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RAND study on recommended care; JAMA study on employer cost of depression; doctors holding back information from patients



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Despite massive expenditures, American adults fail to receive recommended health care -- treatment that can prevent costly complications and even death -- nearly half the time, according to a new study by RAND.

The largest and most comprehensive examination ever conducted on health care quality used telephone surveys and reviews of medical records to rate preventive care and management of 30 common conditions including diabetes, asthma and heart disease. The study was nationwide and covered all types of health insurance.

People with diabetes receive just 45 percent of such basics as regular measurement of blood sugar levels. Patients with coronary artery disease get 68 percent of recommended care, while only 45 percent of heart attack patients get medications that could reduce their risk of death by 20 percent. Other findings include: patients with pneumonia receive only 39 percent of recommended care, colorectal cancer patients just 54 percent, and patients with high blood pressure less than 65 percent. In terms of preventive, acute and chronic care, similar levels of deficiencies abound, with patients failing to receive recommended care roughly 46 percent of the time.

Sixty-two percent of employees would consider buying long-term care insurance if it were offered to them, reveals a new study from Prudential Financial. That number jumps to 82 percent if their employer subsidizes a portion of the cost. The study also revealed that over half of all consumers are unfamiliar with the actual benefits and features of LTC insurance.


A major factor in lost productivity at work, depression costs employers $44 billion a year in reduced productivity and treatment costs, says a new study in The Journal of American Medical Association.

Roughly 9.4 percent of employees suffer from some form of depression, ranging from the general unease of dysthymia at 3.6 percent to major depression at 3.4 percent. Another 2.4 percent suffer partial remission or recurrence of major depressive disorder (2.4 percent). Woman were almost twice as likely to suffer from any depression as men, with the biggest difference centering on major depression (women at 5.3 percent compared to men at 1.6 percent).

Over 80 percent of the lost productive time costs are due to a reduced performance while at work.

Emergency Room visits are up 20 percent from a decade ago, according to a recent Centers for Disease Control and Prevention survey. An estimated 107.5 million patients visited the ER in 2001, as opposed to the roughly 90 million in 1992.


One out of three doctors hold back on offering patients useful medical services that aren’t covered by their insurance, reveals a new study published in Health Affairs. Because of health plan reimbursement restrictions, 31 percent of physicians surveyed don’t bother discussing specific treatments with their patients. Among them, over one-third have used this approach more often in the past five years.

Financial pressures play a part, as doctors whose incomes depend largely on risk-sharing arrangements with managed care plans for patient care costs seemed to shy away from offering patients useful yet uncovered services. The study also found that physicians who worked with a larger number of Medicaid patients were more likely to withhold information.

Oddly enough, many managed care plans in the ’90s included "gag clauses" in their contracts to discourage physicians from discussing uncovered services with their patients. After strong protest from patients and physicians alike, such clauses were pretty much dropped. Apparently, today’s physicians are relying on "self censorship."

Pneumococcal vaccinations may be cost-effective for patients 50 to 64 years old, and not just older patients. According to a new study in the Annals of Internal Medicine, the vaccination would save medical costs of $27.55 per vaccine for blacks at high-risk of the disease in this age group and $5.92 for other high-risk patients.


News & Trends.

Business and Health

Jul. 1, 2003;21.

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