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Health Affairs June Issue: Where Can We Find Savings In Health Care?


June 2nd, 2014

The June issue of Health Affairs, released today, features various approaches to cost-savings in the U.S. health care system. A variety of articles analyze the effects of potential policy solutions on the Medicare and Medicaid programs and their impact on the health of beneficiaries and tax payer wallets.

Federal approaches to reduce obesity and Type 2 diabetes rates by improving nutrition could work—but the how matters. Sanjay Basu of the Stanford University School of Medicine and coauthors modeled the effects of two policy approaches to reforming the Supplemental Nutrition Assistance Program (SNAP), which serves one in seven Americans. They found that ending a subsidy for sugar-sweetened beverage purchases with SNAP dollars would result in a decrease in obesity of 281,000 adults and 141,000 children, through a 15.4 percent reduction in calories by the lowering of purchases of this source. They also found that a $0.30 credit back on every dollar spent on qualifying fruits and vegetables could more than double the number of SNAP participants who meet federal guidelines for fruit and vegetable consumption.

With more than forty-six million people receiving SNAP food stamp benefits, the authors suggest that policy makers closely examine the implications of such proposals at the population level to determine which will benefit people’s health the most and prove most cost-effective.

If you’re between ages 15–39 when you are diagnosed with cancer, the implications later in life extend well beyond your health. Gery P. Guy Jr. of the Centers for Disease Control and Prevention and coauthors examined Medical Expenditure Panel Survey data and determined that survivors of adolescent and young adult cancers had annual per person medical expenditures of $7,417, compared to $4,247 for adults without a cancer history. They also found an annual per capita lost productivity of $4,564 per cancer survivor — because of employment disability, missed workdays, and an increased number of additional days spent in bed as a result of poor health — compared to $2,314 for adults without a cancer history.

The authors suggest that the disparities are associated with ongoing medical care needs and employment challenges connected to cancer survivorship, and that having health insurance alone is not enough to close the gap. They stress the importance of access to lifelong follow-up care and education to help lessen the economic burden of this important population of cancer survivors.

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Traditional Budgeting Fails To Account For The Changing Face Of America


May 23rd, 2014

The United States has been undergoing a major demographic shift over the past four decades, and by 2042, the various “minority” communities will in the aggregate make up the majority of our country.  That has real implications not only for things like immigration policy, but also – and critically – for population health considerations.  And it’s time that Congress started thinking about its health policy decisions in ways that recognize this coming demographic reality.

In 2012, there were more than 53 million Latinos living in the United States – up 50 percent from 2000, and up 600 percent from 1970.  This trajectory is even starker when we note that, in the United States as a whole, the population grew just 12 percent from 2000 to 2012.  Today, meanwhile, African Americans are about 13 percent of the population, and that population grew 15 percent from 2000 to 2010.

If current trends continue, there will be 133 million Latinos and nearly 66 million African Americans in the U.S. by 2050, meaning nearly one in two Americans in 2050 will be African American or Latino.

Why does this matter to health policy and the federal budget?  Because these ethnic groups have different health challenges and realities, and those, in turn, have very real economic consequences.

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A March Madness Health Wonk Review


March 27th, 2014

Welcome to the “March Madness” edition of the Health Wonk Review. The NCAA college basketball tournament seemed like a natural theme for a health care policy blog post: huge amounts of money floating around in ways that only sometimes correlate with performance, and head-to-head match-ups that can yield results no one expected (though in the tournament those unexpected results produce quicker and more certain changes than is often the case in health care).

We considered illustrating each blog post with pictures of a college basketball team from the author’s home state celebrating a championship, but we thought better of that after seeing this cautionary tale. So let’s get to the great collection of posts from our Wonkers.

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The New Nutrition Facts Panel: Public Health Improvement Or Distraction?


March 19th, 2014

Last month, the United States Food and Drug Administration announced long awaited proposed changes to the Nutrition Facts Panel (NFP), the nutrition information found on the back of packaged foods and beverages. The NFP is required to be on all packaged foods, with significant regulations on what is presented and how the information can be presented. Initially mandated in the first Bush Administration, the NFP offers a clear and consistent manner of presenting nutrition information—at least for those with the time and nutrition knowledge to benefit from the information.

The key questions behind the proposed changes are: will they be successful in altering consumer behavior, how might they be improved, and what overall role might they play in obesity prevention?

The NFP is clearly a source from which those already motivated and knowledgeable can easily access information and a base on which to build future approaches to addressing obesity. Put differently, this information will only work if people actively, directly choose to turn the package over, engage in information, and push past the many impulses pulling them towards the less healthy foods. The compelling nature of unhealthy foods means that individuals have to be particularly motivated, or the nutrition information has to be particularly compelling.

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Neighborhood Grocery Stores Combat Obesity, Improve Food Perceptions


March 12th, 2014

The Cummins et al article “New Neighborhood Grocery Store Increased Awareness of Food Access but Did Not Alter Dietary Habits or Obesity,” published in the February issue of Health Affairs, generated considerable media attention, with headlines claiming that grocery stores do not contribute to healthy diets or reductions in obesity.  However, the study offered no conclusive proof showing that access to grocery stores is not a part of the solution to preventing obesity.  In fact, the study showed clear signs of promise that the intervention was working in key aspects during the short time the researchers collected data.  Within just a few months after the new supermarket opened, for example, researchers documented significant improvement in residents’ perceptions about the choice and quality of fresh fruits and vegetables, along with improvements in their perception of healthy food accessibility.

The subject of the study, the Fresh Grocer in North Philadelphia, is a beautiful store with a bountiful fresh produce section. The supermarket, which is now thriving in one of the poorest neighborhoods in the country, was built from the ground up after a 15-year hiatus in which the surrounding community had no grocery store. Its opening has revitalized a historic African-American owned shopping plaza and reinvigorated the local neighborhood’s retail economy.

Has the store reduced the rate of obesity among local residents? This is a crucial question, but one that cannot be adequately deduced from the present study. All we know from this study’s findings is that obesity rates did not change significantly during the first six to nine months after the store’s opening – not surprising, given the many decades of gradual changes in eating habits that have led to the obesity epidemic.

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New Health Affairs Issue: Successes And Missing Links In Connected Health


February 3rd, 2014

Health Affairs’ February issue focuses on the current evidence and future potential of connected health — encompassing telemedicine, telehealth, and mHealth. The importance of connected health is sure to grow as more Americans gain access to health care and new, team-based models seek to provide better quality care in more efficient ways. The issue offers a variety of articles that explore what can entice hospitals, health systems, and individual providers to embrace telehealth, as well as the policy solutions that can better facilitate adoption across the health care system:

Want to increase telehealth adoption among U.S. hospitals? Look to state legislatures. Julia Adler-Milstein of the University of Michigan School of Information and co-authors emphasize that state policies are influential. According to their findings, states that wish to encourage the use of telehealth should promote private payer reimbursement and relax licensure requirements.

Overall, Adler-Milstein and coauthors found that 42 percent of US hospitals had adopted telehealth by late 2012, with significant variation across the country: Alaska was the highest with 75 percent, and Rhode Island had minimal adoption.


Market forces and individual hospital features also influence telehealth adoption rates. Factors that positively influence adoption rates include serving as a teaching hospital, being part of a larger system, having greater technological capacity, and higher rurality. Factors negatively affecting adoption include high population density, being for-profit, and operating in a less competitive market.

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Health Affairs Web First: First-Ever Quantitative Data About The Toll Of BPA Exposure


January 22nd, 2014

The risks of exposure to Bisphenol A (BPA) have been well known for some time. While exposure to BPA in the United States affects an estimated 92.6 percent of Americans over the age of five, there are gaps in the knowledge of the health consequences of BPA exposure.

A new study, released today as a Web First by Health Affairs, presents the first estimate of the potential disease burden and costs associated with ongoing exposure to BPA. Author Leo Trasande found that $2.98 billion in annual costs are attributable to BPA-associated childhood obesity and adult coronary heart disease. Of the $2.98 billion, the study identified $1.49 billion in childhood obesity costs, the first environmentally attributable costs of child obesity to be documented. Trasande holds faculty appointments at New York University’s School of Medicine, Wagner School of Public Service, and Steinhardt School of Culture, Education and Human Development.

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The Unintended Consequences Of The New Statin Guidelines


December 24th, 2013

The American Heart Association (AHA), in collaboration with the American College of Cardiology (ACC), recently released new guidelines that urge a shift in how statins are prescribed. Until now, the drugs had primarily been used to treat high cholesterol; now, the guidelines say they should be used as preventive tools to lower an individual’s overall risk of heart attack and stroke. This change will pave the way for tens of millions of Americans who were previously not candidates for statin therapy to be placed on statins.

Advocates say this new approach will make a big difference in the fight against heart attack and stroke. But in practice such a major change may also have unintended consequences that threaten to move our society even further from prevention toward an increasing reliance on drugs.

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Provider Opportunities for Population Health Improvement


November 5th, 2013

Significant changes in the health care sector have been set in motion or accelerated by the Affordable Care Act.  For health care providers, much of this activity has focused on improving patient care and lowering costs.  There are also numerous opportunities through the Affordable Care Act for health care providers to improve population health, either […]

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Inequality Is At The Core Of High Health Care Spending: A View From The OECD


October 9th, 2013

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

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Food Marketing To Children: A Commentary On William Dietz’s Health Affairs Article


September 19th, 2013

Editor’s note: This post comments on “New Strategies To Improve Food Marketing To Children,” by William Dietz, the former director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention, in the September issue of Health Affairs.

For decades, I have fought to replace our nation’s “sick care” system with a genuine health care system, one focused on wellness, prevention, and public health. In the Affordable Care Act, I made sure that all proven preventive services would be available with no copays or deductibles, and I included provisions to enhance community prevention programs.

However, much more needs to be done, as evidenced by the shocking rise of America’s twin epidemics of childhood obesity and type 2 diabetes in young people. Some attribute this crisis largely to changing nutrition patterns – more calories, more junk food. Others say the cause is a dramatic decline in physical activity. Obviously, both are at fault.

Likewise, who needs a Harvard study to prove that the sophisticated, aggressive, all-pervasive marketing of unhealthy foods and beverages to children is also a contributor to the twin epidemics assaulting our children’s health? Food and beverage companies don’t spend nearly $2 billion a year to market their products to kids because they like to waste money; no, they do so because it is brilliantly effective in persuading children to demand – often to the point of throwing temper tantrums in the supermarket aisle – a regular diet of candy, cookies, sugary cereals, sodas, and all manner of junk food.

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Narrative Matters: Wrestling With Obesity, Individually And Globally


April 22nd, 2013

In the Narrative Matters essay in the April Health Affairs issue, Laura Blinkhorn and Mascha Davis write about how working with an obese woman in a Gabon hospital led them to seek solutions to obesity and its related health problems in the developing world. “Public health campaigns, government regulation, and improved education are necessary to bring about real change,” write Blinkhorn, a fourth-year medical student at the Pritzker School of Medicine, University of Chicago, and Davis, a registered dietician and public health professional who lives in Addis Ababa, Ethiopia, and works for Catholic Relief Services.

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Rachael Fleurence on Patient Engagement


April 3rd, 2013

In today’s Q and A on Patient Engagenment, we feature Rachael Fleurence, a Senior Scientist at PCORI where she leads the research prioritization initiative to help identify important patient and stakeholder generated questions and establish a rigorous research prioritization process to rank these questions. (Also, check out her recent blog post and follow the link to her February Health Affairs article here.)

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A New Feature for Narrative Matters: The Policy Checklist


January 28th, 2013

Health Affairs readers may have noticed something a little different about the Narrative Matters essay in January’s issue. The essay, “To Fight Bad Suga’, Or Diabetes, My Neighborhood Needs More Health Educators,” by Joseph West of Sinai Urban Health Institute, is the first to include the Policy Checklist, a new feature that will accompany all of our Narrative Matters essays going forward.

The feature points readers to related readings, enacted or proposed legislation, current or planned governmental and private initiatives, and other resources that can help to round out perspectives on a given health policy issue. In the case of the checklist accompanying West’s essay, about the need for more community health workers to serve residents in one poor Chicago community devastated by diabetes, the checklist points to Affordable Care Act grants for outreach to medically underserved populations, community-based diabetes management projects like the CDC’s Project DIRECT, and Health Affairs papers on a national diabetes prevention strategy and on the measured benefits of community health workers.

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CMS Spending Articles Lead Health Affairs Top-Ten List For 2012


January 2nd, 2013

An extraordinary slowing of growth in the use of health care goods and services contributed to a second year of slow health spending growth in 2010, analysts from the Office of the Actuary at the Centers for Medicare and Medicaid Services reported in the most-read Health Affairs article of 2012. To celebrate the New Year, […]

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It’s Too Late To Turn Back: A Transformation To Wellcare Is Underway


June 18th, 2012

As pundits and politicians ruminate on the impact of the looming Supreme Court’s decision on the Affordable Care Act, there is one incontrovertible and uncontroversial message for the country. Our commitment to wellness and health, rather than simply treatments for illness is underway. The tide has turned in support of prevention and it is too […]

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Health Policy Brief: The Prevention And Public Health Fund


March 1st, 2012

Editor’s Note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see Health Affairs Blog “Contributing Voices” posts by Georges Benjamin and Jeffrey Levi. The latest policy brief from Health Affairs and the Robert Wood Johnson Foundation focuses on the Prevention and Public […]

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Prevention For A Healthier America


March 1st, 2012

Editor’s note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see this Health Affairs Blog “Contributing Voices” post by Georges Benjamin and an additional post about a Health Policy Brief on the Fund. The Prevention and Public Health Fund, created by the […]

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Prevention Funding: One Step Forward, Two Steps Back


March 1st, 2012

Editor’s note: For more on the state of prevention efforts and the impact of the cuts to the Prevention and Public Health Fund, see this Health Affairs Blog “Contributing Voices” post by Jeffrey Levi and an additional post about a Health Policy Brief on the Fund. Two years ago with enactment of the Affordable Care […]

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A Promising Calorie-Cutting Approach: Would You Like To Downsize That?


February 16th, 2012

How do you get people to eat less? Turns out that, for a significant number of people, the answer may be as simple as asking them. That’s the conclusion of a study in the February issue of Health Affairs, by Janet Schwartz of Tulane’s Freeman School of Business and coauthors, that has been receiving a […]

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