Health expense projections

Here is a comment from the current president and CEO of Kaiser Family Foundation, with a bit of a startling graph:

"This week we put out our annual benchmark survey of employer health coverage and costs. Two numbers jumped off the pages.

The first number was the average cost of a family health insurance policy in 2009: $13,375. To put that number in context, if you are an employer, you can hire an employee at the minimum wage for about $15,000 per year. If you are a consumer, you can rent an average two-bedroom apartment nationwide for $11,136 per year (though it is quite a bit more here in Menlo Park, California where our Foundation is based). You can also buy a new Chevy Aveo for $12,000, and it gets 35 miles per gallon on the highway.

The other result that jumped off the page was the stark contrast between increases in health insurance premiums and overall inflation in the general economy. Premiums went up 5% and prices overall fell 0.7% (mainly driven by a big drop-off in energy prices).

The 5% increase we found in premiums is moderate by long-term historical standards. For example, two different times during the last decade premiums increased by 13% a year, in 2002 and 2003. This year's increase continues a multi-year period of relative moderation in premium increases. Still, over the last ten years premiums have increased by 131%, while wages have grown 38% and inflation has grown 28%. Consider this: If people (and businesses) are as concerned as they are now about rising health care costs in a period when they are actually moderating, how much more concerned will they be when rates of increase return to historic averages?

Let's do some very simple arithmetic. Start with a fairly conservative assumption: If we assume that premium increases over the next ten years will average what they did over the last five (about 6.1% per year), the average premium for a family policy in 2019 will be $24,180. That's a big number. On the other hand, if we assume increases revert to the average of the last ten years—an average annual increase of about 8.7% and a very plausible scenario—premiums in 2019 will average a whopping $30,803, a very scary number (Figure 1).

One obvious implication is that we need to get more serious about reaching agreement on ways to slow the rate of increase in health care costs. But consensus on measures that would put a real dent in the health cost trajectory has been hard to achieve. Even simple first steps, such as comparative effectiveness research to collect data on what works and what does not in medical practice, have proven controversial, requiring language in draft legislation disavowing that they will ever be linked to payment. And when the public can be so readily scared that these efforts will lead to rationing, it's a signal that the obstacles to reigning in health costs are more fundamental than interest group opposition and health reform politics. Our polls show that we are far from the level of public understanding needed to meaningfully take on health care costs.

Even under the most optimistic scenarios, reducing the rate of increase in health costs will take time. This is why decisions about who gets subsidies and how generous subsidies will be in the health reform legislation now being drafted on Capitol Hill are so important. These decisions will determine how many people get help with their health care costs as insurance premiums and cost sharing become ever more unaffordable for average Americans. Projecting a family premium of more than $30,000 in ten years is simple arithmetic, but the implications for people and employers are real. Low and moderate income people are going to need some help paying for health care and health insurance as we learn which delivery and payment reforms work best and cost containment efforts ramp up.

News from UNICEF: Child deaths decreasing somewhat worldwide

Worldwide deaths of children under five decline, continuing positive trend

NEW YORK, 10 September 2009 – There are fewer children than ever dying before they reach their fifth birthday, according to new figures released today by UNICEF.

H1N1 news

Over 2,800 People Worldwide Have Died From H1N1, WHO Reports

Friday, September 04, 2009

The WHO on Friday announced the H1N1 (swine) flu virus has killed at least 2,837 people – the result of an continued increase in the number of H1N1 cases worldwide, not the virulence of the virus, Reuters reports. "There is no sense that the virus has mutated or changed in any sense," WHO spokesperson Gregory Hartl said during a news conference (Nebehay/MacInnis, 9/4).

"The data mark an increase of 652 deaths from the last toll of 2,185 published a week ago," Agence France-Presse/Khajeel Times reports (9/4).

Number Of H1N1 Cases Level Off In Southern Hemisphere, Rise In U.S.

The H1N1 flu continues to "taper off along with the influenza season in the Southern Hemisphere," Reuters reports in a separate article. The results of a "U.S. government analysis of the epidemics in Australia, Argentina, Chile, New Zealand, and Uruguay showed that while H1N1 dominated the flu seasons there, it was only moderately severe," the news service writes (Fox, 9/4). According to a summary of the report, "[a]ll countries report that after mid July, disease activity in most parts of the country decreased … indicating the duration of the current influenza season in the Southern Hemisphere, in which the 2009 H1N1 virus is the predominate strain, may be similar in length to an average seasonal influenza season." The H1N1 virus also caused stress on the healthcare system, according to the report (8/26).

Despite reports of "an uptick" in the number of H1N1 flu cases in the U.S., Thomas Frieden, director of the CDC expressed optimism on Thursday that "so far everything we've seen both here and abroad shows the virus is not changing," the Wall Street Journal reports (Dooren, 9/3). A separate Wall Street Journal article examines the CDC study released Thursday. Though "most of those U.S. children who have died of the new H1N1 flu were at least five years old, and 67% had high-risk medical conditions, predominantly neurodevelopmental disorders such as epilepsy or cerebral palsy. Some otherwise healthy children who died had bacterial infections, the study found, warning doctors to be on the lookout for them so they could be treated quickly" (McKay/Fairclough, 9/4).

Bloomberg Examines Why U.S. Health Officials May Recommend Two, Not One Dose Of H1N1 Vaccine

Bloomberg examines how Americans may need two doses of the H1N1 vaccine in order to be protected from the virus, because U.S. health "officials plan to exclude ingredients used to boost immune responses in shots" called adjuvants.

"We expect that the likelihood of needing two doses of vaccine that’s not adjuvanted is higher than with an adjuvanted vaccine," Frieden said Thursday. "We don’t anticipate that we’ll be using adjuvanted vaccine in most of the scenarios that we anticipate now, though that could change" (Randall, 9/3).

Partners in Health and Rwanda

Thanks to Kashif Khan for this note. Kashif spent this past summer with PIH in Rwanda:

On the evening of September 11, tune in to NOW on PBS for a half-hour show focusing on the innovative partnership between the Rwandan government and PIH to improve health care for the rural poor. Check for the broadcast time in your area, or watch online at www.pbs.org/now/

More on Cambodia's resistant Malaria

Here's a really nice video clip from PBS on the new resistance in Malaria in Cambodia. The video includes descriptions of ways that resistance has developed.

http://www.pbs.org/newshour/bb/asia/july-dec09/cambodia_08-25.html

Migrant care in Italy

An interesting set of short articles in a recent edition of The Lancet discuss the challenges to those who provide care to migrant workers in Italy.

Interestingly, those who are illegal migrant workers are afforded free health care under the Italian Constituation.
Now, "An amendment to the law concerning
public order measures, approved
on May 14, 2009, by the Chamber
of Deputies and now to be approved
by the Senate, introduces thecrime of illegal immigration, and
consequently obliges by law all civil
servants to report undocumented
migrants. Public health workers
are civil servants. Notwithstanding
previous legislation forbidding them
to report undocumented migrants,
this new legislation risks creating
fear among migrants, preventing
them from attending health facilities
and exposing both migrants and the
whole community to higher health
hazards."

So this would create a 'right' to health-care but no access.


Here is a link sent by one of our students with some very compelling photos:
Multimedia from NYTimes.com:

A Powerful Truth


Finally, from the Kaiser Foundation, here are a number of online modules with some information related to health policy.

Obstetrical Fistula

Article from Sojourners.org


Obstetric fistula could be a curse from the book of Job, if Job were a woman: A girl or woman is in labor in rural Africa. Forced to marry when still a child, she is only 13 or 14. Or she is 18 or 20, but malnutrition has stunted her growth. Her pelvis is too small to allow the baby to pass, and she has at most a traditional birth attendant to help her; her obstructed labor lasts days. Sometime during this agony the baby dies, and, eventually, the lifeless body is delivered. The mother, exhausted and grieving, might assume the worst of her physical suffering is over. Then she discovers that the worst may have just begun.

The prolonged pressure of the baby’s head in the birth canal killed tissue, causing a hole between the vagina and bladder or rectum. Urine or feces leak constantly. The odor becomes overwhelming. The woman is likely rejected by her husband. Without medical help, she spends the rest of her life on the fringes of her community.

Precise counts aren’t available, but an estimated 2 million women have obstetric fistula worldwide. Between 50,000 and 100,000 new cases occur each year, mostly in sub-Saharan Africa and parts of Asia. Fistula is virtually nonexistent in countries with widely available emergency obstetric care. Most fistulas occur in childbirth, but others come from the use of rape as a weapon of war, as in Congo and Sierra Leone.

The root causes of fistula are extreme poverty, inadequate health care, and the low social status of women, which deny them basic rights, education, and the capacity for self-determination. For example, when girls are allowed to continue their education at least through adolescence and delay marriage until adulthood, their risk of complicated childbirth is drastically lowered.

Key to reducing fistula is the improvement of women’s health care in the poorest part of the world—creating a network of medical facilities, identifying and monitoring pregnant women susceptible to birth complications, and training surgeons to treat the many who are already injured. A relatively brief operation, costing only about $300, can repair fistula in 60 to 90 percent of cases. Facilities such as the Addis Ababa Fistula Hospital in Ethiopia, which I visited in 2006, do nothing less than give girls and women their lives back. It is featured in the award-winning documentary A Walk to Beautiful, an engaging and inspiring window into the experience of women with fistula.

Worldwide, only a few thousand women a year receive treatment for fistula. Dr. Lewis Wall, founder of the Worldwide Fistula Fund (WFF) and a professor of obstetrics and gynecology at Washington University in St. Louis, proposes a major initiative: A 13-year program creating 40 fistula treatment and prevention outreach centers throughout Africa. The estimated cost—$1.5 billion over 13 years—is equivalent to less than 4 percent of the money the U.S. government has committed to fighting HIV/AIDS over just the next five years. Wall is partnering with Michael Horowitz of the Hudson Institute to build a broad coalition reaching across right-left and religious-secular divides to support this initiative.

As Wall, who is a Christian, writes of fistula repair surgery, “The affluent world needs to understand the profound impact that $300 can have on the lives of these impoverished, suffering women. The ‘widow’s mite’ is not only noble; when used in the right way it can be world-shaking.”

A new United Methodist campaign, Operation Healing Hope, is developing faith-based resources to raise awareness and promote action on fistula among church members. And Addis Ababa Fistula Hospital, WFF, and many other organizations have joined forces with the United Nations Population Fund in the Campaign to End Fistula. Visit www.endfistula.org to see how you can help the cause.

Julie Polter is an associate editor of Sojourners.