Jane Anderson

Major Finding: Between 1987 and 2007, health care spending on normal-weight adults grew by 65%, spending on overweight adults grew by 61%, and spending on obese adults grew by 111%.

Data Source: Congressional Budget Office.

Disclosures: None.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to the report.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

“The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds,” the report said.

The report – “How Does Obesity in Adults Affect Spending on Health Care?” – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out.

Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

“That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight,” the report said.

Major Finding: Between 1987 and 2007, health care spending on normal-weight adults grew by 65%, spending on overweight adults grew by 61%, and spending on obese adults grew by 111%.

Data Source: Congressional Budget Office.

Disclosures: None.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to the report.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

“The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds,” the report said.

The report – “How Does Obesity in Adults Affect Spending on Health Care?” – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out.

Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

“That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight,” the report said.

Major Finding: Between 1987 and 2007, health care spending on normal-weight adults grew by 65%, spending on overweight adults grew by 61%, and spending on obese adults grew by 111%.

Data Source: Congressional Budget Office.

Disclosures: None.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to the report.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

“The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds,” the report said.

The report – “How Does Obesity in Adults Affect Spending on Health Care?” – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out.

Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

“That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight,” the report 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 Nov. 9.

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, 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 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. 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.

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 Nov. 9.

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, 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 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. 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.

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 Nov. 9.

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, 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 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. 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.

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 Nov. 9.

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, 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.

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 Nov. 9.

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, 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.

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 Nov. 9.

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, 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.

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 Nov. 9.

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, 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 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. 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.

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 Nov. 9.

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, 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 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. 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.

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 Nov. 9.

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, 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 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. 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.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to a report from the Congressional Budget Office.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

"The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds," the report said.

The report – "How Does Obesity in Adults Affect Spending on Health Care?" – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out. Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

"That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight," the report said.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to a report from the Congressional Budget Office.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

"The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds," the report said.

The report – "How Does Obesity in Adults Affect Spending on Health Care?" – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out. Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

"That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight," the report said.

If current trends continue and 37% of Americans are obese by 2020, health care spending per person will rise from $4,550 in 2007 to about $7,760 in 2020. But a decrease in the obesity rate would reduce total per capita health care spending by only a few percentage points, according to a report from the Congressional Budget Office.

For example, if obesity rates level off at their current 28% share of the population, health care spending will rise 3% less, to total about $7,500 per person in 2020, the CBO report said. And if obesity in the United States falls to its 1987 level by 2020, projected spending per adult would total $7,230, about 7% lower than if obesity rates continue to rise, the study found.

Even though reducing levels of obesity could also reduce the amount spent on health care, designing public policies to achieve that goal is difficult, and the antiobesity initiatives themselves cost money, the CBO report said.

"The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds," the report said.

The report – "How Does Obesity in Adults Affect Spending on Health Care?" – found that health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much faster among obese individuals than for people of normal body weight.

The percentage of adults considered obese rose from 13% in 1987 to 28% in 2007, while the share of adults considered overweight increased slightly during that period, the CBO report said. Meanwhile, the percentage of adults with normal body mass indexes dropped from 52% to 35%.

Overall, health care spending for all adults rose almost 80% from 1987 to 2007, from $2,560 to $4,550, according to the CBO report. Spending on normal-weight adults grew by 65% in those 2 decades, while spending on overweight adults grew by 61% in the same time frame. However, spending on obese adults grew by 111%.

Specifically, spending for obese adults exceeded spending for normal-weight adults by about 8% in 1987 and by about 38% in 2007. The CBO report said the gap in spending between the two groups may reflect several factors, including changes in health status for the obese and advances in technology that offer new treatments for conditions that plague the obese.

Spending on obesity-related diseases such as heart disease, type 2 diabetes, hypertension, and dyslipidemia generally is higher for obese adults, but normal-weight adults also develop these conditions, the CBO report pointed out. Spending on obesity-related diseases accounted for about 60% of the $1,530 difference in total spending between the obese and normal-weight adults in 2007, the report calculated.

"That finding leaves about 40% of the spending differential unexplained and perhaps attributable to factors other than body weight," the report said.

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Reducing or eliminating copayments for medications to treat common chronic conditions can improve medication adherence by several percentage points, according to a study published Nov. 2 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 to 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 to 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 to the control group. The number of patients who were fully adherent to their statin regimen rose by 17% immediately, compared to controls.

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

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 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."

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. To make a real difference, copayments need to drop to around $4, the price Walmart charges for many generics, she said.

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 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

Avandia Litigation Is Underway

GlaxoSmithKline said that it is responding to a Department of Justice subpoena concerning the company's diabetes drug rosiglitazone (Avandia). In its 2010 third-quarter earnings announcement, GSK also said it has received “civil investigative demands from a number of states' attorneys general offices relating to the development and marketing of Avandia. … These enquiries are at an early stage, and GSK is cooperating with these offices.” Meanwhile, the company said, litigation regarding rosiglitazone is still pending in both federal and state courts “and new cases continue to be filed.” The Food and Drug Administration in September allowed rosiglitazone to remain on the market, but with new labeling and restrictions intended to limit its use to patients for whom other drugs do not work.

Monitor Market Is Growing

Three company's sales of continuous blood glucose systems reached close to $200 million in 2009, nearly double their sales of the year before, according to a market-research firm. In its latest report on the diagnostic testing industry, Kalorama Information said that the continuing-monitoring growth by the companies Medtronic, Dexcom, and Insulet should continue, given the increasing patient population and the building popularity of the devices. Fewer than 30% of type 1 diabetes patients in the United States currently using insulin pumps also have continuous blood glucose monitors, according to the report. Among type 2 U.S. diabetes patients using insulin pumps, fewer than 1 in 100 has a continuous monitor.

FDA Warns of Tainted Supplements

The FDA has reported a surge in the number of nutritional supplements tainted with active pharmaceutical ingredients, with more than one dozen recalled since the beginning of August. In the first three-quarters of 2010, the FDA recalled approximately 80 such products, a spokesperson said. The agency recently recalled three products marketed as testosterone boosters and hormone regulators that contained 6-Etioallochol-1,4-Diene-3,17-Dione, an aromatase inhibitor also known as ATD. “FDA has identified an emerging trend where over-the-counter products, frequently represented as dietary supplements, contain hidden active ingredients that could be harmful,” the agency said in a statement.

Diabetes Harming Young Women

Diabetes-related hospitalizations for adults aged 30-39 doubled from 1993 to 2006, and young women were 1.3 times as likely to be hospitalized as were young men, even without counting pregnancy-related complications, according to a study in the Journal of Women's Health. A University of Michigan, Ann Arbor, team found that overall diabetes hospitalizations rose by two-thirds during those years, while inflation-adjusted costs for that care more than tripled, from around $62 billion to $200 billion. The authors said in a statement that more women may be hospitalized for diabetes because more of them are obese, compared with men in that same age group. It's also possible that women with diabetes may be sicker because they're less likely to receive preventive care.

Groups Open to New Iodine Rules

Current rules governing the use of radioactive iodine, which allow patients to return home quickly after being treated for thyroid cancer, are safe for patients, their families, and the public, according to a joint statement from the American Thyroid Association, the Endocrine Society, the Society of Nuclear Medicine, and the American Association of Clinical Endocrinologists. The groups said they would support reexamining the issue if new data emerge indicating a potential threat to public safety. The American Thyroid Association is updating recommendations for management of these patients, the statement said. At a Nuclear Regulatory Commission hearing on the use of medical isotopes, Rep. Edward Markey (D-Mass.) said there is a “strong likelihood that members of the public have been unwittingly exposed to radiation from patients who are discharged after being treated with radioisotopes.” He blamed ineffective NRC regulation, guidance, and oversight for exposures.

Avandia Litigation Is Underway

GlaxoSmithKline said that it is responding to a Department of Justice subpoena concerning the company's diabetes drug rosiglitazone (Avandia). In its 2010 third-quarter earnings announcement, GSK also said it has received “civil investigative demands from a number of states' attorneys general offices relating to the development and marketing of Avandia. … These enquiries are at an early stage, and GSK is cooperating with these offices.” Meanwhile, the company said, litigation regarding rosiglitazone is still pending in both federal and state courts “and new cases continue to be filed.” The Food and Drug Administration in September allowed rosiglitazone to remain on the market, but with new labeling and restrictions intended to limit its use to patients for whom other drugs do not work.

Monitor Market Is Growing

Three company's sales of continuous blood glucose systems reached close to $200 million in 2009, nearly double their sales of the year before, according to a market-research firm. In its latest report on the diagnostic testing industry, Kalorama Information said that the continuing-monitoring growth by the companies Medtronic, Dexcom, and Insulet should continue, given the increasing patient population and the building popularity of the devices. Fewer than 30% of type 1 diabetes patients in the United States currently using insulin pumps also have continuous blood glucose monitors, according to the report. Among type 2 U.S. diabetes patients using insulin pumps, fewer than 1 in 100 has a continuous monitor.

FDA Warns of Tainted Supplements

The FDA has reported a surge in the number of nutritional supplements tainted with active pharmaceutical ingredients, with more than one dozen recalled since the beginning of August. In the first three-quarters of 2010, the FDA recalled approximately 80 such products, a spokesperson said. The agency recently recalled three products marketed as testosterone boosters and hormone regulators that contained 6-Etioallochol-1,4-Diene-3,17-Dione, an aromatase inhibitor also known as ATD. “FDA has identified an emerging trend where over-the-counter products, frequently represented as dietary supplements, contain hidden active ingredients that could be harmful,” the agency said in a statement.

Diabetes Harming Young Women

Diabetes-related hospitalizations for adults aged 30-39 doubled from 1993 to 2006, and young women were 1.3 times as likely to be hospitalized as were young men, even without counting pregnancy-related complications, according to a study in the Journal of Women's Health. A University of Michigan, Ann Arbor, team found that overall diabetes hospitalizations rose by two-thirds during those years, while inflation-adjusted costs for that care more than tripled, from around $62 billion to $200 billion. The authors said in a statement that more women may be hospitalized for diabetes because more of them are obese, compared with men in that same age group. It's also possible that women with diabetes may be sicker because they're less likely to receive preventive care.

Groups Open to New Iodine Rules

Current rules governing the use of radioactive iodine, which allow patients to return home quickly after being treated for thyroid cancer, are safe for patients, their families, and the public, according to a joint statement from the American Thyroid Association, the Endocrine Society, the Society of Nuclear Medicine, and the American Association of Clinical Endocrinologists. The groups said they would support reexamining the issue if new data emerge indicating a potential threat to public safety. The American Thyroid Association is updating recommendations for management of these patients, the statement said. At a Nuclear Regulatory Commission hearing on the use of medical isotopes, Rep. Edward Markey (D-Mass.) said there is a “strong likelihood that members of the public have been unwittingly exposed to radiation from patients who are discharged after being treated with radioisotopes.” He blamed ineffective NRC regulation, guidance, and oversight for exposures.

Avandia Litigation Is Underway

GlaxoSmithKline said that it is responding to a Department of Justice subpoena concerning the company's diabetes drug rosiglitazone (Avandia). In its 2010 third-quarter earnings announcement, GSK also said it has received “civil investigative demands from a number of states' attorneys general offices relating to the development and marketing of Avandia. … These enquiries are at an early stage, and GSK is cooperating with these offices.” Meanwhile, the company said, litigation regarding rosiglitazone is still pending in both federal and state courts “and new cases continue to be filed.” The Food and Drug Administration in September allowed rosiglitazone to remain on the market, but with new labeling and restrictions intended to limit its use to patients for whom other drugs do not work.

Monitor Market Is Growing

Three company's sales of continuous blood glucose systems reached close to $200 million in 2009, nearly double their sales of the year before, according to a market-research firm. In its latest report on the diagnostic testing industry, Kalorama Information said that the continuing-monitoring growth by the companies Medtronic, Dexcom, and Insulet should continue, given the increasing patient population and the building popularity of the devices. Fewer than 30% of type 1 diabetes patients in the United States currently using insulin pumps also have continuous blood glucose monitors, according to the report. Among type 2 U.S. diabetes patients using insulin pumps, fewer than 1 in 100 has a continuous monitor.

FDA Warns of Tainted Supplements

The FDA has reported a surge in the number of nutritional supplements tainted with active pharmaceutical ingredients, with more than one dozen recalled since the beginning of August. In the first three-quarters of 2010, the FDA recalled approximately 80 such products, a spokesperson said. The agency recently recalled three products marketed as testosterone boosters and hormone regulators that contained 6-Etioallochol-1,4-Diene-3,17-Dione, an aromatase inhibitor also known as ATD. “FDA has identified an emerging trend where over-the-counter products, frequently represented as dietary supplements, contain hidden active ingredients that could be harmful,” the agency said in a statement.

Diabetes Harming Young Women

Diabetes-related hospitalizations for adults aged 30-39 doubled from 1993 to 2006, and young women were 1.3 times as likely to be hospitalized as were young men, even without counting pregnancy-related complications, according to a study in the Journal of Women's Health. A University of Michigan, Ann Arbor, team found that overall diabetes hospitalizations rose by two-thirds during those years, while inflation-adjusted costs for that care more than tripled, from around $62 billion to $200 billion. The authors said in a statement that more women may be hospitalized for diabetes because more of them are obese, compared with men in that same age group. It's also possible that women with diabetes may be sicker because they're less likely to receive preventive care.

Groups Open to New Iodine Rules

Current rules governing the use of radioactive iodine, which allow patients to return home quickly after being treated for thyroid cancer, are safe for patients, their families, and the public, according to a joint statement from the American Thyroid Association, the Endocrine Society, the Society of Nuclear Medicine, and the American Association of Clinical Endocrinologists. The groups said they would support reexamining the issue if new data emerge indicating a potential threat to public safety. The American Thyroid Association is updating recommendations for management of these patients, the statement said. At a Nuclear Regulatory Commission hearing on the use of medical isotopes, Rep. Edward Markey (D-Mass.) said there is a “strong likelihood that members of the public have been unwittingly exposed to radiation from patients who are discharged after being treated with radioisotopes.” He blamed ineffective NRC regulation, guidance, and oversight for exposures.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for these physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned just over $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for these physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned just over $82 per hour (Arch. Intern. Med. 2010;170:1728-34).

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for these physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care, comprising physicians who provide general primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found.

Specifically, specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties, meanwhile, were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Wages per hour for primary care physicians were about $61, while surgeons earned about $90 per hour and other procedure-oriented specialties earned close to $88 per hour. Internal medicine subspecialists and pediatric subspecialists, meanwhile, earned just over $82 per hour (Arch. Intern. Med. 2010;170:1728-34).