Last year I wrote to the health and home secretaries with suggestions on how antidotes for spice could be developed. Their replies revealed a complete lack of appreciation of the magnitude of the synthetic cannabinoid problem and lack of interest in the idea of an antidote.
Spice-induced “zombie” outbreaks in New York and in Manchester have hit the headlines in the past year. Use of these new damaging and powerful forms of synthetic cannabinoids is rife in our prisons and by homeless people, with estimates of up to 50 deaths last year. They can produce extremely strong psychotic states often with very violent behaviour. Sometimes a frozen unconscious state results. Either of these outcomes are health emergencies that consume vast amounts of police, prison officer and health professionals time, and so waste a huge amount of public money.
Spice is a generic term for the hundreds of synthetic versions of cannabis that are used instead of herbal cannabis. The first synthetic cannabinoids were made in the 1970s as potential medicines, but initial human testing found them to be so unpleasant and potent in their actions that none were marketed. Since then they have been sold as legal alternatives to cannabis, and called spice.
The problems with spice are multiple. The first is lack of any quality control: the amount of synthetic cannabinoid in each unit is not known. Second, these substances have little, if any, safety data. Third, many of them are much more potent than traditional cannabis, up to a hundred times more potent in the test tube and have never been tested in animals – let alone humans – so there is no data on real-world safety.
Most are not detectable by current testing processes which is why prisoners prefer them. This high potency means they are very profitable drugs. A spice solution costing a few pounds can be soaked into a single A4 sheet of paper, which, when dried, can be cut up into about 100 units, each of which will give a decent “hit” at £5 each.
The government’s response has been to ban these drugs in a series of amendments to the misuse of drugs act. So now all synthetic cannabinoids are illegal. But, as with other drugs, banning spice doesn’t stop its use. Heroin has been illegal for 50 years yet deaths reached an all-time peak in England and Wales last year.
So what should the government do about spice? First, it must recognise that this problem is not going to be dealt with by simplistic approaches such as more bans or more severe sentencing of users. We should understand that the authorities’ focus on herbal cannabis use is the main reason for spice emerging in the UK. So we should stop testing for cannabis in prisoners and others to encourage a move by users back to herbal cannabis.
The Manchester police commissioner has now publicly wondered if the problem has been exacerbated by the Psychoactive Substances Act which has taken synthetic cannabinoids out of “head shops” and into the underground marketplace. Perhaps we should develop a harm reduction strategy by allowing the sale of safer versions of synthetic cannabinoids, or even cannabis itself, back in head shops?
But to deal with the current epidemic of use we need urgently to develop cannabis antagonists as antidotes to spice for use by health professionals.
The success of naloxone as an antidote for heroin overdose is now well recognised to save lives, and is given to opioid users and their friends for this reason. Several antagonists at the cannabis receptor are known and one, rimonabant, has extensive safety data in humans. It was licensed in Europe a decade ago as a treatment to stop weight gain after people stopped smoking. However post-marketing surveillance found that in some people rimonabant was associated with an increase in depressive reactions, sometimes with suicidal thinking (though not suicides). This led to it being taken off the market for having too low a benefit-risk ratio for this medical indication. But for spice reversal these considerations do not apply – it would only be used once to reverse a bad reaction, and hopefully keep people from harming themselves or others.
The other approach is to develop the herbal antidote THCV. This is made in the cannabis plant alongside d9THC and many other cannabinoids. It has recently been shown to have antagonist actions against the psychosis produced by d9THC and so would almost certainly attenuate spice intoxication. Sadly, just a few months ago, the Advisory Council for the Misuse of Drugs refused to make it available for this purpose on the spurious grounds that a note in a 1974 paper said that when given intravenously in high doses it was a little like d9THC.
Surely it is time for government to push to develop such an antidote to spice if not for humane and health reasons then for economic ones?
Disgraced health blogger Belle Gibson has to pay $ 30,000 towards the legal costs of Consumer Affairs Victoria and has been banned from making deceptive claims about her health in connection with wellbeing advice.
Federal court justice Debra Mortimer made the orders on Friday against Annabelle Natalie Gibson, who claimed she had brain cancer and healed herself with natural remedies.
The judge said Gibson was prohibited from claiming, in connection with the development and promotion and sale of her wellness advice:
that she had been diagnosed with brain cancer at any time before 24 May 2016
that she was given four months to live
that she had taken and then rejected conventional cancer treatments in favour of embarking on a quest to heal herself naturally
Consumer Affairs Victoria took Gibson to court last year alleging she had lied about a 2009 brain cancer diagnosis and subsequent recovery.
It was also alleged that she had lied to consumers about donating to charities from the sales of her Whole Pantry app.
Last month Mortimer found the allegations against Gibson to be mostly true, saying she had “played on the genuine desire of members of the Australian community to help those less fortunate”.
An excerpt from Gibson’s Whole Pantry Book describes her journey from being told she had four months to live, to finding out she was pregnant, to rejecting medical intervention and travelling the country in search of non-medical advice.
If Gibson refused to obey Friday’s court order, she would be liable for imprisonment, sequestration of property or other punishment, the court documents said.
She has been absent from court since the case began and has not defended herself through lawyers.
The cost of an average stay in a residential care home can swallow up more than half the value of an individual’s house in some parts of the country, according to new research. The findings, which show that the typical person entering residential care will face a total bill of £50,000-£93,000 depending on where they live, will fuel the debate about social care funding. The chancellor, Philip Hammond, announced in this month’s budget that an extra £2bn would be granted to social care in England over the next three years. He also said the government would produce a discussion paper later this year that looks into how to fund social care in the future. The new research from the mutual insurer Royal London, whose director of policy is the former pensions minister Steve Webb, found that variations in house prices around the UK mean the cost of a typical residential care home stay could range from 18% to 56% of the value of the average house.
It described the situation as a lottery and said many people were at risk of losing “a large part of the value of their home” if they were hit with such costs. It said that for most pensioners, their house was likely to be by far the biggest asset on which they would need to draw to meet care home bills. For many, that will mean selling the family home to pay the fees. For people in north-east England, where the average house price at the end of 2016 was just under £129,000, an average stay of 30 months in a local home costing £554 a week would eat up 56% of the value of their home. The total bill would be £71,000. For those living in London, where the average house price is around £484,000, 30 months of residential care at a typical cost of £666 a week would only account for around 18% of the value of their home. The total bill would be £86,000. The equivalent percentages for south-east England, East Anglia and the Midlands were 29%, 32% and 40-41% respectively. The research relates to residential rather than nursing care. For those who need nursing care, the total bill is likely to be smaller because average stays in nursing homes are significantly shorter than those for residential homes,which more than offsets the higher weekly costs of nursing care. Webb, a former Liberal Democrat MP, said successive governments had “failed to grasp the nettle” when it came to care costs, and that urgent action was needed.
As every parent of a newborn knows, sleep is a foreign country, a place that they happily visited a long time ago but fear they may now never experience again. The constant disruption to sleep patterns posed by a screaming baby can play havoc with relationships, waistlines and sanity, but it’s also having a deleterious effect on the nation’s finances. Until now.
In the first study of its kind, Joan Costa-i-Font and Sarah Flèche, of the Centre for Economic Performance at the London School of Economics and Political Science, have found that baby-induced fatigue is significantly undermining economic performance. Their work is to be presented at the Royal Economic Society’s annual conference in April.
They reached their conclusion after examining the Avon Longitudinal Study of Parents and Children dataset, which follows a sample of 14,000 British families from a child’s birth to the age of 25. The data contains precise information on the child’s quality of sleep, including whether they wake up at night and how often.
A one-hour increase in the amount of sleep a baby has increases the time a mother sleeps by 12 minutes. Every time a baby wakes up, a mother loses 30 minutes of sleep.
These results were then correlated against the parents’ employment experiences. Costa-i-Font and Flèche say: “The effects of parental sleep on economic performance are substantial.”
A one-hour increase in the amount of sleep a mother has improves their employment prospects by 4%. It also, they say, correlates to a 7% increase in the number of hours they work and an impressive 11% rise in household income. There is also a 1% increase in job satisfaction.
The effect of disruptive children on paternal sleep was found to be only half of that on maternal sleep.
Last week’s Great British Bedtime report by the Sleep Council found that a quarter of people are now using alcohol as a “sleep remedy”, compared to just 16% in 2013.
Low back and neck pain is an increasingly widespread and expensive condition worldwide, costing the US alone $ 88bn a year – the third highest bill for any health condition – despite evidence most treatments do not work.
Millions of people worldwide suffer from low back and neck pain, most of it unexplained, although some professionals think it may be worsened by sitting at desks all day, carrying bags and general bad posture. Episodes of acute pain are very common, but experts say that medical investigations only make things worse and the best cure is often to take painkillers, exercise gently and wait for the pain to pass.
The rising bill for treatment in the US has been uncovered in a new study by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, which looked at public and private spending on all diseases in 2013. Diabetes was in first place on $ 101.4bn and heart disease was second with $ 88.1bn. But neck and lower back pain treatment costs were close behind, at $ 87.6bn. The team split cancer into 29 separate conditions, which meant that none of them made the top 20, although combined the costs of treatment came to $ 115bn.
The most remarkable thing, said Joseph Dieleman, lead author of the paper published in the Journal of the American Medical Association, was the increase in treatment costs for lower back and neck pain, running at 6.5% a year against 3.5% overall. “In absolute terms, there was an increase from $ 30bn in 1996 to $ 88bn in 2013,” he told the Guardian.
The numbers of people suffering low back and neck pain in the US had not changed much, he said, but the spending had soared. Three things were driving the rise, said Dielman: individuals with pain going more often to outpatients’ clinics, increases in the costs and quantity of treatments given to people admitted to hospital, and a larger older population.
Surprised by what they found, Dieleman and his colleagues now plan to do similar work looking at the costs of treatment of low back and neck pain and other diseases in England, Norway and Switzerland.
What they already know is that low back and neck pain is a huge worldwide problem. The latest Global Burden of Disease (GBD) study, also produced by the IHME and published by the Lancet, showed it was “the leading global cause of disability in 2015 in most countries”. In the UK, a third of all long-term sickness absence from work, and nearly a fifth of any sick leave, is caused by musculoskeletal disorders, which is mostly lower back and neck pain, according to the Work Foundation.
“It’s about 30% of GP consultations,” said Karen Steadman, health, wellbeing and work lead at the foundation. A lot of patients have other health complaints at the same time – so-called co-morbidities. “About a third have co-morbid depression,” she said.
Dr Andrea Furlan, a co-ordinating editor of Cochrane Back and Neck – one of the collaborating groups of scientists who assess the worldwide evidence for which treatments work – said back or neck pain affect maybe eight out of 10 people at some point. “Almost everybody in the world will have some kind of back pain in their life,” she said.
Acute lower back or neck pain, which can last for a few days up to a couple of months, can be extremely debilitating, she said. Furlan knows this, as quite apart from being based at the Institute for Work and Health in Toronto, Canada, she has experienced it herself. “It was so painful I had to lie on the floor,” she said. “I was sure I had ruptured a disc or ligament.”
But she also knew she should not get it investigated. “The first thing you have to remember is don’t x-ray, don’t MRI and don’t CT scan – no investigation. I was desperate to have one
“Thank goodness I didn’t [get it investigated] because that’s where things go wrong. I’m 47 years old. When you do an investigation, there is a chance you are going to find something wrong in the spine. Then somebody will want to intervene.”
Injections, electrical nerve stimulation, opioid drugs and a whole host of other interventions are not recommended for lower back and neck pain. The Cochrane group have found no evidence in favour of using these or many other interventions; in the UK, guidance from the National Institute for Health and Care Excellence advises healthcare staff not to offer them.
There are people who will be “red flagged” for investigation because of their age, a fever or other issues, but most people will be advised to keep working, keep moving, keep exercising and taking painkillers and wait to get better. “Rest for acute back pain is the worst thing you can do,” said Furlan. After three weeks, her own pain was gone.
It is important to try to prevent acute pain from becoming chronic pain – the sort that does not permanently go away. Treatment can make things worse, but there is also a mental health element to much chronic pain. Those at risk of developing chronic pain are “yellow flagged”, said Furlan, and risk factors include depression and a lack of social or workplace support. Those with chronic pain will need interventions, which may include professional physiotherapy but also relaxation exercises, meditation and mindfulness.
The epidemic of lower back and neck pain is not surprising, said Furlan. “The spine is a part of the body that is so fragile. People have no idea,” she said. “It is unbelievable what the spine does.” It is also supporting increased weight and changed posture in the many people who have become obese in recent years – plus carrying heavy bags around and tension in neck muscles as people work at computers does not help.
Ending the epidemic, however, is going to be hard.
Ben Dunkle died at the age of 20, abandoned in a carpark by panicked friends who had no idea how to save his life as he overdosed on heroin.
“I’m certain that if they had been carrying naloxone, they wouldn’t have run away,” said his mother, Aimee Dunkle.
After Ben’s death, Aimee made it a mission to get naloxone, an antidote that can bring overdosing opioid users back from the brink of death within minutes, into the hands of as many people as she could. In February she founded the Solace Foundation in southern California to distribute the naloxone among addicts, many of them homeless, their relatives and friends. She says the group has saved at least 365 lives.
But Dunkle said she could have saved more if it were not for the surging cost of the drug which has prompted accusations of pharmaceutical companies profiteering from the US’s opioid epidemic. Costs for pre-filled syringes doubled in 2014 and are three times the price of 15 years ago, while injectors used to administer the spray have increased to more than five times the price in two years.
“More people are dead now than would have been otherwise,” said Dan Bigg, director of the Chicago Recovery Alliance, an important distributor of naloxone in the city. “How many is hard to count, but programmes that would have started didn’t because of the cost of naloxone. Programmes that would have expanded didn’t because of the price of naloxone. To the extent pricing is an impediment, it will prevent this being used as a lifesaving medicine.”
Deaths from opioid overdoses surged again last year to more than 30,000, driven by a sharp increase in the use of heroin and fentanyl.
Heroin deaths were up 23% on the previous year to 12,989, more than the number of lives claimed by guns used in murders, according to data released by the Centers for Disease Control and Prevention (CDC) on Thursday. The sharpest increase came from lives claimed by even more powerful synthetic opioids, such as fentanyl, the drug that killed Prince, which were up 73% to 9,580 deaths, although some of those deaths were in combination with heroin. But prescription opioid painkillers, containing drugs such as oxycodone, remained the biggest killers, taking 17,536 lives.
Medical studies say that most heroin users first become addicted to prescription drugs. It is how Ben Dunkle came to die.
Ben Dunkle in 2012. Photograph: Courtesy of the Dunkle family
Overdoses are so widespread that the National Center for Vital Statistics found drug-related deaths are dragging down life expectancy for white adults.
After 15 years of steadily rising deaths from opioids, what the CDC has called an epidemic has finally forced its way on to the political stage with $ 1bn in treatment and prevention legislation passed by Congress. It has also resulted in ever-widening access to naloxone as more police forces carry it and states liberalise access by making it available without a prescription. But increased demand for the antidote has coincided with a sharp rise in cost.
Naloxone is most commonly administered by injection or spray. Kaléo, a Virginia company, has increased the price of its naloxone auto-injectors, sold as Evzio, from $ 690 for a kit of two to $ 4,500 in less than two years. Amphastar of California nearly tripled the price of syringes pre-filled with naloxone.
“When we started in 1996, a 10cc vial of naloxone was $ 1.63. Now that 10cc vial is almost $ 300 at Walgreens here,” said Bigg. “Has the price been raised well beyond what it costs to make in an obscene way for such an important lifesaving drug? Yes.”
Robert Childs, director of the North Carolina Harm Reduction Coalition, one of the largest non-profit distributors of naloxone in the US, said his organisation has spent about $ 220,000 this year giving out more than 13,000 naloxone kits to police officers and others working with those at risk of overdose.
“If naloxone wasn’t the price it is, we would be able to buy a lot more and get a lot more out there to high-risk populations,” he said. “There’s a public health crisis with opiate and opioid-based drug overdoses, and the response has often been to increase the price which is probably the worst response you can do.”
The increased demand and rising prices has resulted in a surge in income from naloxone for drug companies, up 400% since 2011 to $ 82m last year.
“It’s one thing to charge more for snow shovels when there’s a blizzard, but this is a public health emergency,” said Dr Andrew Kolodny, co-director for opioid policy research at Brandeis University. “When you have an epidemic of people dying of opioid overdoses, [this] should be readily available. We shouldn’t have pharmaceutical companies profiteering.”
Doctors writing in the New England Journal of Medicine called for government intervention to control the price of the drug, saying that cost is discouraging use of naloxone. They said that legislation has greatly expanded access to the antidote but that the price remains an obstacle.
“We believe that such policies should explicitly call on manufacturers to reduce the price of naloxone and increase transparency regarding their costs, particularly those related to the development of new formulations,” it said.
“The message to lawmakers is drug prices are an increasingly important problem for patients,” said one of the article’s coauthors, Dr Joseph Ross, an associate professor of public health at Yale University and a primary care physician.
•••
Aimee Dunkle took one look at the young man slumped on a bench in a Santa Ana carpark three weeks ago and knew she had only minutes to act.
“The giveaway for me was he was drooling. He was breathing very shallowly. I recognised him and called his name. There was no response,” she said.
The man was overdosing on heroin and benzodiazepines, a lethal combination. Dunkle pumped a shot of naloxone – also known by the trade name Narcan – into him.
“I gave him the first shot of Narcan and no response. I gave him the second shot and he woke up. He was groggy, but he was up almost immediately. Someone had dialed 911 but before law enforcement arrived he was walking away,” she said. “It was exhilarating to save a life for the first time but then I realised this is how Ben died, sitting in a car, slumped over.”
Most of the manufacturers distribute a limited amount of free supplies to community groups and emergency services like Dunkle’s or sell naloxone at a discount.Dunkle said her group received free auto-injectors from Kaléo, but when they ran out she could not afford to buy more even at the discounted price for non-profits.
“There’s no way I can even contemplate buying it,” she said. “We sometimes get some financial donations. One time I had about $ 1,500 that had been donated and I bought $ 1,500 of Narcan. Then I had to select who to give it to. Not who was at most risk but who was most likely to witness an overdose. For a mother that’s lost a child, that’s a hellish decision to have to make: who gets the kits and who doesn’t.”
Supplies dried up for three weeks in September. Dunkle said that inevitably meant lives were lost.
“Our waitlist was over 70 people and that meant people died because we didn’t have it,” she said.
But financial donations mean she now has supplies to see her through the first half of 2017 distributing 70 naloxone kits a week. Still, that falls well short of demand.
“There’s never enough,” she said.
naloxone
The rising costs have drawn scrutiny in Congress. Senators Susan Collins and Claire McCaskill wrote to five pharmaceutical companies in June asking them to explain their pricing of naloxone.
A spokesman for McCaskill said that in meetings the companies defended the increases as necessary to cover the cost of new delivery systems. Naloxone, which has been on the market since 1971, is no longer covered by a patent and is cheap to produce. But pharmaceutical companies do have patents on how the drug is administered, such as by spray or auto-injectors, a spring-loaded syringe.
“In meetings, generally speaking the companies have argued that the price increases are due to new and more efficient delivery systems,” he said. “The question is, are these new bells and whistles effective?”
Manufacturers said the introductions of nasal sprays and auto-injectors are easier and safer to use than regular syringes. But Bigg questions whether those modifications justify the cost given that both means of delivery were already commonly used with other drugs.
An Irish company, Adapt Pharma, which makes a widely used naloxone nasal spray with a trade name of Narcan, denied that the patent was a means to price gouge. It said the spray “is designed, tested and approved so that anyone in the community can deliver a proper dose in non-medical conditions”.
“It’s not as simple as just putting naloxone into the device and selling it,” said Mike Kelly, president of Adapt’s US operations. “To obtain Food and Drug Administration approval, we must consistently meet the standards set by the FDA.”
The list price for the spray is $ 150 for the two shots typically administered to someone who overdoses on opioids which Adapt notes is considerably cheaper than a rival, the Ezvio auto-injector, with a retail price of $ 4,500 for a pack of two.
Kelly said the company discounts the cost for community groups and the police by 40% and that a majority of patients using a prescription can obtain it through health insurance for $ 10.
“We have made it our mission to provide more access and availability than ever before – including donating more than 50,000 doses of Narcan nasal spray to increase awareness and experience with the product and naloxone generally,” he said.
Mark Herzog, vice-president of corporate affairs at Kaléo said the six-fold increase in the list price of Ezvio was made in order to cover the cost of ensuring anyone with insurance and a prescription can obtain the drug cheap or free. The company responded to the senators’ letter by claiming that the real barrier to naloxone access is “lack of insurance coverage or unreasonable coverage restrictions”.
The company said it has donated more than 150,000 auto-injectors to public agencies and community groups. Other drug manufacturers did not respond to requests for comment including one of the largest naloxone sellers, Hospira, which has raised the cost of a vial of the drug by 1,700%.
Ministers are looking at increasing council tax to pay for social care but have been warned that it will not tackle funding problems which are “out of control”.
Experts, including the former Tory health secretary Stephen Dorrell, have warned of a growing cash crisis hitting local government and the NHS.
The government is preparing to allow tax precepts to be increased so local councils, which have suffered reductions in government grants totalling more than 40% since 2010, can claw in extra cash to cover the spiralling social care costs.
Izzi Seccombe, the Conservative chair of the Local Goverment Association’s community wellbeing board, confirmed that the idea of an increase in the precept was being considered.
“We have had some dialogue with ministers about this,” she told BBC Radio 4’s Today programme on Monday.
But she said the money raised from such a move would not be enough. Seccombe pointed out a 2% increase in precept imposed by most councils last year raised only £380m, which was not enough to pay the £600m needed to cover increased staff costs under the “national living wage”.
She also warned that a rise in council tax would create a postcode lottery in services because richer areas could raise more than poorer areas where the need is greatest.
Seccombe called for emergency funding. “We need an injection now of £1.3bn because there is a shortfall by the end of 2020 of £2.6bn.”
Dorrell, who is now the chair of the NHS Confederation, said the shortfall in social care was spilling over into the NHS because discharged hospital patients had nowhere else to go.
He said: “What we are talking about is a cash shortage that is threatening the stability not just of local government but of the National Health Service. Unless we address this seriously, we will simply see a failure of service across the range of local public services and people will suffer as a consequence.
“It comes when people find they can’t have access to care homes, so they end up in A&E and GP surgeries. They can’t be discharged from hospital when they are fit and ready to go.”
Dorrell said he would welcome giving councils the flexibility to raise council tax for social care, but he called for a more “fundamental” rethink of both health and social care funding.
Martin Green, the chief executive of Care England, which represents care home providers, said hundreds of providers were on the brink of financial ruin.
He said: “Research recently showed 40% of care services will no longer be viable in the medium term so this is a huge number of care services that will be lost.
“The government needs to have a clear strategy on social care and if they don’t there will be a crisis right across both health and social care.”
Andrea Sutcliffe, the chief inspector for adult social care, told the Times: “The system is approaching a tipping point. We’ve got increased demand and potentially a restriction on capacity.
“Unless we really get to grips with some of these problems … we will get to an absolute crisis.”
Labour peer David Lipsey, who was involved in a royal commission on elderly care funding in the 1990s, added: “There could be mass closures of care homes.
“There’s a danger that poor people in poor areas will end up without care, living a squalid life. There could be care blackspots because the homes that are reliant on state funding will become unsustainable,” said Lord Lipsey.
The Lib Dem shadow secretary of state for health, Norman Lamb, said: “This is dreadful crisis management from the Conservatives.
“They are lurching from crisis to crisis and this is yet another desperate sticking plaster solution which falls short of what is needed. Making councils bear all the burden will increase the postcode lottery which already exists.
“It will mean that wealthy parts of the country will find it easier to meet rising demand whilst those areas where council tax raises less money will be left struggling.
“The government must be held to account for the consequences of leaving more and more people without the care they desperately need.”
Barbara Keeley, the shadow minister for social care, commenting on reports of proposed council tax rises to fund social care, said: “Asking taxpayers and councils to pick up the bill for the Tories’ failure is no substitute for a proper plan.
“It is time for Tory ministers to deal with the crisis they have created in funding social care and to develop a sustainable way of funding the social care on which vulnerable and frail older people depend.”
While the whole world is still in shock over the outcome of the recent US Presidential Elections, the world’s most powerful country still has a lot of issues that need immediate resolutions. One of them is the continuous increase of the US healthcare costs. And regardless of what your political stance is, this problem remains to affect most Americans, especially those who are in their 50s.
Apparently, outgoing US President Barack Obama had his chance of reforming and enhancing the healthcare system. However, the system has not been properly given the needed improvements, because it has been maligned by dissenting opinions from political parties, business leaders, academic authorities, and media experts.
There have been numerous talks about the management of the healthcare system, but most of them lean towards commercialization rather than a benefit that everyone can immediately access. Well, there is nothing wrong in becoming rich, but as we progress, it is inevitable that many Americans will be financially challenged, making it more difficult for them to receive a decent and affordable medical care whenever the need arises. In fact, a lot of Americans have been paying for their healthcare costs already.
For many less privileged citizens, a decent healthcare does not only deal with costs, immediate solutions, or intense workouts. Whether you believe it or not, a lot of them are coping with chronic pains with a wavering hope of getting an appropriate medical resolution. Some of them are even suffering from a terminal illness that can neither receive a good hospital care nor an alternative remedy.
Meanwhile, the major populace of the Americans over 50 years old are able to access high-quality, safe, and affordable medical attention and healthcare choices. Most of the time, patients who can influence the institution receive the best and most rewarding outcomes, while those who expect the blessings from the higher power don’t get what they need – a sad truth that still exists today.
But such circumstance does not have to stay that way forever. You don’t have to suffer from expensive healthcare costs when there are actions you can do in controlling them. On this note, here are 5 ways you can take charge of your healthcare costs that come from well-informed, unintimidated, and fearless patients.
Negotiating with the hospital and/or clinic.
The patients are not only the people who are affected by the high healthcare costs. Even the medical institutions like hospitals and clinics, as well as, general practitioners in the locality are going through tough times as well.
As such, a lot of healthcare providers in the US are willing to come to terms with regards to medical prices. You can negotiate the costs of medical alternatives like going to other countries for the needed medical care – this happens to be a competitive business as of the present time.
If negotiations are successful, then healthcare insurers pay lesser costs than the retail prices for a certain medical procedure. It also helps the uninsured patients in covering their healthcare expenses. But before getting the treatment, it is best to request a quote from the medical establishment. Don’t hesitate to ask because you will never know anything at all if you don’t inquire.
Negotiating with your healthcare insurer.
Here’s the thing: every time healthcare insurers deny or ignore their promised medical coverages, then that would be easy money credited to their wallets. You don’t want that to happen.
Nowadays, insurers have strategized to keep on denying their promises. But if you have the unwavering power to insist, then you may have the chance to acquire what you have invested in. When all else fails, you can seek the help and support from healthcare consumer advocates who can talk with the insurers on your behalf – sometimes it comes with a fee.
Considering medical options from other countries
Globalization has a positive effect on the world economy today. As a result, we intentionally or unknowingly choose products that come from other countries.
We purchase various types of gadgets made in China, buy television sets and other appliances manufactured in South Korea, and/or spend on cars and vehicles assembled in Japan. This goes the same with medical products such as medical apparatus.
As years pass by, we slowly embrace global products and trust their quality, especially when they carry well-established brands that we patronize. There are also instances when American patients choose to receive medical care in other countries.
Taking advantage of your travel options within the country.
Just in case you haven’t know it yet, there is a big disparity of 30 to 70 percent among the treatment quotes in the US. Patients who don’t settle with their doctor’s referrals or the availability of a hospital near their residence would actually look farther, but still within the border, for better and much cheaper medical choices that may reduce the travel expenses.
To make it more convenient, you can search online for comparative treatment costs in the US. There are websites that provide coherent medical details and health prices just like How Coster. This way, you don’t have to go to the hospital or clinic for inquiries. You can just give them a call, which saves your expenses from traveling.
Staying fit and healthy.
I think you are aware of the saying, “Prevention is better than cure”. Although it’s an old adage, it still works effectively today. If you don’t want to spend on expensive medical treatments, then it is best to keep yourself fit and healthy.
Whether you are having joint problems, diabetes, or cardiovascular diseases, most medical conditions become worse due to poor lifestyle habits. Smoking, alcohol drinking, and unhealthy eating top the list.
Apparently, there are so many advocates who strive to reduce, and hopefully, stop the undesirable lifestyle habits of the Americans. But due to the decrease of longevity rates in the US for the first time in 20 years and the rapid increase of juvenile obesity, the fight to a better and healthier living still goes on.
Never Compromise Again on Healthcare Costs
There you have it. Five ways to cut down the healthcare costs. If you are thinking which one is the most effective way, then that would be number 5. In any case, you are suffering from medical conditions, then it is best to listen and comply with what the doctor says and not do reckless activities to avoid frequent hospital trips, which can definitely increase your healthcare costs.
My practice started offering Saturday morning GP appointments as well as weekday slots from 8am. Previously, our surgery opened Monday to Friday from 8.30am to 6.30pm with some evening appointments until 7.30pm. The Saturday slots are now offered as part of a group of local practices (on a rota basis) to all patients across the practices for routine pre-bookable appointments. There are many such pilots across the country – which started in 2013 as part of the then prime minister’s £50m challenge fund. Some, such as those in Greater Manchester, offered Saturday and Sunday urgent and routine appointments in addition to extended weekday access. Others, like ours, offer additional weekday and Saturday morning access for routine appointments only. The government has committed to another year of extended access despite dubious benefits of the first wave.
The health secretary, Jeremy Hunt, has cited lack of GP services as one of the reasons for A&E and acute admission pressures in hospitals. Indeed, studies have shown that seven-day GP access reduces attendances at A&E for minor illnesses but has little impact on emergency hospital attendances for serious medical conditions.
A recent study from Greater Manchester showed that providing extended seven-day GP access to patients across 56 practices reduced A&E attendances for minor ailments by 26% (in comparison to 469 practices that provided routine access). This equated to savings of £767,867 through reduced A&E visits – however, this extended GP access scheme cost around £3.1m, which included evening appointments until 9pm on weekdays and both Saturdays and Sundays (across a range of times). But hospital visits for minor ailments form only a proportion of total A&E visits – this study showed that extending GP access led to only a small reduction of 3.1% in total A&E visits. So overall, the scheme cost three times more than it made in savings.
There has also been further evaluation of the impact of seven-day access on medical admissions of elderly patients at weekends. In central London seven-day GP cover cut weekend A&E visits by 18% and weekend hospital admissions fell by 9.9% (mainly in elderly patients). But there have been many more disappointing outcomes from the extended access schemes with many areas discontinuing the pilots early or cutting their hours.
In areas where extended opening hours are only offering routine appointments, like ours, cost-savings through reduced A&E attendances or emergency admissions is even more questionable since we are not seeing urgent or acute problems – it is the latter group of patients who are more likely to go to out-of-hours services or to A&E.
Nevertheless, NHS England has used some of this early data to extend the seven-day GP access services. In 2015-16, it invested £100m. At a time when both primary and secondary care is seeing unprecedented budget cuts and rationing of “unnecessary” or even routine services, it makes little sense to waste money on weekend opening .
The cost per total extended hour is up to £280, with practices needing to cover premises’ costs and reception, nurse and GP hours. Staffing these hours has been especially problematic for some areas that do not have enough GPs. Within my own practice, there is little appetite to work more. Until a few years ago I used to work GP out-of-hours sessions until it became difficult to manage these with a young family. As a partner in the hub of practices, I am doing the Saturday morning sessions. The 12 slots are booked by a mix of people, some of whom could come during the week.
Expensive extended access is not likely to be sustainable, and my concern is where is this money likely to be diverted from? And should we not put it to the public to decide whether they would like seven-day provision or improved access within existing GP hours?
Evidence suggests that improved access within existing, standard hours leads to a more effective way of reducing patients’ use of out-of-hours services than extending opening times. But this requires more GPs and more rooms to put them in. and better signposting so patients can see nurses, pharmacies and health care assistants rather than only a GP. It makes no sense to run services on a shoestring during the week, offering limited appointments to patients – because you are spreading staff thinly across the week. We should be offering more daytime appointments. This requires a commitment from the government to help primary care tackle its workload and funding crises, rather than persisting with its obsession of seven-day working.
Smokers and obese people will increasingly be denied surgery on the NHS as hospital managers cut costs to deal with financial restraints, prominent health service figures have warned.
The prediction came as one health authority said it would make people wait up to a year for elective surgery for conditions that are not life-threatening if their body mass index (BMI) – which measures weight in relation to height – was 30 or greater.
To score a BMI of 30, a man of average height in Britain – 5ft 10in – would have to weigh 15 stone. A woman of average height (5ft 5in) would have to weigh 12 stone 12lb.
Vale of York clinical commissioning group (CCG) said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”.
But the Royal College of Surgeons (RCS) warned that it was a dangerous move that ranked among the “most severe the modern NHS has ever seen”.
Its president, Clare Marx, said that while the RCS supports helping people to lose weight and stop smoking, “introducing blanket bans that delay patients’ access to what can be life-changing surgery for up to a year is wrong”.
She added: “As the true scale of financial pressure on NHS trusts has become clear over the summer, we are fast finding ourselves in a situation where CCGs are introducing draconian commissioning policies, often flouting Nice [National Institute for Health and Care Excellence] or other clinical guidance, in order to balance the books.
“An honest national debate on exactly what the NHS can afford, and what we are willing to pay, is urgently needed.”
Chris Hopson, the head of NHS Providers – which represents acute care, ambulance and community services – told the Daily Telegraph: “I think we are going to see more and more decisions like this.
“It’s the only way providers are going to be able to balance their books, and in a way you have to applaud their honesty. You can see why they’re doing this – the service is bursting at the seams.”
In a statement released on Friday, Vale of York CCG said: “The local system is under severe pressure. This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it.”
Policy documents produced by bosses in the North Yorkshire authority make clear that adult smokers will have elective surgery postponed “for six months or until they’ve stopped smoking for eight weeks”.
And, for people whose BMI is 30 or more – who are defined as obese – such treatment will be put back a year “or until 10% of weight loss is achieved, whichever is the sooner”.
The CCG added that, in either case, “patients undergoing surgery for cancer will not be affected” and its clinicians would “identify other groups of patients who should be exceptions to the policy”.
In March last year, it was reported that the vast majority of NHS authorities were placing restrictions on access to surgery for overweight people, including one CCG that was refusing all routine surgery to people whose BMI was 35 or greater – those defined as morbidly obese.
The investigation by GP magazine also found that most of England’s CCGs were denying some treatments to smokers.
NHS England’s setback in the high court over its attempt to get one set of cash-strapped public bodies (local councils) to foot the £10m-£20m a year bill for PrEP treatment rather than another – itself – is the latest manifestation of the health service’s increasing efforts to reduce the number of treatments it pays for, or the number of patients who receive them, or both.
Gradually, and largely unacknowledged, the NHS is rationing access to more and more types of care in order to try to balance its books, even when doing so includes treatments – such as PrEP, with its 90% success rate – that are proven to work but deemed prohibitively expensive in the midst of its decade-long funding squeeze.
Doctors, patients and health charities routinely insist that lives will be lost as a result, but still the process rolls on, affecting different groups of patients every time a decision is made.
HIV campaigners ‘delighted’ by high court ruling on preventative drug
Last week, NHS England was criticised by the charity Addaction for “abandoning” people with Hepatitis C, the blood-borne virus that can – if left untreated – cause severe liver problems, by decreeing that just 10,000 patients a year can receive drugs that studies show are effective in 90% of cases.
The 10,000-a-year quota was “manifestly unjust” and would mean “a potential death sentence for thousands”, claimed Simon Antrobus, the charity’s chief executive. About 214,000 in the UK are estimated to be infected with Hep C, and others have it without realising it. Many have contracted it from using needles and syringes to inject illegal drugs.
Addaction is waiting to hear if its application for a judicial review of the NHS’s introduction of quotas last year has been approved, so NHS England may yet have to defend the legality of its decision.
Coincidentally, the BMJ last week published the results of an investigation by academics at Cambridge and Bath universities into the restricted availability of drugs that cost about $ 90,000 per patient in the US and about £35,000 per head in England.
It found that, “NHS England, unable to budget for broad access to these drugs, tried to alter the outcome of the National Institute for Health and Clinical Excellence process [of approving them] and, when it failed, defied Nice’s authority by rationing access to them.”
Dr Andrew Ustianowski, an NHS consultant in infectious diseases who resigned from NHS England’s clinical advisory group in protest at its conduct, told the BMJ: “If you are going to choose a fight, then choosing this battlefield is quite a sensible thing to do – a marginalised population, very high-cost drugs.”
Related: Users of HIV prevention PrEP urge NHS to fund ‘life-changing’ medicine
Similarly, the Anthony Nolan Trust, aided by several dozen doctors, is campaigning to reverse NHS England’s recent decision to stop paying for a second stem cell transplant for people with relapsing blood cancer. Each such treatment gives the recipient a one in three chance of survival but costs between £50,000 and £120,00, which NHS England says is unaffordable. Nolan claims it has handed the 20 people a year who need a transplant but will no longer get one on the NHS “a death sentence”.
Until recently, most rows over NHS rationing have involved decisions by GP-led clinical commissioning groups, the 209 local NHS bodies that hold the health budget in different parts of England, to deny people who need it access to treatment including IVF, cataract surgery, hernia repairs and a new hip or knee.
But NHS England’s need to reduce the cost of what are known as specialised services, which jumped from £13bn in 2013-14 to £14.7bn last year, means it feels obliged to make what the Commons public accounts committee last month called “tough decisions”. It has already been attacked for reducing the number of drug treatments that the newly relaunched Cancer Drugs Fund will pay for from 84 in January 2015 to just 48 now and its budget from £466m to a strictly capped £340m.
NHS England’s actions cast doubt on its chief executive Simon Stevens’s public insistence that the extra £10bn a year ministers have said the NHS will receive by 2020 is enough for it to do its job properly.
With the NHS now desperate to prove it can live within its means, a further tightening of the rationing screw is inevitable, even though the human impact of an NHS struggling to live within its means will be measured in greater suffering, growing unmet medical need, reduced chances of survival, potentially higher costs in the long term, and more early death.
Dealing with the effects of poverty costs the public purse £78bn a year, or £1,200 for every person in the UK, according to the first wide-ranging report into the impact of deprivation on Britain’s finances.
Related: More than a million people in UK living in destitution, study shows
The Joseph Rowntree Foundation (JRF) estimates that the impact and cost of poverty accounts for £1 in every £5 spent on public services.
The biggest chunk of the £78bn figure comes from treating health conditions associated with poverty, which amounts to £29bn, while the costs for schools and police are also significant. A further £9bn is linked to the cost of benefits and lost tax revenues.
The research, carried out for JRF by Heriot-Watt and Loughborough universities, is designed to highlight the economic case, on top of the social arguments, for tackling poverty in the UK. The prime minister, Theresa May, has made cutting inequality a central pledge.
Julia Unwin, the chief executive of the foundation, said: “It is unacceptable that in the 21st century, so many people in our country are being held back by poverty. But poverty doesn’t just hold individuals back, it holds back our economy too.
“Taking real action to tackle the causes of poverty would bring down the huge £78bn yearly cost of dealing with its effects, and mean more money to create better public services and support the economy. UK poverty is a problem that can be solved if government, businesses, employers and individuals work together.”
Responding to the research, a spokeswoman for the government pointed to the former chancellor George Osborne’s introduction of the “national living wage” for over-25s and May’s pledge to share out economic gains more fairly.
“We’re committed to creating a Britain that works for everyone and that means tackling the root causes of poverty,” the spokeswoman said. “Employment is key and we’ve made good progress – there are now more people in work than ever before, millions are receiving a pay rise thanks to the national living wage and we’ve doubled free childcare to 30 hours.
“But there’s more to do and we’re taking action across other areas like education and family breakdown so we can help more people to succeed in life.”
The JRF report, called “counting the cost of UK poverty”, estimates that 25% of healthcare spending is associated with treating conditions connected to poverty.
In education, an extra £10bn – 20% of the schools budget – is spent every year to cope with the impact of poverty through initiatives such as free school meals and the pupil premium, which is funding given to schools to help children from socio-economically disadvantaged backgrounds improve their academic performance.
Police and criminal justiceaccount for £9bn of the annual poverty cost, due to the higher incidence of crime in more deprived areas.
An estimated £7.5bn of spending in children’s services is associated with poverty. This represents 40% of the early years budget and 60% of the children’s social care budget.
The report’s authors said their estimates did not include the full cost of benefits aimed at preventing poverty or helping people to find a way out of it, such as working tax credits or jobseeker’s allowance. Nor did they include the amount that experiencing poverty in adulthood costs the public purse through reduced tax revenue. The estimates for lost tax revenue that the report included were only based on individuals who grew up in poverty.
Prof Donald Hirsch from the Centre for Research in Social Policy at Loughborough University said: “It is hard even to estimate the full cost of poverty, not least its full scarring effect on those who experience it. What our figures show is that there are very large, tangible effects on the public purse.
“The experience of poverty, for example, makes it more likely that you’ll suffer ill health or that you’ll grow up with poor employment prospects and rely more on the state for your income. The very large amounts we spend on the NHS and on benefits means that making a section of the population more likely to need them is extremely costly to the Treasury.”
The researchers noted that a concerted effort to eradicate poverty “may well involve spending more initially on services that help break the long-term cycle of family poverty and its consequences, but bring longer-term social and economic benefits”.
New research published in peer-reviewed medical journal the Lancet attempts to put a price tag on our latest health crisis: sitting too much. According to an international team of researchers, a sedentary lifestyle cost the world a whopping $ 67.5bn in 2013. That’s equivalent to the total GDP of Costa Rica in the same year.
In modern life, there is more temptation than ever to spend most of the day sitting. Between the prevalence of desk jobs and the 2.8 hours of TV the average American watches each day, we’re all guilty of some couch potato tendencies. Most office workers don’t take a lunch break, eating instead at their desks, further cutting down time spent on their feet. We commute to work in cars, and on buses and trains, adding more sedentary time to our day.
The Lancet study attempted to estimate the financial impact of five diseases associated with humans’ increasingly sedentary lifestyle across 142 countries: coronary heart disease, stroke, type 2 diabetes, breast cancer and colon cancer.
Related: An emotional support animal is just a mouse click away
Like all population studies, findings in the paper are based on estimates, as it would be impossible to quantify the exact contribution of a sedentary lifestyle to each case of disease.
The study used the World Health Organization (WHO) guidelines for physical activity – a modest 150 minutes per week – and relied on individuals’ self-reported data, which is not the most reliable.
While the authors fully admit that the data is “imperfect” , the survey does provide a starting point in the conversation around what all that sitting means to the global economy. The Lancet study is the first global estimate of what our collective lack of exercise means in economic terms.
The staggering costs – both from healthcare spending and loss of productivity – are meant as more of a wake-up call to governments and businesses to devote more resources to tackling sedentary lifestyles. Though the personal out-of-pocket costs as estimated in the global study ($ 9.7bn) are also a pretty big chunk of change.
But there is good news amongst the gloom. This price tag comes on the heels of another study in the Lancet, part of the same series on physical activity, that finds that just an hour of moderate exercise each day is enough to offset the health effects of all that sitting.
So go ahead and take a brisk walk during your lunch break. Walk on a treadmill while catching up on your favorite Netflix guilty pleasure. Join an amateur soccer team. You won’t just be doing your health a favor and saving yourself future out-of-pocket health costs: you’ll also be helping to reduce your country’s overall spending and boosting the economy.
Connected: No ice epidemic but growing purity is performing damage, say researchers
Australian prisoners are using amphetamines at record prices, and the most potent type, methamphetamine, is driving this rise, a survey of police detainees by the Australian Institute of Criminology has unveiled.
As component of the annual Drug Use Monitoring in Australia survey, 3,456 adult police detainees had been questioned about their drug use in between July 2013 and December 2014 at six places across Queensland, New South Wales, South Australia and Western Australia. Urine samples were also taken to corroborate answers provided.
“Overall, in 2013–14 the most notable trend in illicit drug use within the Australian detainee sample was a 13% enhance in detainees testing positive to amphetamines,” a report on the survey findings launched on Sunday mentioned.
Connected: Methamphetamine use the largest drug issue dealing with Australian police – report
“This was largely due to an 11 percentage-level improve in detainees testing good to methamphetamine.” Methamphetamine is far more generally acknowledged as ice, and current research suggests its strength and purity has risen, triggering more harm to end users.
Of the prisoners surveyed, 37% examined optimistic to amphetamines, in contrast with 24% the previous 12 months. It marked the highest recorded rate of amphetamine use in the survey’s history, with the previous peak becoming 35% in both 2003 and 2004.
The survey has been running because 1999, generating it the largest and longest-working survey of drug use between police detainees in Australia.
The director of the Australian Institute of Criminology, Chris Dawson, said the findings meant it was important to proceed to closely monitor methamphetamine market trends, this kind of as availability and purity.
“This new information shows the continuing nationwide rise in methamphetamine use amongst Australian police detainees,” he wrote in a foreword to the report.
Connected: Queensland’s ‘war on drugs’ a waste of police time, says Ted Noffs Foundation
“Methamphetamine use was recognized in 23% of urine samples supplied by detainees in Adelaide, 24% in Bankstown, 34% in Brisbane, 37% in East Perth and 52% in Kings Cross.
Whilst specialists are unsure why ice use has elevated provided it remains reasonably costly when in contrast to other medicines, the availability of ice as a end result of growing local awareness and sophistication in how to manufacture it is suspected to have contributed.
The majority of prisoners surveyed – 78% – reported that when ice supply was low, they managed to abstain from utilizing the drug, but did not boost their use of much more readily offered drugs, this kind of as alcohol.
“These findings suggest that provide-side reduction methods may possibly be successful in terms of harm minimisation: that is, a reduction in supply appears to lessen use of that drug with out escalating the use of other substances,” Dawson wrote.
Relevant: Tony Abbott to establish nationwide drug taskforce to tackle ice ‘scourge’
Nonetheless, cannabis continues to be the most typically detected drug amid police detainees. Even though peak cannabis use between prisoners was recorded in 1999, when 61% tested constructive, 46% examined positive in the most latest survey.
Alcohol use was also substantial, with 41% of detainees reporting that they had drunk alcohol in the 48 hrs prior to their arrest.
“The regular quantity of alcohol detainees reported consuming on the final occasion of drinking was 19 regular drinks, although it was as large as 31 standard drinks for the sub-group of detainees who reported consuming a combine of beer, wine or spirits on the last event,” the report found.
The regular in the earlier 12 months was 22 normal drinks, the report said.
Just lately, investigators at the University of Chicago and Northwestern University reported on a new tool, Price, for measuring patients’ concerns about the monetary burden of cancer treatment method. The acronym stands for “COmprehensive Score for financial Toxicity.”
Speaking about money is not an effortless issue for some physicians, which includes oncologists. Several hesitate to bring up the subject, both out of ignorance about pricing, time constraints, lack of concern, a straightforward or idealistic disdain for the topic… But the unfortunate reality is that as issues stand in 2014, U.S. insurance ideas vary in what treatments they cover. A cancer diagnosis can lead to economic hardship and even bankruptcy.
Just feel of the initial season of Breaking Undesirable, when Mr. White’s lung cancer diagnosis prospects him to a life of crime. Nominally, and component-genuinely, the chemistry teacher’s determination to cook and sell methamphetamine comes from wanting to spend his health-related expenses with no accepting charity from friends, and from wanting to depart funds for his wife and kids, like a disabled son, so they might live well, or at least comfortably, after his death.
infusion pump (supply: Wikipedia)
This kind of concern, about the fiscal toxicity of obtaining cancer, is understandable. And it’s however common. A latest poll by Harvard’s School of Public Wellness, NPR and the Robert Wood Johnson Foundation found that health care difficulties are a significant contributor to tension among U.S. grownups (which, in flip, prospects to far more health problems). It is a toxic cycle. Cancer, like any continual illness, can cause financial distress. Even between insured patients, out-of-pocket expenses can restrict patients’ nicely-currently being, leisure actions, family members strategies and happiness. This is nothing to scoff at.
I employed to consider that physicians shouldn’t speak about funds with their sufferers since that sort of conversation has the potential to demean the partnership. It can render doctors’ function like an ordinary company transaction, which IMO medical care need to in no way be. But I’m persuaded that as prolonged as we have a largely private, insurance coverage-based health care system, we – medical professionals and patients – need to talk about how significantly cancer treatment options may possibly cost.
As issues stand, grownups should have the opportunity to weigh the potential charges of their care in the context of the limits of their insurance coverage coverage, cost savings and other elements of their lives, this kind of as responsibilities for having to pay a home loan or lease, their kids’ university tuition, what ever it is they may possibly otherwise decide on to do what they’ve acquired, which is finite.
Acquiring back to the paper out of Chicago…The gist of COST is that it’s a Patient-Reported Final result Measure (PROM) that may give medical doctors a much better way to gauge patients’ economic concerns and, with that, broach the topic. Which sounds good, terrific. Except that ultimately it’s about funds and not genuinely about cancer care.
I’m skeptical, as I am about most checkbox-kind measurements of humans’ emotions and worries. And I wonder if the authors’ purpose is, partly – but with excellent intention, of program, and relatively sufficient, as most medical doctors need to have go about their operate and earn a living – to safe funding to accomplish far more research about COST, which would then be used to predict more cancer patients’ economic stress and issues in the potential. And then we’ll have an even greater cycle of subjective measurements, and researchers collecting data and publishing people findings, rather than just evaluating and supplying greater health care therapies to more people who have cancer and other situations, very carefully and thoughtfully.
Retirement cash flow planning is more than just establishing a steady stream of earnings it also requires arranging for those uncertain events that threaten a secure retirement. Aging brings with it a range of retirement risks, which includes escalating wellness care costs and achievable prolonged-term care bills. Whilst these signify considerable economic hazards for aging retirees, there is an additional chance, a single usually misunderstood and ignored, lurking in the shadows — frailty threat. Frailty threat can pack a powerful punch to the safety of your retirement program.
Also often people lump frailty threat in with long-term care and well being care worries. Nevertheless, frailty risk results from deteriorating mental or physical health, producing a variety of concerns for the retiree. These include economic troubles, preparing problems, lifestyle adjustments, and added threats to physical overall health. Frailty is not usually very easily defined, but can loosely be characterized as that gradual loss of power, strength, physical capability, and psychological sharpness often related with aging. Frailty is not basically aging, although it is extremely correlated with aging. A University of Michigan review exhibits that nearly one/three of folks age 65 and older suffer from some degree of frailty. Even though a lot of people handle to stay active all through retirement, many others go by way of various phases of activity, reducing over time due to frailty problems. Frailty can spell unanticipated monetary chance to a retirement strategy.
An person struggling from frailty for the duration of retirement may face drastically larger bills. As you grow older and carry on to live in location, the family members house, when a crowded 4 bedroom property total of young children, has now turn out to be a massive burdensome home to maintain. Every single weekend you clean, mow the grass, plant flowers, and complete other upkeep chores such as cleaning the gutters to keep your property up and working. Nonetheless, as you age, you may not be able to get out the ladder, climb up onto the roof, and clean the gutters. Perhaps this only expenses you a number of hundred bucks a 12 months to get a business out to clean your gutters. But next, you are no longer ready to mow the lawn each week, or shovel the snow in the course of the winter. Once again, yet another number of hundred bucks is required to employ a person to carry out yard operate. As frailty danger sets in, more and more house, individual, and other duties become financial strains as you need to have to employ someone else to do it, forego the job, or depend on others for aid. If these maintenance jobs are left undone, your residence could diminish in worth and no longer be the financial asset you have been counting on to tap into later on in retirement.
At some point, frailty may well turn out to be an even costlier problem if you are no longer capable to drive. If you reside in an location that demands driving and lacks excellent public transportation this can signify a considerable challenge and added monetary strain. The fees of personal drivers or taxicabs might be prohibitive, seriously curtailing an otherwise active and well being-aware life style, and additional compounding the frailty factor. It must come as no surprise that in some cases, frailty has been shown to reduce one’s ability to continue to be independent in retirement.
In addition to living independently, you may possibly decide you want to acquire a new existence insurance coverage policy or acquire long-phrase care insurance coverage. However, the onset of frailty could be a factor in the underwriting approach, potentially prohibiting you from currently being insurable. In some instances you may possibly be insurable but at a a lot larger value. This is a very good explanation to buy long-term care insurance and lifestyle insurance at an early age, ideally in your 50s when the likelihood of currently being uninsurable is significantly lower.
Hand in Hand (Photograph credit: garryknight)
Frailty will also impact other retirement revenue hazards this kind of as lengthy-phrase care and overall health care expenses. For illustration, new study out of the University of Arizona displays that those suffering from frailty are more likely to have far more serious injuries and produce problems when receiving therapy in the hospital. Moreover, the study suggests that individuals suffering from frailty knowledge each longer intensive unit stays and longer general lengths of keep in the hospital. The increased severity of injuries, further complications, and extended stays in the hospital all add up to improved health care charges as a result of frailty.
Frailty does not have to ruin your retirement. In reality, proactive measures can be taken in buy to minimize the danger of frailty and its possible effect on your retirement. Not every single individual suffers from frailty as they age. A Uk examine recently showed that one element that can actually help hold off frailty is operating longer. Retiring early can have a detrimental effect on each your retirement cost savings and your overall health. As this kind of, maintaining occupation skills, steering clear of burnout, lowering operate hours, and other measures can support maintain you in the workforce longer, and lessen the likelihood of frailty risk.
In addition to operating longer, some other steps can be taken to minimize the probability of struggling from frailty danger. Arranging ahead of time is extremely critical. For instance, setting up a trust and trustee to make selections for you can be a good way to deal with the decline in psychological ability more than time due to frailty. Preparing ahead for the additional expenses that outcome from frailty in preserving a residence, having to pay for wellness care, affording prolonged-term care, and facilitating travel are also critical. Downsizing early on in retirement, or moving to a continuing care local community to lessen the bodily demands of homeownership can also be a good concept. Employing other folks to preserve your residence and perform tasks can be carried out, but ought to be carried out with caution. There is an elevated danger of fiscal elder abuse as a lot more outsiders are launched into the frail individual’s lifestyle just at the time when they could be most vulnerable. Lastly, taking the essential measures to stay healthful and lively as extended as achievable can aid minimize the probability and influence of frailty and all the monetary dangers that come with it.
It may well not be the acme of “Britishness” to talk about other people’s bodyweight, but this country requirements to have an grownup conversation about its weight problems issue. A Freedom of Details request sent by this newspaper to all NHS trusts has exposed that in the past three many years some £5.5 million has been invested on widening doors and buying unique hoists, chairs and sticks for individuals who weigh up to 60 stone. A single believe in had to spend £80,000 widening corridors another paid £15,000 for a specific cooling system for the bodies of deceased obese patients.
We recite these figures not just to highlight the value to the NHS of this obesity crisis – although it comes in at an estimated £5.1 billion every single 12 months. What also actually issues is the cost in terms of human lives. Professor Dame Sally Davies, chief health-related officer for England, just lately wrote that close to ten per cent of deaths in England and Wales are the end result of excess excess weight. Additionally, she warned that weight problems has turn out to be normalised, that many do not recognise that they have a challenge to encounter.
Britain, as politicians are currently keen to remind us, has a tradition of leaving the person alone. But this problem has to be addressed. There are aspects of lifestyle exactly where life-style falls within the purview of the state. It is correct that colleges should make physical exercise a important portion of their curriculum and that the foods dished out in their canteens need to be healthful. The Government can also, as it is presently striving to do, work with food manufacturers to reduce excess fat and sugar content material in their goods. But what is needed most of all is a culture shift that sees people consider accountability for their health and do the appropriate factors to boost it – for their sake, and for the sake of the society that will select up the tab when items go wrong.
Although employers say the Affordable Care Act has surely improved the cost of offering positive aspects to their employees, not even one percent prepare to discontinue overall health rewards, according to a new survey.
A new examination out this week from the Global Foundation of Worker Advantage Strategies is not excellent news for employees provided it is the newest proof displaying employers will carry on to shift a lot more of the share of the firm paid premium onto their employees.
But the survey is in sharp contrast to fears fanned by political opponents of President Obama’s signature legislation that a flood of organizations would drop wellness care coverage for employees.
Employers have been even much more most likely this year to carry on coverage than last 12 months, the basis survey indicated with 74 % of respondents saying they “definitely will” carry on coverage in contrast to 68 percent who explained in 2013 they certainly would continue coverage.
This yr, an additional 20 percent mentioned they had been extremely most likely to continue coverage and 3.5 % saying they had been “somewhat” likely to proceed coverage.
Meanwhile, less than a percentage, or .five %, of those surveyed mentioned they “definitely won’t” carry on coverage, which was the exact same percentage as last yr.
The survey signifies employers greater recognize the law and its effect.
“Some have observed expenses boost by more than ten percent, and to compensate, employers have passed individuals costs on to their personnel,” stated Julie Stich, director of research at the Global Foundation said in a statement to Forbes. “Yet despite these benefits, the bulk of employers have remained good and committed to delivering healthcare coverage in purchase to retain existing workers, appeal to new talent, and preserve or enhance employee effectively-becoming throughout the workforce.”
Here are some further highlights of the survey, linked here, which integrated responses from nearly 700 human sources executives, relevant positive aspects experts and industry authorities:
32 percent of employers has enhanced “out-of-pocket limits” on staff
twenty percent have improved the worker portion of dependent fees
ten % of modest employers have cut back on hiring to remain beneath 50 employees
11 % of employers with 50 personnel or much less have frozen or reduced spend
four percent of employers with 50 or more workers have frozen or reduced pay out
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The U.S. Centers for Condition Control and Prevention (CDC) seems to have assumed a position that was never meant: lowering the capacity of vaccines to conserve lives. At their previous two meetings, the CDC’s vaccine advisory committee, the Advisory Committee on Childhood Vaccines (ACIP), has debated whether or not to eradicate the fourth (and final) dose of the pneumococcal vaccine provided to infants, even though there is proof showing this would lead to a lot more condition and even deaths.
Pneumococcal illness is brought on by infection of bodily fluids and numerous organs by a bacterium referred to as Streptococcus pneumoniae, or pneumococcus. It can be fairly harmless, this kind of as when it triggers the self-restricted ear infections that take place in hundreds of 1000′s of kids yearly, but it can also be really hazardous. It can infect the lungs and result in pneumonia, and if it enters the blood stream, pneumococcus can cause invasive disease, resulting in infections of the blood, internal organs, brain or spine. (Its presence in the blood is acknowledged as bacteremia and inflammation of the membranes that cover the brain and spinal cord is known as meningitis each are existence-threatening illnesses.)
For many years, the CDC has advised 4 doses of pneumococcal vaccine — at 2, 4, 6 and 12–14 months of age (referred to as the “3+1” routine — three major doses, plus a booster) — as the way to defend kids optimally towards these infections. Lately, nonetheless, the agency’s bureaucrats have favored getting rid of the last dose, though it is acknowledged to enhance children’s immunological response, creating them much better capable to resist infection. The primary explanation cited is expense cost savings. (The federal government is by far the greatest purchaser of pediatric vaccines.) The good news is, the ACIP has remained skeptical.
Getting rid of the fourth dose would end result in cost savings of about $ 500 million a yr, but take into account that just over $ 100 per dose for the 4-dose routine supplies lifetime safety against covered strains of pneumococcus. One more benefit is the “indirect effect” of the vaccine – “herd immunity” safety of the recipient’s pals and family members contacts. And assess this penny-wise, pound-foolish approach to the absence of value-advantage considerations in other locations of health care: A single 18-week routine of a certain new lung cancer drug charges $ 80,000 to prolong a patient’s lifestyle just one.2 months.
The potential cost cost savings would not come with out threat eliminating the final dose of pneumococcal vaccine would consequence annually in at least two deaths, 44 cases of invasive pneumococcal condition, twelve,000 cases of pneumonia and 261,000 ear infections. In addition, the value-financial savings calculation assumes that drug companies would not just raise the value of the vaccine in purchase to compensate for fewer doses getting purchased.
In accordance to Dr. Michael T. Brady, chair of the American Academy of Pediatrics infectious conditions committee and an ACIP liaison representative, the diminished routine might specifically put black young children at enhanced risk of ailment. He mentioned at the last meeting that he “would dislike to uncover that we actually do need to have larger amounts of antibody to shield African American kids. If we went to a routine that was either 2+one or three+, and we now returned to possessing a disparity, I would be quite uncomfortable.”
Disparities among individuals who fall beneath the poverty line previously exist, regardless of race. Kids whose households live in poverty are currently far more very likely to receive only 3 doses of the vaccine. According to the latest CDC information, at least 3 doses are required to completely shield most kids. If the official schedule is diminished to three doses it is probable that numerous of these children will then receive fewer than the prescribed amount of doses, more increasing their risk of contracting pneumococcal illness.
This is not the first time the CDC has selected to leave infants vulnerable in purchase to save cash. As I pointed out in 2011, the CDC at that time refused to advocate a meningococcal vaccine for infants in spite of the confirmed effectiveness of the vaccine, since of its higher value. Plainly, fiscal concerns are beginning to trump public overall health at 1 of the nation’s premier public health agencies.
In an attempt to obscure their target on value, the CDC claims that getting rid of a dose of pneumococcal vaccine will enhance parental confidence in immunizations by reducing the quantity of vaccines on the routine. That argument is weak. If a mother or father is concerned about the security or quantity of vaccines, the CDC’s getting rid of a dose of pneumococcal vaccine – which would make infections far more most likely — ought to serve to enhance, not dispel, skepticism about vaccines.
Below the CDC’s rationale, why not eliminate poliovirus vaccination from the schedule? After all, we haven’t seen a case in this country in years, so arguably it is just overloading the vaccination schedule. But that would be a terrible and irresponsible technique. We know that a resurgence of polio – the lead to of dreaded “infantile paralysis” – could be just a plane ride away. Pneumococcal illness is even closer. Young children can be killed or permanently disabled if they are not properly vaccinated.
CDC officials should go back and go through the agency’s mission statement, which involves this commitment: “As the nation’s wellness protection company, CDC saves lives and protects people from well being threats.” And then they need to rethink weakening the schedule for pneumococcal vaccine.
Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution he was the founding director of the FDA’s Workplace of Biotechnology.
