QUALITY

Tracking Hospital Infections

Starting this summer, Maryland hospitals will have to report infections acquired by their patients. HB78 requires hospitals to begin reporting July 1 all health-care-associated infections to the Maryland Health Care Commission, which will post the information on its Web site. Patient advocates, legislators and the Maryland Hospital Association say the law will help make the state’s hospitals safer by encouraging them to lower infection rates, reports the Baltimore Sun. Critics, on the other hand, say the measure will make no difference. “Reporting doesn’t make hospital infections go away,” Dr. William Jarvis, a former Centers for Disease Control and Prevention epidemiologist, told the Sun. Jarvis argued that some hospitals will not look very hard for infections, producing a falsely low rate, while hospitals that report more infections may not actually be more dangerous but may treat patients who are sicker and more vulnerable to disease. A second measure, sponsored by Sen. Paula Hollinger and Sen. Lisa Gladden, that would have required hospitals to test incoming patients and isolate those with contagious infections, failed to pass the House. Disease experts recommend this strategy as one way to contain the growing rate of hospital-acquired infections. Every year, 2 million people contract infections while hospitalized and roughly 90,000 people die from them, according to the CDC.

HEALTH INSURANCE

Choice Down, Price Up

Consolidation among health insurance companies in recent years has resulted in less competition and higher prices for consumers, says a study from the American Medical Association. In 95 percent of sampled markets, a single insurer had a market share of 30 percent or greater, and in 56 percent of those markets, a single insurer claimed 50 percent or more. The AMA analyzed 294 metropolitan health insurance markets in 43 states, measuring market concentration using an index employed by the federal government. Between 1995 and 2005, more than 400 mergers involving insurers and managed care organizations occurred. North Dakota had the highest market concentration, with about 90 percent of its market controlled by the state’s Blue Cross Blue Shield provider. “Health insurers are posting historically high profit margins, yet patient health insurance premiums continue to rise without an expansion of benefits,” said AMA Board Member Dr. James Rohack. “Given the troubling trends in health insurance nationwide, federal regulators need to take a hard look at whether patients are being harmed as mergers and takeovers reduce the number of competing health insurers.” The study is available online.

Youngsters Lack Coverage

During 2002 and 2003, more than half of young adults in the United States lacked health insurance for at least one month, according to a recent report from the Agency for Health Care Quality and Research. The results are based on the annual Medical Expenditure Panel Survey (MEPS), which collects information from a large sample of households. According to the report, young adults aged 18 to 24 and 25 to 29 were the most likely to be uninsured for at least one month during 2002 and 2003 (54.9 percent and 50.7 percent respectively). Children under age 18 were the least likely to be uninsured for the entire 2000-2003 period (2.7 percent). The study also notes that nearly a quarter of low-income respondents younger than age 65 lacked health insurance for the whole period between 2000 and 2003. Out of all racial and ethnic groups, Hispanics were the most likely to be uninsured for at least one month during 2002 to 2003, as well as for the entire 2000-2003 period. According to the study, while Hispanics represented 15 percent of the population under age 65, they represented 37.8 percent of the long-term uninsured. The full report is available online.

TOBACCO

States File Suit Against Companies

On April 18, attorneys general in California, New Hampshire, Massachusetts, New Jersey, New York, Ohio and Oregon filed lawsuits against tobacco companies. The suits charge that the firms have withheld more than $750 million that states were scheduled to receive under the 1998 Master Settlement Agreement (MSA), the Manchester Union Leader reports. The attorney general of Connecticut indicated that he likely will file a similar lawsuit. R.J. Reynolds Tobacco paid states about $1.4 billion but withheld $647 million, while Lorillard Tobacco paid the states about $558 million and withheld $108 million, the states said. Philip Morris USA paid states $3.4 billion and withheld no funds, but is seeking to have that amount reduced. Under the settlement, the tobacco companies agreed to pay more than $240 billion to the states over 25 years as compensation for health-care costs associated with smoking (see SHN #445 for more). The companies withheld payments this year primarily because they claim they are entitled to a reduction in the amount previously paid in 2004. In particular, the companies allege that certain states, which they have not identified, did not diligently enforce the state laws requiring companies that did not join the MSA to place similar amounts into escrow accounts.

MEDICAL MARIJUANA

FDA Rebukes States

The Food and Drug Administration on April 21 released a statement criticizing state measures to legalize the medicinal use of marijuana. A combined review by federal drug enforcement, regulatory and research agencies determined that “smoked marijuana has no currently accepted or proven medical use in the United States and is not an approved medical treatment,” the FDA said. Currently, 11 states – Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, Oregon, Rhode Island, Vermont, and Washington – have legalized marijuana for medicinal use. These state measures “are inconsistent with efforts to ensure that medications undergo the rigorous scientific scrutiny of the FDA approval process,” the FDA said, according to the New York Times. Scientific evidence shows that smoked marijuana is harmful, and there are alternative “FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana,” the statement said. The FDA's release contradicts a 1999 review by the Institute of Medicine that found marijuana to be “moderately well-suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting,” the Times reports.