Programs Cut Smoking Rates
State tobacco control programs are effective at cutting adult smoking rates, according to a study by researchers at the Centers for Disease Control and Prevention and RTI International. The researchers were able to quantify the link between comprehensive tobacco control programs and a decrease in adult smoking, observing a decline in prevalence from more than 29% in 1985 to less than 19% in 2003. Among individual states, declines in adult smoking prevalence were directly related to increases in state per-person investments in tobacco control programs, they wrote. Such programs use educational, clinical, regulatory, economic, and social strategies to establish smoke-free policies and social norms, to help tobacco users to quit, and to prevent people from starting to smoke. The study was published in the February issue of American Journal of Public Health.
Individual Mandates Necessary
Unless the United States adopts a single-payer health system, it will not be possible to achieve universal coverage without a mandate that requires individuals to purchase health insurance, a report from the Urban Institute concluded. A system that encouraged but did not require people to get health insurance would tend to enroll disproportionate numbers of individuals with higher cost health problems, it said. This could create high premiums and instability in the insurance pools that enroll those individuals. In addition, the government would have difficulty redirecting current spending on the uninsured to offset some of the cost associated with a new program without universal coverage, the report noted.
Recertification Could Improve Care
The quality of care provided to patients with hypertension seems to erode as the time since the physician's last board certification increases, a study published online in Circulation found. Researchers analyzed treatment of more than 8,000 patients with hypertension and comorbid diabetes who were treated by 301 internists, and looked specifically at patient visits with documented blood pressure equal or greater to 130/85 mm Hg. They analyzed the association between the number of years since the physician's last board certification and the probability of pharmacologic antihypertensive treatment intensification at a given visit and found that frequency of treatment intensification decreased from about 27% for physicians who were board certified the previous year to about 7% for those who were board certified 31 years before the visit. For physicians recertified more than 10 years previously, the treatment intensification rate was about 22%, compared with 17% for those recertified in the last decade.
Part D Costs Drop
The projected cost of providing Medicare beneficiaries with a prescription drug benefit through private health plans has dropped again, according to the Centers for Medicare and Medicaid Services. CMS said in its fiscal year 2009 budget documents that the overall projected cost of the Part D drug benefit is $117 billion lower over the next 10 years than it estimated last summer. The difference results from the slowing of drug cost trends, lower estimates of plan spending, and higher rebates from drug manufacturers, CMS said. Compared with original projections, the net Medicare cost of the drug benefit will be $243.7 billion lower over the 10 years ending in 2013.
Patient Safety Goals Updated
The Joint Commission has released a preliminary version of its 2009 National Patient Safety Goals for hospitals and critical care facilities, and is seeking to add several new requirements to its list of priorities. According to the draft, the commission would like to add a requirement highlighting the need to eliminate transfusion errors related to patient misidentification. It would also add a requirement that acute care facilities implement best practices to prevent the spread of multiple drug-resistant organisms. Last, the draft specifies new requirements for using best practices to prevent catheter-associated bloodstream infections and surgical site infections and refines points to work toward the commission's goal of reconciling patient medications across the care continuum.
Top 10 Cost Half a Trillion
The nation's 10 most expensive medical conditions cost about $500 billion to treat in 2005, according to the Agency for Healthcare Research and Quality. Heart disease topped the list at $76 billion, with trauma second at $72 billion, and cancer third at $70 billion. Mental illness, including depression, cost $56 billion, and asthma and chronic obstructive pulmonary disease cost $54 billion. Hypertension cost $42 billion to treat, type 2 diabetes cost $34 billion, and osteoarthritis/joint diseases also cost $34 billion. Back problems and normal childbirth rounded out the list at $32 billion each. The agency counted money spent on office visits, clinic and emergency department use, hospital stays, home health care, and prescription medicines.