U.S. District Court Directs FDA to Reevaluate Previous Plan B Decision

Judge Edward R. Korman of the U.S. District Court, Eastern District of New York, issued a decision today (Mar. 23, 2009) in the case of Annie Tummino et al v. Frank M. Torti, Acting Commissioner of the Food and Drug Administration. The case involved plaintiffs\u27 claims that the FDA, in deciding that Plan B, known as emergency contraception or the morning-after pill, be made available over-the-counter (OTC) only with age restrictions, was unduly and inappropriately influenced by pressures from the White House among other factors

An Analysis of the Implications of the Stupak/Pitts Amendment for Coverage of Medically Indicated Abortions

This analysis examines the implications for coverage of medically indicated abortions under the Stupak/Pitts Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health Care for America Act. In this analysis we focus on the Amendment\u27s implications for the health benefit services industry as a whole. We also consider the Amendment\u27s implications for the growth of a market for public or private supplemental coverage of medically indicated abortions. Finally, we examine the issues that may arise as insurers attempt to implement coverage determinations in which abortion may be a consequence of a condition, rather than the primary basis of treatment

Quality and Cost of Diabetes Mellitus Care in Community Health Centers in the United States

Objective To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings. Research Design and Methods We used data from the 2005–2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to predict expenditures for CHC users compared to non-users of CHCs, conditional on patients with positive expenditures. Results Results showed that variations of quality between CHC users and non-CHC users were not statistically significant. Patients with diabetes mellitus who used CHCs saved payers and individuals approximately $1,656 in ambulatory care costs compared to non-users of CHCs. Conclusions These findings suggest an opportunity for policymakers to control costs for diabetes mellitus patients without having a negative impact on quality of care

A Natural Fit: Collaborations Between Community Health Centers and Family Planning Clinics

Federally Qualified Health Centers (FQHCs) and family planning clinics funded through Title X of the Public Health Service Act are critical components of the health care safety net in urban and rural medically underserved communities. Although they share the common mission of serving vulnerable and low-income populations, health centers and Title X clinics possess different, but complementary, strengths. The Patient Protection and Affordable Care Act (Affordable Care Act) will expand coverage to an additional 32 million people while leaving 23 million uninsured. Most of the newly insured and the remaining uninsured will be residents of medically-underserved communities, and thus, positioning the safety net to meet demand will be highly important

Women\u27s Health and Health Care Reform: The Economic Burden of Disease in Women

This report estimates the direct and indirect costs of care for women for the major chronic diseases and conditions that women face across the lifespan. It also identifies the key primary care and preventive services that can lead to prevention, early detection or early intervention for these conditions. Health care screening, counseling, early diagnosis, and early intervention health care services are important for women at each stage of their lives. But women typically seek care in primary care settings for family planning services and cancer screening prior to becoming pregnant. As a result, high quality care during the reproductive years offers an important opportunity to identify risk factors and health conditions and to provide appropriate interventions and quality care. Primary and preventive care standards also underscore that screening for cancer, risks for heart disease, family planning services and detection of violence, as well as smoking cessation and nutrition counseling, should begin during the reproductive years. A healthy pregnancy, leading to the best outcome for both mother and child, begins when the woman is in the best possible health prior to conception. Counseling on obesity prevention and smoking cessation are vital prior to pregnancy; delaying counseling until after conception compromises a woman\u27s ability to achieve the best outcomes. Identification of hypertension and/or gestational diabetes in pregnancy provides an opportunity to identify women at higher risk of heart disease and diabetes later in life. Early care is particularly important for women who are members of racial and ethnic minority groups. Approximately one in every three residents of the United States self-identifies as African-American, American Indian/Alaska Native, Asian/Pacific-American, or Latino. Disparities in health status are closely associated with race and ethnicity – in health insurance coverage, psychosocial stress, discrimination and health care access and quality, and in deaths due to breast cancer and pregnancy-related causes

Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges

To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards. It was jointly authored by policy experts at the Kaiser Family Foundation, The Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital and the Jacobs Institute of Women’s Health at The George Washington University

Patient perspectives on quality family planning services in underserved areas

Ongoing challenges impede efforts to improve the quality of family planning services in underserved communities, which by definition lack sufficient numbers of physicians and other health professionals. Challenges to improving the quality of family planning services include financing difficulties, lack of standards, training deficiencies, as well as little understanding and attention to patient preferences. The objectives of this study were to explore female patients’ preferences for family planning services in underserved areas and to develop a framework to help providers improve patient-centered care. The methodology for this paper included mixed methods research including a survey of women between the ages of 18 and 44 in 19 underserved communities (n=1868) across the United States and qualitative research involving 16 focus groups (n=103) to explore patient preferences and experiences with family planning services. Descriptive statistics of survey items and thematic analysis of transcripts were utilized to analyze study data. Triangulation of data sources and methods resulted in an overall framework for patient-centered family planning care. The results show women in underserved areas identified important aspects of family planning care as: relationship with provider, communication, confidentiality in receiving care, provider competence, service access and convenience. The conclusion suggests improving patient-centered care for family planning services could improve outcomes by increasing patient return for follow up care, patient pursuit of other primary and preventive care services, continuation rates of contraceptive method, and higher contraceptive use. Achieving patient-centered family planning care will require investments in human capital and technology, modifications in clinic operations, and an organizational culture focused on patient preferences and experience

Morally Respectful Listening and its Epistemic Consequences

What does it mean to listen to someone respectfully, that is, insofar as they are due recognition respect? This paper addresses that question and gives the following answer: it is to listen in such a way that you are open to being surprised. A specific interpretation of this openness to surprise is then defended