Longer looks: Shortage of HIV doctors; Oregon program builds on British model

Jul 8 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

American Medical News: HIV In Primary Care: Treating An Aging Epidemic
Of the 3,155 U.S.-based members of the HIV Medicine Assn., 45% are older than 50, according to a March 17 Institute of Medicine report on HIV screening and access to care. The IOM said that as these experts approach retirement, many are downsizing or leaving their practices. Complicating matters, there are not enough new physicians entering the specialty to address the needs of the growing number of Americans living with HIV/AIDS, the IOM said. As a result, the responsibility of treating these patients is expected to fall increasingly to primary care physicians (Christine S. Moyer, 7/4).

National Review: How Obamacare Reduces People To The 'Average Patient' 
Every patient's treatment should be informed by the best evidence and the best science we have, but at the end of the day the best outcomes depend on a doctor using his or her best medical judgment to help the patient sitting in their office — not an abstract "average" patient as defined by large studies that are more designed to cut costs than optimize outcomes. Unfortunately, hundreds of millions of dollars coming from the federal government for something called "comparative effectiveness research" may be used to slash health-care budgets rather than improve individual patient health. Such a strategy will not only be harmful to patients, it is likely to turn out to be penny wise but pound foolish (Paul Howard, 7/5).

Salon: When Health Insurance Isn't Enough 
With 60 percent of all bankruptcies related to medical costs; with many of those medical-related bankruptcies occurring among those who have private insurance; and with the fear of medical bankruptcy encouraging the insured to unduly skimp on medical services, the Obama healthcare bill did purport to address the issue via caps on out-of-pocket expenses. But those weak caps -- and the bill's failure to achieve universal coverage -- promise to allow the medical debt problem to continue, just as they have in the state whose "reforms" most closely mimic Obama's bill (David Sirota, 7/6).

Hospitals & Health Networks: Medicare Disadvantage
We can solve our short-term Medicare budget crisis by slashing provider-payment levels but, in the long run, that will condemn us to a health care system of hamster care, where providers are on a treadmill of discounted fee for service. Rather, we should build organizations and partnerships that embrace risk for the care of the elderly population. These sophisticated service businesses must combine cutting-edge information technologies, evidence-based medicine, and patient- and family-centered support systems to keep costs low and to keep us patients functioning at the highest possible level into our dotage (Ian Morrison, 7/5).

Columbia Journalism Review: Keeping An Eye On Patient Safety: What We Can Learn From The Brits
I have just returned from England, where as a Fulbright Senior Specialist I attended a conference of European health journos and participated in meetings with health care academics and government officials. One of them was from Britain's National Health Service, the NHS—you know, that so-called socialist organization reviled in some quarters here in the U.S for allowing patients to die on the streets. At the NHS Institute for Innovation and Improvement I learned about some pretty cool stuff that has found its way into UK hospitals and improved care for patients. What's more, some of these new practices have taken root in Oregon hospitals in a collaborative organized by CareOregon, a health plan that insures some 150,000 Oregonians, mostly those on Medicare and Medicaid (Trudy Lieberman, 7/6).

Governing: A National Model For Curbing Childhood Obesity
When nearly half of your elementary school student population is either overweight or at risk of becoming obese, you have a serious problem. In 2002, a Tufts University study found that 46 percent of first- through third-graders in the Boston suburb of Somerville, a working-class city of 75,000, were at risk of becoming or were obese, a chronic illness that can lead to diabetes and heart disease. Rather than try to mandate certain behavioral changes, a group of community leaders decided to motivate change by creating a citywide campaign to slow down and reverse the weight epidemic (Jessica B. Mulholland, July 2011).

Time: Less-Educated Women Have More Children. Or Is It the Other Way Around?
It makes sense that education would impede childbearing. In nearly every country, women with more education tend to have fewer children than less-educated mothers. But new research suggests it may actually work the other way around: having more children hamstrings women's education. ... The study's findings also underscore the need for affordable child care — and for contraception, considering that half of U.S. pregnancies are unintended (Bonnie Rochman, 7/5).