Institutions nationwide are piloting new ways to take care of patients’ needs beyond the hospital bed. That task took on added urgency when Republicans on the Joint Economic Committee released the results of their investigation into social networks among the elderly earlier this year. The analysis: social networks are declining and America is going to pay for it – probably in higher healthcare costs.
 
“[A]n increasingly inadequate level of informal care . . . would necessitate a greater amount of institutional care outside the home and away from loved ones, reducing, for many, their quality of life,” the Committee wrote. “[I]nstitutional care often entails burdensome expenses,” including individuals spending down their assets and the public paying for costly nursing home care. 
 
For many seniors, informal networks of friends and family help them perform household chores, organize their finances, and navigate their medical appointments. These informal care networks are vital to addressing, as the CDC put it, “conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks,” or “social determinants of health.” According to scholars at Yale Law School’s Solomon Center, “25 percent of individual health is determined by genetics, medical care, and health behaviors, while 75 percent of health is determined by social and environmental factors.” ​

Nearly everyone has heard from the political left and progressives for plans to create a single-payer healthcare system, Medicare for all, or Medicare-optional programs. However, even many well-informed people don’t know about Maryland’s strategy to fight out of control healthcare costs: the all-payer model. This model, in place for nearly forty years, exempts the state from the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) and allows Maryland to set rates for these services for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) recipients. As part of an agreement with the national Center for Medicare & Medicaid Services (CMS), Maryland must limit inpatient and outpatient hospital per capita growth to 3.58 percent and save $330 million in Medicare costs over a five-year period. Additionally, they must meet several quality measures: matching national Medicare 30-day readmissions rates, reduce potentially preventable complications by 30 percent over five years, and submit annual reports on population health measures. [1]

​For Winston-Salem residents without the means or ability to drive, the bus system plays a critical role in determining their ability to reach jobs, education, medical care, child care, public benefits, and community activities. The Business 40 infrastructure improvement project presents an opportunity to consider the mobility of all Winston-Salem residents and to focus on how the bus system can be used to advance health equity in our community.

The NC DOT has designated funds to expand bus service during the Business 40 closure.

• Both the Piedmont Authority for Regional Transit (PART) and Winston-Salem Transit Authority (WSTA) will receive funds to increase bus services to mitigate the impact of the Business 40 closure on local transportation and traffic.
• WSTA will receive more than $7 million in grant funds to expand bus services.
• The Business 40 closure presents an opportunity to conduct a “natural experiment” to determine the impact of such improvements on the ability to access health resources (Downtown Health Plaza and Novant Health).

​Harm reduction models use a variety of strategies to eliminate the harmful consequences associated with substance abuse. These strategies seek to reduce morbidity and mortality associated with substance abuse for those who are not ready to quit all together. Such programs resemble a stepping stone process and allow persons who inject drugs to make gradual progress to overcome their addiction. According to the Rural Health Information Hub, “The goal of harm reduction models is to reduce at-risk, moderate and high-risk behaviors often associated with substance abuse.”
 
One of the key principles of harm reduction practice from the Harm Reduction Coalition is, “Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.” This principle highlights the knowledge and acceptance that the programs put into place are not direct solutions but help assist people in taking steps towards ending their addiction.
 
Syringe exchange programs allow persons who inject drugs to exchange used needles for new, sterile needles and syringes to reduce the risk of spreading human immunodeficiency virus (HIV).  These programs also provide counselling, HIV and hepatitis B and C testing, and referrals to treatment centers. The hope of these programs is to reduce to spread of HIV and hepatitis B and C while also providing education, counseling and testing to persons who inject drugs.
 
Even though these programs are controversial, they have drastically reduced the rate of HIV transmission and risk of hepatitis infections among injection drug users without increasing the rate of the illegal drug use.  According to the Centers for Disease Control and Prevention (CDC), the use of these programs has increased during the past decade. The service provided by these programs have been misinterpreted as enabling drug users by giving them easy access to clean needles.  However, the goal of these programs is to reduce the transmission of HIV and hepatitis B and C.

by Grady Brown


A potential government shutdown is upon us once again. The federal government’s fiscal year ends September 30 and, pending a temporary budget bill, the government may well shut down for the second time in three years on October 1. It’s a familiar story — one that is emblematic of the gridlock in DC — and it’s an issue at the forefront of debate for the Congressmen returning from summer recess.

So will we see a shutdown or another last second deal? It’s difficult to tell, but any prediction will need to consider one of the core issues that seems to be driving the disagreement: Planned Parenthood. This summer, anti-abortion activists released a number of undercover videos, claiming Planned Parenthood was selling fetal tissue.

It’s unclear whether Planner Parenthood violated the law. The National Institutes of Health Revitalization Act of 1993 makes it illegal to sell fetal tissue, but allows organizations to collect a “reasonable” fee to mitigate the costs of donating the tissue. Nevertheless, the videos initiated a political firestorm from social conservatives, which has only added to the mounting polarization over the nation’s budget.