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Showing posts from December, 2013

Healthcare Spending--moderating? David Blumenthal et al explain.

David Blumenthal and others recently published a paper in the New England Journal of Medicine entitled "Health Care Spending--a Giant Slain or Sleeping?" In it they look at the ongoing, and rarely discussed, phenomenon of slowing of healthcare spending, which has persisted over several years. Health care spending grew remarkably after the establishment of Medicare and Medicaid in the 1960's, resulting in the fact that health care costs now equal about 18% of our gross domestic product (GDP) when they were only 5% before these programs were introduced. This was no coincidence. A third party payer, even one we expect to value frugality such as the government, will increase utilization of services because they are already paid for, and will increase prices for the same reason unless the prices are negotiated. In Europe, prices for procedures and medications are frequently  negotiated, but in the US powerful drug companies and device manufacturers successfully resist this, …

This is what happened when I went to healthcare.gov to sign up for health insurance

Today in the mail I received a letter from my private health insurance company informing me that my current policy, which was being cancelled because it didn't meet minimum standards of the new healthcare law, would actually be available to me next year. In other words, I could keep my plan.

There has been a big kerfluffle about a presidential promise to allow people to keep their health insurance plans if they liked them, which turned out not to be true under the health care law. Having read the law I thought that was pretty clear. I figured that my plan wasn't compliant and I would therefore find myself signed up for some more expensive policy by my health insurance company when 2014 rolled in. I am not entirely sure why the president told people they could keep their non-compliant policies, and apparently he has been spanked soundly for saying it. The "Keep your health plan act of 2013" passed the house in November, but I cannot find anywhere that it passed the s…

Rural Medicine: Idaho and Africa and elsewhere

Rural medicine, I guess, can be defined as health care that happens in places that aren't big cities or referral centers. The vast majority of the populated earth's crust that has any health care at all is served by rural practitioners. I have done a little bit of rural medicine in Haiti, in Mexico and now a bit more in South Sudan. I have also worked in a rural health care system in Idaho for nearly 20 years.  People benefit hugely from health care delivered to them in their less densely populated home turf, despite the fact that health care in such locations lacks technology and specialist services that are often available cities or university medical centers.

In the US, most rural health outposts are within an hour of a major medical center, either by ambulance or helicopter, so transfer to a high tech center is usually possible when there is an indication. In developing countries people are often grateful for any medical care that can be provided and transfer to a higher …

Medical Care in Old Fangak, South Sudan

Two days ago I got back from Old Fangak, a tiny town in Jonglei province on the banks of the Zaraf River, a branch of the Nile. Because I am on a self proclaimed sabbatical, and because I have wanted to visit my friend Jill Seaman who treats tuberculosis and Kala Azar in South Sudan for years, I just took off and went there, and now, many mosquito bites later, I am back.

South Sudan is the newest country in the world, having achieved independence July 9, 2011 after decades of civil war in the Sudan. The politics of independence are complicated, involving routine marginalization of the sub-Saharan population of the south by the Arab north. There are also rich oil reserves in South Sudan which may help fund infrastructure improvements eventually. I visited Juba, the capital city, briefly and spent the vast majority of my time there in the town of Old Fangak where the hospital and medical clinic are located. Two weeks and a bit and basically one small town do not make me a South Sudan e…