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Hedlines: August 23, 2010

by Meg Larkin


            First, a clinic in Virginia is stirring up a debate over health care provider concentration.  The Carilion Clinic owns eight hospitals and employs 550 doctors, and it has set off a debate over whether such concentration is good for patients, or whether it is simply monopolization.  Carilion claims that its large network will improve patient care by enabling better integration of and accountability for patient services.  However, opponents of such concentration claim that it is Carilion is building a monopoly, which will enable it to raise prices above a competitive level.  In the meantime, Carilion is using its expanded staff to encourage the medical home model of care, and increase patient adherence to medical treatment.

            In health reform news, the new federal law may improve available health care for the nation’s homeless population.  Under the health reform law, the Medicaid program will be expanded to cover a greater number of childless adults, which will bring more homeless people into the joint State-Federal health insurance program for the poor.  The increase in Medicaid availability is expected to enable organizations that traditionally provide health care aid to the homeless to use those resources to other services, such as employment and housing assistance.  However, the Medicaid expansion faces barriers in reaching the homeless population because of difficulties finding and registering homeless persons, among other things. 

            In regulatory news, the FDA has shown signs of taking action to reduce the risk of accidental injury caused by similar looking hospital tubes.  Although the exact number of errors is unknown, many patients are seriously injured when a tube designed to provide food or medication is hooked up to a connection designed to provide a different type of substance.  Examples include feeding tubes being hooked up to IV lines, or anesthetics being hooked into tubes designed to provide oxygen.  According to the New York Times, “Experts and standards groups have advocated since 1996 that tubes for different functions be made incompatible — just as different nozzles at gas stations prevent drivers from using the wrong fuel.  But action has been delayed by resistance from the medical-device industry and an approval process at the Food and Drug Administration that can discourage safety-related changes.”  While FDA officials have begun to question applications for approval of tubes that have connections compatible with other types of tubes, flaws in the regulatory process lead to these devices being almost automatically approved.  The Times reported that, “The F.D.A. is in the midst of a wide-ranging reassessment of its device approval process and released a report  Aug. 4 that highlighted some of its flaws, including approvals of devices modeled on unsafe or obsolete predecessors.”

            Finally, in international health news, India is using cash bonuses to encourage newlyweds to delay pregnancy.  By encouraging couples to delay having children, India hopes to gain more time to deal with the problem of a rapidly growing population.  If India’s population growth continues at its current rate, India’s population is expected to surpass that of China in the coming decades.  As a democracy, India has struggled with the issue of population control, and different states have taken different approaches to the issue that range from permissive to coercive.  In rural states, other measures taken have included discouraging teenage marriages and informing couples about birth control options and the opportunities that may be provided by delaying pregnancy.  However, initiatives to delay child birth have been met with resistance from older generations who believe that couples should have children soon after marriage. 


Meg Larkin is a law student at Boston University.  Please feel free to email her with any comments, questions, suggestions or concerns.    


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