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The Promise of the Platform Economy for Health

There’s a lot of talk about the growing platform economy. If well-designed platforms get adopted in healthcare, they may help our ailing healthcare systems get better. The quality, safety, and convenience of healthcare in America suffer from a lack of patients’ personal health data being essentially locked in data siloes. The diagnosis is lack of data “liquidity:” the ability for our health information generated in various touch points in the healthcare system and in our personal lives each day to move outside of the locations where the bits and bytes were first created: to our clinicians, researchers, health providers, and to

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Paper and Fax, Not EHRs or Portals, Are Popular for Health Data Sharing

Faxing in health care ranks higher in patient data information sharing than using secure email, online portals, health information exchange (HIE), or leveraging electronic health records. Welcome to the American healthcare system in 2016, as described in a market spotlight published by IDC, The Rocky Road to Information Sharing in the Health System. IDC’s survey research among healthcare providers forecasts the “rocky road” to information sharing. That rocky road is built for medical errors, duplication of services, greater healthcare costs, and continued health il-literacy for many patients. “The holy grail of interoperability — lower-cost, better-quality care with an improved experience for

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U.S. Health At A Glance – Not So Healthy

People in the U.S. have lower life expectancy, a growing alcohol drinking problem, and relatively high hospital inpatient rates for chronic conditions compared with other OECD countries. And, the U.S. spends more on health care as a percent of GDP than any other country in the world. This isn’t new-news, but it confirms that U.S. health citizens aren’t getting a decent ROI on health spending compared with health citizens around the developed world. In the OECD’s latest global look at member countries’ health care performance, Health at a Glance 2015, released today, the U.S. comes out not-so-healthy in the context

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Consumers trust retailers and techs to manage their health – as much as health provider

40% of U.S. consumers trust Big Retail to manage their health; 39% of U.S. consumers trust healthcare providers to manage their health. What’s wrong with this picture? The first chart shows the neck-and-neck tie in the horse race for consumer trust in personal health management. The Walmart primary care clinic vs. your doctor. The grocery pharmacy vis-a-vis the hospital or chain pharmacy. Costco compared to the chiropractor. Or Apple, Google, Microsoft, Samsung or UnderArmour, because “digitally-enabled companies” are virtually tied with health providers and large retailers as responsible health care managers. Welcome to The Birth of the Healthcare Consumer according

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Doctors who write right: Gawande, Topol and Wachter put people at the center of health/care

There’s a trifecta of books written by three brilliant doctors that, together, provide a roadmap for the 21st century continuum of health care: The Patient Will See You Now by Eric Topol, MD; The Digital Doctor from Robert Wachter, MD; and, Being Mortal, by Atul Gawande. Each book’s take provides a lens, through the eyes of a hands-on healthcare provider, on healthcare delivery today (the good, the warts and all) and solutions based on their unique points-of-view. This triple-review will move, purposefully, from the digitally, technology optimistic “Gutenberg moment” for democratizing medicine per Dr. Topol, to the end-game importance of

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Health and financial well-being are strongly linked, CIGNA asks and answers

The modern view on wellness is “having it all” in terms of driving physical, emotional, mental and financial health across one’s life, according to CIGNA’s survey report, Health & Financial Well-Being: How Strong Is the Link?  The key elements of whole health, as people define them are: – Absence of sickness, 37% – Feeling of happiness, 32% – Stable mental health, 32% – Management of chronic disease, 15% – Financial health, 14% – Living my dreams, 9%. 1 in 2 people (49%) agree that health and wellness comprise “all of these” elements, listed above. This holistic view of health is

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Novel concept: people + health pricing information = market competition

In the post-Recession American economy, people shop for value in all things. And that includes health care services like MRIs — when patients are informed of pricing differences among imaging facilities and given free rein to pick-and-choose among them. In addition to lowering imaging costs in a community, price transparency also generated competition between providers. Health Affairs published this research detailed in Price Transparency for MRIs Increased Use of Less Costly Providers And Triggered Provider Competition in August 2014. An Economics 101 course teaches us that a well-oiled (perfect) market depends on lots of sellers of a product and lots of

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The Season of Healthcare Transparency – Chaos, then Creation, Part 5

The consumer demand side for healthcare transparency is hungry for the light to shine on health care costs, quality and information that’s relevant and meaningful to the individual. The supply side is fast-growing, with websites and portals, government-sponsored projects, commercial-driven start-ups, and numerous mobile apps. These tools endeavor to: Help people find and access services Schedule appointments Compare peer consumers’ reviews for those providers Calculate and prepare for out-of-pocket co-payments deriving from their health plan Negotiate prices with providers Pay for the services, and Reconcile the payment with a high-deductible health plan or health savings account. On the demand side, consumers

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The Season of Healthcare Transparency – HFMA’s Price Transparency Manifesto – Part 1

As Big Payors continue to shift more costs onto health consumers in the U.S., the importance of and need for transparency grows. 39% of large employers offered consumer-directed health plans (CDHPs) in 2013, and by 2016, 64% of large employers plan to offer CDHPs.  These plans require members to pay first-dollar, out-of-pocket, to reach the agreed deductible, and at the same time manage a health savings account (HSA). In the past several weeks, many reports have published on the subject and several tools to promote consumer engagement in health finance have made announcements. This week of posts provides an update on

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HIMSS14 Monday Morning Quarterback – The Key Takeaways

Returning to terra firma following last week’s convening of the 2014 annual HIMSS conference…taking some time off for family, a funeral, the Oscars, and dealing with yet another snowstorm…I now take a fresh look back at #HIMSS14 at key messages. In random order, the syntheses are: Healthcare in America has entered an era of doing more, with less...and health information technology is a strategic investment for doing so. The operational beacon going forward is moving toward The Triple Aim: building population health, enhancing the patient’s experience, and lowering costs per patient. The CEO of Aetna, Mark Bertolini, spoke of the

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Innovating and thriving in value-based health – collaboration required

In health care, when money is tight, labor inputs like nurses and doctors stretched, and patients wanting to be treated like beloved Amazon consumers, what do you do? Why, innovate and thrive. This audacious Holy Grail was the topic for a panel II moderated today at the Connected Health Symposium, sponsored by Partners Heathcare, the Boston health system that includes Harvard’s hospitals and other blue chip health providers around the region. My panelists were 3 health ecosystem players who were not your typical discussants at this sort of meeting: none wore bow ties, and all were very entrepreneurial: Jeremy Delinsky

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Consumers don’t get as much satisfaction with high-deductible health plans

Since the advent of the so-called consumer-directed health care era in the mid-2000s, there’s been a love-gap between health plan members of traditional plans, living in Health Plan World 1.0, and people enrolled in newer consumer-driven plans – high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs). That gap in plan satisfaction continues, according to the Employee Benefits Research Institute (EBRI)’s poll of Americans’ consumer engagement in health care. The survey was conducted with the Commonwealth Fund. As the bar chart illustrates, some 62% of members in traditional plans were satisfied (very or extremely) with their health insurance in 2012.

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The health care automat – Help Yourself to healthcare via online marketplaces

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions? Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange. This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces. What’s driving this new wrinkle in retail health care are: U.S. health citizens morphing into consumers,

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10 Reasons Why ObamaCare is Good for US

When Secretary Sebelius calls, I listen. It’s a sort of “Help Wanted” ad from the Secretary of Health and Human Services Kathleen Sebelius that prompted me to write this post. The Secretary called for female bloggers to talk about the benefits of The Affordable Care Act last week when she spoke in Chicago at the BlogHer conference. Secretary Sebelius’s request was discussed in this story from the Associated Press published July 25, 2013. “I bet you more people could tell you the name of the new prince of England than could tell you that the health market opens October 1st,” the

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Bending the cost-curve: a proposal from some Old School bipartisans

Strange political bedfellows have come together to draft a formula for dealing with spiraling health care costs in the U.S. iin A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment from the Bipartisan Policy Center (BPC). The BPC was founded by Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. This report also involved Bill Frist, Pete Domenici, and former White House and Congressional Budget Office Director Dr. Alice Rivlin who together work with the Health Care Cost Containment Initiative at the BPC. The essence of the 132-page report is that the U.S. health system is

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Let patients help: the BMJ covers an American ePatient’s learnings

In this week’s BMJ (British Medical Journal), an American patient tells his story about being equipped, enabled, empowered and engaged — the many “e’s” making up the prefix of “ePatient.”  This definition comes out of the work of Dr. Tom Ferguson, who worked with the e-Patient Scholars Working Group in 2007, to publish the first white paper about the phenomenon, e-Patients: how they can help us heal health care. ePatient Dave is the patient-author of the BMJ piece, making the case for shared decision-making and patient involvement in health care decisions. He writes in the conclusion, “The value delivered by skilled

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The need for a Zagat and TripAdvisor in health care

  Patient satisfaction survey scores have begun to directly impact Medicare payment for health providers. Health plan members are morphing into health consumers spending “real money” in high-deductible health plans. Newly-diagnosed patients with chronic conditions look online for information to sort out whether a generic drug is equivalent to a branded Rx that costs five-times the out-of-pocket cost of the cheaper substitute. While health care report cards have been around for many years, consumers’ need to get their arms around relevant and accessible information on quality and value is driving a new market for a Yelp, Travelocity, or Zagat in

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Most consumers will look to health insurance exchanges to buy individual plans in 2013

  As the Affordable Care Act, health reform, aka Obamacare, rolls out in 2013, American health insurance shoppers will look for sources of information they can trust on health plan quality and customer service satisfaction — as they do for automobiles, mobile phone plans, and washing machines. For many years, one of a handful of trusted sources for such insights has been J.D. Power and Associates. J.D. Power released its 2013 Member Health Plan Study (the seventh annual survey) and found that most consumers currently enrolled in a health plan have had a choice of only “one” at the time

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Bill Clinton’s public health, cost-bending message thrills health IT folks at HIMSS

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

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Health consumers don’t understand overtreatment, and their role in driving health costs

Overuse of health care is defined as the delivery of health care services for which the risks outweigh the benefits, according to a study into the utilization of ambulatory care health services published in the January 28, 2013, issue of JAMA Internal Medicine (the new title for the Archives of Internal Medicine). “Trends in the Overuse of Ambulatory Health Care Services in the United States” found that, of the estimated $700 billion that is wasted annually in U.S. health care, overuse comprises about $280 billion – over one-third of waste — equal to over 10% of total health spending in

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Living paycheck to paycheck: what it means for health

While 50% of Americans feel they have a sound financial position, the other half is living paycheck to paycheck. 8% say they can’t even pay for essentials. The second annual Allstate “Life Tracks” Poll finds American adults split between have’s and have not’s, with even the “have’s” feeling less than financially literate. There is an equal split between people who feel they’re in an “excellent” or “good” financial position compared with those who feel they’re in financially “fair” or “poor” shape. Men feel more financially secure than women; 3 in 4 single parents feel less well-off compared to the average

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Employees will bear more health costs to 2017 – certainty in an uncertain future

Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in

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Said the EHR to the doctor, “you like me, you really like me!”

Over one-half of office-based physicians in the U.S. had adopted an electronic health record (EHR) in 2011. Among theese adopters, 85% were satisfied: 38% “very,” and 47% “somewhat.” Those are pretty good reviews considering so many came to EHRs based on the government’s HITECH incentive and not motivated purely out of intrinsic personal passion to adopt digital medical records systems. This update comes from the July 2012 Data Brief from the National Center for Health Statistic, Physician Adoption of Electronic Health Records Systems: United States. 2011. The report details survey findings from 5,232 office-based physicians who completed the mailed questionnaire in

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Converging for health care: how collaborating is breaking down silos to achieve the Triple Aim

  On Tuesday, 9 July 2012, health industry stakeholders are convening in Philadelphia for the first CONVERGE conference, seeking to ignite conversation across siloed organizations to solve seemingly intractable problems in health care, together. Why “converge?” Because suppliers, providers, payers, health plans, and consumers have been fragmented for far too long based on arcane incentives that cause the U.S. health system to be stuck in a Rube Goldbergian knot of inefficiency, ineffectiveness and fragmentation of access….not to mention cost increases leading us to devote nearly one-fifth of national GDP on health care at a cost of nearly $3 trillion…and going up.

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Why we now need primary care, everywhere

With the stunning Supreme Court 5-4 majority decision to uphold the Patient Protection and Affordable Care Act (ACA), there’s a Roberts’ Rules of (Health Reform) Order that calls for liberating primary care beyond the doctors’ office. That’s because a strategic underpinning of the ACA is akin to President Herbert Hoover’s proverbial “chicken in every pot:” for President Obama, the pronouncement is something like, “a medical home for every American.” But insurance for all doesn’t equate to access: because 32-some million U.S. health citizens buy into health insurance plans doesn’t guarantee every one of them access to a doctor. There’s a

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58% of Americans self-rationing health care due to cost

Since the advent of the Great Recession of 2008, more Americans have been splitting pills, postponing needed visits to doctors, skipping dental care, and avoiding recommended medical tests due to the cost of those health care services. Call it health care self-rationing: the Kaiser Family Foundation (KFF) has been tracking this trend for the past several years, and the proportion of American adults rationing health demand is up to 58%. This KFF Health Tracking Poll interviewed 1,218 U.S. adults age 18 and older via landline and cell phone in May 2012. As the chart illustrates, 38% of people are “DIYing” health care

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Improving health care through Big Data: a meeting of the minds at SAS

Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs. Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey

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It’s the prices and the technology, stupid: why U.S. health costs are higher than anywhere in the world

The price of physician services, proliferation of clinical technology and the cost of obesity are the key drivers of higher health spending in the U.S., according to The Commonwealth Fund‘s latest analysis in their Issues of International Health Policy titled, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, published in May 2012. The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%. On the physician pay front, primary care

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A $132 doctor’s visit in Hanoi, Vietnam: a diagnosis, value-based health care and a new friend

$132 won’t go far in a U.S. emergency room, but in Vietnam, it gets you first class treatment, a highly-trained and empathetic French doctor, and cheap prescriptions, as well. You could call it Presidential treatment, as a certificate from the White House was proudly displayed in the lobby waiting area sent in appreciation of great care received by President George W. Bush. After arriving in Hanoi two nights ago, following three airline flights over nearly 24 hours, our daughter developed a rough cough that gave her chest pains. We gave the condition one day to improve and then spoke with

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Patient engagement and medical homes – core drivers of a high-performing health system

It was Dr. Charles Safran who said, “Patients are the most under-utilized resource in the U.S. health system,” which he testified to Congress in 2004. Seven years later, patients are still under-utilized, not just in the U.S. but around the world. Yet, “when patients have an active role in their own health care, the quality of their care, and of their care experience improves,” assert researchers from The Commonwealth Fund in their analysis of 2011 global health consumer survey data published in the April/June 2010 issue of the Journal of Ambulatory Care Management. This analysis is summarized in International Perspectives on

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From volume to value: how health execs see the future of health care

Transparency and authenticity, constant and clear communication, and a drive toward value underpin the future health system — for those health leaders who can commit to these pillars of transformational change. Leading Through Transformation: Top Healthcare CEOs’ Perspectives on the Future of Healthcare summarizes the interaction among 17 health execs who convened at the second CEO Forum held by Huron Healthcare Group. The report was released in January 2012. Health leaders concur that regardless of the politics of the Affordable Care Act and its prospects for whole or partial survival beyond November 2012, market pressures in the health sector are driving

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The average annual health costs for a U.S. family of four approach $20,000, with employees bearing 40%

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context, The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350 The car buyer could purchase a Mini-Cooper with $20,000 The investor could invest $20K to yield $265,353 at a 9% return-on-investment. The MMI increased 7.3% between 2010 and 2011, about the same

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The story of Kaiser Permanente’s EHR

“To call health care’s information management for the most part ‘twentieth century’ is as wrong as calling it ‘twenty-first century;’ it’s nineteenth century,” begins Dr. Donald Berwick, Administrator of the Centers for Medicaid and Medicare Services, in the foreword to a new book that tells the story about how the world’s largest health IT project was successfully implemented. Connected for Health was edited by Dr. Louise L. Liang who was senior vice president, Quality and Clinical Systems Support, for the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals between 2002 and 2009. It was during that time that Kaiser envisioned and implemented KP

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Choosing doctors in the dark: consumers can’t yet pick docs based on quality

The usual questions a rational health citizen might ask when selecting a physician based on quality aren’t consistently yielding the best choices, according to a study funded by The Commonwealth Fund, Associations Between Physician Characteristics and Quality of Care. Researchers found that individual physician-comparative parameters such as malpractice claims and disciplinary actions, years in practice or medical school ranking had no significant association with better quality performance. Female physicians (vs. male) and Board certification had small significance, 1.6 points and 3.3 points, respectively. This study’s results demonstrate that the metrics consumers assume should be useful proxies for physician quality aren’t as useful

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The role of retail health clinics post-health reform

  Retail health clinics have served American health consumers for about a decade. What have we learned over these ten years? As retail clinics proliferate the U.S. health care ecosystem, what is their impact on the health system, health consumers, and the health economy? The RAND report, Policy Implications of the Use of Retail Clinics, responds to these issues. The key implications of RAND’s study are that: – Health programs should be designed and paid-for to incorporate the adoption of retail clinics and reduce fragmentation and dis-continuity of care. – Learn from the best practices and patient outcomes gained from

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Health reform = meaningful use among health executives

Meeting meaningful use for inpatient EHRs is the top priority among the many challenges health executives face when considering how the Patient Protection and Affordable Care Act (PPACA) will impact their organizations. Overall, 2 in 3 health execs place MU for inpatient EHRs as the “highest priority;” among health IT executives, the proportion citing this as the highest priority is 84%. The second-most pressing PPACA priority for health executives is preparing for new models of payment, cited by 17% of health execs overall, and 31% of non-IT executives. CSC surveyed health executives in July to gauge their temperatures on several PPACA line-items including

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More money, less effective: the U.S. ranks last again in health system effectiveness

  Among seven developed countries – Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States of America — it’s the U.S. that ranks dead last in the effectiveness of the nation’s health system. In particular, the U.S. rates poorly on the issues of coordination of health care, cost-related problems causing access challenges for health citizens, efficiency, equity, and long/healthy/productive lives for citizens. Of course, it also figures in that the U.S. spends more per capita on health care than any other country on the planet: $7,290 per person compared with Health Nation #1, the Netherlands, which

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Getting Americans to "right-size" health care: understanding evidence-based medicine

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A picture tells a thousand words and health cost disparities in the State of Maine

By Jane Sarasohn-Kahn on 17 May 2010 in Health disparities, Health Economics, Health Quality

The Dartmouth Atlas and other health cost analysts have exposed the phenomenon of varying health costs, from the state of Florida to California, Oregon to McAllen, Texas. Now we have evidence of big cost disparities within a relatively small state – the State of Maine. Details on this story appear in the May 16th 2010 Portland Press Herald, which created the illustration shown here based on pricing data collected throughout the state. Health citizens in Maine are fortunate to have a state-funded resource that aggregates and analyzes data on health care cost and quality from health care providers in the state,

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Affordable care and better information: what Americans want from a new-and-improved US health system

Anxiety about health care costs tops American citizens’ concerns about health care in the U.S. Rich, poor, insured or un-, 2 in 3 Americans worry about the affordability of health care in America.   So it follows, then, that among those without health insurance, 57% blame their uninsured state on the fact that they simply cannot afford it, as shown in the table on the right. Beyond this group, 30% of the uninsured cite the employer’s role in health insurance: 14% aren’t employed, 9% have employers who don’t offer coverage, and 7% are “between jobs.”   These findings come from

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In the health system popularity contest, the U.S. loses

By Jane Sarasohn-Kahn on 10 July 2008 in Global Health, Health Quality, Health reform, Public health

In this season’s Health System Idol contest, the U.S. loses to most other developed countries. One in three Americans would like to “completely rebuild” the U.S. health system, according to The Harris Poll conducted in ten nations.   And another 50% believe that, “fundamental changes are needed to make it work better.”   Harris also measured ‘unpopularity’ with another metric: asking whether, “the system works pretty well and only minor changes are necessary.” Adding this yin to the other yang, the mash-up is still the same: the U.S. plays last fiddle to the rest of the world’s health system orchestra.

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