In the documentary US Healthcare: the Good News, we learn that there is such a thing as unneeded care and it raises the costs of healthcare much more than it needs to be. The documentary follows several communities that have managed to give its people high quality healthcare for low costs.
The Darthmouth Atlas of Healthcare is a record of variations in US healthcare. It uses Medicare data to follow the differences between healthcare and costs in various communities in the US. Put simply, it is, as the name tells us, an atlas of healthcare. This atlas started as the Dartmouth project when Dr. Jack Wennberg was sent to study the places in Vermont that weren't getting enough medical care but instead found variations between treatment and costs in Vermont's communities. This was evidence that in healthcare, the bigger the number of doctors in an area, the bigger the number of doctor visits. So all around the country, treatments are being given to patients who don't need them and the healthcare system is paying for these unnecessary treatments.
I believe healthcare is a privilege rather than a right. A right is something that we as individuals just get without the permission/concern of others. A privilege is a special right granted by someone or a group of people. Access to healthcare is not a right because it involves more than our individual selves. Some parts of health can be taken care of individually but most parts require the help/advice of a physician. If we say healthcare is a right, then in getting a physician's help, we are including other human beings in our right. We are saying that this doctor and that doctor has a right and an obligation to help us when in fact, they only have a moral duty to help us. I believe something is only a right when it doesn't interfere in other people's rights. At the same time, access to healthcare is a privilege because when we are able to see a doctor that is willing to treat us, it becomes a special right that a doctor and an insurance company grants. Many people in America do not receive help from their insurance companies and in turn, their doctor. They are not given this privilege. In various places in Africa, some people are allowed the privilege of seeing a doctor and others are without that help. If access to healthcare were a right, then everyone would get it without help from anyone but since that is impossible, it becomes a privilege that has to be granted with the help of someone else.
Many communities in the US are creating a good balance between healthcare and costs using various methods. The doctors in Grand Junction, Colorado decided that every patient they get should pay the same fee for the same treatment. Even though this makes sense, it was found that all over the US, different patients pay different fees for the same treatment. Grand Junction is one of the few communities that does not do this and the results have been favorable to them. The hospital, GroupHealth, in Seattle, Washington is also doing its best for high quality health with low costs. GroupHealth uses the Patient Centered Medical Home where doctors organize their day around the schedule of their patients and since doctors are paid salaries, they don't have to worry about their income being affected. It's easier for doctors and patients to access medical records since all medical records are electronic. GroupHealth also uses virtual medicine to help treat patients and that increases patient doctor time and they try to treat patients before they become sick. Another place that balances healthcare and costs is The Everette Clinic in Everette, Washington. Some of their methods includes taking out unneeded treatments and unneeded pharmaceuticals. This way, they save money without risking their patient's health. The Providence Regional Medical Center also cuts costs and provides quality healthcare through blood transfusions. They found that many patients who do not need blood transfusions get them so they worked to lower the number of transfusions given to patients. One last place that follows the low cost, quality health mission is the Dartmouth-Hitchcock Medical Center. Here, the doctors involve the patients in treatments choices. In doing this, they decrease the number of unneeded treatments and make their patients much happier.
I am from Baltimore city and I think that the way medical care is delivered in the places in the documentary can be duplicated in my area. Baltimore has some of the highest rates of violence and crime in the US which equals more doctor/emergency room visits.In Baltimore city especially, many of the residents cannot afford to pay very much for healthcare so getting better quality health for low cost would be really beneficial to the people who need it and to Baltimore as a whole. One reason I believe this has not occurred already is because of lack of information or disbelief in available information. Many of the physicians in Baltimore City, would need to come together believing that in lowering costs in various areas of healthcare , there would be more benefits than losses to them.
Saturday, February 23, 2013
Saturday, February 16, 2013
Vaccine Wars
The Vaccine War is a film about the pro side and the con side of vaccinations. The film analyzes the oppositions against vaccines and works to counter the arguments that are turning people's positive views of vaccines negative. The recommendations of many health agencies like FDA, the CDC, the NIH, and more are being ignored because more and more parents and adults are becoming hesitant when it is time to give their children and themselves vaccines. Even though study after study is used to disprove the allegations against vaccinations as well as to prove the effectiveness and benefits of vaccines, people are still more likely to listen to celebrities and the media (rather than health officials) when it comes to the health of their children.
When a large portion of a population is vaccinated for a certain disease and that population has gained immunity against that disease, the population that has not been vaccinated benefits from a certain amount of immunity as well. In a community where most of its population is vaccinated against a contagious disease, the disease would have a difficult time spreading if it keeps moving to a person that has developed immunity. As a result, the disease could be eradicated before it has the chance to move to a person who is not vaccinated. This is called herd immunity. The importance of vaccines increases when faced with benefits like this. As long as a large percentage of the public is vaccinated, there can be less and less incidences of many of the diseases that are still around.
There are many personal health decisions that people make everyday like going to see a physician yearly, seeking health care when it's needed, and maintaining good health (emotional, mental, physical, etc.). Vaccination is another personal health decision. However, it is different from most other health decisions because of the way it can affect the general public. When a person makes the decision to not see their physician or not have a good diet, they are the only one who will be affected. In some cases, they and a small number of people (family and friends) will be affected. On the contrary, when one person refuses to get vaccinated for a contagious disease, a large number of people (from a small community to even a whole country) could potentially be affected depending on the level of immunity of the population involved. Children are to young to make sound health decisions for themselves so the adults around them are given that task. Guardians and physicians should be involved in deciding whether children receive specific vaccines; the guardians because they have sole responsibility over a child's life and welfare, and the physicians because they understand more about what specifically should be done to keep children healthy.
Children may sometimes not receive the recommended immunizations for several reasons. Two of many important reasons are parents and the healthcare system. There are many parents today that believe it is safer for their children to not get vaccines and others who believe that their children will not be affected whether they get their vaccines or not. Parents who think like this add to the number of children that are not vaccinated. Healthcare systems also contribute to this problem in various ways. One way is through insurance companies. There are some individuals that do not have health insurance and others who do not receive the best care from their insurance companies. People who do not have health insurance find it easy to tell themselves that they do not need vaccines because they cannot afford it. Sometimes, health insurance companies do not cover the costs people need to get care from their physicians so people have no choice but to skip their vaccinations.
As a policymaker, I would first make it so that all schools, public and private, require that children receive certain vaccinations before entry into schools. While most schools already have rules about vaccinating children before they can be enrolled, not all schools are like this. Another thing I would do is increase public understanding of the benefits of receiving vaccinations. If the public is aware of the importance of vaccinations, more people would willingly get vaccinated. I would make use of the media to spread this awareness.
When a large portion of a population is vaccinated for a certain disease and that population has gained immunity against that disease, the population that has not been vaccinated benefits from a certain amount of immunity as well. In a community where most of its population is vaccinated against a contagious disease, the disease would have a difficult time spreading if it keeps moving to a person that has developed immunity. As a result, the disease could be eradicated before it has the chance to move to a person who is not vaccinated. This is called herd immunity. The importance of vaccines increases when faced with benefits like this. As long as a large percentage of the public is vaccinated, there can be less and less incidences of many of the diseases that are still around.
There are many personal health decisions that people make everyday like going to see a physician yearly, seeking health care when it's needed, and maintaining good health (emotional, mental, physical, etc.). Vaccination is another personal health decision. However, it is different from most other health decisions because of the way it can affect the general public. When a person makes the decision to not see their physician or not have a good diet, they are the only one who will be affected. In some cases, they and a small number of people (family and friends) will be affected. On the contrary, when one person refuses to get vaccinated for a contagious disease, a large number of people (from a small community to even a whole country) could potentially be affected depending on the level of immunity of the population involved. Children are to young to make sound health decisions for themselves so the adults around them are given that task. Guardians and physicians should be involved in deciding whether children receive specific vaccines; the guardians because they have sole responsibility over a child's life and welfare, and the physicians because they understand more about what specifically should be done to keep children healthy.
Children may sometimes not receive the recommended immunizations for several reasons. Two of many important reasons are parents and the healthcare system. There are many parents today that believe it is safer for their children to not get vaccines and others who believe that their children will not be affected whether they get their vaccines or not. Parents who think like this add to the number of children that are not vaccinated. Healthcare systems also contribute to this problem in various ways. One way is through insurance companies. There are some individuals that do not have health insurance and others who do not receive the best care from their insurance companies. People who do not have health insurance find it easy to tell themselves that they do not need vaccines because they cannot afford it. Sometimes, health insurance companies do not cover the costs people need to get care from their physicians so people have no choice but to skip their vaccinations.
As a policymaker, I would first make it so that all schools, public and private, require that children receive certain vaccinations before entry into schools. While most schools already have rules about vaccinating children before they can be enrolled, not all schools are like this. Another thing I would do is increase public understanding of the benefits of receiving vaccinations. If the public is aware of the importance of vaccinations, more people would willingly get vaccinated. I would make use of the media to spread this awareness.
Saturday, February 9, 2013
Non-Smoking Wives of Heavy Smokers
The effects of second hand smoking have been proven to be highly
dangerous in various studies. Cigarette smoke includes many toxic substances that
reach even people who don’t smoke so it makes sense that many of the
non-smokers associated with heavy smokers are affected by these substances. Takeshi
Hirayama decided to study the effect of husbands smoking on the risk of lung
cancer in their non-smoking wives. 29 health centre districts in Japan
interviewed and followed 265,118 adults over 40 years old to study the
consequences of several health risk factors like alcohol and cigarettes on
health. During 14 years of follow up, it was found that out of 346 lung cancer
related deaths, 174 of the deaths were of non-smoking wives.
Results showed that heavy smoking in husbands did not have
much effect on the non-smoking wives’ risk of developing some cancers like
stomach or cervix cancer, but the risks of getting illnesses like emphysema and
asthma were higher among the same wives. There seemed to be no correlation
between other health risk factors like alcoholism and the risk of non-smoking
wives getting lung cancer. Surprisingly, the data gathered also showed that
non-smoking wives of heavy smokers who work in agriculture was higher than with
husbands who do not work in agriculture. Most importantly, the results showed
that non-smoking wives of heavy smokers did in fact have a higher risk of
developing lung cancer than wives of non-smokers.
I found it really interesting that agriculture and location
of a family became such an important variable in the course of the experiment. Since
the study was focused on smoking in non-smoking wives, I expected variables
that could be easily matched with smoking like whether the type of smoking
involved was passive or direct. It amazed me that during the course of an
experiment, variables like agriculture and whether a family is urban or rural
were noticed. It made sense in the end that since wives of husbands who work in
agriculture spend more time with their husbands, their risks for getting lung
cancer was higher than in the wives of husbands who do not work in agriculture.
The same logic applies to why non-smoking wives of heavy smokers in rural
families have a higher risk of getting lung cancer than those in urban
families.
The study design Takeshi Hirayama used included interviewing
and following a population and recording data using a record linkage system.
This study design made it possible for the Hirayama to have a high representation
in his study. With a high representation, he is able to generalize his results
to larger populations and that make his results more reliable. Since his
results are reliable, more people are likely to take the results of his study
seriously. In using a record linkage system, Hirayama was able to gather data in
a more convenient manner. Also, a record linkage system make it easier to put
data from different sources together and since the data was gathered from 29
different health centers, it made the results more united.
The results of this study do support second-hand smoke as a cause of lung cancer for many reasons. First of all, this study included a large population and that makes the results more valid than if the population was small. Also, there is a strong association already between smoking and lung cancer. The smoke from cigarettes contains toxic substances like carcinogens that have been proven to be involved in causing cancer. Even if non-smokers do not smoke, just inhaling the smoke raises their risk of cancer. Another reason that study supports second-hand smoke as a cause of lung cancer is that the results of this experiment are consistent with other experiments of this nature. There have been many studies that draw the same conclusions that Hirayama does. Even the American Cancer Society's website states clearly that secondhand smoke causes cancer.
Saturday, February 2, 2013
Binge Drinking Among Women and High School Girls
As the title shows, the article Vital Signs: Binge Drinking Among Women and High School Girls - United States, 2011 reviews the drinking habits of women and high school girls in 2011. It was found that during the years 2001 - 2005, binge drinking lead to many health and social complications such as unintentional injuries, heart disease, and alcohol dependence. Binge drinking also contributed to the numbers of sexually transmitted infections, miscarriages, etc. that was already prevalent in the United States. These complications usually ended with death. The article states that "reducing the prevalence of binge drinking among adults and youths is a leading health indicator in Healthy People 2020." In moving towards these goals, the CDC used data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS) and the 2011 national Youth Risk Behavior Survey (YRBS) to monitor binge drinking among women and high school girls.
BFRSS is a telephone survey system that works annually to collect information on the health of US civilians 18 years and older. The CDC's binge drinking analysis included 278,243 women in the United States. Binge drinking was defined by the CDC as women who had "four or more alcoholic drinks per occasion during the past 30 days." They found that the prevalence of binge drinking in women 18 years and older in 2011 was 12.5% and the frequency among these women was 3.2 episodes per month and 5.7 drinks per occasion. The prevalence among women 18 to 24 years old was 24.2% and the percentage increased with age. Women 18 to 24 years old also had the highest frequency and intensity of binge drinking: 3.6 episode and 6.4 drinks.
YRBS monitors health risk behaviors that may lead to death and disability among youth and adults through surveys. The analysis that the CDC collected from them showed that the prevalence of binge drinking among girls from grades 9 to 12 was 19.8%. In contrast to binge drinking among women, binge drinking among high school girls increased with grade.
Binge drinking is an important public health issue because it greatly affects the health of not only the people who consume alcohol, but also others who have any association (whether intentional or not) with drinkers. Just drinking alcohol to point of being drunk has high consequences like the accidents and deaths caused by drunk driving. Binge drinking can lead to even more serious problems for drinkers, like unintended pregnancies and the results of adverse reproductive health. There is greater exposure to alcoholic drinks due to marketing and the ease of obtaining them. As this exposure increases, so does mortality among youth and adults; those who drink as well as those who do not.
Although I am sure the results from the BFRSS and the YRBS are not totally representative, they still do not surprise me. The survey method has many advantages that make it possible to have current data but it also has disadvantages that take away from the reliability of the results. In using national telephone and paper surveys, the BFRSS are able to reach more people in the whole of the US than they would have in any other way. They also decrease the risks of experimenter bias and are more efficient that any other experiment method. However, the data gathered may not be very reliable since it depends on the honesty of the surveyors. These results also suffer from recall bias since the surveys require the surveyors to recall information that is at least a month old. Alcohol affects memory among other things, so a person may only recall drinking 3 times when in fact, they drank 6 times.
To reduce the prevalence of binge drinking in college and high school students, I would make sure that the dangers are emphasized more in their surroundings: classrooms, school buildings, dorms, etc. I would also appeal to them through ads available in social media. Lastly, since people are more responsive to warnings that relate to them, I would try to address risk factors that are more common in certain areas. For example, in an area where unplanned pregnancies are more common, I would put up posters showing the correlation between binge drinking and unplanned pregnancies.
BFRSS is a telephone survey system that works annually to collect information on the health of US civilians 18 years and older. The CDC's binge drinking analysis included 278,243 women in the United States. Binge drinking was defined by the CDC as women who had "four or more alcoholic drinks per occasion during the past 30 days." They found that the prevalence of binge drinking in women 18 years and older in 2011 was 12.5% and the frequency among these women was 3.2 episodes per month and 5.7 drinks per occasion. The prevalence among women 18 to 24 years old was 24.2% and the percentage increased with age. Women 18 to 24 years old also had the highest frequency and intensity of binge drinking: 3.6 episode and 6.4 drinks.
YRBS monitors health risk behaviors that may lead to death and disability among youth and adults through surveys. The analysis that the CDC collected from them showed that the prevalence of binge drinking among girls from grades 9 to 12 was 19.8%. In contrast to binge drinking among women, binge drinking among high school girls increased with grade.
Binge drinking is an important public health issue because it greatly affects the health of not only the people who consume alcohol, but also others who have any association (whether intentional or not) with drinkers. Just drinking alcohol to point of being drunk has high consequences like the accidents and deaths caused by drunk driving. Binge drinking can lead to even more serious problems for drinkers, like unintended pregnancies and the results of adverse reproductive health. There is greater exposure to alcoholic drinks due to marketing and the ease of obtaining them. As this exposure increases, so does mortality among youth and adults; those who drink as well as those who do not.
Although I am sure the results from the BFRSS and the YRBS are not totally representative, they still do not surprise me. The survey method has many advantages that make it possible to have current data but it also has disadvantages that take away from the reliability of the results. In using national telephone and paper surveys, the BFRSS are able to reach more people in the whole of the US than they would have in any other way. They also decrease the risks of experimenter bias and are more efficient that any other experiment method. However, the data gathered may not be very reliable since it depends on the honesty of the surveyors. These results also suffer from recall bias since the surveys require the surveyors to recall information that is at least a month old. Alcohol affects memory among other things, so a person may only recall drinking 3 times when in fact, they drank 6 times.
To reduce the prevalence of binge drinking in college and high school students, I would make sure that the dangers are emphasized more in their surroundings: classrooms, school buildings, dorms, etc. I would also appeal to them through ads available in social media. Lastly, since people are more responsive to warnings that relate to them, I would try to address risk factors that are more common in certain areas. For example, in an area where unplanned pregnancies are more common, I would put up posters showing the correlation between binge drinking and unplanned pregnancies.
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