India has allocated almost 70 percent of its national HIV budget to prevention, focusing on high-risk sexual behavior and injecting drug use, the main drivers of the nation’s HIV/AIDS epidemic. So report Mariam Claeson and Ashok Alexander in the July/August issue of Health Affairs, a thematic volume on health in China and India.

“There are no real ‘innovations’ in India’s approach to HIV planning, but, rather, sound policy making: investment in good data to inform decisions; analysis of the data to determine the epidemic drivers; and comprehensive plans for scaling up known interventions directed at those populations with the behavior that is responsible for the most exposure to HIV, without moral undertones. The world has much to learn from India’s approach,” say Claeson, a program coordinator at the World Bank, and Alexander, the director of Avahan, the Bill & Melinda Gates Foundation’s anti-HIV/AIDS initiative in India. Read the rest of this entry »

Public spending for health care goes disproportionately to seniors and those in poor health, but it is less concentrated among low-income Americans than is sometimes thought.

In a study published today on the Health Affairs Web site, government analysts provide the first study since the 1970s that comprehensively analyzes the distribution of health care outlays and health care tax subsidies provided by federal, state, and local governments. By breaking down public spending on health by age, race, sex, health status, coverage status, and income, the work fills important knowledge gaps as the United States begins a fundamental debate over the role of the public sector in the health care system. Read the rest of this entry »

Today Health Business Blog hosts the Health Wonk Review, which sums up the best of health policy blogging–from questions about future of managed care, Medicare, and health reform to nursing staff ratios, physician planning and more.

Government policymakers and private-sector stakeholders have been crafting the nation’s health care workforce for years without answering definitively a question that lies at the heart of the matter: should policymaking follow the values of many Americans and rely on market-based solutions, or — in this instance — does more prescriptive government regulation make more sense? Without a clear preference, the history of policymaking that addresses the size and composition of the nation’s health care workforce is, at best, checkered. An array of private and public organizations play a wide variety of roles in shaping the workforce, but there is no overall design or policy that guides it.

Given this split, a prescription set out in a new report by the Association of Academic Health Centers (AAHC) comes down decidedly, if not definitively, in favor of one direction. The report calls for the creation of a “new health workforce planning body to ensure development and implementation” of a “comprehensive and coordinated national health workforce policy.” Read the rest of this entry »

In June, Health Affairs Blog featured a series of guest posts on pay for performance and offered blogs from the Global Health Council meeting and Annual Research Meeting of AcademyHealth, both held in Washington, D.C. Sign up for email or RSS feed alerts to stay on top of new postings. Additional commenting always welcome.

1. Health Wonk Review: Washington Week
   by Jane Hiebert-White
2. Toxic Waste In the U.S. Health System
   by Arnold Milstein
3. Pay For Performance: From Quality To Value
   by James C. Robinson
4. Designing Effective P4P Systems: It’s About Appropriateness
   by Howard Beckman
5. Who Speaks For The Health Care Consumer?
   by Rob Cunningham
6. Obama Health Adviser, Indiana Reform In Top 10 Blog Posts
   by Jane Hiebert-White
7. Indiana: Health Care Reform Admidst Colliding Values
   by Mitchell Roob and Seema Verma
8. Efficiency Measurement In P4P: Moving From Alchemy To Science
   by Tom Williams
9. Flying Blind With $500 Billion: CMS To Unhood Part D Data
   by Rob Cunningham
10. Global Health Conference Focuses On Community Health
    by Maurice Middleberg

No doubt that Teddy Kennedy’s dramatic return to the Capitol on Wednesday and the senatorial smackdown on Medicare that ensued were the stuff of legend. With Kennedy’s vote putting the Senate Democrats over the hump on cloture on S. 3101, nine Republicans who had voted against cloture last week pivoted to produce a potentially veto-proof 69-30 vote in favor of linking another temporary physician-pay fix to Medicare Advantage (MA) modifications already passed in the House by a 355-59 margin.

With the White House ideologically committed to protecting MA, the outcome of a veto struggle remains uncertain. Republican senators who changed their votes will be under heavy pressure from the administration to support a veto. But state chapters of the American Medical Association are well positioned to target campaign ads at those who are up for reelection and to paint them as insensitive to Medicare beneficiaries if a pay cut prompts doctors to drop out of the program.

Easily lost in all the political drama is the modesty of the compromise that won over so many Republicans in both chambers. The controversial benchmark system for setting bid targets for MA plans remains untouched, despite repeated recommendations from the Medicare Payment Advisory Commission to equalize payments for MA and traditional Medicare. The bill phases out a payment adjustment to MA plans for indirect medical education (IME) by a maximum of one-half of one percentage point a year, worth a total of $12.5 billion from 2008 to 2013. But as the Congressional Budget Office points out, the current IME adjustment represents a double payment to MA plans, because Medicare’s fee-for-service hospital rates, on which MA benchmarks are partially based, already include an IME add-on. Read the rest of this entry »

Like the United States, China is grappling with a serious obesity epidemic, with nearly 25 percent of its adults considered overweight or obese, according to a study out today in Health Affairs. The rate of overweight adults in the country is predicted to double by 2028 without interventions to stem the growth rate. An increasingly Westernized diet and a decline in physical activity are seen as culprits.

A report on BBC today notes that while obesity has often been associated with China’s new affluence and more urban lifestyle, this new study finds that low-income Chinese in rural areas are more susceptible to becoming overweight. However, as USAToday notes, China still lags far behind the United States, where 66% of Americans are overweight.

Study author, Barry Popkin, a professor of nutrition at the Carolina Population Center at the University of North Carolina, told Health Affairs:

“What’s happening in China should be seen as a marker for what is going to hit the rest of the developing world if we fail to act. We need to find the right investments and regulations to encourage people to adopt a healthy lifestyle, or we risk facing higher rates of death, disease, and disability and the related costs.”

The study is part of the July/August 2008 Health Affairs issue released today on “China and India: Reform Goes Global,” published with support from the Bill & Melinda Gates Foundation. BBC offers an interview with study author, Popkin.

India and China have undergone major economic transformations in the past quarter-century – and each now has a middle class that is bigger than the entire U.S. population. Their health care systems have improved but are still facing fundamental challenges. As a result, both countries now stand on the brink of major health reforms. At the same time, they face other health concerns: HIV/AIDS, aging populations, and, as their populations grow wealthier, many of the same chronic diseases that affect nations like the United States.

Health Affairs explores these issues in its July/August 2008 thematic issue on health in India and China. This issue was supported by a grant from the Bill and Melinda Gates Foundation. At the upcoming briefing, Somnath Chatterji of the World Health Organization will present new findings about the health status of older adults in China and India. Tsung-Mei Cheng of Princeton University will describe her interview with China’s health minister, Chen Zhu, and trends on obesity and nutrition in China. World Bank public health specialist Kees Kostermans will discuss India’s five-year HIV prevention plan and related policy implications. CMS researcher Aman Bhandari will discuss a successful specialty eye care network in India, called Aravind, which won the Gates Award for Global Health in May 2008. Read the rest of this entry »

For the second time in as many weeks, a respected research organization has reported sharp increases in reported difficulties with access to care for insured as well as uninsured patients. Earlier this month, in a study on underinsurance widely reported by national media, Cathy Schoen and colleagues at the Commonwealth Fund found that the share of insured people with annual out-of-pocket health spending exceeding 10 percent of family income (5 percent for those below 200 percent of the federal poverty level) had risen from 9 percent in 2003 to 14 percent in 2007.

In a similar set of results released this week, Peter Cunningham and Laurie Felland of the Center for Studying Health System Change (HSC) found that 17.3 percent of insured respondents to an HSC survey said they had experienced access problems in 2007, up from 11.1 percent in 2003. A much larger proportion of uninsured people reported problems in both years, but the rate of growth in access problems from 2003 to 2007 was greater for the insured than for the uninsured in the HSC report, and the overall growth in access problems for insured and uninsured alike was “by far the biggest change we’ve seen” in the ten years HSC has been tracking these data, Cunningham said at a June 26 National Press Club briefing. Read the rest of this entry »

Today’s edition of the Health Wonk Review features a post on Federal Reserve Chairman Ben Bernanke’s economic assessment of health care presented at last week’s Senate Finance Committee Health Reform Summit. While rising U.S. health care costs pose a strain on the economy, there are positive aspects of new health care technology, says Bernanke:

“Although the high cost of health care is a frequently heard complaint, it is important to note that a substantial portion of the cost increases that we have seen in recent decades reflects improvements in both the quality and quantity of care delivered rather than higher costs of delivering a given level of care. Notably, new technologies, despite greatly adding to cost in many cases, have also yielded significant benefits in the form of better health. People put great value on their health, and it is not surprising that, as our society becomes wealthier, we would choose to spend more on health-care services. Indeed, although quantifying the economic value of improved health and greater expected longevity is difficult, most researchers who have undertaken an exercise of this type find that, on average, the health benefits of new technologies and other advances have significantly exceed the economic costs.”

Jaan Sidorov of Disease Care Management Blog is this week’s host of the Health Wonk Review, the biweekly round-up of the best of health policy blogging.