want easy health care access and good quality care, you should seriously consider traditional Medicare. It is likely your only option that will ensure you get the care you want and need. Traditional Medicare generally covers your care hassle-free whenever you need it, wherever you are in the US.

    Traditional Medicare with supplemental coverage offers the greatest choice of doctors and hospitals anywhere in America and allows you to budget for your health care. Supplemental coverage picks up most if not all of your Medicare out-of-pocket costs. Often, retiree coverage from a former job offers people this supplemental coverage. And, in many states, people with Medicaid can rely on Medicaid as their supplemental coverage.

    If you don’t have retiree coverage or Medicaid, you can buy Medicare supplemental coverage or Medigap in the individual market. The cost can easily be $250 a month, which is significant. But, for anyone who ends up in the hospital, choosing traditional Medicare and buying supplemental coverage generally allows you to: 1. See the doctors you know and trust wherever you are in the US with little or no out-of-pocket costs, 2. Receive whatever care your doctors think you need, and 3. Keep your health care costs down.

    In sharp contrast to traditional Medicare, a Medicare HMO or other private Medicare Advantage plan 1. restricts your access to doctors and hospitals, 2. determines what care they will cover, and 3. can leave you responsible for paying hundreds or even thousands of dollars every time you need care.

    To be clear, upfront costs for Medicare HMOs and other Medicare Advantage plans are generally lower than those for Medicare supplemental coverage. But, there’s absolutely no way to budget for your care. You cannot know whether a private Medicare Advantage plan with a limited network of doctors and hospitals will meet your unforeseeable care needs—the care you want at a price you can afford from doctors and hospitals you want to use, wherever you are in the US.

    For example, with rare exceptions, in a Medicare Advantage plan, you will not have coverage outside your community, you will not have coverage from doctors outside the health plan’s network, and you may find that high deductibles and copays as well as health plan denials of coverage prevent you from getting the care you need. For costly care, you will generally need to go through a prior authorization process, during which your plan will decide whether it will cover your care.

    With a Medicare Advantage plan, if you need costly services you could end up spending as much as $6,700 out of pocket for in-network services alone.  And, you will likely end up spending far more if the doctors and hospitals you use are out of network; in those cases, you will generally be liable for the full cost of their care. Moreover, if you are hospitalized, it’s more than likely that some of your doctors will be out of network. (Here are four things to think about when choosing between traditional Medicare and a Medicare Advantage plan.)

    A Kaiser Family Foundation study examines the literature comparing access and quality in traditional Medicare and Medicare Advantage plans. The data is limited.  But, not surprisingly, data from people with complex and costly conditions rate the private Medicare Advantage plans “substantially lower” than traditional Medicare on access and quality.

    Here’s more from Just Care:
  • Lowering health care costs, drug prices, top policy priorities

    Lowering health care costs, drug prices, top policy priorities

    A new Kaiser Family Foundation health tracking poll shows continuing strong bi-partisan support for Congressional action to to rein in the cost of health care and the price of drugs. More than six in ten Democrats and Republicans see lowering health care costs and drug prices as top policy priorities.

    When asked how should government rein in drug prices, more than nine out of ten people surveyed said that the government should negotiate drug prices for people with Medicare. The survey did not ask people’s views on government drug price negotiation for all Americans, which Congress could achieve at no cost, by expanding Medicare to everyone in the U.S. exclusively for the purpose of ensuring everyone benefit from low drug prices.

    More than seven out of ten people supported allowing people to import drugs from Canada. Of note, Kaiser Health News reports that some 19 million Americans import their drugs from abroad. The FDA appears never to have prosecuted anyone for doing so for personal use.

    The charts below shows people’s top health priorities and people’s views on how to bring down drug costs.

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    Here’s more from Just Care:

  • Life expectancy projected to rise in 35 countries, with smaller gains in U.S.

    Life expectancy projected to rise in 35 countries, with smaller gains in U.S.

    Life expectancy is projected to rise in 35 countries, with smaller gains in the U.S., according to a recent report in The Lancet. Researchers believe that the chance of people born in 2030 living longer than they do today is 65% for women and 85% for men. As a result, countries need to plan for greater health and social services needs.

    Some high-income countries, including the U.S., fare worse than others in the researchers’ model. Life expectancy in the U.S., Japan, Sweden, Greece, Macedonia, and Serbia is not expected to increase as much as in other countries. Life expectancy at birth in the U.S. is lower today than in most other high-income countries. The researchers project that U.S. life expectancy will worsen, so that in 2030, U.S. life expectancy will be on a par with the Czech Republic for men, and Croatia and Mexico for women.

    Of all the high-income countries studied, the U.S. has the highest child and maternal mortality, homicide rate, and body-mass index. The U.S. population has also seen an end to its height increases, which is associated with longer life.

    The researchers suggest that lower life expectancy in the U.S.–and even declining life expectancy for some populations–stems in part from our lack of universal health coverage. More than any other high-income country, the U.S. has the highest unmet health care needs because health care is unaffordable to so many people. They conclude that “the poor recent and projected U.S. performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.”

    Japan has had the highest life expectancy for women for decades. At 65, Japanese women are expected to live on average more than 24 additional years (89), followed by French women, who at 65 on average live an additional 23 years (88).

    The researchers expect South Korean women born in 2030 to live to 86.7. And, they believe that there’s a better than 50-50 chance that South Korean women will live to be 90 or older.  The researchers project life expectancy for women in France, Spain, and Japan to be close to that of South Korea.

    The researchers believe with near certainty that men born in South Korea, Australia, and Switzerland in 2030 will live past 80, and there’s better than a one in four chance that these men will live past 85.

    Researchers further say that it is more than likely that women born in 2030 will live on average to 90 or older.

    Here’s more from Just Care:

  • Why you should question your doctor’s orders

    Why you should question your doctor’s orders

    A new Pro Publica report explains how even when the data show that the best treatment for a health condition is exercise, a healthy diet and lifestyle changes, a large proportion of doctors continue to deliver medical treatments that are unnecessary, unhelpful and sometimes harmful. It’s well worth a thorough read. Here’s the big takeaway: When your doctor is proposing a new medication or an invasive procedure, it’s wise to question your doctor’s orders.

    What’s the problem? Doctors may not stay on top of the latest science, or they may not believe the new findings, or they may have a financial incentive to perform an unnecessary procedure. Doctors and patients also often focus on the purported benefits of a medication or procedure or see the treatment as at worst neutral, without giving adequate attention to its risks.

    How big is the problem? The problem is enormous, affecting millions of people and concerning a wide range of treatments. The report describes, among other things, the unnecessary and often risky implantation of stents in patients in stable condition who have not suffered heart attacks, the extensive prescribing of atenolol to prevent heart disease and stroke, when it has been shown not to do so, and the frequency of arthroscopic surgery to fix meniscus tears when physical therapy appears to be the appropriate treatment.

    The problem with stent implantations: Although stents have not been shown to prevent heart attacks in patients in stable condition who have not suffered a heart attack, it is still a very popular procedure for these patients. In one instance described in the report, a patient in his early 60’s who was suffering from heart pain went to an emergency clinic and was told that he needed an invasive procedure—a coronary angiogram–to determine whether he needed a stent implantation to unclog an artery. The man had not suffered a heart attack, and his heart was functioning normally.

    Rather than getting the procedure, the man sought out other opinions, only to learn that the data showed that stents for patients in stable condition do not prevent heart attacks nor do they extend the lives of patients. The safer and better treatment is a change in diet, weight loss and medication. But, hundreds of thousands of patients each year get stent implants, which are both unnecessary and can be a risky procedure.

    And, lest you believe the stent implantation does no harm, the report describes how a man recovering from treatment for Hodgkin’s lymphoma who was suffering from shortness of breath, received a stent implant—presumably to address his shortness of breath–he did not need. Then, when he needed a life-saving lung transplant, he couldn’t get it because the medications he was taking for the stent implant would cause a dangerous interaction. Before he could get off those medications, he ended up dying.

    The problem with atenolol, a beta blocker: After atenolol, a beta blocker, was found to lower blood pressure, it became a commonly prescribed medicine, particularly for older adults. What’s concerning is that after it was determined to not be effective in preventing heart attacks and stroke and in fact to increase the chances of stroke in older adults, it was prescribed to 2.6 million people with Medicare in 2014 alone. While each year fewer prescriptions for atenolol are written, the report indicates that it likely will be more than a decade before doctors stop prescribing it.

    The problem with arthroscopic partial meniscectomies (APMs): Though physical therapy has been found to be the effective treatment for people with torn menisci, patients with meniscus tears too often receive unnecessary and unhelpful arthroscopic surgery to repair the tears.

    What consumers can do: Because we have little or no medical expertise, questioning our doctors can be challenging. We may need to do our own research or to get a second or a third opinion. But, it can be well worth the time and effort.

    Here’s more from Just Care:

  • What are the most common injuries in U.S.?

    What are the most common injuries in U.S.?

    Amino, Inc. a health care data insights firm, looked at 244 million claims in its database between 2012 and 2016 to determine the most common injuries in the U.S. for which people receive medical attention. As it turns out, almost one in six doctor visits include a physical injury diagnosis. Amino also identified different predominant injuries in different states, ones that are disproportionately frequent.

    No matter which state you live in, having an “open wound”–essentially a cut–and “bruising” are the two most frequent injuries for which people receive medical attention. Colorado is the one exception, with falls as its most common injury. Curiously, bruises rank at the top in the northeast, south, California and Oregon and open wounds rank at the top everywhere else. You’re left wondering what explains this difference and whether this difference is more about doctor labeling than anything meaningful.

    Behind open wounds and bruising, injuries that are disproportionately frequent in different states vary widely. Some of the variation is easier to understand than other variation. In Idaho, Utah, Wyoming, Colorado, New Mexico and Nevada, suffocation is more common, perhaps because they are mountain states, and suffocation is related to oxygen deficiency. People in Hawaii tend to have a higher incidence of near-drowning diagnoses. Nebraska, Wyoming, Montana are a few of the states with a higher than normal proportion of “animal-drawn vehicle accident” diagnoses. New York residents are more likely than people in other states to get treatment related to an “unarmed fight or brawl.”

    Who knows why, but motor vehicle accidents are more common in Tennessee, Arizona and California than in other states. Head injuries are more common in Florida. People in Massachusetts have disproportionately more concussions.

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