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Partnership And Progress On The Path To Achieving Millennium Development Goal 6


August 25th, 2014

Editor’s note: For more on global health, stay tuned for the upcoming September issue of Health Affairs.

In 2000, nearly 200 world leaders came together and agreed on a set of objectives intended to tackle some of the most pressing development challenges of our time, such as poverty, AIDS, and child mortality. With a target date of December 31, 2015, the Millennium Development Goals (MDGs) provided a clear path for progress and a platform for immediate action. Last week, on August 18, we reached a milestone on that path –- as of that date, 500 days remained to achieve these eight goals. So where do we stand, and what more must be done?

Combatting HIV/AIDS, Malaria, and Other Diseases

For those of us focused acutely on MDG number 6—combatting HIV/AIDS, malaria, and other diseases—the recent Millennium Development Goals Report had encouraging news. An estimated 3.3 million deaths from malaria were averted between 2000 and 2012 due to the expansion of malaria interventions, and efforts to fight tuberculosis have saved an estimated 22 million lives since 1995.

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Development Assistance For Global Health: Is The Funding Revolution Over?


April 17th, 2014

In many ways, the last twenty years have been somewhat of a “revolution” in global health, as marked by rising attention, growing funding, and the creation of new, large scale initiatives to address global health challenges in low and middle income countries.  Indeed, the 1990s brought a steady increase in global concern about health, largely centered on the HIV epidemic and due to civil society organizing to draw attention to the growing crisis, leading to the creation of the Millennium Development Goals, and soon thereafter, the GAVI Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the U.S. President’s Emergency Plan for AIDS Relief, and other efforts.

A key driver of increased funding has been donors – governments and multilateral agencies, non-governmental organizations (NGOs), and foundations.  And tracking their funding has become one of the critical measures of the global health response.

A new analysis from Dieleman et al., published as a Health Affairs Web First on April 8, provides a needed contribution to the literature on donor funding for health, including an understanding not just of where donor funding is going but of the relationship between aid, burden, and income.

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Health Affairs Web First: Global Health Funding In 2013 Five Times Greater Than 1990


April 8th, 2014

Development assistance for health (DAH) to low- and middle-income countries provided by donors and international agencies are given in the form of grants, low-cost loans, and goods and services. Without this assistance, some of the poorest countries would be less able to supply basic health care.

A new study, being released today as a Web First by Health Affairs, tracked the flow of development assistance for health and estimated that in 2013 it reached $31.3 billion.

Looking at past growth patterns of these international transfers of funds for health, authors Joseph Dieleman, Casey Graves, Tara Templin, Elizabeth Johnson, Ranju Baral, Katherine Leach-Kemon, Anne Haakenstad, and Christopher Murray identified a steady 6.5 percent annualized growth rate between 1990 and 2000, which nearly doubled to 11.3 percent between 2001 and 2010 with the burgeoning of many public-private partnerships. Since 2011, however, annualized growth has dramatically dropped, to 1.1 percent, due, in part, to the effect of the global economic crisis.

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Exhibit Of The Month: More HIV Testing With Medicaid Expansion


March 28th, 2014

Editor’s note: This is the second post in the new “Exhibit of the Month” series. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

This month’s exhibit examines the potential impact of the Affordable Care Act’s Medicaid expansion on HIV testing from 2013-2017, comparing a nationwide eligibility expansion with one limited to the eighteen states that had committed to expansion as of July 2013.

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Implementing Health Reform: Ryan White Third-Party Payments, 2015 Letter To Issuers, And Other ACA Developments


March 15th, 2014

On March 14, 2014, the Department of Health and Human Services released a flood of regulations, proposed regulations, and guidance addressing a host of Affordable Care Act implementation issues. From all indications, HHS has cleared the decks of all the regulatory issuances it had under consideration– nothing involving ACA implementation remains pending at the Office of Management and Budget. Perhaps someone made a promise that all would be completed by the end of the winter (or by Saint Patrick’s Day). More likely the necessity of having the ground rules for 2015 in place so that insurers could proceed with their 2015 forms and rates, and states with approving them, drove the deluge. In any event, it will take several posts to cover it all.

Yesterday’s post covered a notice on extending the federal preexisting condition high risk pool and a frequently asked questions document on coverage of same-sex spouses. The Internal Revenue Service also released a set of general Tax Tips for Same-Sex Couples (which covers general tax information and will not be discussed here), while HHS issued a blog post summarizing its frequently asked questions document.

This post will cover several other issuances released late in the day on March 14, 2014. These include an interim final rule (with comment period) dealing with third party payments for qualified health plans (QHPs) and stand-alone dental plans (SADPs); the 2015 final annual letter to issuers in the federally facilitated marketplace; a set of frequently asked questions on retroactive coverage, and a set of frequently asked questions on the use of exchange grants and no-cost extensions.

A final post will examine a proposed rule on exchange and insurance standards for 2015 and beyond and an accompanying bulletin on product discontinuance.

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Ethical Dilemmas In Prison And Jail Health Care


March 10th, 2014

Editor’s note: This post is published in conjunction with the March issue of Health Affairs, which features a cluster of articles on jails and health.

Prison and jail health care, despite occasional pockets of inspiration, provided by programs affiliated with academic institutions, is an arena of endless ethical conflict in which health care providers must negotiate relentlessly with prison officials to provide necessary and decent care.  The “right to health care” articulated by the Supreme Court pre-ordained these ongoing tensions.  The court reasoned that to place persons in prison or jail, where they could not secure their own care, and then to fail to provide that care, could result in precisely the pain and suffering prohibited by the Eighth Amendment to the Constitution.

Good reasoning was followed by a deeply flawed articulation of the “right” that defines the medical care entitlement as care provided to inmates without “deliberate indifference to their serious medical needs.” By forging a standard which was, and remains, unique in medicine and health care delivery — designed to avoid intruding on state malpractice litigation regarding adequacy of practice and standards of care — the court guaranteed that dispute would surround delivery.  That first framing, which did not establish a right to “standard of care” or to care delivered according to a “community standard,” set the stage for endless ethical and legal conflict.

The Eighth Amendment’s deliberate indifference standard, forbidding cruel and unusual punishment, presents a relatively demanding standard for proving liabil­ity.  The Eighth Amendment, as interpreted by the federal courts, does not render prison officials or staff liable in federal cases for malpractice or accidents, nor does it resolve inter-professional disputes — or patient-professional disputes — about the best choice of treatment. It does require, however, that sufficient resources be made available to implement three basic rights: the right to access to care, the right to care that is ordered, and the right to a professional medical judgment.

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Howard Koh To Keynote Health Affairs Briefing Tomorrow On ACA And HIV/AIDS


March 10th, 2014

One of the least explored yet most important parts of the Affordable Care Act (ACA) are provisions that hold promise for addressing serious health care challenges facing the 1.1 million Americans who are living with HIV/AIDS — and others like them — most of whom are impoverished and uninsured.

Please join Health Affairs Founding Editor John Iglehart on Tuesday, March 11, in Washington, DC, for a Health Affairs briefing on our March issue where we will spotlight topics related to the ACA and people with HIV/AIDS. The briefing will be keynoted by Howard K. Koh, Assistant Secretary for Health, U.S. Department of Health and Human Services.

WHEN:
Tuesday, March 11, 2014
9:00 a.m. – Noon

WHERE:
National Press Club
529 14th Street NW, Washington, DC, 13th Floor (Metro Center)

REGISTER ONLINE

Follow live Tweets from the briefing @HA_Events, and join in the conversation with the hashtag #HA_HIVAIDS

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The ACA And People With HIV: The ACA’s Impact And The Implications Of State Choices


March 3rd, 2014

Editor’s note: This post is also co-authored by Rachel Garfield, a senior researcher and associate director at the Kaiser Commission on Medicaid and the Uninsured, the largest operating program of the Henry J. Kaiser Family Foundation.

Among the groups that stand to benefit from the Affordable Care Act (ACA) are people living with HIV, a population with significant and high-cost health care needs but one that has historically faced barriers to coverage and care.  While several provisions of the ACA are of particular importance for this population, two are expected to have the most far reaching effects on coverage – the expansion of Medicaid eligibility to include most Americans with incomes up to 138 percent of the federal poverty level (FPL) (although the Supreme Court’s 2012 decision effectively made the Medicaid expansion optional for states) and the creation of new Health Insurance Marketplaces where individuals can purchase private coverage, including subsidized coverage for those with lower incomes.  Others include an end to pre-existing condition exclusions, a ban on premium rate setting based on health status, and an end to annual and lifetime caps on coverage, all of which posed barriers for people with HIV prior to the ACA.

Despite the importance of these changes for people with HIV, little has been known about how many are estimated to gain new coverage.  While there are more people living with HIV in the U.S. than ever before (an estimated 1.1 million), almost two-thirds are not yet in regular care, either because they have not yet been diagnosed or have not been retained in care, thus challenging efforts to develop nationally representative estimates of the population of people with HIV in the U.S. by income and coverage.  Indeed, a recent Institute of Medicine study concluded that no single data source was yet available that could establish baseline estimates of coverage before 2014; instead, the Committee recommended that multiple data sources should be considered.

Examining The Population Of Americans With HIV/AIDS

Two new studies, each using different data sources, shed light on this question — our study from the Kaiser Family Foundation, conducted in collaboration with researchers at CDC, and Snider et. al’s analysis published in the March issue of Health Affairs.  While the two studies use different data sources and methodological approaches, they arrive at a similar conclusion: significant shares of people with HIV stand to benefit from Medicaid expansion (as well as subsidized coverage in Health Insurance Marketplaces), but state choices about Medicaid expansion will affect the ACA’s reach for this population.  As such, both studies highlight the continued importance of the Ryan White HIV/AIDS Program (Ryan White Program), first created in 1990, which has become a critical safety net for people with HIV who have no coverage or face limits in their coverage.

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New Health Affairs: ACA’s Impact On Americans With HIV/AIDS And Jail-Involved Individuals


March 3rd, 2014

Health Affairs’ March issue, released today, explores how the Affordable Care Act (ACA) could affect two key sectors of the population with unique public health needs—those living with HIV/AIDS and people who have recently cycled through local jails.

When it comes to HIV treatment, timing is everything. Dana Goldman of the University of Southern California and coauthors modeled HIV transmission and prevention based on when HIV-positive individuals started combination antiretroviral treatment (cART). They estimate that from 1996-2009, early treatment initiation in the US prevented 188,700 HIV cases and avoided $128 billion in life expectancy losses.

The authors highlight treatment at “very early” stages (when CD4 white blood cell counts are greater than 500, consistent with current treatment guidelines in the US) as responsible for four-fifths of prevented cases. Early treatment both reduces morbidity and mortality in people living with HIV/AIDS, and decreases the transmission of the disease to the uninfected. Goldman and coauthors conclude that early treatment has clear value for both HIV-positive and HIV-negative populations in the US.

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HA Issue Briefing: The ACA And The Future Of HIV/AIDS In America


February 28th, 2014

One of the least explored yet most important parts of the Affordable Care Act (ACA) are provisions that hold promise for addressing serious health care challenges facing the 1.1 million Americans who are living with HIV/AIDS — and others like them — most of whom are impoverished and uninsured.

Please join Health Affairs Founding Editor John Iglehart on Tuesday, March 11, in Washington, DC, for a Health Affairs briefing where we will spotlight issues related to the ACA and people with HIV/AIDS.

WHEN:
Tuesday, March 11, 2014
9:00 a.m. – Noon

WHERE:
National Press Club
529 14th Street NW, Washington, DC, 13th Floor (Metro Center)

REGISTER ONLINE

Follow live Tweets from the briefing @HA_Events, and join in the conversation with the hashtag #HA_HIVAIDS

Read the rest of this entry »

Don’t Put The Brakes On Ending AIDS


January 27th, 2014

One year ago in his State of the Union Address, President Obama reaffirmed the United States’ goal of achieving an AIDS-Free Generation.  The year that followed brought fresh evidence that this goal is within reach: new HIV infection rates are beginning to fall in countries where people have access to HIV programs.

A major part of this success is the result of expanded access to HIV treatment, which has been shown to both save millions of lives and prevent HIV transmission.  Moreover, an analysis by UNAIDS found that the faster countries scaled up access to HIV treatment, the faster their rate of new HIV cases fell.  A study in KwaZulu-Natal, South Africa, determined that the risk of HIV infection was 38 percent lower in communities where HIV treatment had been scaled up.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), regarded as one of the most successful global health programs in history, is currently helping provide lifesaving HIV treatment to 6.7 million people.  The program has the potential to make major additional contributions in this area—and indeed 40 members of Congress recently asked that the program be expanded to reach 12 million people by 2016.

But it is deeply concerning that instead of reaching this bold goal, the pace of HIV treatment scale-up could slow considerably in the coming years because of budget cuts to U.S. global AIDS programs.  Without new resources for PEPFAR, as well as additional program efficiencies, the number of new people put on HIV treatment with U.S. support will plummet. The graph below shows our analysis of the pace of scale-up under PEPFAR, based on publicly available data and consultation with experts in the field.

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A Tribute To Surgeon General C. Everett Koop


March 1st, 2013

A frequent statement of mine is, “We need public health leadership that cares enough, knows enough, is willing to do enough, and will be persistent.” Surgeon General C. Everett Koop was just such a leader, for he was caring; he was competent; he was courageous; and he was passionately persistent.

Before he was a Surgeon General, he was a pediatric surgeon. This was before the field was well-established. But he cared about children and their health. He gave conjoined twins the chance to live independent lives by performing surgery to separate them before the art was well developed. He cared about the education of medical students and residents, and spent time educating and counseling them. His former students still tell stories of their interactions with him.

The Office of the Surgeon General is not political. The American people look to the Surgeon General for reliable information based on the best available public health science, not politics, religion, or personal opinion. A combination of presidential nomination, Senate confirmation, and science-based expertise all have resulted in the Surgeon General maintaining, in the minds of the American people, a place of authority. As Surgeon General, Koop spoke and wrote with authority.

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From The Health Affairs Archives: An Interview With C. Everett Koop


February 27th, 2013

In 2004, Health Affairs’ Fitzhugh Mullan interviewed C. Everett Koop, who passed away on Monday. The full interview is freely available to all readers, as is a 1998 Health Affairs article coauthored by Dr. Koop evaluating health education programs designed to reduce health risks and costs. Health Affairs Blog will carry more about Dr. Koop’s life and work in the coming days.

Koop is probably best-known for his pioneering work as Surgeon General under President Ronald Reagan, but his interview with Mullan begins with a discussion of children’s health, reflecting Koop’s role in helping to found the discipline of pediatric surgery. Koop sounds a warning about the nation’s treatment of its children. “We always talk about children being our future,” he notes,

but I’m afraid we don’t always deliver … the older I get, the more I understand the relationship of poverty in a child and poor outcomes in everything else. I’m not beating a socialist kind of drum here. I think as we look to the future, unless we take into account what a severe role poverty plays in the lives of many children, we will never be able to achieve good child health in the United States.

Since children can’t vote or lobby as seniors do, “In the long run, child health is about advocacy,” says Koop, who also highlights the challenge of pediatric obesity.

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Health Affairs Resources On HIV/AIDS


November 29th, 2012

As we mark World AIDS Day and the Obama Administration releases its new “PEPFAR Blueprint,” Health Affairs Blog wanted to remind readers that the July 2012 issue of Health Affairs provides a comprehensive look at PEPFAR, the President’s Emergency Plan for AIDS Relief. The issue contains a wide array of articles by leading voices such as Ambassador Eric Goosby, the US Global AIDS Coordinator in the Department of State, Michael Merson, the founding director of the Duke Global Health Institute, and many others. Health Affairs also published a Health Policy Brief on PEPFAR to accompany the issue.


In addition, readers may view the release event for the July issue on the Health Affairs website. The briefing featured many of the authors from the issue as well as others such as Jim McDermott, the co-chair of the Congressional HIV/AIDS Caucus.

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New Health Affairs: Promise & Pitfalls Of Comparative Effectiveness Research


October 9th, 2012

The October 2012 issue of Health Affairs provides an in-depth look at challenges in comparative effectiveness research. To surface issues around communication of research results, the issue includes a hypothetical comparative effectiveness case study of a fictional migraine drug and offers varying commentaries and analyses of the hypothetical case study from the Patient-Centered Outcomes Research Institute (PCORI), the Food and Drug Administration, the pharmaceutical industry, payers, and representatives of patient groups.

These and related articles raise questions about how the research might be applied to decision making across the health care system and the ways it could affect how pharmaceutical companies communicate to both health professionals and the public about competing treatments and options in the future.

Other studies examine additional issues related to comparative effectiveness research as well as topics of interest to the pharmaceutical and medical device industries, insurers, health care providers, and consumers.

The new Health Affairs volume will be discussed at a Thursday, October 11, briefing in Washington DC. The issue has funding support from the National Pharmaceutical Council.

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Primary Care Reform Led Health Affairs Blog’s Top Ten For August


September 17th, 2012

Rushika Fernandopulle’s proposal for rethinking the nation’s primary care system was the most-read Health Affairs Blog post for August. It was followed on the month’s top-ten list by Michael Cannon and Jonathan Adler’s argument that the Affordable Care Act does not allow premium tax credits on federally facilitated exchanges, and Jacob Bor’s reflections on the […]

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Reflections On AIDS 2012


August 1st, 2012

Editor’s note: The current issue of Health Affairs is a thematic volume focusing on the President’s Emergency Plan For AIDS Relief (PEPFAR). Last week’s 19th International AIDS Conference in Washington, D.C. convened 25,000 scholars, activists, practitioners, policy makers, and members of the general public; people living with HIV and people living without the virus; students, […]

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Celebrating The End Of The HIV/AIDS Travel Ban


July 20th, 2012

This year’s International AIDS Society (IAS) conference, taking place in the US for the first time after a 20-year boycott, has a special meaning to me.  As an infectious diseases doctor, I provide primary care to HIV-positive patients.  I first became drawn to HIV/AIDS in 1989 when I was 10 years old.  At that time […]

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Health Policy Brief: PEPFAR & Global HIV/AIDS


July 16th, 2012

On the eve of AIDS 2012, the international HIV/AIDS conference, soon to get under way in Washington, DC, a new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the President’s Emergency Plan for AIDS Relief, or PEPFAR. This major program of assistance to foreign countries affected by HIV/AIDS was created […]

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New Health Affairs: Assessing The President’s Emergency Plan For AIDS Relief


July 10th, 2012

Articles published yesterday in the July 2012 issue of July 2012 issue of Health Affairs focus on the President’s Emergency Plan for AIDS Relief (PEPFAR), the US program to address global HIV and AIDS, and the largest investment to date of any country to fight a single disease.  The thematic issue examines the origins of […]

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