Violence and Public Health

This year I have written several times about violence and its impact on the public’s health, and last week I shared our N.H. physician survey results indicating that addressing gun violence was a priority for many of you.

We asked, you spoke!

"We live on an island surrounded by a sea of ignorance. As our island of knowledge grows, so does the shore of our ignorance." - John Archibald Wheeler, eminent American theoretical physicist

Earlier this year, NHMS conducted a survey to learn more about you, what is important to you, and what you think should be priorities for NHMS. We had a great response and learned the following:

Choice of Physician or Network?

My last two posts dealt with the new Health Insurance Exchange, or “Marketplace,” which opened yesterday, and I talked about some of the concerns with the limited options and a limited provider network. What will be the impact for 2014 for our patients and costs? I heard from several of you with your ideas and concerns and thought I would share them with you today.

 

Slower Growth in Healthcare Spending and Lower Insurance Rates on the Exchange

I was struck by two articles this week about healthcare expenditures and costs. The first, in this week’s Health Affairs, details the various trends and components for measuring our nation’s healthcare expenditures. The authors attribute the slower growth to several factors, including the sluggish economy and greater out-of-pocket expenses for those covered by commercial insurers. The growth in national health spending was 3.9% in 2012 and an estimate of less than 4% in 2013.

New Hampshire's Limited Network......

This week I’d like us to consider the new Health Insurance Marketplace in New Hampshire. You may have heard that only one insurer decided to participate and so, for now, the marketplace is limited in carriers and the one carrier has a limited network. Anthem will have 11 lines and will release details of the plans later this week, sharing representative examples of the rates people will pay.

Recognizing When Thanks are Due

  * Second Contoocook bartender diagnosed with hepatitis A"  Concord Monitor 8/31/2013

We Need to Do Better

Last week New Hampshire lost two young university women to suspected Ecstasy or MDMA overdoses.  We offer our deepest sympathies to the families and friends of these women.  Such tragedies highlight the problems we face of drug use and addiction in New Hampshire and serve as a call to action to do all we can to prevent the physical and emotional harm that result from substance use and abuse.

50 Years Ago Today

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” -- Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966

Fifty years ago today, nearly 250,000 people joined together in the March on Washington for Jobs and Freedom, calling for human, civil and economic rights for African Americans.  This march has been heralded as one of the greatest political rallies in our nation’s history and is widely credited for helping pass the Civil Rights Act of 1964 and the Voting Rights Act of 1965 (which has now recently come under attack).

Overdiagnosed? The wrong prescription?

I recently saw a patient who came to me looking for an antidepressant. She explained that she is under a great deal of stress at home and work. We talked about the impact of the stress on her ability to function, sleep and participate in enjoyable activities. I asked her about suicidal ideation and administered a standardized, evidence-based, depression screening tool, the PHQ-9 (Physician Health Questionnaire 9. (You can download it here)

Medicaid Expansion Part 2: Understanding the Health Insurance Premium Payment Program

Two weeks ago I wrote about the work that I am doing on the Medicaid Expansion Study Commission and mentioned the Health Insurance Premium Payment Program, or HIPP Program. Since I received a number of emails from you asking for more information about the program and what role it may play in Medicaid expansion, I am writing about it today.

The Medicaid expansion population includes adults with or without children who make 0-138% of the federal poverty level (FPL), meaning individuals who earn less than $15,500 annually. Many people in the expansion population work in low-paying jobs, often doing seasonal work or in the hospitality industry. Currently, only parents who make less than 54% of FPL (earning less than $6,300 annually) are eligible for Medicaid. So, childless adults and parents making more than 54% of FPL define the expansion population.

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