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Time for change: PhRMA survey shows insurance creates barriers to healthcare in US

Health insurance is not enough to provide the necessary affordable access to care for the US’ most vulnerable,
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Health insurance is not enough to provide the necessary affordable access to care for the US’ most vulnerable, finds new PhRMA report.

For too many Americans, insurance coverage is not providing the health security it’s meant to.

The Pharmaceutical Research and Manufacturers of America’s (PhRMA) first Patient Experience Survey (PES) has found that three in ten people with medical insurance still face financial barriers to accessing healthcare and prescription medicines.

This is leading to poor adherence and worsening outcomes according to Stephen Ubl, President and Chief Executive officer of the organisation.

The in-depth survey of almost 5,000 people, including more than 3,500 who rely on prescription medicines, suggests that “insurance policies and practices create barriers to life-saving care” with “devastating results”

“These include worse health outcomes for patients and higher costs throughout the healthcare system,” he said, adding that the system was not working for the “sickest and most vulnerable” in society.

Out of pocket costs

Launched in the wake of the COVID-19 pandemic, the PES has been designed to explore common barriers to accessing healthcare and prescription medicines in the US.

“This insecurity in health care access disproportionately affects those reporting the poorest health, the disabled, and patients suffering from the most serious health conditions.”

It aims to understand how patients engage with the healthcare system, uncover the challenges Americans face around access and affordability, and identify solutions.

This first piece of work found that while 70% of people were satisfied with the ease at which they could access the care they needed, this certainly wasn’t the case for everyone.

Thirteen per cent said they had to forgo needed care, had trouble paying medical bills, had out-of-pocket costs they could not afford, or had no savings to cover medical expenses.

“This insecurity in health care access disproportionately affects those reporting the poorest health, the disabled, and patients suffering from the most serious health conditions,” says the report.

Importantly, these “systematic challenges” are not confined to the uninsured. In fact, almost a third of people with insurance, 30%, said they could not afford medical bills or out-of-pocket costs.

Americans spent an average of $1,568 on out-of-pocket healthcare costs over the past year, but 44% of respondents had less than $1,000 in savings to pay for emergency or unforeseen expenses.

Poor adherence, poor outcomes

Unaffordable out-of-pocket costs are “strongly correlated with prescription abandonment”, warns the report.

The survey found that 52% of patients who take prescription medicines and have a high-deductible health plan reported at least one episode of non-adherence in the past year. That figure rose to 87% in those who had accumulated medical debt.

“Predictably, Americans who forego strict adherence to their prescription medicines face adverse health outcomes. Half, 48%, of all those reporting one or more episodes of non-adherence say their health suffered consequently. That number increases to 82% of patients with an infectious disease,” said the report.

Disproportionate utilisation

The survey also shows how health plan utilisation management tools create significant barriers that disproportionately impact the sick and the vulnerable.

“Health insurers use utilisation management tools to determine when and how a patient can access a particular medicine, through methods such as prior authorisation and step therapy,” explained the report.

“These additional barriers to accessing prescription medicines can result in delays, prevent patients from picking up their prescriptions, or require patients to take an alternative medicine (which is) preferred by the insurance company.”

Crucially, these hurdles disproportionately affect patients who have the most concerns about accessing and affording their care.

Seven in ten, 68%, of those who said they were “very worried” about accessing and affording the care they need reported utilisation management barriers, compared with just 38% of the rest of the population.

Patients with chronic diseases, such as autoimmune diseases, allergies, and diabetes, were more likely to report experiences with utilisation management than those who take prescription medicines for other conditions.

In addition, 56% of Black Americans and 60% of Hispanic Americans surveyed were subject to utilisation management practices, compared to just 36% of white Americans.

“The data reveal that health insurance benefit design – including out-of-pocket expenses not covered by insurance and utilisation management practices – is contributing to healthcare access insecurity, and may be leading to poor health outcomes,” say the authors.

Patient-centred solutions

The report notes that access and affordability challenges are “largely driven by deteriorating health insurance coverage”, and calls on the sector to make changes that consider the “entire healthcare landscape and the patient experience”.

“The policy solutions that Americans value tend to focus on demystifying their coverage – promoting transparency and predictability – and lowering their out-of-pocket costs.”

This could include limiting out-of-pocket expenses to a certain percentage of a household income, making it easier to find and understand cost estimates before embarking on treatment, and providing fixed co-pays instead of co-insurance, for example.

Interestingly, the survey respondents said they would prefer the lowering of out-of-pocket costs to a decrease in health insurance premiums.

It is time, the report makes clear, to make a change.

“Missing from the current healthcare debate are any reforms that will help address the structural problems many patients say they face in the healthcare system today.

“This survey shows that policymakers should focus on the real problems patients are experiencing, by advancing solutions that address healthcare inequities, lower out-of-pocket costs, and remove barriers to care,” said Ubl.

About the author

Amanda Barrell is a freelance health and medical education journalist, editor and copywriter. She has worked on projects for pharma, charities, and agencies, and has written extensively for patients, HCPs, and the public

The post Time for change: PhRMA survey shows insurance creates barriers to healthcare in US appeared first on .

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Mathematicians use AI to identify emerging COVID-19 variants

Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants…

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Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants and could help with other infections in the future.

Credit: source: https://phil.cdc.gov/Details.aspx?pid=23312

Scientists at The Universities of Manchester and Oxford have developed an AI framework that can identify and track new and concerning COVID-19 variants and could help with other infections in the future.

The framework combines dimension reduction techniques and a new explainable clustering algorithm called CLASSIX, developed by mathematicians at The University of Manchester. This enables the quick identification of groups of viral genomes that might present a risk in the future from huge volumes of data.

The study, presented this week in the journal PNAS, could support traditional methods of tracking viral evolution, such as phylogenetic analysis, which currently require extensive manual curation.

Roberto Cahuantzi, a researcher at The University of Manchester and first and corresponding author of the paper, said: “Since the emergence of COVID-19, we have seen multiple waves of new variants, heightened transmissibility, evasion of immune responses, and increased severity of illness.

“Scientists are now intensifying efforts to pinpoint these worrying new variants, such as alpha, delta and omicron, at the earliest stages of their emergence. If we can find a way to do this quickly and efficiently, it will enable us to be more proactive in our response, such as tailored vaccine development and may even enable us to eliminate the variants before they become established.”

Like many other RNA viruses, COVID-19 has a high mutation rate and short time between generations meaning it evolves extremely rapidly. This means identifying new strains that are likely to be problematic in the future requires considerable effort.

Currently, there are almost 16 million sequences available on the GISAID database (the Global Initiative on Sharing All Influenza Data), which provides access to genomic data of influenza viruses.

Mapping the evolution and history of all COVID-19 genomes from this data is currently done using extremely large amounts of computer and human time.

The described method allows automation of such tasks. The researchers processed 5.7 million high-coverage sequences in only one to two days on a standard modern laptop; this would not be possible for existing methods, putting identification of concerning pathogen strains in the hands of more researchers due to reduced resource needs.

Thomas House, Professor of Mathematical Sciences at The University of Manchester, said: “The unprecedented amount of genetic data generated during the pandemic demands improvements to our methods to analyse it thoroughly. The data is continuing to grow rapidly but without showing a benefit to curating this data, there is a risk that it will be removed or deleted.

“We know that human expert time is limited, so our approach should not replace the work of humans all together but work alongside them to enable the job to be done much quicker and free our experts for other vital developments.”

The proposed method works by breaking down genetic sequences of the COVID-19 virus into smaller “words” (called 3-mers) represented as numbers by counting them. Then, it groups similar sequences together based on their word patterns using machine learning techniques.

Stefan Güttel, Professor of Applied Mathematics at the University of Manchester, said: “The clustering algorithm CLASSIX we developed is much less computationally demanding than traditional methods and is fully explainable, meaning that it provides textual and visual explanations of the computed clusters.”

Roberto Cahuantzi added: “Our analysis serves as a proof of concept, demonstrating the potential use of machine learning methods as an alert tool for the early discovery of emerging major variants without relying on the need to generate phylogenies.

“Whilst phylogenetics remains the ‘gold standard’ for understanding the viral ancestry, these machine learning methods can accommodate several orders of magnitude more sequences than the current phylogenetic methods and at a low computational cost.”


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International

There will soon be one million seats on this popular Amtrak route

“More people are taking the train than ever before,” says Amtrak’s Executive Vice President.

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While the size of the United States makes it hard for it to compete with the inter-city train access available in places like Japan and many European countries, Amtrak trains are a very popular transportation option in certain pockets of the country — so much so that the country’s national railway company is expanding its Northeast Corridor by more than one million seats.

Related: This is what it's like to take a 19-hour train from New York to Chicago

Running from Boston all the way south to Washington, D.C., the route is one of the most popular as it passes through the most densely populated part of the country and serves as a commuter train for those who need to go between East Coast cities such as New York and Philadelphia for business.

Veronika Bondarenko captured this photo of New York’s Moynihan Train Hall. 

Veronika Bondarenko

Amtrak launches new routes, promises travelers ‘additional travel options’

Earlier this month, Amtrak announced that it was adding four additional Northeastern routes to its schedule — two more routes between New York’s Penn Station and Union Station in Washington, D.C. on the weekend, a new early-morning weekday route between New York and Philadelphia’s William H. Gray III 30th Street Station and a weekend route between Philadelphia and Boston’s South Station.

More Travel:

According to Amtrak, these additions will increase Northeast Corridor’s service by 20% on the weekdays and 10% on the weekends for a total of one million additional seats when counted by how many will ride the corridor over the year.

“More people are taking the train than ever before and we’re proud to offer our customers additional travel options when they ride with us on the Northeast Regional,” Amtrak Executive Vice President and Chief Commercial Officer Eliot Hamlisch said in a statement on the new routes. “The Northeast Regional gets you where you want to go comfortably, conveniently and sustainably as you breeze past traffic on I-95 for a more enjoyable travel experience.”

Here are some of the other Amtrak changes you can expect to see

Amtrak also said that, in the 2023 financial year, the Northeast Corridor had nearly 9.2 million riders — 8% more than it had pre-pandemic and a 29% increase from 2022. The higher demand, particularly during both off-peak hours and the time when many business travelers use to get to work, is pushing Amtrak to invest into this corridor in particular.

To reach more customers, Amtrak has also made several changes to both its routes and pricing system. In the fall of 2023, it introduced a type of new “Night Owl Fare” — if traveling during very late or very early hours, one can go between cities like New York and Philadelphia or Philadelphia and Washington. D.C. for $5 to $15.

As travel on the same routes during peak hours can reach as much as $300, this was a deliberate move to reach those who have the flexibility of time and might have otherwise preferred more affordable methods of transportation such as the bus. After seeing strong uptake, Amtrak added this type of fare to more Boston routes.

The largest distances, such as the ones between Boston and New York or New York and Washington, are available at the lowest rate for $20.

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International

The next pandemic? It’s already here for Earth’s wildlife

Bird flu is decimating species already threatened by climate change and habitat loss.

I am a conservation biologist who studies emerging infectious diseases. When people ask me what I think the next pandemic will be I often say that we are in the midst of one – it’s just afflicting a great many species more than ours.

I am referring to the highly pathogenic strain of avian influenza H5N1 (HPAI H5N1), otherwise known as bird flu, which has killed millions of birds and unknown numbers of mammals, particularly during the past three years.

This is the strain that emerged in domestic geese in China in 1997 and quickly jumped to humans in south-east Asia with a mortality rate of around 40-50%. My research group encountered the virus when it killed a mammal, an endangered Owston’s palm civet, in a captive breeding programme in Cuc Phuong National Park Vietnam in 2005.

How these animals caught bird flu was never confirmed. Their diet is mainly earthworms, so they had not been infected by eating diseased poultry like many captive tigers in the region.

This discovery prompted us to collate all confirmed reports of fatal infection with bird flu to assess just how broad a threat to wildlife this virus might pose.

This is how a newly discovered virus in Chinese poultry came to threaten so much of the world’s biodiversity.

H5N1 originated on a Chinese poultry farm in 1997. ChameleonsEye/Shutterstock

The first signs

Until December 2005, most confirmed infections had been found in a few zoos and rescue centres in Thailand and Cambodia. Our analysis in 2006 showed that nearly half (48%) of all the different groups of birds (known to taxonomists as “orders”) contained a species in which a fatal infection of bird flu had been reported. These 13 orders comprised 84% of all bird species.

We reasoned 20 years ago that the strains of H5N1 circulating were probably highly pathogenic to all bird orders. We also showed that the list of confirmed infected species included those that were globally threatened and that important habitats, such as Vietnam’s Mekong delta, lay close to reported poultry outbreaks.

Mammals known to be susceptible to bird flu during the early 2000s included primates, rodents, pigs and rabbits. Large carnivores such as Bengal tigers and clouded leopards were reported to have been killed, as well as domestic cats.

Our 2006 paper showed the ease with which this virus crossed species barriers and suggested it might one day produce a pandemic-scale threat to global biodiversity.

Unfortunately, our warnings were correct.

A roving sickness

Two decades on, bird flu is killing species from the high Arctic to mainland Antarctica.

In the past couple of years, bird flu has spread rapidly across Europe and infiltrated North and South America, killing millions of poultry and a variety of bird and mammal species. A recent paper found that 26 countries have reported at least 48 mammal species that have died from the virus since 2020, when the latest increase in reported infections started.

Not even the ocean is safe. Since 2020, 13 species of aquatic mammal have succumbed, including American sea lions, porpoises and dolphins, often dying in their thousands in South America. A wide range of scavenging and predatory mammals that live on land are now also confirmed to be susceptible, including mountain lions, lynx, brown, black and polar bears.

The UK alone has lost over 75% of its great skuas and seen a 25% decline in northern gannets. Recent declines in sandwich terns (35%) and common terns (42%) were also largely driven by the virus.

Scientists haven’t managed to completely sequence the virus in all affected species. Research and continuous surveillance could tell us how adaptable it ultimately becomes, and whether it can jump to even more species. We know it can already infect humans – one or more genetic mutations may make it more infectious.

At the crossroads

Between January 1 2003 and December 21 2023, 882 cases of human infection with the H5N1 virus were reported from 23 countries, of which 461 (52%) were fatal.

Of these fatal cases, more than half were in Vietnam, China, Cambodia and Laos. Poultry-to-human infections were first recorded in Cambodia in December 2003. Intermittent cases were reported until 2014, followed by a gap until 2023, yielding 41 deaths from 64 cases. The subtype of H5N1 virus responsible has been detected in poultry in Cambodia since 2014. In the early 2000s, the H5N1 virus circulating had a high human mortality rate, so it is worrying that we are now starting to see people dying after contact with poultry again.

It’s not just H5 subtypes of bird flu that concern humans. The H10N1 virus was originally isolated from wild birds in South Korea, but has also been reported in samples from China and Mongolia.

Recent research found that these particular virus subtypes may be able to jump to humans after they were found to be pathogenic in laboratory mice and ferrets. The first person who was confirmed to be infected with H10N5 died in China on January 27 2024, but this patient was also suffering from seasonal flu (H3N2). They had been exposed to live poultry which also tested positive for H10N5.

Species already threatened with extinction are among those which have died due to bird flu in the past three years. The first deaths from the virus in mainland Antarctica have just been confirmed in skuas, highlighting a looming threat to penguin colonies whose eggs and chicks skuas prey on. Humboldt penguins have already been killed by the virus in Chile.

A colony of king penguins.
Remote penguin colonies are already threatened by climate change. AndreAnita/Shutterstock

How can we stem this tsunami of H5N1 and other avian influenzas? Completely overhaul poultry production on a global scale. Make farms self-sufficient in rearing eggs and chicks instead of exporting them internationally. The trend towards megafarms containing over a million birds must be stopped in its tracks.

To prevent the worst outcomes for this virus, we must revisit its primary source: the incubator of intensive poultry farms.

Diana Bell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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