Between 12,000 and 20,000 patients might need to look for a new doctor after Jan. 1 if health insurer United Healthcare and a group of practices affiliated the Unified Women's Health of NC banner can't reach a contract agreement. Piecing together exactly where negotiations broke down is difficult and neither the insurer nor the practice administrators will give specifics on negotiations. United, the insurer, says Unified is seeking a 20 percent increase in reimbursements. In response, Unified claims its proposal would actually cost the patients less. If the two sides can't reach an agreement, 13 practices would be impacted for a total of 20,000 patients, of which about 12,000 have been seen by a Unified physician recently.
In American medicine today, "variation" has become a dirty word. Variation in the treatment of a medical condition is associated with wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from asthma to diabetes, from urinary incontinence to gout. At some level, this makes sense. Some types of variation are unwarranted, even deadly. For example, we know that ACE inhibitor drugs improve quality of life and survival in heart-failure patients, but only two-thirds of American physicians prescribe these drugs to such patients.
Healthcare organizations must tighten security or risk getting breached, penalized, and potentially ostracized by a public fed up with seeming carelessness with their personal information. Unfortunately, the task of securing protected health information (PHI) is only becoming more challenging for even the best-prepared organizations. Fitness bands, hospital portals, electronic health records, health information exchanges, insurance networks -- the list of Internet-connected devices, tools, and sites containing personal and medical data keeps growing. The healthcare sector has been under attack for some time. In 2014, despite headlines dominated by JPMorgan Chase, Home Depot, and other retail or financial entities, the healthcare industry accounted for 43% of all major breaches, according to the Ponemon Institute.
Every spring for the past three years, I have posed a question to the small group of first-year medical students who signed up for my Health and Human Rights course: "Who here has heard of the Universal Declaration of Human Rights?" It's an elective course, so the students are motivated. Of the 10 or 15 present, about three raise their hands. Then I ask the awkward follow-up: "Who has actually read it?" That is when all of the hands go down. Today, Dec. 10, is Human Rights Day. It marks the date, 66 years ago, when the United Nations adopted of the Universal Declaration of Human Rights.
In some ways, Americans today are healthier than they were in 1990, when the United Health Foundation first published America's Health Rankings, an annual state-by-state assessment of our nation's health. Cardiovascular and cancer deaths are down, and the smoking rate has decreased 36%. Plus, life expectancy is at an all-time high—78.7 years. "But although we're living longer, we're also living sicker, with preventable illness at an alarming level," says Reed Tuckson, MD, external senior medical advisor to United Health Foundation. The number-one reason: Obesity. "Since 1990, the obesity rate went from 11.6% to 29.4%, a 153% increase," Dr. Tuckson says. In the last year alone, it rose 7%. Physical inactivity is also at a new high: 23.5% of Americans do not exercise at all.
Maybe this is true in any battle; it is surely true of a war that is waged with bleach and a prayer. For decades, Ebola haunted rural African villages like some mythic monster that every few years rose to demand a human sacrifice and then returned to its cave. It reached the West only in nightmare form, a Hollywood horror that makes eyes bleed and organs dissolve and doctors despair because they have no cure. But 2014 is the year an outbreak turned into an epidemic, powered by the very progress that has paved roads and raised cities and lifted millions out of poverty. This time it reached crowded slums in Liberia, Guinea and Sierra Leone; it traveled to Nigeria and Mali, to Spain, Germany and the U.S.