AHLAlerts: American Health Line’s Blog

Obesity is on the rise in 28 states, according to a new report by the Robert Wood Johnson Foundation.

Igor Volsky of “The Wonk Room” believes that all U.S. residents must relieve the burden of caring for obese people by accepting tax increases and admitting that even members of their own family might be part of the problem. He writes that although the report found that the “public is fairly receptive to using taxpayer dollars to help bring down obesity rates,” it is “easy to support general obesity reduction efforts that don’t have any specific proposals or cost estimates attached to them — particularly when you see the whole thing as someone else’s fault.” He notes that the survey “found that 84% of parents believe their children are at a healthy weight, ‘but research shows nearly one-third of children and teens are obese or overweight.’”

In related news, recent findings by the Organization for Economic Co-operation and Development show that the most developed countries in the world, on average, allocated 9% of their national budgets to health in 2008. However, the findings show that the U.S. dedicated 16%. “Health Populi” writes, “The annual release of OECD data leads to inevitable discussions about which nation’s health care system is ‘best.’ Instead of asking that question, ‘Health Populi’ thinks about value-for-money,” adding, “For the U.S., budget deficits and public expectations for the health system are squaring off as the nation spends nearly one in five dollars in the economy on health care.” The post continues that the new health reform law “just begins” to “chip at this iceberg in the form of comparative effectiveness regimes and pilot programs that seek to manage population health and reward care based on health outcomes.”

Meanwhile, David Williams of the “Health Business Blog” examines an opinion piece in the Boston Globe by Christoph Westphal of drugmaker GlaskoSmithKline. According to Williams, the piece “describes how patients have over-reacted to the risks of Vioxx, and repeats the tired assertion that ‘it is possible that aspirin would not be approved today by the FDA, so dramatic is the shift in society’s risk-benefit views regarding pharmaceutical products.’” Williams writes that Westphal is “warning that ‘society’ is making a mistake by over-weighting the risks relative to the benefits” of the drug. However, Williams writes, “Merck heavily promoted the drug” for people with varying levels of arthritis, and physicians often “prescribed it based on its presumably benign profile.” After a series of problems with the drug, “it’s entirely reasonable for consumers (i.e., society) to become more risk-averse and for the government to step in.” Williams notes, “It’s odd that Westphal wrote a whole article blaming society without once acknowledging the role his industry and profession have played in getting us to this point.”

by Matthew Wayt, staff writer

For decades, health experts have said that the lifestyles we lead, the food we eat and the activities we seek all play a role in how healthy we are, and feel. But there might be a lot more at play, according to some researchers.

• “Health and Class: A New Look at Poverty and Illness“: Many researchers have conducted studies with the goal of understanding health differences across socioeconomic gradients, but they have mostly been focused on chronic conditions, according to Kaiser Health News. However, a few of those studies, including one that was published in the Archives of Internal Medicine in March, found that “education and psychological stress may be just as important markers of disease and pain as poor environment.”

It’s an issue that has become more prevalent, probably because of greater publicity in the media and increased awareness among consumers that it now is a problem requiring attention — a person walks into a hospital or clinic expecting to pay a certain amount of money for treatment, but walks out having paid significantly more.

• “Want To Know What A Hospital Charges? Good Luck“: The problem, according to Kaiser Health News and some patients, can be linked to several reasons: “hospital prices are moving targets, varying with patients’ needs and doctors’ treatment strategies,” the cost of treating complications, and a possible break in communication about the treatment plan and cost between surgeons and the billing departments. Although the new health reform law includes provisions that require hospitals to disclose at some of their service charges, similar legislation in the House that would require hospitals to publish comprehensive cost information has stalled (Weaver, Kaiser Health News, 6/29).

by Santosh Rao, staff writer

Pay-for-performance models will exaggerate regional disparities in care and further penalize hospitals serving poor communities, according to a study published in the journal PLoS Medicine finding that hospital quality variations are “substantially associated” with a region’s economic and workforce resources, Reuters reports (Norton, Reuters, 6/29).

For the study, researchers from New York University Medical School analyzed performance for two common cardiac conditions — heart attack and heart failure — at 2,705 hospitals between 2004 and 2007 and regional variation across five “dimensions of location”: poverty, unemployment, provider shortage, non-high school graduates in the work force and college graduates in the work force.

Using quality measures from the Hospital Quality Alliance, the researchers found that clinical performance for the conditions varied across facilities and that hospitals located in disadvantaged regions delivered poorer quality care than facilities located in wealthier and better-educated communities. For example, hospitals in poor counties had a HQA score of 73, compared with 84.1 among hospitals in wealthier counties. In addition, hospitals located in regions with fewer college graduates had an average HQA score of 76.7, compared with a score of 86.2 for hospitals in regions with the highest amount of college graduates.

The researchers note that although overall performance for heart attack and heart failure improved across the study, quality at hospitals in disadvantaged regions continued to “lag significantly behind” better-advantaged peer institutions. The researchers determined that these facilities would receive reduced reimbursement under a pay-for-performance system. Noting that nearly 33% of the hospitals studied were in “locationally disadvantaged” counties, the researchers warn that a pay-for-performance model may “exacerbate inequalities” across regions by rewarding hospitals located in regions that are rich in economic and human resources, and punishing facilities that are in disadvantaged locations (Blustein et al., PLoS Medicine, June 2010).

Although CMS, which is poised to implement a pay-for-performance system within Medicare in 2013, says that it will scrutinize the distribution of funds to determine whether hospitals are being disadvantaged, the study’s authors stress that the agency must take a more “proactive” approach. To divorce hospital quality from locational factors, the researchers say policymakers must be cognizant of whether hospitals have a “level playing field to begin with,” and suggest using a hospital’s baseline score to measure improvement, rather than compare a “low-attaining” facility with institutions that may start at a higher baseline. Additionally, the researchers say CMS could reward quality improvement regardless of a hospital’s starting point (Reuters, 6/29).

– Audrey Horn