Archive for the ‘Assistance’ Category
Posted in Advocacy, Assistance, Discrimination, Ethics, Global Health, Health Care Marketing, Health Care Reform, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Hispanic/Latino, Immigrants, Language Access, Language Services, Limited English Proficiency, Medicaid, Promotions, State of Washington, Translation on 20 December 2013 | Leave a Comment »
Posted in Advocacy, Assistance, Children's Health, Community clinics, Economics of Health Care, Health Care Reform, Health Disparities, Health Insurance, Healthcare Inequalities, Medicaid on 6 May 2012 | Leave a Comment »
In these times of intense attention to healthcare from all quarters of the US, a new study by USA Today and Kaiser Health News reporters focused on community clinics. Over the past 2 decades community clinics have developed from origins often as volunteer-run efforts, to become a vital part of what is called the safety-net. Frequently they now are the sole source of care available to over 20 million people, often as the only providers who will accept patients covered by Medicaid, and for the growing ranks of the uninsured. The sorry state of healthcare access would be far worse if it were not for community clinics. These centers will play an important role too in the reforms set to start in 2014. It is expected that many who will become newly insured by Medicaid will be seeking care at community clinics. Long woefully underfunded, clinics will be eligible to receive help from the $10 billion approved by Congress for expanding their service capacity.
The report entitled Community clinics have odds stacked against them looked at almost 1200 community clinics across the country, and ranked them based on the 6 categories of performance quality measures which federally qualified health centers (FQHCs) must report to the federal government. The categories cover care for patients with diabetes and high blood pressure, rates of screening for cervical cancer and childhood immunizations, plus timeliness of prenatal care and rates of low birth-weight babies.
Using 2010 clinic performance data obtained by FOIA request, the reporting team found wide variations in care by center, by region of the country, and between specific centers in the same city. Generally, clinics in the South performed worse that those in New England, the Midwest, and California. Overall, their survey showed community clinics not performing as well as the national averages for the study parameters .
There is more context to understanding the survey results however, that was not part of the report. The National Association of Community Health Centers issued a statement about the report which while recognizing the value of examining clinic performance, expressed concern about the wrong impressions that the media study might give:
The article disregards the better quality care that most health centers achieve when compared to care provided to other low-income patients elsewhere. However, at least the article does reveal what few Americans realize– that every health center reports on the quality of care their patients receive….
…When you compare the federal data that is the focus of the USA Today article with national data from the National Center for Health Statistics, health centers performed better than national averages for entering women into prenatal care during the first trimester, childhood immunization rates, reduced low birth rates and hypertension control…..
NACHC recently published its report Health Wanted – The State of Unmet Need for Primary Health Care in America which takes an in-depth look at the factors behind the consistent and increasing demand for community clinics, the links to social determinants of health and how funding has not kept up to meet population needs. In FY 2011 for example, only 67 out of some 1900 applications for new health center service sites were funded.
Seattle/Local Health Guide extracted localized figures from the report to create a Washington State Comparison Chart. Janna Wilson, Senior External Relations Officer for the Seattle-King County Department of Public Health shared additional concerns with me in a personal communication, about implications and lack of context for specific data used for the local news article:
The data provided for Public Health represents a small subset of the patients we see—our homeless primary care patients. This is because Public Health’s federal health center grant comes under a targeted program called Health Care for the Homeless. Our federal data report, therefore, is specific to our homeless patients per federal reporting requirements. As you know, homeless patients face barriers that often exacerbate medical and behavioral health conditions and complicate treatment plans.
While most community health center grants and programs are for the general low-income population, some — like ours — target special population groups such as homeless people or migrant workers. There is nothing in the USA Today article that provides this important context. That said, quality improvement is a big part of our program for all our patients, whether homeless or housed.
Posted in Access to Medicines, Advocacy, Assistance, Children's Health, Consumer Protection, Economics of Health Care, Health Insurance, Pharmacists, Prescription drugs, State of Washington on 7 November 2011 | Leave a Comment »
Now more so that ever, learning of positive developments and new efforts of those working to make a difference, helps me to keep going . I share here with you some news of significance at the local, state, and national levels.
In Washington State:
In New York State:
Medicaid team passes four sets of reform proposals, including Safe Rx to “Promote Language Accessible Prescriptions”
Posted in Access to Medicines, Advocacy, Assistance, Children's Health, Economics of Health Care, Environmental Health, Ethics, Global Health, Health Care Marketing, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Language Access, Recession, State of Washington, Workers' rights on 18 May 2011 | Leave a Comment »
From Pharmalot, May 24, 2010:
A pair of former hospital sales reps filed a whistleblower suit alleging Wyeth, which is now owned by Pfizer, illegally promoted its Rapamune kidney transplant drug for use with other organs and targeted African-Americans, even though this is a high-risk patient group, according to the product labeling ………..
“Despite limited data on high-risk patients, Wyeth targeted transplant centers that catered primarily to African-American patients, typically in urban areas…………… Wyeth also instructed reps to use journal articles, including one published in Transplantion in July 2002 to off-label market Rapamune to African-Americans for combinations that were not approved by the FDA…………….
From Oncology NEWS International, May 13, 2010:
Survey results indicate patient access schemes in the UK and the U.S. need refinement.
With the cost of cancer drugs increasing at a rate that is generally thought to be unsustainable, many countries are faced with the difficult question of how to ensure access to these drugs without breaking the financial resources of individuals and systems paying for them……….
From BBC News, June 3, 2010
Making more cancer drugs available could cost far more than government estimates according to a BBC investigation.The government has allowed for a £200m cancer drug fund to pay for more cancer treatments from next year. But the cost could rise to £600m based on figures from drug manufacturers and the National Institute for Clinical Excellence (NICE).
Health economist Professor Alan Maynard……………..said many of the cancer drugs were portrayed as wonder drugs when they only extend a patient’s life by three to four months.”The pharmaceutical companies’ PR has been first class.”
Posted in Access to Medicines, Assistance, Cause Marketing, Consumer Protection, Cord Blood, Economics of Health Care, Ethics, Health Care Marketing, National Marrow Donor Program, Promotions on 1 June 2010 | Leave a Comment »
These news items have as yet not received much attention, but highlight health issues of concern:
Asda is to sell cancer drugs on a not-for-profit basis while thousands of NHS patients continue to be denied medicines that are deemed too expensive.
The supermarket giant called on other pharmacists to follow its lead and lower the price of all cancer drugs that are prescribed privately, to give patients access to drugs that are not always available on the NHS.
The move could save cancer patients thousands of pounds on the cost of treatments that may extend their lives by weeks, months or years, but which have been judged to be too expensive to be routinely available for free from the health service.
The move comes as the Government restated a pledge to make more expensive treatments available to NHS patients from April next year, with a £200million fund to pay for cancer drugs………..
What is not mentioned in the article is urgent need for price controls on medicines. If the NHS is going to be successful in implementing the new cancer drugs fund, it’s going to need to negotiate prices with the biopharmas. No health system public or private, nor any insurer, employer, or individual has endless resources, although the drug companies typically act like purchasers do. And for the most part , advocacy campaigns by patient and disease groups, no matter their location, seem to focus only on demands for drugs, not that genuinely useful drugs be made available by being affordable. With so many patient groups receiving industry funding, this is no surprise, but it certainly is not a sustainable position for resolving the access problems. While the conflict-of-interest issue may have often garnered more attention in the UK than in the US, it’s a growing, worldwide phenomenon. And even in the UK, most ordinary folks simply cannot afford to pay out of pocket for drugs with 5- and 6- figure annual costs, nor can the NHS if it is to continue to fulfill its mission.
Asda is a large UK supermarket chain, part of the Walmart group. Earlier this year, Asda pharmacies started selling specialty prescription drugs needed for IVF treatments, which likewise were not being covered by the NHS.
Also relevant to cancer treatment is a news item from the US:
A judge has ordered Cryobanks International, an Altamonte Springs company that stores stem cells in super-cold freezers, to either repay a California businessman the $3.5 million he loaned it or be sold at a courthouse auction in two weeks.
Company President John R. Edwards, M.D., would not predict Wednesday what would happen to the company or who would wind up owning it.
Of the auction, he said, “I don’t know if anything can be done to stop it.”
But he stressed that the company’s stem cells would remain safe. From 5,000 to 10,000 units are currently housed in liquid-nitrogen freezers at the company’s Altamonte Springs office…………
The type of stem cells referred to are those from the umbilical cord blood of newborns, which now can be used in the same way as bone marrow and peripheral blood stem cells, for transplantation to replace the malfunctioning immune systems of patients with blood cancers and other diseases. Most of the customers of Cryobanks International are private individuals who have paid to store the cord blood of their newborns as supposed “biological insurance” against many future ills, often wooed by emotional marketing of an industry that is still unregulated in the US. Most medical groups worldwide, including the American Academy of Pediatrics, recommend against private cord blood banking, and stress the tremendous unmet need for donation to public banking programs to serve today’s patients. Because of the small volume of blood from the umbilical cord, most such transplants are done for children.
And therein lies the public health concern about the future of Cryobanks International. In addition to its private clients, since late 2005 the company has been a network member of BeThe Match (formerly called the National Marrow Donor Program or NMDP) , the federal contractee which operates the US national public cord blood registry. Currently it’s possible to donate cord blood only in a handful of states, and Cryobanks International is listed as offering a unique “mail-in” option for interested expectant parents living everywhere else. Information does not seem to be readily available about the federal subcontract, nor on how many cord blood units have been collected by Cryobanks International for the NMDP. (It’s also not clear why an exact count of stored CBUs held by Cryobanks did not seem to be available for the news story.) CI states it has a division in India as well, with an India-specific website listing multiple sites nationwide.
This is not the first time that questions and controversy have swirled around Cryobanks International. In 2003, CI was identified as the supplier of cord blood to an Atlanta regenerative medicine clinic raided and shut down by the FDA. Run by an osteopath named Mitchell Ghen, the clinic offered unapproved treatments to desperate patients with diseases like ALS. Ghen offered expensive therapies using cord blood stem cells, but it is not clear if these were actual blood stem cell transplants. CI cut off supplies of cord blood units (CBUs) to Ghen, who then relocated his clinic to Belize ,offering the same treatments– source of the CBUs unknown–and generating the same concerns.
Subsequently, media outlets including the New York Times reported on other business activities involving CI. In 2005, CI stated it was negotiating a merger with a new cord blood company named Biostem, which previously ran parking lots, provided Internet services, and operated a small mining company in Washington state. According to the Times, Biostem was being promoted to potential investors through dubious advertising pitches for so-called penny stocks. According to SEC records, the merger was abandoned in 2007.
I’ll be writing more soon about the complex field of blood and marrow transplantation and other key policy issues. In the meantime, the public needs solid information about what’s going on with Cryobanks International and the Be the Match program. Stay tuned as I endeavor to learn more.