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About The skanner. (Portland, Or.) 1975-2014 | View Entire Issue (Aug. 28, 2013)
Health & Education States Experimenting to Lower Health Care Costs By Jonathan J. Cooper The Associated Press SALEM, Ore. (AP) — Oregon health officials are concentrating on coordinating services and preventing hospital stays. New Jersey medical centers are rewarding doc- tors who can save money without jeopardizing patient care. And Massachu- setts is expanding the role of physician assistants and nurse practitioners. As states work on implementing the com- plex federal health care reforms, some have begun tackling an issue that has vexed employers, individuals and governments at all levels for years — the rapidly rising costs of health care. The success of models that are beginning to emerge across the country ultimately will determine whether President Barack Obama’s Affordable Care Act can make good on its name. It’s too early to tell what will work and what won’t, but states, insurers and medical groups are experimenting with a variety of programs to contain costs without under- mining care. These test runs come as millions of new patients will gain eligibility for health insurance under the federal law, putting additional pressure on the system. ``Look at any of the long-term projections for the federal budget or for state budgets,’’ said Alan Weil, executive director of the National Academy for State Health Policy. ``If we don’t bring down health care costs, we’re either going to be paying a whole lot more in taxes or we’re going to stop spend- Often overlooked are the law’s efforts to stabilize constantly rising costs. U.S. health care spending reached $2.7 trillion in 2011, or $8,700 per person, according to the Centers for Medicare and Medicaid Services. The agency says those numbers are climbing and predicts spending will reach $14,000 per person by 2021. ‘If we don’t bring down health care costs, we’re either going to be paying a whole lot more in taxes or we’re going to stop spending money on other things we care about’ ing money on other things we care about.’’ The Affordable Care Act is expected to extend coverage to many of the roughly 50 million Americans who lack insurance by expanding Medicaid, the state-federal health care program for low-income people, and requiring most others to purchase insur- ance or pay a fine. The higher costs mean higher premiums for businesses, which are passing on more of those expenses to their employees, and for individuals, who are seeing a rise in out- of-pocket costs. In the Portland area, spiking costs have forced Steve Ferree to reduce the benefits he offers his 32 employees at the Mr. Root- er Plumbing franchise he owns. ``We feel bad about it,’’ he said. ``We do provide good insurance, and we want to make sure we take care of folks, so that’s a tough decision to make.’’ Premiums for employee-only coverage have spiked 65 percent since 2006, Ferree said, and employee and spouse plans rose 90 percent. Workers cover a quarter of the premium. The struggles of business owners such as Ferree illustrate the difficulty of finding solutions, even in a state that has been held out as a potential national model for sav- ings. The recession provided what is expected to be a temporary reprieve, with health care costs slowing to 3.9 percent annually between 2009 and 2011, the slowest growth rate since the government began keeping track in 1960, according to data from the Centers for Medicare and Medicaid Servic- es. Over the preceding 18 years, per capita health care costs grew an average of 6.5 percent a year. Yet despite the recent slowdown, health See CARE on page 11 Winter Depression Not as Common as Many Think, OSU Research Shows By Angela Yeager, Oregon State University CORVALLIS, Ore. – New research suggests that getting depressed when it’s cold and drea- ry outside may not be as common as is often believed. In a study recently published online in the Journal of Affective Disorders, researchers found that neither time of year nor weather conditions influenced depressive symptoms. However, lead author David Kerr of Oregon State Uni- versity said this study does not negate the existence of clinically diagnosed seasonal affective dis- order, also known as SAD, but instead shows that people may be overestimating the impact that seasons have on depression in the general population. “It is clear from prior research that SAD exists,” Kerr said. “But our research suggests that what we often think of as the winter blues does not affect people nearly as much as we may think.” Kerr, who is an assistant profes- sor in the School of Psychological Science at OSU, said the majority of studies of seasonal depression ask people to look back on their feelings over time. “People are really good at remembering certain events and information,” he said. “But, unfortunately, we probably can’t accu- rately recall the timing of day-to-day emotions and symptoms across decades of our lives. These research methods are a problem.” So Kerr and his colleagues tried a different approach. They ana- lyzed data from a sample of 556 community participants in Iowa and 206 people in western Ore- gon. Participants completed self-report measures of depressive symptoms multiple times over a period of years. These data were then compared with local weather conditions, including sunlight were a problem. Yet the study sug- gests that people may be overestimating the impact of win- tery skies. “We found a very small effect during the winter months, but it was much more modest than would be expected if seasonal depression were as common as many people think it is,” said Columbia University researcher Jeff Shaman, a study co-author and a for- mer OSU faculty member. “We were surprised. With a sample of nearly 800 people and very pre- cise measures of the weather, we expected to see a larger effect.” Kerr believes the public may have overestimated the power of the winter blues for a few reasons. These may include awareness of Fortunately, there are many effective treatments for depression, whether or not it is seasonal intensity, during the time partici- pants filled out the reports. In one study, some 92 percent of Americans reported seasonal changes in mood and behavior, and 27% reported such changes SAD, the high prevalence of depression in general, and a legiti- mate dislike of winter weather. “We may not have as much fun, we can feel cooped up and we may be less active in the winter,” Kerr said. “But that’s not the same as long-lasting sadness, hopeless- ness, and problems with appetite and sleep – real signs of a clinical depression.” According to Kerr, people who believe they have SAD should get help. He said clinical trials show cognitive behavior therapy, anti- depressant medication, and light box therapy all can help relieve both depression and SAD. “Fortunately, there are many effective treatments for depres- sion, whether or not it is seasonal,” he said. “Cognitive behavior therapy stands out because it has been shown to keep SAD from returning the next year.” August 28, 2013 The Portland Skanner Page 9
