Health Care


10 years ago the International Diabetes Federation Diabetes Atlas indicated that just over 150 million people had diabetes worldwide.  Now, less than 10 years later the survey shows 285 million worldwide cases, more than half of those aged between 20 and 60.

To put this rise in perspective in 1985 it was estimated there were 30 million worldwide cases.  India and China lead the way in cases but are followed closely by the US.  About 9% of the US population is found to have been diagnosed with diabetes (26.8 million) at a rate of $198 billion a year.  This is 52.7% of worldwide spending on diabetes, an incredible number!

At this growth rate the number should reach above 435 million by 2030 (US population today is 303 million).  As I’ve said before, if we really want to cut down on health expenditures this is a major area of public health we have to target and not just by paying it lip service.  Since a majority of cases are type II (insulin resistance with obesity and diet as contributors) we need to target the food and food services industries and the way the consumer is informed of their decision.

Of course a huge problem is getting people to realize the long term health affects of diet and exercise which is very difficult.  Incremental weight loss and an abstract number like fasting glucose levels are difficult means to motivate people into life altering habits. This has been proven with the massive diet industry which peddles unnecessary measures to lose weight.  This is easily seen by the yo-yo effect from people losing weight off of a diet and then gaining the weight back, only to have to find another diet.  I’ve seen family members go from diet program to diet program to find one which will “keep the weight off” but the only way to keep the weight off is to change your eating and exercise habits,  dirty secret the industry wishes to keep from you.

I guess I got way off topic but the obesity and diabetes problems are closely related, so there’s my diatribe for the day…

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This has been going around the interwebs for a week or more but I keep coming back to it, what great insight in such a humorous post.  This is what happens when lawyers run the way medicine is delivered…

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below:

  • Spilling 200
    • Spilling, Water – 210
      • Spilling, Water, Hot – 211
        • with blisters 211.1
        • without blisters 211
      • Spilling, Water, Warm – 212
      • Spilling, Water, Cold – 213
  • Spilling, Coffee – 240.1
    • Spilling, Coffee, Hot – 240.11
        • with blisters – 240.121
        • without blisters 240.122
      • Spilling, Coffee, Hot, With Cream only – 240.12

      • Spilling, Coffee, Hot, With Regular Milk only – 240.13
      • Spilling, Coffee, Hot, With 2% milk only – 240.14
      • Spilling, Coffee, Hot, With Skim Milk – 240.15
      • Spilling, Coffee, Hot, With Soy milk only 240.16
      • Spilling, Coffee, Hot, With Sugar only – 240.17
      • Spilling, Coffee, Hot, With Artificial Sweetner (of any type, including, but not limited to Nutrasweet, Spenda, Sweet ‘n Low) – 240.18

    • Spilling, Coffee, Hot, With Cream and Sugar 240.16

To see the whole post head on over to Dr. Wes, always good writing and insightful views from the inside of medicine.

I think this was a pretty smooth move on the part of St. Vincent Health System.  Instead of mandating their workers to get the seasonal flu vaccine or letting them have full discretion of whether or not to get it they gave the workers a choice.  Either get the vaccine or wear a mask while you’re at work.  Only 6 employees opted for the mask while all others got the stick.

This was a really innovative way to incentivize the vaccination decision as well as meeting an ethical standard of minimizing exposure of both patients and staff that are in the hospital.  I think that the healthcare industry does have an obligation to protect their patients from all potential exposures and the flu is no different.

Another obligation of the hospital is to have enough healthy staff to serve their patients, this is a step in that direction for the coming flu season and considering the population of hospitals (old, sick, and very young) it seems a good idea to put these measures into practice.

This idea is a great way to maintain the autonomy of the healthcare workers while putting a leading foot forward for the patients and other staff that are at the hospital.

Hattip to Effect Measure

What a brilliant piece of writing.  The National Journal Magazine has published a great perspective on how the health care industry works and why other industries would fail in this model.  Please go read it here.  My favorite part of the piece:

“Great, thank you, I’ll be happy to make that booking for you. That’s one flight from Washington Dulles to Chicago O’Hare on October 26. Will there be anything else?”

“Wait, hold on. Chicago? I’m going to Eugene. It’s in Oregon.”

“Yes, sir. The Eugene portion of your trip will be handled by a western specialist. We’ll be glad to bring you back from Chicago to Washington, though.”

“You mean I have to call another carrier and go through all this again? Why don’t you just book the whole trip?”

“Sorry, sir, but you do need to make your own travel appointments. We would be happy to refer you to some qualified carriers. May I have your fax number, please? Before I can confirm the booking, we’ll need you to fill out your travel history and send that back to us.”

Echoing my sentiments in my post about what scares me in the future of health care, Dr. Ken Mattox, vice chairman of surgery at Baylor College of Medicine has written a great post over on the Texas Medical Association’s blog, Blogged Arteries about why HR 3200 will cause the cost of medical care to rise in the US.

My thoughts are that none of the plans proposed do anything to stop the actual reasons our cost in the US is so high.  Dr. Mattox seems to agree.

This bill does not address the cost drivers like futility, duplicate or unnecessary ordering of tests, nor the 50 percent of the health care costs that are administrative, hassle, and tort focused. CBO Director Douglas Elmendorf stated on Thursday that this bill would break the budget. I heard the President and others state that the overriding force to reform health care is to reduce costs and to address the economics to the benefit of all. HR 3200 does not do this, it does just the opposite. I do not understand.

And Dr. Mattox and I aren’t the only ones not pleased about the current attempt at reform, Dr. Wes presented at the National Press Club last week and again brought up some of the same points.  And he makes a great statement about the fact that the voices of physicians and all care-givers are not being heard in our current push to reform (which is capitalization on panic, a strategy Obama has made good use of).  From Dr. Wes:

Yes, there are problems with our current system, too many to describe in this brief press conference, but for the first time, a serious dialog about our problems and how to solve them is underway. How these reform ideas really translate into reality, how they look to those of us on the ground, has to be played out before our patients are put at risk. The only people who can play that out for you are the frontline caregivers. If we don’t have the time or patience to do that, we’ve got a problem.

It’s good to know that I’m not alone in thinking that the current ideas on the table are not a fix, hell they’re not even a band-aid for the actual problems facing the health care industry.  Hopefully the politicians will begin to listen before it’s too late.

Just a little bit of my opinion on health care and the reform that is trying to be pushed through the government, I don’t plan on covering this because there are far more intelligent and well-read people than myself so I’ll leave it to them for the expert comments.  But I do feel that there are some easily seen problems facing both the attempts at reform and the practice of health care in general, so here are my thoughts.

So far we’ve done a bunch of talking about universal coverage, the public option, and whether health care is a right.  It is unfortunate that none of these has anything to do with the real problem, the level of spending we do on health care.  This is one of my favorite graphs I’ve seen that can give us some insight into a few aspects of the economy of health care. HT to The Enterprise Blog

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Over at Better Health Dr. Rich has a well reasoned post about the troubles Obama is now facing getting his health care reform pushed through. He also nicely details some other proposals which have been brought forward by other members of congress and policy wonks.

I try not to delve into much if the reform policy but seeing as it’s a major topic of discussion I think I might start.

Later I’ll have a post up explaining why almost no reform is going to save the healthcare industry (advanced hint: I’ll look at the coming diabetes crisis). But for now enjoy Dr. Rich’s thoughts.

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