Archive for the ‘Health Care Reform’ Category

No More Labs in Public Hospitals in China?

March 12, 2017
supersized-medication-inside-china’s-biggest-hospital-006.jpg

A Typical Day in a Chinese Hospital; Source: sixth tone

Prior to the 2009 health system reform, in the face of dwindling governmental health spending, Chinese public hospitals relied primarily on drugs with high mark-up and expensive laboratory tests as their sources of revenue. In fact, according to earlier estimation, lab testing expenditure alone costs the system 751.9 billion RMB in 2015. Unlike in the U.S. where lab tests are conducted in both hospital lab settings (62%) and independent laboratories, lab tests are completed almost exclusively within public hospital laboratories (99.3%) in China.

In the effort to improve healthcare quality and cost-effectiveness, the Chinese central MOH has recently published policy recommendations that call for labs within public hospitals to register as independent legal entity. In addition, the development of independent medical laboratory companies is also encouraged. However, actual implementation of such policy recommendations (not mandate) is at the discretion of individual provincial MOH, whose opinion is largely influenced by large public hospitals. In this case, public hospitals are unlikely to support such policy in fear that they will lose another source of revenue (in light of the recent “zero drug mark-up” policy). General publics have also voiced concerns related to whether all hospital laboratory services will be removed and how that might affect their care-seeking experience.

To maintain healthcare quality and mitigate the risk of national health insurance fund deficit , the central government of China should enforce such policy with no delay. However, in order to generate buy-in and reconcile the conflicts between different stakeholders, the CMOH should:

  1. Change the “policy recommendation” to “policy mandate”, set pilot cities, start from small-scale implementation to national roll-out;
  2. Subsidize public hospitals to help them go through the transition period;
  3. Emphasize to the public that frequently used lab services will be available at public hospitals, only to be financially separated from the public hospitals’ revenue streams;
  4. Set high quality control standard for independent lab services.

Group member: Ai Liu, Zhengchun Jiang, Shanshan Wang

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.

Replacing the Affordable Care Act

March 12, 2017

Lab 5 Blog

The Affordable Care Act was put into place by President Obama to help insure millions of American’s by expanding Medicaid to cover more low-income Americans. The Affordable Care Act also made it so that insurance companies could not refuse people because of pre-existing conditions and made birth control free, along with many other preventative services.

The current pressing issue around the ACA is that the Republican majority congress has stated that they will repeal and replace the ACA. Until earlier this week, congress had not presented an option for replacement of the ACA. Many stakeholders are against the repeal of the ACA without a replacement that they deem to be reasonable, which means the new proposal will be under much scrutiny.

There are already many negative reactions to the proposed replacement, not only from those against repealing, but also some that are for it. Many House and Senate Republicans, who support repealing the ACA, have stated that the replacement would negatively effect the Medicaid expansion put into place by the ACA and will hurt many of their states citizens. While others, who are more conservative, feel that the replacement is simply “ObamaCare-lite” and is not a good enough solution to the problems they see in the ACA.

While Republicans are torn about the proposed replacement, House and Senate Democrats are presenting a firm stance against repealing and replacing the ACA. This split in support will make it very difficult for the suggested replacement, as it stands, to be passed through Congress. If the Republican majority wants to replace the ACA, they will have to find a more agreeable suggestion with which to do so.

CCMDD: A vehicle towards universal access to Anti Retrovirals and other chronic medicines in South Africa.

March 12, 2017

Over the past decade, South Africa has experienced an unprecedented growth in patients requiring access to long-term therapies. Not only has South Africa introduced universal access to antiretroviral therapy (ART) for patients living with HIV and AIDS, but there has also been a steady increase in the number of patients with non-communicable diseases (NCDs), requiring chronic therapy.  gapminder_hiv_chart_feb09_a

Slide1South Africa’s changing epidemiological profile has led to an over-extension of public sector healthcare facilities including primary health care (PHC) clinics. This has placed enormous strain on available resources and has contributed towards medicine shortages and declining quality of care.

South African government response to this and other health disparities was the introduction of the new policy called  National Health Insurance (NHI) which “seeks to transform the South African Healthcare system with emphasis on the promotion of health and the prevention of diseases. It also seeks to provide access to quality and affordable healthcare services for all South Africans based on their health needs irrespective of their socio-economic status”, according to the South African Government website.

To improve patient access to needed medicines, especially for patients on chronic medication, as well as to assist with decongesting public clinics, the Department implemented the Centralised Chronic Medication Dispensing and DistributiSlide1on (CCMDD) policy. This is comprised of two programme components, Central Chronic Medicine Dispensing and Distribution (CCMDD) and Pick-Up Points (PuPs).

This system will lead to shorter waiting times at facilities – patients would collect their medicine from an alternative pick-up point; patients would be able collect medicines from places closer to their homes and work. There will be improved retention of patients on treatment and follow-up on defaulters.  I strongly support this policy and advocate for more funding as it is currently underfunded by at least R 800 million to be fully implemented in the whole country (Gray A et al, 2015).

.

 

Need for Sustainable Financing of Long Term Services for United States Seniors

March 12, 2017

According to the United States Department of Health and Human Services’ Administration on Aging, in 2014, there were 46.2 million people 65 years and older in the U.S. This number is expected to grow to 98 million by 2060, with a significant proportion requiring long term services and supports (LTSS) to help with activities of daily living (such as bathing, dressing, eating) and instrumental activities of daily living (such as medication management, financial management, and housecleaning) due to physical, developmental or cognitive impairments.

그림1.png

LTSS are provided by skilled nursing facilities, assisted living facilities, senior living communities, community senior agencies, home aide agencies and family/friend caregivers. Unfortunately, Medicare does not pay for these services. Currently, the methods of financing these services are Medicaid, private long term insurance policies, private pay services, and unpaid caregivers. The challenge is that none of these methods alone is sustainable, affordable, or  available to a socioeconomically diverse aging population.

그림3.pngThe U.S. Congress has made various efforts to promote community and social program support for the aging population, however, it has been unable to pass comprehensive legislation that would allow for public funding of LTSS  due to lack of bipartisan support and the diversity of needs that must be met. Several non-governmental senior and public policy advocacy groups, such as the National Council on Aging, the Bipartisan Policy Center (BPC), The Convergence Center for Policy Resolution and Leading Age have recognized that a multipronged approach to sustainably financing LTSS which includes expanding Medicaid options for community and home based services, making private long term insurance more affordable, and creating a plan to finance LTSS for high utilizers is needed.

Continued collaboration between governmental health agencies (federal and states), advocacy groups, LTSS providers, private insurance companies and seniors is required to create actionable proposals to present to Congress in the next 2-5 years.

Written by Aruna Josyula, Euijae Kim

National Health Reform in Mexico

March 12, 2017
seguro_popular

Photo credit: The Yucatan Times via google

 

In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.

 

A Questionable Solution to Maryland’s Opioid Crisis

March 11, 2017

In 2015, over 1,000 Marylanders died due to opioid-related overdoses. This week, in response to increasing opioid-related deaths, Senate Bill 868 will be heard. This bill increases the scope of the Overdose Response Program (ORP), which provides education and reduces overdose by certifying and training Marylanders to assist overdose victims.

The bill allows healthcare professionals to dispense naloxone to individuals without any of the previously required education. The intent is remove the barrier of attending an educational session for obtaining naloxone, with the hope of curbing the opioid-overdose epidemic.

While naloxone is not difficult to administer, an overdose cannot be treated by just administering naloxone once. Naloxone wears off quickly, and it is critical to call emergency medical services and understand how to initiate CPR. Allowing access to the drug without education may not improve outcomes, and may become a financial burden to those trying to help.

Naloxone-instructions-SQUARE-768x859_harmreductioncoalition.jpg

Image Credit: The Harm Reduction Coalition

While the Department of Hygiene and Mental Health, the Institute for Emergency Medical Services System, and The American Pharmacists Association are invested in this bill, other associations have yet to make formal statements. The American Medical Association has a task force increasing access to naloxone, the American Society of Addiction Medicine, and the Substance Abuse and Mental Health Services Administration recommend and encourage individuals who carry naloxone to receive a comprehensive overdose-related education.

While the bill’s intention is noble, removing education is not the right way forward. There are other possibilities, including requiring healthcare professionals to provide a standardized pamphlet each time they provide or dispense naloxone – which would please all stakeholders.

Nelson Mandela said, “Education is the most powerful weapon which [we] can use to change the world.” In our attempt to save lives, Maryland should be cautious in skipping education.

The Global Gag Rule

March 11, 2017

The Mexico City Policy, introduced at the 1984 United Nations International Conference on Population, was an expansion of the 1973 Helms Amendment that restricted NGOs receiving US federal funds from providing abortions as a family planning method. This policy, commonly known as the Global Gag Rule (GGR), prevents NGOs from performing or promoting abortion as a condition of receiving US federal funds earmarked for family planning purposes. This controversial policy has been repealed or reinstated by Executive Order with each presidential administration since the 1990s.

The Trump Administration iteration of the GGR goes a step further and applies the same limits to all US global health funding.

028-daai-pbasu_dsc0531-002-

via NPR

Groups currently receiving US global health funds are either remaining quiet about the policy or speaking against it. Those rejecting the policy stand to lose millions of dollars typically allocated to sexual and reproductive health (SRH) services globally, which could result in the closure of clinics, decreased access to care, and the associated increases in unplanned pregnancies, unsafe abortions, and maternal mortality.

Organizations working in SRH not reliant on US funding are coming out in opposition to the policy, signaling to other organizations their resistance to limitations on free speech in the delivery of care. Despite not receiving funds, these organizations will be indirectly impacted by the GGR as women seek care in areas where access is limited as a result of the GGR.

In the face of the GGR, the international community has stepped forward, with governments pledging funds for SRH organizations in an effort to cover the loss of funds, services, and care resulting from the policy.

To continue to undermine the efficacy of the policy, international NGOs and governments should reject the Mexico City policy while advocating for women’s rights and health globally. The US government should follow the lead of other western nations, permanently block the GGR (and Helm’s Amendment)and fight for the quality of SRH services, rather than their existence.

Increased Utilization of Physician Associates in the UK

March 5, 2017

download

A June 2016 national survey by the British Medical Association highlighted a shortage of General Practitioners (GP) in the UK, finding that 17% of GP positions are unfilled. The shortage of GPs is compounded by an aging UK population requiring more healthcare resources. Physician Associates (PAs) help narrow the GP staffing gap and increase access to care for National Health Service (NHS) patients.

However, PAs in the UK are unable to practice to the full extent of their training, experience and ability because PAs are unregulated medical providers. Unregulated means there are regulatory barriers forbidding PAs to write prescriptions or order x-rays or labs for patients. As a regulated medical profession, those barriers could be removed and PAs would fully function as members of a physician-PA medical team.

Comments to Parliament from the British Medical Association such as “physician associates must not replace doctors” and Royal College of General Practitioners “skeptical of the intention behind expanding the PA profession” ring of trade unionist protectionism and ignore numerous studies that validate PAs value to healthcare teams.

A 2015 observational study of PAs and GPs in the UK show that for same-day walk-in appointments there was no significant difference between PAs and physicians in re-consultation ratios, rates of diagnostic tests ordered, or patient satisfaction.

The Royal College of Physicians and Faculty of Physician Associates regularly advocate for stronger physician-PA relationships in the NHS by educating GPs and others who are skeptical about the value of PAs. In 2017, NHS committed to spend £15m on training 1,000 GP physician associates by 2020 to address the shortage of primary healthcare providers.

Removing regulatory barriers that prevent PAs from practicing to the full extent of their training will allow NHS to narrow the GP staffing gap and improve access to care for NHS patients.

Minority Youth, HIV and access to Pre-exposure Prophylaxis in NYC

August 20, 2016

Problem

The number of cases of HIV throughout the United States has decreased or stabilized among intravenous drug users and heterosexuals, but increased among men who have sex with men (MSM) especially minority youth and young adults. In 2014, 22% of newly diagnosed HIV cases were in youth between the ages of 13 and 24 years of age and more than 80% of those individuals were MSM/bisexual. There has also been significant increases in minority cases of HIV (87% increase in black MSM who are newly diagnosed HIV cases).  Reasons for increased HIV rates in this population include poor education (in the form of age appropriate sexual education), risk taking behaviors (low use of barrier protection, multiple sexual partners), increases in sexually transmitted disease rates, substance abuse, psychosocial issues (loneliness, fear of rejection, bullying) and poor screening habits.

In New York City, sections of the Bronx, Brooklyn and Northern Manhattan have some of the highest rates of new HIV cases and these areas are also the location of the poorest neighborhoods in the city. As with the national trends, the majority of these new cases involve minority youth and increases in new cases in these communities suggest that there are multifactorial issues that need to be addressed.

pic.jpghttp://www.avert.org/professionals/hiv-programming/prevention/pre-exposure-prophylaxis

Prevention

One preventative that has been successful in reducing exposure to HIV is pre-exposure prophylaxis (PrEP). There is controversy regarding its use in adolescents because of concerns about bone growth and other potential side effects. When taken properly, it can reduce the risk of contracting the infection in high risk individuals by 92% making it an option that cannot be ignored.

Intervention

In NYS, minors do not have the same protections (NYS Public Health Law, Minors’ Consent Law) as those seeking reproductive health care or treatment for sexually transmitted disease. Individuals desiring this medication must have parental consent for treatment and many providers are unwilling to prescribe without some clear guidelines and protections from the state and the CDC. This requirement likely prevents minors from seeking care, making a powerful preventative unattainable to high risk youth. Amendments to the Minor Consent and Public Health Laws would set the groundwork for the introduction of PrEP to these populations in the city allowing clinicians to address this issue and hopefully see a reduction in new cases.