Bloomberg recently reported a story that highlighted the recommendations of the U.S. Preventive Service Task Force on yearly mammograms for women aged 40 and above. According to the story, the guidelines released by the task force suggested that annual mammograms for most women in their 40s have more drawbacks than benefits and therefore, women should wait until age 50 to start getting breast cancer screening tests every two years.

Here is the story:

November 17, 2009

Annual mammograms for most women in their 40s have more drawbacks than benefits, said a panel of U.S. doctors that recommended women wait until age 50 to start getting breast cancer screening tests every two years.

The change in guidelines released by the U.S. Preventive Service Task Force, a government-backed physician group, said women in their 40s are more likely to get false-positive tests that can lead to unnecessary biopsies and anxiety. The recommendations, which also said that self-examinations were unnecessary, don’t apply to women who carry a high risk for breast cancer. Those women should talk to their doctors about when to get screening, the panel said.

The new guidelines, published yesterday in the Annals of Internal Medicine, pit the task force against the American Cancer Society, which insisted doctors should still advise women to undergo routine annual screening starting at age 40. About 64 percent of women ages 40 to 49 had an X-ray of their breasts during the past two years, the panel’s report said.

“This is not a blanket recommendation not to worry until age 50,” said Diana Petitti, a disease epidemiologist at Arizona State University in Tempe, Arizona, and vice chair of the panel. “It’s a recommendation to have a discussion with your physician to better understand the trade-offs between starting exams now and starting later.”

Imaging machines for mammograms, and related supplies, are marketed by Fairfield, Connecticut-based General Electric Co., Bedford, Massachusetts-based Hologic Inc. and Munich-based Siemens AG.

Insurer Coverage

J. Leonard Lichtenfeld, the American Cancer Society’s deputy chief medical officer, said the panel’s guidelines may affect insurance payouts. ‘Our hope is that insurers will not make any change in coverage,” Lichtenfeld said.

WellPoint Inc., the top U.S. health insurer by enrollment with 34 million members, pays for annual mammograms for women age 40 in the majority of its health plans. The Indianapolis- based company periodically reviews its reimbursement policies and “doesn’t adhere to any one source” for guidance, said Jill Becher, a company spokeswoman in Milwaukee.

The new guidelines, if widely adopted by physicians and insurers, could reduce the number of U.S. mammogram screenings by 58 percent, from the current 37.2 million annually to 15.6 million under a “worst-case scenario,” Junaid Husain, a Boston-based analyst at Soleil Securities, wrote in a note to investors today.

Detecting Cancer

Mammograms, self-breast examinations, and doctor’s exams are the three main forms of detecting breast cancer. The task force said there was no evidence that self-exams reduce breast- cancer deaths, and insufficient information exists to recommend that doctors do routine physical exams.

The mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease, and also to check for breast cancer after a lump or other signs of cancer have been found, according to the National Cancer Institute.

Breast cancer is the second-leading cause of cancer-related deaths among U.S. women, after lung cancer, killing 40,480 women in 2008, according to the task force report.

The task force analyzed published research and developed computer-simulation models to evaluate the likely health outcomes if mammograms were begun at certain ages and done every one or two years.

Deaths, False Positive Tests

The study confirmed earlier research that women who have mammograms die less frequently of breast cancer than those who don’t have the tests. About two deaths per 1,000 women are averted if women begin annual screenings rather than exams every two years starting at age 40, the task force estimated.

It also estimated that women who begin getting mammograms at 40 will have about 60 percent more false positive results per 1,000 exams than women who start screenings at age 50. A false positive, in which an abnormality is seen that proves not to be cancer, typically leads to additional screenings and tissue biopsies, the panel’s researchers said.

The cancer society challenged the reliability of the task force study’s methods.

“We are reluctant to recommend changing a proven program that has helped to save lives,” Lichtenfeld said. The society questions whether the task’s force computer modeling “is sufficiently sophisticated and accurate enough,” he said.

High-Risk Women

The recommendations aren’t intended for women older than 40 who have a higher risk for breast cancer. Increased risk can come from having a gene mutation linked to breast cancer or having been exposed often to chest radiation, which can raise the probability of breast cancer.

The task force said it didn’t make recommendations for these higher-risk groups because it lacked sufficient data to know the benefits of more frequent screening tests.

Women’s health groups varied in their responses to the new guidelines.

Susan G. Komen for the Cure, the Dallas-based breast cancer advocacy group, said it won’t change its recommendation that women ages 40 to 49 get annual mammograms. “We would not want to see a change in policy or reimbursement for screening mammography at this time,” said Eric Winer, the group’s chief scientific adviser, in a statement.

The task force’s recommendations were applauded by the National Breast Cancer Coalition, a Washington-based advocacy group, which said the guidelines support its position.

‘Deserve the Truth’

“Women deserve the truth even when it is complicated,” said Fran Visco, the coalition’s president, in a statement. “They can accept it.”

The American College of Obstetricians and Gynecologists rejected the task force’s recommendations, maintaining its guidelines that women in their 40s be screened every one to two years and women age 50 and older get annual exams, according to a statement issued by the group on Monday.

Researchers and physicians know that results from the X- rays aren’t as reliable in younger women as in older women. Women in their 40s typically have denser breast tissue, making it more difficult for technicians to determine if an image is normal or cancerous.

After women enter menopause, typically about age 50, the breast tissue becomes less dense and more fat, and the X-rays can be more accurately interpreted, said Susan Love, president and medical director of the Dr. Susan Love Research Foundation in Santa Monica, California.

‘Long Overdue’

The panel’s suggestions for women ages 40 to 49 are “long overdue,” said Love in a telephone interview. “Most countries in the world do not do mammography screening until age 50.”

“There is a lot of anxiety created when someone tells you that there is something that showed up in a test,” said Karla Kerlikowske, an epidemiologist at the University of California, San Francisco, Medical Center who wrote an editorial accompanying the task force report.

Subsequent exams expose women to more radiation, and although biopsies are “low risk,” some patients develop infections or experience pain and bruises, she said.

Screening women ages 50 to 74 every two years “achieves most of the benefit of annual screening with less harm,” the task force said. Now women in the older age group get a mammogram, on average, every 14 months, according to the report.

In forming its guidelines, the task force’s “biggest concern” was that women would be confused by conflicting advice from health experts or wrongly interpret the panel’s message as a blanket recommendation for those ages 40 to 49 to forego screening until they turn 50, Petitti said.

Risks, Preferences

Instead, decisions by women younger than 50 and their doctors should be based on “the risk for breast cancer and preferences about the benefits and harms” the task force wrote in the study.

Although the recommendations are “very clear and thoughtful,” women are likely to be confused by the different advice of health experts, Kerlikowske said.

It may be difficult to persuade many women in their 40s who have been told by their doctors for years that annual screenings are beneficial to accept the panel’s recommendations, said the cancer society’s Lichtenfeld.

“The task force is saying you can get 70 percent of the benefit if you get a mammogram every two years compared with every year,” Lichtenfeld said. “There will be women who say, ‘I want 100 percent of the benefit.’”

Source: Bloomberg

FREE cost estimate for surgery in any of the 18 countries supported by Healthbase

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl/diigo

googlegoogle netscapenetscape/propeller redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb

Advertisements

Why Health Care Costs Keep Rising – Analysis and Solutions

It’s no secret that the health care in the United States is expensive. But have you wondered why this is the case? Here’s an excellent analysis of the situation that we came across with proposed solutions of what can be done to cut down prices for the health care consumer – something which we feel you will find useful too. So, read on…

Summary

When economist Charles Wheelan published an analysis titled “The Top 10 Reasons for Soaring Health-Care Costs,” it was refreshing to read about the problem from an economics point of view. What Wheelan did not cover, however, was what we can do to address the issues that continue to cause health care costs to spiral out of control. What follows is a point-by-point look at Wheelan’s top 10 reasons followed by a discussion of what we are doing—or could do—to control costs better.

Analysis

Reason 1.
Nobody Shops for Value

Wheelan argues that when it comes to health care, everyone wants and expects the best. “There’s no medical equivalent of Wal-Mart,” he writes. “Everyone wants Neiman Marcus.”
Solution: Some health plans are addressing this issue by discouraging patients from using expensive facilities for common problems, such as a sore throat, through co-pay incentives and member education. Not only are patients encouraged to find a less expensive facility, they also are encouraged to ask the doctor to write generic prescriptions.
The question is, how do patients know which facilities offer reasonable prices and quality medical care? It will take greater health care cost and quality transparency—and better consumer education—to get health care shoppers to the same level of sophistication they use in buying other high-end goods (e.g., cars), but progress is being made. A number of health plans now offer cost information on various treatment options, and web sites such as HealthGrades offer quality information on doctors, making it possible for people to shop for health care online.

Reason 2.
Medical Innovations Are Usually More Expensive

The basis of medical progress is learning to do new things, no matter the cost. In the case of pharmaceuticals, the system has been designed so new drugs are expensive. Breakthrough medications receive patent protection, and the better the drug, the more its producer can charge. High prices yield high profits, which creates an incentive to develop the next generation of drugs.
Solution:Although we, as a society, have agreed to pay more for innovative medications and medical devices, especially those that introduce new cures, we have not agreed on who is going to pay for them. Part of the solution lies in the expansion of employer-sponsored wellness and health promotion programs that focus on keeping healthy people healthy and helping those who are sick to better manage their illnesses by steering them toward proven treatments. Value-based benefit plan design tries to achieve this by removing barriers that may be barring patient access to the most effective medications.
Furthermore, not all innovations (which include diagnostic tests, imaging tests, medications and medical devices) should be treated equally. While some add value, some do not. One solution is to use a creative plan design that identifies the most effective innovations and reimburses them with a premium.

Reason 3.
Some Health Care Is a ‘Luxury Good’

Used as a technical economic term, a “luxury good” is something wealthy people demand in disproportionately greater amounts than less wealthy people do. Richer societies and richer people within a society have higher expectations for health care. They expect medical fixes—such as hip replacements, stomach stapling and Lasik eye surgery—for problems that people with lower expectations will just tolerate.
Solution: While it’s easy to poke fun at medical tourism, it may well emerge as one of the solutions to this problem. Medical tourism generally involves traveling to another country for non-emergency care, including knee replacements, shoulder surgery and even heart bypasses. A knee or hip replacement that may have a retail price of $65,000 to $80,000 in the United States costs between $8,000 and $10,000 in India. The Deloitte Center for Health Solutions predicts that the number of Americans using medical tourism could jump tenfold over the next decade, to nearly 16 million a year.

Reason 4.
We Don’t Pay for What We Consume

Health care is unique in that neither the service provider nor the patient gets the bill, especially when insurance out-of-pocket maximum provisions are reached. The patient who is directly involved in the transaction has little incentive to control costs when out-of-pocket costs are removed. When insurance companies try to do so, it can lead to arbitrary limits on care, time-consuming hurdles for more expensive procedures and additional bureaucracy for doctors. Even then, it’s easy to game the system.
Solution:One possible solution is moving away from fee-for-service provider reimbursement and returning to a staff-model health maintenance organization (HMO), where providers employed by the health plans are charged with offering patients the most cost-efficient care without compromising quality. Two studies have found that this model works quite well. A 2002 paper in the British Medical Journal (BMJ), “Getting More for Their Dollar: A Comparison of the NHS with California’s Kaiser Permanente,” compared HMO provider Kaiser and Britain’s National Health System (NHS), concluding that Kaiser achieved better outcomes than the NHS for similar inputs. And a 2003 study in the BMJ, “Hospital Bed Utilization in the English NHS, Kaiser Permanente, and the US Medicare Program: Analysis of Routine Data,” which reported on hospital stay lengths, produced similar conclusions.
Over the past few years, several large employers have brought care delivery on-site in the form of clinics, using the same premise as the staff-model HMO. Revisiting global provider payments per admission or bundled payments for treating all the medical needs of specific patients with chronic disease might return to favor.

Reason 5.
Baumol’s ‘Disease’

Not a disease, but an important insight by economist William Baumol on what afflicts certain sectors of the economy, such as health care and higher education. He found that as societies become richer, labor-intensive endeavors, such as health care, become increasingly expensive relative to goods and services that can be produced using less labor. As long as the doctor-patient relationship remains relatively unchanged, health care costs will rise faster than prices in general.
Solution: Because there are no economies of scale, a surgeon cannot perform more than X number of surgeries and a primary care physician (PCP) cannot see more than X number of patients in a day (although we have seen the latter rise dramatically in the past two decades). For them to keep up with others, who are earning more money in less time because of technological advances, they have to increase their unit cost.
Pay-for-performance-type programs can help identify providers who are practicing quality medicine in the most judicious and cost-effective way. Once such high-quality and cost-efficient providers are identified, patients need to be directed to them. Specialized cancer and transplant centers are a good example of where upfront costs are relatively high but long-term outcomes are better and repeat illnesses are fewer.

Reasons 6 & 7.
Living Longer and Living an Unhealthy Lifestyle

Not only are people living longer (which in itself increases health care costs), but too many people are living unhealthy lives. This includes smoking, eating fast food and driving instead of walking, to name but a few.
Solution: While we can’t change the fact that people are living longer (nor would we want to), we can help them live healthier lives. The latest shift in health care is to focus on keeping the healthy healthy and to stop diseases from progressing from bad to worse. This can be achieved through wellness and health promotions, health education and coaching, communicating information on healthy lifestyle choices, and making sure those who need care have access to the right care at the right time to maximize clinical and economic value. People who are at risk or at high risk can be identified via health risk appraisals and sophisticated technology and tools, such as predictive modeling, which uses claims data to identify risk.

Reason 8.
The Uninsured

The uninsured end up costing the system a great deal of money. In a family that is uninsured, a child with a high fever and a bad cough will probably be treated in a hospital emergency room—a very expensive use of a trauma center and its highly trained staff. Or the child might not be treated at all until five years later when he or she develops asthma or another chronic condition that could have been managed far less expensively with better primary care.
Solution: This is a problem that needs government intervention. Although President Barack Obama has pledged to intervene, his health care program has yet to be addressed—specifically, how his programs will cover all Americans in the most cost-effective delivery setting.
One solution that plan sponsors can undertake in the meantime involves helping their pre-age-65 retirees with health insurance. They can take advantage of the innovative solutions that some health plans now offer—allowing employees to prefund premiums that contribute toward buying coverage after retirement but before they are eligible for Medicare.

Reason 9.
The High Cost of End-of-Life Care

Even people who are treated successfully for heart disease or cancer eventually die. Any medical success begets additional medical expense, which is especially true for end-of-life care. The last six months of life are typically the most expensive period of a person’s life.
The escalating cost of treating illness at the end of life raises moral and politically charged issues that are difficult to address: What is the actual value of using expensive treatments on people whose life expectancy is drastically limited, even with the treatment? While other countries have begun to base coverage decisions, in part, on how many years of quality life a treatment is expected to produce—for example, the clinical guidelines created by the U.K.’s National Institute for Clinical Excellence—this issue still seems to be taboo in the United States. Most of these costs are incurred by Medicare and Medicaid.
Solution: We need to be better at considering quality of life in decisions about treatments and services for chronically ill elderly patients. It has been suggested that Medicare and Medicaid could form a governing body of clinicians that can make and authorize these difficult decisions.
In addition, society needs to make better use of hospice care. Employers and plan sponsors should educate their beneficiaries about hospices and the situations in which they are the best option.

Reason 10.
Malpractice Suits

Malpractice is more of a legal problem than an economic one because doctors tend to practice “defensive medicine” out of fear of being sued. Seeking to avoid lawsuits, they have an incentive to over-treat all kinds of maladies. Research shows that physicians in countries such as the United States—where the risk of malpractice suits is high—tend to order more investigative tests than those in countries with less risk, such as the U.K. (See, for example, the New York Times article “Why Does U.S. Health Care Cost So Much?”)
Solution: Washington Post columnist George F. Will has proposed an appropriate solution to this complex issue. We have juries of people who have no knowledge of the complexities of medicine handling decisions on whether a patient’s death resulted from negligence on the part of the physician or whether the doctor did everything in his or her power to save the patient. Instead, the state judicial system could create a panel of highly qualified judges with access to independent clinicians who are familiar with the highly complicated nature of such cases and remove some of the emotional overreactions by juries that result in disproportional monetary awards that should be reserved for cases of gross negligence. This will help physicians use sound clinical judgment instead of practicing defensive medicine.

One More Reason: Lack of Access to Complete Information
Doctors collect and create a lot of information—everything from notes to diagnosis codes. The insurance companies add another level of data. While much of this information could be used to improve treatment and reduce costs, no one is in a position to see it all. A doctor who prescribes a treatment doesn’t know what it costs or whether the patient’s insurance covers it. An insurance company that questions a doctor about a treatment might never receive all of the information it needs. When a patient switches providers, it can result in duplicate tests and services and potentially dangerous treatments. All this creates tremendous administrative waste and resource consumption for providers and payers.
Solution: Electronic medical records (EMR) and health information exchange (HIE) are two steps in the right direction toward health care interoperability (the ability of different information technology systems and software applications to communicate; to exchange data accurately, effectively and consistently; and to use the information that has been exchanged). Developing standards for EMR interoperability is at the forefront of the president’s health care agenda. Many physicians have computerized practice management systems that can be used in conjunction with HIE, allowing them to share patient information (e.g.,lab results, public health reporting), which is necessary for timely, patient-centered and portable care.
Similar movement is happening on the payer side, which is attempting to collect more information from providers as well as consumers. They are making decision-support tools available to their beneficiaries, to help them navigate the system. Some payers are also adopting personal health records, which members can take with them if they change insurance providers.
Another step in the right direction is the patient-centric medical home model, in which a patient’s physician knows everything there is to know about that person’s health care. This requires comprehensive patient management software that allows the physician to coordinate all the care the patient needs.

Conclusion
The good news is, there are potential solutions to most of the reasons health care is so expensive. The real challenge is in getting the different stakeholders to work together to solve this monumental problem.

* Analysis by: GLG Expert Contributor
* Analysis of: Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth
* Published at: http://www.brookings.edu

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl

googlegoogle ma.gnoliama.gnolia netscapenetscape redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb

Brought to you by Healthbase www.healthbase.com info.hb@healthbase.com 1-888-MY1-HLTH


Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

WHAT IS CANCER?

Cancer, which causes about 13% of all deaths worldwide, is a group of diseases in which cells are:
1. aggressive – grow and divide without respect to normal limits,
2. invasive – invade and destroy adjacent tissues, and
3. sometimes metastatic – spread to other locations in the body.
These three malignant properties of cancers differentiate them from benign tumors, which are self-limited in their growth and do not invade or metastasize (although some benign tumor types are capable of becoming malignant).

CAUSES OF CANCER

Cancer may be caused by:

– Chemical carcinogens such as tobacco smoke and alcohol
– Ionizing radiation such as radon gas and UV rays from the sun
– Ifectious diseases associated with viruses like human papillomavirus, hepatitis B and hepatitis C virus, Epstein-Barr virus, and human T-lymphotropic virus
– Hormonal imbalances
– Immune system dysfunction like HIV
– Heredity

Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

SIGNS AND SYMPTOMS

Roughly, cancer symptoms can be divided into three groups:
Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice.
Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain, it is often not the first symptom.
Systemic symptoms: weight loss, poor appetite and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.

Every symptom in the above list can be caused by a variety of conditions (a list of which is referred to as the differential diagnosis). Cancer may be a common or uncommon cause of each item.

TREATMENT

Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. Cancer may be treated by:

– Surgery
– Radiation therapy
– Chemotherapy
– Targeted therapies
– Immunotherapy
– Hormonal therapy
– Symptom control

PROGNOSIS
Cancer has a reputation for being a deadly disease. While this certainly applies to certain particular types, this is increasingly being overturned by advances in medical care. Some types of cancer have a prognosis that is substantially better than nonmalignant diseases such as heart failure and stroke.

Cancer patients, for the first time in the history of oncology, are visibly returning to the athletic arena and workplace. Patients are living longer with either quiescent persistent disease or even complete, durable remissions.

For affordable cancer treatment overseas, please contact Healthbase. Healthbase is a medical tourism expert connecting patients to leading healthcare facilities worldwide. Healthbase also offers medical tourism plans for self-insured businesses looking for affordable healthcare benefits for employees.

Like it? Share it or save it!!

blinklistblinklist blogmarksblogmarks del.icio.usdel.icio.us diggdigg furlfurl

googlegoogle ma.gnoliama.gnolia netscapenetscape redditreddit spurlspurl

stumbleuponstumbleupon technoratitechnorati yahoo mywebyahoo myweb