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Health Headlines - February 25

Posted Oct 23 2008 2:23pm
U.S. Health-Care Costs to Top $4 Trillion By 2016

Federal forecasters predict that U.S. health-care spending will double by 2016, to $4.1 trillion per year.

That's one-fifth of the nation's gross domestic product (GDP).

Health spending in 2006 was projected at $2.1 trillion, or 16 percent of the GDP.

"There is a relatively modest and stable projection for 2006 to 2016, with an average growth rate of 6.9 percent," John Poisal, deputy director of the National Health Statistics Group at the Centers for Medicare and Medicaid Services (CMS), said during a Tuesday teleconference. He noted that with projected growth rates falling slightly in 2006 and 2007, "that would result in five consecutive years of slowing growth."

But the projected decelerations didn't impress outside experts.

"We haven't solved the health-care cost problem," stated Karen Davis, president of the Commonwealth Fund. "There was a lot of feeling when the 2006 numbers came out and we were growing at about 7 percent a year, that maybe it wasn't a continuing problem. But, I think even growing at 7 percent a year you see that by 2016 we are going to be spending 20 percent of the nation's economy on health care. I think it says we've got to get serious about doing something that really improves the efficiency of the health-care system and not just shifting money."

Here are other highlights from the report, prepared by CMS actuaries and Medicaid Services and appearing in today's online edition of Health Affairs:

  • Medicaid spending is expected to reach $313.5 billion in 2006, about the same as in 2005.
  • Medicaid drug spending is projected to drop 36 percent between 2005 and 2006 as low-income recipients who also are eligible for Medicare start receiving drug coverage through the new Part D program.
  • With the addition of Part D, total Medicare spending growth is expected to reach $417.6 billion in 2006, up from $342 billion the year before. Medicare spending growth is expected to slow to 6.5 percent in 2007, partly due to legislated cuts in payments to managed-care plans and to physicians. By 2016, Medicare spending is expected to more than double, reaching $862.7 billion.
  • U.S. prescription drug spending should reach $497.5 billion by 2016, more than double the expected level for 2006. Prescription drug spending will grow at an average annual rate of 8.6 percent until 2016.
  • The cost of hospital care is expected to climb to more than $1.2 trillion by 2016, vs. $651.8 billion expected for 2006. The growth rate for hospital spending is expected to slow, from 7.9 percent in 2005 to 6.6 percent in 2006.
  • In 2006, consumers are expected to spend slightly less than 1 percent more in out-of-pocket ($250.6 billion) health-care costs. The total spent will reach $440.8 billion by 2016, however. In 2005, an individual spent an average of $850.02 on health care and in 2006 they are projected to spend $846.50. In 2016, the average spent will be $1,405.73, although that number is not adjusted for inflation, officials said.
  • Private health insurance premiums are expected to grow 4.4 percent in 2006, down from a high of 11 percent in 2002.
  • Growth in total physician and clinical spending is expected to slow from 7 percent in 2005, to 6.1 percent in 2006.
  • Growth in nursing home spending is also expected to slow, from 6 percent in 2005 to 3.4 percent in 2006, largely as a result of slowing Medicaid and Medicare spending.
  • Home health spending is likely to rise 1.4 percentage points to 12.5 percent in 2006, or $53.4 billion. This would make it the fastest growing area of health care.

Many of the changes reflect cost shifting, Davis said.

"They're trying to deflect costs onto other parties," she said. "What we really need is a transformation of the health-care system that gives us value for the money we're spending. We clearly have to do something about the underlying rising health costs that affect everyone."


Many Stroke Patients Affected by Hospital Errors

Hospital procedures need to be modified to reduce the risk of medical errors and adverse events in stroke patients, U.S researchers say.

A new study found that 12 percent of stroke patients had suffered adverse events during treatment.

Researchers analyzed data on 1,440 stroke patients admitted to Strong Memorial Hospital at the University of Rochester Medical Center between July 2001 and December 2004.

Of those 1,440 patients, 173 (12 percent) suffered a total of 183 adverse events, defined as an injury to a patient during medical management. Adverse events are not necessarily the result of a medical error, which are incorrect actions or plans that may harm a patient.

Of those 183 adverse events, 86 were preventable, 37 were not preventable, and 60 were indeterminate, the study said.

Of the 86 preventable adverse events, 37 percent were transcription/documentation errors, 23 percent were failure to perform a clinical task, 10 percent were communication/handoff errors between health providers, and 10 percent were failed independent checks/wrong calculations.

"Although most patients who experienced a preventable adverse event were not seriously harmed, adverse events do lead to temporary discomfort, longer hospital stays, and, in some cases, serious injury or the potential for legal action," study author Dr. Robert G. Holloway, of the University of Rochester Medical Center, said in a prepared statement.

"If these figures were applied to the nearly 1 million patients admitted to U.S. hospitals each year for stroke, 50,000 to 100,000 patients may experience an adverse event related to an error," he said.

The study is published in the Feb. 20 issue of Neurology.


Health Tip: What Happens During Coronary Bypass Surgery?

When arteries become blocked by fat, cholesterol and other substances, blood flow to the heart is blocked.

Coronary bypass surgery sidesteps the blockage from these substances -- collectively called plaque -- and restores blood flow to lessen a person's risk of heart attack.

Here's are two possible ways to accomplish a coronary bypass, courtesy of the American Heart Association:

  • An artery is detached from the chest wall and the loose end attached to the coronary artery below the blockage.
  • A section of a long vein in the leg is removed and sewn (grafted) onto the large vessel that leaves the heart called the aorta. The other end is attached to the coronary artery below the blockage.

Either of these methods will allow blood to follow a new path, bypass the clogged portion of an artery, and restore a free flow to the heart.


Health Tip: Signs of Binge-Eating Disorder

Binge eating occurs when a person habitually overeats.

A person with the disorder often eats quite rapidly, may not stop eating when they are full, and usually feels unable to stop.

These actions often are a response to stress, anger or being emotionally upset, the Nemours Foundation says.

The foundation offers this list of common warning signs:

  • Eating very quickly.
  • Eating until extremely full or uncomfortable.
  • Eating large amounts when not hungry.
  • Being too embarrassed to eat around other people, or eating alone.
  • Feeling guilty or disgusted after binge eating.
  • Excessive weight gain.

Words Can Help the Healing

For years, Harvard researcher Susan Bauer-Wu has worked with people struggling with a dreaded diagnosis -- cancer.

Many turn to support groups, psychotherapy or antidepressant drugs to help them cope with the fears and challenges the illness brings.

Her team offers them a pen and paper.

Those are the only tools required for a simple, increasingly popular intervention called "expressive writing" or "journal therapy."

The research suggests that by spending 30 minutes each day for four days to write out their innermost thoughts and feelings, patients can significantly boost mental and physical health.

And experts say nearly everyone who tries journal therapy stands to benefit.

"Many people are so surprised at how it really works," said Bauer-Wu, director of the Cantor Center for Nursing and Patient Care Research at the Dana Farber Cancer Institute in Boston. "Even people who were reluctant to do it, who say, 'I'm not a good writer, I can't write well, or I don't like to.' They'll go through the process and have that 'A-ha' moment. They'll tell us -- 'Wow, I never realized this about myself, or about this disease -- it just came out onto the paper.' "

Expressive writing therapy is just that: Patients are encouraged to express whatever is on their mind, letting their hopes and fears flow out in a natural, unrestrained way. It's akin to keeping a journal, but more focused on the things that might be bothering you or triggering stress.

"We tell them, 'Don't worry about the punctuation, the words, just go with the process,' " Bauer-Wu said. "We also encourage them to build on whatever they have written before."

The result, for many patients, is a kind of catharsis -- a release and articulation of issues bottled up inside -- and also a healthy coming to terms with some of those issues.

"It's about stepping back and thinking about things in a different way, making linkages," explained Dr. Robin Fivush, a professor of psychology at Emory University, in Atlanta. She's conducted her own research on expressive writing.

"It's not just about expressing the emotion, because then you'd just ruminate on it," she said. "If you take a close look at those who benefit from it most, you see a lot of them using what we call 'cognitive processing' words -- 'I realize, I understand, now I see that.' "

Insights like these appear to help patients with cancer or other illnesses cope better, studies suggest. "I just read one review article that contained over 140 studies on this subject, and it seems very effective," Fivush said.

Bauer-Wu has conducted three studies of her own, tracking the effects of journal therapy for patients with breast and other cancers. She noted that while the classic program involves 30 minutes per day of writing for four days, cancer patients "may require more than that."

"In my work, we do a four-day intervention, but then repeat it a month later and then a month later again," she said. Patients can write using a pen and paper or computer. Surprisingly, about half of younger, computer-savvy participants in one study opted to handwrite their journal entries. "What's most important is that you find that place each day where you can most freely write," Bauer-Wu said.

"One of the things that's been found in cancer patients across different studies is what we call 'improvements in health-care utilization,' " she said. "Patients end up going to their doctor or calling nurses less frequently. They need fewer sessions with a mental health counselor. Basically, they are having fewer physical symptoms and coping better."

Indeed, there's data that suggest that writing out your emotions eases stress and, in turn, boosts the immune system. "We're not sure how that might work," Fivush said.

She added that the therapy does work better for some patients than for others. Preadolescent children, especially, will probably not benefit. "We think that they may not have the cognitive or emotional skills [at that age] to work through things on their own," Fivush said.

According to Bauer-Wu, patients who are solitary and private by nature may benefit the most.

"There's a lot of hype about support groups, but we know that some people just aren't 'talkers,' " the Boston researcher said. "To me, expressive writing is a wonderful alternative for these people. It gives them a way to express their feelings and process what's going on in their minds."

It's important to note that patients who engage in journal therapy don't write with any intended audience in mind. In most cases, according to experts, they don't even have to read back their own journal entries to benefit. "It's the act of writing that seems to be important," Fivush said.

And, as treatments go, expressive-writing therapy is cheap. "Obviously, there's nothing fancy or high-tech that's required, and you don't need to spend money on a therapist," Bauer-Wu pointed out.

"It's right there, it's self-care," she said. "People can heal themselves."


Pregnancy Hormone May Ease Multiple Sclerosis

A hormone produced during pregnancy may benefit multiple sclerosis patients, a Canadian study finds.

Multiple sclerosis (MS) affects about 2.5 million people worldwide. It occurs when the body's immune system attacks myelin, which insulates nerve cells and plays a critical role in the transmission of messages from cell to cell. Reductions in myelin lead to a progressive loss of sensation and movement in MS patients.

Interestingly, MS goes into remission when women get pregnant. Since prolactin is a hormone that is produced during pregnancy, the researchers sought to determine if prolactin was the reason behind MS remission during pregnancy.

"It was thought that during pregnancy, [women's] immune systems no longer destroyed the myelin," study author Samuel Weiss, of the Hotchkiss Brain Institute of the University of Calgary, said in a prepared statement. "But no previous study has tested whether pregnancy actually results in the production of new myelin, which may explain improvement of symptoms," he said.

In the study, published in the Feb. 21 issue of the Journal of Neuroscience, researchers counted hundreds of cells in the brains and spinal cords of mice. They compared the cells in pregnant versus virgin female mice of the same age.

The team found that the pregnant mice had twice as many myelin-producing cells and continued to generate new ones during pregnancy. Even after giving birth, the once-pregnant mice had 50 percent more myelin coating their nerve cells.

The researchers also found that prolactin mimicked the effects of pregnancy, increasing both myelin production and repair in the mice.

If future research confirms the benefits of prolactin in animal models of MS, Weiss says the hormone will be ready for testing as a treatment for people with MS.

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