Citizens' Council on Health Care
CCHC HEALTH eNEWS
Monday, October 15, 2001


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Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
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* RESEARCHERS CHAFF UNDER NEW RESTRICTIONS ON TISSUE ACCESS *

* PAVING THE WAY TO MIDDLE-AGED MEDICARE *

* FEDERALLY-FUNDED INSTITUTE PUSHES FOR UNIVERSAL COVERAGE *

* FEDS WANT TO DIRECT TRAINING DECISIONS OF MEDICAL STUDENTS *

* HEALTH CARE ACCESS AT MEXICAN BORDER TO BE STUDIED

* PATIENTS AND DOCTORS SUFFER UNDER NATIONAL HEALTH CARE

* HUMAN RIGHTS LAWS COULD PREVENT MEDICAL RESEARCH

* HEALTH DATA VULNERABLE TO CYBER ATTACKS

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* CCHC Commentary included
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RESEARCHERS CHAFF UNDER NEW RESTRICTIONS ON TISSUE ACCESS

The new federal medical privacy rule requires researchers
who use the nation's tissue banks to receive specific patient
consent prior to accessing patient-specific information, such
as medical histories. Researchers are concerned that "the
enormous archives of human-tissue samples in hospitals and
academic medical centers may be at risk."

The rule allows access to the data without consent if the
data is deidentified. It also allows access to patient-specific
data without a consent only if researchers take their request
to an Institutional Review Board, and the IRB agrees that the
importance of the research outweighs the minimal privacy risks.
But the access must be quantified and limited. Previously, a
standard consent form, filled out as part of the surgical
procedure, allowed access for research at any time.

Researchers say that this new requirement limits access to
a long-standing resource that like a library "you can't
predict what the specific uses may be in the future." They
expect less research to be done due to the cost of acquiring
consent or using the IRB process.

Some envision new entities to deal with the problems of
patient privacy barriers. Carol Pratt, a health care attorney
thinks data mining companies will become the "keepers of
the code." They will have the capacity to relink de-
identified information with the patient's name and other
identifying information. These companies, rather than
pharmaceutical and research firms, would be responsible for
protecting patient privacy.

Source: "New Federal Privacy Rules Stump Researchers:
Research using the nation's genetic tissue
banks may be challenged," Katherine Uraneck, MD, The
Scientist 15[18]: 33, September 17, 2001.

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CCHC Commentary: Human tissue is a rich sources of genetic
information. Consent should be required. While the rule, as
noted above, does allow IRBs to bypass the requirement for
patient consent,it does put an enormous administrative and
legal barrier to unmitigated access to patient-specific tissue
and genetic data. The Office of Civil Rights is responsible
for enforcing the rule. Note, however, that the privacy rule
allows the U.S. Department of Health and Human Services to
access the data at any time without patient consent or a search
warrant.

-Citizens' Council on Health Care
-October 15, 2001


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PAVING THE WAY TO MIDDLE-AGED MEDICARE

A new study published in the Oct. 11 issue of the New England
Journal of Medicine found that a lack of health insurance may
increase the risk of a decline in overall health for adults ages
51 to 61, Reuters/Contra Costa Times reports (Reuters/Contra Costa
Times, 10/10). In the study, researchers analyzed 7,577 files from
the Health and Retirement Study, a national survey of adults who were
aged 51 to 61 in 1992, to determine the risks of a decline in health
and the development of new physical problems, adjusting for
sociodemographic factors, preexisting medical conditions and
health-related behaviors such as smoking and alcohol use.
Study Finds Lack of Health Insurance May Increase Risk of Health
Decline for Late Middle-Aged Adults

Participants included 717 "continuously uninsured" adults who lacked
health coverage in both 1992 and 1994; 825 "intermittently uninsured"
adults who lacked health coverage in either 1992 or 1994; and 6,035
"continuously insured" adults who had health coverage in both years.
The study found that 21.6% of continuously uninsured participants
suffered a decline in health from 1992 to 1996, compared with only
8.3% of continuously insured participants. In addition, the study
found that 28.8% of continuously uninsured participants developed new
health problems, such as difficulty walking or climbing stairs,
compared with only 17.1% of continuously insured participants.

Researchers found that the "continuously uninsured participants were
63% more likely than the privately insured participants to have a
decline in their overall health" and "23% more likely to have a new
physical difficulty" (Baker et al., NEJM, 10/11). The rate of
uninsured adults ages 55 to 64 increased from 12.9% in 1998 to 16.1%
in 1999 (Reuters/Contra Costa Times, 10/10). According to
researchers, "Renewed efforts at comprehensive reform of the U.S.
system of health insurance may be needed to increase coverage among
adults in late middle age" (NEJM, 10/11). An abstract of the study,
titled, "Lack of Health Insurance and Decline in Overall Health in
Late Middle Age," is available online.

Source: Taken directly from "Study Finds Lack of Health Insurance
May Increase Risk of Health Decline for Late Middle-Aged Adults,"
KAISER DAILY HEALTH POLICY REPORT, October 12, 2001.

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CCHC Commentary: The Clinton Administration tried hard to extend
Medicare coverage down to age 55, as they, and now the Bush Adminis-
tration continue to bring Medicaid coverage into the middle class
through KidCare, the Children's Health Insurance Program implemented
on a state by state basis. Passed in 1997, the idea, according to
Clinton Health Care Task Force documents was called Option Three.
Begin with the Children and their parent will follow. The bigger idea,
is to connect Medicare and Medicaid by working toward the middle with
both. This study is an attempt to encourage that process.


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FEDERALLY-FUNDED INSTITUTE PUSHES FOR UNIVERSAL COVERAGE

An IOM study released Oct. 11 found that the increased cost of
health insurance and a slower economy will likely boost the number
of uninsured Americans in future years, the AP/Nando Times reports
(Schmid, AP/Nando Times, 10/11). In the report, titled "Coverage
Matters: Insurance and Health Care," researchers on the IOM's
Committee on the Consequences of Uninsurance outlined who lacks
health insurance in the United States, "how coverage is gained
and lost" and "why so many people" lack health insurance
("Coverage Matters: Insurance and Health Care," October 2001).

The report found that about two-thirds of Americans receive health
insurance through their employers or families, and many Americans
"gain or lose" coverage when they marry, divorce or move to new jobs.
As a result, one out of seven Americans lacks health coverage for
a year at some point in his or her life, and many lack coverage for
"shorter periods." Increased health care costs and a slower economy
may also prompt employers to pass more of the cost of insurance
premiums to employees, who may decide that they cannot afford the
increased cost (IOM release, 10/11).

Employees currently pay about 14% of the cost of individual health
insurance and 27% for family coverage. In addition, 13.6 million
uninsured Americans have employers that do not offer health insurance.
The report also found that Medicaid and CHIP often have "stringent"
eligibility and enrollment requirements that "can make coverage
difficult to obtain and hard to keep." According to Iowa Health
System President Mary Sue Coleman, who helped draft the report,
"Unless health insurance is made more affordable, the number of
uninsured Americans is likely to continue growing over time" (AP/
Nando Times, 10/11). Families USA Director Ron Pollack added that
the report "demonstrates how many working families not covered through employment-based insurance fall through the cracks" (Families USA
release, 10/11).....

Source: Taken directly from "IOM Report Finds Number of U.S.
Uninsured Likely to Rise, Provides Profile of Uninsured Population,"
KAISER DAILY HEALTH POLICY REPORT, October 12, 2001.

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CCHC Commentary: Four reminders to readers. 1) Employees pay 100%
of the cost of their insurance. What they don't pay in cash they pay
in lost wages--and lost choices. 2) Even if we were to agree with the
idea that employers pay for insurance, one has to question the
rationale and wisdom for employer payment. Citizens pay 100% of their
home, car, and other insurance products. They somehow make personal
value-benefit judgments for these products, $20,000 cars, and $250,000
houses, and the daily necessities of life. 3) Medicaid and CHIP (the
federal Childrens Health Insurance Program) are not insurance. They are subsidized government health care programs. 4) Coverage does not
guarantee access to care. HMO patients know this all too well.
The IOM receives 85% of its support from federal agencies.


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FEDS WANT TO DIRECT TRAINING DECISIONS OF MEDICAL STUDENTS

Many U.S. residents are unable to access "quality, affordable
health care" because the communities in which they live lack the
"proper mix" of care providers, a new HHS study says. The study,
conducted by the Health Resources and Services Administration,
examined workforce issues in California, Connecticut, Florida,
Illinois, Iowa, Texas, Utah, Washington, West Virginia and Wisconsin.

Researchers examined how states structure and pay for health care,
the impact of investing in primary care education and the need for
high retention rates for providers trained in-state. The study
recommends that state health policymakers "take a hard look at how
they" pay for care providers' education, license and regulate
providers and insurers, pay Medicaid providers and create programs to
encourage providers to select certain specialties and practice
locations.

HHS Secretary Tommy Thompson said, "We need to do more to get enough
doctors, nurses and other health care professionals into the
underserved areas where they're needed most. This report offers
data and analysis to guide states in how they can strengthen the care
available in these areas through workforce development" (HRSA
release, 9/19). For a free copy of the study, "The Health Care
Workforce in Ten States: Education, Practice and Policy," call (888)
ASK-HRSA.

Source: Taken directly from "Lack of Proper Provider Mix Limits
Access to Health Care for Many, HRSA Study Finds," Kaiser Daily
Health Policy Report, 9/21/01.

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CCHC Commentary: Just for the record, Canadian health care
professionals are often forced to work wherever the government
tells them they must work. Such requirements in the U.S. could make
the growing shortage of health care professionals an even bigger
problem than it already is. As is clear in the many debates over
state's accessing federal dollars for programs, government subsidies
(in this case, medical education funding) can force recipients (medical
students) to follow government demands. Look for these demands to
increase as medical and health care professional shortages grow.


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HEALTH CARE ACCESS AT MEXICAN BORDER TO BE STUDIED

As part of the Border Health Initiative, the federal Health
Resourcs and SErvices Administration (HRSA) has today announced
a $250,000 grant to the University of Texas Health Science Center
at San Antonio. Health care workforce issues will be addressed.
This represented the initial investment in a five-year cooperative
agreement to establish a Regional Center for Health Workforce
Studies at the school.

The Center will examine " regional staffing levels for physicians,
nurses, dentists, public health, mental health and allied health
professionals; placement of these professionals throughout the
region; training needs; and recruitment and retention." according
to a department press release. HRSA has invested $280 million in
the past four years to improve health care along the border,
including roughly $83 million in fiscal year 2001.

HHS Secretary Tommy Thompson also announced the renewal of
cooperative agreements with the four other educational institutions
that conduct workforce studies for much of the United States: the
University of California at San Francisco, the University of
Illinois at Chicago, the State University of New York at Albany,
and the University of Washington, Seattle.

Source: "HHS TO FUND UT-SAN ANTONIO RESEARCH ON ACCESS TO CARE,
WORKFORCE ISSUES ALONG U.S.-MEXICO BORDER," HHS Press Release
October 15, 2001

Fact sheet: http://newsroom.hrsa.gov/factsheets/borderhealth2001.htm.
For more information: http://bhpr.hrsa.gov/healthworkforce/

-Citizens' Council on Health Care
-October 15, 2001

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U.S. DOCTORS BETTER OFF WITHOUT NATIONAL HEALTH

Physicians for a National Health Program and other groups
advocate a single-payer health care system as a way to improve
health care quality and access, and reduce the frustrations of
managed care. However, critics argue that national health care
would make matters worse.

American doctors complain they spend too little time with
patients, however:

o Physicians in the U.S. actually spent an average of 18 to
20 minutes with each patient in 1998, one to two minutes
MORE than 10 years earlier.

o They spend more time with patients than doctors in other
countries (see figure
http://www.ncpa.org/ba/ba370/ba370fig1.gif).

o Physicians in Canada and Britain see an average of about
40 percent more patients annually.

U.S. doctors complain that insurance paperwork reduces their
ability to practice medicine -- but their frustration is nothing
compared with the dissatisfaction in the British National Health
Service, where a recent survey found eight out of 10 family
doctors would quit the NHS if they could.

American physicians believe they're expected to do more for less
compensation, but doctors working for national health or single-
payers systems make out much worse. On average, doctors in Canada
and Germany earn about half what their U.S. counterparts do. In
Austria, France and Britain it's less than one-third, and in
Finland, Norway and Sweden just one-fourth.

The quality of care also suffers under national health or single
payer systems, due to rationing. One in five British physicians
knows someone who has been harmed by delays in receiving
treatment.

o Approximately two-thirds of Canadian and Australian
physicians sampled -- and more than three-quarters of
British and New Zealand doctors -- believe delays are a
problem.

o But only seven percent of American physicians say delayed
treatment is a problem.

Source: Devon Herrick (NCPA research manager), "Would National
Health Insurance Benefit Physicians?" NCPA Brief Analysis No.
370, August 31, 2001, National Center for Policy Analysis.

For text http://www.ncpa.org/ba/ba370/ba370.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, September, 2001.


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HUMAN RIGHTS LAWS COULD PREVENT MEDICAL RESEARCH

According to a clinical neuroscientist at the University of
Edinburgh, European human rights legislation could prevent
medical research into illness and injuries that leave people
unconscious.

Charles Warlow, a physician, says new laws inspired by the
European Human Rights Act change the requirement for patient
consent. Regulations in the United States, and formerly in
Europe, allow for so-called "waiver of consent," which permits
certain interventions to be administered if the patient is
unconscious.

Under new European regulations, if you want to do a randomized
trial of a new treatment for stroke, head injury or cardiac
arrest, you must get the patient's consent, or if unconscious,
the consent of the next of kin.

There are problems however:

o Often you can't find next of kin quickly enough.

o A third of the cases in a recently published U.S. study on
the cooling of head injuries employed waiver of consent.

o A New England Journal of Medicine editorial pointed out
this trial would never have happened if waiver of consent
did not exist.

Currently involved in a trial of a clot-busting drug on victims
of sudden stroke, Warlow would likely not be able to recruit
patients because they can't give consent.

A study of the treatments paramedics give to heart attack
victims, being conducted by cardiologist Stewart Cobb at Glasgow
University, is particularly at risk. Speaking at the British
Association Festival of Science, Warlow says peer review and
ethical approval of proposed research is essential and that
consent is preferable. But for cases where urgent treatment is
also essential, "if you don't have waiver of consent, the trials
will stop."

Source: Damian Carrington, "Human rights laws could prevent
medical research," New Scientist, September 1, 2001.

For text http://www.newscientist.com/news/news.jsp?id=ns99991136

For more on Other Health Policy Issues
http://www.ncpa.org/pi/health/hedex8e.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org, September 11, 2001.


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HEALTH DATA VULNERABLE TO CYBER ATTACKS

The "somewhat laggard entry" of insurance companies into online
distribution of policies and services may be exposing customers,
business partners and themselves to "massive losses caused by
breaches in security," according to a study from Conning & Company
released before the Sept. 11 terrorist attacks in New York City
and the Pentagon.

Cyber-Security for Insurers: The Virtual Fortress? stated that
insurers may be "very attractive" targets for attacks because they
manage substantial liquid financial assets and because they may be
easy targets due to their use of legacy computer systems. In addition,
insurance firms may be specifically targeted by aggrieved hackers to
avenge perceived ill treatment.

The company observed that the proliferation of rules, regulations
and standards regarding cyber-security will result in unintended
consequences.

"Too great a focus on the security-related privacy provisions of the Gramm-Leach-Bliley Act of 1999 or the Health Insurance Portability
and Accountability Act of 1996 may actually result in reduced security,"
the financial analysts stated.

Source: Taken directly from PrivacySecurityNetwork, Site Update,
October 8, 2001.


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NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
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