Research Roundup: Palliative Care; Increasing Cost Of Insulin; Health Coverage For Prisoners
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The New England Journal of Medicine:
Palliative Care For The Seriously Ill
Palliative care is the interdisciplinary specialty focused on improving quality of life for persons with serious illness .... Over the past decade, the field has undergone substantial growth and change, including an expanded evidence base [and] new care-delivery models .... The core components of palliative care include the assessment and treatment of ... symptoms, identification of and support for spiritual distress, expert communication to establish goals of care and assist with complex medical decision making, and coordination of care. Ideally, many of these components can and should be provided by primary treating clinicians .... most physicians and other health care professionals ... have had limited or no formal training in these areas. The following sections highlight key concepts and recent developments in palliative care practice. (Kelley and Morrison, 8/20)
JAMA Internal Medicine:
Trends In Medicaid Reimbursements For Insulin From 1991 Through 2014
Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. ... In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit [1 mL of insulin]. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) .... Total Medicaid reimbursements peaked at $407.4 million ... in quarter 2 of 2014. ... Our findings suggest a lack of price competition in the United States for this class of medications. (Luo, Avorn and Kesselheim, 8/24)
Health Affairs:
Aligning FDA And CMS Review
Both the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) play a critical role in the development and uptake of new medical technologies. ... The FDA approves drugs and devices based on evidence that the product is "safe and effective," whereas CMS makes coverage determinations based on whether the product is "reasonable and necessary." In practice, this has created two separate evidentiary hurdles for some product sponsors, which can lead to substantial delays or limitations in patient access or can even block market entry. ... Two initiatives have the potential to help address this bottleneck: parallel review and coverage with evidence development (CED). However, implementation of these two programs has been slow and somewhat piecemeal, and they have yet to reach their full potential. (Richardson, 8/27)
Centers for Disease Control and Prevention/Mortality and Morbidity Weekly:
QuickStats: Percentage Of Adults Aged 19–25 Years With A Usual Place Of Care, By Race/Ethnicity — National Health Interview Survey, United States, 2010 And 2014
From 2010 to 2014, the percentage of persons aged 19–25 years who had a usual place to go for medical care increased for Hispanics (50.7% to 65.1%) and non-Hispanic blacks (65.4% to 74.3%). In 2010, among persons aged 19–25 years, non-Hispanic blacks (65.4%) were less likely than non-Hispanic whites (73.0%) to have a usual place to go for medical care; however, in 2014, no significant difference between the two groups was found. In 2010 and 2014, Hispanic adults aged 19–25 years were the least likely to have a usual place to go for medical care. (Martinez, Ward and Adams, 8/21)
National Health Law Program/The Kaiser Family Foundation:
State Medicaid Eligibility Policies For Individuals Moving Into And Out Of Incarceration
Many individuals in prisons and jails have significant physical and behavioral health care needs, but lack health insurance and regular access to care. ... Medicaid coverage for individuals moving into and out of incarceration may help increase their access to care and improve their health status, and thus contribute to broader benefits. Enrolling these individuals in Medicaid may also contribute to state savings. ... this brief highlights how state eligibility policies for incarcerated individuals differ, based on a review of state statutes, regulations, Medicaid eligibility manuals and other Medicaid agency guidance publicly available online and Medicaid managed care contracts. (McKee et al., 8/4)
Here is a selection of news coverage of other recent research:
Reuters:
Women, Minorities Still Underrepresented In Medical Specialties
Too few women and minorities are entering certain medical specialties in the U.S., researchers say. Diversifying the physician workforce may be key to addressing health disparities and inequities, Dr. Curtiland Deville of Johns Hopkins University in Baltimore, Maryland, who worked on the study, said in an email. "Minority physicians continue to provide the majority of care for underserved and non-English speaking populations,” Dr. Deville added. Yet "in no specialties . . . were the percentages of black or Hispanic trainees comparable with the representation of these groups in the US population," he and his colleagues wrote in JAMA Internal Medicine. (Brooks, 8/24)
Reuters:
Veterans Discharged For Misconduct Have Higher Risk Of Homelessness
U.S. veterans returning from Afghanistan and Iraq who were discharged due to misconduct are more likely to be homeless than other returning vets, according to a new study. “The most significant finding was that 26 percent of veterans who were separated for misconduct-related reasons were homeless at their first VA encounter; and this number climbed to 28 percent within one year after their first VA encounter,” said lead author Dr. Adi V. Gundlapalli of the VA Salt Lake City Health Care System. (Doyle, 8/25)
The New York Times:
School Lunches Becoming Healthier, Statistics Indicate
The humble school lunch — the staple of most every American child’s diet — has become healthier. That was the conclusion of new federal data released Thursday that showed that the nutritional profile of meals in the nation’s public schools had improved substantially since higher government standards went into effect in 2012. (Tavernise, 8/27)
Reuters:
Use Of Statins Rising Among Very Elderly
Between 1999 and 2012, the use of cholesterol-lowering statin drugs increased among people over age 79 with no history of coronary heart disease, stroke or vascular disease, according to a new study. People who have had a heart attack, stroke or diabetes are often prescribed a statin like atorvastatin (Lipitor) to reduce their risk of another event in the future, but there is little evidence for using the drugs preventively in the oldest old who have not had a heart attack or stroke, the authors write in a research letter in JAMA Internal Medicine. (Doyle, 8/25)
Reuters:
Spouses Of Stroke Survivors Face Lingering Health Issues
Spouses of stroke survivors may themselves face lasting mental and physical health issues, according to a new study. These caregiver spouses are at an increased risk of mental and physical health issues even seven years after their care recipient’s stroke, said lead author Josefine Persson, a Ph.D. candidate at Sahlgrenska Academy, University of Gothenburg, Sweden. (Doyle, 8/26)
Reuters:
Endometrial Cancer On The Rise In U.S., Black Women Most At Risk
Endometrial cancer is becoming more common in the U.S. and black women appear more likely to get the most aggressive types of tumors and die from the disease, a new study suggests. Researchers analyzed cancer registry data from 2000 to 2011 and found incidence rates for endometrial tumors increased among all racial and ethnic groups. But for white women, the increase was less than one percent overall, compared with 1.8 percent for Hispanic women and 2.5 percent for black and Asian women. (Rapaport, 8/19)
The Chicago Tribune:
Pain Relievers May Factor Into Cancer Protection
Regularly taking low-dose aspirin or other common pain relievers may lower long-term risk of colon cancer, new research suggests. Men and women who took low-dose (75 to 150 milligrams) aspirin for five years or more saw their risk of colon cancer drop by 27 percent. And taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for that long was linked to a 30 percent to 45 percent drop in colon cancer risk, the study found. (Mozes, 8/25)
Reuters:
Military Kids May Be More Apt To Smoke, Drink And Carry Guns
Teens with parents or caregivers in the military may be more likely to drink, smoke, and carry weapons than other kids, a U.S. study suggests. Researchers also found that adolescents with close ties to the military were more apt to be victims of physical violence and harassment. (Rapaport, 8/17)
Medscape:
Delivery Outcomes Similar With Family Doctors, Obstetricians
For pregnant women who are at low risk for delivery complications, newborn and maternal outcomes are similar for obstetric deliveries by family physicians and obstetricians, according to a retrospective, population-based cohort study published online August 24 in the Canadian Medical Association Journal. (Barclay, 8/25)