Following the third straight year in which the Centers for Medicare and Medicaid Services estimated the growth in national health expenditures to be a record-low 3.9 percent, considerable speculation on the causes of slower spending growth has come from a variety of sources. There seems to be a consensus among actuaries, academics, and other analysts that the recession and the associated increase in unemployment and decline in insurance coverage led individuals to cut back on their use of health care services. (See here, here). But, while the recession is clearly associated with the dramatic slowdown in spending growth from 2007-2009, there is also evidence that the slowdown in spending preceded the recent recession and seems to be continuing during the modest economic recovery.

Observers of this more general trend have begun to suggest that fundamental structural changes in the health system are playing a role in recent spending trends. The ability of some high profile providers and health systems to achieve high quality outcomes with greater efficiency has garnered a lot of attention and some suggest that more salaried employment of physicians could be altering the practice patterns that developed under a fee-for-service system. Others have pointed to patient-centered medical homes, accountable care organizations, and other payment and delivery system reforms as potential contributors to the slowdown in spending growth. The Obama administration has also argued that the Affordable Care Act has started to have a moderating effect on spending growth.

The extent to which the economy versus broader systemic changes has been driving slower spending growth has enormous implications for forecasting future spending trends. If the economy has been the primary driver of recent trends, we should expect spending growth to return to historically high levels as the economy recovers. The Congressional Budget Office (CBO) and the CMS actuaries have revised their Medicare and Medicaid forecasts downward to reflect the latest trends, but both entities seem to suggest that spending growth over the long term will return to historical levels. If, however, more structural changes are at work, then perhaps there is reason to be hopeful that health care spending growth will continue at a rate much closer to the rate of growth in the economy.

Read the complete post here.

One of the many roles of public health is to protect consumers from threats like foodborne outbreaks. Much of this hinges on quickly getting out clear messages to the public that provide simple steps to help stem the spread of disease. This is something public health professionals have been doing for over a hundred years, but a recent outbreak of Salmonella Heidelberg got us wondering, “Are we doing enough to keep the public safe? Are we too slow? And, How can we improve?”

That’s not to say there weren’t triumphs in this outbreak, but like most responses we had a moment of self-reflection when the crisis was over and we were able to take a step back and consider our methods. What we found was a need for stronger policies and faster messaging to the public.

Between June 2012 and January 2013 epidemiologists with Oregon Public Health, along with the Washington State Department of Health, CDC, and the US Department of Agriculture independent of each other, began noting increases in the number of Salmonella infections. Thanks to surveillance systems like CDC’s Pulsenet and National Retail Monitoring System (NARMS), epidemiologists were able to narrow down the specific genetic make-up of the Salmonella in question (Salmonella Heidelberg) and link it to raw or undercooked Foster Farms brand chicken.

Read the complete blog post here.

Last month, a series of Commonwealth Fund–supported articles in Health Affairs brought to light international efforts to achieve better health care at lower costs. In a new blog post, Commonwealth president David Blumenthal, M.D., and vice president Robin Osborn, director of the International Practice and Innovations program, discuss the findings and explain why cross-national studies of fundamental health care issues are so important: they show where the U.S., and other countries, can do better, as well as the high levels of performance that are possible.

The authors point out that the health system overhaul now under way in the U.S. is unique in its scope—and may offer lessons to our peer nations. Total U.S. health spending in 2011 was $2.7 trillion, an amount larger than the economies of all but four nations.

“The dramatic changes in our health care system are worth close observation,” Blumenthal and Osborn say. “Both drawing from and contributing to the body of international health policy research will be an important responsibility for health services researchers and policymakers going forward.”

With this context, I was unsettled to read headlines last week informing me of the “new” G8 opinion that “Rape must be outlawed as a weapon of war.”  I thought to myself, “Surely rape perpetrated as a weapon of war is already outlawed…” Upon researching, I found that despite the recent flurry of activity surrounding the subject, wartime rape IS already a criminal offense under the Geneva Conventions. It’s just that the world has just been looking the other way as the offenses pile up, with little political will at the highest level  to prevent or prosecute the pandemic of sexual violence committed during, or as a strategy of, war.

The Geneva Conventions, first established in 1949, mandate the humane treatment of individuals during conflict worldwide, with different protections for combatants than for civilians. The Conventions also enumerate specially “protected persons,” including women. New projects like Women Under Siege are documenting the chronic failure of the Conventions to protect women and girls (and civilian men and boys) from sexual violence during past and current conflicts, from the Holocaust to modern-day Libya.

In the face of mounting evidence of the perpetrators of wartime rape continuing with impunity, UK Foreign Secretary William Hague has been outspoken in his call for G8 leaders to take action, creating the Preventing Sexual Violence in Conflict initiative. With Hague’s leadership, the G8 decided on a new resolution:

“ …obliges its member states to develop a comprehensive protocol for investigations, and says amnesties for sexual violence must be excluded from all peace agreements. It promises to review the training provided to national armies, police forces and peacekeepers to ensure that those deployed to war zones can respond adequately, and supports the employment of international experts to help build judicial capacities in countries that request help. The declaration also calls for enhanced support for the victims of rape and the inclusion of women in peace negotiations.”

To support these policy changes, the G8 nations have also pledged an additional $36 million in funding.

Sexual violence at any time is unacceptable, and this new resolution from the G8 addresses the widespread recognition that women, girls, men and boys are especially vulnerable during periods of conflict. The G8’s recent efforts will not be sufficient to end sexual violence in conflict, but are a necessary and welcome steps towards the Millenium Development Goals to protect women and children’s health and promote gender equality worldwide.

To learn more, visit the Taubman Health Science Library’s Sexual & Reproductive Health research guide.

According to a Centers for Disease Control and Prevention report, chronic diseases are responsible for 70% of deaths in America each year, and 75% of the nation’s health care spending focuses on chronic conditions. Using patient-reported data to help manage chronic disease care and reduce costs is a strategy that many health care providers are now exploring.

The featured Innovations describe a tool that uses self-reports from patients with diabetes to generate intervention options, a self-assessment for patients with mental illness that improves communication with providers, and a smartphone application that allows patients with Crohn’s disease to track health information and share it with providers.

The featured QualityTools include a pre-visit questionnaire for asthma patients, a quality-of-life assessment for diabetes patients, and a tool to help patients track and monitor their blood pressure, cholesterol, blood glucose, diet, and physical activity.

For more information, visit AHRQ’s Innovations Exchange.

The April issue of Health Communication Science Digest (HCSD or Digest) is now available at http://www.cdc.gov/healthcommunication/ScienceDigest/index.html

This month in the Digest are discussions of several new ideas and methodologies scholars are generating to better evaluate social media user-generated content and metrics. Other works examine user behaviors and responses to new media channels (e.g., online communities, video games). Health communication messaging is the focus of several studies. Theaccuracy and credibility of health content via media outlets is also analyzed. You will find studies of the efficacy of written health information and others exploring intercultural differences in health message and health literacy responses.

Health plans participating in Medicare Advantage (MA), the private insurance option for Medicare beneficiaries, have long been paid considerably more to provide coverage of hospital and physician services than what the government spends to deliver the same benefits to enrollees in traditional Medicare.

Under the Affordable Care Act, overpayments to these plans are gradually being pared back. But will private plans be able to cope with the reduced payments?

Using newly available government data, Marsha Gold, a senior fellow with Mathematica Policy Research, found that risk-adjusted MA plan costs in 2009 were, on average, 4 percent higher than those for traditional Medicare. Among plan types, only health maintenance organizations (HMOs) had lower average costs, while costs for more than 75 percent of local preferred provider organizations (PPOs) and private fee-for service plans exceeded traditional Medicare’s. According to Gold, the wide variation in MA plan costs relative to traditional Medicare suggests there is room for many of these plans to deliver care more efficiently and keeps costs down.

Visit commonwealthfund.org to read more.

A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.

In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.

Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely.

The data for 3,300 hospitals, released by the federal Center for Medicare and Medicaid Services, shows wide variations not only regionally but among hospitals in the same area or city.

Government officials said that some of the variation might reflect the fact that some patients were sicker or required longer hospitalization.

Nonetheless, the data is likely to intensify a long debate over the methods that hospitals use to determine their charges.

Read the complete story here.