Tag: "seniors"

The Cost Effectiveness of New Drugs

Between 1996 and 2003, the mean vintage of prescription drugs increased by 6.6 years. This is estimated to have increased life expectancy of elderly Americans by 0.41-0.47 years. This suggests that not less than two-thirds of the 0.6-year increase in the life expectancy of elderly Americans during 1996-2003 was due to the increase in drug vintage. The 1996-2003 increase in drug vintage is also estimated to have increased annual drug expenditure per elderly American by $207, and annual total medical expenditure per elderly American by $218. This implies that the incremental cost-effectiveness ratio (cost per life-year gained) of pharmaceutical innovation was about $12,900.

NBER working Paper by Frank R. Lichtenberg.

Headlines I Wish I Hadn’t Seen

Goodbye to Long-Term Care Insurance

Scott Burns says there are probably better alternatives.

Most seniors don’t have many assets and will end up on Medicaid, if the need arises. You may die before you ever need long-term care. There is always self-insurance, and this:

The continuing care retirement community is another alternative. You can receive guarantees of lifetime care by becoming a member of a continuing care retirement community. These residential communities bundle senior residences, assisted living and nursing care in a single property to provide a continuum of care. You become a member with a substantial initial payment and a monthly payment for a broad package of services. Some of the initial payment may be returned to your estate upon death.

More Evidence against the Checkup

How many times did you hear Democratic candidates brag about the new wellness exams for seniors during the last election? All the while claiming that ObamaCare is going to eliminate unnecessary care and make health delivery more efficient?

The results of [the Cochrane review by Krogsbøll et al] are consistent with a previous systematic review by Boulware et al that also evaluated the benefits and harms of general health checks. […] The authors of both reviews reported that general health checks had no effect on mortality, disability and hospitalizations compared with usual care. […]

How should practitioners use the findings of Krogsbøll et al? Although available trials have limitations, there is no convincing evidence that general health checks are beneficial. Since patients who seek or are willing to undergo routine screening are generally healthier than those who are not (indicating that general health checks are least likely to reach those who could benefit the most), and because most people do not receive interventions that are known to be beneficial, general health checks do not appear to be a wise use of scarce healthcare resources. Heeding the Canadian recommendations (made more than 30 years ago) to abandon routine health checks would save money that could be better used by population-level interventions supported by effective health policy, such as the campaigns to reduce dietary sodium in Finland and the United Kingdom.

From a Cochrane Library review editorial via Austin Frakt.

Recessions Are Good for Nursing Homes

Nursing homes are chronically understaffed in times of economic prosperity. But…a one percent increase in unemployment sees full time employment in nursing facilities rise three times as fast. After a recession, when the economy picks back up and jobs become available again, low skilled workers abandon nursing homes jobs’ low pay and even fewer accolades for better prospects. The shift of workers in and out of nursing jobs drives the swings in the national death rate and underscores the importance of these under-appreciated jobs.

A look at the relationship between economic downturns and health outcomes in the United States reveals a complex picture: harm from lost insurance and increased anxiety but better care for the elderly. These two trends coexist because, while harm concentrates in working age people, retirees reap the majority of the benefit.

Neal Emery in The Atlantic. HT: Tyler Cowen.

Did the Election Save ObamaCare?

The morning after Tuesday’s vote, there is one thing every commentator agreed on. The election of Barack Obama guaranteed that his signature piece of legislation — health reform — can now go forward. Republicans are powerless to stop it.

Yet there is something all these commentators are overlooking. There are six major flaws in ObamaCare. They are so serious that the Democrats are going to have to perform major surgery on the legislation in the next few years, even if all the Republicans do is stand by and twiddle their thumbs.

Here is a brief overview.


But can you save me
Come on and save me

Read More » »

HHS Agrees to Pay for Unnecessary Care

How many times have we been told that ObamaCare would usher in a new age of evidence-based medicine? Well, that idea was short lived.

Should the federal government cover the costs of many kinds of treatments for patients who aren’t going to get any better?

It didn’t, for many years. But after the settlement of a landmark class-action lawsuit this week, Medicare will soon begin paying more often for physical, occupational and other therapies for large numbers of people with certain disabilities and chronic conditions like Alzheimer’s disease, multiple sclerosis and Parkinson’s disease.

Oops. I almost forgot. Wellness checkups for seniors are an example of unnecessary care actually written into the legislation. Ah, yes…and there is all that unnecessary preventive care

Entire article on the treatment of “hopeless” patients in the NYT.

Rhode Island’s Medicaid Block Grant

To date, Rhode Island projects that by various new measures — focusing on community-based care that keeps seniors out of expensive nursing homes, for instance, and medical supervision that can keep children and adults out of emergency rooms — the state has saved $100 million. The flexibility to plan care has also helped reduce its projected Medicaid spending rate to 3% from 8% annually.

More on the broken Medicaid safety net in the WSJ.

Commonwealth Misses — Again

The Kaiser study claims that a Medicare “premium support” plan — that the authors claim resembles the plan offered by Representative Paul Ryan and Democratic senator Ron Wyden — would drive up costs on seniors by hundreds of dollars per month. Conveniently, the Kaiser release provides helpful state-by-state numbers so reporters can pull out premium-hike estimates in critical swing states.

There are three problems with the study. First, it doesn’t analyze anything close to the Ryan-Wyden plan. Second, its methodology is biased against the benefits of competition and consumer choice. And, third, if there were any conclusion to be drawn from the data used to produce the study, it’s that Representative Ryan has been right all along in saying that private plans have the capacity to dramatically reduce costs for Medicare — without shifting costs onto any seniors… [U]nder Ryan-Wyden, future enrollees into the program — those who have not yet enrolled in any Medicare option — would be guaranteed at least two options that would cost no more than what current Medicare would require. So, under Ryan-Wyden, no senior — present or in the future — would ever have to pay more than they do today for Medicare. Period…According to the data used by Kaiser, private plans can in fact deliver the guaranteed Medicare benefit package at lower cost than Medicare FFS in large portions of the country

James Capretta at the National Review Online.

Why Parasites May be Good for You

Your great-grandparents faced infectious diseases that hardly threaten you today: tuberculosis, polio, cholera, malaria, yellow fever, measles, mumps, rubella, smallpox, typhoid, typhus, tapeworm, hookworm…But there’s also a long list of modern illnesses that your great-grandparents barely knew: asthma, eczema, hay fever, food allergies, Crohn’s disease, diabetes, multiple sclerosis, rheumatoid arthritis. The coincidence of the rise in these “inflammation” diseases, characterized by an overactive immune system, with the decline of infection is almost certainly not a coincidence.

Matt Ridley in the WSJ.