Health care

Yoga and meditation offer health care savings—and you can do them at home

Marlynn Wei, MD, JD
Marlynn Wei, MD, JD, Contributing Editor

Results from a recent study show that people enrolled in a mind-body relaxation program (that included yoga, meditation, mindfulness, and cognitive behavioral skills) used 43% fewer medical services than they did the previous year, saving on average $2,360 per person in emergency room visits alone. But you don’t need to participate in a formal program to reap the many benefits of these practices. Many of them can be learned and practiced at home.

Compassionate veteran care: Embracing respect for the individual

Sigmund Hough, PhD, ABPP/rp
Sigmund Hough, PhD, ABPP/rp, Contributing Editor

The need to support injured soldiers dates back to our country’s earliest days. That mission remains essential today. Those who may be eligible for VA benefits and services — veterans and their family or survivors — make up a quarter of the United States’ population. Individuals seeking care through the Department of Veterans Affairs deserve a thoughtful and compassionate evaluation to not only compensate them for their service, but connect them with the care they need.

A checkup for the checkup: Do you really need a yearly physical?

Amy Ship, MD
Amy Ship, MD, Contributing Editor

Many people believe the annual physical is the cornerstone of preventive care and crucial to staying healthy. While it can be comforting to have your doctor check you over once a year, research suggests that a yearly checkup doesn’t actually help people stay healthier or live longer. But a shift away from regular exams doesn’t have to weaken your relationship with your doctor or leave gaps in preventive care. A shift in how primary care doctors take care of patients, and in how patients interact with their physicians, can keep the benefits of the annual checkup intact in other ways.

Doctor-rating websites offer helpful but limited advice

Julie Corliss
Julie Corliss, Executive Editor, Harvard Heart Letter

Websites that rate doctors and their practices can offer valuable information, but it’s often incomplete. Narrative reviews, in which patients describe in their own words their experiences with clinicians, are usually the most helpful — but could be even more so if they were collected in a standardized format. What’s more, only 40% of doctor-rating sites list information on how well a provider performs in terms of offering timely appointments and following guidelines for preventive screening tests. If you’re looking for a new clinician, it may be most helpful to ask trusted friends and family members for recommendations.

Report proposes new “vital signs” to measure the nation’s health

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Doctors use vital signs as a relatively straightforward way to detect an illness or monitor a person’s health. Key ones include blood pressure, body temperature, breathing rate, and heart rate. A report from the newly christened National Academy of Medicine (formerly the Institute of Medicine) proposes using 15 “vital signs” to track how health care in the United States measures up. These include life expectancy, well-being, access to care, patient safety, evidence-based care, and others. Why bother creating such a list? Health care costs in the U.S. are the highest in the world, yet people in many countries that spend less on health care are in better health overall and have better health care outcomes. In order to improve the performance of health care, we need to measure how it is doing in a logical, sustainable way. These vital signs will help us answer questions about what we are doing well and where we must improve.

Everywhere, hospitals are merging — but why should you care?

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

Hospitals across America are merging. In 2014 alone, there were 95 mergers, acquisitions, and joint ventures among U.S. hospitals, down only slightly from 98 in 2013. What is fueling this trend toward hospital consolidation — and why should you, as a consumer of health care, be concerned about it? Hospital administrators who create the mergers believe that hospital consolidation improves efficiency, access to care, and quality of care, and may lower costs. In contrast to hospital administrators, many health economists are wary about the growing number of these mergers. When individual hospitals merge into larger systems, they gain a larger share of the consumer health market. That puts them in a position to ask health insurance companies to pay more for medical care and procedures. These higher prices are not borne by the insurers, but by consumers in the form of greater premiums. Thus, some economists argue, mergers drive up health care costs and place added financial pressure on consumers.

Precision medicine is coming, but not anytime soon

Beverly Merz
Beverly Merz, Executive Editor, Harvard Women's Health Watch

President Obama’s announcement of a Precision Medicine Initiative was one of the few items in this year’s State of the Union address to garner bipartisan support. And for good reason. Precision medicine, also known as personalized medicine, offers the promise of health care based on your unique DNA profile and the profiles of a million other individuals. Getting to precision care will require new diagnostic tests. It will also need a new regulatory framework to make sure that technologies aren’t launched before they’ve been proven to be safe and effective, according to a Perspective article in The New England Journal of Medicine. It may take a few years to design this new vetting system and put it in place. In other words, precision medicine is on the horizon, but it isn’t around the corner.

Will the Supreme Court send Obamacare into a death spiral?

Gregory Curfman, MD
Gregory Curfman, MD, Editor in Chief, Harvard Health Publications

The Supreme Court heard arguments this morning in a case that could threaten the viability of the Affordable Care Act, President Obama’s signature health care law. The law, also known as Obamacare, survived a previous Supreme Court challenge in 2012. But this new case, called King vs. Burwell, has many people worried, and rightfully so. At issue in the case are the financial subsidies provided to millions of Americans to buy health insurance through the insurance marketplaces, called exchanges. Without these subsidies, many people of lower income would not be able to afford coverage. Stopping these subsidies would put a big dent in the “affordable” part of the law’s name. The plaintiffs argue that the Affordable Care Act allows for subsidies to be provided when insurance is purchased on exchanges “established by the State” (there are 17 of these), but not on the exchange established by the federal government for the other states. The outcome of the case may hinge on how the justices interpret those four words in the health law.

Better use of medicines could save billions

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

Wiser use of prescription medications by everyone—doctors and their patients—could save the U.S. health care system more than $200 billion a year. That’s the conclusion of a new report, Avoidable Costs in U.S. Healthcare, from the IMS Institute for Healthcare Informatics. Inefficient or ineffective use of medications lead to six million hospitalizations, four million trips to the emergency room and 78 million visits to doctors and other care providers each year, according to the report. Those are huge numbers. Although $213 billion represents less than 8% of what Americans spend on health care each year, it’s still a staggering sum. It also exacts human costs that aren’t reflected in the estimates. The report identifies 6 things that can be improved to address the problem: 1) not taking medications as directed, 2) taking too many medications, 3) delayed treatment, 4) overuse of antibiotics, 5) medication errors, and 6) underuse of generic medications.

Cities can learn lessons about diabetes from rural areas

Daniel DeNoon
Daniel DeNoon, Executive Editor, Harvard Heart Letter

City dwellers often think of rural America as a throwback to past “good old days.” But when it comes to obesity and diabetes, people living outside urban areas offer a frightening glimpse of the future. While more than 8% of Americans now have diabetes, in some rural counties 20% of the residents have diabetes. Those counties also tend to have high rates of obesity. Barriers to healthy living contribute to both obesity and diabetes. So does lack of primary care physicians. One answer may be greater reliance on community health workers—lay people trained to provide diabetes education and outreach. In Birmingham, Alabama, the Cities for Life program has doctors refer people with diabetes to “patient navigators” who help them find local resources such as nearby exercise classes or mobile farmers’ markets.