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Blog Posts (13)

January 17, 2017

The Future of Health Insurance May Look A Lot Like Our Past

by Craig Klugman, Ph.D.

This week marks the transition of power from President Obama to President-elect Trump. One issue that has been high on Trump’s list of policy changes is a repeal and replace of the Affordable Care Act (a.k.a.…

January 11, 2017

The Cost of Being Whole: Double-Standards and Discrimination in Trans Healthcare

by Jenji C. Learn, BA

How much are your genitals worth to you? Your beard? Your breasts?

What’s a reasonable price for them?…

January 9, 2017

Crossing the Line: When Doctors’ Beliefs Endanger Patients’ Autonomy and Health

by Craig M. Klugman, Ph.D.

In 2016 the Illinois legislature passed and Governor Bruce Rauner signed into law Public Act 099-690 (SB 1564), an amendment to the Health Care Right of Conscience Act.…

January 6, 2017

Party politics, people’s lives

As health care financing rises yet again to the top of our national legislative agenda, some fundamental questions ought to be strongly considered. First, and most fundamental: Is some level of healthcare a right, that the government is therefore obligated to protect? Is it better viewed as a common good, like roads and fire protection services, that everybody pays for through taxes and everybody benefits... // Read More »
January 6, 2017

BioethicsTV (January 2-6, 2017): Violating promises, coma v. PVS, transplant evaluation, and whether to abort

by Craig Klugman, Ph.D.

Pure Genius (Season1; Episode 10- 1/5). In this episode, Dr. Channarayapatra is working with a patient in lung failure.…

January 4, 2017

Last Days of the ACA

by Craig M. Klugman, Ph.D.

Politicians are notorious for making campaign promises and then not carrying them out. With the beginning of the 115th Congress, the GOP has doubled-down on its promise to repeal the Affordable Care Act (aka “Obamacare”).…

January 4, 2017

Ethics, Undocumented Immigrants and the Issue of Integration: Making a Better Life for Everyone in New York City

STUDENT VOICES By: Yohan Garcia This essay is in response to the Carnegie Council for Ethics in International Affairs video clip “Nisha Agarwal: IDNYC & the Undocumented Community.”   According to a study conducted by the Migration Policy Institute (MPI), an estimated 643,000 undocumented immigrants live within the five boroughs of New York City. Advocates of the New … More Ethics, Undocumented Immigrants and the Issue of Integration: Making a Better Life for Everyone in New York City
December 7, 2016

TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko

As one of the most groundbreaking sitcoms of all time, The Golden Girls introduced a range of bioethical issues on the show regarding medicine, the human body and women’s health. In this TEDx Talk, Dr. Elizabeth Yuko, a Fordham University Center for Ethics Education  fellow and adjunct professor, discusses how influential Golden Girls was, and still is, … More TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko
November 15, 2016

Making Progress in Improving End-of-Life Care

This past week the JAMA Network and the Kaiser Family Foundation published a one-page graphic providing the latest data and information about Medicare patients and end-of-life care. JAMA. 2016;316(17):1754. In 2014, there were 2.6 million total deaths in the US; 2.1 million or about 80% of the total were persons covered by Medicare. These 2.1 million 2014 Medicare decedents accounted for 13.5% of all Medicare spending. That is about $35,529 per Medicare beneficiary who died in 2014. Other Medicare beneficiaries – those who did not die in 2014 – cost the system about $9,121 per person. This is a remarkable difference from 1978, when Medicare decedents in the last year of life accounted for 28% of program expenditures. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328(15):1092-1096. Interestingly, the percentage between 1978 and 1988 did not change.

The new data show that trends have changed over the intervening decades. One of the more definitive descriptions of Medicare expenditures for beneficiaries in the last year of life was published in the New England Journal of Medicine in 1993. Lubitz JD, Riley GF. Trends in Medicare payments in the last year of life. N Engl J Med. 1993;328(15):1092-1096. In some respects the data may not be exactly the same, for example, one compares payments in calendar years, and the other the last 12 months of patients’ lives; but the trends are fairly clear anyway:

·         In 1988, Medicare charges for decedents were 6.9 times those for other Medicare patients. In 2014, Medicare charges for decedents were 3.7 times those for other Medicare patients. That was a 46% reduction in charges for end of life care from 1988.

·         In looking specifically at the 65-year-old range age group of Medicare beneficiaries who died in 1988 and 2014 respectfully, decedent charges were 10.6 and 7.4 times higher than other Medicare beneficiaries in the category. This was a 30% reduction in charges for end-of-life care from 1988.

·         In 2000, about 21% of Medicare patients who died that year received hospice care; in 2014, about 46% of Medicare patients who died that year received hospice care. The number of dying Medicare patients referred to hospice over the 14-year period more than doubled.

·         In 2000, total Medicare hospice spending was $2.3 billion; in 2014, total Medicare hospice spending was $10.4 billion. This was a 352% increase over the 14-year period. This growth comes primarily from the time a Medicare decedent is enrolled in a hospice program. The median length-of-stay in hospice has increased from 15 days in 1994 to 18 days in 2014, but the level of hospice services provided was enhanced. Taylor DH Jr, et al. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Social Science & Medicine. 2007;65(7):1466-1478. Curiously, the percentage of adult patients who died within 7 days of entering hospice care services increased from 22.8% in 1992 to 35.5% in 2014. Han B, et al. National trends in adult hospice use: 1991-1992 to 1999-2000. Health Affairs. 2006;25(3):792-799. National Hospice and Palliative Care Organization 2015 Facts and Figures.

Regardless, Medicare expenditures for beneficiaries in the last year of life are about half of what they were about 30 years ago. The emphasis on hospice and palliative care services for patients who are near death appears to be making a significant difference in a more appropriate allocation of health care resources while improving the quality of care. But unfortunately, we still have a long way to go in some areas: (1) Many persons 65 and older (73% of respondents) have not discussed end-of-life care preferences with a physician and 40% have not documented end-of-life wishes. (2) Moreover, two-thirds (68%) of physician respondents report not having been trained to discuss end-of-life care with patients.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 6, 2016

Another election, another round of health care reform

Now that we Chicagolanders don’t have the World Series to distract us anymore, we have to go back to thinking about the upcoming election. Health care financing is of course one important issue in the presidential race. One side wants to repeal and replace the Affordable Care Act (aka Obamacare), the other wants to keep it and work to fix it. Whoever wins, it’s evident... // Read More »

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Published Articles (2)

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy Douglas MacKay & Alexandra Robinson

American Journal of Bioethics: Volume 16 Issue 10 - Oct 2016

Governance of Transnational Global Health Research Consortia and Health Equity Bridget Pratt & Adnan A. Hyder

News (7)

January 20, 2017 9:00 am

New Common Rule on the Federal Policy for the Protection of Human Subjects (Federal Register)

The departments and agencies listed in this document announce revisions to modernize, strengthen, and make more effective the Federal Policy for the Protection of Human Subjects that was originally promulgated as a Common Rule in 1991. This final rule is intended to better protect human subjects involved in research, while facilitating valuable research and reducing burden, delay, and ambiguity for investigators.

December 14, 2016 9:00 am

Endgame in Aleppo, the most decisive battle yet in Syria’s war (Washington Post)

Aleppo would go down in history as one of the great failures of the international community to halt human rights abuses.

November 23, 2016 9:00 am

Young African women are especially vulnerable to HIV/AIDS (Science)

91% of new infections in the 15- to 19-year-old group were in adolescent girls.

November 22, 2016 9:00 am

Missouri appeals court rules frozen pre-embryos are marital property (Jurist)

Any frozen pre-embryos, fertilized eggs that are not implanted in the uterus, are legally classified as marital property

November 10, 2016 10:52 am

U.S. watchdog told Medicare, Medicaid that EpiPen was misclassified in 2009: senator (Reuters)

The internal watchdog at the U.S. Department of Health and Human Services warned the office tasked with administering federal health insurance programs that Mylan NV’s EpiPen was improperly classified as a generic drug in 2009, Senator Charles Grassley said on Tuesday.

November 2, 2016 8:00 am

Male Birth Control Injections Found Effective, But Study Cut Short Due to Side-Effects (US News)

New research published Thursday in The Journal of Clinical Endocrinology & Metabolismshows hormonal birth control injections for men could be effective. But don’t expect to see them on the market anytime soon. The study was cut short due to side effects including depression, mood changes and libido issues – in short, side effects similar to those experienced by women who take hormone-based birth control.

October 3, 2016 8:00 am

Furor Over Drug Prices Puts Patient Advocacy Groups in Bind (NY Times)

Public anger over the cost of drugs has burned hot for a year, coursing through social media, popping up on the presidential campaign, and erupting in a series of congressional hearings, including one last week over the rising price of the allergy treatment EpiPen.