New Mammography Van Unveiled in Newark, NJ

Photo by Doris Cortes, UMDNJ. Breast cancer survivors joined with the City of Newark, the Susan G. Komen for the Cure, and University of Medicine and Dentistry of New Jersey to unveil the “Mammography in Motion” vehicle, which will provide Newark residents with breast cancer screenings and information about breast cancer awareness. From left: Pamela Hodges, Ann Davis, and Roselyn Harkey, all Newark residents and breast cancer survivors.

The City of Newark, NJ, the University of Medicine and Dentistry of New Jersey (UMDNJ), and the Susan G. Komen for the Cure North Jersey recently unveiled a new and expanded Mobile Mammography Van, aptly called “Mammography in Motion.”  According to UMDNJ, “The Mammography in Motion mobile van provides access to screening mammograms, clinical breast exams and educational information for uninsured and underinsured residents in Newark and other northern New Jersey communities.”

As I reported earlier, studies have indicated that uninsured women are diagnosed with larger tumors and at later stages than otherwise similar, but insured women. The cause of this later and larger diagnosis may be attributable, in part, to a lack of mammography providers — an indication of just how critical the van is to the Newark community.

The new van was funded through the North Jersey Affiliate of Susan G. Komen for the Cure and is markedly more advanced and comfortable than its predecessor, which was a retro-fitted recreational vehicle that provide analog, as opposed to digital, mammography.  The van is a part of the New Jersey CEED (Cancer Education and Early Detection) S.A.V.E. (Screening Access of Value to Essex) Women and Men Project.  According to Catherine Marcial, Project Coordinator for S.A.V.E. Women, the new van is bigger and more pleasant.  It now has an exam room, changing room, reception area and all updated equipment.   She also pointed out that providers on the van — a physician or physician assistant and a mammography technician from UMDNJ — offer pelvic exams, PAP Smears (cervical cancer screenings) and recommend colorectal cancer screenings when warranted.  Deborah Q. Belfatto, Komen North Jersey Affiliate co-founder and executive director, commented that, “The Mammography in Motion program will provide state-of-the-art breast health screening services for women right in their own neighborhoods.  This is a giant step in addressing access to care for all women, especially those with no readily available resources.”  This is especially true given the prediction that the demand for mammography, and other outpatient diagnostic imaging, is expected to increase by double digits over the next three years.  Further, there is strong evidence that the provision of cancer education and screening programs serves to significantly reduce cancer rates in Newark, as was evidenced by a study on cervical cancer in the city.  This study found that “the ratio of in situ to invasive cervical cancer increased and decreased in a striking parallel with the provision and subsequent cessation of funding.”

Finally, it should be noted that cancer screenings are only the beginning of the battle for improving cancer outcomes for the un- and underinsured, Read more

Quality of Care Differences by Insurance Status at Community Health Centers

by Maggie Osterberg via flickr

On the heels of President Obama’s announcement designating $155 million to establish 126 new community health centers across the country, a study recently published in the American Journal of Public Health found that these centers do not provide the same quality of care to all their patients.  These centers, also known as Federally Qualified Health Centers or safety net providers, are intended to “enhance the provision of primary care services in underserved urban and rural communities.”  Unfortunately, studies appear to indicate that even within the confines of the same community health centers, quality of care received by patients varies depending on insurance status — those with private insurance receiving the best quality of care and those without insurance at the opposite end of the spectrum.

In their article, Insurance Status and Quality of Diabetes Care in Community Health Centers, Zhang et al. found that uninsured patients were the least likely to satisfy specified diabetes quality of care measures and Medicaid patients’ quality of care closely resembled that of the uninsured.  It might be tempting to explain away this phenomenon by pointing out that this study is limited only to diabetes care and may not be representative of quality of care overall.  This assertion, however, may be at least somewhat quelled by a study published last year in Inquiry, where Bradley et al. found a similar pattern in breast cancer patients treated in a safety net setting.  In that study, Differences in Breast Cancer Diagnosis and Treatment:  Experiences of Insured and Uninsured Women in a Safety-Net Setting, researchers found that within the same safety net setting, “insured women with breast cancer were diagnosed with smaller tumors and at earlier disease stages, and received surgery and initiated chemotherapy considerably faster than otherwise similar uninsured women.”

So, how could quality of care disparities exist in a safety-net setting whose very goal is to “enhance” care to the underserved?  Read more

Free Healthcare for the Newly Uninsured?

Photo by Sean Davis via Flickr

In a move that has garnered both praise and criticism, Walgreens is offering free health care at its in-store Take Care clinics to patients (and their uninsured children and spouses) who have lost their jobs.  This program, called the Take Care Clinic Take Care Recovery Plan, is designed to assist current and future patients who lose their jobs and health coverage on or after March 31, 2009.

Free services do not include full spectrum preventive care, but do include routine screening and treatment for respiratory illnesses, seasonal allergies, urinary tract infections, etc.  Quest Diagnostics has teamed up with Walgreens to provide free laboratory testing services associated with the care of qualified patients.   A significant item not covered by the program is the cost of any prescription necessary to complete treatment for any of these conditions.

Walgreens warns that “[t]he Take Care Recovery Plan is in no way intended as a substitute to COBRA health benefits or any other insurance” and advises patients to carefully consider all forms of coverage that may be available to them given the limitations of care available for free through a Take Care Clinic.

While many may view the program as an advertising stunt, it is hard not to take solace in the fact that families who might otherwise have to resort to a hospital emergency room, and potentially face an exhorbitantly high bill, may now take refuge in a local clinic.

As the economy continues to sour and the unemployment rate reaches levels not seen in more than a quarter-century (8.5%), the impact on access to healthcare and our economy could prove to be unprecedented.  One study indicates that for every 1% increase in unemployment, Medicaid and SCHIP enrollment would increase “by 1 million (600,000 children and 400,000 non-elderly adults) and cause the number of uninsured to grow by 1.1 million.” And as we noted in a post at the beginning of this year, there are those (including Jane Sarasohn Kahn of The Health Care Blog) who believe that even that dire metric will prove to be  somewhat understated for present conditions.

I am certain that Walgreens is concerned with its bottom-line in this effort: calling it an “experiment,” restricting the hours that non-paying patients can seek care, and noting that every patient who visits a clinic talks to about 8 other people about the experience.  Most people, I am certain, are aware that the move is a mere band-aid on a wound that is hemorrhaging.  But for the families the program helps, these points are probably irrelevant.  What is relevant is the fact that a company is using its own resources to provide free health care to a growing population who need it.

Universal Health Insurance for America’s Children - Can It Happen?

by katchingkyleigh1 via flickr

It is no secret that America’s health care infrastructure leaves much to be desired.  It spends more on health care than any other country in the world, but is far from achieving the best results.  The extreme cost of care has contributed to increased rates of the un- and underinsured — climbing from 41.2 and 15.6 million in 2003 to  49.6 and 25.2 million, respectively, in 2007.

Most observers agree that the American health care system is badly broken–if it ever was intact–as evidenced by the large number of Americans without health insurance, the high and rising costs of health care, and the relatively poor health outcomes achieved for the money spent.

What might be lesser known is the degree to which lack of health coverage affects children.  In their article, Universal Health Insurance for Children, published in the Journal of Health Care for the Poor and Underserved, Hughes et al. note that despite programs designed to enhance children’s access to coverage like State Children’s Health Insurance Program (SCHIP), about 8.1 million children were a part of the uninsured population in 2007.  Confusion about eligibility is often cited as a reason many children — over 80% of low income uninsured children - who are eligible for coverage do not have it.

Children’s health insurance status helps predict whether they receive needed health care and provides a critical means for identifying and addressing their health problems early in life… Children  who experience unmet health problems are more likely to miss school, to incur high costs for medical care, and to have parents miss work due to caring for an ill child.

Consequences of non-coverage of children start with compromised access to health care and turn into compromises to the American economy.

Lack of insurance coverage for children not only has an immediate impact on those whose access to care is limited, but it also has social implications in terms of potential public health threats due to untreated communicable diseases, higher health care costs for end-stage treatment, and consequences for the economy in terms of productivity and high insurance costs to businesses.

It has been well documented that providing health insurance coverage is cheaper than paying for the consequences associated with the alternative, but America has been resistant to providing universal coverage.  Providing coverage specifically for children, on the other hand, has been met with less resistance.

The social and individual benefit of extending preventive care and health insurance to children, however, is somewhat less contentious [than providing insurance to adults], largely because children are viewed more sympathetically than adults by health care leaders and the American public.

Hughes et al. argue for immediate universal coverage for children, rather than waiting for universal coverage for the country as a whole and note that it would have to occur at the federal, as opposed to state and local, levels.  They make two recommendations for achieving this goal.

One option is to create a Medicare-like federal program under which all children are automatically enrolled in a comprehensive insurance program, regardless of income. By and large, Medicare works well for seniors and is a reasonable model for children. Another option involves modifying Medicaid, SCHIP, and other categorical programs to create a uniform insurance program for low-income and undocumented children that eliminates the confusion and complexity associated with multiple programs. Both options would require sufficient minimization of paperwork and reimbursement to providers to ensure that coverage translates into genuine access to care.

Hughes et al. point out that most Americans support universal coverage, especially for children, despite the added tax burden it may cause.  This is probably a sentiment reflecting the reality of the extreme cost and gross inefficiency of the American health care system.  As children constitute a categorically vulnerable population which affords them the sympathy of the country, it makes sense to begin the road to universal health care in this country with them.  The vast majority of taxpayers are willing to foot the bill and we have an administration ripened to bring about such a change.  If ever there was the time to begin the process of providing universal health insurance to children in America, it would be now.

Surprise, Surprise: Older Americans are Sicker than their European Counterparts

In this international study, we found that US adults of all wealth levels reported worse health than did Europeans at comparable wealth levels.  Poor Americans were at particularly worse health compared with their English or other European counterparts, but even well-off Americans reported health comparable to substantially poorer Europeans.  Differences in behavioral risk factors accounted for only a fraction of these disparities.

As behavioral factors were insufficient to account for this disparity, Avendano et al. distinguish between national health care systems.

Features of the US health care system may contribute to the worse health of Americans compared with Europeans.  In particular, most European countries have a stronger primary care orientation than does the United States.  Previous evidence suggests that a strong primary care system is associated with better health outcomes, partly because it entails a stronger focus on primary prevention, a more equitable distribution of resources, and a higher efficacy of the health system.

Investing less at the primary care stage where prevention is key, necessarily means that there is a greater focus on disease maintenance or amelioration after its onset.  Which is to say that Americans, for the most part, are not afforded significant medical attention until they are sick.

In addition to having a stronger focus on primary care than the United States, European countries have greater protections for their poor.  European countries offer virtually universal health care coverage, so even the poor have relatively unfettered access to necessary care.  The United States on the other hand, has an uninsured population totaling 41 million (or over 45 million by some estimates).

The fact that health disparities in England still persists despite access to care,

suggests that mechanisms outside the health care system may also be involved.  Wealth enhances access to material resources such as housing, and is a source of immediate consumption in periods of economic strain. Wealth may also increase sense of control over life and other psychosocial resources that can enhance health.

This study gives further credence to the notion that America has at least something to learn from the European health care system.  Universal health care is one component, but focusing more keenly on primary care and easing the social burdens of the poor are another.  Racial health disparities is also an issue that has to be addressed in the United States, but this study restricted its study population to non-Hispanic Whites in order to determine what factors beyond those attributable to race are at issue in the United States’ lag behind its European peers.  Given the fact that racial health disparities are prevalent in the United States, it would not strain reason to conclude that the gap between Americans and Europeans would be exacerbated if racial minorities were included.  The correlation between economic status, residential segregation and well being may help explain why this is the case.

The United States health care system clearly demonstrates that dollars spent is no indication of the quality or efficacy of health care actually received.  Moving into a more cost-effective health care  paradigm that provides access to comprehensive care at a stage where it can impact long-term health is essential.  The Avendano study offers proof of this.