The week in review: April 30-May 4 2012
MedWire News: Among this week's featured stories are conflicting data on the benefits of US healthcare spending, a new front in the war on obesity, and maternal and child health issues. Here is a roundup of this week's news for US physicians:
Community health centers serve 3 million more patients
Obama Administration spending on community health centers appears to be paying off, according to a new White House report.
Enrollment in community health centers increased by nearly 3 million patients nationwide from 2008 to 2011, says the report. This increase is attributed to an infusion of $ 1 billion in funds from a total of $ 9.5 billion allocated to community health centers under the Patient Protection and Affordable Care Act, derided by its detractors as "Obamacare," and to the Administration's economic stimulus program, known as the Recovery Act.
"The healthcare law has already supported the construction and renovation of 190 capital projects at health centers and the creation of 67 new health center sites across the country, and will support the construction and renovation of more than 485 health center sites and the creation of more than 245 new community health center sites over the next 2 years," the report states.
High costs, mediocre results
Yet as a Commonwealth Fund report found, overall the USA spends more on healthcare than 12 other leading developed nations, with relatively little to show for it.
In 2009 the USA spent $ 7960 per capita on healthcare, translating into 17.4% of the gross domestic product. The next highest expenditure was by Norway, at $ 5352 per capita, comprising 9.6% of its GDP. Japan was the most frugal with its healthcare yen, spending just $2,878 (2008 figures) per capita, or 8.5% of its GDP.
The USA has the highest proportion of obese citizens of any of the 34 nations of the Organization for Economic Cooperation and Development (OECD). Additionally, US citizens pay higher prices for drugs, office visits, and procedures than residents of any other nation studied, and US clinicians have more frequent and widespread use of expensive medical technologies such as computed tomography, magnetic resonance imaging, positron-emission tomography, and mammography.
The report's author points out that while breast cancer and colorectal cancer survival rates are the highest among the countries studied, the survival rate for cervical cancer was below that of the OECD median, and substantially lower than that of Norway. Additionally, the USA had the highest rates of asthma mortality and lower-extremity amputations due to diabetes, "suggesting a failure to effectively manage these chronic conditions that make up an increasing share of the disease burden," the report states.
Too many preemies
The USA is also high on the list of countries with premature births, says a report issued jointly by the World Health Organization and leading international maternal and child health advocacy agencies.
The USA ranks sixth among nations in the number of preterm births annually, behind only India, China, Nigeria, Pakistan, and Indonesia, according to the report. Worldwide, more than 15 million babies - more than one in 10 infants - are born preterm, defined as before the 37th week of gestation, the report says, noting that preterm births are increasing in nearly all countries that have reliable data.
Prematurity is the leading cause of death in neonates, and the second-leading cause, after pneumonia, in children under 5 years of age, the report states.
According to National Center for Health Statistics data cited in the report, nearly 12 of every 100 infants born in the USA in 2010 were premature, an increase of 30% since 1971.
The report calls for prevention of preterm births through "family planning and increased empowerment of women, especially adolescents, plus improved quality of care before, between, and during pregnancy."
Texas versus Planned Parenthood Federation
Women's health was at the center of a different controversy, revolving around the state of Texas' so-called "affiliation rule." The rule, which would bar the Planned Parenthood Federation of America (PPFA) from receiving reimbursement from the state's Women's Health Program (WHP), could result in the loss of medical care services for nearly half of all women who receive healthcare under the program, suggests a report from the George Washington University School of Public Health and Health Policy in Washington, DC.
The law, if enacted, would prevent participation in the WHP by any health services organization that provided abortions or was affiliated with abortion providers, say the authors. A Federal Court judge in Texas issued a preliminary injunction against the law on April 30 2012, but a judge for the Fifth US Circuit Court reversed the injunction May 2 2012, allowing the law to stand for the moment.
The rule could mean that nearly 52,000 women in Texas will lose access to preventive healthcare services provided by PPFA clinics under the WHP, according to the authors of the report.
"Planned Parenthood clinics are by far the dominant source of care under the WHP," they say, noting that PPFA clinics made up approximately half of all WHP-financed care in 2010. PPFA clinics provided services to 51,953 of the 105,998 WHP clients served. In all, 1469 providers billed the WHP in 2010, of which 908 (62%) served 10 or fewer patients, and 368 (25%) served just one patient.
In the realm of child and adolescent health, investigators from the Johns Hopkins Bloomberg School of Public Health said that states need to a better job at shielding children and adolescents from alcohol advertising and marketing.
They examined advertising regulations in all 50 states, measuring the success of regulatory strategies in curbing youth-oriented alcohol marketing in both traditional "measured" advertising media (broadcast, print, signs and billboards), and nontraditional "unmeasured" media (internet, sweepstakes, TV/movie product placement, T-shirts, novelties, etc). Each state was ranked according to its adherence to eight best practices.
They found that 22 states had laws that did not incorporate any of the best practices, did not regulate the activities of concern, or had laws on the books that were unenforceable. Only 11 states had laws incorporating more than one of the recommendations, and none had more than five.
Fighting fat with best health practices is the goal of "The Obesity Prevention Source," a new website launched by the Harvard School of Public Health.
For clinicians, the site provides specific recommendations for action by provider care providers, hospitals and clinics, health insurance plans, and professional organizations. For example, the site recommends that pediatricians measure body mass index percentiles at well-child visits, counsel patients and families on healthy eating and limiting televisions time, inform parents about limiting consumption of sugar-sweetened beverages, promote moderate to vigorous daily physical activity, establish procedures for follow-up assessments of overweight and obese children, and establish policies in pediatric clinics to prevent weight bias.
By Neil Osterweil