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Number in U.S. who can’t afford to see doctor rising despite Obamacare

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Even though the Affordable Care Act expanded access to health insurance, the number of Americans who can’t afford to see a doctor keeps increasing, a new study shows.

The researchers found that compared with two decades ago, more Americans today say they have skipped a needed trip to the doctor due to costs, despite a roughly 60 percent increase in people with health insurance.

The trend, researchers said, is likely related to a years-long decline in the quality of private health insurance. Americans today face higher deductibles and co-payments, along with ever narrowing networks of providers covered by their plan.

So, while the Affordable Care Act — widely known as Obamacare — reduced the ranks of the uninsured, it has left fundamental problems with private insurance unaddressed.

The study is not an indictment of Obamacare, stressed lead researcher Dr. Laura Hawks.

“Our opinion is things would be much worse without it,” said Hawks, a research fellow at the Cambridge Health Alliance, an affiliate of Harvard Medical School.

That’s because Americans without health insurance still have the hardest time affording care. Of people who remained uninsured in 2017, the study found, almost 40 percent said they’d been unable to see a doctor in the past year because of costs; that compared with roughly 12 percent of Americans with health insurance.

Dr. John Ayanian directs the Institute for Healthcare Policy and Innovation at the University of Michigan.

Twenty years ago, he co-authored a study showing that many Americans were forgoing doctor visits due to money, and the uninsured were clearly hardest-hit.

The new study, using the same government dataset, shows that the problem has only gotten worse.

“Lack of health insurance is still the biggest barrier,” said Ayanian, who wrote an editorial published with the study in the Jan. 27 online edition of JAMA Internal Medicine.

But, he added, it’s not the only one. Over the years, Americans with insurance have faced ever more “cost-sharing” — including a rise in high-deductible plans, Ayanian said.

Employers have been turning to those plans to help keep monthly premium costs down. The problem is that when employees need health care, they have to pay for a large chunk of it before their coverage kicks in.

In addition, insurance plans have been narrowing their lists of in-network providers. So people often end up seeing a doctor out-of-network — sometimes unknowingly, Ayanian noted — and get hit with a big bill.

It all amounts to one thing, Hawks said: “Private health insurance is not doing what it’s supposed to — making health care affordable when you need it.”

For the study, her team used data from a long-running federal health survey. They compared over 117,000 Americans aged 18 to 64 who responded in 1998 with over 280,000 who responded in 2017.

Over those two decades, there was a significant increase in the percentage of people saying they skipped seeing a doctor in the past year because of costs — from just over 11 percent to almost 16 percent.

That figure increased from 33 percent to almost 40 percent among people without insurance. Among the insured, meanwhile, the numbers were smaller — rising from about 7 percent to 11.5 percent — but the relative increase was bigger, at 60 percent.

Of particular concern, Hawks said, was the fact that people with serious chronic illnesses were commonly skipping care due to money. Among Americans with heart disease, for example, over one-quarter said they were unable to afford a doctor visit in 2017.

Ayanian agreed that the benefits of Obamacare, which rolled out in 2014, are clear. The law expanded Medicaid in many states, and offered subsidies to help middle-income individuals buy private insurance through Obamacare “exchanges.”

By 2017, just under 26 million Americans were uninsured — down from 50 million in 2010. And based on other research, Ayanian said, the law did lower out-of-pocket health care spending for many lower-income Americans.

But for those with incomes above 400 percent of the federal poverty line, there was no such benefit, he noted.

To truly make health care affordable, Hawks said, the cost-sharing pervasive in private insurance “needs to be eliminated.”

A universal health care system would do that, according to study co-author Dr. David Himmelstein, of Harvard and Hunter College, in New York City.

“A single-payer reform, like Medicare-for-All, that eliminates financial barriers to care is what patients need,” he said.

More information

The American Academy of Family Physicians has more on understanding health insurance.

Copyright 2020 HealthDay. All rights reserved.



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2 in 3 parents would send kids to school in the fall, survey finds

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About two-thirds of U.S. parents say they’ll send their kids to school again this fall, and most also support COVID-19 testing and social distancing policies for schoolchildren, a new survey finds.

Among parents, only about 12 percent said they would not send at least one of their kids to school, while 21 percent were still uncertain about their decision. Many are waiting to hear more about their schools’ plans.

Many parents said they had no choice but to send their children to school because they had to work.

For many families, a surge in COVID-19 cases would make them reconsider sending children to school, the survey found.

Most did support measures to safeguard kids against the new coronavirus.

Those measures could include fewer children on buses, daily temperature screening, alternating classroom and online learning, testing school staff and requiring staff and older kids to wear masks, researchers report.

For the report, researchers from the Susan B. Meister Child Health Evaluation and Research Center at the University of Michigan, Ann Arbor, surveyed nearly 1,200 parents in Michigan, Ohio and Illinois in June.

“Families are facing a challenging decision regarding whether to send their children to school for in-person classes in the middle of the COVID-19 pandemic,” said researcher Dr. Kao-Ping Chua, a pediatrician at Michigan Medicine C.S. Mott Children’s Hospital.

“On the one hand, sending children to school could increase the risk of COVID-19 among children and family members. On the other hand, children who don’t return to in-person school may experience disruptions in their education,” Chua said. “Some families simply don’t have a choice because they need to go to work.”

According to the survey, 75 percent of parents supported daily temperature checks and testing of kids if one tested positive for COVID-19.

Over 60% supported limiting the number of kids on buses, alternating between in-person and virtual classes, staggering arrival and pick-up times, and random weekly COVID-19 testing for staff.

Half supported random weekly COVID-19 testing of kids and having children eat meals in classrooms, not in cafeterias.

Most parents supported face masks for staff and middle and high school students, but not for younger children, especially kindergarten through second grade.

There wasn’t much support for closing playgrounds and halting all extracurricular activities.

“Preferences for the number and types of measures vary among parents,” Chua said in a university news release. “But they broadly agree with the notion that schools should take steps to keep children as safe as possible.”

More information

For more on COVID-19 and schools, head to the U.S. Centers for Disease Control and Prevention.

Copyright 2020 HealthDay. All rights reserved.



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Study: Deep brain stimulation may slow Parkinson’s disease

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Data from a five-year clinical trial is adding to growing evidence that deep brain stimulation, or DBS, can slow the ravages of Parkinson’s disease.

Researchers at Vanderbilt University Medical Center in Nashville, Tenn., said that the therapy appears to curb any worsening of tremor and other symptoms, as well as lessening a patient’s need for medications.

“Parkinson’s is relentless,” senior study author Dr. David Charles, Vanderbilt professor and vice-chair of neurology, said in a medical center news release. “There’s nothing that slows down its progression.”

However, “with this pilot study, we’ve shown that if DBS is implanted early it’s likely to decrease the risk of progression, and if this is borne out in our larger study it would be a landmark achievement in the field of Parkinson’s disease,” he said.

The new study was small — just 30 patients. Between 2006 and 2009, the participants were randomly selected to receive either the optimal Parkinson’s disease drug therapy, or optimal drug therapy plus DBS.

In DBS, doctors surgically implant a pair of ultra-thin electrodes deep into the brain. The electrodes target electric pulses to the subthalamic nucleus, a small cluster of neurons. Similar to a heart pacemaker, the device is powered by a small battery implanted under the skin near the patient’s collarbone.

After five years, patients who’d received only the drug therapy had a five times higher risk of progression of “rest tremor” — a key Parkinson’s symptom — compared to those patients who’d gotten the electrode implants as well as drug therapy, the researchers reported.

What’s more, patients who got DBS needed far fewer meds going forward.

“Patients who were randomized to receive early optimal drug therapy [only] had 15-fold greater odds of needing multiple types of Parkinson’s disease medications,” study project leader Mallory Hacker, an assistant professor of neurology at the medical center, said in the news release.

The evidence of reductions in another key Parkinson’s symptom — worsening motor symptoms — did not reach statistical significance, the researchers said, although there was a trend suggesting a benefit from DBS.

Still, this study was small and the results should be considered preliminary, Charles said.

“While this is an incredibly exciting finding, patients and physicians should not change clinical practice at this time,” Charles said. “What this pilot study is most clearly telling us is that the new FDA-approved Phase III study must be done to definitively determine whether DBS slows the progress of Parkinson’s disease when implanted in the very earliest stages.”

Dr. David Weintraub directs functional neurosurgery at North Shore University Hospital in Manhasset, N.Y. Reading over the study he said that it “provides evidence that the use of DBS surgery early in the course of Parkinson’s disease can have meaningful benefits for patients compared to medication alone.”

Weintraub agreed that the findings remain preliminary. However, he said that positive results from a “larger scale, multicenter trial could potentially lead to the adoption of DBS surgery even earlier in the course of Parkinson’s disease treatment, which would be a very significant advance in the field.”

The study was published in the July issue of Neurology. It received funding from the U.S. National Institutes of Health, the Michael J. Fox Foundation for Parkinson’s Research, and Medtronic, Inc., the manufacturer of the DBS system used in the trial.

More information

Visit the Parkinson’s Foundation for more on Parkinson’s disease.

Copyright 2020 HealthDay. All rights reserved.



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Study finds differences in heart failure trends between former East, West Germany

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July 1 (UPI) — Differences in heart health between people in the eastern and western parts of Germany show a long-term effect of the Berlin Wall on the country, according to new findings presented Wednesday on HFA Discoveries.

Germany was divided in the aftermath of World War II, and different healthcare structures developed in East and West Germany. The country became unified again in 1990, but new research shows effects of the decades-long separation persist, researchers say.

From 2000 to 2017, the absolute number of hospital admissions due to heart failure throughout Germany increased continuously by nearly 94 percent — to approximately 465,000 from just under 240,000 — researchers said.

However, the increase was much higher, at 119 percent, in the region that once encompassed East Germany, compared to just over 88 percent in the region once known as West Germany, they said.

Study co-author Marcus Dörr, a professor at the University Medicine Greifswald in Germany, said differences between the two regions in prevalence of heart failure risk factors may explain the findings.

“In fact, previous research has shown that, for example, hypertension, diabetes and obesity are much more common in East than in West Germany,” Dörr said in a press release.

In addition, lingering differences in patient care, as well as in the management of healthcare systems between the two regions, still might exist, Dörr said.

In general, heart failure is the most common reason for hospital admissions in the United States, Germany and much of the world, he said.

For their research, Dörr and his colleagues analyzed data from the Federal Health Monitoring project, an annual census of routine health data in Germany, for 2000 through 2017.

Heart failure was the leading cause of disease-related hospitalization in Germany in 2017, they found.

However, heart failure hospitalization rates nearly doubled in the former East Germany — to 2.9 percent from 1.5 percent — from 2000 to 2017, while it increased to 2.2 percent from 1.4 percent in the former West Germany over the same period, the researchers said.

While the overall length of hospital stays decreased continuously over the same period, the total number of heart failure-related hospital days increased by 51 percent in East Germany, compared to 35 percent in West Germany.

In 2017, heart failure was by far the leading cause of in-hospital death across Germany, accounting for 8.2 percent of deaths, they found.

However, in the region that once was East Germany, heart disease caused 65 deaths per 100,000 inhabitants in 2017, compared to 43 deaths per 100,000 inhabitants in the former West Germany, they said.

The differences may have to do with the average age of people in East Germany — four years older than it is in the West — but the differences in heart failure-related parameters were similar after standardization, the researchers said.

Before reunification in 1990, East and West Germany had distinct healthcare systems, Dörr said. The system in East Germany was essentially run by the state, with less than 1 percent of physicians working in private practice, and there were often shortages of technical equipment, he said.

“Since 1990, both regions have the same federal healthcare system with more physicians in private practice and similar clinical care pathways” Dörr said. “More research is needed to explain the huge differences observed between East and West Germany.”



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