More Talk, Fewer Errors
Most physicians have witnessed medical mistakes—but few are willing to talk about it, results of a study of more than 1,700 physicians, nurses, and clinical care staff indicated. Specifically, 84% of physicians and 62% of nurses and other clinical care providers have seen coworkers taking shortcuts that could be dangerous to patients, and 88% of physicians work with people who show poor clinical judgment. Yet fewer than 10% of providers address problem behavior by colleagues, which routinely includes trouble following directions, poor clinical judgment, or taking dangerous shortcuts. The study was cosponsored by the American Association of Critical-Care Nurses (AACN), and VitalSmarts, a company that specializes in organizational performance and leadership training. “The truth is we must build environments that support and demand greater candor among staff if we are to make a demonstrable impact on patient safety,” AACN President Kathy McCauley, R.N., said in a statement.
Get Sick, Go Bankrupt
It doesn't pay to get sick: Medical problems contributed to about half of all bankruptcies involving 700,000 households in 2001, according to a study published as a Web-exclusive article by the journal Health Affairs. More than 2 million people are directly affected by medical bankruptcies annually. “When medical debts and lost income from illnesses leave families facing a mountain of bills, bankruptcy is their last chance to stop the collection calls and try to put their lives back on track,” said study coauthor Elizabeth Warren, the Leo Gottlieb, Professor of Law at Harvard University, Boston. Most who have been bankrupted by medical problems had health insurance. Among those with private insurance, one-third had lost coverage at least temporarily by the time they filed for bankruptcy. The researchers obtained their information by surveying 1,771 bankruptcy filers and reviewing their court records.
Health Savings Accounts = Debt?
Nearly half of all insured adults who have a high deductible health plan have medical bill problems or debts, compared with less than one-third of those with lower-deductible plans, according to a study from the Commonwealth Fund. “Health savings accounts (HSAs) coupled with high deductible health plans have potential pitfalls, especially for families with low incomes or individuals with chronic health conditions, who are at greater risk of accruing burdensome medical debts and facing barriers to needed health care,” said Commonwealth President Karen Davis. Individuals with high-deductible plans also struggle with access problems, such as not filling a prescription, or skipping a medical test or treatment, due to cost. To prevent medical access problems and debt, Ms. Davis suggested some legislative fixes for HSAs, such as reducing deductibles for lower-income families and requiring provider discounts for uninsured, low-income families.
New HHS Chief and Medicaid
Medicaid reform will be high on the agenda for new Health and Human Services Secretary Michael O. Leavitt. “Medicaid is not meeting its potential,” Mr. Leavitt, former governor of Utah and former head of the Environmental Protection Agency, said at health care congress sponsored by the Wall Street Journal and CNBC. “It's rigid, inflexible, inefficient, and, worse yet, not financially sustainable. We need to have a serious conversation about Medicaid.” Among the ideas he's considering are negotiating reductions in the prices Medicaid pays for prescription drugs and closing loopholes relating to coverage for long-term care. He also wants to stop states from manipulating Medicaid rules to garner federal matching funds. President Bush in the meantime focused on medical liability reform and health savings accounts in his State of the Union address, asking Congress to move forward on tax credits to help low-income workers buy insurance, and on establishing community health centers in impoverished counties.
Older Patients and the Internet
Online health information has the potential to become an important resource for seniors “but it's not there yet,” the Kaiser Family Foundation reported in a survey of 1,450 adults aged 50 and older. Of the 583 respondents aged 65 and older, less than a third had ever gone online. But more than two-thirds of the next generation of seniors (50-64 years) has done so, indicating that online resources may soon play a much larger role among older Americans. Seniors whose annual household income is under $20,000 a year are much less likely to have gone online (15%) as opposed to those with incomes of $50,000 or more (65%). “We know that the Internet can be a great health tool for seniors, but the majority are lower-income, less well-educated, and not online,” said Drew Altman, the foundation's president and chief executive officer.