Tag: Data

Do mammograms do more harm than good?

For sure, mammograms contribute to the income of radiologists and other professionals who provide medical services to screen for breast cancer as well as the medical device manufacturers. And, the U.S. Preventive Services Task Force recommends a mammogram every other year for women between 50 and 74, suggesting that for this age group mammograms do more good than harm. But, the Task Force once again does not recommend mammograms for women under 50, concluding that, for younger women, mammograms do more harm than good.

Since the U.S. Preventive Services Task Force last looked at the value of mammograms for women in 2009, according to Shannon Brownlee and Lisa Simpson, “the number of studies of mammography has grown, and if anything, the evidence is even stronger: we are consistently over-diagnosing and over-treating breast cancer — and younger women are paying the highest price.” There’s a better than even chance that women under 50 who get mammograms for ten years will receive a false positive and need further unnecessary testing, increasing psychological stress and costs for them.

There’s also mounting evidence that between one in three and one in five breast cancers that mammograms detect do not need to be treated or could be treated later in women’s lives. For now though, doctors cannot know the difference between those cancers that need treatment and those that do not.

The Cochrane Collaboration reviewed seven trials involving 600,000 women between the ages of 39 and 74, half of whom were randomly chosen for screening before a lump could be felt. They reported that the studies with the most reliable data showed that mammography screening did not reduce a woman’s chance of dying of breast cancer.

At the end of the day, women should consult with their doctors about whether they need screening mammograms more frequently than the U.S. Preventive Services Task Force recommends. They should understand the benefits and harms. The Cochrane Collaboration has a good information sheet capturing the scientific evidence.

The evidence on mammograms provides powerful reasons to heed the advice of the U.S. Preventive Services Task Force. Today, we collectively spend an estimated $4 billion a year on false positive mammograms and breast cancer overdiagnoses. Without compelling evidence of lives saved and little risk, it’s hard to see the benefits of more mammograms as worth their psychological and financial costs.

May 29, 2015
Older and living alone, the rise of elder orphans

Elder orphans, older adults living alone, should be among the chief concerns of health policy gurus and, for that matter, presidential candidates. They are single, divorced or widowed, and without children, or with children living far away. These older isolated individuals need both personal resources and community resources in order to age in place.

According to a new report out of North Shore-Long Island Jewish Health System, there are now more than 9 million elder orphans or individuals at risk to become elder orphans—roughly 22 percent of the older adult population. In 2012, there were 43.1 million adults over age 65, representing about 13 percent of the population, according to the federal Administration for Community Living.

Elder orphans do not have a health care proxy. They may be physically or cognitively impaired. They have no one to care for them, to act on their behalf, if they are sick or hospitalized, if choices need to be made about their current situation and the future. They often have little income and few assets. That puts them at great risk of not having their health care or life wishes honored. They often live in nursing homes, with no one to visit them or provide companionship.

If elder orphans cannot make decisions for themselves, the state appoint may conservators or guardians to be responsible for the elder orphans’ finances and persons. The elder orphans become wards of the state and lose all rights to make decisions for themselves.

The number of elder orphans is likely to grow substantially as the population ages. In 2012, about one in three Americans between the ages of 45 and 63 were childless and living alone, which is 50 percent more than in 1980. We need a strategy for helping them as they age; we need to plan ahead for the next likely larger generation of elder orphans.

By 2030, some estimate that more than 5 million people—of the estimated 70 people over 65, including 9 million over 85–will need to live in a nursing home or alternative care facility because they will not have anyone to care for them at home. It’s not even clear whether there will be enough nursing home beds for these elder orphans, if they wanted to enter a nursing home. Today, there are 15,700 nursing homes with 1.7 million beds and 1.4 million residents, according to the CDC.

May 27, 2015
Many Americans billed for care they thought was covered

A new survey of Americans by Consumer Reports National Research Center reveals that nearly one in three insured Americans (30 percent) are billed for care they thought was covered; they receive bills for services they expected their health plans to pay for. Almost a quarter of them received a doctor’s bill they did not expect. Of those who received these bills, more than a third took no action. And only a small fraction (28 percent) understood their right to appeal these bills and how to do so.

Most of the people who receive these bills are not happy with the way the payment issue is resolved. Survey results suggest that the majority of Americans pay these bills. Only 28 percent of people surveyed were satisfied with the outcome.

The problem is that even when insured Americans use network hospitals, their health plan does not guarantee that the doctors who provide their care are also in the network. It’s often hard for a patient to avoid getting care from out-of-network doctors, particularly radiologists, anesthesiologists and pathologists. And, it is especially difficult to avoid receiving out-of-network care in emergency situations. Click here for more information on how to protect yourself.

Consumer Reports is advocating for consumer protections that would prevent patients from receiving these unexpected bills in emergency situations and ensure consumers had notice before out-of-network doctors treated them. New York recently passed a law to this effect. And, several other states are now considering similar laws.

If you receive a medical bill that you don’t think you should pay, it’s always smart to appeal. Consumer Reports has launched a web site to help consumers figure out where to go to fight medical bills they believe their health plan should be paying for. People with Medicare have appeal rights that are very simple. And, most people who appeal win.

May 16, 2015
New data on Medicare drug spending reveals Nexium is the biggest coster

New 2013 data on Medicare drug spending from the Centers for Medicare and Medicaid Services tells important story about drug costs and drug use among people with Medicare. You can learn about physician prescribing habits by specialty and geography. There’s also data on the top prescribed drugs based on claims submitted and the top prescribed drugs based on cost.

The data clearly show that the use of generic drugs is up. A 2014 Congressional Budget Office report on falling Medicare drug costs recognizes this increase in generic drug use; it stems in part from a loss in patent protection for several commonly prescribed high-cost drugs. In the top five medical specialties with the highest total prescription drug costs, more than three quarters of drugs prescribed are generic. And of the top ten prescribed drugs based on claims submitted, all ten are generic.

More than three of four drugs dispensed to people with Medicare were generic. People living in Texas, Hawaii and Alaska used slightly fewer generics than people in most of the rest of the country.

The top prescribed drug based on cost is Nexium. Almost 1.5 million people with Medicare Part D were prescribed Nexium costing more than $2.5 billion. But, Advair is not far behind.

May 15, 2015
Government drug price negotiation is top policy issue for a strong majority of Democrats and Republicans

A new poll of likely voters shows that allowing government drug price negotiation ranks as the top policy issue for Americans. A Medicare buy-in for all ranks eighth and expanding Social Security benefits ranks 13th. Based on poll results, economic security issues are of paramount concern to Americans.

More than three quarters of likely voters, 79 percent, support government negotiation of drug prices. Almost 90 percent of Democrats (89 percent) support government drug price negotiation and more than three-quarters of Republicans (76 percent). Of note, the question posed concerned lower drug prices for people with Medicare and Medicaid and not everyone in the country. Every other wealthy nation negotiates drug prices for all its residents.

Seven out of ten likely voters (71 percent) support giving all Americans the choice of buying into Medicare as a way to drive competition in the health insurance marketplace. More than three quarters of Democrats (77 percent) support this policy, along with a healthy majority of Republicans (63 percent).

Seven out of ten likely voters (70 percent) also support expanding Social Security by having wealthy Americans pay Social Security contributions throughout the year, like everyone else. Eighty-five percent of Democrats support this policy, as do a 62 percent of Republicans.

April 2, 2015
Americans with Medicare are most satisfied with our health care system

According to two Gallup polls over the last year, people over 65 with Medicare are more satisfied with their health insurance than people under 65 with commercial insurance.

One poll found that people with government-provided health insurance, including people with Medicare and VA coverage, are more satisfied with their health care coverage than other Americans. Almost four out of five people 65 and older are satisfied with their treatment by the health care system (79 percent of people with Medicare, Medicaid and VA coverage) as compared with about three out of five people between 18 and 45 (61-66 percent).

More specifically, people without health insurance are the least satisfied with the health care system (36 percent). People with military or veterans coverage are the most satisfied (77 percent) and people with Medicare or Medicaid are the next most satisfied (76 percent).For this survey, Gallup did not separate out satisfaction rates for people newly insured in the health insurance exchanges. They plan to do so in future polls as soon as practicable.

The survey also does not speak to the reasons why people over 65 are more satisfied with the health care system than the rest of the population. Joe Baker, president of the Medicare Rights Center, speculates it’s because Medicare and Medicaid coverage are easier to use than private insurance and in most cases provides better protection against financial risk. “For sure, Congress can improve Medicare. But, compared with the hassles of referrals and huge copays and deductibles with private insurance, Medicare is relatively simple.”

The second survey reveals again that people over 65 are more satisfied (79 percent) with our health care system than any one else. It further shows that people with health insurance are far more satisfied with the health care system (70 percent) than people without health insurance (37 percent). Interesting, Democrats and Democratic-leaning independents are more satisfied with the health care system (74 percent) than Republicans and those who lean Republican (60 percent).

March 16, 2015
You might just live to 100!

With each passing decade there’s an increasing chance that more people in the US will live to 100 or older. In the last 30 years, the Census Bureau reports that the number of people living past 100 has increased by more than 65 percent, from 32,194 to more than 53,364 in 2010.

The proportion of centenarians in the U.S. is still relatively small, 1.73 for every 10,000 people. It’s also a slightly smaller proportion than in other countries such as the United Kingdom, Sweden and France. And, if you would like to increase your odds of living into your 100s, you might want to move to Japan, which has twice the proportion of centenarians as we do, 3.43 for every 10,000 people.

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February 19, 2015
Friends are closer to family than you might imagine

A recent study by researchers at UC San Diego and Yale found that friends are closer to family than you might imagine. They have more DNA in common with one another than with strangers. Yet, these friends were not biologically related.

Put differently, we share genetic similarities with our friends that we do not share with strangers. The researchers found a 1 percent genetic similarity among friends, the same degree of similarity to be found among fourth cousins. Similarities were closest among genes that affect our sense of smell.

It’s no wonder that we often think about our friends more as family. It is well understood that “genes are known to play a role in the formation (6), attributes (7), and structures (8) of friendship ties.”

February 9, 2015
Almost one in five people uninsured in states that have not expanded Medicaid coverage

Almost one in five people are uninsured in states that have not expanded Medicaid coverage. A recent report from the Urban Institute shows that states which have opted to expand Medicaid coverage show higher rates of insured residents than states that have opted not to expand coverage. The Affordable Care Act gave states this right and substantial funding for this expansion.At the end of June 2014, states that had expanded Medicaid coverage had a 10.1 percent uninsurance rate. States that had not expanded Medicaid coverage had an 18.3 percent uninsurance rate. Overall, 13.9 percent of adults are uninsured.

As of the end of November 2014, twenty-eight states are expanding Medicaid coverage, including the District of Columbia. California, Illinois, New York, Pennsylvania and Ohio are all expanding coverage. Florida, Texas, Nebraska and Georgia are among the states that have not expanded Medicaid coverage to date.

February 5, 2015
Fed survey highlights financial stress of Americans

A 2013 survey by the Federal Reserve shows that a significant portion of the U.S. population exhibit evidence of financial stress. More than a third of people surveyed (38 percent) reported that they were either “just getting by” or “struggling” to do so. And, one in three said that they were worse off than they were five years ago.

Expanding Social Security would be a big help. About half of respondents are saving some money for retirement. But one in four respondents had done no retirement planning whatsoever, and another 24 percent said they had only given a little thought to retirement planning. Almost one in five people 55-64 had no retirement savings. Of respondents who had retired, 74 percent cited Social Security as a source of funds.

Since the Great Recession, many boomers and older adults are struggling to make ends meet, have little savings and see themselves retiring later than originally planned. Almost a quarter (24 percent) of people between 55 and 64 who had not retired said they planned to work as long as possible. Of particular concern, 64 percent of 45-59 year olds and 42 percent of 60+ year olds said they have not set aside emergency funds that would cover their expenses for even three months.

Medical expenses were large and unexpected for one in four respondents. And, one in three respondents (34 percent) said they had postponed medical care because they could not afford to pay for it.

Social Security lifted 22 million Americans out of poverty in 2012. Strengthening it and expanding benefits would help strengthen the financial security of Americans.

The Federal Reserve survey was designed to understand the financial well-being of American households and the challenges they face since the Great Recession, as well as the financial risks ahead. It was completed by 4,134 households.

January 29, 2015