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7 days in healthcare (April 3rd-9th, 2023)

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Summary

From the point of view of Biomedicine, vaccines against cancer and heart disease, based on mRNA technology, which are looming on the horizon 2030, seem to be the next great advance in medicine, potentially saving millions of lives. The Economist dedicates an article and an editorial to demonstrate the weak evidence for the therapy of gender transitions in adolescents, especially when they include pharmacological or surgical medication. Contrary to what had been a very popular assumption, moderate alcohol consumption does not produce health benefits, according to a study of more than 40 years published by the JAMA Network Open. Rather the opposite is true.

As regards Global Health, the WHO, born after the Second World War, is celebrating its 75th anniversary. He has emerged from the pandemic with injuries and issues, but acutely aware of his mission, purpose, and need for change. One of the problems it encounters is the discrepancies between countries in the discussion of a treaty on pandemics, which it intends to be approved in 2024. The Lancet publishes several articles on the commercial determinants of health, a subject of great interest. interest. Four industries – tobacco, unhealthy eating, oil and fossil fuels, and alcohol – are responsible for a third of deaths each year globally.

As for International Health Policy, in the United States, a federal judge in Texas has just banned the use of an abortion drug, which had been approved by the FDA more than 20 years ago. In France, the citizens’ convention, made up of 184 citizens chosen by lot, has just ruled in favor of euthanasia and assisted suicide, although with certain “red lines”. Macron wants to discuss the bill before the summer.

If we talk about National Health Policy (Spain), surgical waiting lists set a new record, according to the report made public by the Ministry of Health, with data as of December 31, 2022. Almost 900,000 people waiting for a surgical intervention. An absolutely delegitimizing element of the system. As is well known, the Ministry only makes public the waiting lists for surgical intervention or specialist consultations, but not for special tests (radiology, radiotherapy, ultrasound, etc.), on which there are no national data, although there are some autonomous communities. Interesting article published in Gaceta Sanitaria on the economic impact of including dental care in public coverage. This is an issue that the majority political parties have been pronouncing in favor of for several years, but nothing has been done on it. Spain is possibly the European country with the least percentage of its health spending devoted to dental care. The declarations of the Minister of Health of Catalonia are surprising, justifying the dismissal of the nurses who criticized the Catalan C1. Since this type of statement about specific dismissals is not common among regional ministers, it is to be assumed that there is an important political background. The decision of Navarra and Asturias to launch public companies, one for medical transport and another for a hospital laundry, is also surprising. Wouldn’t there have been the possibility of resorting to private initiative to solve these needs, perhaps more efficiently than through a public company?

In the field of Companies, internationally, agreement between Medtronic and Davita to launch Mozarc. At the national level, it is worth noting the start of work on the Viamed hospital in Tarragona, and the separation of the “pharmacy” and “chemistry” areas of the company Esteve.

Biomedicine

Global Health

International Health Policy

National Health Policy

Companies

 

 

Dental coverage in Medicare in the United States

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See PDF of the article:

 

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In a recent issue of N Engl J Med (December 2, 2021), the subject of Medicare dental coverage, currently excluded, and the many attempts to introduce it are discussed.

The article mentions that in 1958 the American Medical Association, the American Dental Association and other professional organizations created the Joint Council to Improve Health Care of the Aged, whose objective was to oppose the creation of what would later become Medicare (medical care public to those over 65 in the United States).

Despite that, Medicare was created in 1965, without dental care being covered. From this point of view we can say that the doctors lost, but the dentists won. Dental care continues to operate under a fee-for-service formula, with a high proportion of the cost of out-of-pocket money and with greater financial barriers than in other forms of health care.

After decades of attempts to cover dental care with Medicare, it appears that the American government is close to achieving this goal. There was a previous attempt in 2019 through a law passed in the House of Representatives, but rejected by the Senate. A law with similar claims was introduced in Congress in 2021, forming part of Joe Biden’s “reconciliation package.” The Centers for Medicaid and Medicare have already appointed a “chief dental officer.”

This time, the American Dental Association supports the introduction of dental care into Medicare, but only if it only covers people below 300% of the FPL (federal poverty level).

The health system in general is assuming the problems of the absence of dental coverage, in the form of millions of patients, including older adults, who present themselves in the emergency areas, hospitals and primary care for dental pain, a visit that generally concludes with the recommendation to go to a dentist, which many cannot afford. Untreated dental disease can lead to endocarditis, brain abscess, and mediastinitis.

Even if the law that includes dental care in Medicare is finally signed, many problems will remain to be solved, such as the need to enroll dental providers.

In any case, if this measure is finally introduced, it will have been a giant step in the improvement of American healthcare and, this time, with beneficial consequences for Europe and, specifically, for Spain, the country that dedicates the least public budget to dental care in European countries.