Tuesday, February 7, 2017
Collaboration with a robotic scrub nurse
Some of you are interested in AI or robots in healthcare. I was going to share this with certain students, but then thought you might all might find it interesting. I found this in the ACM (Association of Computing Machinery - an excellent resource on all things technology) UA library database. The article* is how surgeons use hand gestures and/or voice commands to the robot without interrupting the natural flow of a procedure.
The Soaring Cost of a Simple Breath
In the article, “The Soaring Cost of a Simple Breath”, readers are presented with the high-costs of asthma inhalers. Asthma is the most common chronic disease that affects around 40 million Americans and it is common knowledge that asthma is very controllable with drugs. In the United States, obtaining these drugs at fair costs is nearly impossible and requires the best insurance or tons of disposable income. Author Elizabeth Rosenthal meets with an upper-middle class family to understand the financial impact of these easy-to-make drugs. Pulmicort is a steroid inhaler that retails for over $175 dollars in the United States, it retails for $20 dollars in the Britain and is also dispensed to asthma patients free of charge. Even simple inhalers such as nasal sprays are $250 in the U.S. while the cost for Europeans is around $7.
Even with the insane costs of on-brand medicines, the United States is also dealing with rising costs of generic medicines. Generic Augmentin, a very common antibiotic, retails up to $120 for a 10-day prescription and the generic version of Adderall costs up to $150 per month. It’s also important to note that generics don't’ even exist for some medical conditions, including asthma. Generics increased in price at an average of 5.3% with brand-name medicines skyrocketing over 25% in 2012.
Every developed nation in the world has either direct or indirect government influence on the price of national wholesale price for each drug, while the United States leaves all of the prices up to competition in the free market. “Competition in the free market” is complete coded language in today’s health care arena. An incredible amount of lifesaving drugs is made by only one manufacturer and businesses can only slightly blunt market forces. The patent system in the United States allows for pharmaceutical companies to reign over the prices of their drugs. The repatening of older drugs (birth control, insulin and colchicine) is a way to charge exorbitant prices for drugs that once cost pennies. Besides repatening, pharmaceutical companies also gouge patients by choosing to sell drugs via prescription rather than over the counter, so that the insurers are forced to cover a price tag that would be considered unacceptable for customers to cover on their own. This article sheds light on the complete necessity of government intervention in the healthcare “industry.” It won’t be an easy battle considering that over $250 million was spent on pharmaceutical and healthcare lobbying in 2012.
Even with the insane costs of on-brand medicines, the United States is also dealing with rising costs of generic medicines. Generic Augmentin, a very common antibiotic, retails up to $120 for a 10-day prescription and the generic version of Adderall costs up to $150 per month. It’s also important to note that generics don't’ even exist for some medical conditions, including asthma. Generics increased in price at an average of 5.3% with brand-name medicines skyrocketing over 25% in 2012.
Every developed nation in the world has either direct or indirect government influence on the price of national wholesale price for each drug, while the United States leaves all of the prices up to competition in the free market. “Competition in the free market” is complete coded language in today’s health care arena. An incredible amount of lifesaving drugs is made by only one manufacturer and businesses can only slightly blunt market forces. The patent system in the United States allows for pharmaceutical companies to reign over the prices of their drugs. The repatening of older drugs (birth control, insulin and colchicine) is a way to charge exorbitant prices for drugs that once cost pennies. Besides repatening, pharmaceutical companies also gouge patients by choosing to sell drugs via prescription rather than over the counter, so that the insurers are forced to cover a price tag that would be considered unacceptable for customers to cover on their own. This article sheds light on the complete necessity of government intervention in the healthcare “industry.” It won’t be an easy battle considering that over $250 million was spent on pharmaceutical and healthcare lobbying in 2012.
A Funeral May Cost You Thousands Less Just By Crossing The Street
I read this article and thought about the costs that occur by one large funeral conglomerate over the prices by others.
In a months-long investigation into pricing and marketing in the funeral business, also known as the death care industry, NPR spoke with funeral directors, consumers and regulators. They collected price information from around the country and visited providers. They found a confusing, unhelpful system that seems designed to be impenetrable by average consumers, who must make costly decisions at a time of grief and financial stress [my emphasis].
Funeral homes often aren't forthcoming about how much things cost, or embed the information in elaborate package deals that can drive up the price of saying goodbye to loved ones.
Read more.... and comment below.
In a months-long investigation into pricing and marketing in the funeral business, also known as the death care industry, NPR spoke with funeral directors, consumers and regulators. They collected price information from around the country and visited providers. They found a confusing, unhelpful system that seems designed to be impenetrable by average consumers, who must make costly decisions at a time of grief and financial stress [my emphasis].
Funeral homes often aren't forthcoming about how much things cost, or embed the information in elaborate package deals that can drive up the price of saying goodbye to loved ones.
Read more.... and comment below.
Wednesday, February 1, 2017
In Need of a New Hip, but Priced Out of the U.S.
Link: http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html
A man by the name of Michael Shopenn was in need of getting a hip replacement. His artificial hip was made by a company based out of Europe that had to be installed at their manufacturing center. Michael had to fly all the way to Europe to get his hip replaced. The reason for his need of hip replacement was because he had arthritis and could barely stand long enough to make coffee. He had health insurance, but his health care did not cover his joint replacement because it was caused by a pre-existing condition. He became desperate to find a solution to his problem that was affordable and convenient for him. The surgery would be over $65,000 which was about a third of Michaels savings at the time so he had to look elsewhere. He compared prices from all over the world and found that they were mostly the same price but cheaper anywhere outside the United States.
The reason for implant list prices being so high as well as them rising by more than 5 percent a year is due to a cartel. All hip and knee implants are made by only 5 companies that simply tweak old models and patent the changes as new products and continue to bump up the price. This is a commonality throughout the healthcare world, this existence of cartels or monopolies that are able to charge ridiculously high prices simply because they can. They do not have enough competition to make them charge anything lower nor is there a reason to in their eyes.
In my opinion this is why medical costs are so high is because manufacturers are more focused on how much money they can make by charging the highest possible price people are willing to pay. They manufacture implants to help people live a better life but are not making it affordable. They should be wanting to help as many people as they can, not focus on the money. Its all about helping others and making sure they are happy and healthy. That is my biggest take away from this article.
A man by the name of Michael Shopenn was in need of getting a hip replacement. His artificial hip was made by a company based out of Europe that had to be installed at their manufacturing center. Michael had to fly all the way to Europe to get his hip replaced. The reason for his need of hip replacement was because he had arthritis and could barely stand long enough to make coffee. He had health insurance, but his health care did not cover his joint replacement because it was caused by a pre-existing condition. He became desperate to find a solution to his problem that was affordable and convenient for him. The surgery would be over $65,000 which was about a third of Michaels savings at the time so he had to look elsewhere. He compared prices from all over the world and found that they were mostly the same price but cheaper anywhere outside the United States.
The reason for implant list prices being so high as well as them rising by more than 5 percent a year is due to a cartel. All hip and knee implants are made by only 5 companies that simply tweak old models and patent the changes as new products and continue to bump up the price. This is a commonality throughout the healthcare world, this existence of cartels or monopolies that are able to charge ridiculously high prices simply because they can. They do not have enough competition to make them charge anything lower nor is there a reason to in their eyes.
In my opinion this is why medical costs are so high is because manufacturers are more focused on how much money they can make by charging the highest possible price people are willing to pay. They manufacture implants to help people live a better life but are not making it affordable. They should be wanting to help as many people as they can, not focus on the money. Its all about helping others and making sure they are happy and healthy. That is my biggest take away from this article.
As Hospital Prices Soar, a Stitch Tops $500
In the article, As Hospital Prices Soar, a Stitch Tops $500, author Elizabeth Rosenthal explains the the high costs involved with trips to the Emergency Room, and the reasoning behind why hospitals charge that much. Rosenthal sums up why hospitals are able to charge exorbitant prices for things such as gauze, IV bags, and pills quite simply: because they can. Rosenthal mentions "Economists note that hospitals can bill for emergency room care with relative impunity, since injured patients generally rush to the nearest treatment facility", an idea that we have discussed in class about how hospitals are able to use peoples fear to set prices well above market value.
Another big reasoning behind costs going up is attributed to mergers and consolidation of hospitals. Rosenthal points to Sutter in northern California, as the author writes "Sutter operates the only hospital in some California cities." providing them with the market power to raise prices without worrying about fear of decreased demand. She also notes how these major healthcare providers like Sutter or Banner are able to use their size and market power to dictate terms and pricing in contracts, as well as including gag orders that prevent patients from knowing what rate their insurers negotiated on their behalf.
One of the more interesting parts of the article was the interactive map of the cost of the medical care to treat a cut finger, highlighting the differences by regions. Next to the map was a bar graph of each of the regions and the amount that was paid to both the hospitals and doctors. Although there was a slight difference across the country in the amount paid to doctors (the biggest gap being $200 between Texas and New England), there is a huge discrepancy in the amount paid to hospitals with west coast hospitals collecting almost twice as much compared to those on the east coast. Again as we have discussed in class, is there any justification for massive difference in prices? The article points to the arbitrarily set prices on the "chargemaster".
There are many questions to think about going forward, such as what are we able to do about this? What alternatives do we, the consumer, have when it comes to receiving treatment with out being forced to pay the high prices?
Another big reasoning behind costs going up is attributed to mergers and consolidation of hospitals. Rosenthal points to Sutter in northern California, as the author writes "Sutter operates the only hospital in some California cities." providing them with the market power to raise prices without worrying about fear of decreased demand. She also notes how these major healthcare providers like Sutter or Banner are able to use their size and market power to dictate terms and pricing in contracts, as well as including gag orders that prevent patients from knowing what rate their insurers negotiated on their behalf.
One of the more interesting parts of the article was the interactive map of the cost of the medical care to treat a cut finger, highlighting the differences by regions. Next to the map was a bar graph of each of the regions and the amount that was paid to both the hospitals and doctors. Although there was a slight difference across the country in the amount paid to doctors (the biggest gap being $200 between Texas and New England), there is a huge discrepancy in the amount paid to hospitals with west coast hospitals collecting almost twice as much compared to those on the east coast. Again as we have discussed in class, is there any justification for massive difference in prices? The article points to the arbitrarily set prices on the "chargemaster".
There are many questions to think about going forward, such as what are we able to do about this? What alternatives do we, the consumer, have when it comes to receiving treatment with out being forced to pay the high prices?
Patients' Costs Skyrocket; Specialists' Incomes Soar
We've been introduced to the rise of health care costs in our past lectures, and in the movie Escape Fire. In a New York Times article, Patients Costs Skyrocket;Specialists' Incomes Soar, the author focuses on the astronomical increase of the cost of specialists in comparison to their primary care physician counterparts. There are certain specialists that are the top earners of any other physician in the field, these include orthopedics, cardiology, anesthesiology, radiology, dermatology, plastic surgery, urology, gastroenterology, and ophthalmology. These physicians earn more than $350,000 annually, according to American Medical Group Association. In some cases, certain specialists incomes have risen more than 10% since 2011 (Medscape). For dermatologists, gastroenterologists and oncologists, their incomes have risen 50% or more between 1995 and 2012. These prices are protected by the more than 750 lobbyists in Washington, as they push back on any efforts to limit the doctors' incomes. Primary care doctors on the other hand have only about 5 representatives who are often struggling to make ends meet without the extra cash from side surgeries/x-rays/etc. The incomes for primary care doctors only rose 10% in that same 17 year period.
The article talks of Ms. Little from Arkansas who felt she was bullied into seeing 3 different specialists for the removal of a small white mole on her cheek using the Mohs surgery (an effective way of removing carcinogenic moles but not needed more several cases). She started in with the dermatologist who removed the mole. Then, he sent her across the street to see the plastic surgeon who would close the wound with a "couple of stitches". Yet when she arrived, she was greeting by nurses who prepared her to see an anesthesiologist to sedate her as well. According to the article, "the vast majority of Mohs procedure are sewed up by the dermatologist or just bandages and left to heal." Her bills totaled more than $25,000.
It's alarming to me that many patients out there don't feel as if they can get in a say in what kind of treatments they receive. We are taught to trust doctors because of their extensive training in the medical field, and we think to trust specialists even more for their dedication to a specific trade. However, reading Ms. Little's story makes me think otherwise. My mom actually had Mohs surgery a few years ago for a spot on her nose, and she informed me that she only saw the dermatologist who diagnosed the spot and then was sent to just one Mohs specialist who did everything else. No plastic surgeon, and no anesthesiologist. This just shows the varying types of treatment people face all over the country. Now I don't know how much my mom paid before insurance because she also worked for the hospital at the time so her rates I believe were a bit discounted. Unfortunately, as the article mentioned, incomes are only going to increase over the years. So I wonder what we really can do to stop these inflated prices for certain treatments?
The article talks of Ms. Little from Arkansas who felt she was bullied into seeing 3 different specialists for the removal of a small white mole on her cheek using the Mohs surgery (an effective way of removing carcinogenic moles but not needed more several cases). She started in with the dermatologist who removed the mole. Then, he sent her across the street to see the plastic surgeon who would close the wound with a "couple of stitches". Yet when she arrived, she was greeting by nurses who prepared her to see an anesthesiologist to sedate her as well. According to the article, "the vast majority of Mohs procedure are sewed up by the dermatologist or just bandages and left to heal." Her bills totaled more than $25,000.
It's alarming to me that many patients out there don't feel as if they can get in a say in what kind of treatments they receive. We are taught to trust doctors because of their extensive training in the medical field, and we think to trust specialists even more for their dedication to a specific trade. However, reading Ms. Little's story makes me think otherwise. My mom actually had Mohs surgery a few years ago for a spot on her nose, and she informed me that she only saw the dermatologist who diagnosed the spot and then was sent to just one Mohs specialist who did everything else. No plastic surgeon, and no anesthesiologist. This just shows the varying types of treatment people face all over the country. Now I don't know how much my mom paid before insurance because she also worked for the hospital at the time so her rates I believe were a bit discounted. Unfortunately, as the article mentioned, incomes are only going to increase over the years. So I wonder what we really can do to stop these inflated prices for certain treatments?
Preventive Vaccines - Costing more than just dollars!
“The Price of Prevention: Vaccine Costs Are Soaring” presents an interesting coverage on the pain of needle prick felt by the providers, policy makers, parents and of course neonatal alike. For few it is a pinprick pain of losing money on every single shot they give - providers; for few it is a pinprick pain brought by the frustration of their kids are being left deprived of life-saving vaccination - parents, and lastly for few other it is a pinprick pain felt by policy makers once their well-thought plans don’t produce effective results - the vaccine advisory committee.
In the USA, the cost of essential vaccination has increased steeply in last few years. Many clinicians have stopped providing the vaccination shots as they incur a loss for each shot they provide. In the article, a situation is illustrated for San Antonio, Texas where providers are facing an ethical dilemma associated with this peculiar issue. Providers know that it is absolutely imperative to provide the life-saving vaccination to the infants but it is a question of how much loss they can incur. Approximately 40% providers have stopped vaccinations as they are not profitable anymore which has certainly worsened the situations for consumers.
Many states recommend (if not mandate) vaccination like Prevnar before children can enter daycare or preschool. This recommendation has created a strong demand for vaccination in the market; and have allowed pharmaceutical companies to increase the costs. In a few cases, pharmaceutical companies patents a drug and hence monopolize the market. A specific example quoted in the article is of Prevnar 13 - a vaccination sold by Pfizer accounting to their $4 billion sales every year. Prevnar has no real competitor in US markets and courtesy to this fact, the price of Prevnar 13 has gone up 6% each year since its inception in 2010.
Even policy makers have failed to steady the ship. Ironically, their policies are promoting the price increase of vaccinations. For example, CDC(Centers for Disease Control) is contemplating on a recommendation of Prevnar 13 to people over 65. If this recommendation comes into the force, it will further monopolize the drug maker and increase the revenues by $1 billion.Moreover, there is no policy by CDC to sustain the profitability of solo practices who have smaller purchasing power.
I would like to conclude by pointing out that it’s unfortunate that high cost is a deterrent to the life-saving vaccination in a developed nation like the USA. Below mention policy changes would probably have a positive impact on this grim situation:
1. Vaccination patenting should be discouraged. If this is not possible(in order to give a fair return on investments made on R&D by companies), the length of the patent should be reduced so that monopoly could be countered after certain years.
2. The purchasing power of solo and small practices should be protected and they should be encouraged to participate in the vaccination program.
3. Mandatory vaccination should be provided free by the government (much like what happens in developing nation like India under Universal Immunization Plan).
Trump’s new vaccination safety committee may be a ray of hope? Maybe!
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