HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Wednesday, June 30, 2010

A New Report Ranks U.S. Last Among 7 Industrialized Countries On Health System Performance

Even though the US health care system is the most expensive, a new Commonwealth Report ranks the US last on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives in comparison to Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. According to a new ScienceDaily Report:

[w]hile there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall.

Provisions in the Affordable Care Act that could extend health insurance coverage to 32 million uninsured Americans have the potential to promote improvements to the United States' standing when it comes to access to care and equity, according to Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update, by Commonwealth Fund researchers Karen Davis, Cathy Schoen, and Kristof Stremikis. The United States' low marks in the quality and efficiency dimensions demonstrate the need to quickly implement provisions in the new health reform law and stimulus legislation that focus on realigning incentives to reward higher quality and greater value, investment in preventive care, and expanding the use of health information technology.

"It is disappointing, but not surprising that, despite our significant investment in health care, the U.S. continues to lag behind other countries," said Commonwealth Fund President and lead author Karen Davis. "With enactment of the Affordable Care Act, however, we have entered a new era in American health care. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."

Earlier editions of the report, produced in 2004, 2006, and 2007, showed similar results. This year's version incorporates data from patient and physician surveys conducted in seven countries in 2007, 2008, and 2009.

Key findings include:

·         On measures of quality the United States ranked 6th out of 7 countries. On two of four measures of quality -- effective care and patient-centered care -- the U.S. ranks in the middle (4th out of 7 countries). However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. U.S. patients with chronic conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, and experiencing delays in being notified about an abnormal test result.

·         On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. Nineteen percent of U.S. adults with chronic conditions reported they visited an emergency department for a condition that could have been treated by a regular doctor, had one been available, more than three times the rate of patients in Germany or the Netherlands (6%).

·         On measures of access to care, people in the U.S. have the hardest time affording the health care they need -- with the U.S. ranking last on every measure of cost-related access problems. For example, 54 percent of adults with chronic conditions reported problems getting a recommended test, treatment or follow-up care because of cost. In the Netherlands, which ranked first on this measure, only 7 percent of adults with chronic conditions reported this problem.

·         On measures of healthy lives, the U.S. does poorly, ranking last when it comes to infant mortality and deaths before age 75 that were potentially preventable with timely access to effective health care, and second to last on healthy life expectancy at age 60.

·         On measures of equity, the U.S. ranks last. Among adults with chronic conditions almost half (45%) with below average incomes in the U.S. reported they went without needed care in the past year because of costs, compared with just 4 percent in the Netherlands. Lower-income U.S. adults with chronic conditions were significantly more likely than those in the six other countries surveyed to report not going to the doctor when they're sick, not filling a prescription, or not getting recommended follow-up care because of costs.

June 30, 2010 | Permalink | Comments (0) | TrackBack (0)

Tuesday, June 29, 2010

HHS Launching Health Website For Consumers This Week

Finding health insurance may become as easy as shopping for an airline ticket with a new federal website which will give consumers a list of all private and government health care plans for individuals and small businesses in their areas. The new site is and it is created as the result of a mandate contained in the new health reform law. Starting on July 1, it will initially provide just basic facts, such as the names of companies, health plans and Web links. However, starting in October, it will list detailed cost and benefits information. According to a story prepared jointly by the Kaiser Foundation and USA Today, consumer groups and insurers already are fighting the kind and extent of the information that should be displayed:

"What we are trying to do is create some order in the marketplace," says Karen Pollitz, a top official at the new Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. She acknowledges the site won't be the Expedia of health care any time soon: "This ain't like buying a plane ticket; it is much more complicated."

For example, unlike the popular travel sites where people can immediately buy an airline ticket, consumers will have to contact insurers directly to sign up.

Insurers including UnitedHealthcare and Aetna say HHS is going too far in planning to list certain data, such as the percent of claims that health plans deny, the rate at which they cancel policies after customers get sick and the number of times patients appeal coverage decisions. They say the data would mislead potential customers. "Let's do what the legislation sets out and not overcomplicate, which will lead to consumer confusion and higher costs," says Aetna spokesman Mohit Ghose.

Consumer groups such as AARP and Families USA counter the data are vital in helping people pick a plan. The site can "be the great equalizer so consumers can have equal access to information and be on the same playing field as insurance companies," says Elisabeth Benjamin, co-founder of Health Care for All New York, a consumer health care coalition. "The government needs to make the information as open as possible …. AARP lobbyist Paul Cotton says “it is a very important first step to give consumers the information they need … so insurers are competing on quality of care and customer service."

HHS has said that in October, when it will begin listing premiums for insurance plans, it will use what Pollitz calls "sticker prices." Actual rates could be significantly higher based on an individual's health status. Until 2014, insurers are allowed to charge sicker people more, and to deny applications altogether. UnitedHealthcare is concerned that consumers could misinterpret even those base prices. The company wants the site to list average prices. Meanwhile, consumer advocates such as Benjamin say consumers should be able to get exact prices from insurers on the site. That could require patients to submit detailed medical histories — at least until 2014.

June 29, 2010 | Permalink | Comments (0) | TrackBack (0)

Saturday, June 26, 2010

Updated Medicaid Primer Explains the Basic Components of Medicaid and How the New Health Reform Law Will Change the Program

Kaiser Foundation’s Commission on Medicaid and the Uninsured posted an update to its Primer on Medicaid and explains how the new health reform law will change Medicaid: 

Medicaid: A Primer … provides an overview of the basic components of Medicaid, the nation's largest health coverage program. Medicaid covers nearly 60 million low-income individuals, including children and families, people with disabilities and seniors who are also covered by Medicare. The primer explains how the program is currently structured, who it covers, what services it provides, how much it costs and how it is jointly financed by the federal government and the states. In light of the new health reform law, the primer also examines how Medicaid will change and expand as it serves as the mechanism to provide coverage to millions of previously uninsured low-income adults and children. Also available is an updated two-page fact sheet, about the Medicaid program.

June 26, 2010 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 24, 2010

Proposed Model Jury Instructions Limiting the Use of Electronic Technologies by Jurors

As a result of the increased use by jurors of web enabled mobile phones and devices, the Judicial Conference Committee on Court Administration and Case Management of the Judicial Conference of the United States has issued a memo regarding Juror Use of Electronic Communication Technologies. This memo provides a set of suggested jury instructions that federal district judges should consider using to help deter jurors from using electronic technologies to research or communicate about cases while they serve as jurors.

The Proposed Model Jury Instruction reads as follows:

Proposed Model Jury Instructions

The Use of Electronic Technology to Conduct Research on or Communicate about a Case Prepared by the Judicial Conference Committee on Court Administration and Case Management

December 2009

Before Trial:
You, as jurors, must decide this case based solely on the evidence presented here within the four walls of this courtroom. This means that during the trial you must not conduct any independent research about this case, the matters in the case, and the individuals or corporations involved in the case. In other words, you should not consult dictionaries or reference materials, search the internet, websites, blogs, or use any other electronic tools to obtain information about this case or to help you decide the case. Please do not try to find out information from any source outside the confines of this courtroom.

Until you retire to deliberate, you may not discuss this case with anyone, even your fellow jurors. After you retire to deliberate, you may begin discussing the case with your fellow jurors, but you cannot discuss the case with anyone else until you have returned a verdict and the case is at an end. I hope that for all of you this case is interesting and noteworthy. I know that many of you use cell phones, Blackberries, the internet and other tools of technology. You also must not talk to anyone about this case or use these tools to communicate electronically with anyone about the case. This includes your family and friends. You may not communicate with anyone about the case on your cell phone, through e-mail, Blackberry, iPhone, text messaging, or on Twitter, through any blog or website, through any internet chat room, or by way of any other social networking websites, including Facebook, My Space, LinkedIn, and YouTube.

At the Close of the Case:
During your deliberations, you must not communicate with or provide any information to anyone by any means about this case. You may not use any electronic device or media, such as a telephone, cell phone, smart phone, iPhone, Blackberry or computer; the internet, any internet service, or any text or instant messaging service; or any internet chat room, blog, or website such as Facebook, My Space, LinkedIn, YouTube or Twitter, to communicate to anyone any information about this case or to conduct any research about this case until I accept your verdict.

June 24, 2010 | Permalink | Comments (0) | TrackBack (0)

Tuesday, June 22, 2010

Witness Prep Increases Accuracy of Testimony

Listen up lawyers. Finally some good empirical evidence to support what we already know --  careful prep of our witnesses helps them to provide more accurate testimony. Forensic Magazine provides the story:

The study, by researchers at the Universities of Liverpool and Leeds, showed that the construction and phrasing of 'lawyerese' questions can inhibit processes in the brain that impact on how a witness responds under cross-examination. The use of complex questions, containing multiple parts, double-negatives and advanced vocabulary may affect the brain's ability to filter and streamline information effectively.

Researchers showed more than 50 participants footage of a staged crime, as though they were eye-witnesses, and then subjected them to the kind of questioning techniques they might encounter in court. They found that participants, who had been given prior guidance on cross-examination techniques, were seemingly able to add to their understanding of the cross-examination process, so that when they encountered complex questions in court they were more able to respond appropriately and less likely to make errors.

Dr Jacqueline Wheatcroft, from the University's Centre for Investigative Psychology, said: 'Witnesses who come to court to give evidence have 'schematic' structures of experience. These structures allow the brain to organize knowledge around themes or topics. They act to streamline information so that we can cope effectively with daily life. We believe that exposing witnesses to the techniques used in cross-examination before they enter court, engages these structures, allowing the witness to organize their knowledge of events so that information can be accessed more easily in response to complex questions.'

'Witnesses who are were not given prior guidance, however, are likely to work much harder to answer cross-examination questions accurately and tend to become nervous and frustrated in court as a result. Familiarisation with questioning techniques 'frees up' capacity in the brain to process information, but if a witness is not given guidance, the frontal/executive systems in the brain are potentially forced to work harder, leaving less processing capacity to work on understanding and responding to questions properly.'

Dr Louise Ellison, senior lecturer in law at the University of Leeds added: 'People are going into the witness box with very little knowledge and preparation. The lay person has little idea of what to expect and this understandably impacts on their evidence. It puts witnesses at a disadvantage and barristers are able to exploit their inexperience. There is increasing evidence that the accuracy of evidence is undermined by these questioning techniques.'

June 22, 2010 | Permalink | Comments (0) | TrackBack (0)

Saturday, June 19, 2010

FDA Advisory Panel Nixes "Pink Viagra"

Flibanserin is a drug under consideration by the FDA for the treatment of Hypoactive Sexual Desire Disorder in women. An FDA advisory panel voted 10 to one that flibanserin was not significantly better than a placebo, and unanimously that the benefits did not outweigh side effects like dizziness, nausea and fatigue. While the FDA hasn’t officially ruled on this drug, it usually follows the advice of its advisory committees.


According to CBS “[e]ven before the vote today, the maker of flibanserin had started a web promotion - and caught heat for it.”  For more on this, the Nature blog The Great Beyond sends us over to Pharmalot where Ed Silverman points out that

a documentary on female sexuality has been airing on the Discovery Channel website this month. (Here’s part one of the four part series.) It’s sponsor: Boehringer Ingelheim, the German pharmaceutical company that makes flibanserin. Boehringer has also tried to ‘raise awareness’ of the controversial Hypoactive Sexual Desire Disorder via Twitter.

CBS goes on to state that

 [w]ith almost $2 billion a year in sales, male sexual dysfunction drugs are big business - so the drug companies are eager to please women, too. Viagra and drugs like it fix the physical problem of blood flow, but flibanserin is an antidepressant to treat vague symptoms by targeting the brain. Drug companies have tried more than two dozen times to come up with a treatment to reawaken a woman's sex life. But for many women, the idea of popping a pill just isn't that sexy.

June 19, 2010 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 17, 2010

Are Seasoned Profs Better at Preparing Students for Advanced Learning?

In an article published in the Journal of Political Economy, researchers detail the results of a study that indicates that experienced professors are better at preparing students for long-term academic success than their less-experienced counterparts. However, that ability isn't necessarily reflected in their students' teaching evaluations. As ScienceDaily reports,

the study's authors, Scott Carrell of U.C. Davis and James West of the U.S. Air Force Academy, say their results raise questions about the value of student evaluations as measures of instructor quality. Student evaluations are widely used by colleges in tenure and promotion decisions, but Carrell and West considered a different measure of instructor quality. They looked at how well instructors in introductory courses prepare students for more advanced courses in related subjects.

Their data come from Calculus I and follow-on classes at the U.S. Air Force Academy. All Air Force Academy students are required to take Calculus I, Calculus II, and nine math-based technical courses regardless of their majors, and professors in all sections of classes use an identical syllabus and give identical exams. That gives the researchers a chance to compare instructors on a relatively even playing field.

The study found that students' achievement in follow-on coursework was strongly influenced by their Calculus I instructor. Students who had a seasoned Calculus I professor with a Ph.D. tended to do better in follow-on coursework than students who had less-experienced and less-credentialed Calculus I instructors. This happened despite the fact that students of seasoned professors tended to have lower grades in Calculus I. The results, the researchers say, suggest that less experienced instructors have a tendency to "teach to the test," while more experienced teachers produce "deep learning" of the subject matter that helps students down the road.

The findings weren't a result of newer professors being "easy-graders," because the Calculus I course was designed to remove as much instructor discretion as possible from their student's grades. Midterm and final exams are group graded, where one instructor grades a single question for the entire course to ensure uniformity of partial credit. The deep learning produced by more-experienced instructors was not reflected in their students' teaching evaluations, the study found. Less-experienced instructors -- whose students tended to do better in the short-term but worse in later classes -- received higher ratings on student evaluations. For example, the instructor who ranked dead last in "deep learning" in the sample of 91 Calculus I instructors ranked sixth best in student evaluations.

Taken together, the findings imply that student evaluations give instructors -- especially those who do not have tenure -- incentive to teach in ways that "have great value for raising current scores, but may have little value for lasting knowledge," the authors conclude.

June 17, 2010 | Permalink | Comments (0) | TrackBack (0)

Tuesday, June 15, 2010

Study Suggests that A Combo of Polyphenols in Green Tea and Red Wine Could Halt Prostate Cancer Growth

Scientists believe that antioxidants in a combination of red wine and green tea inhibit the growth of prostate cancer as well as colon cancer, breast cancer and gastric cancers. An article in ScienceDaily discusses this new and exciting discovery that may lead to a major advance in the treatment of these cancers:  

This new discovery, published online in The FASEB Journal, explains how antioxidants in red wine and green tea produce a combined effect to disrupt an important cell signaling pathway necessary for prostate cancer growth. This finding is important because it may lead to the development of drugs that could stop or slow cancer progression, or improve current treatments.

'Not only does SphK1/S1P signaling pathway play a role in prostate cancer, but it also plays a role in other cancers, such as colon cancer, breast cancer, and gastric cancers,' said Gerald Weissmann, MD, editor-in-chief of The FASEB Journal. 'Even if future studies show that drinking red wine and green tea isn't as effective in humans as we hope, knowing that the compounds in those drinks disrupts this pathway is an important step toward developing drugs that hit the same target.'

'The profound impact that the antioxidants in red wine and green tea have on our bodies is more than anyone would have dreamt just 25 years ago,' Weissmann added. 'As long as they are taken in moderation, all signs show that red wine and green tea may be ranked among the most potent 'health foods' we know.'

June 15, 2010 | Permalink | Comments (0) | TrackBack (0)

Sunday, June 13, 2010

Regulations For 10% Tax on Tanning

The Internal Revenue Service announced that it has issued regulations detailing how the 10-percent excise tax on indoor tanning services (created by the Patient Protection and Affordable Care Act ) will be administered. The regulations go into effect on July 1 and were published in the Federal Register. According to the IRS press release

[i]n general, providers of indoor tanning services will collect the tax at the time the purchaser pays for the tanning services. The provider then pays over these amounts to the government, quarterly, along with IRS Form 720, Quarterly Federal Excise Tax Return.

The tax does not apply to phototherapy services performed by a licensed medical professional on his or her premises.  The regulations also provide an exception for certain physical fitness facilities that offer tanning as an incidental service to members without a separately identifiable fee.

Hat tip to Alan Goldberg, Attorney, Adjunct Professor of Health Law at George Mason University and Moderator of the HIT listserv for the AHLA.

June 13, 2010 | Permalink | Comments (0) | TrackBack (0)

Saturday, June 12, 2010

$25 Million in Federal Grant Monies for Programs to Reduce Medical Malpractice Lawsuits

The WSJ reports that $25 million dollars in grant monies is being distributed to three-year demonstration projects designed to reduce medical malpractice lawsuits. The grant money is part of a “compromise offered by President Barack Obama last year in response to calls for an overhaul of the malpractice system.”

During last year's health debate, Republicans criticized the president for not addressing the rising cost of medical liability lawsuits as part of his sweeping health overhaul legislation. The final health bill passed in March included only limited measures aimed at curbing such lawsuits.

In his joint address to Congress last September, Mr. Obama asked the Department of Health and Human Services to take action, separate from the broader legislation, to reduce malpractice costs.

The result is a slate of demonstration programs aimed at reducing preventable injuries, improving communication betweens doctors and patients, ensuring patients are compensated more quickly and reducing liability insurance premiums.

A seven-member group that includes health-care systems, a state court and a state health department will conduct three-year demonstration projects. One is a $3 million grant to the New York State Unified Court System that will funnel obstetric and surgery patients toward an alternative dispute resolution system overseen by the court. Other demonstrations will disclose medical errors to patients as early as possible, with the hope of minimizing the chances of a lawsuit.

A smaller set of one-year grants will go to 13 states and health-care systems. Among other things, they will go toward developing evidence-based guidelines to curb lawsuits, reducing patient suicides and developing a legislative proposal that will define a legal standard of care for health-care providers.

June 12, 2010 | Permalink | Comments (0) | TrackBack (0)

Friday, June 11, 2010

A Pharmacy Feud Erupts Disrupting Consumer Choice

Two of the nation’s biggest drugstore chains, Walgreen and CVS Caremark, have begun a duel that may affect where millions of consumers can fill their prescriptions. According to The New York Times:

On Monday, Walgreen, which operates about 7,500 drugstores across the country, announced it would not participate as a prescription drug provider for customers in new drug benefit plans administered by CVS Caremark. CVS Caremark, besides operating more than 7,000 of its own drugstores, is also a leading provider of prescription drug benefit plans that many employers offer workers and their dependents. On Wednesday, CVS Caremark countered the Walgreen move. The company said that anyone now enrolled in its drug benefit plans would have to stop filling their prescriptions at Walgreen within a month.

Smaller drugstore operators had already raised antitrust concerns against CVS Caremark, citing potential conflicts caused by its dual role as a pharmacy chain and a drug plan administrator. Independent pharmacists argue CVS Caremark has limited consumers’ choices of where to refill their prescriptions.

“When a patient does not have the right to choose the health care provider, in this case the pharmacy that they choose and trust, that’s not good,” said Joseph H. Harmison, the president of the National Community Pharmacists Association, a group representing nearly 23,000 independent community pharmacies and pharmacy chains. “Some people who feel intimidated by physicians turn to their local pharmacists for medical advice about their prescriptions, he said. “The pharmacist is often the person a patient will wait to ask the questions to,” he said.

Last May, his association filed a complaint with the Federal Trade Commission alleging that CVS Caremark had used its dominant position in the pharmaceutical service industry to eliminate consumer choice and drive consumers away from competing pharmacies. The F.T.C. confirmed Wednesday that it was investigating CVS Caremark, but Richard A. Feinstein, the director of the agency’s bureau of competition said the commission would not comment on the subject of the probe. Attorneys general in 24 states are conducting a similar investigation, according to CVS Caremark.

June 11, 2010 | Permalink | Comments (0) | TrackBack (0)

Wednesday, June 9, 2010

Pesticide Exposure May Contribute to ADHD, Study Finds

An article published in the journal Pediatrics provides evidence that exposure to organophosphate pesticides may be associated with increased risk of Attention-Deficit Hyperactivity Disorder (ADHD) in children. The study focused on 1,139 children from the general U.S. population and measured pesticide levels in their urine.The authors conclude that exposure to organophosphate pesticides, at levels common among U.S. children, may contribute to a diagnosis of ADHD.  See also CNN Health.

"Previous studies have shown that exposure to some organophosphate compounds cause hyperactivity and cognitive deficits in animals," says lead author Maryse F. Bouchard of the University of Montreal Department of Environmental and Occupational Health and the Sainte-Justine Hospital Research Center. "Our study found that exposure to organophosphates in developing children might have effects on neural systems and could contribute to ADHD behaviors, such as inattention, hyperactivity, and impulsivity."

This study was supported by the Canadian Institutes for Health Research and the National Institute of Environmental Health Sciences.The study was authored by Maryse F. Bouchard of the University of Montreal and Harvard University, David C. Bellinger, Robert O. Wright, and Marc G. Weisskopf of Harvard University.



June 9, 2010 | Permalink | Comments (0) | TrackBack (0)