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Health Insurance

Lack of Diversity among Healthcare Providers Impacts Healthcare Disparities

By | Diversity & Inclusion, Health Insurance, Healthcare Access, Healthcare Providers, Patients | No Comments

The U.S. faces great changes in the 21st century.  High levels of immigration from Asia, Central, and South America have dramatically shifted U.S. demographics.  According to the U.S. Census survey, the U.S. may be a majority non-White nation by as early as 2043.  By 2060, the relative percentage of non-Hispanic Whites in the population is expected to decrease to just 43% from 63% in 2010, whereas the relative percentage of Hispanics will nearly double, from 17% in 2010 to a predicted 32% (1).  Despite the rapidly growing minority populations within the U.S., there remain relatively few minority healthcare providers, such as nurses, physicians, and technicians.  For example, as of 2013, 70% of physicians identified as White, while only 6.4% identified as Hispanic and 5.9% as African American (2).

 

The lack of diverse and culturally competent healthcare providers may adversely impact the efficacy and frequency with which this care is administered.  A patient’s language and culture dictate how they express and explain their symptoms, as well as the degree to which they are comfortable seeking medical assistance.  Patients and providers who understand one another’s core principles – especially with regards to medicine – and can communicate effectively have a better chance of achieving a better patient outcome (3).  When asked the question, “do you think that African American and Hispanic patients receive a lower quality of care, the same quality of care, or a better quality of care than White patients?”, A majority of African American patients answered lower, along with around 40% of Hispanic patients (4).  Even 25% of White patients felt that they received a higher quality of care than their minority counterparts (4).  Perhaps even more convincingly, as early as 2005, over 75% of physicians felt that minorities were receiving a lower level of care than White patients, and that figure has been steadily rising (4).  This is an alarming trend.  While these numbers do not necessarily indicate a systemic discrimination within the healthcare industry, it may show a mistrust and lack of communication between minority patients and the mostly White male dominated healthcare industry.

 

This mistrust and miscommunication can manifest itself in other ways, such as insurance coverage.  While Hispanic people make up a mere 17% of the U.S. population, they represent 33% of all uninsured Americans (4).  Lack of insurance coverage, borne of distrust for a largely White-dominated medical system only makes access to adequate care more difficult for minorities.  While the solutions to such endemic issues cannot be solved overnight, the first steps can be taken to rebuild trust between the healthcare industry and minorities, beginning with making provider diversity a priority to bridge the many cultural gaps spanning this great melting pot of a nation.

 

On June 22, 2016, the Center for Healthcare Innovation will be further exploring these issues at the 6th annual Diversity, Inclusion & Life Sciences Symposium, which is the leading annual, collaborative event for life sciences and healthcare executives, physicians, HR professionals, clinical trial professionals and patients, entrepreneurs, patient groups, researchers, academics, and diversity and inclusion advocates to discuss diversity and inclusion in healthcare. Please visit chisite.org/education/diversity-symposium/ for more information.

 

 

References

  1. U.S. Population Projections: 2012-2060 | George Washington University https://www.gwu.edu/~forcpgm/Ortman.pdf
  2. Diversity in the Physician Workforce: Facts and Figures 2014 | AAMC http://aamcdiversityfactsandfigures.org/section-ii-current-status-of-us-physician-workforce/#fig16
  3. Missing Persons: Minorities in the Health Professions | Sullivan Commission on Diversity in the Workforce, pgs. 13-27 http://health-equity.pitt.edu/40/1/Sullivan_Final_Report_000.pdf
  4. Eliminating Racial/Ethnic Disparities in Healthcare: What are the Options? | The Henry J. Kaiser Foundation http://kff.org/disparities-policy/issue-brief/eliminating-racialethnic-disparities-in-health-care-what/

The Evolving Role of Healthcare Providers

By | Affordable Healthcare Act, Collaboration, Global Healthcare Trends, Health Insurance, Healthcare Innovation, Healthcare Providers, Patient Engagement, Patient-Driven Healthcare | No Comments

The Evolving Role of Healthcare Providers

We are in an age of healthcare consumerism where patients’ interests are more vested than ever. It’s important for providers to accommodate the power shift. This means increasing transparency, finding new ways to facilitate communication, responding directly to patient concerns and questions when raised, and being proactive in staying ahead with new innovations in health and medicine.

Patients are also now more informed than ever, which has helped to create a competitive atmosphere in the world of healthcare. Patients can compare services and prices, so healthcare providers must be able to meet expectations and show how they will work with patients to achieve the best outcomes. Healthcare providers can no longer afford to stay on the sidelines and wait for patients to interact; they must actively engage patients regularly.

Attracting New Patients

In the past, healthcare providers could depend on word of mouth and a small ad in the local phone book to bring in patients. A passive approach like this will not work anymore. It is imperative for healthcare providers to carefully create and refine their online presence, not only providing basic information, but also working to appeal to patients. Social media interactions and patient testimonials may help to make an office or provider seem more accessible and attractive.

Working with Health Insurance Agencies

Most patients now have health insurance, thanks in part to the Affordable Care Act. It is wise for healthcare providers to work closely with health insurance agencies to create a seamless experience for patients. Being “in-network” will help patients with particular plans learn about healthcare providers. Being knowledgeable about what services will cost patients out of pocket and taking steps to make the claims process simple for patients may help to distinguish one in-network provider from the rest.

Facilitating Meaningful Engagement

There are now many different options for engaging with patients, so sticking to only contacting patients via telephone sends a message that a provider is behind the times or not willing to make an effort to engage patients. Providers should find out patients’ favored method of communication when gathering basic personal and health information and use those methods to communicate regularly between visits. Patients want evidence that their healthcare providers truly care about their health.

Anticipating Future Changes

The healthcare landscape is becoming ever more connected and comprehensive. Taking action to keep up with current industry trends-such as making information easily accessible by other providers during transitions of care and allowing patients to access information online – will help healthcare providers to stay relevant and in business. Since healthcare is rapidly changing, it is also important to stay one step ahead and anticipate future changes so that it is easy to continue to adapt as shifts occur.

The Urgency in Increasing Diversity in Clinical Trials

By | Clinical Trials, Diversity & Inclusion, Health Insurance, Healthcare Access, Healthcare Quality, Patients | No Comments

 

The Food and Drug Administration (FDA), the key regulatory authority in bringing new drugs to the market, must balance between introducing life-saving treatments to people who need them as soon as possible and ensuring that these drugs have been thoroughly tested and are safe for the general population. A drug must undergo extensive testing in clinical trials before it gets approved as both safe and effective. These trials document how well the treatment works on individuals and also of the likelihood of the occurrence of severe side effects.1 The FDA has programs to accelerate the usually rigorous process needed to test drugs that are the first proven treatment of an ailment or have a significant advantage over already approved drugs.2

Often clinical trials fail to achieve adequate representation for minorities. African Americans represent 12% and Hispanics represent 16% of the U.S. population, but are only represented as 5% and 1% of clinical trial participants, respectively.3 Caucasians are still overly represented in clinical trials.4 The FDA and National Institute of Health (NIH) must urgently address this situation.

Significant genetic variations in various ethnic groups may cause different reactions to certain treatments. This difference puts people at risk as certain treatments’ side effects affect various groups differently. Differences in individuals’ genetic codes can alter the effectiveness of drugs as genes affect how a drug is metabolized and how an individual responds to a drug.5 A recent study on anti-HIV drugs revealed that genetic differences could render drugs completely ineffective in patients.6 These genetic differences can differ between individuals of difference races and/or ethnicities.5 Thus it makes difficult for the physician to determine if the drug will be effective for their minority patients if minorities are not tested thoroughly with that drug in the clinical trials.

One of the reasons as to why there is a lack of minority representation is mistrust of the established medical system. This is most notably seen with the infamous Tuskegee Syphilis Study in which physicians knowingly withheld treatment for African Americans infected with syphilis.7 Physicians’ bias also plays a role in the low amount of minority participants in trials. Physicians combine prior experiences treating patients of similar race, age, gender, and socioeconomic status into a stereotype in how to treat their current patients.8 Physicians use this bias to determine which patients to recommend for clinical trials. A study determined that physicians believe African Americans are two-thirds as likely to adhere to a clinical trial regimen compared to their Caucasian counterparts.9 In addition, minority populations have historically had poor access to healthcare. Minorities are less likely than Caucasians to have access to health insurance, a requirement for some Phase III clinical trials. This lack of insurance restricts many minorities to only receive health care in emergency rooms and unable to participate in trials.10

These and other obstacles prevent accurate minority representation in clinical trials need to be addressed and solved. The NIH Revitalization Act of 1993 by Congress meant to solve this problem by mandating women and minority representation in clinical trials, but the results are not promising as the proportion of minorities in clinical trials is still significantly lower than the proportion of minorities in the United States.11 Thus, before different methods other than passing acts in Congress will be implemented, minorities will continue to be at risk with their treatments.

References

  1. “Clinical Trials: MedlinePlus.” S National Library of Medicine. U.S. National Library of Medicine, 21 July 2015. Web. 5 Aug. 2015.”U.S. Food and Drug Administration.”
  2. Fast Track, Breakthrough Therapy, Accelerated Approval, Priority Review. 18 Sept. 2014. Web. 4 Aug. 2015.
  3. “U.S. Food and Drug Administration.” Clinical Trials Shed Light on Minority Health. 1 Apr. 2015. Web. 4 Aug. 2015.
  4. Culp-Ressler, T. “There Are Too Many White People In Clinical Trials, And It’s A Bigger Problem Than You Think.” ThinkProgress RSS. 4 Apr. 2014. Web. 4 Aug. 2015.
  5. Bradford, L. DiAnne. “Race, Genetics, Metabolism: Drug Therapy and Clinical Trials – MIWatch.” Race, Genetics, Metabolism: Drug Therapy and Clinical Trials – MIWatch. MIWatch, 10 Apr. 2008. Web. 18 Aug. 2015.
  6. “New Evidence That Genetic Differences May Help Explain Inconsistent Effectiveness Of Anti-Hiv Drug.” John Hopkins Medicine. 15 July 2015. Web. 4 Aug. 2015.
  7. Corbie-Smith, G., Thomas, S.B., Williams, M.V., Moody-Ayers, S.(1999) Attitudes and beliefs of African Americans toward participation in medical research.  Gen. Intern. Med.14, 537–546.
  8. Smedley, B.D., Stith, A.Y., Nelson, A.R., editors. ,Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy of Sciences; 2003.
  9. van Ryn, M., Burke, J.(2000) The effect of patient race and socio-economic status on physicians’ perceptions of patients.  Sci. Med. 50, 813–828.
  10. Regenstein, M., Huang, J.Stresses to the Safety Net: The Public Hospital Perspective. Washington, DC: Kaiser Family Foundation; 2005.
  11. Chen, M.S., Lara, P.N., Dang, J.H. T., Paterniti, D.A. and Kelly, K. (2014) Twenty years post-NIH Revitalization Act: Enhancing minority participation in clinical trials (EMPaCT): Laying the groundwork for improving minority clinical trial accrual. Cancer 120, 1091–1096.

Drug Pricing Debate Heats Up as Turing Pharma Raises Price 5,000%

By | Drug Costs, Health Insurance, Healthcare Providers, Rising Cost | No Comments

9:30

Drug pricing continues to be a prevalent issue affecting many Americans’ daily lives. In fact, high drug costs are one of the most important issues affecting Americans. This issue recently made headlines after Turing Pharmaceuticals acquired the rights of Daraprim and raised prices from $13.50 a tablet to $750 overnight. That’s a 5,000% increase – Imagine if the price of a $4 gallon of gasoline rose to $222 per gallon. Daraprim is used to treat a parasitic infection called toxoplasmosis that can be life-threatening for people with weakened immune systems like newborns and those with cancer or AIDS. The drug has been on the market and approved by the FDA since 1953, so many are outraged that, after six decades, a drug price suddenly surges more than 5,000%. Even with insurance, people could be paying around $150 per pill, according to the HIV Medicine Association.

Two Democrat presidential hopefuls, Bernie Sanders and Hillary Clinton, both expressed outrage over this sharp drug price hike and have proposed plans to reduce drug costs and to prevent seemingly drastic arbitrary drug price increases if elected.  Sanders drew Turing into an ongoing congressional investigation of drug price increases as Daraprim is not an isolated case of drug price spikes. Sanders along with his colleague, Elijah E. Cummings, stated that “Americans should not have to live in fear that they will die or go bankrupt because they cannot afford to take the life-saving medication they need.” Clinton echoed this sentiment by stating, “nobody in America should have to choose between buying their medicine and paying their rent.” Even industry representatives showed outrage.  In what was perhaps one of the most stinging criticisms, John J. Castellani, President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry’s trade group, disavowed the company and Shkreli.  “PhRMA typically does not comment on matters related to individual company products or product pricing decisions,” he said in a statement. But, “Turing Pharmaceutical is not a member of PhRMA and we do not embrace either their recent actions or the conduct of their CEO.”

Turing CEO Martin Shkreli defended the new pricing of the drug by stating that the increase in revenue will be used to further research treatments for toxoplasmosis with fewer side effects, as well as allowing the company to invest in marketing and education to raise awareness of the disease. “This isn’t the greedy drug company trying to gouge patients, it is us trying to stay in business. This is still one of the smallest pharmaceutical products in the world,” he said. “It really doesn’t make sense to get any criticism for this.” He went on to say that Daraprim only has about an 80% success rate for treating toxoplasmosis, with also some possible toxic side effects. With increased funding for research and development, he believes that Turing can make a better drug with a higher success rate.  He went on to argue in an interview with CBS News that there “hasn’t been one pharmaceutical company focused on [the disease] for 70 years,” and this increase in funding will help the company dedicate itself to finding a cure to toxoplasmosis. He further stated that it would be losing money if it didn’t raise the drug price and now at the current price they are making “a reasonable profit, not excessive at all.”

Other professionals in the industry vehemently disagree. “Patients shouldn’t be taxed and charged for future research and development. Patients should pay for the drug they’re getting and what they need in the situation that they are” Oncologist Dr. David Agus said. He further added that “it’s predatory practice and it’s inappropriate.”

Shkreli emphasized the importance of the profitability success of his drug company which can be applied to other companies as well. “There’s no doubt, I’m a capitalist. I’m trying to create a big drug company, a successful drug company, a profitable drug company,” he said. “We’re trying to flourish, but we’re also — our first and primary stakeholders are patients, there’s no doubt about that.” However, the NASDAQ biotech index went down 4.41 percent on Monday September, 21st after headlines regarding this issue spread.

Questions of how the patients using the life-saving drug before or new users can obtain it if they cannot afford the new prices were prevalent immediately following Shkreli’s decision. After facing backlash, Shkreli made an announcement that if someone cannot afford the drug, the company will “give it away totally for free,” according to Bloomberg. He went on to state that the company would not deny someone a drug based on their inability to pay for it.

Dr. Judith Aberg, Chief of the Division of Infectious Diseases at Mount Sinai, raised concerns that hospitals may find the drug too expensive now after the price increase to keep in stock, which could result in treatment delays. She went further to say that “this seems to be all profit-driven for somebody and I just think it’s a very dangerous process.”

The case of Turing demonstrates that drug pricing still remains a hot bed issue. In December 2013, the FDA approved a new drug, Sofosbuvir, for the treatment of Chronic Hepatitis C.  The drug, commonly known as Sovaldi, was developed by Gilead Sciences, a U.S. biotechnology company.  The initial price tag of a 12-week treatment of Sovaldi was reported as approximately $84,000, or nearly $1,000 per pill.  This resulted in considerable media attention and an ensuing pricing controversy.  Editorials and op-eds sprung up around the country debating Sovaldi’s price tag and the broader debate over fair drug pricing.  Some politicians expressed outrage over the cost of new drugs, while others argued for free market pricing and rewards for the considerable R&D costs that biopharmaceutical companies incur when bringing a new drug to market.  The often niche drug pricing debate had officially spilled over into the mainstream conversation.  Payers, policymakers, pharma, patients, and providers all voiced strong— and sometimes contrasting— opinions.

To be sure, the issue of drug pricing is a hotbed issue that won’t go away anytime soon.