Naseem S. Miller

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women’s Health (ORWH). "We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women’s Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women’s Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important," she said. "That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We’ve saved lives. A million at a time."

Women’s health goes beyond just women, Dr. Pinn said. "We don’t see women’s health research as for being just for women but really for the broader community."

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is "really about the future, not just the past."

There have been three women’s suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women’s Health (ORWH). "We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women’s Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women’s Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important," she said. "That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We’ve saved lives. A million at a time."

Women’s health goes beyond just women, Dr. Pinn said. "We don’t see women’s health research as for being just for women but really for the broader community."

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is "really about the future, not just the past."

There have been three women’s suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

BETHESDA, MD. – The next decade worth of research in women’s health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women’s Health at the National Institutes of Health.

"We need to continue the research that will help us better understand the health of women and of men," said Dr. Vivian W. Pinn, director of the Office of Research on Women’s Health (ORWH). "We need to continue to expand the scientific base and make sure we have better ... and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research."

The plan, "A Vision for 2020 for Women’s Health Research: Moving Into the Future With New Dimensions and Strategies," was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women’s Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

• Increase sex differences research in basic science studies.

• Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

• Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

• Create strategic alliances and partnerships to maximize the domestic and global impact of women’s health research.

• Develop and implement new communication and social networking technologies to increase understanding and appreciation of women’s health and wellness research.

• Employ innovative strategies to build a well-trained, diverse, and vigorous women’s health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women’s health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

"Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics," the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

"There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they’re important," she said. "That’s something that leaves me very concerned. We don’t have the power to change it. We just have to make pleas."

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women’s health research.

Scientists and policy makers gathered at the NIH meeting to celebrate 20 years of the ORWH.

Sen. Barbara Mikulski (D-Md.), who was among the first women in the Senate and was instrumental in the establishment of ORWH in 1990, encouraged the audience to continue work and research on women’s health, because that’s one issue that goes beyond party lines, she said. She summed up the history of ORWH in two sentences: "We’ve saved lives. A million at a time."

Women’s health goes beyond just women, Dr. Pinn said. "We don’t see women’s health research as for being just for women but really for the broader community."

Dr. Bernadine Healy, the first female NIH director and current health editor at U.S. News and World Report, said on Monday that research on women’s health is "really about the future, not just the past."

There have been three women’s suffrage movements, according to Dr. Healy. "First, was women getting to vote. Second, was women getting educated and getting access to jobs. And the third, we’re in the midst of it. It’s been primed for the past 20 years and it’s going to continue. It’s about women and men being equal when it comes to their access to health care and health information, health knowledge and health leadership."

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

The Food and Drug Administration has recalled millions of glucose test strips because they may be giving low blood glucose results due to their inability to absorb enough blood.

The agency has recommended that consumers and health care professionals immediately discontinue using the affected test strips and switch to an unaffected product.

As many as 359 million strips, which are sold directly to consumers in online or retail stores, and which are used in health care facilities, may be affected by the recall, according to the FDA. The test strips were manufactured between January and May 2010 and have been distributed in the United States and Puerto Rico.

The test strips were manufactured by Abbott and marketed under the following brand names: Precision Xceed Pro; Precision Xtra; Medisense Optium; Optium; OptiumEZ; and ReliOn Ultima. The strips are used with Abbott’s blood glucose monitoring systems, which have the same brand names but are not affected by this recall, according to the FDA.

"Patients with diabetes should be aware of the recalled glucose test strips and take steps to prevent them from affecting their health," Alberto Gutierrez, Ph.D., director for the Office of In Vitro Diagnostic Device Evaluation and Safety at the FDA Center for Devices and Radiological Health, said in a statement. "FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future."

For more information on the recalled products, call Abbott Diabetes Care customer service at 1-800-448-5234 (English) or 1-800-709-7010 (Spanish), or visit precisionoptiuminfo.com to look up test strip lot numbers.

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners' shoulders and question what it is that they're doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America's Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans' administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. For more information, visit http://www.hhs.gov/ociio/initiative/index.html.

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners' shoulders and question what it is that they're doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America's Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans' administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. For more information, visit http://www.hhs.gov/ociio/initiative/index.html.

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners' shoulders and question what it is that they're doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America's Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans' administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. For more information, visit http://www.hhs.gov/ociio/initiative/index.html.

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In an effort to control rising health insurance rates and to bring transparency to the market, the federal government today announced new proposed rules requiring insurers to publicly disclose and justify large rate increases.

Starting in January, proposed rate increases of 10% or higher will be publicly disclosed and reviewed to determine if the rate increase is reasonable, Health and Human Services Secretary Kathleen Sebelius announced Dec. 21. The effort will be conducted in collaboration with the states.

[Virginia Judge Strikes Down Individual Health Insurance Mandate]

The initial threshold for review is set at 10% next year, Ms. Sebelius said; however, starting in 2012, the states will set their own thresholds based on data and trends they gather. If a state is unable to do so, the proposed rule allows the HHS to do so.

Beginning in 2014, states will be able to exclude from the new health insurance exchanges any health plans that show a pattern of excessive or unjustified premium increases.

Ms. Sebelius said that the states will have the responsibility to keep insurance rates in check, and that the federal government is "not going to be sitting on state commissioners’ shoulders and question what it is that they’re doing."

Over the past decade, the average health insurance premiums for family coverage have risen 131%, according to the HHS. Some states such as Connecticut and Rhode Island already have the power to review and reject excessive rate increases but not all do and some lack the legal authority or resources to do so.

[Family Physicians Face Reform's Regulatory Challenges]

"The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified," Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, said in a statement.

The Affordable Care Act makes $250 million available to states to take action against insurers seeking unreasonable rate hikes, and so far $46 million has been awarded to 45 states and the District of Columbia for improving oversight of health insurance rate increases, according to the HHS. The proposed rules will also work in conjunction with medical loss ratio regulations, which were released in November.

In a statement, Karen Ignani, president and CEO of the insurance trade group America’s Health Insurance Plans, said, "While the proposed rule gives consideration to the impact of rising medical costs, it also establishes a threshold for review that is incomplete because it does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage. Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees, and of the individual market in which people move in and out of coverage depending on whether they anticipate needing medical services." She added, "It is also important to remember that the new federal law already caps health plans’ administrative costs and profits. We welcome the opportunity to submit comments on this proposed rule."

The proposed rule will be open for public comment once it has been published in the Federal Register. A final rule could be issued in 6 months. More information is available on the HHS website. 

[U.S. Falls Behind 10 Other Countries on Access, Cost of Care]

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

In two similar Texas cities with a nearly twofold difference in Medicare spending, a new study released Dec. 7 has found there is very little difference between the two cities in private insurance spending on patients under age 65.

Wide variations in Medicare spending in the Texas cities of McAllen and El Paso were detailed in a 2009 New Yorker article by Dr. Atul Gawande, who examined data from the Dartmouth Atlas of Health Care. He attributed those variations to changes in McAllen during the mid-1990s, when health care providers adopted a greater "entrepreneurial spirit" and a "culture of money" that increases the use of profitable Medicare services when there is diagnostic and procedural discretion and clinical latitude.

Given that the same providers who care for Medicare patients generally also care for privately insured patients, researchers in the new study sought to determine whether spending also differed for privately insured patients under age 65 in the same cities.

Luisa Franzini of the Fleming Center for Healthcare Management at the University of Texas, in Houston, and her associates used price-adjusted Medicare claims data for 2007, removing all regional differences in prices to construct a price-neutral index of the use of medical services. They also considered a variety of health indicators such as hip fracture rates and cardiovascular and cancer mortality in the two regions that could explain observed differences in Medicare.

The researchers also obtained 2008 data for 65,701 Blue Cross and Blue Shield of Texas members in McAllen (Hidalgo County) and 66,657 in El Paso. With approximately 4.5 million members and one-third of the statewide commercial health insurance market, Blue Cross and Blue Shield of Texas is the largest commercial health insurance company in the state and the only statewide, customer-owned health insurance company. The data represented 10% of the population younger than age 65 in each county (Health Affairs 29, No. 12 (2010): 2302-2309) doi: 10.1377/hlthaff.2010.0492).

Total price-adjusted Medicare spending was 86% higher in McAllen than in El Paso, and was 75% above the national average in 2007. Medicare spending in McAllen was 63% higher than in El Paso for inpatient care, 32% higher for outpatient care, and 65% higher for Part B professional services. There was little difference in spending for durable medical equipment.

For home health care, spending in McAllen was 4.63 times the average in El Paso, and 7.14 times the national average. Hospice spending in McAllen was one-quarter of the level in El Paso and the United States. Further, Medicare enrollees in McAllen were more likely to be seen near the end of their lives by more than 10 physicians.

In contrast, for private insurance patients under age 65, total spending per member per year in McAllen ($2,266) was 7% lower than in El Paso ($2,428).?Outpatient services spending was 31% lower, and professional and inpatient services spending were similar or lower in McAllen, compared with El Paso.

For members aged 50-64, however, inpatient admissions for the privately insured population were 89% higher, and per patient inpatient spending was 117% higher in McAllen than in El Paso. The difference is roughly the same as that seen in Medicare spending. Due to lower outpatient spending, the overall spending in McAllen for this age group was 23% higher – still well below the 86% Medicare differential between the two cities.

In a blog post about the Health Affairs study, Dr. Gawande wrote, "But there is an important revelation here: not all the health care in a high-cost community has to be out of whack. The questions we then must ask are why the pattern is different for some groups of people, and whether such differences suggest ways to change the pattern for everyone."

The authors said the most probable explanation for their findings was payers’ cost-control mechanisms, especially in "gray zones of treatment." For patients with chronic conditions, for example, Blue Cross and Blue Shield of Texas has management programs and several mechanisms that encourage cost-effective care. "All elective inpatient admissions must be preauthorized, and counseling before admission and after discharge is used to establish postoperative goals and identify discharge planning needs. Furthermore, triggers such as a catastrophic event or claims higher than $50,000 per month activate a case management process that entails reviews of potential alternative treatment plans and follow-up after discharge from acute care.

"In contrast, there are fewer medical service controls in Medicare. Although the federal government can threaten providers with jail time and fines for fraud, unreasonable and unnecessary treatments are rarely monitored or prosecuted. Furthermore, it is unclear how the "utilization review plan" would be expected to scale back the use of medical services in practice. Medicare still enjoys some advantages over private insurance in its ability to set prices for payment to providers. Private insurance companies by contrast must negotiate prices. Yet for managing the use of medical services, private insurers have the advantage of a "threat point" at which they can ultimately refuse to contract for services to specific physicians or hospitals—something that Medicare cannot do," the researchers wrote.

The researchers acknowledge that their study is limited by a lack of good data on pricing, outcomes, and clinical services for the population under age 65. Also, the sample population was not representative of the entire under-65 population in the two cities.

BETHESDA, MD. — Physicians face several barriers when it comes to immunizing adolescents, including infrequent access to the age group, low reimbursements, difficulty tracking immunization history, and lack of education about vaccine safety, Dr. Amy B. Middleman said.

The 2009 National Immunization Survey shows that the vaccination rates “remain unacceptably low for those vaccines that are targeted specifically to prevent disease in adolescents,” according to a Society for Adolescent Health and Medicine (SAHM) statement. The survey shows that among 13- to 17-year-old teens, roughly 54% received meningococcal meningitis vaccines; 44% got human papillomavirus (HPV) vaccine (with only 27% receiving all three recommended doses), and nearly 56% got tetanus-diphtheria-pertussis (Tdap) vaccines.

“Low rates among adolescents may be responsible for the epidemic of pertussis that is presently occurring in California,” according to the SAHM statement.

But there are opportunities to improve adolescent immunization rates, Dr. Middleman said at the meeting, which was sponsored by the National Foundation for Infectious Diseases.

Some polls show that 80% or more of adolescents have visited a health care provider within the last 12 months, but those visits may not necessarily be preventive in nature, and physicians can turn them into comprehensive visits and update the patients' vaccinations, said Dr. Middleman, who is an SAHM liaison to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Reimbursement rates are another barrier, Dr. Middleman pointed out, saying that there is a “significant correlation between reimbursement rates and childhood immunizations,” with a correlation of 0.42 (Pediatrics 2006;115:833). A 2009 Pediatrics article (124:S466-71) shows that 49% of primary care physicians delayed vaccine purchase because of finances, and 53% had decreased profit margins due to immunizations.

There is a need for a standardized vaccination visit during adolescence, said Dr. Middleman, and so far state policies and school mandates have shown a great impact on increasing the rates.

For instance, a 2004 study showed that adolescents were significantly more likely to have completed their hepatitis B series in states with school mandates (75%) versus those without a mandate (39%), she said (J. Adolesc. Health 2004;34:420-23). Such mandates also help eliminate preventive care disparities, given available funding, she added.

Dr. Middleman said that in one of her recent surveys in Houston, 41% of the parents indicated they would be willing to immunize their children in schools (Vaccine 2010;28:2674-6).

The rate, however, varies depending on the type of vaccines, with the influenza vaccine getting the highest support (57% of parents) and human papillomavirus the least (27%), according to one study (J. Adolesc. Health 2010;47:249-53). She added that other studies have shown that as many as 88% of practicing pediatricians are receptive to programs such as school vaccinations, and 61% said they would participate in such programs (BMC Pediatrics 2009;9:8).

In addition, alternative immunization sites, such as pharmacies, city and county clinics, emergency departments, and even ob.gyn. offices and clinics, provide additional opportunities to immunize the adolescent age group. Dr. Middleman said there are drawbacks for alternative sites, including poor follow-up and lack of access to immunization information systems. But there are potential benefits for adolescents who lack a medical home or need to complete multiple-dose regimens.

Immunization Information Systems are another tool recommended by the National Vaccine Advisory Committee and the National Immunization Program as a way to consolidate fragmented records and automate reminders and recalls. Such programs have been very successful, even in extreme situations such as Hurricane Katrina, she said.

Dr. Middleman stressed the importance of education about vaccine recommendations and safety for physicians, their staff, and parents. She recommended physicians “capitalize on noncomprehensive visits” such as camp or sports physicals or precollege visits to immunize the otherwise-hard-to-reach adolescents.

Dr. Middleman said that she receives research funding from Sanofi Pasteur and MedImmune.

Resources for Immunization Info.

▸ Centers for Disease Control and Prevention:

www.cdc.gov/vaccines

▸ Immunization Action Coalition:

www.immunize.org

▸ National Foundation for Infectious Diseases:

www.nfid.org

▸ National Network for Immunization Information:

www.immunizationinfo.org

▸ Texas Children's Hospital Center for Vaccine Awareness and Research:

www.texaschildrens.org/vaccines

BETHESDA, MD. — Physicians face several barriers when it comes to immunizing adolescents, including infrequent access to the age group, low reimbursements, difficulty tracking immunization history, and lack of education about vaccine safety, Dr. Amy B. Middleman said.

The 2009 National Immunization Survey shows that the vaccination rates “remain unacceptably low for those vaccines that are targeted specifically to prevent disease in adolescents,” according to a Society for Adolescent Health and Medicine (SAHM) statement. The survey shows that among 13- to 17-year-old teens, roughly 54% received meningococcal meningitis vaccines; 44% got human papillomavirus (HPV) vaccine (with only 27% receiving all three recommended doses), and nearly 56% got tetanus-diphtheria-pertussis (Tdap) vaccines.

“Low rates among adolescents may be responsible for the epidemic of pertussis that is presently occurring in California,” according to the SAHM statement.

But there are opportunities to improve adolescent immunization rates, Dr. Middleman said at the meeting, which was sponsored by the National Foundation for Infectious Diseases.

Some polls show that 80% or more of adolescents have visited a health care provider within the last 12 months, but those visits may not necessarily be preventive in nature, and physicians can turn them into comprehensive visits and update the patients' vaccinations, said Dr. Middleman, who is an SAHM liaison to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Reimbursement rates are another barrier, Dr. Middleman pointed out, saying that there is a “significant correlation between reimbursement rates and childhood immunizations,” with a correlation of 0.42 (Pediatrics 2006;115:833). A 2009 Pediatrics article (124:S466-71) shows that 49% of primary care physicians delayed vaccine purchase because of finances, and 53% had decreased profit margins due to immunizations.

There is a need for a standardized vaccination visit during adolescence, said Dr. Middleman, and so far state policies and school mandates have shown a great impact on increasing the rates.

For instance, a 2004 study showed that adolescents were significantly more likely to have completed their hepatitis B series in states with school mandates (75%) versus those without a mandate (39%), she said (J. Adolesc. Health 2004;34:420-23). Such mandates also help eliminate preventive care disparities, given available funding, she added.

Dr. Middleman said that in one of her recent surveys in Houston, 41% of the parents indicated they would be willing to immunize their children in schools (Vaccine 2010;28:2674-6).

The rate, however, varies depending on the type of vaccines, with the influenza vaccine getting the highest support (57% of parents) and human papillomavirus the least (27%), according to one study (J. Adolesc. Health 2010;47:249-53). She added that other studies have shown that as many as 88% of practicing pediatricians are receptive to programs such as school vaccinations, and 61% said they would participate in such programs (BMC Pediatrics 2009;9:8).

In addition, alternative immunization sites, such as pharmacies, city and county clinics, emergency departments, and even ob.gyn. offices and clinics, provide additional opportunities to immunize the adolescent age group. Dr. Middleman said there are drawbacks for alternative sites, including poor follow-up and lack of access to immunization information systems. But there are potential benefits for adolescents who lack a medical home or need to complete multiple-dose regimens.

Immunization Information Systems are another tool recommended by the National Vaccine Advisory Committee and the National Immunization Program as a way to consolidate fragmented records and automate reminders and recalls. Such programs have been very successful, even in extreme situations such as Hurricane Katrina, she said.

Dr. Middleman stressed the importance of education about vaccine recommendations and safety for physicians, their staff, and parents. She recommended physicians “capitalize on noncomprehensive visits” such as camp or sports physicals or precollege visits to immunize the otherwise-hard-to-reach adolescents.

Dr. Middleman said that she receives research funding from Sanofi Pasteur and MedImmune.

Resources for Immunization Info.

▸ Centers for Disease Control and Prevention:

www.cdc.gov/vaccines

▸ Immunization Action Coalition:

www.immunize.org

▸ National Foundation for Infectious Diseases:

www.nfid.org

▸ National Network for Immunization Information:

www.immunizationinfo.org

▸ Texas Children's Hospital Center for Vaccine Awareness and Research:

www.texaschildrens.org/vaccines

BETHESDA, MD. — Physicians face several barriers when it comes to immunizing adolescents, including infrequent access to the age group, low reimbursements, difficulty tracking immunization history, and lack of education about vaccine safety, Dr. Amy B. Middleman said.

The 2009 National Immunization Survey shows that the vaccination rates “remain unacceptably low for those vaccines that are targeted specifically to prevent disease in adolescents,” according to a Society for Adolescent Health and Medicine (SAHM) statement. The survey shows that among 13- to 17-year-old teens, roughly 54% received meningococcal meningitis vaccines; 44% got human papillomavirus (HPV) vaccine (with only 27% receiving all three recommended doses), and nearly 56% got tetanus-diphtheria-pertussis (Tdap) vaccines.

“Low rates among adolescents may be responsible for the epidemic of pertussis that is presently occurring in California,” according to the SAHM statement.

But there are opportunities to improve adolescent immunization rates, Dr. Middleman said at the meeting, which was sponsored by the National Foundation for Infectious Diseases.

Some polls show that 80% or more of adolescents have visited a health care provider within the last 12 months, but those visits may not necessarily be preventive in nature, and physicians can turn them into comprehensive visits and update the patients' vaccinations, said Dr. Middleman, who is an SAHM liaison to the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Reimbursement rates are another barrier, Dr. Middleman pointed out, saying that there is a “significant correlation between reimbursement rates and childhood immunizations,” with a correlation of 0.42 (Pediatrics 2006;115:833). A 2009 Pediatrics article (124:S466-71) shows that 49% of primary care physicians delayed vaccine purchase because of finances, and 53% had decreased profit margins due to immunizations.

There is a need for a standardized vaccination visit during adolescence, said Dr. Middleman, and so far state policies and school mandates have shown a great impact on increasing the rates.

For instance, a 2004 study showed that adolescents were significantly more likely to have completed their hepatitis B series in states with school mandates (75%) versus those without a mandate (39%), she said (J. Adolesc. Health 2004;34:420-23). Such mandates also help eliminate preventive care disparities, given available funding, she added.

Dr. Middleman said that in one of her recent surveys in Houston, 41% of the parents indicated they would be willing to immunize their children in schools (Vaccine 2010;28:2674-6).

The rate, however, varies depending on the type of vaccines, with the influenza vaccine getting the highest support (57% of parents) and human papillomavirus the least (27%), according to one study (J. Adolesc. Health 2010;47:249-53). She added that other studies have shown that as many as 88% of practicing pediatricians are receptive to programs such as school vaccinations, and 61% said they would participate in such programs (BMC Pediatrics 2009;9:8).

In addition, alternative immunization sites, such as pharmacies, city and county clinics, emergency departments, and even ob.gyn. offices and clinics, provide additional opportunities to immunize the adolescent age group. Dr. Middleman said there are drawbacks for alternative sites, including poor follow-up and lack of access to immunization information systems. But there are potential benefits for adolescents who lack a medical home or need to complete multiple-dose regimens.

Immunization Information Systems are another tool recommended by the National Vaccine Advisory Committee and the National Immunization Program as a way to consolidate fragmented records and automate reminders and recalls. Such programs have been very successful, even in extreme situations such as Hurricane Katrina, she said.

Dr. Middleman stressed the importance of education about vaccine recommendations and safety for physicians, their staff, and parents. She recommended physicians “capitalize on noncomprehensive visits” such as camp or sports physicals or precollege visits to immunize the otherwise-hard-to-reach adolescents.

Dr. Middleman said that she receives research funding from Sanofi Pasteur and MedImmune.

Resources for Immunization Info.

▸ Centers for Disease Control and Prevention:

www.cdc.gov/vaccines

▸ Immunization Action Coalition:

www.immunize.org

▸ National Foundation for Infectious Diseases:

www.nfid.org

▸ National Network for Immunization Information:

www.immunizationinfo.org

▸ Texas Children's Hospital Center for Vaccine Awareness and Research:

www.texaschildrens.org/vaccines

BETHESDA, MD. — The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). “We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The plan, “A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies,” was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

▸ Increase sex differences research in basic science studies.

▸ Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

▸ Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

▸ Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

▸ Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

▸ Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important,” she said. “That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Women's health goes beyond just women, Dr. Pinn said. “We don't see women's health research as for being just for women but really for the broader community.”

BETHESDA, MD. — The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). “We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The plan, “A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies,” was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

▸ Increase sex differences research in basic science studies.

▸ Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

▸ Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

▸ Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

▸ Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

▸ Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important,” she said. “That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Women's health goes beyond just women, Dr. Pinn said. “We don't see women's health research as for being just for women but really for the broader community.”

BETHESDA, MD. — The next decade worth of research in women's health should focus on increasing understanding of the role of sex factors in differential disease risk, vulnerability, progression, and outcomes, as well as the effects of being female on health, according to the strategic plan for the Office of Research on Women's Health at the National Institutes of Health.

“We need to continue the research that will help us better understand the health of women and of men,” said Dr. Vivian W. Pinn, director of the Office of Research on Women's Health (ORWH). “We need to continue to expand the scientific base and make sure we have better … and more effective ways of communicating the results of that research to women as well as to health care providers so that they have the benefits of that research.”

The plan, “A Vision for 2020 for Women's Health Research: Moving Into the Future With New Dimensions and Strategies,” was unveiled at a meeting to celebrate the 20th anniversary of the creation of the NIH Office of Research on Women's Health.

The strategic plan, the third agenda-setting report produced by ORWH over the past 20 years, specifies six goals:

▸ Increase sex differences research in basic science studies.

▸ Incorporate findings of sex/gender differences in the design and application of new technologies, medical devices, and therapeutic drugs.

▸ Actualize personalized prevention, diagnostics, and therapeutics for girls and women.

▸ Create strategic alliances and partnerships to maximize the domestic and global impact of women's health research.

▸ Develop and implement new communication and social networking technologies to increase understanding and appreciation of women's health and wellness research.

▸ Employ innovative strategies to build a well-trained, diverse, and vigorous women's health research workforce.

Despite better understanding of certain diseases, little progress has been made in addressing debilitating conditions such as autoimmune diseases, addiction, lung cancer, and dementia, according to a recent Institute of Medicine committee report. There are still health disparities among different groups of women, and the impact of social and behavioral factors on women's health is not yet well-understood, according to the IOM report.

According to the ORWH strategic plan, research going forward must reach into a number of different areas.

“Sex differences research is needed not only in fields such as endocrinology and immunology, but also in rapidly evolving areas such as epigenetics, systems biology, and neuroscience; and new technology–enabled fields such as genomic, proteomics and metabolomics,” the plan points out.

And there still remains a disconnection between research and the literature available to health care providers, Dr. Pinn said.

“There has been great variation in the receptivity of different professional and scientific journals in addressing sex differences or accepting results of sex difference analyses or believing they're important,” she said. “That's something that leaves me very concerned. We don't have the power to change it. We just have to make pleas.”

The ORWH strategic plan calls for partnerships across NIH, academia, and the advocacy and public policy groups for a better understanding of women's health research.

Women's health goes beyond just women, Dr. Pinn said. “We don't see women's health research as for being just for women but really for the broader community.”