Talking About Health; Why Health Communication Matters

Public Health and Health Insurance as a Public Good: Part 3

October 30, 2013

While the media has given a lot of coverage to citizens complaining about having to pay for health insurance for pregnancy when they are men or have wives past child-bearing age/interest, or for pediatric care, or birth control–the story being lost is the one about health insurance as a public good. If all citizens have access to a certain level of care, then all citizens should achieve a certain level of health, and that should be good for all of us, the public good associated with health insurance and the public’s health.

Of course, we hear these arguments in other contexts. There are people who don’t have children who don’t want to pay for public schools. People who don’t use the interstate system not wanting to pay for maintenance of the interstate system. So it seems to be a very old tune, but the words for the new verse haven’t been rehearsed very well. Without telling more about how sharing the cost of paying for a level of health care aims to benefit all of us, complaints get heard and the argument for the ACA gets lost.

Likely, over time, debates will unfold as data collects to support or fail to support ACA’s benefits for society. Will we improve on some of the major health indicators, such as infant mortality rate–with the U.S. ranking 30th on a recent list [http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/]. That is the hope. It will likely take some discussion and some effort to work toward achieving such aims. And some revision of the ACA. A foundation of understanding related to its purpose is a good place to start.

Public Health in the U.S., Public Good, and the Affordable Care Act: Part II

October 20, 2013

Most of us learn at a very young age what “medical doctor” means. Far fewer of us learn what “public health” means. Our nation’s public health system functions largely as a backdrop to promote the well-being of all of us in the U.S. As a member of the Institute of Medicine–IOM–committee that wrote the report, “Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century,” [http://www.iom.edu/Reports/2002/Who-Will-Keep-the-Public-Healthy-Educating-Public-Health-Professionals-for-the-21st-Century.aspx] this reality emerged time and again, as we discussed and debated the roles that the public health force play.

I often teach Korean and Chinese graduate students who look to the U.S. for a model for public health and how to organize and deliver it in their countries where policies are newer and emerging.We tend to take for granted that someone has inspected the safety and health of restaurants where we eat, the meat and produce that we buy to consume, and the water quality coming into our work sites and homes. These “luxuries” sometimes become more salient when we visit outside the boundaries of the U.S. In reality, these illustrate ways that our health is being safeguarded, not only for our individual well-being but for the health of all of us–with inoculations required for public school one of the most recognized acts taken for this aim.

The public good is served when actions are taken to protect and promote the health of each one of us as individuals in order to reduce the likelihood that any one of us will contribute to the illness of others and/or incur costs linked to the poor health of others. This principle frames some of the actions taken as part of the Affordable Care Act but has not been emphasized or clearly explained.

Social Justice, Workers and Congress, and the Affordable Care Act: Part 4

September 30, 2013

It didn’t take long for efforts associated with covering costs associated with worker’s health care to become burdensome. In 1927, the Congressional Committee on Costs of Medical Care proposed Health Maintenance Organizations [HMOs] as a strategy aimed at providing affordable health care to all citizens. A minority report written by doctors and adopted by the American Medical Association, however, took the position that HMOs would hurt the quality of health care. As a result, the Committee’s recommendation was not seriously considered.

Congress initiated a program for its own health care in 1928. In response to a number of elected lawmakers collapsing and even dying while on duty that year, Congress asked the Navy to provide a physician for the Capitol. The Office of the Attending Physician provides some basic care to members at a cost of about $500 a year, the same rate that has been in place since 1992. The budget for the Office of the Attending Physician is more than $3 million [http://thomas.loc.gov/cgi-bin/cpquery/?&sid=cp113l8f0T&r_n=hr173.113&dbname=cp113&&sel=TOC_22349]. There are several Navy doctors providing the care, together with more than a dozen registered nurses. The budget also includes a pharmacist, an ambulance available at the steps of the Capitol building, plus first-aid stations that staff members may use, and the x-ray and lab equipment available for care. In addition, care for families of Congress comprises choices much like all of us must make [http://jeffduncan.house.gov/legislative-work/fact-or-fiction/fact-or-fiction-do-members-congress-get-free-health-care].

Social Justice, Workers, and the Affordable Care Act: Part 3

September 25, 2013

In the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury through no fault of their own. Work places were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation [see http://www.proquest.com/en-US/catalogs/collections/detail/American-Association-for-Labor-Legislation-38.shtml].

The AALL group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job.

Woodrow Wilson joined the AALL [http://www.ssa.gov/history/corningchap1.html]. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, the AALL published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it. As debate continued within the States, so did opposition to a proposal for government health insurance. AALL leaders assumed that such reform would be viewed as beneficial to all. The stage was set for health insurance to dominate conversations about health care.

Social Justice, Military, and Affordable Care Act: Part 2

September 20, 2013

Other early federal debates led to the provision of health care to the armed forces, naming the public good and satisfaction of economic aims to support the government’s role. It was argued that a healthy army and navy were necessary for national defense. The patchwork of care for the U.S. military covers decisions relating to those who serve, have served, and their families [see http://usmilitary.about.com/cs/healthcare/a/medicalcare_4.htm for a summary]. Lost in the conversation about the uninsured and the Affordable Care Act is the data about our nation’s veterans. They comprise a very large group of the uninsured. Here is the estimate from the Robert Wood Johnson Foundation: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/uninsured-veterans-and-family-members.html — 1.3 million veterans plus their families [about another 1 million] have no access to health care.

How does the Affordable Care Act affect military families? An analysis that includes comparisons between Tricare and ACA requirements appears at: http://www.militarytimes.com/article/20130926/BENEFITS06/309260025/Affordable-Care-Act-No-impact-Tricare-some-coverage-isn-t-equal. It appears that the ACA will require more coverage than Tricare offers in various instances.

As for veterans and their families, if their income levels fall within Medicaid guidelines, they may receive care through an ACA Medicaid-expansion option. That depends upon their State’s buy-in, however, so it remains unclear whether this group of hundreds of thousands will find a path to care or not.

Social Justice and the U.S. Affordable Care Act: Part 1

September 15, 2013

As President Obama took on the health care issue, his overall aim appeared to be to address access to health care for those who do not have it. This includes some of our most vulnerable citizens, ranging from children living in poverty to the elderly who lack the resources for care. This President, as others before him, sought to promote the dignity of citizens through the provision of health care and to exercise social justice in ways that represent ideals expressed in the Declaration of Independence—promoting “life, liberty, and the pursuit of happiness.”

The U.S. Constitution, which was adopted in 1787 as the supreme law of the newly formed national government for the thirteen states, does not endow Americans with a protected right to health care. This was a conclusion reached by the U.S. Supreme Court but one that finds itself at odds with other republics where a level of health and health care are explicitly guaranteed [see Poland, for example—p. 3 of http://www.ehma.org/files/Benefit_Report_Poland.pdf].

The reasons for an absence of reference to health and health care in the U.S. Constitution likely reflect both the desire to avoid government intervention—related to the very foundation leading to the formation of this nation–and the practical reality that medicine was in its infancy at that time. Thus, there was not much anyone, let alone government, could do to promote the health of individuals. Family comprised the primary unit of both social and economic life, and family assumed the role of caring for sick and injured members.

Very early on, these realities conflicted with the fact that merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled in the performance of their duties. Thus, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end. The health and well-being of individual seamen was not the argument used to support a role for government in providing health care. The need for a government role in health and health care resided in a focus on promoting commerce. Government efforts to provide health care, however, were squarely on the table, beginning a path toward where we are today.

The Affordable Care Act and part time employment

June 1, 2013

…thanks to Darci Slaten for this picture…

One of the most gifted undergraduate students I’ve had in a Penn State health communication classroom is crossing her fingers that she will get a job she has interviewed for. I am hopeful for her as well. An odd thing about the job is that it is for less than 30 hours a week. I also have a nephew who recently started a new job at a sandwich shop. He loves the work. And he too is being employed for less than 30 hours a week. Neither was looking for part time work. And it does make me wonder. Could it be the Affordable Care Act’s rule that companies with 50 or more employees be required to provide health insurance to employees–except if they work less than 30 hours a week.

I don’t know the answer to this question. I haven’t talked to my nephew’s employer and the question doesn’t fit into a conversation as a reference for a former student. I do wonder about risk data relating to part time employees and projecting the cost for health care.

State laws covering workmen compensation do cover part time employees. If my nephew is hurt on the job–let’s say, for example, cuts off the tip of his finger with a meat slicer or gets a hand caught under a heavy bread tray and breaks a finger–workmen’s compensation will require his employer to pay the medical costs related to the accident and cover wages for the time he cannot work. So, that is a relief. But what it won’t cover is time off or care for the flu or a bad cold.

Looking at the issue from a public health and public good perspective: Do we unintentionally incentivize ill workers to come to work when we adopt policies that won’t cover their care or give sick leave benefits? Do we pose other risks to the public besides exposure to ill workers when we move toward part time employment, risks associated with the experience one gains from being on a job full time, for example?

Clean Your Hands Campaign

February 19, 2013

The World Health Organization — WHO — has long promoted hand-washing as an important way to reduce the risk of spreading infections. While we all can reduce the risk by washing our hands, we may also assume that healthcare workers would be among the people most likely to practice hand-washing. Apparently not. A study designed to increase hand-washing among healthcare works cites evidence that compliance with the practice is just 25-40%. The article appears online in PLOS ONE [ a publication of PLOS [ http://www.plos.org/] an organization designed to make peer-reviewed medical research accessible in less time and with less cost than more traditional approaches to publishing scientific results. The research led by Chrsitopher Fuller, “The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers A stepped Wedge Cluster Randomised Trial”, conducted the study in 60 locations that included 16 acute hospitals and 44 general medical wards or acute elderly care sites. All sites were already participating in the “Clean Your Hands” campaign. This campaign includes placing alcohol hand-rub at patient bedsides, using posters and other educational materials to encourage workers to clean their hands. an audit and feedback on compliance was cinluded at least once every six months, so workers knew that the behavior is expected and would be evaluated. The FIT focused on goal-setting for and rewarding of handwashing behavior as an additional compoment to the national campaign.

A significant increase in hand-washing occurred with the FIT, with more change in the 16 intensive therapy units than in the other sites — achieving 13-18% change versus 10-13% change, ranging about 60% to nearly 80% compliance. The improvement declined over time. There were difficulties associated with implementing the protocol, including that the trial place extra responsibilities on some ward staff, who did not receive additional training beyond the initial introduction to the intervention and were not monitored after the initial observation of their placement of materials bedside. To increase the likelihood that such a campaign would be successful over time, the authors recommend that the tasks be integrated into the role of some employees and audited regularly as part of job performance. As for me, I will be watching to be sure healthcare workers wash their hands. And I will do the same.

Taking Healthcare Into Your Own Hands Guest Post by Bill Paquin

January 24, 2013

Debates about the federal health care overhaul aside, one truth has emerged from the recent national discussion about the health care and insurance industries. In the end, we are all responsible for our own individual health.

Now, that sounds obvious, but it’s not necessarily how we’ve lived for half-a-century, in a world where many peoples’ employers covered whatever malady might strike them. Without the financial stress of paying ‘a la carte’ for anything from stitches to a coronary stent, there was less pressure on the individual to take preventative action to protect their health. When an issue arose, you went to the doctor, and that was that.

With far fewer employers offering comprehensive health care, and those that are moving to high deductible plans that put the burden of paying for small accidents and illnesses back on the individual, personal health care has become much like other commodities, where shoppers find the best price and only purchase what they need.

Whether you’re self-employed or a full time employee living with a high deductible plan as your sole coverage, remember these guidelines to help you navigate the ever-changing system:

Get in Shape

If wanting to look and feel your best never motivated you to eat the right foods and exercise, perhaps saving big money at the doctor will. Obesity accounts for more health maladies than any other condition, from type II diabetes to heart problems. By keeping your weight in check, you’ll need fewer trips to the doctor. When you’re feeling great, your wallet will thank you.

Read the Fine Print of Your Insurance Plan

Every insurance plan is different, and finding out that a test or doctor’s visit isn’t covered after you’ve already gone can be an unexpected roadblock in our budget. Read your plan, understand the terminology, and ask questions about cumulative costs of any tests and procedures before agreeing to them. Of course, don’t forgo necessary care, but do seek out the best options and decide ahead of time, if possible, if you plan to reach your deductible or not.

Ask Questions About Cost

It’s somewhat engrained in our culture to follow ‘doctor’s orders.’ But if the doctor suggests a further test or procedure, don’t hesitate to ask about the costs. Oftentimes there may be an alternative that better fits your budget. [or the constraints of your insurance]

Use In-Network Doctors

Insurance providers typically have a network of ‘preferred’ providers, and finding a doctor within this list can mean significant savings. Also remember that you never have to stick with the first doctor you find — search around until you find a provider you relate to and trust. And if you’re starting from scratch, your provider’s network list is a good place to begin your search.

Keep Track of Your Health Expenditures

Although tax write-off eligibility for health care expenses may be slightly altered in 2013 at the national level, you’re still likely entitled to a tax break if you have significant health-related costs in your budget. Save every receipt and keep track of any expense that’s health related to report on your tax forms.

Start a Health Savings Account

People with a high-deductible health insurance plan are eligible to begin an HSA, which lets account holders deposit pre-tax dollars into a fund specifically for their own health care. This money can be used for doctor’s visits and procedures and count against your deductible, but can be written off of income taxes. Best of all, an HSA means you’ll already have money set aside when an emergency arises.

Research What Ails You

In the past, doctors have advised patients not to trust what they read online. Fortunately, reputable providers like the Mayo Clinic now offer comprehensive, accurate information about health issues and diseases on the internet. Understanding your symptoms and diagnoses is integral to making smart financial decisions about your own health care.

Choose Generic Medications

Doctors may prescribe a name brand medication . Most doctors, however, will be responsive to your inquiries about less expensive, generic alternatives. Of course, ensure that the drug you are prescribed is safe and effective, but oftentimes a generic medication may be exactly the same as the well-known name brand manufacturer.

When it comes to paying for care, individuals are more responsible than ever for their own health. Remember, the buck ultimately stops with you.

About the Author

As the CEO of Vertical Health, patient care advocate http://www.billpaquin.com Bill Paquin works to convey accurate health information to consumers. He operates web sites including http://www.diabeticlifestyle.com, http://www.endocrineweb.com and other sites focused on improving patient care associated with endocrine disorders. Bill is a husband and father, and writes about improving patient care in our healthcare system.

Health Communication, Health Literacy, and the Affordable Care Act

November 8, 2012

If you are like me, you imagine a time when you will be less ‘scheduled’. This has been a time of being over-scheduled in the past half dozen weeks. I have a pile of topics I want to discuss relating to communicating about health. And too little time to do so.

One of the topics that keeps coming through my piles relates to an article written by Stephen A. Sommers and Roopa Mahadevan that was commissioned by The Institute of Medicine–IOM–and published in October 2010. I came across it when preparing to talk about health literacy and health communication with my undergraduates last year. It has been shuffling about on my desk since then. Today is finally the day I will share my thoughts about it.

First, the relationship between health literacy and health communication that I discuss with my undergraduates in a ‘designing health messages’ course is two-fold. On the one hand, low levels of health literacy, meaning the audience is unlikely to understand many health and science terms or be able to use math and statistics to make decisions–suggests that health communicators, whether they are public health program planners or medical doctors, should adapt their communication so that it will be understood, and informed decisions can be made based on an accurate understanding. A great deal of health communication message design research and practices focuses on this effort, working to assure that knowledge gaps do not become wider between more and less educated audiences, for example.

The second issue related to health communication and health literacy relates to efforts to improve health literacy. In other words, how could we communicate to motivate someone with low levels of health literacy to become excited about learning more vocabulary and applying more statistics in making choices about health?

Addressing both health literacy issues in health communication is the ethical thing to do. Knowing that someone does not understand health vocabularies or may be embarrased to ask questions when they do not understand places a responsibility on the health communicator to adapt. Knowing that high levels of health illiteracy uniformly exist in the U.S. suggests that health communicators ought to be involved with improving the situation across the many contexts for talking about health.

Stephen A. Sommers and Roopa Mahadevan open their paper with the statement that the Affordable Health Care Act does not address low health literacy directly. BUT–they assert–the law cannot be successful unless national efforts strive to address low health literacy. Health literacy is mentioned in the ACA in relation to research dissemination, shared decision-making, medication labelings, and workforce development. “All four suggest the need to communicate effectively with consumers, patients, and communities in order to improve the access to and quality of health care” (p. 6).

So there we have it. If we are to achieve the aims associated with the ACA, including improving the population’s health and bringing health care costs under control, we will only achieve these aims through communication that adapts to and accommodates low levels of health literacy while motivating citizens to improve their health literacy.