Friday, August 25, 2017

Why Medical Care and Dental Care are Separate

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If you’re fortunate, you have health insurance and dental insurance provided either through your employer or through your parents or guardians. If you’re an adult on Medicaid, you may not have any dental coverage at all.

But why are dental insurance and health insurance—and the professions of doctors and dentists—separate, when our teeth are so important to our general health?

The separation between dentistry and the rest of medicine starts from the fact that dental procedures were often performed by barbers. They would pull painful teeth and lance abscesses once they were done giving their clients a haircut or beard trim.

The dental profession didn’t really become a profession until 1840, when the first dental college in the world opened at the University of Maryland in Baltimore. Prior to that, Chapin Harris and Horace Hayden tried to get dental courses to be taught in medical schools, but the doctors believed that dentistry was more of a “mechanical challenge” than a medical issue and rejected their proposal.

Because of the “historic rebuff,” as it is known, medicine and dentistry became separate professions, and remain that way to this day, despite many efforts to make dentistry an essential part of the healthcare system and provide insurance for dental and medical procedures under public insurance programs.

Oddly enough, these days it’s dentists who want to stay separate from doctors. Part of it is about the marketplace, and part of it is about the fact that medical records and dental records have separate diagnostic codes and it would be difficult to get dental records integrated into medical ones. It’s also the reason why health insurance and dental insurance are separate entities.

It’s this divide that brings more than a million people each year to emergency rooms with dental pain. The doctors there can’t do anything but provide antibiotics and pain relief and encourage people to see their dentist to have the problem treated—and for that, it costs the system more than $1 billion a year.

This separation between dentistry and medicine is especially frustrating because dental problems can affect everything about us: our ability to meet our basic nutritional needs, our ability to maintain our overall health, and even our ability to get a job (missing teeth can be a real handicap when searching for employment).

The state of our teeth is also an easily visible status symbol. Wealthy people tend to have nice, straight, white “Hollywood smiles,” while the poorer among us may have crooked teeth, extensive tooth decay, or other dental problems. “Perfect teeth are a very clear way of signaling your wealth,” wrote Julie Beck in The Atlantic, “More clear than if everyone had access to good care and had decent teeth.”

What do you think? Should dental care and medical care be separate? Why or why not? Please share your thoughts in the comments.

Friday, August 18, 2017

13,000 Sick Florida Children Went Without Care in 2015

A young boy lying in a hospital bed, attached to an IV.
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Whether they were politically motivated or not, some seriously dangerous healthcare malfunctions that were endangering Florida children have just come to light.

With about half of all children in Florida on Medicaid in 2015, lives were thrown out of balance when, during the spring and summer, the state switched about 13,000 children out of a program called Children's Medical Services (CMS) and into other insurance programs that don't specialize in caring for extremely sick children.

This meant that children suffering from things like birth defects, heart disease, diabetes, and blindness couldn't get the help they needed.

There were several problems at play here. First off, according to medical experts, the data analysis used to transfer the children was "inaccurate" and "bizarre." Florida Department of Health nurses asked the parents of sick children a very particular question: "Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?"—which disqualified children who were seriously ill but could still get by day to day.

"This was a truly duplicitous question," said pediatrician Dr. Philip Colaizzo. Many of his patients, he reports, were taken off CMS.

Second problem: the screening tool the state used had already been dubbed "completely invalid" and "a perversion of science" by experts in children's health. But it was still being used.

And finally, while a state administrative law judge ruled in the fall of 2015 that the Department of Health should stop using the tool, the DOH didn't automatically re-enroll many of the children into CMS.

Then there's the potential political issue: the new version of Medicaid that didn't cover these children was made up of insurance companies that gave money to the Republican party during the last election.

Luckily, the insurance process has since been corrected, so these kids can get the healthcare they need.

While the Florida DOH argues that the recent CNN article with the above allegations is "100% false," they're basing their statement on the current healthcare system—not what Florida had in place during 2015.

Meanwhile, the political element is still getting play. Democratic gubernatorial candidate Chris King recently called for an independent investigation into the situation. 

American Medical Response Acquired for $2.4 Billion

A computer generated image of an ambulance.
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It’s official: private equity firm KKR is purchasing American Medical Response. The $2.4 billion acquisition is the latest addition to KKR’s growing list of healthcare portfolio companies.

Turns out the recent buyout, combined with similar purchases, is a new direction for George Roberts and Henry Kravis, co-CEOs and co-chairmen of KKR. Just last month, the firm also acquired online health publisher WebMD. And in a separate deal, the private equity giant also obtained a majority stake in Nature’s Bounty.

So what does it mean? It means that investors see the value of the healthcare industry and expect it to grow in the near future.

KKR's actually been at it for a while when it comes to investing in healthcare. Two years ago they also bought Air Medical. According to Reuters, “the merger with American Medical Response (AMR), the largest U.S. provider of ambulance services, would allow KKR's Air Medical Group to easily substitute costly helicopter flights with ambulances for shorter trips.”

Together, Air Medical and American Medical Response will transport an estimated five million patients every year. As of now, Air Medical and American Medical Response services are available in 46 states. But who’s to say they won’t expand that to all 50 states soon?

It’s easy to see why KKR and other private equity firms are investing in healthcare. After all, it's a safe bet. As management consultant firm Bain & Company puts it, the healthcare industry has a “proven resilience to economic turbulence.” Maybe that’s why last year the deal value for healthcare private equity reached $36.4 billion, the highest level since 2007.

In a recent article published in Forbes, contributor Todd Millay gave his thoughts on why healthcare stocks are hot right now:

“The long-term fundamentals of the healthcare sector compare favorably to the broader market. The sector has superior earnings-per-share growththe key driver for long-term equity returns. The healthcare sector also has a higher and more stable return on equity than the broader market. Healthcare stocks have traditionally declined less than the overall market in downturns.”

It makes sense, given that everyone needs healthcare and it will always be in demand.

Friday, August 11, 2017

Your Pet is Not Actually Making You Healthier

An assortment of animals looking directly at the camera, including: two dogs, two cats, a bunny, a guinea pig, and a mouse.
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I hate to be the bearer of bad news, but a recent study suggests that Spot isn't actually making you any healthier.

Since the 1980s, we've heard that having a pet leads to better health, whether it's higher survival rates from myocardial infarction, a lower number of GP visits, reduced risk of asthma, or better physical and psychological well-being, particularly in the elderly. And there's no question that having a pet provides companionship—and the opportunity to get more human interaction (just visit any dog park for evidence of this!).

Trouble is, there are so many factors that go into determining the correlation between having a pet and being healthy, it's hard to know if one can really cause the other.

The most recent study, courtesy of RAND and run by Harvard-trained biostatician Layla Parast, found that it's less about the pets and more about what they signify: namely, that families with pets tend to be better off financially, which means they can afford bigger homes and better healthcare.

The study looked at more than 5,000 households and analyzed children's health, comparing kids in homes with cats versus children in homes without cats. (Don't worry, dog-lovers: portions of the study included dogs as well.) While researchers found that children from cat-owning homes did tend to have "better general health" and parents who were less concerned about their mood, behavior, or learning abilities, there was no direct evidence that the pets had anything to do with it.

"I think there are many other positive benefits to owning a pet besides thinking that it will improve your health," said Parast. "Obviously having a pet brings joy and companionship and a multitude of other things." 

She added that, as a pet owner herself, she'd be very pleased to see future research supporting the idea that pets can have a positive influence on their owners' health. "It would be great to have a reason to hand out cuddly puppies to everyone who needs better health," she was quick to add. "I would be completely in favor of that. But there's no scientific evidence right now that shows that."

Friday, August 4, 2017

Study Finds Moderate Drinking Can Improve Cognitive Health

A happy elderly couple drinking wine.
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Researchers from the University of California San Diego School of Medicine in La Jolla have found a link between modest alcohol consumption and prolonged cognitive health. Dr. Linda McEvoy, senior study author, believes that the finding is groundbreaking. Indeed, it does appear to be the first study of its kind to take into account the effect of alcohol on an older population.

"This study is unique because we considered men and women's cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age," Dr. McEvoy stated.

The research is based off data gathered from 1,344 adults728 of which were women and 616 of which were men. However, as Medical News Today points out, almost all participants were white (99.4 percent) and belonged to the middle or upper-middle class.

Information was collected over a period of 29 years. Participants’ cognitive health was analyzed at baseline, and again every four years.

It’s also important to know that “moderate alcohol consumption” was defined as one standard drink per day for women of all ages and men aged 65 or older. Men under the age of 65 were afforded two standard drinks per day. 

"This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging,” said Erin Richard, lead author of the study. “However, it is not a recommendation for everyone to drink. Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences."

In other words, great news for those of us that enjoy an alcoholic beverage here and there! Here’s to better cognitive health! Cheers!