What's new in Public Health

The Great Brook Valley Neighborhood Health Center in Worcester changed names this Thursday, becoming the Edward M. Kennedy Community Health Center, a tribute to Ted Kennedy's role in bringing Community Health Centers into being. Seems like a good time to review the history and role of a neighborhood health center.

The Massachusetts health reform law (often called "chapter 58") made several special provisions for young people (defined as those between 19 and 26), because they represented a disproportionate share of the uninsured population, and were less likely to have access to insurance through work (as most of the jobs available to people in that age group don't come with insurance).

Many of you will remember the "death panel" controversy during the health care reform debates last year. For those who don't, a proposal to create a better payment mechanism for discussions between physicians and patients about end-of-life choices was derided by opponents of reform as funding for "death panels" which would make sure that elderly people chose the option of "dying early" to save on health care costs. Now it appears that early palliative care not only helps you be more comfortable and more in control of your health during serious illness, it can help you live longer as well.

Some of you have heard my psychiatry rant. In short, it goes like this: Psychiatrists are not doctors, in the "physician" sense. They don't do any of the things I recognize as "being a doctor"; they don't examine patients or their pathologic equivalents (xrays, tissue slides, lab values-doctors do that stuff in some specialities and are still "physicians" in my book). Yes, they went to medical school, they learned all the stuff I learned, and then proceeded to enter a field where most of that knowledge is largely unnecessary.

The health reform law (now mostly called the Patient Protection and Affordable Care Act, or just the Affordable Care Act (ACA) requires many insurers to maintain a "medical loss ratio" of at least 85%. The medical loss ratio is the percentage of premiums which the insurer must pay out as health care. So if the premium for health insurance is $100 per month, the insurer must, on average, spend $85/month on payments for health care used by everyone insured by the company.

As may be apparent, I recently had a complete database meltdown while upgrading this site. While I did have backups (more than one), they all appear to have been done after the corrupting event.

So-I'll be rebuilding this site from scratch and cached entries for a bit. I probably won't be able to reload all of the entries, but I'll try to get all of this year's entries, in any event. This page will evaporate once I get a few real entries up. Thanks for bearing with me.

>Tom<

A story in today's Modern Healthcare (a magazine I just discovered through the good offices of Emily Friedman, who was one of my favorite teachers at BUSPH) (Also, registration required) reports that a significant minority of nurses have little confidence in the institutions where they work, and a remarkable 72% majority feel that the institution where they work understaffs for the work done.

So there's a story in today's Boston Globe, which reports that slightly more than half of overweight adults are healthy, as measured by their cholesterol levels and blood pressure (and a few other things, basically measuring 'metabolic health'). And not a few (about one quarter) of people of 'normal' weight were unhealthy by those measures.

Well, that'll set the fox in the henhouse, won't it?

Let's have a look at the original, shall we? It does say about what is reported (have a look), but is interesting for what else it says: