The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now According to Information Week there are now approximately 100,000 mobile medical applications (double the number from last year) and the market for these applications is expected to grow from $500 million in 2010 to $8 billion by 2018.  These applications promise to provide the consumer with everything from health and wellness information to cancer diagnoses.  What do we know about who...

Listen Now In 1999 the Institute of Medicine published "To Err Is Human," a report that shocked the medical establishment because it concluded as many as 98,000 Americans die annually from hospital caused medical errors.  In 2000 the highly respected scholar Dr. Barbara Starfield estimated medical errors or adverse events actually amount to 225,000 deaths annually making them the 3rd leading cause...

Listen Now It's estimated in the next few years the Affordable Care Act will add 25 million Americans to the health care insurance rolls.  In addition, 10,000 Americans age into Medicare every day.  Current estimates by the Health Resources and Services Administration and others show the country already has a shortage of health care providers, particularly primary care physicians, and the shortage...

Listen Now Conservative estimates show hospital-acquired infections (HAIs) sicken two million Americans, directly kill 23,000 and contribute to a total of 100,000 deaths each year.  The bacterial infection C. diff ( Clostridium difficile ) alone causes 250,000 people to be hospitalized annually.  Healthcare costs associated with these infections are estimated at over $50 billion.  These illnesses...

Listen Now US medical malpractice policy is considered to be substantially flawed.  Only a small percent of patients harmed file claims, awards even for similar injuries vary widely, and "defensive" medicine that leads to over-testing and treatment inflate health care costs by as much as $55 billion annually.  What reforms can be made to "medmal" policy to improve patient safety, reduce health car...

Listen Now For nearly four decades, Maryland's “all payer” system has set hospital prices for the state's 53 hospitals.  The state regulates prices for every insurer including Medicaid, Medicare and patients who pay their own bills.  Last week the state proposed to substantially alter how it pays state hospitals by creating over time a capitated payment system (a hard cap) that would increase over...

Listen Now This past October 1st uninsured Americans who qualify for coverage under the Affordable Care Act could begin choosing a health care insurance plan offered via their state's healthcare insurance marketplace or exchange.  The CBO estimates about 14 million Americans will buy health care insurance for 2014 and about 25 million will do so by the end of the decade (still leaving about 20 mil...

Listen Now As part of last year's "fiscal cliff" agreement the Congress created a Long Term Care/LTC Commission tasked to make recommendations to improve LTC delivery.   (The Commission was created largely as a result of the demise of the ACA's CLASS Act.  See the related August 5th interview with Connie Garner.)  Today more than 12 million Americans rely on LTC services and this number will grow...

Medical devices, everything from tongue depressors to pace makers and defibrillators, are regulated by the FDA.  How competently or effectively the FDA regulates these products has been questioned for several years in part due to the substantial increase in recent years in product recalls, for example the recall of certain hip implant devices.  More specifically is the question whether the FDA's 5...

Listen Now Today nearly all large employers offer a workplace wellness programs and most small employers that offer health benefits also offer at least one wellness program.  Typically these programs consist of health risk assessments, biometric screenings, health coaching and lifestyle management education.  Program popularity is not surprising considering the epidemic in what's termed "lifestyle...

Listen Now During this 21-minute interview, Professor Nichols discusses the reasons for the decline in health care cost growth and whether its slowing will persist, alternative payment models (to fee for service) that contribute to this decline, how worrisome or not health care market consolidation is as well as the prospect of employers dropping employee health care coverage, why Congressional Re...

Listen Now The most expensive Medicare beneficiaries are not those with multiple chronic conditions.  They are those with chronic conditions AND functional impairment (i.e., those needing help with routine life activities).  For example, the 15% of Medicare enrollees with both chronic conditions and functional limitations disproportinally account for one-third of Medicare spending.  Alternatively,...

Listen Now In 2009 the Congress overwhelmingly passed landmark legislation (commontly termed the "Tobacco Control Act") that included banning flavored cigarettes - except menthol.  Instead, the Congress called upon the FDA to first study the use of menthol before taking action.   In 2011 the FDA released an initial report, the conclusions of which were widely interpreted.  Two weeks ago the FDA re...

Listen Now While the vast majority (70%) of people turning 65 will need long term care services for an average of three years, only 7 million Americans own a long term care insurance policy.  Medicare does not provide for long term care and Medicaid only covers long term care costs for those with very limited financial means.   The CLASS Act, a provision within the ACA, would have created a volunt...

Listen Now Recently the French government fined Sanofi $53 million for what it called a smear campaign against a competitor drug manufacturer.   Ranbaxy was fined $500 million, in part, for making false statements to the FDA.   Last year the pharamaceutical industry in sum paid out $5.5 billion to resolve fraudulent marketing practices.  These included $3 billion in fines against GlaxoSmithKline (...

Listen Now The lowlight during the 2009-2010 ACA debate was Governor Palin's invention of "death panels" (PolitiFact's 2009 "Lie of the Year") in response to a proposal to allow Medicare to pay physicians whom voluntarily counsel patients about advanced care planning or directives.   The fear mongering was so convincing the proposal was dropped by the Congress and later, via rule making, by the Wh...

Listen Now The homeless of course suffer substantial health problems.  The CDC estimates nearly half have one or more chronic health condition (e.g., heart disease, diabetes, cancer), two in five have a mental health diagnosis/es, one-fourth suffer substance abuse, one-third are alcohol addicted.  One 2005 study showed shocking mortality rates, the median age of death was 45.  Over half do not hav...

Listen Now In 2009, or the year before the Affordable Care Act passed, the Herfindahl-Hirschman Index (used by the FTC and the DoJ) defined hospital ownership as "highly concentrated" in over 80% of the 380 MSAs (Metropolitan Statistical Areas).  Since passage of the ACA, a law that among other things strongly encourages care continuity and coordination between/among providers, hospital mergers an...

Listen Now The centerpiece of the Affordable Care Act are the state health insurance exchanges where individuals beginning October 1st will be able to buy health care insurance with coverage beginning January 1st.   There are numerous questions regarding how and how well the exchanges will function.  For example, how may insurance plans will participate in each state, how competetive will these ma...

Listen Now The health care sector has substantially lagged all other major industries in the adoption and use of information technology.  For example, per the CDC, in 2011 still slightly more than half of physicians (54%) used an electronic health record (EHR) (though compared to 17% in 2008), among of solo practitioners only 29% and among specialities only 48% of surgeons.  However, since 2009 th...

Listen Now After the doubling of the National Institutes of Health's (NIH) budget between 1998 and 2003, federal funding for medical research and more widely federal R&D has been falling or stagnate over the past several years.  Most recently, the federal budget sequester slashed NIH funding by 5.5  percent leading to a $1.6 billion funding reduction in 2013, the largest cut in the agency’s histor...

Listen Now Since the 1970s Medicare beneficiaries have had the option of receiving their Medicare benefits via private health insurance plans.  Today 27% of Medicare beneficiaries, or 13.3 million seniors, are enrolled in these private plans.  MA program growth in the past few years has been rapid, enrollment almost tripled between 2003 and 2012 and the program is estimated to add another 1.5 mill...

Listen Now It's estimated the Affordable Care Act will add another 16-17 million lives to the 60 million Americans already receiving Medicaid.  Of these current 60 million Medicaid enrollees, two-thirds receive their health care via managed care companies and over half of Medicaid managed care enrollees are in for profit plans.  Concerning the quality of care for profit plans deliver, a 2011 study...

Listen Now Tooth decay affects US children more than any other chronic infectious disease.  It is five times more common than asthma and almost entirely preventable.  Between 41% and 55% of children age 2 to 11 suffer tooth decay and upwards of 34% of this decay is untreated.  Disparities in dental health, the CDC has termed, "profound."  This is explained in part by fact that one-third of the pop...

Listen Now Over 80 percent of Americans take at least one medication, nearly 30 percent take five or more. That translates to more than 3.5 billion prescriptions written every year making drugs the third highest health care delivery cost after hospital and physician services - amounting to over $250 billion annually. While the benefits of medication therapy are or can be substantial medication err...