Can #Massachusetts tame #health #spending with transparency and oversight?

Stuart Altman, the Brandeis University healthcare economist who has advised presidents from Nixon to Obama, talked to Health Leaders last week. He is now  the head of the Massachusetts Health Policy Commission, which tracks total health spending statewide.  

HLM: How is Massachusetts trying to address high costs?

Altman: First of all, it is the only state that has recognized that it should be involved in total state spending. Some other states that are closer are Vermont and Maryland. But the Massachusetts state government is really acknowledging that it has responsibility for not only what it spends on Medicaid, but that it should be concerned with total spending.

Full story at Health Leaders. 

Would you take a pill to prevent AIDS? Those at risk should consider it, says Massachusetts.

The Globe reports today on the push to make an AIDS prevention drug available. After
many years of struggling to come up with a vaccine, this was a true breakthrough. (We don’t use that word lightly on this page.) But instead of a shot that stays with you for year, here you have to take a pill.

Critics questioned the wisdom of giving powerful drugs to healthy people, and worried that access to a preventive drug would encourage promiscuity or lead to a spike in other sexually transmitted diseases by reducing condom use.

But as study after study — some conducted in Boston — found the drug safe and effective, public health officials came to embrace PrEP, concluding the benefits exceed the hazards. The US Centers for Disease Control and Prevention estimates that some 1.2 million people at risk of HIV infection should at least consider PrEP.

 

 

 

 

 

The New Yorker:#Boston researchers are hunting for a #Zika vaccine — trco201

The August 22 edition of The New Yorker includes a story by Siddhartha Mukhergee on Dan Barouch, director, Center for Virology and Vaccine Research at BIDMC. He’s on the hunt for a Zika vaccine and his work on HIV is informing the effort. From the article, which is not behind the NYer pay wall:

 

Service dogs add to the debate over environment and fertility, but what does that mean for humans?

A lab, like the dogs in the study. But a troublemaker, not a service dog.

A study of generations of services dogs raised in identical conditions adds new evidence to the much-debated theory that common chemicals in the environment may impact fertility.

This from a story buried in this morning’s paper. 

From 1988 to 2014, researchers studied between 42 and 97 stud dogs annually. Between 1994 and 2014, they also noticed that the mortality rate of the female puppies, although small, showed a threefold increase. And the incidence of undescended testicles in male puppies, also small, had a 10-fold increase, to 1 percent from 0.1.

When the researchers tested testicular tissue for chemical content (in dogs retired from breeding or neutered for other reasons), they found concentrations of chemicals that had been common in electrical transformers and paint, and others still used in plastics. In additional analyses done in the last three years, researchers found concentrations of the same chemicals in the dogs’ semen. The chemicals include polychlorinated bisphenol (PCB), which, though banned, has a long half-life, and diethylhexyl phthalate (DEHP).

As noted, there is a ferocious debate over this. The researcher at the Silent Spring Institute in Newton have been trying to sort it out. Go here for some of their research. 

Do note that even one of the critics of the research into the links between human health and estrogen-mimicking compounds has this to say about the study:

Peter J. Hansen, a professor of reproductive biology at the University of Florida, describes himself generally as a skeptic of many studies linking chemical exposure to declining sperm quality. Much research on the effect of environmental hazards on humans is typically done by administering doses of hazards to research animals in much greater concentrations than is typically found in water supplies, he said.

But the Nottingham study, he noted, detected the chemicals in the dogs’ tissue and also in the dogs’ food. And researchers did so over decades, tracking a concurrent decline in reproductive markers.

“I think it was very rigorous,” he said. “It’s much more clear from their data that there was a decline over time, which agrees with the human data but doesn’t suffer from the same research problems.”

 

Will genetic advances address health disparities? Not much unless they are accessible.

The new issue of Health Affairs looks at health policy and health disparities. Many local researchers represented.

Of interest: Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities. 

The authors include two local researchers: Katherine L. Tucker is a professor in clinical laboratory and nutritional sciences at the University of Massachusetts, in Lowell…José M. Ordovás is director of the Nutrition and Genomics Laboratory at the Human Nutrition Research Center on Aging at Tufts University

Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization.

And, a team from Harvard offers this :

Across US Hospitals, Black Patients Report Comparable Or Better Experiences Than White Patients

Patient-reported experience is a critical part of measuring health care quality. There are limited data on racial differences in patient experience. Using patient-level data for 2009–10 from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), we compared blacks’ and whites’ responses on measures of overall hospital rating, communication, clinical processes, and hospital environment. In unadjusted results, there were no substantive differences between blacks’ and whites’ ratings of hospitals. Blacks were less likely to recommend hospitals but reported more positive experiences, compared to whites. Higher educational attainment and self-reported worse health status were associated with more negative evaluations in both races. Additionally, blacks rated minority-serving hospitals worse than other hospitals on all HCAHPS measures. Taken together, there were surprisingly few meaningful differences in patient experience between blacks and whites across US hospitals. Although blacks tend to receive care at worse-performing hospitals, compared to whites, within any given hospital black patients tend to report better experience than whites do.

 

 

 

Are two big #hospital groups better than one? #consolidation

At Wednesday’s meeting, the  Massachusetts Health Policy Commission heard a staff report on the proposed merger of Beth Israel Deaconess Medical Center

From the report. AMC= academic medical center

 In summary, we find that these transactions are anticipated to increase market concentration, solidify BIDCO’s position as the second largest hospital network in the state, and could strengthen BIDCO’s ability to leverage higher prices and other favorable contract terms. However, BIDCO’s market share will remain far smaller than the dominant system in the state for most services.

Member of the commission pondered the impact of having two large hospital systems, instead of just one giant one — Partners. Their conclusion — no one really knows, but it would be worth finding out.  We’ll see where that goes.

From the Globe:

“… commissioners noted that the growth of Beth Israel Deaconess Medical Center and Beth Israel Deaconess Care Organization, or BIDCO, could be a good thing. BIDCO is a network of affiliated doctors and hospitals that negotiates contracts with insurers and gives its members set budgets under which to manage patient care.

“To me, big is not necessarily bad,” said Marylou Sudders, the state secretary of health and human services, who sits on the commission. “Shouldn’t Massachusetts have… a strong competitor to what is the largest and most expensive health system?”

The commission said that by adding MetroWest and the Baptist to its network, BIDCO will solidify its place as the state’s second largest provider network. But it will remain much smaller than Partners, with about 13 percent of all hospital discharges, compared to 29 percent for Partners.

 

Germs not bugs: Harvard SPH finds that not all the #microbes on the #Boston subway surfaces will make you sick #MBTA

Or, in more technical terms: Urban Transit System Microbial Communities Differ by Surface Type and Interaction with Humans and the Environment