Search This Blog

Tuesday, September 27, 2016

Rheumatoid Arthritis-Impacting 10% of the U.S. Population, Treatment, and Research

Treatment and Research for Rheumatoid Arthritis and Other Autoimmune Diseases
Rheumatoid Arthritis (RA), the first time I heard of this disease as a college sophomore, I was amazed it affected young people. The treatment used to be loads of steroids, which have plenty of side-affects including weight gain. My little-league-pitching nephew, Sebastian was struck with this dreaded youth flaying arthritis when he was twelve years old. I went to one of his games and yelled, “Swing batter” or “Knock the cover off”, not PC at all, but I am so glad I did it. His diagnosis was a slow process and needless to say, it ended his pitching career. When Sebastian came to visit me for one of our camping expeditions, I took him to a Mariners game (at his request). After sitting through all of the innings, he could barely get up and drag himself the few blocks to the car. It was as if his limbs were numb. This disease affects 10% of our nation, 1 in every 100 people.[1]
21st Century Treatments
Flash forward to the advent of two important innovations in the 21st century, first the introduction of the arthritis treatment, etanercept, was approved for treatment of RA in 1998, and became ubiquitous for treatment a few years later. When Enbrel was launched by Amgen, the price of the drug was $1,500 a month per patient or $18,000 a year, in 2008. The current price of this medication is about $40,000 per patient per year in the U.S. In 2015, Canadians paid about $20,000 per patient per year for the same medication, no wonder they are so pleasant up north.
How Do People Pay for this Drug?
One giant leap forward for humanity in 2010, when the Patient Protection and Affordable Care Act mandated that insurance companies could no longer discriminate on the basis of health. This law made it much easier for Sebastian and others like him to gain access to affordable health insurance and thus, treatment. With the medicine he has been able to thrive, working for the same employer for five years, working out at a gym, and welcoming the birth of his second child. It is doubtful this would have been possible without access to health care. Employers frown on employees who are tired or move a bit stiffer than the others, even if they are in their twenties and this is what life was like without his medication.
As of this year, there are three biologic drugs approved by the Federal Drug Administration, all of which will compete with Enbrel, so that should soften the price somewhat. Of course the way our nation pays for drugs without negotiating effectively with their largest customer (the government) is the antithesis of good stewardship.
New Horizons for researching a cure for Rheumatoid Arthritis
The Benaroya Institute, long noted for its research to cure type 1 diabetes and global leader of the Type 1 Diabetes Trial Net study to identify those at risk of diabetes, which is funded by the National Institutes of Health, is also studying the cellular behavior of people with RA compared to the non-RA population. This approach is to detect those vulnerable to this debilitating disease earlier and pre-treat the condition before full blown symptoms occur. The Benaroya Research Institute has also been awarded an 8 million-dollar grant from the National Institute of Allergies and Infectious Diseases to study the lung epithelium cells, which provide the main response to allergens. [2] The foundation’s research shows that multiple autoimmune diseases are often more likely to occur in family populations with an existing autoimmune disease, such as RA. If you are interested in learning more about current research on cellular behavior to identify, pre-treat, and eventually cure autoimmune diseases like Rheumatoid Arthritis or Type 1 Diabetes, join the scientists at the foundation’s annual outreach luncheon to learn more. This year’s event will be held at the Fairmont Hotel in Seattle on October 28, 2016. To participate in the event, find more information at this link:
This article was written by Roberta E. Winter, using the trademark healthpolicymaven, and may be shared virally. Winter is the author of as well as 97 articles on healthcare systems and resourcing better health care.

Saturday, September 3, 2016

Hospital Closures In the United States and the Impact on the Availability of Health Care Services

Hospital Closures throughout the United States-Adversely Impacting Small Towns

Today, I opened the paper to learn that the Catholic order which purchased the community hospital in my city of 39,056 souls is going to close the hospital.[1] The hospital was built with public funds and run as a nonprofit, but gradually began to branch out into more lucrative service areas. My community has the largest concentrated population of low-income (Medicaid eligible households) in the county, which was by design, thanks to government sanctioned higher-density housing to accommodate the burgeoning ranks of WWII workers. Consequently, the availability of low-income housing and access to health care, with minimal transit costs, made this a live-able community for veterans, retirees, and single families. In recent years, the area has enjoyed a resurgence in popularity with young families, moving over from the mainland, because of the good schools, clean air, and affordable homes. However, young families may give pause to relocate to a city without a hospital. When my son was hit by a car I was awfully glad to have a short commute to the local hospital.
 Rallying Cry
When HMC was purchased by CHI Franciscan, it was put on notice that the Catholic hospital group intended to close the Bremerton hospital. The nurse’s union actually ran a protest, but now there doesn’t even appear to be a whimper. The current hospital in town has 253 beds, which means it is not a small facility.  The hospital cites inadequate parking and requisite system upgrades as the reasons it wants to leave the present facility. Why can’t the city arrange a bond issue to help pay for facility upgrades along with the Franciscan Order? Because the hospital was purchased from our locally funded  community hospital and absorbed by the much larger private nonprofit hospital group, the tether of control has been snipped. This issue is now up to the Washington State Hospital Commission, under the State Department of Health, to approve, deny, or stipulate changes to CHI.
No Money No Mission
Having worked for the network finance office of Ascension Health, the largest Catholic hospital chain in the U.S. with facilities in 24 states, I can assure you they do make a healthy profit, part of which winds its way to the Vatican. To understand the economic reasons for the Franciscan Hospital relocation to a wealthier suburb north of town, versus upgrading facilities in our community of 39,056 people, I have prepared this chart which shows income and Medicaid levels, as indicated through public school lunch subsidies for each community.

Percentage on Subsidized School Lunches
58.4% of school enrollment
24% of school enrollment
38.2% of enrollment
Average Household Income
Enrollment in school lunch programs is based on the high school for each location, as it represents the most consolidated public school student population for that community.[2]
Income information comes from public web sites for each city or in the case of Silverdale, which is an unincorporated area, from The people of Silverdale have consistently voted against incorporating and this is the area which Franciscan wants to expand their facilities.

Impact of Medicaid Expansion
Washington State was one of the states to adopt the Affordable Care Act’s expanded definition for Medicaid eligibility, allowing enrollment for those with incomes up to 133% of the Federal Poverty Level. This has resulted in a massive enrollment increase in state Medicaid plans, with approximately one third of the state population now enrolled on Medicaid. This means that one third of that population are of low-income status.  I suspect this phenomenon is true or even more pronounced throughout much of the country, but those states which did not increase their Medicaid eligibility do not have to report or be financially accountable for this expanded demographic. Essentially, the Medicaid population includes a lot of single-parent families, disabled persons, students, and those who are under-employed, which means they are only able to obtain part-time or inconsistent employment. The insurance companies (Aetna and United Healthcare) participating in the insurance exchanges are currently decrying the expense for medical claims for this very population, whom you can imagine had no health care for years, and probably more than a few ailments. This phenomenon is referred to as deferred health care, as in when-you-can't-afford-to-pay-for-it-you-don't-get-treatment.
National Perspective
Could your hospital be slated for closure? Currently there are 77 hospitals slated for closure in the U.S. up from 50 just two years ago. Texas has had 10 hospital closures, more than any other state and 175 employees were laid off in Dallas, following closure of Forest Park Medical Center.[3] Review this list by Becker Hospital Review, from August of 2016 to see how your state fares.[4] 
Lack of access to health care is cause by three things, lack of facilities, available trained staff, and inadequate financial reimbursements for some services. This article illustrates how the frayed safety net of health care services adversely impacts the vulnerable through facilities closure, for in the United States, healthcare is all about the money trail.

And this is the healthpolicymaven signing off encouraging you to be fully informed before you consent to any health care procedure, regulation, or contract. The "healthpolicymaven" is trademark of Praevalere Inc. and Roberta E. Winter, in continuous publication since 2007. Winter is the author of a guidebook to the U.S. healthcare system, which was published by Rowman and Littlefield in 2013.

[1] Mark Briant, CHI Franciscan Health Planning to Close Harrison Medical Center, Bremerton Patriot, September 2, 2016, vol. 9 no. 24
[2] Office of the Superintendent of Public Instruction, Washington State
[3] Ayla Ellison, Texas Hospital Closes, Lays off 175 Before New Owner’s Take Over, Beckers Hospital, May 26, 2016
[4]Ayla Ellison, A State By State Breakdown of 76 Rural Hospital Closures, Beckers Hospital, August 23, 2016