Consumer-directed health plans (CDHPs) are attracting new interest as a result of a ruling by the Internal Revenue Service (IRS) over what constitutes preventive services. CDHP benefit designs take various forms, but in general, these are low-premium, high-deductible plans that provide full or close to full coverage for enrollees once the deductible is met and are typically tied to a health savings account (HSA).
A proposal by the Centers for Medicare & Medicaid Services (CMS) published in the January 8 issue of the Federal Register would allow stand-alone Part D plans to offer reduced premiums to enrollees with limited incomes and resources-a rule intended to give such enrollees in each Medicare prescription drug benefit region at least 5 options with no monthly premium.
Health care spending in the United States increased 6.7% in 2006 to $2.1 trillion or $7026 per person. Prescription drug costs increased faster, up 8.5% to $216.7 billion from 5.8% in 2005, and were spurred in part by the launch of the Medicare Part D prescription drug benefit in 2006 (Cover Figure).
According to a survey published in January by the International Foundation of Employee Benefit Plans (IFEBP), Brook field, Wis (http://www.ifebp.org), US employers are increasingly covering alternative/complementary therapies and medical tourism as part of their health benefit cost-containment efforts. Currently, chiropractic care is covered by 80.5% of employers, and 33.5% of employers cover acupuncture or acupressure expenses. The IFEBP survey found that medical tourism-a practice in which US residents travel to other nations, such as India, Mexico,and Thailand, to obtain lower-cost treatment (Figure), including heart bypass surgery and hip or knee replacement surgery-is covered by 11% of employers.
Dr Thomas Fekete's recent article on emerging infections (CONSULTANT, October 2007) was timely, given recent evidence that the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection, both hospital-acquired and community-acquired, has assumed pandemic proportions.
NEARLY A THIRD (31%) of personsliving with tuberculosis (TB) are unawareof their HIV status, accordingto a study highlighted in the CDC'sMorbidity and Mortality Weekly Report(Reported HIV status of tuberculosispatients-United States, 1993-2005.MMWR. 2007;56:1103-1106). Thestudy evaluated retrospective healthdata from 49 states and the Districtof Columbia and found that eventhough reporting status of personswith TB increased from 35% in 1993to 68% in 2003, it has remainedrelatively unchanged since then.
HIV infection continues to exact a devastating toll worldwide.Advances in antiretroviral therapy have helped bring theHIV/AIDS epidemic under control in developed countries.Antiretroviral drugs, however, are not widely available inthose developing countries where HIV poses a catastrophicthreat. Effective strategies for HIV prevention are thereforecrucial to curbing the global epidemic. Vaccination, microbicideuse, and male circumcision are 3 key preventive interventions.Current research is focused on developing effective vaccinesand microbicides and on determining the extent to whichcircumcision helps prevent HIV acquisition and transmission.[Infect Med. 2008;25:63-72]
Critical ViewsinInfectiousDiseaseMedicine A
Several reports have documented an increased incidence of smooth muscle tumors in patients with AIDS and in those with other immunocompromised conditions.
Recently the CDC released a report of a study on coinfection with HIV and Mycobacterium tuberculosis that found that many US patients with tuberculosis (TB) are still not being tested for HIV.
Reviewing just a 2-month interval of HIV/AIDS-related publications and announcements, from mid-September to mid-November of 2007, produced discouraging news in 3 key areas: vaccine development, female-initiated barrier protection, and HIV treatment in the resource-poor world.
We evaluated a cohort of persons with late-stage HIV infection currently enrolled in a longitudinal tracking study to determine whether coinfection with hepatitis C virus (HCV) is associated with a greater prevalence and/or severity of HIV-associated cognitive-motor complex and distal predominantly sensory peripheral polyneuropathy compared with persons with HIV infection alone
Writing a book about the history of anything is an ambitious undertaking, and this book is no different. For those of us who witnessed HIV from the beginning of its re-corded history, Engel does a good job of hitting the highlights and examining the issues.
Imagine yourself living with a chronic infection and-after trying your best to adhere to the recommended course of treatment-being told by your doctor: “You have failed your medication. The most we can do now is salvage therapy.
Much has been written about the increase in non–AIDS-defining cancers in HIV-infected persons over the past decade.
Cinti and colleagues1 call further attention to an increasing concern for people living with HIV infection and those providing their care: the increased risk of cancers that are not considered AIDS-defining events.
The first step in the workup of a patient with a persistent asymptomatic alkaline phosphatase (ALP) elevation is to measure gamma-glutamyltranspeptidase to determine whether the elevation is liver-related or bone-related.
Bipolar disorder (also known as manic-depressive illness) affects nearly 6 million adults in the United States.1 This psychiatric disorder was first described at the time of Hippocrates and is currently one of the most prevalent and severe mental illnesses in our society.
To help answer the question of Mary Ellen Lewis, PA-C, about her patient with a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 100 mg/dL(CONSULTANT, June 2007), I would like to describe my approach to the treatment of dyslipidemia.
Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.
