Tuesday, November 13, 2012

And officials ask why residents don't follow evacuation advice!

Before and after Hurricane Sandy hit officials at every level (Governors, Mayors, emergency management) urged residents to evacuate...and bemoaned that less than 50% headed their warnings.  

Historically residents have been reluctant to leave their homes for any number of reasons: nowhere to go, no money to get there, not being physically well enough, not wanting to go to a shelter, not wanting to leave their pets, fear of looting while they're gone, to say nothing of the powerful emotional and psychological attachment we have with "home".

Post Katrina, and the fiasco of official directions to " go to the Convention Center", many, especially low income and minority residents lack TRUST in officials and their judgements.
(photo below Daily News/11/13/12)

And now we have the head of NYCHA telling residents that getting a rent reduction for the time they suffer few living back in the 18th century a "nice little Christmas present." 

Clumsy statement or worse, this callousness goes a long way to extinguishing any remnants of trust people in Red Hook and elsewhere have.

Eroding public trust in the commons, won't help us out when the next complex emergency is on our doorstep. 

Saturday, November 10, 2012

States Rush to get Health Exchanges Up and Running

Now that Pres. Obama has been re-elected (a positive call to action for those of us in public health!), states are going to be in a rush to get their health exchanges up and running (NYT 11/10/12). Many states were playing a wait-and-see game, doing little to plan for their exchange. 

By Jan. 1, 2014 the Fed Gov’t.  is requiring most Americans to have health insurance.  Every state is supposed to have an exchange by Jan. 1, 2014.  

How Will the Health Exchanges Operate?
Great question!
That's much less clear.  
If states want to run their own exchanges, they have until Dec. 14 ( with extensions, now maybe until Feb. 15)  to submit applications, or blueprints. Right now, less than half the states say they are going to run their own exchanges.  In that case the Federal govt. will run the exchanges.

Consumers May Be the Losers
Unless the health exchanges are up to the task of really assisting consumers understand health plans and choose wisely, consumers may be the losers.

We’ve known from research over the last two decades, that choosing a health plan is a difficult and confusing task for consumers.  See “What’s Behind the Door: Consumers’ Difficulties Choosing a Health Plan, Consumers Union) -

(Consumers Union, 2012; Sofaer and Hibbard, 2010; I too worked on an AHRQ SBIR 1997,creating health plan choice tools for underserved and low literate populations) as just some examples.

Most consumers don’t know enough about health plans and their products, (often due to plan information written in a very difficult manner) and have a near impossible time trying to compare plans and make the best choice for themselves and their families (Council of Economic Advisors, 1994; OTA, 1988).

The Health Exchanges, the materials the produce, the hiring and training of the staff they have to assist consumers will play a very key role in the successful entry of millions of people into the health system.  They must do the heavy lifting when it comes to getting consumers ready to choose and use a health plan – a key cost control criteria.

Health Exchanges need to be on top of their game when it comes to understanding that the majority of new health plan consumers are likely low health literate - 50% of adults in the US are, and disproportionately so if they are poorer or less educate.  Clear communication and effective decision-making tools will be absolutely vital.

Can the health exchanges get consumers ready?

Will they use the best practices we’ve been developing in health literacy?