Spending on health to rise dramatically
Tue, 26 Feb 2008 23:26:56 GMT
By KEVIN FREKING, Associated Press Writer
WASHINGTON - By 2017, total health care spending will double to more than $4 trillion a year, accounting for one of every $5 the nation spends, the federal government projects.
The 6.7 percent annual increase in spending — nearly three times the rate of inflation_ will be largely driven by higher prices and an increased demand for care, the Centers for Medicare and Medicaid Services said Monday. Other factors in the mix include a growing and aging population. The first wave of baby boomers become eligible for Medicare beginning in 2011.
With the aging population, the federal government will be picking up the tab for a growing share of the nation's medical expenses. Overall, federal and state governments accounted for about 46 percent of health expenditures in 2006. That percentage will increase to 49 percent over the next decade.
"Health is projected to consume an expanding share of the economy, which means that policymakers, insurers and the public will face increasingly difficult decisions about the way health care is delivered and paid for," CMS economists said.
Overall health care spending in 2017 was estimated to increase to $4.3 trillion. That would be about 20 percent of U.S. gross domestic product, or GDP, the total monetary value of all finished goods and services produced in a country.
In 2006, people and the government spent $2.1 trillion on health care, an average of $7,026 a person. In 2017, health spending will cost an estimated $13,101 a person.
In his budget for next year,
President Bush recommended slowing the yearly growth of Medicare from about 7 percent to about 5 percent. The slowdown would occur primarily by freezing reimbursement rates for the next three years to scores of health care providers, such as hospitals, nursing homes and home health centers. Bush also proposed requiring wealthier Medicare beneficiaries to pay higher monthly premiums when participating in Medicare's
prescription drug coverage plan.
Those recommendations would reduce spending by nearly $178 billion over five years, but have little chance of passage in Congress. Health and Human Services
Secretary Mike Leavitt has acknowledged the unpopularity of the recommendations, but he said politicians must make some hard decisions. The longer lawmakers wait, the more difficult the decisions will be.
"Medicare, on its current course, is not sustainable," Leavitt testified.
Democratic lawmakers also have proposed ways to slow health spending, primarily by trimming payments to private insurers who oversee health coverage for nearly
9 million Medicare beneficiaries. A growing number of the nation's elderly and disabled are electing to get health coverage through private plans that contract with the federal government and government economists predicted that trend will continue. Now, about one in six beneficiaries get their health benefits through a private plan. By 2017, more than one in four beneficiaries will get their coverage that way, Medicare officials said.
Health experts tell Congress that Medicare pays much more for each beneficiary who opts for a private plan than it would if they stayed in the
traditional Medicare program, which reimburses providers at a set fee for a particular service. That difference increases the burden on taxpayers as well as beneficiaries, because participants pay higher monthly Medicare premiums.
The government economists say it's hardly a new trend that the
health care sector will grow more quickly than the overall economy. Over the past 30 years, health spending has exceeded growth in the gross domestic product by about 2.7 percentage points each year. Over the coming decade, that difference is expected to narrow slightly. Still, the continued gap is worrisome, said the agency's acting administrator, Kerry Weems. He said consumers, particularly businesses, need more information about the quality and cost of care.
"We have an approaching crisis in this country unless we change the way we do business," Weems said.
Within the health sector, economists project that spending on hospital care will increase at rate of 6.9 percent a year over the coming decade, spending on physician services will rise 5.9 percent annually, and spending on nursing homes will grow 5.2 percent a year.
The economists' report will be published online by the journal Health Affairs.
___
On the Net:
Health Affairs: http://www.healthaffairs.org/
Centers for Medicare and Medicaid Services: http://www.cms.gov
Study suggests antibiotics are overused
Tue, 26 Feb 2008 22:55:40 GMT
By CARLA K. JOHNSON, Associated Press Writer
CHICAGO - A woman dying of Alzheimer's has a fever. Should she be given antibiotics? Many people would say yes. But a provocative new study suggests that antibiotics are overused in people dying of dementia diseases and should be considered more carefully because of the growing problem of drug-resistant superbugs.
The study raises ethical questions about when it's acceptable to withhold perhaps futile treatment and let people die, and whether public health issues should ever be considered.
"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in
Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."
Many experts, including the Alzheimer's Association, consider Alzheimer's and other dementias to be fatal brain diseases. Patients die of infections such as pneumonia and other complications, but the underlying cause is damage to brain cells.
In the study, more than 200 people with advanced dementia from Boston-area nursing homes were followed for 18 months or until their deaths. Almost half died during that time. All the patients failed to recognize loved ones, had stopped speaking, were unable to walk or feed themselves and were incontinent.
"They were at what anyone would consider the very final stage," Mitchell said.
Researchers reviewed medical records to see what kind of care they were given and found that 42 percent received antibiotics — many intravenously — within two weeks of their deaths. The closer they were to death, the more likely they were to receive antibiotics.
The study appears in Monday's
Archives of Internal Medicine.
Antibiotic overuse contributes to the rise of superbugs, so experts have been calling on doctors to curb the liberal prescribing of antibiotics in many types of patients, including children with earaches and adults with sore throats.
Nursing homes often harbor drug-resistant bacteria, prior studies have shown, and residents can spread dangerous infections when they are admitted to hospitals.
Dr. Daniel Brauner, a geriatrician and ethicist at the
University of Chicago Medical Center who was not involved in the study, said cautious use of antibiotics in nursing homes would require doctors to more closely monitor residents.
"But the standard of care is for doctors to see residents once a month, or once every two months," Brauner said. "I'm sure a lot of these antibiotics were prescribed over the telephone."
Doctors should discuss antibiotics with family, just as they would discuss placing a feeding tube, Mitchell said. None of the residents in the study who received antibiotics had living wills spelling out their wishes on antibiotic treatment, she said.
If the family's goal is to keep their loved one comfortable, rather than to prolong life, alternatives such as oxygen and Tylenol can help, she said.
Giving antibiotics is sometimes appropriate for such patients, she acknowledged.
"Maybe it's important for the family for the patient to live two weeks longer, or if they have a bad pneumonia and they're suffering and they're coughing," she said.
An accompanying editorial in the journal cautions that public policy limiting antibiotics to patients with advanced dementia would be "ethically untenable." But the editorial calls on doctors to consider the public health ramifications when prescribing antibiotics to such patients.
Other experts disagreed.
"Until that decision is made that death is imminent, there's always hope," said Dr. Eric Tangalos, a geriatrician at Mayo Clinic in Rochester, Minn., who was not involved in the study. "People do recover from those infections."
Once called "the old man's friend," pneumonia can be an acceptable end when a patient's quality of life is extremely low and everyone agrees the patient would want a dignified death, said another expert not involved in the study.
"You might rescue the patient from life-threatening pneumonia and they live a few days, weeks or even months longer," said Bruce Jennings, a bioethicist with the Hastings Center, a research institute on medical ethics. "But the extra time you have bought them by that rescue is not beneficial."
___
On the Net:
Archives of Internal Medicine:
http://www.archinternmed.com
Men as well as women need bone tests
Tue, 26 Feb 2008 22:55:58 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Bone tests aren't just for women anymore. New guidelines are calling for older men to get a routine check for bone-thinning osteoporosis.
There's news for women, too: A new computerized tool uses more than bone-density tests to predict who is at highest risk of breaking a bone in coming years — by adding in such important risk factors as whether a parent ever broke a hip.
It's an effort to better target who really needs treatment and who can safely skip it, even before someone's bones become thin enough to be officially labeled an osteoporosis patient.
And it promises a major shift in bone care.
"You treat the people who have high risk, and you would reassure the women at low risk and ask them to come back for a re-check in a few years," explains Dr. Ethel Siris of
Columbia University and president of the
National Osteoporosis Foundation, which issued the new guidelines last week.
Moreover, the new work stresses that a disease long associated with little old white ladies actually can strike anyone as they age. The biggest change: The NOF guidelines recommend a bone-mineral density X-ray test for all men 70 and older, just like women 65 and older have long been urged to get.
"There's a recognition more so now than in the past that men are at risk," says Dr. Jay Magaziner of the
University of Maryland medical school, who has long researched hip fractures — osteoporosis' most-feared break.
Don't misunderstand. Postmenopausal women are still at greatest risk of osteoporosis, when bone-strengthening estrogen plummets. But a quarter of hip fractures occur in men, and as men live longer, the number who break a hip is steadily rising, Magaziner told a recent meeting of the
American Academy of Orthopaedic Surgeons.
Screening men "as we do with women can have some real payoffs in terms of prevention," he says.
Another conundrum: More than half of fractures due to bone loss occur in people whose bones are thinning but aren't quite thin enough to be labeled osteoporosis. They're in a gray zone known as osteopenia.
In the U.S. alone, some 10 million people have osteoporosis but 34 million are estimated to have osteopenia. With the population rapidly aging, the government estimates half of Americans over 50 will be at risk of fractures from too-thin bones by 2020.
The World Health Organization funded a Web-based tool called FRAX, unveiled last week, that helps calculate the odds of a hip, wrist, shoulder or spine fracture within the next 10 years for anyone 40 or older in nine different countries — regardless of whether they have full-fledged osteoporosis or just low bone mass.
Both geography and ancestry matter for bone health. Consider differences such as diet, exercise and exposure to Vitamin D-making sunlight, and odds of a break differ dramatically from
China and
Japan, to
France and
Spain, and on to the highest-risk U.S. and
Sweden. Here, white women have the highest risk and black women the lowest. FRAX lets users take all that into account.
How? Researchers at Britain'
s University of Sheffield used data from 60,000 people in developed countries — where life expectancy is long enough for osteoporosis to be an issue — to determine factors that play the biggest role in an individual's odds of thinning bones as they age.
Breaking a bone during adulthood that's not the result of, say, a bad car crash is one risk factor. A parent who broke a hip suggests a genetic risk. Smoking also thins bones, as does heavy alcohol consumption and long-term use of steroid-containing medicines.
Plug in a patient's score from a
bone-density measurement of the hip for the final calculation.
That number alone doesn't say whether someone needs bone-building treatment. So in the U.S., the
National Osteoporosis Foundation went a step further. It used the FRAX predictions to update guidelines on who needs bone-density testing, and to calculate when fracture risk becomes high enough that bone-building drugs would be cost-effective.
In addition to a routine bone check for older men, the guidelines recommend:
_Treat postmenopausal women and men 50 and older who have thinning bones, but not osteoporosis yet, if they have at least a 20 percent risk of any major fracture in the next decade, or at least a 3 percent risk of a hip fracture.
_Check for
osteoporosis risk factors in postmenopausal women and men 50 and over, to see who needs a bone test before their senior years.
_A bone test for anyone who has any type of fracture after age 50, or who has conditions associated with bone loss, such as rheumatoid arthritis.
_For adults over 50, 1,200 milligrams a day of calcium and 800 to 1,000 international units a day of Vitamin D, more D than the government recommends.
_Do regular weight-bearing and muscle-strengthening exercise.
___
EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
FRAX Web site: http://www.shef.ac.uk/FRAX
