President's Health Care Agenda
The federal government has a responsibility to provide health care for the poor and the elderly, as well as confront its rising costs, strengthen the doctor-patient relationship, and help people afford insurance coverage, President Bush said in his State of the Union Address. Medical associations praised the president for calling medical liability reform a priority, and for his pledge to make broader use of electronic health records. “We applaud President Bush for calling on Congress to pass medical liability reforms this year,” Dr. J. Edward Hill, president of the American Medical Association, said in a statement. But Ron Pollack, executive director of the consumer group Families USA, noted that the president failed to mention the recent efforts by the White House and Congress to cut Medicaid funding. “These Medicaid cuts will drive many low-income seniors and children out of the system and leave millions of people without any health care coverage whatsoever.”
Health Care Spending 2004
Growth in U.S. health care spending slowed for the second straight year in 2004, increasing by only 7.9%, according to the Centers for Medicare and Medicaid Services' annual report on health care spending. This compares with an 8.2% growth rate in 2003 and a 9.1% growth rate in 2002. The report attributed slower growth in prescription drug spending as a contributor to this overall slowdown. In 2004, prescription drugs accounted for only 11% of the growth in national health care expenditures, a smaller share of the increase than in recent years. In a statement, the Pharmaceutical Care Management Association attributed the slowdown to increased reliance on generic drugs and mail-service pharmacies. Spending for physician services grew 9.0% in 2004, nearly the same as 2003's 8.6% increase. Hospital spending, by comparison, continued on its upswing, accounting for 28% of the growth in personal health spending between 1997 and 2000 and increasing to 38% by 2002–2004.
Foreign Drug, Wrong Drug
Filling prescriptions abroad may have adverse health consequences because of confusion about drug brand names, the Food and Drug Administration cautioned in an advisory. In an investigation, the agency found that many foreign medications, although marketed under the same or similar-sounding brand names as those in the United States, contain different active ingredients. For example, Norpramin is the brand name for the antidepressant desipramine in the United States. In Spain, the same brand name is used for a drug that contains the proton pump inhibitor omeprazole. The FDA also found 105 U.S. brand names with foreign counterparts which look or sound so similar that consumers who fill such prescriptions abroad may receive a drug with the wrong active ingredient. For example, in the United Kingdom, Amyben is the brand name for the antiarrhythmia drug amiodarone. In the United States, Ambien is the brand name for the hypnotic zolpidem.
Assessing Emergency Care
Emergency care provided in 80% of the states earned mediocre or near failing grades according to the first-ever National Report Card on the State of Emergency Medicine, conducted by the American College of Emergency Physicians. Overall, the nation's emergency medical care system received a grade of C-. Half the states provided less-than-average support for their emergency medical systems, earning poor or near-failing grades. No state received an overall A grade, although the highest overall B grades were given to California, ranked first in the nation, followed by Massachusetts, Connecticut, and the District of Columbia. Arkansas, Idaho, and Utah had the weakest systems, receiving the worst overall grade of D. Emergency care suffers from overcrowding, declining access, high liability costs, and a dwindling capacity to deal with public health or terrorist disasters, the report stated. “Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly this isn't the case,” said Dr. Frederick C. Blum, ACEP president. “In a nation that has prided itself on providing the highest-quality medical care in the world, anything less than an A is unacceptable.”
Evidence-Based Research
More cost-effectiveness studies are needed to evaluate public health interventions, according to Barbara K. Rimer, Dr.P.H., a member of the Task Force on Community Preventive Services who spoke at an audioconference sponsored by AcademyHealth, Washington. The task force is an independent, nonfederal group that was convened by the Department of Health and Human Services and is supported by staff from the Centers for Disease Control and Prevention and other public and private partners. Cost information is especially important as groups have to make decisions about scarce resources, she said. There are a number of areas where researchers can build on existing evidence-based public health research, said Dr. Rimer, who is also the dean of the school of public health at the University of North Carolina in Chapel Hill. For example, researchers should evaluate what are the most effective sites for public health interventions and which providers are more effective in delivering those interventions. There are also unanswered questions about the best duration for proven approaches such as disease screening, she said.