JustCare

Tag: Mortality

  • The deadly consequences of out-of-pocket drug costs

    The deadly consequences of out-of-pocket drug costs

    A new paper in NBER looks at the deadly consequences of out-of-pocket costs in the Medicare Part D prescription drug program. As you might expect, deductibles and copays keep people from filling their prescriptions. What you might not expect is that when costs rise on one prescription, people sometimes stop filling all of their prescriptions.

    Most people have little ability to rank order the value of their different prescriptions or to prioritize one prescription over another when they cannot afford them all. So, instead, they make random decisions about which ones to stop taking or decide to stop taking all of them. In short, while cost-sharing might reduce overuse of medicines, it also can lead to poor health outcomes and premature deaths.

    The researchers found that a $10.40 increase in a drug’s cost leads more than one in five people to stop filling their prescriptions altogether. It also increases the likelihood of people dying.

    When out-of-pocket costs rise, people stop taking statins and antihypertensives which can extend their lives significantly. And, people who are most at risk for a heart attack or stroke are likely to reduce their use of these drugs even more than people who are at lower risk. Socioeconomic status apparently has little bearing on people’s behavior.

    Most interesting and disturbing, the researchers find that, when drug prices increase, nearly one in five additional people opt not to fill any prescriptions. This reaction apparently holds whether they take one additional medicine or multiple additional medicines. Moreover, the risks of not taking medicines apparently have no bearing on people’s behavior.

    The researchers only looked at the effects of drug costs on patient mortality not on morbidity. They conclude that “patient cost-sharing introduces large and deadly distortions into the cost-benefit calculus. Payers should evaluate the merits of these policies in light of their impact on health, not just on health care costs.”

    If we value people’s lives and well-being, it’s time to do away with rationing care based on ability to pay. It’s time for Medicare for all.

    Here’s more from Just Care:

     

  • Where’s your body fat?

    Where’s your body fat?

    Nicholas Bakalar reports for The New York Times on how extra fat in different parts of your body could affect your life expectancy. With fat in some places, you reduce your life expectancy. With fat in other places, you increase your life expectancy.

    Generally, if you have body fat, no matter where it sits, you are likely to be at higher risk of dying younger. But, a meta-analysis of an enormous amount of research found that your risk varies based on where the extra body fat is located.

    Researchers looked at 72 studies involving a total of 2.5 million people. They found that people with a lot of body fat in their waists, in the abdomen, were most likely to die prematurely. And, the amount of extra fat around your waist matters. An additional four inches added an 11 percent greater likelihood of dying prematurely.

    Large waist size often means a higher likelihood of heart disease. It also can mean a higher risk of diabetes, cancer and Alzheimer’s disease.

    What’s interesting is that the researchers found that there are some locations where extra fat increases your life expectancy. People with large thighs are less likely to die prematurely. Every two inches in thigh circumference means a 19 percent lower risk. People with larger thighs have more protective muscle.

    For women, every four inches extra in hip circumference reduced risk of death by 10 percent. Women with larger hips have subcutaneous fat, not visceral fat, and that can be helpful.

    The researchers also looked at people who had both larger waists and larger hips. They found that people with both still had a greater risk of dying early.

    You might wonder how people who have less than the normal about of fat on their waists fare when it comes to life expectancy. There’s not as much research. But, what the data show is that, within a range, less waist fat could improve life expectancy. Outside that range, it’s unclear.

    What can you do to extend your health and life expectancy? Focus less on your overall weight and more on your waist size!

    Here’s more from Just Care:

  • The wrong choice of Medicare Advantage plan could kill you

    The wrong choice of Medicare Advantage plan could kill you

    Older adults and people with disabilities have the choice of private health plans that offer Medicare benefits, sometimes called Medicare Advantage plans. Through an analysis of mortality rates at different Medicare Advantage plans, Jason Abaluck, Associate Professor of Economics, Yale University and colleagues at Brown University, University of Chicago and Northwestern University, found that the wrong choice of Medicare Advantage plan could kill you. The government would save thousands of lives if it terminated contracts with Medicare Advantage plans that have high mortality rates.

    After studying mortality rates in hundreds of Medicare Advantage plans with 15 million enrollees over five years, the researchers determined that people who choose the wrong Medicare Advantage plan have a much higher risk of dying. Put differently, your choice of health insurer affects how long you will live, along with other health outcomes.

    The researchers suggest that giving people the ability to choose between a plan that has their primary care doctor in network and one that saves them money is crazy. And, who knows which of these plans will prolong people’s lives and which will shorten them?

    They recognize that people cannot make good choices. They further recognize that the private health insurance market is broken. The Medicare Advantage plans have very little reason to put money towards keeping people healthier. In fact, some have mortality rates as high as eight percent–one in twelve of their members die each year; others have mortality rates of two percent.

    The researchers looked specifically at what happened to people’s mortality rates when they switched out of one Medicare Advantage plan and into a different Medicare Advantage plan. They found that a Medicare Advantage plan’s mortality rate had a direct effect on whether a person lived or died.

    To be clear, people have no clue what the mortality rate is for a given Medicare Advantage plan. That data is not publicly reported. And, star-ratings of Medicare Advantage plans are of no help.

    The researchers say that Medicare Advantage plans with higher premiums and better drug coverage tend to have better health outcomes. But, these two factors alone will not tell you whether you have a better chance of survival in a particular Medicare Advantage plan.

    What’s the solution? The researchers recommend that the government terminate contracts with Medicare Advantage plans that have the highest mortality rates. By so doing, the government could save around 10,000 lives a year. The better solution: Terminate all Medicare Advantage plans, eliminate out-of-pocket costs in traditional Medicare and move everyone into traditional Medicare or, better still, Medicare for All.

    Here’s more from Just Care:

  • Medicare for all would save 68,000 lives a year

    Medicare for all would save 68,000 lives a year

    New research by Yale Professor Alison P. Galvani et al., published in The Lancet, concludes that Medicare for All could guarantee health care for everyone in the US at far less overall cost than we spend today. The research adds to a body of 22 other studies which also conclude that Medicare for All saves money. As important, Galvani’s team finds that Medicare for All would save 68,000 lives a year.

    The researchers project a 13 percent savings in national health expenditures from Medicare for All. Put differently, we would spend about $450 billion a year less on health care each year. The analysis considers the costs associated with extending coverage to 37 million without health insurance and 41 million with inadequate coverage.

    Going from a multi-payer system to a single-payer system would save doctors and hospitals a lot of time and money. They would be relieved of many administrative headaches. And, doctors would be able to spend more time with their patients.

    In an interview with Amy Goodman of Democracy Now, Galvani explains that Medicare’s administrative overhead is nearly 10 percent less than private health insurance overhead, 2.2 percent v. 12 percent respectively. Eliminating private health insurance would therefore save $200 billion a year in insurer overhead alone. In 2019, the private health insurance industry made $100 billion in profits.

    In addition, Galvani explains that a public option, what Pete Buttigieg calls “Medicare for all who want it,” does not save money. The exorbitant administrative overhead costs of the private insurers remain. It is inefficient and expensive, costing $175 billion more a year than what we currently spend. And, it costs $600 billion more a year than Medicare for All.

    Galvani’s team calculated that Medicare for All would save 68,000 lives a year based on data revealing that people without health insurance have 40 times higher mortality rates than people with decent health insurance. The team did not factor in additional lives saved as a result of the fact that 41 million additional people would no longer be underinsured.

    Here’s more from Just Care:

  • Seven tips for getting a good night’s sleep

    Seven tips for getting a good night’s sleep

    According to the Centers for Disease Control, sleep matters–not getting a good night’s sleep is a public health problem. Insufficient sleep leads to poor health outcomes and greater risk of early death. Yet, one third of adults in the U.S. do not get enough sleep on a regular basis. We need between seven and nine hours a night.
    Here are seven tips for a good night’s sleep from the National Institutes of Health:
    1. Develop a sleep routine: Set a daily bedtime and wake-up time and stick to it. If you have an iphone or ipad, the clock app has a helpful bedtime setting. In addition to tracking your sleep, it turns off all the sounds on the device during bedtime hours.
    2. Exercise daily:  Even 20 to 30 minutes a day of exercise can help you sleep soundly.
    3. Avoid alcohol, cigarettes and caffeine, especially directly before you go to sleep.
    4. Relax before bedtime: Do something quiet and calming–take a bath, listen to classical music, read a book.
    5. Let the sun wake you up. Bright sunlight has been shown to reset your biological clock.
    6. Only go to sleep when you’re ready to fall asleep. It can be anxiety-producing and cause insomnia to lay in bed awake trying to sleep if you don’t feel tired.
    7. See a doctor if you continue to struggle to fall asleep or stay asleep at night.  There are effective cures. Here are five proven interventions for sleeplessness or insomnia.

    Keep in mind that if you are often tired during the day, you could have sleep apnea.

    A recent Rand study also recommends limited use of electronics before sleep. The Rand study finds that people who sleep on average fewer than six hours a night have a 10 percent higher risk of mortality than people who sleep between seven and nine hours a night. And, people who sleep on average between six and seven hours a night have a four percent higher mortality risk.

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  • 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:

  • People in many developing countries live longer than poor in U.S.

    People in many developing countries live longer than poor in U.S.

    New research published in the November 17, 2016 American Journal of Public Health confirms that poor people in the U.S. die sooner and are otherwise less healthy than people with higher incomes. Indeed, people in many developing countries live longer than poor people in the U.S., and wealthy Americans typically live seven to ten years longer than poor Americans. The study also finds that to improve health we need to address economic inequality.

    Researchers refashioned the U.S. into “states” based on income and analyzed both the least wealthy areas in the U.S. and the most wealthy areas. They “redefined America, not by geography or race, but by socioeconomic status”– to conduct their research. In the most wealthy areas, the median household income is about three and a half times greater than in the least wealthy areas, $89.723 as compared to $24,960. The wealthiest areas have more than 25 times as many people as the poorest areas, about 362,000 as compared to about 14,000. About four and a half times as many non-Hispanic African Americans live in the poorest areas as in the wealthy areas.

    People in the wealthiest areas live longer, with women living more than seven years longer–until 83–and men living almost ten years longer–until 79.3. In fact, in the poorest areas, life expectancy is lower than in half the countries in the world.

    Adults who live in the poorest areas are twice as likely to smoke, 50 percent more likely to be obese and 69 percent more likely to be physically inactive. Adults in the wealthiest areas are more likely to have graduated from high school and far more likely to be employed.

    Five states included both the poorest and the wealthiest areas: Georgia, Illinois, Kentucky, Tennessee and Texas. The poorest areas were located in Alabama, Arkansas, Georgia, Illinois, Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, South Dakota, Tennessee, Texas and West Virginia. The wealthiest areas were located in Alaska, California, Colorado, Connecticut, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Minnesota, Ohio, New Jersey, New Mexico, New York, Pennsylvania, Utah, Tennessee, Texas and Virginia.

    The researchers found that state data is less useful than local data for understanding public health. They argue that local interventions, rather than state interventions, are warranted to address socioeconomic disparities and the dangerous effects of poverty. That should help increase life expectancy for poor Americans.

    That said, overall life expectancy in the U.S. is not increasing or even holding steady. The latest data from the National Center for Health Statistics show that overall life expectancy in the U.S. has declined by one-tenth of a year from 78.9 in 2014 to 78.8 in 2015.

    Here’s more from Just Care:

  • Risk to older adults of underuse of prescription drugs

    Risk to older adults of underuse of prescription drugs

    A paper in the British Journal of Clinical Pharmacology reports on the risks of underuse of prescription drugs for older adults living in the community. The older adults studied were all over 80, active and cognitively fit. But, almost half of them took five or more medications and both underused and misused them. Fewer than one in five of them, 17 percent, took medications appropriately.

    The average age of the 503 older adults studied was 84.4, and they took an average of five medications. Almost six in ten of them, 58 percent, took five or more medications. Almost seven in ten of them, 67 percent, did not take as much medicine as prescribed. And, more than half of them, 56 percent, misused their prescriptions. Four in ten of them both underused and misused their medications.

    The researchers found a link between underuse of medications and mortality and hospitalization. The more medications were underused, the higher the risk of hospitalization and mortality. For each medication that was not taken as much as prescribed, the risk for mortality increased 39 percent and the risk for hospitalization increased 26 percent. The researchers did not find as a clear a link between misuse of medications and hospitalization and mortality.

    Interestingly, the researchers found that fewer than one in ten of the older adults studied, 9 percent, took between one and four prescription drugs and used them appropriately.

    Here’s more from Just Care:

  • Having good friends promotes better health, longer life

    Having good friends promotes better health, longer life

    A meta-analysis in PLOS Medicine reveals that having good friends promotes better health, longer life. Yet, over the last several generations we have become more socially isolated, increasingly less likely to have many strong social relationships. Different generations of families no longer tend to live together or even near each other. Moreover, a larger number of people are putting off marriage and children and many more people are living alone.

    The study looked at how different types of social relationships can lower a person’s risk of death.  It analyzed 148 studies, including 308,849 people, and found that people with good social relationships had a 50 percent higher chance of living than people who lacked those relationships. It further found that the chance of survival increased regardless of age, gender, initial health status, reason for death and length of the study period.

    The findings show that lack of social relationships can have as great an effect on risk of early death as smoking. Indeed, poor or few social relationships can have a greater bearing on likelihood of premature death than lack of exercise and obesity. Like loneliness and social isolation, negative social relationships are associated with a higher likelihood of early death.

    A separate 2016 study in Heart found a link between social isolation and heart disease and stroke. It finds that loneliness is a risk factor for cardiovascular disease. Another study we reported on Just Care suggested that if you want to improve your heart health, you should get married!

    Some believe that social relationships influence people cognitively, emotionally, behaviorally and biologically even when one person in a social relationship has no explicit intent to support another. For example, if a friend or partner models healthy behaviors, you are more likely to engage in healthy behaviors. One study we wrote about on Just Care, found that a person could help his or her spouse by exercising because it models healthy behavior.  Social relationships also help give people’s lives meaning and purpose.

    There is also evidence that suggests social relationships can improve patient care, reduce the length of a hospital stay, raise the likelihood of a person complying with his or her medical regimens. The findings suggest that doctors and other health care providers should recommend more and better social connections to their patients. Some believe that simply strengthening existing positive family relationships through more frequent interactions could be helpful.

    Another meta-analysis reported in Sage finds that perceived social isolation is as much associated with higher risk of early death as actual social isolation.

    Here’s more from Just Care:

  • Emergency room closures are hurting patient care

    Emergency room closures are hurting patient care

    In the 13 years between 1996 and 2009, the number of emergency rooms has dropped more than 6 percent to 4,594, while emergency department (ED) visits have increased by 50 percent to 136.1 million from 90.3 million.  And, a new Health Affairs study shows that these ED closures has led to an increase in the number of people admitted to an emergency room who die; specifically, people whose nearby emergency room has closed are at higher risk of death.

    In short, ED closures have hurt the quality of care at nearby emergency rooms.  Many of the emergency rooms that have closed had served low-income vulnerable communities, people likely to be Black, Hispanic and female, have Medicaid, be uninsured and in poor health. Patients from communities whose EDs have closed often have travel further to get to an emergency room. The nearby EDs who have taken on more patients as a result of ED closures have been operating over capacity, requiring patients to wait longer for treatment and demanding more of their already busy staff.

    The study reveals a five percent greater likelihood of patient death in hospitals affected by ED closures than at other hospitals. Patients who had heart attacks, stroke and sepsis had a 15 percent greater likelihood of death than patients at hospitals unaffected by ED closures. Patients admitted with asthma or COPD did not have a greater risk of death.

    Emergency rooms are required to take all comers. They cannot turn a patient away for any reason.  Back in 2007, the Institute of Medicine described Emergency Departments as “at a breaking point.” And, more have closed since then. The study suggests a closer look at whether we need more Emergency Departments in vulnerable communities and incentives that would keep more Emergency Departments from closing, including higher payment rates.  The authors further suggest that “it may be time to reassess the extent to which market forces are allowed to dictate ED closures and access.”

    The study looked at more than 16 million ED admissions but only at Emergency Department closures in California. About 12 percent of the US population lives in California, but it is demographically different from the rest of the country, with a much smaller Black population and a much higher non-White population.

    Click here for tips on how to choose your emergency room, and here for how to keep your emergency care costs down.  Click here for how to plan for a hospital visit, particular an emergency visit.