2010 Potpourri XIII

John Goodman, a knowledgeable health policy writer, has a blog post at Health Affairs discussing the international trends toward self-directed care, particularly in the treatment of chronic illness.  He cites several examples in various countries of programs furthering patient control of spending and treatments.  These programs tend to result in greater satisfaction, as good or better care on both process and health outcomes, and lower costs.  What is most encouraging is that if some of the frailest, most vulnerable populations can learn to manage their care effectively, then the vast majority of people should be able to do so.  We need more benefit design changes mandated to encourage self-responsibility.  (Health Affairs Blog)

Telemedicine and telehealth, in all their forms, are growing rapidly, but barriers remain.  One of the most prominent of those barriers is state licensing laws.  A local newspaper reports on the North Carolina medical licensing board’s discipline of a physician for prescribing medicine over the phone without a physical exam.    (Article) The physician has responded by suing the telemedicine company which sponsored his work for not warning him about the potential problems that might arise.  Other states have threatened out-of-state physicians for conducting telemedicine sessions with patients located in the state, without getting a license in the state where the patient is.  Confusion about these state issues may hinder appropriate expansion of telemedicine.

Technology continues to move in the direction of creating greater ability to generate and use information at the point of care, particularly diagnostic information.  A German company unveiled plans for a lab on a chip, which it anticipates will be on the market soon. This chip can take blood, saliva and other specimen types and provide an analysis in as quickly as a few minutes.  The chip could be used in a doctor’s office, in a surgical suite or even in a patient’s room in the hospital.  Even more far-reaching would be the ability for a  patient to use the chip at home and have the results transmitted to providers.  While access to such timely information has immense potential, processes will need to be developed to be sure that providers can use the data to improve health outcomes.  (Lab Chip Story)

HCA, the large for-profit hospital chain taken private several years ago, is apparently planning a return to public status.  (HCA Story) This development may be seen as either a vote of confidence in the future of hospitals under the newly passed health law or a sign of fear about whether this may be peak of earnings potential for for-profit hospitals.  HCA has done well through turbulent times since going private and being public again may give more visibility to its strategies and operations.

For doctors looking for ways to improve their interaction with patients, sit down when you talk or visit with them.  That is the message from new research.  When doctors sat, patients perceived they were staying longer than they were and were more satisfied with the interaction than when physicians stood.  Seems like a little thing, but that is the nature of human emotions and perceptions.  (Story)

As we discussed in a recent post, researchers have looked at differences in health care and health outcomes by racial, demographic and socio-economic factors.  In one such study, results showed that persons at lower socio-economic levels were 20-25% more likely to die in the five to ten years after heart surgery, regardless of race or gender, than those in higher levels.  (Heart Surgery Study) Being poor is linked with lower education and other circumstances which make it not surprising that health and health outcomes are worse for these persons.