Category Archives: healthcare

Are you happier than a Santa Monica resident?

Flickr user João André O. Dias
Flickr user João André O. Dias

Santa Monica, Calif., on Monday unveiled an index of its residents’ well-being. Cue the California jokes.

But look again. Researchers spent a year and used a $1 million grant that the city  won from Bloomberg Philanthropies in its initial Mayors Challenge competition. Santa Monica’s index uses dozens of measures ranging from produce consumption to library card ownership to feelings of safety.

An explosion of social statistics has spawned city, state and national rankings, many not worth the time it takes to click through the photo gallery. They’re often a mess of inappropriate or incomplete data sliced down to a top 10 list.

But serious efforts to improve social yardsticks have been developing for years.  A growing body of research shows that cities where people feel happier have better economic gains. So an accurate measurement that focuses more on people and less on economic measures like gross domestic product,  is the Holy Grail.

The first United Nations Human Development Index was published in 1990. The playfully named Happy Planet Index made its debut in 2006. The U.S.-based Social Science Research Council published the first American Human Development Index in 2008.

And just this month, Gallup and Healthways published the latest version of their polling-driven well-being rankings of large U.S. cities and the UN-affiliated Sustainable Nations Development Network published its third World Happiness Report.

Most share a focus on how well people live, as measured by health, education and living standard data.

Santa Monica’s index goes farther. It includes outlook — how people feel — and a measure of the environment, both natural and man-made. Findings:

  • 70% report being happy all or most of the time; only 5% report being sad all or most of the time.
  • Older age groups score higher overall than young ones, whites and Asians higher than Hispanic and blacks.
  • On survey statements like “I am free to decide for myself how to live my life,” and “Most days I get a sense of accomplishment from what I do,” 70% to 80% of residents agreed, matching levels seen on similar surveys in Europe.

Many U.S. communities have assessed themselves at least once through a set of indicators. Few have used them to drive government policy, foundation funding or measure change with regular updates.

With its beautiful location, mild climate and strong economy, Santa Monica would seem to have few worries.

But the report uncovered weaknesses. A fifth of residents worry about paying their rent or mortgage, an affordability concern driven by high housing prices. That concern is higher among minorities and the young.

Residents score below the U.S. average in feeling they can count on the people around or in their ability to change local conditions.

The report authors suggested that the city try to strengthen civic engagement by leveraging its outdoor spaces and facilities.

Self-assessment,  change and reassessment — not list rankings — represent the real potential of well-being indexes.

–Paul Overberg

 

 

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Why cancer costs more at 11 hospitals

Medicare could save as much as a half billion dollars annually if it reimbursed 11 cancer centers the way all others are paid, according to a report released last week.

The average teaching hospital treating a Medicare cancer patient for a week-long inpatient stay gets about $14,500. But 11 cancer specialty centers get more than $20,500.

How did it get this way? In 1983, Congress created a loophole for the centers, which argued that their care is so complex and their patients so ill that they would lose money if they were paid under Medicare’s bundled payments. So the 11 centers are paid for actual costs — which means there’s little motivation to keep costs down, the Government Accountability Office report says.

Ten of those hospitals – which include Dana-Farber Cancer Institute in Boston and Memorial Sloan Kettering Cancer Center in New York – were forced to ‘rebalance’ in 2007, but retained 42% higher payouts, according to the GAO report.

But Seattle Cancer Care Alliance stands out. It was not required to rebalance, so its potential billing target –- the amount Medicare would pay if the hospital proves treatment costs that much — is nearly $135,000, or more than five times that of the other specialty centers. Payment figures show its 20-bed inpatient unit received $60,000 for every patient discharged — more than double any of the other centers.

Seattle Cancer Care Alliance
Dr. Oliver Press, left, examines a three-time transplant patient as Dr. Corey Casper, right, looks on with three Ugandan visiting physicians at the Seattle Cancer Care Alliance.

Seattle’s Alliance only treats bone marrow transplant patients at the small inpatient facility, communications director Holly Rosenfeld says. Other cancer patients are all seen at outpatient clinics or at University of Washington’s hospital.

Is the high-cost care worth it? GAO investigators found that the severity of illness, length of patient stay and complexity of cases barely differed between the 11 special cancer centers and other hospitals that treat cancer patients each year. Better technology and medications, along with some changes to Medicare funding to account for difficult cases, have leveled the playing field, the report concluded.

The Alliance of Dedicated Cancer Centers, which represents the 11 facilities, says the hospitals have  a five-year survival rate 17% higher than others. The group says the GAO’s recommendations would be “catastrophic,” costing its members 33 cents on every dollar spent on patients.

The organization said any changes to Medicare funding should be carefully considered. While a half-billion dollars in savings sounds like a lot, it’s a small fraction of what Medicare spends on cancer. According to the American Cancer Society, in 2011, almost 10 percent of  Medicare fee-for-service spending went toward cancer services and drugs. The total cost? $34.4 billion.

–Meghan Hoyer

The measles outbreak showed us how little we know

As the Disneyland measles outbreak spread across the country, reporter Steve Reilly and I started looking for national school-level vaccination data to show pockets of where young children might be most vulnerable.

We couldn’t find it. And neither can the government agency tasked with controlling epidemics.

“It’s incredibly frustrating,” says Anne Schuchat, director of the National Center for Immunization and Respiratory Disease at the Centers for Disease Control and Prevention. Although the CDC offers guidelines, it can’t control how state health departments do the work — and strained budgets, staffing shortfalls and indifference means each state collects and reports the numbers differently.

Schuchat told a National Press Foundation panel last month that although data collection is improving, each year the CDC comes to the same conclusion: overall, it’s still pretty lousy.

“Diseases spread at the local level, not at the national or state level,” she says. “The reality is happening neighborhood to neighborhood.”

So what would happen in a disease outbreak more serious than measles? Hard to tell when so many states don’t provide the numbers. Only 13 states collect and report the data along CDC guidelines.

Steve and I contacted officials in each state to get their data. To date, we’ve collected vaccination rates from nearly 45,000 schools in 28 states. We anticipate we’ll get a few more, but we’ll fall far short of a 50-state look at vaccination.

For parents who want to know, California is the best at data collection, capturing figures for each school – broken out by specific vaccine and exemptions – and posts it all online.

Utah collects that same data, but only provides it with a FOIA request. In South Carolina, officials could provide only exemption rates – no word on what vaccines a kid had received. From Nevada we received a sample of the vaccination levels of 3% of the state’s kindergartners, collected from 50 random schools.

And that was in the states that admitted they even had the data. Indiana officials said they didn’t collect it. Ohio officials said it didn’t exist, and when we showed them the web form they use to collect it from each school, they stopped responding to us. People in Maine said they reported the numbers to the CDC and then destroyed the data — even though the whole purpose of collecting it is so the state can identify at-risk communities.

In Hawaii, the Department of Health said residents might get angry at schools if they knew the vaccination rates at some of them, and said that was reason to withhold the numbers.

But there’s some hope for the future. Iowa health officials said USA TODAY’s  efforts convinced them there was public interest in vaccination levels; they plan to publish the school data on their website annually from now on. And Schuchat said with renewed research and media interest this year, the CDC is leaning harder on states to fall in line to collect and report out their numbers.

“We’ve been stressing with the states the need to gather this data in a consistent way,” she says. “It’s of increasing priority to us – we’re pushing it more now.”

–Meghan Hoyer