Declining Medicine Use and Costs: For Better or Worse? A Review of the Use of Medicines in the United States in 2012
Declining Medicine Use and Costs: For Better or Worse? A Review of the Use of Medicines in the United States in 2012 (PDF)
Source: IMS Institute for Health Informatics
From press release:
Total spending on U.S. medicines fell 3.5 percent on a real per capita basis in 2012 and the use of healthcare services overall declined for the second consecutive year, according to a new study released today by the IMS Institute for Healthcare Informatics.
The report – Declining Medicine Use and Costs: For Better or Worse? – finds that total dollars spent on medications in the U.S. reached $325.8 billion last year, or real per capita spending of $898, down $33 from 2011. Underlying drivers for the overall decline in healthcare service use included fewer patient visits to office-based physicians, fewer non-emergency admissions to hospitals and outpatient facilities, and a less severe flu season in the early part of 2012. Patent expiries in 2012 contributed $28.9 billion to the reduction in medicine spending. This was their largest-ever impact as millions of patients accessed lower-cost generic versions of additional medicines.
Patients with insurance paid higher deductibles, copays and co-insurance for their overall healthcare, but prescription drug copays for most patients declined. At the same time, new transformative medicines became available to treat a large number of diseases with small or strictly defined patient populations.
Genworth 2013 Annual Cost of Care Survey: Nursing Home Costs Up, At Home Care Prices Remain Relatively Flat
In its 10th year, the Genworth 2013 Cost of Care Survey shows a continued upward trajectory when it comes to the cost of obtaining long term care services. The cost of receiving care in a setting such as an assisted living facility or nursing home is dramatically increasing, while the cost to receive care at home through homemaker services or a home health aide is rising at a much more gradual pace.
"There are many factors that go into rising care costs, from the number of available skilled professionals to real estate prices," said Pat Foley, president of distribution and marketing for Genworth. "If you look at national private nursing home costs over the past 10 years that we’ve done this study, the median annual costs have gone up from $65,200 to $83,950, increasing at more than four percent a year. The better news is that costs for homemaker services and home health aides have remained relatively flat. Since 70% of Genworth’s first time long term care claimants choose in-home care, these costs have remained more manageable."
Nationally, the 2013 median hourly cost of homemaker services and home health aide services is $18 and $19 respectively. Homemaker costs have risen just 1.4 percent since 2012 and 0.8 annually over the past five years. Home health aide services have risen 2.3 percent since 2012 and 1.0 percent annually over the past five years.
The costs to receive care in an assisted living facility are rising much faster. The median annual cost for care in an assisted living facility is $41,400. This represents an increase of 4.6 percent since 2012 and a 4.3 percent annual increase over the past five years. The comparable cost for a private nursing home room rose 3.6 percent from 2012 to 2013, to $83,950, or 4.5 percent annualized over the past five years.
Roxarsone, Inorganic Arsenic, and Other Arsenic Species in Chicken: A U.S.-Based Market Basket Sample
Source: Environmental Health Perspectives
Background: Arsenic-based drugs are permitted in poultry production. Inorganic arsenic (iAs) causes cancer and maybe other adverse health outcomes. The contribution of chicken consumption to iAs intake, however, is unknown.
Objectives: To characterize arsenic species profile in chicken meat and estimate bladder and lung cancer risk associated with consuming chicken produced with arsenic-based drugs.
Methods: Conventional, conventional antibiotic-free, and organic chicken samples were collected from grocery stores in ten US metropolitan areas from December 2010 to June 2011. 116 raw and 142 cooked samples were tested for total arsenic, and 78 samples ≥10µg/kg dry weight underwent speciation.
Results: Total arsenic geometric mean (GM) in cooked chicken meat samples was 3.0 µg/kg (95% CI: 2.5, 3.6). Among 78 cooked samples that were speciated, iAs concentrations were higher in conventional samples (GM = 1.8 µg/kg; 95% CI: 1.4, 2.3) than antibiotic-free (GM = 0.7 µg/kg; 95% CI: 0.5, 1.0) or organic (GM = 0.6 µg/kg; 95% CI: 0.5, 0.8) samples. Roxarsone was detected in 20 of 40 conventional samples, one of 13 antibiotic-free samples, and none of the 25 organic samples. iAs concentrations in roxarsone-positive samples (GM = 2.3 µg/kg; 95% CI: 1.7, 3.1) were significantly higher than in roxarsone-negative samples (GM = 0.8 µg/kg; 95% CI: 0.7, 1.0). Cooking increased iAs and decreased roxarsone concentrations. Compared to organic chicken consumers, we estimated that conventional chicken consumers would ingest an additional 0.11µg/day iAs (in an 82g serving). Assuming lifetime exposure and a proposed cancer slope factor of 25.7 (mg kgBW-1 day-1)-1, this could result in 3.7 extra lifetime bladder and lung cancer cases per 100,000 exposed-persons.
Conclusions: Conventional chicken meat had higher iAs concentrations than conventional antibiotic-free and organic chicken meat samples. Cessation of arsenical drug use could reduce exposure and the burden of arsenic-related disease in chicken consumers.
Source: Environmental Health Perspectives
Metal content in lip products has been an issue of concern.
We measured lead and eight other metals in a convenience sample of 32 lip products used by young Asian women in Oakland, California, USA, and assessed potential health risks related to estimated intakes of these metals.
We analyzed lip products by inductively coupled plasma optical emission spectrometry and used previous estimates of lip product usage rates to determine daily oral intakes. We derived acceptable daily intakes (ADIs) based on information used to determine public health goals for exposure, and compared ADIs with estimated intakes to assess potential risks.
Most of the tested lip products contained high concentrations of titanium and aluminum. All examined products had detectable manganese. Lead was detected in 24 products (75%) with an average concentration of 0.36 ppm ± 0.39, including one sample with 1.32 ppm. When used at the estimated average daily rate, estimated intakes were >20% of ADIs derived for aluminum, cadmium, chromium and manganese. In addition, average daily use of 10 products tested would result in chromium intake exceeding our estimated ADI for chromium. For high rates of product use (above the 95th percentile) the percentages of samples with estimated metal intakes exceeding ADIs were 3% for aluminum, 68% for chromium, and 22% for manganese. Estimated intakes of lead were < 20% of ADIs for average and high use.
Cosmetics safety should be assessed not only by the presence of hazardous contents, but also by comparing estimated exposures with health based standards. In addition to lead, metals such as aluminum, cadmium, chromium and manganese require further investigation.
Source: Centers for Medicare and Medicaid Services (HHS)
Today, as part of the Obama administration’s work to make our health care system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge. New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services. Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.
“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.”
The data posted today on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service.
State Spending On Consumer Assistance Could Have ‘Huge Impact’ On Marketplace Enrollment
Source: Kaiser Health News
Florida is on course to spend $6 million to reach out to nearly 4 million uninsured people and help them sign up for coverage in the federal health law’s online marketplace this fall.
Maryland will spend more than four times as much, or about $24.8 million, to help about 730,000 uninsured. The District of Columbia expects to spend about $9 million assisting 42,000 uninsured.
The wide variation in spending to hire and train people to provide consumer assistance in the first year of the new marketplaces could have a major impact on how many people actually get coverage under Obamacare, experts say.
Yet states with some of the nation’s highest uninsured rates, such as Florida and Texas, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, according to a Kaiser Health News analysis.
Source: Consumer Financial Protection Bureau
Did you know we’ve received more than 5,000 complaints from servicemembers, veterans, and their families? By and large, statistics for complaints submitted by the military track with those of the population at large. But these complaint statistics aren’t just numbers to us: they represent military members and their families and we know the impact consumer financial issues can have on their quality of life.
In one complaint, an active-duty airman received permanent change of station orders in April 2012 – meaning he had no choice but to move – and tried to get approval from his mortgage servicer to sell his house in a short sale. In August, the company denied his request. He contacted his judge advocate to find out his rights; the judge advocate contacted the CFPB and learned about the guidance we had issued to clarify what mortgage servicers should do when contacted by a servicemember who has received PCS orders.
Based on that guidance, the judge advocate advised the airman to submit a complaint to us. We monitored the complaint and helped address the issues raised in the complaint. After previously denying the short sale, the company re-reviewed the airman’s request and approved it.
In another complaint, an active-duty army officer had been told by her student loan servicer that they were going to terminate her SCRA rights unless she provided a new set of orders that contained an end date. As an officer, she did not have orders with an end date, so the servicer terminated her interest-rate protection while she was still serving on active duty. The consumer complained to the CFPB and even before the complaint was routed to the relevant enforcement agency, a representative from the Office of Servicemember Affairs was able to communicate with the servicer and ensure the rate was reinstated.
Source: General Services Administration
This everyday guide to being a smart shopper is full of helpful tips about preventing identity theft, understanding credit, filing a consumer complaint, and more.
SIGTARP: Office of the Special Inspector General for the Troubled Asset Relief Program Quarterly Report to Congress (4/24/13)
SIGTARP: Office of the Special Inspector General for the Troubled Asset Relief Program Quarterly Report to Congress (PDF)
Source: Office of the Special Inspector General for the Troubled Asset Relief Program
In this report, we discuss “too big to fail” and HAMP. Too big to fail caused the TARP bailout and continues to be a threat because of the interconnections of the largest firms. To prevent a future crisis and bailout, regulators should use a tool in Dodd-Frank called “living wills” to roadmap interconnections that pose a grave threat to our financial system and break them off now, rather than waiting until a company’s deathbed. Additionally, SIGTARP is concerned that homeowners are redefaulting on HAMP permanent mortgage modifications at an alarming rate: 46.1% and 39.1% of HAMP modifications from Q3 and Q4 2009 redefaulted, 28.9% to 37.6% from 2010 redefaulted. SIGTARP recommended that Treasury research and analyze the causes of redefaults, develop an early warning system to try and prevent redefaults, and better help homeowners who have redefaulted.
Source: RAND Corporation
Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.
Source: Chatham House
In a move that is likely to prove expensive for motorists and consumers, the UK government, on 15 April, is set to increase its target for biofuel use to 5 per cent of transport fuels.
But new research from Chatham House estimates that as this target is reached, biofuels will cost UK motorists in the region of £460 million in the coming year. This figure represents the increased cost of fuel from higher prices at the pump and the need to fill-up the car more often because biofuels have lower energy content. Further increases to comply with EU biofuels targets mean that this could triple to around £1.3 billion a year by 2020.
The report, The Trouble with Biofuels, by Rob Bailey, argues that this does not represent good value for money. Biofuels are an expensive way to reduce greenhouse gas emissions – the research found that typically the cost of emissions reductions from biofuels are several times what the government has identified as an appropriate price to pay.
Expanding biofuel use is also leading to higher food prices. This has damaging implications for food security in poor countries and is also likely to contribute to higher emissions, as farmers respond to higher prices by expanding production, sometimes into rainforest. After incorporating these ‘indirect emission’ effects, the analysis found that biofuels produced from vegetable oils are likely to be worse for the climate than fossil fuels.
Source: Federal Reserve Bank of New York
Student loans have soared in popularity over the past decade, with the aggregate student loan balance, as measured in the FRBNY Consumer Credit Panel, reaching $966 billion at the end of 2012. Student debt now exceeds aggregate auto loan, credit card, and home-equity debt balances—making student loans the second largest debt of U.S. households, following mortgages. Student loans provide critical access to schooling, given the challenge presented by increasing costs of higher education and rising returns to a degree. Nevertheless, some have questioned how taking on extensive debt early in life has affected young workers’ post-schooling economic activity.
To address this issue, we examine trends in homeownership, auto debt, and total borrowing at standard ages of entry into the housing and vehicle markets for U.S. workers.
As seen in the chart below, the share of twenty-five-year-olds with student debt has increased from just 25 percent in 2003 to 43 percent in 2012. Further, the average student loan balance among those twenty-five-year-olds with student debt grew by 91 percent over the period, from $10,649 in 2003 to $20,326 in 2012. Student loan delinquencies have also been growing…
“How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department
We examined the charges, their variability, and respective payer group for diagnosis and treatment of the ten most common outpatient conditions presenting to the Emergency department (ED).
We conducted a cross-sectional study of the 2006–2008 Medical Expenditure Panel Survey. Analysis was limited to outpatient visits with non-elderly, adult (years 18–64) patients with a single discharge diagnosis.
We studied 8,303 ED encounters, representing 76.6 million visits. Median charges ranged from $740 (95% CI $651–$817) for an upper respiratory infection to $3437 (95% CI $2917–$3877) for a kidney stone. The median charge for all ten outpatient conditions in the ED was $1233 (95% CI $1199– $1268), with a high degree of charge variability. All diagnoses had an interquartile range (IQR) greater than $800 with 60% of IQRs greater than $1550.
Emergency department charges for common conditions are expensive with high charge variability. Greater acute care charge transparency will at least allow patients and providers to be aware of the emergency department charges patients may face in the current health care system.
New GAO Reports
Source: Government Accountability Office
AUTOMATED TELLER MACHINES
Some Consumer Fees Have Increased
GAO-13-266, Apr 11, 2013
COMMERCIAL SPENT NUCLEAR FUEL
GAO-13-532T, Apr 11, 2013
INDIAN HEALTH SERVICE
GAO-13-272, Apr 11, 2013
THE FEDERAL GOVERNMENT’S LONG-TERM FISCAL OUTLOOK
Spring 2013 Update
GAO-13-481SP, Apr 11, 2013
GAO-13-275, Apr 3, 2013
DEPARTMENT OF JUSTICE
GAO-13-505T, Apr 10, 2013
GAO-13-243, Mar 11, 2013
SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS EDUCATION
GAO-13-529T, Apr 10, 2013
Federal Student Loan Debt Burden of Noncompleters
Source: National Center for Education Statistics
Federal Student Loan Debt Burden of Noncompleters, a Statistics in Brief, focuses on the federal student debt burden accrued by students who do not complete a postsecondary credential within 6 years of enrolling. It is based on data from the two most recent longitudinal studies of beginning postsecondary students conducted by the National Center for Education Statistics: students who first enrolled in 1995-96 (as of 2001) and those who first enrolled in 2003-04 (as of 2009).
• In 2009, the percentage of noncompleters after 6 years ranged from 19 percent of students in private nonprofit 4-year institutions to 46 percent in public 2-year colleges or for-profit institutions. An increase in noncompletion between 2001 and 2009 was observed only for students in for-profit institutions (35 percent to 46 percent).
• In 2009, borrowing rates from federal student loan programs ranged from 25 percent of students in public 2-year colleges to 86 percent in for-profit institutions; comparable rates for students in 4-year public and nonprofit institutions were 58 percent and 64 percent, respectively.
• In 2009, the cumulative amount borrowed per credit earned was highest for noncompleters in for-profit institutions ($350 per credit, compared with $80 to $120 per credit in the other three sectors).
• In 2009, the median cumulative federal student debt for all noncompleters amounted to 35 percent of their annual income; debt burden was highest for students in 4-year nonprofit institutions (median debt equaled 51 percent of borrowers’ annual income). Debt burden among noncompleters who started in for-profit institutions increased from 20 percent to 43 percent of annual income between 2001 and 2009.
Airline Quality Rating 2013
Source: Purdue University/Wichita State University
The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method for assessing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2013, reflects monthly Airline Quality Rating scores for calendar year 2012. AQR scores for 2013 are based on 15 elements in four major areas that focus on airline performance aspects important to air travel consumers over the calendar year of 2012.
The Airline Quality Rating 2013 is a summary of month-by-month quality ratings for U.S. airlines that are required to report performance by virtue of having at least 1% of domestic scheduled-service passenger revenue during 2012. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, airlines’ comparative performance for the calendar year of 2012 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for domestic airline operations for the 12-month period of 2012, and industry results. Also, comparative Airline Quality Rating data for 2011 are included, where available, to provide historical perspective regarding performance quality in the industry.
Source: National Research Council
The standard incandescent light bulb, which still works mainly as Thomas Edison invented it, converts more than 90% of the consumed electricity into heat. Given the availability of newer lighting technologies that convert a greater percentage of electricity into useful light, there is potential to decrease the amount of energy used for lighting in both commercial and residential applications. Although technologies such as compact fluorescent lamps (CFLs) have emerged in the past few decades and will help achieve the goal of increased energy efficiency, solid-state lighting (SSL) stands to play a large role in dramatically decreasing U.S. energy consumption for lighting. This report summarizes the current status of SSL technologies and products—light-emitting diodes (LEDs) and organic LEDs (OLEDs)—and evaluates barriers to their improved cost and performance.
Assessment of Advanced Solid State Lighting also discusses factors involved in achieving widespread deployment and consumer acceptance of SSL products. These factors include the perceived quality of light emitted by SSL devices, ease of use and the useful lifetime of these devices, issues of initial high cost, and possible benefits of reduced energy consumption.
The New Real Estate Mantra: Location Near Public Transportation (PDF)
Source: National Association of Realtors, American Public Transportation Association, Center for Neighborhood Technology
Fueled by demographic change and concerns over quality of life, there has been a growing interest in communities with active transportation modes. The recession added another dimension to these discussions by emphasizing the economic impli cations of transportation choices. Housing and transportation, the two economic sectors mostly closely tied to the built environment, were both severely impacted by the economic downturn. There has been a growing effort among planners, real estate professionals, and economists to identify not only the economic benefits of alternative transportation modes in and of themselves, but also the impact that they have on housing prices and value retention. The real estate mantra of “location, location, location” is more important than ever. Moving beyond the traditional arguments that good schools and neighborhood amenities impact housing prices, emerging research has indicated that urban form and transportation options have played a key role in the ability of residential properties to maintain their value since the onset of the recession.
tudies have shown that consumers are willing to pay more for housing located in areas that exemplify new urbanist principles or are “traditional neighborhood developments.” These neighborhoods are walkable, higher density, and have a mix of uses as well as access to jobs and amenities such as transit.
This analysis investigates how well residential properties located in proximity to fixed-guideway transit have maintained their value as compared to residential properties without transit access between 2006 and 2011 in five regions: Boston, Chicago, Minneapolis-St. Paul, Phoenix, and San Francisco. The selection of these places for the study regions provides not only a geographic distribution, but also an illustrative sample of the types of fixed-guideway transit systems in the US. Minneapolis-St. Paul and Phoenix have newer light rail systems, while Boston, Chicago, and San Francisco are mature systems dominated by heavy and commuter rail. Additionally, Boston is also home to one of the earlier BRT lines.
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
The HealthCare.gov Plan Finder is the first comprehensive, online portal that assists consumers in comparing their health insurance coverage options. All private health insurers in the individual and small group markets are required to submit information to populate the Plan Finder. The data collection conducted by CMS to populate the Plan Finder represents the first national attempt to identify these insurers and the products and plans they offer. To realize the benefits of expanded consumer information, the data displayed on the Plan Finder must be complete and accurate.
HOW WE DID THIS STUDY
We reviewed CMS’s policies and procedures, survey responses, and interview responses regarding oversight of insurers’ data submissions. We selected a purposive sample of 98 small group products and 94 individual plans displayed on the Plan Finder for its November 2011 and January 2012 updates, respectively. For each sampled product and plan, we identified aberrant or inconsistent data displayed on the Plan Finder and determined whether displayed data were consistent with information provided by insurers’ telephone customer service representatives.
WHAT WE FOUND
Most private insurers reported data to the Plan Finder. However, gaps exist in CMS’s oversight of private insurers’ compliance with Plan Finder reporting requirements. CMS did not conduct targeted follow-up with insurers that did not report detailed pricing and benefit information. CMS also has not been able to identify the entire population of insurers required to report basic company and product information. In addition, CMS has not asked insurers to certify to the completeness of submitted data in accordance with Federal regulation. CMS implemented numerous strategies to monitor data accuracy. However, the data displayed on the Plan Finder for the sample of products and plans contained some inconsistencies that may confuse consumers. The products and plans displayed were not always available for sale or were not always recognized by insurers’ representatives. When products and plans were available and were recognized, 81 percent of their data displayed on the Plan Finder matched the information provided by insurers’ representatives.
WHAT WE RECOMMEND
Our findings indicate that additional efforts are needed to oversee private insurers’ compliance with reporting requirements for the HealthCare.gov Plan Finder and to ensure that the data displayed on the Plan Finder are accurate.
Therefore, we recommend that CMS:
(1) Establish and implement procedures to identify and pursue private insurers that do not submit required data to the Plan Finder,
(2) Ensure that each private insurer’s Chief Executive Officer or Chief Financial Officer certifies to the completeness of data submitted to the Plan Finder,
(3) Design and implement additional strategies to ensure Plan Finder data accuracy, and
(4) Validate that products and plans submitted to the Plan Finder are available for sale.
CMS generally concurred with our recommendations and is taking steps to address them.