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Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 10-24-2006

Health Savings Accounts Slow to Catch on Among Insured
The Dallas Morning News, 10-24-06

Editor's Notes:

This article, from the Dallas Morning News, chronicles the challenges facing employers who adopt Health Savings Accounts, which combine high-deductible health insurance with a savings account where consumers can deposit tax-free contributions to cover the costs of routine care. While the number of consumers with HSAs at first rose sharply after they were first created in 2003, the percentage of consumers now remains low. According to this article, one problem is that consumers need to be educated on the use of HSAs.

Still, there are some bright spots for HSAs on the horizon, including Wal-Mart's decision to offer them to its employees.

Starting in January, Wal-Mart's primary health insurance offering for new employees will be a high-deductible health plan with premiums as low as $11 per pay period in some areas.

After employees are enrolled in Wal-Mart's coverage for a year, they can pair the high-deductible plan with a health savings account, plus a contribution of up to $2,400 from Wal-Mart.

Because of Wal-Mart's size, its move is "very significant," Mr. Goodman said.

What's more, Wal-Mart's recent announcement that it's expanding its offer of $4 prescriptions for some generic drugs to Texas will enable consumers to better use HSAs, said Devon Herrick, senior fellow at the National Center for Policy Analysis.

"Wal-Mart gives price transparency," he said. "You would immediately know what the price is. With a drug plan, you have to call the drugstore, you have to ask them how much does this drug cost, and they would ask you who insures you."

There's also legislation in Congress that would make HSAs more attractive by allowing consumers to make contributions that would exceed their insurance deductible.

Under current law, you can make tax-deductible contributions to an HSA up to the amount of your deductible in the high-deductible health plan, or up to the limit on HSA contributions, whichever is lower. For 2006, those annual contribution limits are $2,700 for individual coverage and $5,450 for family coverage. The amounts are adjusted annually for inflation.

The greatest benefit to consumers would be the ability to use their own tax dollars to choose among a wide variety of health insurance offerings—not just the two or three (if employees are very lucky) typically offered by employers. One good model to follow would be the Federal Employees Health Benefit Program; it allows federal employees to choose from an array of offerings, including HMOs, PPOs, and consumer-driven plans.

[permanent link]

Tying Diseases to DNA in Thousands of Women
Wall Street Journal, 10-24-06

Editor's Notes:

This article provides an interesting overview on how scientists are trying to mine genetic materials collected in large clinical trials for links to common, chronic diseases—and how researchers, government agencies, and pharmaceutical companies are joining hands to work around thorny intellectual property rights problems.

Starting from the disease and working back to the DNA, a team of academic, government and industry researchers hope to discover the genetic causes of breast cancer, heart disease and a host of other common disorders affecting women.

The novel collaboration, which involves Brigham and Women's Hospital in Boston, the National Institutes of Health and the biotechnology giant Amgen Inc., will analyze DNA collected more than a decade ago from 28,000 participants in the Women's Health Study, combing it for differences between those who have developed serious illness and those who have remained healthy. Researchers believe the results will eventually enable physicians to better predict a woman's risk for disease and to tailor more effective treatments.

The project is part of a new gold rush sweeping medical research aimed at uncovering the genetic underpinnings of common diseases using new DNA–reading technologies. The joint involvement of corporate, government and academic players underscores the increased interest in translating existing genetics research into practical medical knowledge. But it also raises thorny questions about how to patent and commercialize discoveries stemming from publicly funded research efforts...

Under the terms of the new project, called the Women's Health Genome Study, results describing associations between genes and diseases will be posted in a public database through the NIH and made available to any scientist interested in conducting further research. "The overwhelming primary aim is to get the vast amount of these data in the public domain as quickly as possible so they can immediately advance patient care," Dr. Ridker says.

Once in the public domain, the genetic associations can't be patented, but scientists could use them as a springboard to research how to develop diagnostic tests and treatments that could be patented. "The purpose of this is to make a contribution to the global knowledge base," says Joseph P. Miletich, Amgen's senior vice president, research and development. "Amgen isn't looking for any rights to anything."

That reflects the view of the NIH that the basic links between genes and disease are such a fundamental discovery that patenting them should be discouraged. The NIH is developing guidelines for genome–wide association studies that are expected to emphasize that policy, but it has no firm rule against patents.

The new study "might be an interesting test case" of how academic scientists and industry should work together on such projects, says Elizabeth Nabel, director of the NIH's National Heart, Lung and Blood Institute. The NHLBI is contributing $4 million in grant support over five years to Dr. Ridker's study.

[permanent link]

Ethics Rules Send NIH Scientists Packing
USA Today, 10-28-06

Editor's Notes:

Who isn't in favor of more ethical scientists? Or better ethics rules? No one—at least no one who cares about good medical research. But more regulations don't always lead to less corruption or better science. Revelations that a handful of government scientists at the NIH had undisclosed dealings with private industry seem to have led to extensive new regulations that may be hurting the agency's ability to retain the best talent. For instance, USA Today reports that

Nearly 40% of the scientists conducting hands-on research at the National Institutes of Health say they are looking for other jobs or are considering doing so to escape new ethics rules that have curtailed their opportunity to earn outside income.

Most scientists say the ethics crackdown is too severe, and nearly three-quarters of them believe it will hinder the government's ability to attract and keep medical researchers, according to a survey commissioned by the government's premier medical research agency.

The tightened rules were put in place last year after NIH found dozens of scientists had run afoul of existing restrictions on private consulting deals that had enriched them with money from drug and biotechnology companies. Outside income from such companies is now banned. NIH also is placing greater restrictions and disclosure requirements on employees' financial holdings.

"Of course we are concerned when any employees are saying they might consider leaving as a result of a change of policy," said Dr. Raynard Kington, the agency's principal deputy director. But he said in a telephone interview Friday that the survey results are muddy because they combine both those actively seeking to leave and those thinking about it.

NIH Director Elias Zerhouni, in a letter Thursday to the staff, said the survey "does suggest concerns about the impact of the regulations on recruitment and retention." But he added, "At this time we do not anticipate revisions in the regulations."

About 8,000 NIH employees, or about half the workforce, responded to the Internet-based survey.

Employee job satisfaction was high overall, the survey found. But 39% of the scientists researching disease and cures—known as tenure and tenure-track scientists—said they actively were seeking new work or considering leaving NIH because of the rules.

[permanent link]

Employers, Insurers Push Generics Harder
Wall Street Journal, 10-31-06

Editor's Notes:

Competition between branded and generic drugs in the U.S. offers consumers a good balance between value (cheap generics once drugs go off-patent) and innovation (new patented medicines).

Over the next few years, according to the Journal, competition will only increase, as public and private insurers try to shift consumers to generic versions of blockbuster drugs whose patents have expired. This is all to the good, as markets offer consumers a wide range of choices at various price points. Some patients will do well on generics, some will need more expensive new drugs, and some people will want to pay a premium for the brands they trust even when generic versions are available. But we should also remember that, at the end of the day, consumers should be empowered to make the right choices—rather than having one-size-fits-all decisions imposed by insurers or regulators.

At prices often 80% cheaper than those of brand-name medicines, generics have become a key tool for health insurers and employers trying to hold back soaring medical costs. There's hardly a health plan today that doesn't use higher copayments on branded drugs as a way to nudge employees toward less-expensive copycat versions.

But as employees re-enroll in benefit plans this fall, many will encounter more-aggressive efforts to make generics the clear-cut choice. Some companies, such as small employers insured by Blue Cross and Blue Shield of Minnesota, have stopped charging any copayment or out-of-pocket cost for generics. Others are taking a different tack, adopting plans that cover only generics, such as a new, less-expensive prescription-drug plan from Medco Health Solutions Inc., one of the country's biggest pharmacy-benefit managers. And some employers are trying to tee up savings by steering employees onto brand-name drugs that will soon face generic competition.

The concerted push comes in part because the availability of generics is fast reaching a critical mass—and as health-care costs continue to soar, employers and insurers are eager to take full advantage of the generics' lower prices. Over the past 12 months, four of the biggest blockbuster medicines—the cholesterol drug Zocor, the antidepressant Zoloft, the antibiotic Zithromax and the nasal spray Flonase—have gone generic. Patents for at least 11 more top-selling medicines are expected to expire within the next two years. All told, nearly half of the 60 most commonly prescribed drugs will become available generically over the next four years, at prices that could save health plans and consumers a potential $49 billion by 2010.

[permanent link]

What Pilots Can Teach Hospitals About Patient Safety
The New York Times, 10-31-06

Editor's Notes:

The New York Times reports on a growing interest among health care providers to improve patient safety by looking at how other industries—in this case, the airline industry—have grappled with the problem of human error, the cause of "the majority of adverse events in health care."

It is well established that, like airplane crashes, the majority of adverse events in health care are the result of human error, particularly failures in communication, leadership and decision-making.

"The culture in the operating room has always been the surgeon as the captain at the controls with a crew of anesthesiologists, nurses and techs hinting at problems and hoping they will be addressed," Dr. Smith said. "We need to change the culture so communication is more organized, regimented and collaborative, like what you find now in the cockpit of an airplane."

The Federal Aviation Administration requires that all pilots for commercial airlines and the military undergo the [safety] training. They learn, among other things, to recognize human limitations and the impact of fatigue, to identify and effectively communicate problems, to support and listen to team members, resolve conflicts, develop contingency plans and use all available resources to make decisions.

Recognizing the positive impact of the program on the aviation industry's safety record, the Institute of Medicine in 2001 recommended similar training for health care workers. The National Academies, the Agency for Healthcare Research and Quality and the Institute for Healthcare Improvement also advocate the training, as well as the use of other aviation-inspired practices like pre- and post-operative briefings, simulator training, checklists, annual competency reviews and incident reporting systems.

The British medical journal BMJ, The Journal of the American Medical Association and The Journal of Critical Care have also published research suggesting that hospitals that adopt these measures have fewer malpractice suits and postsurgical infections. Patient recovery times tend to be lower, and employee satisfaction is higher.

[permanent link]



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