This Week's News 6-10 June 2011

India health costs a crisis impoverishing millions

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India health costs a crisis impoverishing millions

Manila Bulletin

ALIGARH, India (AP) – When Nasir Khan cried out at night from the searing pain of kidney stones, the entire slum could hear him.
A magic healer promised an inexpensive cure through chanting while pinching his side where the kidney stones were lodged, but it only made it worse. His condition became life-threatening, and doctors said he would need surgery for a fourth time.
The operation cost him — and his extended family — their home.
Without insurance and unable to get a loan, they sold the broken brick shack in the industrial north Indian city of Aligarh for 250,000 rupees, or about $5,500. It had been home to the 35-year-old Khan, his four brothers, three wives and 11 children.
"There is no choice. It is my life," Khan said in gasps, writhing atop a crude wooden cot as his relatives hovered helplessly nearby. He screamed for his mother. He screamed for Allah. He screamed for anyone to deliver him from the pain.
His story is repeated so often across India it evokes little sympathy, yet it represents one of the biggest threats to India's battle to lift its poor up from squalor.
Each year, the cost of health care pushes some 39 million people back into poverty, according to a study published in the Lancet medical journal. Patients shoulder up to 80 percent of India's medical costs. Their share averages about $66 (3,000 rupees) annually per person — a crippling sum for the 800 million or so Indians living on less than $2 a day.
A diagnosis of asthma, a broken leg or a complicated childbirth can mean having to choose between medicine or food, spending on treatment or relying on prayer.
"We are too poor," Khan's uncle Bhuere Khan said. His aunt Rafiquan Mohammed offered another justification for selling the house, as if one were needed: "He has to live. He has small children."
While India boasts an economic growth rate near 9 percent, the wealth has done little to help millions burdened by poverty and disease. The poor, aside from struggling to afford care, also face extreme shortages of doctors and medicines.
The situation is particularly dire in rural areas, where more than 70 percent of the country's 1.2 billion people live. Some desperate patients resort to seeing quacks. Others pay bribes. Many simply don't seek help until it is too late.
The World Bank and other experts have warned that failure to address the country's health care woes could take a toll on long-term growth — especially as two-thirds of the population is under 35 and would form the backbone of India's work force for decades.
Yet India's government spends comparatively little on health care: just 1.1 percent of the country's GDP, a figure that hasn't changed much since 2006 when China was spending 1.9 percent; Russia, 3.3 percent and Brazil, 3.5 percent, according to World Health Organization figures.
"The political will is simply not there yet. We have to help realign the country's priorities," said Dr. K. Srinath Reddy, president of the Public Health Foundation of India and part of a government-commissioned committee recommending reforms.
Statistics that might highlight areas of need are scarce, thanks to erratic case reporting, few autopsies and a tradition of quick cremation that destroys evidence of disease. WHO reports often leave India out for lack of data. A recent study in the Lancet suggests malaria deaths could be 10 times higher than estimated.
India, which says hospital costs impoverish a quarter of all patients, has vowed to raise spending on health to 3 percent of GDP by 2015 and provide universal primary health care — but it's an unfilled promise that's been made before.
The Lancet, in a series on India in January, urged the government to double its pledge to 6 percent by 2020 or jeopardize its ability to shake off poverty.
"What is the point of economic success if there is nothing in it for the population?" Lancet editor Richard Horton said. "In a short amount of time you can do a lot — if you have the right leadership, the right administration and the public will. India has the people and it has the funds. We'll see if they can do it."
Meanwhile, India boasts a thriving medical tourism industry with shiny private clinics luring tens of thousands of foreigners for everything from bargain tummy tucks to experimental stem-cell treatments in an industry estimated to be worth nearly 100 billion rupees ($2.3 billion). The pharmaceutical industry is making lifesaving drugs at cut-rate costs, private hospitals are pioneering advances in open-heart surgery and medical schools are churning out physicians eager to work in the West.
For most Indians, however, this is happening in another world.…Continued

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Money in illegal sex-determination tests keeping doctors off villages: Ghulam Nabi Azad

India Today


Savita Verma

Azad on Monday blamed doctors for ignoring rural areas and instead pursuing money-making medical practices such as sex-selection tests.
He put the blame for lack of adequate healthcare services in rural areas on doctors, who he said are scuttling the government's plan to create a rural health workforce.
Instead, they prefer to offer lucrative services such as sex-selection tests in district headquarters and small towns.
"Doctors do not want to work in primary health centres and sub-centres. They do not want anybody to work there," the minister said during an interaction with journalists. They want all patients to come to district towns for treatment," he said.
Currently, rural areas have only around four doctors for 10,000 people. Despite initiatives to lure doctors to villages, they are simply just not interested in going to villages. The government had announced schemes such as 10 per cent marks for each year of rural service for MBBS doctors, who want to apply for MD, for three years. Another scheme, providing 50 per cent reservations in post-graduate diploma courses for doctors who are already in service, for working in rural areas for three consecutive years had also failed in luring doctors to villages.
Linking doctors' disinterest in serving rural areas with female foeticide, Azad said he used to wonder why doctors were not ready to go to villages despite the government trying so hard. After all not all doctors go and work in big hospitals in the private sector.
"Only specialists and super-specialists go there," he said.
The real reason, according to the minister, was that doctors buy ultrasound machines and set up centres in districts where they carry out sex- determination tests. Since sex-selection tests are not permitted under law, they charge big amounts-even Rs 50,000 to Rs 1 lakh - from people.
According to the 2011 census, illegal sex test cash keeps our docs off rural jobs says Azad there are 7.1 million fewer girls than boys aged zero to six. In 2001, this gap was six million fewer girls. This means around 3.1 to six million girls have been aborted in the past decade.
Abortion of female foetus is now being practiced almost all over the country, including Jammu and Kashmir, where the sex ratio has fallen from 959 in 1971 to 859 now.
The minister blamed "unscrupulous doctors" for this decline.
The government has reconstituted the Central Supervisory Board under the Pre-conception and Pre-Natal Diagnostics Techniques Act 1994, which met for the first time on June 4. The Medical Council of India (MCI) should make sure that registration of doctors found guilty of violating the law is suspended or cancelled immediately, Azad said.
According to quarterly progress reports submitted by states and Union territories, there are 42,190 registered ultrasound medical units, 298 machines have been sealed and seized for violations and a total of 843 court cases filed. So far, only 55 convictions have taken place under the Act. The number of unregistered ultrasound machines could be much higher.
Doctors' associations have also sabotaged government plans to start a new three-and-a-half year course to create a medical workforce to serve in underserved rural areas. States like West Bengal and Chhattisgarh are already running such courses. The proposal was supported by all political parties and chief ministers.
But the MCI unfortunately, under pressure from the medical community, did not give recognition to the course. The ministry was in favour of creating a syllabus at the national level, which should be recognised by the MCI. Without MCI's recognition, the course would not be as attractive for takers, Azad said.
Now, the government would have a re-look at the issue and send the proposal to the newly constituted MCI board of governors.
Such a course is the need of the hour since doctors are not ready to go to rural areas, he said


National medical body 'a debacle'
The Australian


Milanda Rout

THE introduction of a national medical registration body was a "debacle" that resulted in doctors being unknowingly deregistered and losing income and patients being left without healthcare.
A Senate inquiry found the Australian Health Practitioner Regulation Agency failed to notify health practitioners that they needed to renew their licence or that they had been deregistered as a result.
The agency - which took over the registration from 85 different state boards - also spent an "inordinate amount of time" processing applications and did not provide any help to worried doctors who unknowingly had their registration cancelled.
The Royal Australian College of General Practitioners told the inquiry the transition to the new national agency was "the worst crisis in our workforce in living memory" and the Australian Medical Association described it as a "debacle".
The Coalition-dominated finance and public administration references committee found the COAG-created body had failed to fulfill its primary functions of maintaining a national register to protect the public.
"The mistakes, omissions and poor processes that were clearly evident from the evidence received during the inquiry calls into question the ability of the AHPRA to carry out its primary purpose," it concluded.
"For AHPRA itself to be responsible for the breakdown of the entire system of registration of health practitioners in Australia is a dismal example of policy implementation and public administration."
The committee found that AHPRA's failures went beyond doctors, as patients experienced financial loss because they could not claim Medicare rebates for services provided by deregistered doctors. "Patients of practitioners who were deregistered had appointments cancelled or postponed," the report found. "This was of great inconvenience and concern."
They recommended AHPRA write letters of apology to affected doctors as well as urging all state and federal health ministers to "establish and improve" the accountability of the body.
But a minority report by Gillard government senators on the committee disagreed with the findings, saying it was not a debacle and the conclusions were for "political purposes only".
"It would have been unreasonable to expect such a large undertaking to be without problems in the initial phase," they wrote.
Opposition health spokesman Peter Dutton said the shift from "a myriad of state bodies to one national body" should have been done over time instead of overnight.


Specialists paid to embrace telehealth

The Sydney Morning Herald


Medical specialists who provide videolink consultations to patients in remote areas will be paid a 50 per cent bonus in an effort to encourage them to adopt the new technology.

Under Labor's $620 million telehealth initiative both city specialists and any healthcare worker physically with the patient will receive additional Medicare rebates.
Federal Health Minister Nicola Roxon said GPs, nurses, midwives and Aboriginal health workers who sit with patients during their video consultation will receive their usual Medicare fee plus an extra 35 per cent.
"New Medicare items will allow a range of existing consultation services to be provided via video conferencing and additional rebates on top of these items recognise the increased complexity of providing a service to a remote patient," Ms Roxon said in a statement.
The Gillard government will offer a $6000 one-off incentive payment to practitioners when they provide their first telehealth consultation.
To encourage bulk billing, the commonwealth will pay practitioners an extra $20 for each videolink service charged in that manner. But only for 12 months.
The new Medicare rebates for telehealth services will begin on July 1.
Patients in rural, regional and outer metropolitan areas will normally link to a big city specialist from their GP's clinic.
But a centrally-located facility could provide the service. That central location could be a community centre, chemist, aged-care home or Aboriginal medical service.
Further, patients won't always need to have a healthcare worker with them when they consult their specialist online if it is not "clinically relevant or the best use of available resources".

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North America


H.P. Tests Mobile Technology in Fight Against Malaria

The New York Times

For years Hewlett-Packard has been equated with computers and printers. The company is looking to be a player in a new era of mobile health monitoring.
H.P. said on Monday that it was beginning a yearlong clinical trial in Botswana that will equip doctors and nurses with Palm Pre 2 smartphones and an application that is designed to collect information about malaria outbreaks.
The data will be collected through an app that stores pictures, video, audio and GPS information, all of which can be stored and visually monitored in a larger database. The goal of this information is to help officials and doctors deter a huge malaria outbreak as it begins spreading through an area.
“H.P. recognizes the transformative power of applying mobile and cloud technology to advance health care in both developing and developed markets,” said Gabriele Zedlmayer, vice president at H.P. in the office of global social innovation. The technology is being built in a partnership with the mobile health company Positive Innovation for the Next Generation.
H.P. has been running a similar trial in Singapore that is being used to monitor cardiovascular disease. Heart disease accounted for more than 31 percent of deaths in the country in 2009.
In this trial, people are asked to wear an H.P. watch-like device that includes a number of sensors capable of tracking a patient’s heart-rate and other vital signs. As the data is collected on the watch, it is sent through an application on a patient’s mobile phone and then transmitted to a doctor. Doctors are then given a Palm Pre 2 cellphone with a propriety app that can show graphs and charts of an individual’s vital signs.
It’s only a matter of time before these kind of mobile health monitors become globally commonplace. The vast majority of next-generation smartphones will include heart monitors to keep tabs on your well-being and help doctors determine the early stages of disease and health problems.


Nurses Rally for Health Care Funding

The New York Times

Hundreds of members of the nation’s largest nurses’ union demonstrated outside the U.S. Chamber of Commerce and on Capitol Hill on Tuesday.
The union, National Nurses United, held the event to promote its “Main Street Contract for the American People,” which aims, in part, to increase tax revenue from corporations to prevent cuts in entitlement programs like Medicare and Medicaid.
The protesters started in Lafayette Square and marched to the chamber’s headquarters. Two demonstrators in tuxedoes — one labeled “Goldman” and the other “Sachs” — collected “invoices” of demands like “pension contribution increases” and “Mortgage payments” from nurses on the steps of the building.
After the event, a spokeswoman from the chamber said the country’s corporate tax burden was too high as it is.
“The chamber welcomes all voices to the debate, but the debate has to remain focused on creating American jobs and keeping our economy growing,” the chamber’s director of communications, Blair Latoff, wrote in an e-mail. “Right now U.S. businesses are saddled with one of the highest corporate tax rates in the world, which is undercutting our global competitiveness.”
Ms. Latoff, who did not see the protest but learned of it afterward, also noted that President Obama supported lowering the corporate tax burden. In his most recent State of Union address, Mr. Obama said he wanted Congress to close loopholes in the tax code and “use the savings to lower the corporate tax rate for the first time in 25 years.”
After the chamber demonstration, protesters boarded buses to Upper Senate Park for a rally, which included a speech by Senator Bernie Sanders, independent of Vermont.
“From birth to death, the people who are at our sides when we get sick are our nurses,” he said.
Mr. Sanders recently introduced a bill to create a single-payer health care system, which would require state governments to provide universal coverage. The measure is not expected to move forward.
“Health care must be a right for all people,” Mr. Sanders said at the rally. “We are at that moment where we got to push. We got to shove.”
Senator Barbara Boxer, Democrat of California, also spoke.
“The Republicans once had a ‘Contract With America,’” Mrs. Boxer said, referring to the agenda the Republican Party used to capture the House in 1994. “I’m ready for a good contract, and this is it.”
After the rally, representatives from the nurses’ union met with members of Congress to lobby for support.
Although much of the union’s political support comes from liberals, National Nurses United has a nonpartisan mission, the executive director of the group, Rose Ann DeMoro, said in an interview. Mr. Sanders’ comments on a single-payer system were not intended to be the theme of the day, she said.
Ms. DeMoro, in a letter in The New York Times last month, criticized both sides of the debate over entitlement spending. In it, she called the plan of Representative Paul D. Ryan, Republican of Wisconsin and chairman of the House Budget Committee, to turn Medicaid into a block grant program a “thinly veiled scheme to destroy” the program and attacked the Democrat-backed health care overhaul last year because it “expands the role of private insurers.”
“The politicians spend all our time lowering our expectations about what is possible,” Ms. DeMoro said on Tuesday.
Calls for increased governmental involvement in the health care system are unlikely to gain traction any time soon. After the midterm elections, in which Republicans took control of the House, the House voted to repeal the law. The measure was defeated in the Democrat-controlled Senate.
Many nurses at the rally said they were concerned that staffing reductions in hospitals and doctors’ offices due to budget cuts could be dangerous to patients.
“People are suffering, because there are not enough nurses at the bedside,” said Pamela Young, 54, who traveled from Oviedo, Fla., for the event.
With more than 160,000 members, National Nurses United formed in 2009 with the consolidation of three unions: United American Nurses, Massachusetts Nurses Association, and California Nurses Association/National Nurses Organizing Committee.


The hard truth about health care

The Washington Post

By Ezra Klein
Everyone in Washington claims to want the same thing lately: a “serious conversation” about health-care costs. So let’s have one.
Republicans have a plan that has been tried repeatedly but that has never worked. Democrats have a plan that might work in theory, but it is untested at the scale they’ll need for it to work in practice. And both parties are too scared to talk about the only plan that has worked.
But before we get to that plan, I want to tell you about a graph.
I found it buried inside a Kaiser Family Foundation brief entitled “Health Care Spending in the United States and Selected OECD Countries.” Inauspicious, maybe. But it should change the way we think about health-care costs. Because what it shows is that we’ve failed. Failed to control costs. Failed to restrain the growth of government.
And it shows something else, too: Where we’ve failed, others have succeeded.
Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts: the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results to figures from 12 other countries that are members of the Organisation for Economic Co-operation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.
Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.
And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.
This is where a “serious conversation” on health-care costs would start — with what has worked, and what we can learn from it. Instead, it’s where our conversation about health-care costs never quite goes.
The Republican plan, in fact, heads in the opposite direction: The GOP outsources Medicare to private insurers and gives senior citizens checks that cover less and less of the cost of insurance every year. Republicans hope that when faced with more cost pressure and more options, seniors will be able to exert the sort of consumer pressure that lowers prices while retaining, or even improving, quality.
What they’ve got in mind already exists in Medicare. “Our premium-support plan is modeled after the Medicare Part D prescription-drug program,” Paul Ryan (R-Wis.) told me. But Part D hasn’t controlled costs. Instead, premiums have risen by 57 percent since 2006, and the program is expected to see nearly 10 percent growth in annual costs over the next decade.
Moreover, this isn’t the first time we’ve tried to let private insurers into Medicare to work their magic. The Medicare Advantage program, which invited private insurers to offer managed-care options to Medicare beneficiaries, was expected to save money, but it ended up costing about 120 percent of what Medicare costs.
The Democratic plan, conversely, quietly recognizes that government-run health-care systems that are willing to throw their weight around can control costs. So the plan is to have Medicare try to pay for quality, not volume..…Continued

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