Disparities

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Medical debt and its consequences illustrate the detrimental effect of inadequate health insurance coverage. The financial stress resulting from unaffordable healthcare costs makes it harder for Californians to pay other bills. For Californians with medical debt, their physical, mental and financial health are at risk, as is their long term financial security.

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Even after the passage of the Affordable Care Act, an estimated 80% of farm workers, who are undocumented, will continue to struggle with being uninsured and accessing healthcare. This can lead to medical debt that makes it harder for them to pay other bills and leads to financial and mental stress. For residents with medical debt, both their physical and financial health are at risk.

Over two million Californians have medical debt. These residents find it difficult to access needed health care or affordable credit. Even with the passage of the Affordable Care Act, many Los Angeles residents will continue to struggle with medical debt that makes it harder for them to pay other bills and leads to financial and mental stress.

Like many American patients, the American health care delivery system suffers not only from acute crises, but also from a chronic, poorly managed and debilitating disease. Primary care is in trouble. Not only are primary care physicians (PCPs) fleeing the profession in droves, but fewer and fewer medical students express an interest in pursuing a primary care career. Those entering the profession don't last long - 1 in 5 general internists become specialists by their tenth year in practice. The workforce pyramid needed to support effective health care reform – with a broad base of primary care providers – is being steadily eroded.

The coming crisis was the topic of a recent conference hosted by the American Board of Family Medicine and the Robert Graham Center. Dr. Robert Phillips, director of the Graham Center, emphasized that while the average ratio of individuals in the U.S. to PCPs is 1500:1, that ratio ranges from 500:1 to 5000:1 depending upon the region you’re talking about. While we don’t know the “right” ratio, we do know that rural communities are particularly barren of PCPs.

Don't forget to join us today for the event Moving Beyond Death Panels, where a distinguished panel of experts will discuss the implications of the most recent Dartmouth Atlas, Quality of End-of-Life Cancer Care for Medicare Beneficiaries Regional and Hospital-Specific Analyses. This study reinforces previous findings that the end-of-life care patients receive often falls short of their desires and wishes, and those of their families. All health care, including -- if not especially -- that which comes at the end of life, must be responsive to patients' needs and respectful to their personal values and choices.

To RSVP or see a full list of speakers, click here. If you can't make it in person, be sure to check out our live webcast or follow along on our Twitter feed, the NewHealthDialog. We'll be live-tweeting under the hashtag #nafevents. We hope to see you there!

The Health Policy Program invites you to join us at an event tomorrow from 12 to 2pm to discuss the controversial issue of end-of-life care, and the implications it holds for patients, families, providers and yes -- even those who pay for the care. While last year's contentious health reform debate painted the issue in harsh and often equivocal terms, the choices around end-of-life care are complex and deeply personal and are not a simple contrast between cure vs. care.

At the event, Moving Beyond Death Panels, a distinguished panel of experts will discuss the implications of the most recent Dartmouth Atlas, "Quality of End-of-Life Cancer Care for Medicare Beneficiaries Regional and Hospital-Specific Analyses." This study reinforces previous findings that the end-of-life care patients receive often falls short of their desires and wishes, and those of their families. All health care, including -- if not especially -- that which comes at the end of life, must be responsive to patients' needs and respectful to their personal values.

Lunch will be available at noon. To RSVP or see a full list of speakers, click here. If you can't make it in person, be sure to follow along on our Twitter account, NewHealthDialog. We'll be live-tweeting under the hashtag #nafevents. We hope to see you there!

Should people be able to use food stamps to buy sodas and other sugary beverages? New York City thinks not.

As we’ve often noted, food policy will increasingly play a large role in health policy, as we institute programs and policies to curtail the obesity epidemic threatening the health of our nation. New York City, a city always at the top of fashion and food, has already begun a public education campaign about sugary beverages. It is now contemplating further action.

Nearly 57 percent of adults in New York City and 40 percent of children in New York City public schools are either overweight or obese. The potential health consequences are frightening, and obesity rates are particularly alarming in New York's low income neighborhoods (30 percent in the poorest neighborhoods versus 17 percent in the richest). Obesity-related health care conditions cost New Yorkers nearly $8 billion a year in tax dollars, or $770 per household. (That's one reason that the city was at the vanguard of the move to require menus to display calorie counts, now a part of the national health care law.)

Interesting story in this weekend’s Baltimore Sun about a new residency program at Johns Hopkins that focuses on “urban health,” primary care, and public policy. Young doctors like Deanna Wilson won’t just wear white coats and treat patients in hospitals. They will spend time in community clinics, HIV/AIDs centers, and prisons. They will sit in on police department domestic violence conferences. They will learn about social services that can help improve both the health and the lives of their patients. They will try to address not just diseases, but some of the larger social circumstances that contribute to poor health and poor health outcomes.

Sun writer Jonathan Pitts describes Wilson’s half-hour appointment with a 17 year old with ADHD. She asks him about what he eats for breakfast, how much TV he watches, what kind of chores he does at home, what that tattoo on his arm means, what his friendships are like. He leaves -- feeling listened to -- not only with a traditional prescription for a medication but with a letter to his school so he can get all the educational support services to which he is entitled.

For many rural areas of the country, telemedicine has long been more of an elusive dream than an everyday reality. And the challenge of getting up-to-date specialty care and continuing medical education into underserved areas has taken a back seat, on many occasions, to the challenge of creating interoperable electronic health records and streamlining the transmission of clinical data between hospitals and physicians.

But this week's official launch of the California TeleHealth Network is a big step forward for telemedicine. Four years in the making, this effort will link eight hundred medical facilities in the state through telehealth and broadband technologies and will be run by the University of California.

Yesterday, the National Association of Free Clinics put on the seventh of a national series of massive free clinics, this time choosing D.C.’s Walter E. Washington convention center for the deployment of their hospital-in-a-box.  Being a burgeoning health-wonk, and wanting to put a face on the frequently abstract issue of the “uninsured,” I ventured out of the confines of the think tank and volunteered as a “patient-escort” at the clinic.