Jane Anderson

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in one self-employed company.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (Health Affairs 2010;doi:10.1377/hlthaff.2010.0808).

To measure medication adherence, the researchers estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month during 2006-2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with the control group.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared to the control group, the investigators wrote. The number of patients who were fully adherent rose by 20% immediately, compared with controls.

This type of value-based benefit design can improve compliance, but physicians and policymakers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Decreasing copayments from $50 to $30, for example, wouldn't make much difference, Dr. Gerdes said, because most patients can no more afford the $30 copayment than the $50 one. For a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

View on the News

Carrots and Sticks in Health Reform

One possible way to save health care dollars is to use tradeoffs in the form of higher cost-sharing for care deemed less essential, according to Marjorie Ginsburg.

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Ms. Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think.

If employers and insurers truly want to employ both the “carrot” of positive incentives and the “stick” of higher costs for services deemed lower-value, they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MS. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010[doi:10.1377/hlthaff.2010.0808]).

Major Finding: The U.S. compares poorly with 10 other industrialized nations when it comes to major indicators of access to care, including cost, difficulty paying medical bills, difficulty accessing needed care, and overall problems with health insurance.

Data Source: Survey of 19,700 adults in 11 countries by the Commonwealth Fund.

Disclosures: The study was supported by the Commonwealth Fund. No disclosures were reported.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost or have difficulty paying medical bills, according to a new 11-country survey.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries.”

But some of these disparities could be reversed as provisions of the Affordable Care Act begin to take effect, Karen Davis, president of the Commonwealth Fund, said in a telephone press briefing. “There could be some effects early on, but the big difference should show up in 2015 or 2016.”

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures − 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem in paying a health care bill, compared with 9% in France, the next highest on this measure.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

Major Finding: The U.S. compares poorly with 10 other industrialized nations when it comes to major indicators of access to care, including cost, difficulty paying medical bills, difficulty accessing needed care, and overall problems with health insurance.

Data Source: Survey of 19,700 adults in 11 countries by the Commonwealth Fund.

Disclosures: The study was supported by the Commonwealth Fund. No disclosures were reported.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost or have difficulty paying medical bills, according to a new 11-country survey.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries.”

But some of these disparities could be reversed as provisions of the Affordable Care Act begin to take effect, Karen Davis, president of the Commonwealth Fund, said in a telephone press briefing. “There could be some effects early on, but the big difference should show up in 2015 or 2016.”

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures − 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem in paying a health care bill, compared with 9% in France, the next highest on this measure.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

Major Finding: The U.S. compares poorly with 10 other industrialized nations when it comes to major indicators of access to care, including cost, difficulty paying medical bills, difficulty accessing needed care, and overall problems with health insurance.

Data Source: Survey of 19,700 adults in 11 countries by the Commonwealth Fund.

Disclosures: The study was supported by the Commonwealth Fund. No disclosures were reported.

Adults in the United States are far more likely than those in 10 other countries to go without health care due to cost or have difficulty paying medical bills, according to a new 11-country survey.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries.”

But some of these disparities could be reversed as provisions of the Affordable Care Act begin to take effect, Karen Davis, president of the Commonwealth Fund, said in a telephone press briefing. “There could be some effects early on, but the big difference should show up in 2015 or 2016.”

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription due to the costs involved. Germany and Australia also scored poorly on those measures − 25% of Germans and 22% of Australians reported going without care due to costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem in paying a health care bill, compared with 9% in France, the next highest on this measure.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study. Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000–$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings.

“There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured. The agency found that “half of the uninsured are nonpoor,” Dr. Frieden said.

About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, noted Dr. Frieden.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report.

For those aged 18–64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forgo needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

About 16% of currently insured people in that same age group who had a 1- to 3-month coverage gap during the preceding year reported not having a usual source of care, and 26% reported delaying needed care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“People who are uninsured are much less likely to have a regular doctor,” said Dr. Frieden.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes, he said.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000–$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings.

“There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured. The agency found that “half of the uninsured are nonpoor,” Dr. Frieden said.

About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, noted Dr. Frieden.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report.

For those aged 18–64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forgo needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

About 16% of currently insured people in that same age group who had a 1- to 3-month coverage gap during the preceding year reported not having a usual source of care, and 26% reported delaying needed care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“People who are uninsured are much less likely to have a regular doctor,” said Dr. Frieden.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes, he said.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000–$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings.

“There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured. The agency found that “half of the uninsured are nonpoor,” Dr. Frieden said.

About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, noted Dr. Frieden.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report.

For those aged 18–64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forgo needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

About 16% of currently insured people in that same age group who had a 1- to 3-month coverage gap during the preceding year reported not having a usual source of care, and 26% reported delaying needed care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“People who are uninsured are much less likely to have a regular doctor,” said Dr. Frieden.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes, he said.

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in the journal Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808).

To measure medication adherence, the study's authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared with the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared with the control group.

This type of value-based benefit design can improve compliance, but physicians and policy makers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost definitely plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their medications, and so “the effect may be diminished. If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” Dr. Dickson said in an interview.

“Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with medications. What this shows us is, sometimes they just can't afford it.”

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in the journal Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808).

To measure medication adherence, the study's authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared with the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared with the control group.

This type of value-based benefit design can improve compliance, but physicians and policy makers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost definitely plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their medications, and so “the effect may be diminished. If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” Dr. Dickson said in an interview.

“Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with medications. What this shows us is, sometimes they just can't afford it.”

Major Finding: Eliminating the copayment for statin drugs led to a 3.1% increase in medication adherence among employees at self-insured Pitney Bowes.

Data Source: A comparison of medication adherence in employees whose copayments were modified and those whose were not.

Disclosures: The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study in the journal Health Affairs.

“We observed improvements in adherence that were relatively modest in scale and that are consistent with the findings of other investigators,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues. “This highlights the various factors involved in nonadherence. Thus, the ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated.”

The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared with those of 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808).

To measure medication adherence, the study's authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared with the total number of days in each month between January 2006 and December 2007.

Adherence to statins rose by 3.1% immediately after the copayment was eliminated, compared with controls. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared with controls.

Meanwhile, when copayments were reduced for clopidogrel, adherence rates rose by 4.2% in the intervention group compared with the control group, according to the investigators. The number of patients who were fully adherent rose by 20% immediately, compared with the control group.

This type of value-based benefit design can improve compliance, but physicians and policy makers will need to address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Cost definitely plays a role in patient adherence, but it's not the only factor, noted Dr. Melissa S. Gerdes, a family physician at Trinity Clinic Whitehouse, in Texas. “I get people who don't want to pay a $10 copay to see me, but who will go to McDonalds and drop $20,” Dr. Gerdes said in an interview. “They – in general – consider anything over $10 as high for a copay.”

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that the patients in Dr. Choudhry's study already were paying a reduced cost for their medications, and so “the effect may be diminished. If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “A lot of factors play into it,” Dr. Dickson said in an interview.

“Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with medications. What this shows us is, sometimes they just can't afford it.”

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in the journal.

“The ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues.

The researchers manipulated drug copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808). The authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month between January 2006 and December 2007.

Compared with the control group, adherence to statins rose by 3.1% immediately after the copayment was eliminated, and the number of patients who were fully adherent to their statin regimen rose by 17%. When copayments were reduced for clopidogrel, adherence rates rose by 4.2% and the number of patients who were fully adherent rose by 20% immediately, compared to the control group.

But physicians and policy makers must address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.) said that to make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that these patients already were paying a reduced cost. “If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

View on the News

Involve the Employees

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Marjorie Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think. And they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MARJORIE S. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010 [doi:10.1377/hlthaff.2010.0808]).

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in the journal.

“The ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues.

The researchers manipulated drug copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808). The authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month between January 2006 and December 2007.

Compared with the control group, adherence to statins rose by 3.1% immediately after the copayment was eliminated, and the number of patients who were fully adherent to their statin regimen rose by 17%. When copayments were reduced for clopidogrel, adherence rates rose by 4.2% and the number of patients who were fully adherent rose by 20% immediately, compared to the control group.

But physicians and policy makers must address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.) said that to make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that these patients already were paying a reduced cost. “If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

View on the News

Involve the Employees

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Marjorie Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think. And they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MARJORIE S. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010 [doi:10.1377/hlthaff.2010.0808]).

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published in the journal.

“The ability of benefit design and patient financial incentives to address this complex problem completely should not be overestimated,” wrote lead author Dr. Niteesh Choudhry of Harvard Medical School, Boston, and his colleagues.

The researchers manipulated drug copayments for a subset of employees of Pitney Bowes, a self-insured company. For a total of 2,830 employees, copayments for statins were eliminated and the copayment for clopidogrel was significantly reduced. Their medication adherence patterns were compared to 49,801 fellow employees whose copayments were not changed (doi: 10.1377/hlthaff.2010.0808). The authors estimated the number of days of medication each patient actually received through the pharmacy benefit manager, compared to the total number of days in each month between January 2006 and December 2007.

Compared with the control group, adherence to statins rose by 3.1% immediately after the copayment was eliminated, and the number of patients who were fully adherent to their statin regimen rose by 17%. When copayments were reduced for clopidogrel, adherence rates rose by 4.2% and the number of patients who were fully adherent rose by 20% immediately, compared to the control group.

But physicians and policy makers must address other compliance factors in order to have a major cost-saving effect, Dr. Choudhry wrote.

Dr. Melissa S. Gerdes, a family physician at Trinity Clinic–Whitehouse (Tex.) said that to make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics.

Dr. Dennis Saver, a family physician in Vero Beach, Fla., agreed, but added that these patients already were paying a reduced cost. “If they did a study of someone paying $150 or $200 out of pocket for a medication and then bring that down to $15, they might see a greater effect,” he said in an interview.

Finally, financial considerations in overall care compliance have a cascade effect, said Dr. Gretchen Dickson of the department of family medicine at the University of Kansas, Kansas City. “Not making appointments, not going in for testing, not filling the prescription – all just go along with not being compliant with your medication. What this shows us is, sometimes they just can't afford it.”

The study was supported by the Commonwealth Fund. The authors disclosed grant funding from Aetna Inc. and the Robert Wood Johnson Foundation.

View on the News

Involve the Employees

Employers increasingly are using positive incentives to persuade employees to get needed care and stay healthier, Marjorie Ginsburg wrote. Few employers have tried raising costs for high-cost, low-value care in order to save money, but that approach might receive more support than insurers and employers might think. And they should consider giving employees and patients a voice in the decision-making process.

“There is no substitute for getting people to help design the coverage that will affect them directly,” she wrote. “Giving them a voice will make them more supportive of the result, even if some people do not end up with their ideal plan.”

MARJORIE S. GINSBURG is executive director of the Center for Healthcare Decisions in Rancho Cordova, Calif. Her comments were made in the same issue of the journal (Health Affairs 2010 [doi:10.1377/hlthaff.2010.0808]).

Unhealthy Fast Food Meals Rule

Most children eat fast food at least once per week, and practically none of these meals meet nutrition criteria for calories, fat, sugar, and sodium content, according to a study from Yale University. The report examined 3,039 possible children's meal combinations at a dozen restaurant chains and found only 12 meals that met the criteria for preschoolers and 15 that met them for older children. Although it's possible to buy healthful side dishes and beverages as part of youngsters' meals at fast food restaurants, those options rarely are offered as the default choices, the researchers noted. The study found that 84% of parents had fed their children fast food from McDonald's, Burger King, Wendy's, or Subway in the past week.

Schools Offer Unhealthy Drinks

Despite efforts to limit students' access to sugary and high-fat beverages, almost half of the nation's public elementary students could buy sodas, sports drinks, and high-fat milk in schools during the 2008–2009 school year, a study showed. The Institute of Medicine recommends that schools provide access to only water, 100% juice, and 1% or nonfat milk, but few schools conform, the study found. Students also could buy unhealthful drinks in school stores, from vending machines, and along cafeteria lines. Although many schools had removed high-fat milk from their lunch programs, they sold it a la carte. In the South, where obesity rates are highest in the nation, more than 20% of public elementary school students could purchase sugar-sweetened drinks, the study found.

Mental Health Funding Awarded

The Substance Abuse and Mental Health Services Administration has awarded more than $19 million to six organizations to prevent mental, emotional, and behavioral disorders in young children and promote health. The grants through Project LAUNCH (Linking Actions for Unmet Needs in Children) will fund efforts such as integrating behavioral health and primary care, family-strengthening programs, parenting-skills training, and public education on healthy child development. The six organizations are based in Colorado, Connecticut, Missouri, New York, Oregon, and Texas.

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012.

Study: Kids Stress With Parents

Parents underestimate how much stress their children experience, according to a survey from the American Psychological Association. Children as young as 8 reported that they experience physical and emotional symptoms often associated with stress. According to the survey, one-third of parents say their stress levels are extreme. Children who say their parents are always stressed were more likely to report stress themselves. Many teens and tweens reported feeling sad, worried, or frustrated when their parents are stressed. “It's critical that parents communicate with their children about how to identify stress triggers and manage stress in healthy ways while they're young and still developing behavioral patterns,” psychologist Katherine Nordal, Ph.D., the association's executive director for professional practice, said in a statement.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Unhealthy Fast Food Meals Rule

Most children eat fast food at least once per week, and practically none of these meals meet nutrition criteria for calories, fat, sugar, and sodium content, according to a study from Yale University. The report examined 3,039 possible children's meal combinations at a dozen restaurant chains and found only 12 meals that met the criteria for preschoolers and 15 that met them for older children. Although it's possible to buy healthful side dishes and beverages as part of youngsters' meals at fast food restaurants, those options rarely are offered as the default choices, the researchers noted. The study found that 84% of parents had fed their children fast food from McDonald's, Burger King, Wendy's, or Subway in the past week.

Schools Offer Unhealthy Drinks

Despite efforts to limit students' access to sugary and high-fat beverages, almost half of the nation's public elementary students could buy sodas, sports drinks, and high-fat milk in schools during the 2008–2009 school year, a study showed. The Institute of Medicine recommends that schools provide access to only water, 100% juice, and 1% or nonfat milk, but few schools conform, the study found. Students also could buy unhealthful drinks in school stores, from vending machines, and along cafeteria lines. Although many schools had removed high-fat milk from their lunch programs, they sold it a la carte. In the South, where obesity rates are highest in the nation, more than 20% of public elementary school students could purchase sugar-sweetened drinks, the study found.

Mental Health Funding Awarded

The Substance Abuse and Mental Health Services Administration has awarded more than $19 million to six organizations to prevent mental, emotional, and behavioral disorders in young children and promote health. The grants through Project LAUNCH (Linking Actions for Unmet Needs in Children) will fund efforts such as integrating behavioral health and primary care, family-strengthening programs, parenting-skills training, and public education on healthy child development. The six organizations are based in Colorado, Connecticut, Missouri, New York, Oregon, and Texas.

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012.

Study: Kids Stress With Parents

Parents underestimate how much stress their children experience, according to a survey from the American Psychological Association. Children as young as 8 reported that they experience physical and emotional symptoms often associated with stress. According to the survey, one-third of parents say their stress levels are extreme. Children who say their parents are always stressed were more likely to report stress themselves. Many teens and tweens reported feeling sad, worried, or frustrated when their parents are stressed. “It's critical that parents communicate with their children about how to identify stress triggers and manage stress in healthy ways while they're young and still developing behavioral patterns,” psychologist Katherine Nordal, Ph.D., the association's executive director for professional practice, said in a statement.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Unhealthy Fast Food Meals Rule

Most children eat fast food at least once per week, and practically none of these meals meet nutrition criteria for calories, fat, sugar, and sodium content, according to a study from Yale University. The report examined 3,039 possible children's meal combinations at a dozen restaurant chains and found only 12 meals that met the criteria for preschoolers and 15 that met them for older children. Although it's possible to buy healthful side dishes and beverages as part of youngsters' meals at fast food restaurants, those options rarely are offered as the default choices, the researchers noted. The study found that 84% of parents had fed their children fast food from McDonald's, Burger King, Wendy's, or Subway in the past week.

Schools Offer Unhealthy Drinks

Despite efforts to limit students' access to sugary and high-fat beverages, almost half of the nation's public elementary students could buy sodas, sports drinks, and high-fat milk in schools during the 2008–2009 school year, a study showed. The Institute of Medicine recommends that schools provide access to only water, 100% juice, and 1% or nonfat milk, but few schools conform, the study found. Students also could buy unhealthful drinks in school stores, from vending machines, and along cafeteria lines. Although many schools had removed high-fat milk from their lunch programs, they sold it a la carte. In the South, where obesity rates are highest in the nation, more than 20% of public elementary school students could purchase sugar-sweetened drinks, the study found.

Mental Health Funding Awarded

The Substance Abuse and Mental Health Services Administration has awarded more than $19 million to six organizations to prevent mental, emotional, and behavioral disorders in young children and promote health. The grants through Project LAUNCH (Linking Actions for Unmet Needs in Children) will fund efforts such as integrating behavioral health and primary care, family-strengthening programs, parenting-skills training, and public education on healthy child development. The six organizations are based in Colorado, Connecticut, Missouri, New York, Oregon, and Texas.

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012.

Study: Kids Stress With Parents

Parents underestimate how much stress their children experience, according to a survey from the American Psychological Association. Children as young as 8 reported that they experience physical and emotional symptoms often associated with stress. According to the survey, one-third of parents say their stress levels are extreme. Children who say their parents are always stressed were more likely to report stress themselves. Many teens and tweens reported feeling sad, worried, or frustrated when their parents are stressed. “It's critical that parents communicate with their children about how to identify stress triggers and manage stress in healthy ways while they're young and still developing behavioral patterns,” psychologist Katherine Nordal, Ph.D., the association's executive director for professional practice, said in a statement.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Adults in the United States are far more likely than those in 10 other countries to go without health care because of cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published last month.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” published online in the journal.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing.

“There could be some effects early on, but the big difference should show up in 2015 or 2016,” Ms. Davis said.

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription because of the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care because of costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance–related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn't paid as much as expected.

Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study.

Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

“Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick,” according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients' income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care because of cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published last month.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” published online in the journal.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing.

“There could be some effects early on, but the big difference should show up in 2015 or 2016,” Ms. Davis said.

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription because of the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care because of costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance–related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn't paid as much as expected.

Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study.

Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

“Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick,” according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients' income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

Adults in the United States are far more likely than those in 10 other countries to go without health care because of cost, have difficulty paying their medical bills, and have disputes with their insurers over bills, according to a new 11-country survey published last month.

The United States lags significantly on access, affordability, and problems with health insurance despite spending more than twice as much on average as the other 10 countries included in the annual survey, according to “How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries,” published online in the journal.

But some of these disparities could be reversed as provisions of the Affordable Care Act, approved last spring, begin to take effect, Karen Davis, president of the Commonwealth Fund, said during a telephone press briefing.

“There could be some effects early on, but the big difference should show up in 2015 or 2016,” Ms. Davis said.

The Commonwealth Fund has surveyed adults in these 11 countries for the last 13 years to gain insights into how different coverage and program designs affect access, financial protection, and other health insurance issues. The 2010 edition of the survey involved interviews with 19,700 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States (10.1377/hlthaff.2010.0862).

The report found significant disparities between the United States and most of the other countries studied.

For example, the report showed one-third of U.S. adults went without necessary care, failed to see a physician when sick, or failed to fill a prescription because of the costs involved. Germany and Australia also scored poorly on those measures – 25% of Germans and 22% of Australians reported going without care because of costs.

About 35% of Americans faced $1,000 or more in out-of-pocket costs each year, more than any of the other countries studied, the survey found. Twenty-one percent of Australians and 25% of Swiss residents also faced out-of-pocket costs of $1,000 or more.

One-fifth of U.S. respondents reported a serious problem with affordability or being unable to pay a health care bill, compared with 9% in France, the next highest on this measure.

In addition, 31% of Americans said they spent a lot of time on health insurance–related paperwork or disputes over medical bills, or that their health insurer had denied payment or hadn't paid as much as expected.

Twenty-three percent of respondents in France and Germany each reported those problems, according to the study.

“We emerged as the only country in the study where being insured doesn't guarantee you'll be covered when you get sick,” said Cathy Schoen, senior vice president at the Commonwealth Fund and lead author of the study.

U.S. adults were significantly less likely than their international peers to have confidence in their ability to afford care, and were less confident than adults everywhere except in Sweden and Norway that they would receive the most effective treatment when needed, according to the study.

Only 70% of U.S. adults said they expected they would receive the most effective treatment, including diagnostic tests and drugs.

To determine the responsiveness of the different health care systems, the survey asked about waiting times to receiving care.

“Switzerland stands out for rapid access: 93% of the Swiss respondents had received a same- or next-day appointment the last time they were sick,” according to the study report. Meanwhile, one-fourth or more of Canadian, Swedish, and Norwegian adults reported having to wait 6 days or more to see a doctor or nurse when sick, and also reported waits of at least 2 months to see specialists.

Rapid access to health care when sick varied significantly when patients' income was considered in Canada, the Netherlands, and the United States, with the widest income gap in the United States.

The Affordable Care Act should begin to reverse some of the disparities between the United States and other industrialized countries, although the changes will take some time to be felt, said Ms. Davis. “The new law will ensure access to affordable health care coverage to 32 million Americans who are uninsured, but just as important are the system reforms in the new law.”

However, with health care spending in the United States topping $7,500 per person, more than twice the average of the other 10 countries in the survey, it will take time to begin to “bend the cost curve,” she said, adding that “we see about half a percentage point slowdown” in the annual increase in health care costs as a result of ACA provisions.

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four adults aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1-7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, the report stated.

For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely – 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely – 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four adults aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1-7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, the report stated.

For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely – 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely – 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four adults aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1-7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference on the findings. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, the report stated.

For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely – 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely – 47% vs. 8% – to skip necessary care because of cost.

More than half of adults under age 65 who were without health insurance for more than a year did not have a usual source of care, compared with about 9% of those who were continuously insured, the report found.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Mammography Devices Relisted

The FDA is making it easier for companies to get new digital mammography systems approved. The agency said it is reclassifying these devices, known as full field digital mammography systems, as medium-risk (class II) devices. When first approved by the agency in 2000, digital mammography systems were categorized as high risk (class III) because of their novelty. Since then, digital mammography has been validated in scientific studies involving tens of thousands of patients, the agency said. To win approval for a class III device, companies need to prove safety and effectiveness. Class II approval involves establishing that a device is substantially equivalent to one already on the market. Today, about 70% of the mammography units in use are digital and 70% of certified U.S. mammography centers have at least one digital unit, the FDA said.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 experienced at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said that 44% of the adverse events, such as hospital-acquired infections, and temporary-harm events were clearly or probably preventable.

Medicare Reduces Bad Payments

Following a pledge to reduce waste, fraud, and abuse in Medicare, the Centers for Medicare and Medicaid Services said it has already reduced the error rate for claims since 2009 and is on track to cut it 50% by 2012. Improper payments don't necessarily represent fraud and abuse, the CMS said. Instead, most such errors stem from insufficient documentation and provision of medically unnecessary services. In 2009, the fee-for-service error rate was more than 12%, or an estimated $35.4 billion in improper claims, according to the report. In 2010, the rate has fallen to less than 11%, or an estimated $34.3 billion. The agency said it continues to work with providers across the country to help them eliminate errors.

Industry-Physician Ties Persist

Although most physicians continue to have financial relationships with industry, the percentage has declined significantly since 2004, according to a study led by Harvard Medical School researchers in Boston. They reported in the Archives of Internal Medicine that although fewer physicians are accepting gifts such as drug samples and food, most continue to do so. About 64% take drug samples, compared with 78% in 2004, and 71% accept free food and beverages, compared with 80% in 2004. However, the number of physicians accepting payments for consulting, speaking, or enrolling patients in clinical trials has fallen by half since 2004, according to the study. Only 18% of physicians said they accept reimbursements for meeting expenses, compared with 35% in 2004, and just 14% receive payments for professional services, compared with 28% in 2004. “These data clearly show that physician behavior, at least with respect to managing conflicts of interest, is mutable in a relatively short period,” the researchers concluded. “However, given that 83.8% of physicians have [physician-industry relationships], it is clear that industry still has substantial financial links with the nation's physicians.”

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Mammography Devices Relisted

The FDA is making it easier for companies to get new digital mammography systems approved. The agency said it is reclassifying these devices, known as full field digital mammography systems, as medium-risk (class II) devices. When first approved by the agency in 2000, digital mammography systems were categorized as high risk (class III) because of their novelty. Since then, digital mammography has been validated in scientific studies involving tens of thousands of patients, the agency said. To win approval for a class III device, companies need to prove safety and effectiveness. Class II approval involves establishing that a device is substantially equivalent to one already on the market. Today, about 70% of the mammography units in use are digital and 70% of certified U.S. mammography centers have at least one digital unit, the FDA said.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 experienced at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said that 44% of the adverse events, such as hospital-acquired infections, and temporary-harm events were clearly or probably preventable.

Medicare Reduces Bad Payments

Following a pledge to reduce waste, fraud, and abuse in Medicare, the Centers for Medicare and Medicaid Services said it has already reduced the error rate for claims since 2009 and is on track to cut it 50% by 2012. Improper payments don't necessarily represent fraud and abuse, the CMS said. Instead, most such errors stem from insufficient documentation and provision of medically unnecessary services. In 2009, the fee-for-service error rate was more than 12%, or an estimated $35.4 billion in improper claims, according to the report. In 2010, the rate has fallen to less than 11%, or an estimated $34.3 billion. The agency said it continues to work with providers across the country to help them eliminate errors.

Industry-Physician Ties Persist

Although most physicians continue to have financial relationships with industry, the percentage has declined significantly since 2004, according to a study led by Harvard Medical School researchers in Boston. They reported in the Archives of Internal Medicine that although fewer physicians are accepting gifts such as drug samples and food, most continue to do so. About 64% take drug samples, compared with 78% in 2004, and 71% accept free food and beverages, compared with 80% in 2004. However, the number of physicians accepting payments for consulting, speaking, or enrolling patients in clinical trials has fallen by half since 2004, according to the study. Only 18% of physicians said they accept reimbursements for meeting expenses, compared with 35% in 2004, and just 14% receive payments for professional services, compared with 28% in 2004. “These data clearly show that physician behavior, at least with respect to managing conflicts of interest, is mutable in a relatively short period,” the researchers concluded. “However, given that 83.8% of physicians have [physician-industry relationships], it is clear that industry still has substantial financial links with the nation's physicians.”

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

FDA Warns on Beverages

A maker of one of the now-notorious, high-potency, caffeine-and-alcohol drinks said it would remove the stimulant from its product as the Food and Drug Administration warned other makers that they must do the same or face action such as seizure of their products. The FDA cautioned Charge Beverages Corp., New Century Brewing Co. LLC, Phusion Projects LLC, and United Brands Company Inc. that the caffeine represents an “unsafe food additive” that can mask sensory cues individuals normally rely on to determine their level of intoxication. The result can be risky behaviors and life-threatening situations, the agency said. Phusion Projects, which makes the drink Four Loko, announced the day before the FDA warning that it would remove caffeine and two other stimulants, taurine and guarana, from its beverages. Wake Forest University's Dr. Mary Claire O'Brien, who has researched caffeinated alcoholic products, said that they allow drinkers to stay awake to drink more, “well beyond the amount they would otherwise be able to tolerate if they were only drinking alcohol.”

Mammography Devices Relisted

The FDA is making it easier for companies to get new digital mammography systems approved. The agency said it is reclassifying these devices, known as full field digital mammography systems, as medium-risk (class II) devices. When first approved by the agency in 2000, digital mammography systems were categorized as high risk (class III) because of their novelty. Since then, digital mammography has been validated in scientific studies involving tens of thousands of patients, the agency said. To win approval for a class III device, companies need to prove safety and effectiveness. Class II approval involves establishing that a device is substantially equivalent to one already on the market. Today, about 70% of the mammography units in use are digital and 70% of certified U.S. mammography centers have at least one digital unit, the FDA said.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 experienced at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said that 44% of the adverse events, such as hospital-acquired infections, and temporary-harm events were clearly or probably preventable.

Medicare Reduces Bad Payments

Following a pledge to reduce waste, fraud, and abuse in Medicare, the Centers for Medicare and Medicaid Services said it has already reduced the error rate for claims since 2009 and is on track to cut it 50% by 2012. Improper payments don't necessarily represent fraud and abuse, the CMS said. Instead, most such errors stem from insufficient documentation and provision of medically unnecessary services. In 2009, the fee-for-service error rate was more than 12%, or an estimated $35.4 billion in improper claims, according to the report. In 2010, the rate has fallen to less than 11%, or an estimated $34.3 billion. The agency said it continues to work with providers across the country to help them eliminate errors.

Industry-Physician Ties Persist

Although most physicians continue to have financial relationships with industry, the percentage has declined significantly since 2004, according to a study led by Harvard Medical School researchers in Boston. They reported in the Archives of Internal Medicine that although fewer physicians are accepting gifts such as drug samples and food, most continue to do so. About 64% take drug samples, compared with 78% in 2004, and 71% accept free food and beverages, compared with 80% in 2004. However, the number of physicians accepting payments for consulting, speaking, or enrolling patients in clinical trials has fallen by half since 2004, according to the study. Only 18% of physicians said they accept reimbursements for meeting expenses, compared with 35% in 2004, and just 14% receive payments for professional services, compared with 28% in 2004. “These data clearly show that physician behavior, at least with respect to managing conflicts of interest, is mutable in a relatively short period,” the researchers concluded. “However, given that 83.8% of physicians have [physician-industry relationships], it is clear that industry still has substantial financial links with the nation's physicians.”

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the AMA called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, CDC director, said at a press conference. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found. Being uninsured raised the risk of going without needed care substantially, especially for adults, the report indicated.

The findings in the report represent a significant problem for the 40% of U.S. adults with a chronic disease, Dr. Frieden said.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, CDC director, said at a press conference. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found. Being uninsured raised the risk of going without needed care substantially, especially for adults, the report indicated.

The findings in the report represent a significant problem for the 40% of U.S. adults with a chronic disease, Dr. Frieden said.

An estimated 59.1 million Americans, including one in four adults aged 18–64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]:1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18–64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, CDC director, said at a press conference. “There are multiple factors contributing to that increase.”

The CDC conducted in-person interviews of a sample of the U.S. population during the first quarter of 2010 to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

The percentage of adults with incomes between two and three times the FPL who had coverage gaps in the past year has increased dramatically, from less than 28% in 2006 to 32% in 2009, Dr. Frieden said.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010. In 2008, more than 13% of children and teens lacked health insurance at some point the prior year, compared with less than 12% in 2010, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found. Being uninsured raised the risk of going without needed care substantially, especially for adults, the report indicated.

The findings in the report represent a significant problem for the 40% of U.S. adults with a chronic disease, Dr. Frieden said.