Health disparities and inequities were of particular interest to SmartBrief readers in May, with many of them clicking on stories about difficult-to-afford drugs, gaps in mental health services and continued challenges with the nation’s maternal mortality rate. They also wanted to know how the financial health of US hospitals affects their own well-being and ability to access services.
Here’s a closer look at some of the most-read stories last month.
Weight loss, diabetes drugs tough for some to access
What happened: Insurance hurdles, growing demand, supply shortages and high costs may make it difficult for some residents of underserved communities to get GLP-1 drugs for diabetes and obesity. The blockbuster medications can cost upwards of $1,000 per month, and Medicare spending on three of them – Rybelsus, Mounjaro and Ozempic – took a jaw-dropping leap from $57 million in 2018 to $5.7 billion in 2022, KFF research showed. Some legislators contend the financial ramifications for government-funded insurance and the health care system could be serious – as could the health implications for patients with a low income who need the drugs.
What’s next: Sen. Bernie Sanders, I-Vt., chair of the US Senate Committee on Health, Education, Labor and Pensions, wrote a letter to manufacturer Novo Nordisk this spring, calling attention to the drugs’ high prices and the difficulty underserved patients have accessing them. “They’re kind of disadvantaged in multiple ways already, and this is just one more way,” Piedmont Healthcare endocrinologist Dr. Wedad Rahman said of many of her patients.
Physicians and drugmakers hope to control demand by discouraging cosmetic weight loss use of the drugs, and pharmaceutical companies said they are working to step up production. Medication substitutions and periods of transitioning on and off the drugs may be a reality for some patients in the meantime.
Mental health disparities feed into higher costs
What happened: Mental health inequities in the US are likely to cause nearly a half-trillion dollars in preventable costs through the end of this year, and expenditures could top $1 trillion by 2040 without intervention, a Deloitte report projected. Most of the unnecessary costs could be attributed to premature death and loss of productivity, particularly in certain demographics, researchers found. They also noted that in the early part of 2024, “excessive reliance” on emergency department care for mental health issues led to more than $5 billion in excess costs.
What’s next: Deloitte researchers said there still could be a break in the medical expenditure cost curve over the next decade and a half, due to prevention, diagnosis and treatment advancements, new technology, and gains in patient engagement. Racial and ethnic disparities in care access could be addressed with more culturally and language-appropriate services, some experts have noted, and others feel that integrating mental health care into primary care practices can help more patients get the care they need.
US maternal death rate dips, but disparities remain
What happened: CDC data indicate that the US maternal death rate declined significantly in 2022 after experiencing a sharp rise during the first part of the COVID-19 pandemic. A report showed that the rate decreased from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 per 100,000 a year later. That’s good news, but some marked inequities persist, including a higher maternal mortality rate for Black women than other groups. Dr. Angela Bianco of the Icahn School of Medicine at Mount Sinai said the prior uptick in maternal deaths may have been due in part to pandemic-related issues, but also to social and care access factors.
What’s next: Obstetrician/gynecologist Dr. Yolanda Lawson of the National Medical Association said she hopes the rate will continue to move in the right direction. Other research has shown that Nordic nations and Switzerland have the lowest maternal mortality rates among 17 high-income countries. The US mortality rate is the highest among these.
Hospital labor costs head upward as margins change
What happened: A Kaufman Hall National Hospital Flash Report showed US hospitals had thinner month-to-month operating margins in March, with lower patient volumes and revenue and increasing labor expenditures driving the trend. Staffing accounted for 84% of hospital expenses in the first quarter of this year. Hospitals are contending with a continuous cycle of high labor costs, subsequent staffing and shift cuts, employee dissatisfaction and turnover.
What’s next: Kaufman Hall researchers said at the time that narrow margin trends were likely to continue, with charity care expenses and bad debt contributing to the picture as well. However, in April, indicators such as margins, outpatient revenue and operating room minutes did increase, while average length of stay went down.
Erik Swanson of Kaufman Hall said in a recent interview that current trends may represent “a new normal” for the health care system. “Organizations who have weathered the challenges of the last few years have adopted a wide range of proactive and growth-related strategies, including improving discharge transitions and building a larger outpatient footprint,” he said.
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