2011 Potpourri IV

The Wall Street Journal reports that some governors are looking for more leeway in what they do with their Medicaid programs.  For most states, Medicaid is one of the biggest expenses and the fastest growing.  They get federal contributions, but with those contributions come rules on who has to be enrolled and what benefits they have to be offered; rules that make the program even more expensive.  Here is a relatively fearless prediction for 2011–the Medicaid expansion contemplated by the PPACA is unaffordable and will be reversed in whole or in part, possibly at the federal level and almost certainly at the state level.  It is not beyond the realm of possibility that a state will actually drop out of the program, as Texas threatened to do.  This program offers gold-plated benefits, which is offensive to the tens of millions of working Americans who have lesser benefits, but pays physicians far less than other payers, which creates access problems.  It also creates incentives and rewards for people who don’t work and don’t try to work.  How about lowering the benefits, forcing beneficiaries to engage in appropriate health behaviors or lose coverage, and paying providers more, so that there is better provider access for those who really need the program.   (WSJ Article)

The Harvard Business Review carried an article on the value of wellness programs.  The article cites some studies demonstrating ROI and lists six success factors for such efforts:  multilevel leadership; commitment and alignment with long-term goals; a broad scope and specific relevance to the employee population; low cost and other barriers to participation; good partnerships with vendors;  and good communications.   The points are all excellent, but the references to the value of the programs ignore the significant methodological issues in showing real long-term reductions in health care spending from wellness efforts.   (HBR Article)

Another Wall Street Journal Article discussed patients who are learning to say no to the seemingly never-ending parade of medical tests and treatments. The author is a writer who has had significant health problems but has put her foot down to limit follow-up visits and use of drugs that seemed to cause her pain.  The author notes that while well-meaning, all this medical attention may not improve health and might contribute to anxiety and a feeling that precious time is being wasted for older people.  The writer is probably unusually well-informed and strong-willed; more patients need to be encouraged to take a skeptical view of much that physicians suggest doing for, or rather to, them.   (WSJ Article)

The Economist reports on a study looking at what makes for good management of a hospital, at least judging by mortality after heart attacks.  The study summarized five characteristics associated with better management:  competition with other facilities; size–larger hospitals seem to have better management; private ownership (no, really, not government owned or not-for-profit!); having clinically-qualified managers; and giving managers autonomy.  The study was done by McKinsey and a researcher at the London School of Economics so it has significant credibility.   (Economist Article)

Research reported in the Annals of Internal Medicine indicates that colonoscopy does in fact reduce risk for colon cancer, rather dramatically.  There is a lot of discussion at times about the value of prevention or early detection screenings and on whom and how often they should be conducted.  This research shows that  having a colonoscopy in the prior ten years was associated with a 77% risk reduction for having colon cancer.  Especially if you are middle-aged or older, or if you have some specific risk factor, if you haven’t had a colonoscopy recently, you probably should get one.   (Annals Study)

And finally, if you want to live longer and healthier, walk faster.  At a minimum, you might convince a doctor that you are in better health.  A meta-analysis reported in the Journal of the American Medical Association finds a correlation between older people’s walking pace and how long they are likely to live.  Walking involves a number of neurological and muscular capabilities, so it makes sense that it might be reflective of overall health.  Walking faster than one meter per second suggests you will be alive longer.  (JAMA Article)