Transcript Slide 1

Preventative Services
for Women’s Health &
Well Being
Francisco R. Velázquez, M.D., S.M., FCAP
Managing Director, Quest Diagnostics Nichols Institute
Vice President, Focus Diagnostics
Agenda
I.
Population Changes and Demographics
II.
Women and Healthcare
III. Women’s Health Status/Coverage
IV. Health Interview Survey (selected topics)
V.
Women’s Health and the 2008 Election
VI. PPACA Publication: Women’s Health Perspective
VII. Preventative Services/Research
VIII. Long-term Issues/Questions
Quest Diagnostics
U.S. Population Distribution and Changes 2000 – 2010 1,2
• Population
– 27.3 million more than 2000 (9.7%)
– Approximately
49% male
51% female
• Mean age/sex
– Male
– Female
– Population
35.4
38.2
36.8
1
U.S. Census Bureau, Current Population reports June 2010, http://www.census.gov/popest/nationalasrh/WC-Est2009/NC-Est2009-01.xls >last
accessed May 2, 2011
2
U.S. Census Bureau, “2008 National Population Projections,” August 2008, modified: U.S. National Center for Health Statistics, National Vital
Statistics Report (NUSR), Vol 58, No. 19, May 2008
Quest Diagnostics
Expectation of Life at Birth 2010 – 2020 3
– 2010:
» Male
» Female
» Population
3U.S.
– 2020:
75.7
80.8
78.3
» Male
» Female
» Population
77.1
81.9
79.5
National Center for Health Statistics U.S. Census Bureau; The 2011 Statistical Abstract, The National Data Book Table 102; Expectation
of Life at Birth and Projections, January 20, 2011 last accessed June 1, 2011
Quest Diagnostics
Life Expectations by Sex, Age and Ethnicity 3
– White
» Male
» Female
3
75.8
80.8
– Asian
» Male
76.3
» Female 81.1
– Black
» Male
» Female
70.0
76.8
– American Indian/Native Alaskan
» Male
76.6
» Female 81.5
– Hispanics
» Male
» Female
78.4
83.7
Ibid
Quest Diagnostics
2010 Census Results Key Findings 4,5,6
• Population shift south/west
• From 2007-2009 birth rates for women aged 15-44 declined
• Birth rates declined for all women under age 40
• Fertility rates dropped for all major racial groups and all birth orders
4
2010 Census Data/2010 Census Demographic profile: http://2010.census.gov/2010census/data . Last accessed May 16, 2011
5
Sutton PD. Recent trends in births and fertility rates through June 2010. National Center for Health Statistics Health E-Stat. 2010
6
Sutton PD. Hamilton BE, Matthews TN. Recent decline in births in the United States, 2007-2009. NCHS data brief, No 60. Hyattville, MD:
National Center for Health Statistics. 2011
Quest Diagnostics
National Population by Race United States 2010 7,8
White
Black
Am Indian/Alaskan
Asian
Native American
Other Race
Three of more races
% Population
72.4
12.6
0.9
4.8
0.2
6.2
2.9
Change
2000-2011
5.7%
12.3%
18.4%
43.3%
35.4%
24.4%
32.0%
16.3
83.7
43.0%
4.9%
Hispanic or Latino Origin
Hispanic/Latino
Non-Hispanic or Latino
7
US Census 2010 Census Data
Demographic profiles. http://2010.census-gov/2010census/data last accessed Mary 23, 2011
8 Sharon R. Ennis, Merarys Rio-Vargas and Nora G. Albert. The Hispanic Population: 2010
2010 Census Brief, May 2011
Quest Diagnostics
Percent Distribution of Number of Visits to Health Care
Professionals (National Health Interview Survey) 9
Characteristic
None
1-3
4-9
10 or more
Population
Sex
Male
Female
15.5
20.7
10.8
46.8
47.5
46.2
24.8
22.2
27.3
12.9
10
15.8
22.7
14.4
7
3.9
46.3
44.5
35.7
25.4
19.4
25.7
36.4
39.1
11.7
15.5
20.9
27.6
15.4
15.4
24.3
18.2
15.4
46.2
48.7
44
53.7
42.8
25.1
24.2
20.6
20.9
29.1
13.3
12.2
11.1
7.2
12.7
Age
18 - 44
45 - 64
65 - 74
75 and over
Race
White
Black
Hispanic
Asian
Am Indian/Alaskan
9
U.S. Census Bureau, Statistical Abstract of the United States: 2011 p 114, Health and Nutrition, Table 162.
http://www.census.gov/compenida/statab/2011table/11s0162 last accessed June 3, 2011
Quest Diagnostics
Population Trends
• Population 2015: 325,540,000 (Projected) 10,11,12
– 160,424,000 Male
– 165,116,000 Female
– Numeral difference expected to continue increasing
– Women 65 and above will increase from 14.57% (2010) to 21.79% (2050)
U.S. Census Bureau. 2008 National Population Projections”. August 2008,
< http://www.census.gov/population/www/projections/2008projections.html/ >. Last Accessed May 7, 2011
11 Population Division, U.S. Census Bureau; Projections of the Populations by Selected Age Groups and Sex for the U.S.: 2010-2050 (NP
2008-T2), August 14, 2008. Last accessed May 11, 2011
12 Population Division, U.S. Census Bureau; Percent Distribution of the Projected Populations for the U.S.: 2010-2050 (NP 2008-T3),
August 14, 2008. Last accessed May 11, 2011
10
Quest Diagnostics
Population Characteristics 13
• 12% of women over 18 are head of household
–
Non-Hispanic blacks more likely to be head of household (28.1%)
• 40 million Americans below poverty level
–
15% are women age 18 or older
–
13% of adult female population
• 15.5% of women experience household food insecurity
–
Female headed households with children make 27.4% of households that rely on food
stamps
–
Represent 57.7% of food stamps households with children
• 59.5% of women 16 or older participate in the labor force
• 1.8 million are veterans (9% of veteran population)
• Veterans of OEF/OIF are younger than previous veterans (75% 16-40 years)
• 22.7% of women live in rural areas
Women’s Health USA 2010: U.S. Department of Health and Human Services. Health Resources and Services Administration. HRSA
Information Center 2010 http://mchb.hrsa.gov/whusato/index.html . Last accessed May 21, 2011.
13
Quest Diagnostics
Women and Healthcare
14-16
– 85% mothers choose their children’s doctor
– 84% take their children to appointments
– 79% ensure follow-up care
– 48% take time off work for sick children
– 45% of low income women have paid sick leave
– 12% of women care for sick or aging relative
– 17% are uninsured
– 35% have a chronic condition that requires on-going medical attention
– 24% of non-elderly women went without or delayed care due to cost
– 51% of women use at least one prescription on a regular basis
– 17 million low income women (18-64 years) covered under Medicaid
– 75% of adult Medicaid population
– 15.1 maternal deaths/100,00 live births
– 40% of uninsured women do not fill their prescriptions
Rani, Ushape, Salganicoff, A., PhD. Women’s Healthcare Chart book Key Findings From the Kaiser Women’s Health Survey. The Henry J.
Kaiser Family Foundation: pp 1-40, May 2011.
14
15
Ranji, Usha MS, Salganicoff, A., PhD, Stewart, Alexandra JD, Cox, Marisa, MA, MPH and Doamekpor, Lauren: State Medicaid Coverage of
Family Planning Services: Summary of State Survey Findings November 2009. The Henry J. Kaiser Family Foundation and The George
Washington University School of Public health and Health Services: pp 1-29, 2005
Chaukin, Wendy et al: Women’s Health and Healthcare Reform: The Key Role of Comprehensive Reproductive Healthcare; Columbia University
Mailman School of Public Health. November 2007.
16
Quest Diagnostics
Women’s Health Status 17-21
– 18% of women 18-64 are in fair or poor health
– 35% have chronic conditions requiring ongoing medical attention
– 18-44 years 9% arthritis, 11% hytpertension, 9% high cholesterol
– 45-64 years rate triple to 39%, 36% and 34% respectively
– Leading seven causes of death
•
Heart Diseases (25.8%)
•
Cancer (22%)
•
Stroke (6.7%)
•
Chronic Lower Respiratory Diseases (5.3%)
•
Alzheimer’s Disease
•
Unintentional Injuries
•
Diabetes
– 68.4% of women 65 and older report at least one condition that limits their ability to perform
common activities
– 15.7% prevalence of “dementia”
– 6.3 million adults over the age of 65 have osteoporosis; approximately 90% are women
– Hospice care discharges 55.1% are women, 65.3% of all hospice care patients 85 and older are
women
17
Ibid
Centers for Disease Control and Prevention; FASTSTATS Women’s Health http://www.cdc.gov/nchs/faststats/womens_health.htm . Last
accessed April 29, 2011.
19 Nicholas, Carol, MSTC; May, Rick, MD: The Seventh Annual Health Grades Women’s health in America Hospitals Study: 1-47, April 2010
20 Cancer Facts and Figures 2010. American Cancer Society.
http://www.cancer.org/acs/groups/content/epidemiologysurveillance/documents/document/acspc-026238.pdf Accessed June 5, 2011
21 Hartker, M. MD and Reed, K: The Twelfth Annual Healthgrades Hospital Quality in America Study. Healthgrades, Inc. October 2009
18
Quest Diagnostics
Women’s Health Insurance Coverage 22-26
– 32% Employer sponsored primary
– 40% of uninsured women work
– 29% Employer sponsored dependant
– 7% of women were uninsured at some point
during prior year
– 17% Uninsured
– 6% Individually purchased
– 24% of women 18-64 are currently without
health insurance or have been uninsured in
the past year
– 4% Medicare
– 35% of women under poverty level
– 2% Other
– 29% of near poor women (100% to 199% of
poverty lack coverage)
– 10% Medicaid
– 42% of non elderly Latina women are
uninsured
22
Ibid
Glied S, Jack K, Rachin, J: Women’s Health Insurance Coverage 1980-2005, Women’s Health Issues: 2008 Jan-Feb; 18(1) 7-16
24 Salganicoff, A, Cubanski J, Ranjiu, Newman, T: Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being: Journal of
Women, Politics and Policy, 30: 222-247, 2009
25 Angel J.L., Karas Montez J, Angel RJ: A Window of Vulnerability Health Insurance Coverage Among Women 55 to 64 Years of Age.
Women’s Health Issues, Volume 21 (1) pp 6-11 (January 2011)
26 Gold, R.B., Alrick, C: role of Medicaid Family Planning Waivers and Title X in Enhancing Access to Preconception Care. Women’s Health
Issues. 2008 Nov-Dec; 18 (6 Suppl): 547-51.
23
Quest Diagnostics
Obtaining Needed Medical Care 27
27
Centers for Disease Control, Early Release of Selected Estimates Based on Data From the 2010 National
Health Interview Survey http://www.cdc.gov/nchs/data/nhis/earlyrelease/earlyrelease201106.pdf
Quest Diagnostics
Current Smoking
27Ibid
Quest Diagnostics
Alcohol Consumption
27Ibid
Quest Diagnostics
Leisure-time Physical Activity
27Ibid
Quest Diagnostics
Personal Care Needs
27Ibid
Quest Diagnostics
Women’s Health and the 2008 Election
• Top Issues for women
28
– Coverage/Affordability
– Preventive Services & Primary Care
– Long-term Care/Medicare
– Reproductive Health
28
Kaiser Health Tracking Poll: Election 2008 (conducted April 3-13, 2008)
http://www.kff.org/womenshealth/h08_7822.cpm . Last accessed June 1, 2011
Quest Diagnostics
Election 2008 Tracking Poll 29
29
Kaiser Health Tracking Poll: Election 2008 (conducted April 3-13, 2008)
Quest Diagnostics
PPACA Public Law: Women’s Health Perspective 30-34
• Coverage/affordability
• Gender Ratings
• Preventative Services/Primary Care
• Imbalance
• Long-Term Care/Medicare
• Workplace “Reasonable Accommodations”
• Reproductive Health
• Health Policy/Health Research
30
Ibid
Kosiak B, Sangl J, Correa-de-Arraujo R: Quality of health Care for Older Women: What Do We Know. Women’s Health Issues, 2006 MarApri; 16 (2) 18-99
32 Rochman B: What Healthcare Reform Means for You. Forbes.com Sept 11, 2009. http://www.forbes.com/2009/09/11/healthcare-reforminsurance-forbes-woman-well-being-maternity.html Accessed April 29, 2011
33 Proskauer: Healthcare Reform Has Arrived: “Benefits for Women and Responsibilities for Employers” Client Alert April 6, 2010.
http://www.proskauer.com/publications/client-alerts/health-care-reform-has-arrived-benefits-for-women-and-responsiblitieis-for-employers .
Accessed April 29, 2011
34 Wood, S.F, Blehar M.C., Marvery D.R.: Policy Implications of a New National Institutes of Health Agency for Women’s Health Research 20102020 . Women’s Health Issues 21-2 (2011) 99-103
31
Quest Diagnostics
Key Milestones 35-40
• “Patient Protection and Affordable Care Act”35
(Patient Protection and Affordable Care Act (P.L. 111-148) as amended by the Health Care and
Education Reconciliation Act of 2010 (P.L. 111-152)
• Interim Final Rules for Group Health Plans and Health Insurance Issues Relating
to Coverage of Preventative Services under the Patient Protection and Affordable
Care Act36
• Institute of Medicine: Women’s Health Research: progress, pitfalls and
promise37,38
• Institute of Medicine: Clinical Preventive Services for Women: Closing the Gaps39
• Health Resources and Services Administration – Supported Women’s Preventive
Services: Required Health Plan Coverage Guidelines40
35
Ppaca & Hcera; Public Laws 111-148 & 111-152, One Hundred Eleventh Congress Second Session, January 5, 2010
Preventative Regulations: Department of the Treasury 26 CFR 54, Department of Labor 29 CFR part 2590, Department of Health and Human
Services OCIIO-9992-IFC, 45 CFR part 147
37 Women’s Health Research: Progress, Pitfalls and Promise, Institute of Medicine, The National Academy of Sciences Press. Consensus Report pp114, September 23, 2010
38 Consolidated Appropriations Act of 2008: 110th Congress, Public Law 110-161 H.R. 2764, December 26, 2007
39 Clinical Preventive Services for Women: Closing the Gaps, The National Academy of Sciences Press, Consensus Report, July 20, 2011
40 The Health Resources and Services Administration (August 1, 2011), http://www.healthcare.gov/news/factsheets/womenprevention08012ulla.html
36
Quest Diagnostics
Covered Preventive Services for Women, Including Pregnant
Women
• Anemia
• Gestational diabetes*
• Bacteriuria
• Gonorrhea
• BRCA
• Hepatitis B
• Breast Cancer Mammography
• Human Immunodeficiency Virus (HIV)*
• Breast Cancer Chemoprevention
• Human Papillomavirus (HPV) DNA Test*
• Breastfeeding*
• Osteoporosis
• Cervical Cancer
• Rh Incompatibility
• Chlamydia Infection
• Tobacco Use
• Contraception*
• Sexually Transmitted Infections (STI)*
• Domestic and interpersonal violence*
• Syphilis
• Folic Acid
• Well-woman visits*
35Ibid
Quest Diagnostics
Services marked with an asterisk (*) must be covered with no
cost sharing in plan years starting on or after August 1, 2012
Conditions Discussed by Committee, Categorized by Extent
of Progress
• Conditions on Which Research Has Contributed to Major Progress
– Breast Cancer
– Cardiovascular Disease
– Cervical Cancer
• Conditions on Which Research Has Contributed to Some Progress
– Depression
– HIV/AIDS
– Osteoporosis
• Conditions on Which There Has Been Little Progress
– Unintended Pregnancy
– Lung Cancer
– Maternal Morbidity and Mortality
– Gynecological Cancers Other than Cervical Cancer
– Autoimmunne Diseases
– Non-Malignant Gynecological Disorders
– Alcohol and Drug Addiction
– Alzheimer’s Disease
37,38Ibid
Quest Diagnostics
Health Resources and Services Administration-Supported
Women’s Preventive Services: Required Health-Plan Guidelines
Type of Preventive Service
36,40Ibid
Quest Diagnostics
Frequency
Well-woman visits
Annual, although HHS recognizes that several
visits may be needed to obtain all necessary
recommended preventive services, depending on
a woman’s health status, health needs, and other
risk factors
Screening for gestational
diabetes
In pregnant women between 24 and 28 weeks of
gestation and at the first prenatal visit for
pregnant women identified to be at high risk for
diabetes
Human papillomavirus
testing
Screening should begin at 30 years of age and
should occur no more frequently than every 3
years
Counseling for sexually
transmitted infections
Annual
Counseling and screening for
human immune-deficiency
virus
Annual
Contraceptive methods and
counseling **
As prescribed
Breastfeeding support,
supplies, and counseling
In conjunction with each birth
Screening and counseling for
interpersonal and domestic
violence
Annual
Key Issues Long-Term
• Implementation
• Affordability and Scope of Coverage
• Primary Care and Prevention
• Long-Term Care
• Research / Policy
• Excluded Populations
• Economic Recovery
Quest Diagnostics
Questions…
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