DCMedical News: Tuesday, January 8, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, January 8, 2019
DCMedical News is published every day either the House or the Senate is in regular session.
THE BIG STORY IN HEALTH CARE: Medical Marketing in the United States
Advertising and Marketing in American Health Care: Drs. Lisa Schwartz and Steven Woloshin completed a major study (here) on medical marketing in the United States. The study, published as a “Special Communication” in JAMA, illuminates the role of advertising for medical products, services and organizations, including those of pharmaceutical manufacturers, “disease awareness” campaigns, and advertising by hospitals and academic medical centers. The study notes that physicians when polled are rarely supportive of direct-to-consumer advertising, and that the United States remains one of a very few countries that permit it.
Schwartz and Woloshin found that in the era from 1997 (the Clinton Administration’s approval of direct-to-consumer advertising) to 2016 spending on medical marketing doubled, to $30 billion. The number of direct-to-consumer prescription drug ads increased from 79,000 in 1997 to 4.6 million in 2016. Only the dollar volume of advertising in journals declined substantially, from $744 million to $119 million. Scrutiny of the accuracy, truthfulness and relevance of advertising by the FDA’s Office of Prescription Promotion also declined: the number of advertisement submissions for review tripled, but the number of “violation letters” declined from 156 to eleven.
The Schwartz and Woloshin study is rich in data, sources and implications.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Jobs, Jobs, Jobs: The December 2018 Bureau of Labor Statistics “Jobs” report (here) showed the consistent growth of health care, now with a majority of new jobs in ambulatory care. Says the report, “Employment in health care rose by 50,000 in December. Within the industry, job gains occurred in ambulatory health care services (+38,000) and hospitals (+7,000). Health care added 346,000 jobs in 2018, more than the gain of 284,000 jobs in 2017.”
But Fewer People, the Lowest Annual Population Increase in 80 Years: The U. S. Census Bureau reported on population growth in the U.S. (here, graphic here, Brookings report here) for the year through July 1, 2017 to July 1, 2018, with these highlights.
First, “The U.S. population grew by 0.6 percent and Nevada and Idaho were the nation’s fastest-growing states between July 1, 2017, and July 1, 2018. Both states’ populations increased by about 2.1 percent in the last year alone. Following Nevada and Idaho for the largest percentage increases in population were Utah (1.9 percent), Arizona (1.7 percent), and Florida and Washington (1.5 percent each).”
But, second, “Population declines were also common, with losses occurring in nine states and Puerto Rico. The nine states that lost population last year were New York (down 48,510), Illinois (45,116), West Virginia (11,216), Louisiana (10,840), Hawaii (3,712), Mississippi (3,133), Alaska (2,348), Connecticut (1,215) and Wyoming (1,197).”
Showing the impact of immigration, the Bureau found that “Nationally, natural increase (the excess of births over deaths) was 1.04 million last year, reflecting 3,855,500 births and 2,814,013 deaths. With fewer births in recent years and the number of deaths increasing, natural increase has declined steadily over the past decade. In 2008, natural increase was nearly 1.8 million (based on National Center for Health Statistics data,” italics added.)
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
AHRQ Reports on Maternal Morbidity and Mortality: The Agency for Healthcare Research and Quality reported (here) on the state of maternal morbidity and mortality findings. Highlights: “Childbirth-related maternal health outcomes have been worsening for some time in the United States. After a dramatic reduction in maternal mortality over most of the 20th century, mortality rates began to climb in the late 1980s.”
“The Centers for Disease Control and Prevention report that the US pregnancy-related mortality ratio has increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. Maternal mortality has declined outside the US, which now lags behind other industrialized countries in maternal mortality, including many countries with much more limited resources. In a study of pregnancy-related deaths from 2011–2013 in the US, approximately 30% of these deaths occurred before birth, 17% during birth, 18% in the 1–6 days after birth, and 34% more than 6 days after birth.” And “[C]areful analysis consistently demonstrates that at least 50% of deaths are potentially preventable.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
HRAs and STDLIs: Health Reimbursement Accounts and their use to purchase Short Term Limited Duration [health] Insurance plans were the subject of a proposed regulation (here) for which the comment period closed December 28. Among the 415 comments (here), many expressed concern about the potential to undermine the market for “ACA-compliant” plans, that is, those providing benefits in the ten “Essential” categories. The proposal would allow small- and medium-sized companies that don't currently provide employer-based insurance coverage to use health reimbursement arrangements to reimburse employee premiums up to $1,800. The commercial insurers (through AHIP, America’s Health Insurance Plans), wrote that "Permitting HRAs to be integrated with STLDI would open the door to employers replacing coverage that is prohibited from discriminating based on pre-existing conditions with coverage that may charge more for pre-existing conditions or deny enrollment outright. It could also lead to significant increases in individual market insurance premiums in states where a significant number of employees are offered Integrated HRAs by their employer."
READINGS & REFERENCES
Texas v. Azar: Opinion (stay and partial final judgment) here, appeal here.
340B: Judge Contreras’ opinion here, injunction here, HFM discussion here, FierceHealthcare report here.
U.S. House of Representatives: Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees
U. S. Senate: Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
Publication dates are the regularly scheduled days the House or the Senate is in session.
Remaining January publication dates: 9, 10, 11, 14, 15, 16, 17, 18, 28, 29, 30, 31
February publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28
March publication dates: 1, 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 25, 26, 27, 28, 29
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.