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Tuesday
Sep162008

The Heritage Foundation weighs in with its own vision of Reproductive Health Care Reform

What’s at stake in health care reform? Take a look at a recent article from the Heritage Foundation, which proposes many ways to deny comprehensive reproductive health care, especially to young women and women on Medicare and Medicaid, in any effort at health care reform.

http://www.heritage.org/Research/Family/bg2181.cfm
Friday
Sep122008

Testimony Before the President's Council on Bioethics: Protecting Patients' Rights

by Lois Uttley on September 12, 2008 - 8:00am

Recently, a great deal of public attention and public policy has been focused on protecting the religious and ethical beliefs of health providers. As your council discusses this issue, I urge you to consider another imperative - protecting the rights of patients to receive accurate medical information and needed treatment in a timely manner. In a pluralistic society such as we have in the United States, public policy must carefully balance the needs and rights of all affected parties.

Let's use an example to make this discussion very concrete:
A 19-year-old rape victim - let's call her Sally -- is brought to a hospital emergency department by the police. The physician who treats her numerous injuries - Let's call him Dr. Brown -- omits any mention of the potential to prevent pregnancy from the rape by using emergency contraception, because he does not approve of it for religious reasons. Many hours later, Sally leaves the hospital without being informed about emergency contraception, or offered the medication. A friend takes her back to the college dorm where they live and Sally, exhausted, falls asleep for 24 hours. Because emergency contraception is the most effective when taken shortly after unprotected intercourse, Sally's opportunity to prevent pregnancy has now been greatly diminished.

What has just happened? Is this proper medical care? What are Sally's rights? What are Dr. Brown's? And, how should they be properly balanced?
The patient's rights

Let's start with Sally. After all, the patient is supposed to be the focus of what the health professions now refer to as "patient-centered care." According to the Institute of Medicine, "patient-centered care is defined as health care that establishes a partnership among practitioners, patients and their families (when appropriate) to ensure that decisions respect patients' wants, needs and preferences and solicit patients' input on the education and support they need to make decisions and participate in their own care."

One of the central tenets of patients' rights and "patient-centered care" is the right to informed consent. For a patient to make an informed decision about medical treatment, he or she must have knowledge of all potential treatment options, and their risks and benefits. In this case, the rape victim has not been informed about an important potential treatment option - use of emergency contraception to prevent pregnancy. As it happens, Sally is one of the millions of American women of reproductive age who are not aware of EC. So, Sally has had no opportunity to consider this option or use her own moral, ethical or religious perspectives to decide whether she wishes to risk the chance of bearing the child of a rapist. Further, she has had no chance to discuss with her physician the potential medical complications of an unplanned pregnancy, in view of her existing medical conditions, which include diabetes.

How could this violation of patients' rights be corrected? The simplest method would be to require all hospital emergency department personnel, including Dr. Brown, to always offer EC to rape victims who are of reproductive age...

For the full article, please visit: http://www.rhrealitycheck.org/blog/2008/09/11/testimony-before-presidents-council-bioethics-protecting-patients-rights
Thursday
Sep112008

Worse for Women An Analysis of the Effects Senator McCain's Health Plan Would Have on Women's Access to Health Care

By Jessica Arons, Karen Davenport, Stephanie Bell, Amy Yenyo

September 10, 2008






Senator John McCain’s health plan would drastically restructure America’s health care system, with especially devastating effects on women. The health plan of the Arizona senator and Republican presidential nominee would dangerously destabilize the employer-based health insurance system upon which 160 million non-elderly Americans rely for their health care, steering them instead toward the individual market where basic medical needs often are not covered.

Tens of millions of women would be at risk of losing their current insurance coverage even though they use health care services more frequently than men, suffer chronic illness more often than men, and require maternity care and other reproductive health services. Specifically, under the McCain health plan:

  • More than 59 million women who receive their health insurance through their job, ƒƒor their spouse’s job, are at risk of losing that insurance

  • More than 30 million women with employer-sponsored health insurance who suffer ƒƒfrom a chronic condition could lose their coverage, find it harder to obtain coverage, or have to purchase supplemental insurance to cover their chronic condition


In addition, Sen. McCain’s health plan would erode important state requirements aimed specifically at protecting women’s access to some of their most basic health needs. By permitting plans to cherry-pick their state of residence as well as enabling plans to sell policies without regard to state insurance rules through so-called “association health plans,” Sen. McCain’s plan would encourage insurers to eliminate coverage of basic health services. These state requirements include:

  • Twenty-nine statesƒƒ require cervical cancer and Human Papillomavirus screening Sixteen statesƒƒ require coverage of the HPV vaccine

  • Thirty-one statesƒƒ require comprehensive drug benefit plans to include contraception

  • Twenty-one statesƒƒ require coverage of maternity care

  • Forty-nine statesƒƒ require breast reconstruction

    Depending on where a woman lives, the state protections at risk include:

  • Direct access to obstetricians/gynecologistsƒƒ

  • Annual breast, ovarian, and cervical cancer screeningƒƒ

  • Sexually transmitted infection screeningƒƒ

  • Prohibitions on gender-based premium rating

  • Limited definitions of pre-existing conditions that prevent surgeries like Caesarean sections from limiting women's coverage


Rather than giving women more control over their health care decisions, as Sen. McCain promises to do, his health plan would take away women’s ability to access critical health care services.

For the full article, please visit: http://www.americanprogressaction.org/issues/2008/womens_health_mccain.html
    Thursday
    Sep112008

    Continuous Innovation in Health Care: Implications of the Geisinger Experience











    Medical Homes Can Reduce Hospitalizations and Total Health Care Costs


    Findings from a new study published today in Health Affairs provide evidence that the patient-centered medical home model can improve quality of care and reduce health care costs. According to first-year results from pilot-test sites, Geisinger Health System in Pennsylvania--which has adopted the model--has managed to reduce hospital admissions by 20 percent and save 7 percent in total medical cost

    For the full case study, please visit:  http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=704008
    Thursday
    Sep112008

    Fewer US med students choosing primary care

    By CARLA K. JOHNSON, Associated Press Writer Wed Sep 10, 12:44 AM ET


    Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.


    The results of a new survey being published Wednesday suggest more medical students, many of them saddled with debt, are opting for more lucrative specialties.


    Just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary care internal medicine, according to results published in the Journal of the American Medical Association. In a similar survey in 1990, the figure was 9 percent.


    Paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.


    "I didn't want to fight the insurance companies," said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.


    Primary care doctors he met as a student had to "speed to see enough patients to make a reasonable living," Shipman said.


    Dr. Karen Hauer of the University of California, San Francisco, the study's lead author, said it's hard work taking care of the chronically ill, the elderly and people with complex diseases — "especially when you're doing it with time pressures and inadequate resources."



    The salary gap may be another reason. More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study...

    For the full article, go see:
    http://news.yahoo.com/s/ap/20080910/ap_on_he_me/med_fewer_docs;_ylt=AlGyAI9m48wSMGHB.z1RnqpZ24cA