Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.

Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.

While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. “The U.S. just pays providers of health care much more for everything,” said Tom Sackville, chief executive of the health plans federation and a former British health minister.

Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo — and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.

Why Do So Many Doctors Regret Their Job Choice?

In an online questionnaire of 24,000 doctors representing 25 specialties,only 54%, said they would choose medicine again as a career, down from 69% in 2011. Just 41% would choose the same specialty again. Only a quarter of doctors said they would choose the same practice setting, compared with 50% a year ago. Why such frustration and discontent among physicians? The Medscape survey cites declining incomes, excessive paperwork, and vast uncertainty about changes dictated by the Affordable Care Act.

Especially for patients over 65, doctors must fill out multiple layers of insurance forms. A single elderly patient can have Medicare, and then secondary and tertiary insurance coverage, all of which require separate forms.

The Medscape survey also describes how hospitals are buying up private practices both in primary care and other specialties. This makes some doctors feel less independent and discouraged, says Howard Forman, a professor at the Yale School of Management who researches diagnostic radiology, health policy and healthcare leadership. “The transformation of the field from independence and professionalism to being commoditized and feeling like you’re just another worker is disheartening to some,” he says.

A insustentabilidade dos sistemas de saúde públicos

O tema é quente em Portugal, nos EUA ou em Espanha: El PSOE defiende sin fisuras la sanidad pública y es partidario de reformas para adaptarla al siglo XXI frente a la amenaza que ve que representa la derecha.

Há alguns sistemas de saúde públicos que se mantém viáveis e com alguma sustentabilidade, como o sistema alemão, o francês e de alguns países do norte da Europa. Mas, só são sustentáveis, porque há uma conjugação de esforços público-privados, e um férreo rigor, que faz desses países uma amostra de que é possível manter à tona sistemas de saúde públicos. Os EUA tentaram com o ObamaCare criar uma rede assistencial pública de acesso generalizado. Não foi até agora implementado. Aliás, o sistema de saúde dos EUA é o pior dos exemplos, uma vez que a sociedade americana gasta quase 20% em saúde. Valores incomportáveis para qualquer sociedade.

O idealismo é positivo, mas levado ao extremo, leva à insanidade e a inevitáveis rupturas.

Taxa de natalidade dos "teens": EUA

The U.S. teen birth rate in 2009 fell to its lowest point in almost 70 years of record-keeping a decline that stunned experts who believe it's partly due to the recession. The birth rate for teenagers fell to 39 births per 1,000 girls, ages 15 through 19, according to a government report released Tuesday. It was a 6 percent decline from the previous year, and the lowest since health officials started tracking the rate in 1940.

Overall, about 4.1 million babies were born in 2009, down almost 3 percent from 2008. It's the second consecutive drop in births, which had been on the rise since 2000. The trend may continue: A preliminary count of U.S. births through the first six months of this year suggests a continuing drop, CDC officials said. A decline in immigration to the United States, blamed on the weak job market, is another factor cited for the lower birth rate. A large proportion of immigrants are Hispanic, and Hispanics accounted for nearly 1 in 4 births in 2009. The birth rate among Hispanic teens is the highest of any ethnic group with 70 births per 1,000 girls in 2009. However, that rate, too, was down from the previous year.

Food-borne illnesses make 1 in 6 Americans ill each year

Food-borne illnesses: how prevalent are they? Roughly 48 million Americans – or 1 in 6 – get sick and about 3,000 die from some type of food-borne illness each year, the Centers for Disease Control and Prevention says. Reports published Wednesday in Emerging Infectious Diseases also provide a picture of which pathogens cause the most illnesses. Salmonella tops the list for hospitalizations and deaths.

1 in 5 gay, bisexual men in U.S. cities has HIV

Nearly one in five gay and bisexual men in 21 major U.S. cities are infected with HIV, and nearly half of them do not know it, U.S. health officials said on Thursday.

Young men, and especially young black men, are least likely to know if they are infected with HIV, according to a study by the U.S. Centers for Disease Control and Prevention.

The study found that 28 percent of gay black men infected with HIV, compared with 18 percent of Hispanic men and 16 percent of white men. Black men in the study were also least likely to be aware of their infection, with 59 percent unaware of their infection compared with 46 percent of Hispanic men and 26 percent of white men. Age also plays a role. Among 18 to 29-year-old men, 63 percent did not know they were infected with HIV, compared with 37 percent of men aged 30 and older, the team reported in the CDC's weekly report on death and disease. "This alarming new data provides further evidence that prevention efforts for gay men have not been adequate to meet the growing epidemic and should be dramatically scaled up," said Carl Schmid of the nonprofit AIDS Institute.

U.S. birth rate fell in 2008

The U.S. birth rate fell 2 percent in 2008. Here are some facts about births in the United States from the NCHS, part of the Centers for Disease Control and Prevention: 4,251,095 babies were born in the United States in 2008, down nearly 2 percent from the 2007 peak of 4.317 million; the general fertility rate, which measures births among women aged 15 to 44, declined in 2008 to 68.7 per 1,000; The crude birth rate, which refers to births in the total population, was 14 per 1,000, 2 percent lower than the rate in 2007.

Economy sends plastic surgery down 17%

Last year’s economic slowdown caused a 17 percent drop in plastic surgeries, according to a survey by the American Society for Aesthetic Plastic Surgery. Demand for non-invasive procedures such as Botox injections remained fairly steady, dropping less than 1 percent. For both types of procedures combined, the overall decline was 2 percent. For the second year in a row, the No. 1 surgical treatment was breast augmentation, with an estimated 312,000 procedures last year, followed by liposuction, at 284,000. As has been the case for years, those operations were far outpaced in frequency by Botox injections — an estimated 2.55 million last year.

Post Scriptum: só assim se compreende que a despesa com a saúde nos EUA esteja cada vez mais próxima dos 20% do PIB!

A explosão da diabetes

A diabetes é uma doença difícil. A diabetes implica uma perda de qualidade de vida significativa. A diabetes tem tendência a aumentar, atendendo à má alimentação que as pessoas têm nos dias de hoje.

Vejamos este estudo da situação previsível nos EUA:

• The number of Americans with diabetes may almost double in 25 years, and the annual cost of treating them may triple to $336 billion, according to a study published today in the journal Diabetes Care.
• Without new programs to assure that people get health care to manage their condition, 44.1 million people in the U.S. will have diabetes by 2034, from 23.7 million today.
• The number of diabetics on Medicare, the government plan for the elderly, will reach 14.1 million from 6.5 million today.
• Diabetes drugs were the fourth-best selling medications in 2008, with $27.3 billion in global sales, according to IMS Health.
• “To do nothing is going to be extremely expensive,” O’Grady said in a Nov. 24 telephone interview. “It’s going to mean millions of Americans continuing to get this disease and a lot of heartache.”.
• The analysis by O’Grady and his colleagues included the impact of aging and obesity rates as well as the natural progression of the disease over time to come up with estimates on numbers and costs. They found diabetes treatment estimates of $113 billion this year would increase to $336 billion by 2033.

Este estudo é importante. Este estudo deveria ser feito em Portugal.

Apenas e só um aspecto lateral, mas de relevo: Copenhagen-based Novo Nordisk A/S, the world’s biggest maker of insulin, funded the study. The company sold $6.1 billion of insulin products in 2008.

Obesidade nos EUA

Fonte: aqui.

In 31 states, more than one in four adults are obese, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

Health economists once made the harsh financial calculation that the obese would save money by dying sooner. But more recent research instead suggests that better treatments are keeping them alive nearly as long — but they're much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese.

O maior desafio de Obama

O Presidente Obama tem uma capacidade de comunicação única. O Presidente Obama está perante o maior desafio dos EUA, desde a II Grande Guerra: tentar travar o declínio evidente dos EUA.

Uma das fontes de declínio Americano é sem dúvida, a imensa despesa em saúde e um consumismo elevadíssimo. Obama prometeu criar, se fosse Presidente, a chamada "global healthcare coverage". Vai ser tudo, menos fácil.

Vejamos alguns detalhes desta "quadratura do círculo" de Obama:

• A Associação de Médicos dos Estados Unidos da América terminou hoje a reunião anual, em Chicago, sem definir uma posição sobre a reforma de saúde que o presidente Barack Obama pretende instalar. Os delegados da Associação, a maior do país com 250 mil membros, acordaram hoje apoiar alternativas ao actual sistema de saúde através de uma reforma mas não referiram nenhuma opção concreta.
• A opinião da Associação de Médicos é fundamental para o êxito ou fracasso da iniciativa de Obama, que pretende iniciar a reforma de saúde ainda este ano e que está a recolher apoios junto da indústria e dos críticos tanto republicanos como democráticos.
• A Associação, que rejeitou recentemente um plano público que concorria com as seguradoras privadas, comprometeu-se apresentar uma reforma de saúde que garanta a todos os norte-americanos uma cobertura dos serviços sanitários acessível e de qualidade.
• "A situação é insustentável para as famílias, as empresas e o governo. Os EUA gastam....quase 50 por cento a mais por pessoa do que o segundo país com maior despesa na saúde (...) Mesmo assim, temos cada vez mais cidadãos sem seguro, a qualidade do serviço tem-se deteriorado a população não está mais saudável", afirmou Obama.
• Obama pretende reduzir as despesas de saúde e alargar a cobertura dos cuidados médicos a 46 milhões de norte-americanos que continuam excluídos (cerca de 15 por cento da população).

Lembramo-nos logo daquele filme "Os Deuses devem estar loucos". E porquê? Porque, se Obama conseguir fazer esta reforma, ficará na História dos EUA ao lado de Roosevelt, Reagan ou Lincoln. De outra forma, vai ficar muito mal visto!

Aguardemos.

Ofertas a desempregados

O tempo que corre é parco em emprego. Tenta-se, através de paliativos, criar algum conforto aos desempregados. Não será o caso disto: The world's biggest drugmaker said Thursday it will give away the medicines for up to a year to Americans who lost jobs since Jan. 1 and have been on the Pfizer drug for three months or more. The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer's top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence.

Maravilhas da ciência

Legenda: antes da tentativa de homicídio.

Legenda: depois da cirurgia.

Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a dead woman. Connie Culp stepped forward Tuesday to show off the results of the nation's first face transplant, and her new look was a far cry from the puckered, noseless sight that made children run away in horror.

Ofertas: boas práticas precisam-se

A polémica relacionada com as ofertas a clientes ou prescritores é muito antiga. Em vários sectores de actividade. Naturalmente, que os mais polémicos são os que geram maior volume de negócio. Os sectores farmacêutico e de equipamento médico têm gerado polémica por estarem muitas vezes ligados a formas mais ou menos inadequadas de "incentivos à compra", para não lhe chamar outra coisa.

Nos EUA, o Congresso prepara-se para mudar a legislação por proposta da própria comunidade médica. Vejamos:

• the nation’s most influential medical advisory group said doctors should stop taking much of the money, gifts and free drug samples they routinely accept from drug and device companies.
• “It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy,”
• The report calls on Congress to pass legislation that would require drug and device makers to publicly disclose all payments made to doctors.

Ora bem, o combate às más práticas deve partir daqueles que têm uma visão ética e de princípios da vida. E claro, o poder político deve apoiar e liderar este tipo de iniciativas.

E por cá? Espera-se que as Faculdades de Medicina ou a Ordem dos Médicos venham a solicitar ao Parlamento alguma iniciativa que limite ou impeça a oferta de bens por parte das farmacêuticas ou das empresas de equipamentos médicos aos médicos? Seria bom, que assim acontecesse.

EUA: viver sem cuidados de saúde

Fonte: aqui.

Nos EUA, os Deuses estão loucos

Quando lemos isto: Healthcare costs doubled from 1996 to 2006, and are projected to rise to 25 percent of GDP in 2025; 49 percent by 2082 if something does not change. Percebemos, que algo está muito errado na sociedade ocidental. Há com certeza muita gente equivocada, quando organismos públicos estimam que os custos com a saúde poderão representar cerca de 50% do produto de uma economia! Ainda que estejamos a imaginar o não tão longinquo ano de 2082!

Talvez porque estes organismos públicos apenas conjecturam cenários loucos, há alguém que sente necessidade de mudar as coisas: Reform of the U.S. healthcare system is vital this year because of growing costs and worsening care, the Health and Human Services Department said in a report on Monday.

É que os EUA atingem sempre cenários inimagináveis para os outros:

• The report points out that the United States spent $2.2 trillion on healthcare in 2007, or $7,421 per capita. Healthcare accounts for more than 16 percent of gross domestic product, nearly twice the average of other developed nations.
• "In spite of the vast resources invested, the health care system has not yet reached the goal of high-quality care," the report said.
• "Across 37 performance indicators, the United States achieved an overall score of 65 out of a possible 100," it said, citing the non-profit Commonwealth Foundation.

Do or die, parece ser a opção do Presidente Barack Obama.

Obama e o universal healthcare II

O Presidente Obama trouxe muita esperança. O Presidente Obama está em estado de graça. Aguardemos.

Uma das principais esperanças que Obama trazia, tinha que ver com os cerca de 45 milhões de Americanos excluídos de um serviço de saúde universal. Ainda assim, os EUA gastam cerca de 17% do seu PIB em saúde. Ou seja, Obama prometeu trazer serviços de saúde a quem não os tinha.

Vejamos, o que nos dizem as últimas notícias:

• President Barack Obama will ask Congress to set aside $634 billion over 10 years to help pay for an overhaul of the nation’s health-care system.
• About half the money will come from cost cuts in the Medicare and Medicaid programs and the other half from tax provisions.
• The tax changes would limit deductions for wealthy tax payers.
• “The cost of our health care has weighed down our economy and the conscience of our nation long enough,” Obama told a joint session of Congress.
• Obama has set a goal of reducing the nation’s spending on health care and getting more of the nation’s uninsured covered.

Disse o Poeta, que "o sonho comanda a vida". Contudo, não acreditamos em milagres, sejam de que tipo forem. No país em que se gasta mais em serviços de saúde, o Presidente Obama quer aumentar o nível de serviços aos que não os têm, e simultaneamente reduzir os custos globais de saúde.

A quadratura do círculo!

Os orçamentos da saúde

A despesa em saúde representa cerca de 10% do PIB da generalidade dos países desenvolvidos (nos EUA, já representa quase 18% do PIB). É muito? É pouco? Há pessoas que dizem que a saúde não tem preço! Será que não tem? Será que não tem que se impor um limite aos gastos com a saúde?

Vejamos o que por aqui se escreve:

• The American hospital is a 19th-century cottage industry in the postmodern world. The problem is not medical or technological.
• The first problem is correcting wasteful and dangerous management practices before extending coverage to more patients. Knowledge exists to transform every hospital in the country to deliver higher quality care and in so doing substantially reduce costs and save lives.
• Extending health care to more people without correcting the antiquated delivery system doesn’t make sense.
• In fact, two large hospitals systems — in Pittsburgh and across the Midwest — cut costs in half and significantly reduced hospital-acquired infections and medical and medication errors.
• This solution of continually improving patient care was based on the Toyota management system. The hospital managements created an environment — without blame — where their employees could learn and practice continual improvement of their processes, systems and themselves in pursuit of “perfect patient care.”

O próximo Presidente dos EUA, Barack Obama, prometeu uma cobertura de saúde alargada, tendo em vista dar mais saúde àqueles que não têm dinheiro para comprar uma apólice de seguro de saúde. Mas, como se diz acima, se alargar a cobertura de saúde, sem racionalizar custos, vai apenas transformar um grande problema, na falência do Estado Americano!

Atenção aos Consultores Médicos

Correia de Campos levantou há alguns dias, a possibilidade da existência de conluios entre Consultores médicos, em funções de avaliação de medicamentos e simultaneamente em colaboração com laboratórios farmacêuticos.

Nos EUA, a Eli Lilly, um dos maiores laboratórios do mundo, vai iniciar uma nova política de publicação dos valores que paga aos seus Consultores, que são sobretudo médicos:

• In an industry first, Eli Lilly and Co. says it will begin disclosing how much money it paid to individual doctors for advice, speeches and other services.
• The drug company's move comes as members of Congress push a disclosure bill in an effort to prevent such payments from improperly influencing medical decisions.
• Beginning next year, Eli Lilly will disclose payments of more than $500 to doctors for their roles as advisers and for speaking at educational seminars. In later years, the company will expand the types of payments disclosed to include such things as travel, entertainment and gifts.
• Some have voiced concerns that doctors are influenced by these payments in their treatment decisions and that this in turn can drive up medical bills. Although most physicians believe that free lunches or trips have no effect on their medical judgment, research has shown that these type of payments can affect how people act.

Ora bem, poderemos estar perante uma revolução na prática do exercício clínico, nomeadamente na forma como os médicos processam a sua decisão face a medicamentos alternativos. Não significa isto, que se vá eliminar até à eternidade as eventuais ligações perigosas que possam existir. Mas, os seres humanos devem tentar buscar em cada momento, servir mais os cidadãos e procurar menos formas ilícitas, ainda que subreptícias de ganhar dinheiro rápido, como se diz aqui:

• "The ethical handwriting is on the wall. Disclosure is coming. States are pushing for it, and once a few states do, it's hard to imagine the federal government won't line up behind," said Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "I think that's a good thing because we have a great deal of empirical evidence that gift giving can influence behavior in terms of prescriptions, publishing positive findings but suppressing negative findings, and generating enthusiasm for new drugs."

O acesso facilitado aos medicamentos

Não sabemos o que se passa em Portugal, sobre o acesso a medicamentos sob prescrição. Nos EUA, a situação não é boa, sobretudo tendo em conta que muitos dos que acedem aos medicamentos são jovens e podem utilizá-los com fins não desejáveis.

Vejamos o que aqui nos dizem:

• A growing number of teenagers say it's easier to illegally obtain prescription drugs than to buy beer, according to a survey published today.
• The National Center on Addiction and Substance Abuse at Columbia University asked: "Which is easiest for someone your age to buy: cigarettes, beer, marijuana, or prescription drugs such as OxyContin, Percocet, Vicodin or Ritalin, without a prescription?" Nineteen percent of teenagers found it easier to purchase prescription drugs than cigarettes, beer or marijuana, compared with 13 percent a year ago.

Mas, o pior é que os jovens têm uma confiança excessiva nos medicamentos: "Kids think that because these are medicines that are prescribed, they are safe," she said. "The problem is that there is very little difference between the amount they take for a high and the amount that causes an overdose."