While the quest to reform healthcare and promote affordable medical care steadily moves forward on Capitol Hill, a gap remains on how healthy Americans actually are—and how healthy they could be in the future. By failing to take proven steps to promote better health throughout communities—including discouraging smoking and promoting healthy foods and physical activity—children today face having sicker, shorter lives than their parents, according to recommendations released Thursday by a panel of healthcare experts.
A new definition of health reform is needed that addresses people's daily lives, said Mark McClellan, MD, PhD, co-chair of the Commission to Build a Healthier America that was launched by the Robert Wood Johnson Foundation just over a year ago. "The evidence is clear that how we live, learn, work and play has a much greater influence over how well and how long we live than our healthcare."
"It's time to take a wider view of what we need to do to improve our health," added McClellan, the former administrator of the Centers for Medicare and Medicaid Services and the Food and Drug Administration, who is now director of the Engelberg Center for Healthcare Reform at the Brookings Institution, Washington.
The commission called for individuals to take more responsibility for their health choices. But, it also recognized that many individuals face obstacles in making healthy choices outside the healthcare system. For instance, the lack of grocery stores in various lower-income communities may hinder attempts to include more fresh fruits and vegetables in daily diets.
To help break through these barriers, the commission called for initiatives that promote a "national culture of health"—especially among children. They include:
Banning junk food from schools.
Getting children to be physically active at least an hour every day.
Designing public programs that support the needs of hungry families for nutritious foods.
Eliminating smoking and promoting a smoke-free nation.
Giving children, especially those from low-income families, a healthy start by ensuring that they have high-quality education and child care.
Commission member Gail Warden, MD, president emeritus of the Henry Ford Health System in Detroit, suggested that emphasis needs to be placed on creating sophisticated school-based health programs in which "all aspects of the mental and physical needs of individual students are taken into consideration."
These programs should "put great emphasis on wellness and prevention" and "educate [children and parents] about their own personal responsibilities about their health," he said. A recent example of these programs involve getting childhood immmunizations that have received high compliance rates nationwide.
The full report, "Beyond Healthcare: New Directions for a Healthier America," which includes examples of community programs successfully addressing various health issues, is available at the Commission's website (www.commissiononhealth.org).
Minnesota-based Fairview Health Services suffered a net loss of $114 million in 2008, largely because of investment losses and higher interest rates on debt, according to unaudited numbers. Even without investment losses, the chain of hospitals and clinics had a tough year because of fewer inpatient visits and more unpaid medical bills. Net operating income was $20.8 million, down 57% from 2007. That translated to an operating margin of just 0.8%, compared with 2.1% in 2007.
The economic downturn has put a Band-Aid on one of the most vexing problems in healthcare: a shortage of nurses that has slowed care at some hospitals and forced others to turn away the ill. With some nurses postponing retirement and others resuming their careers for financial reasons, many hospitals across the region and the nation say they have few, if any, openings. After more than a decade when hospitals struggled to maintain sufficient staffing, the want ads have virtually disappeared, and only acute-care and emergency-room nurses remain in great demand.
New York-Presbyterian Hospital, whose centers and clinics provide about 20% of the healthcare in New York, is the first large institution to move beyond the pilot stage this week as it begins to offer consumer-controlled health records for patients. New York-Presbyterian has been working with Microsoft for more than a year, not only on technical matters but also ease-of-use concerns with patients. The introduction will be gradual, beginning with heart patients, who will be told of the potential benefits of personal health records when they visit a NewYork-Presbyterian hospital or outpatient clinics.
The government is expected to set in stone the 2010 rates it will pay health insurers to run private Medicare plans. Most signs suggest that cuts are coming in the subsidies that the industry got during the Bush administration. Stocks of health insurers were sucked into a surprise tailspin in February after Medicare officials signaled they planned an effective 5% cut in those payments after formula adjustments. Insurers, medical societies and others have had six weeks to give regulators their arguments before the payment rates become final for next year.
New Jersey Gov. Jon Corzine's budget calls for limiting new adult enrollment in a popular state health insurance program, reversing course on a healthcare expansion he signed into law just nine months ago. The change would backtrack on part of an initiative that some hailed in July as the first step toward universal health coverage in New Jersey. It would also save $9.7 million on a program whose costs have ballooned, just as state revenues deflated.