Briefly

Easing restrictions: The British Government will in 2010 ease restrictions on access to its National Health Service (NHS) by expatriates living overseas. Since 2004, British expatriates living outside the European Economic Area could not access NHS services for free if they were absent from the area for more than three months a year. Under the new government policy, that period will be extended to six months. The government had faced criticism for penalizing Britons who contributed to the national insurance system their entire lives but have retirement properties in countries outside Europe, such as South Africa and Australia.

Doctor-free clinics: More than 150 nurse-led, and doctor-free, clinics are set to open in Australia by 2012. The clinics will be run by Perth-based Revive Clinics and the Pharmacy Alliance group, which manages about 200 pharmacies. Three such clinics are already in operation, run by nurse practitioners, and about six are set to open by the end of 2009. The Australian Medical Association has objected to these clinics, referring to their services (treatments for minor ailments) as “supermarket medicine” that poses “a risk to the government, to the health system and to patients.”

Obesity worries: A University of Michigan poll indicates that parents believe obesity is the biggest problem facing children in the United States today. The C.C. Mott Children’s Hospital National Poll on Children’s Health was released on Aug. 10 and found that 42% of adults believe childhood obesity is a major problem, up from 35% in 2008. In 2007, obesity ranked third. The poll also indicated that, for the first time, obesity ranked highest with Caucasians, African-Americans and Hispanics. In 2008, only Caucasians chose obesity as the biggest problem facing children, while African-Americans ranked teenage pregnancy as the top problem, with Hispanics choosing smoking. Doctors involved in the poll say that US parents are finally realizing that childhood obesity is not a phase children grow out of, and increases the chances of getting diabetes, heart disease and high blood pressure later in life.

Negative ratings: Concerns about the impact of proposed United States health reforms have prompted credit rating agency the Fitch Group to revise its rating outlook for six US health insurance groups to “negative” from “stable.” Placed in the negative category were Aetna Inc., Blue Cross Blue Shield of Florida, Blue Cross Blue Shield of Idaho Health Service Inc., Cigna Corporation, Coventry Health Care Inc. and Health Care Service Corporation. The downgrading of the six means that all 12 insurer groups now rated by the Fitch Group fall within the negative category. The other six are: Health Insurance Plan of Greater New York; Health Net Inc., Healthmarkets Inc., Humana Inc., UnitedHealth Group Inc. and Wellpoint Inc.

Dr. Google: As much as 37% of the population will be using the Internet to diagnose themselves by the year 2020, according to a report prepared by the London-based consumers and business trends think tank, the Future Foundation, on behalf of Lloyds Pharmacy, the largest community pharmacy outlet in the United Kingdom. About 14% of consumers searched for medical information online in the fall of 2008, an increase of four percentage points over the previous year, while a poll indicates that half of respondents are interested in online prescriptions, states the report (www.lloydspharmacy.com/wps/wcm/connect/ebfb41804f30c58482c38bfaff868ea2/Future+Foundation+report+-+FINAL.pdf?MOD=AJPERES).

Simpler sequencing: Stanford University Professor of Bioengineering Stephen Quake has sequenced his genome, using a refrigerator-size instrument called the Helicos Biosciences SMS Helioscope. The cost? A mere US$50 000, using a staff of two, which is somewhat less than the $300 million that an international team of hundreds of researchers spent to sequence the human genome over 13 years. “This is the first demonstration that you don’t need a genome centre to sequence a human genome,” stated Quake in a press release. “It’s really democratizing the fruits of the genome revolution and saying that anybody can play in this game.”

Markups: Physicians who are not part of American health insurance networks often charge patients upwards of 1000% more than they’d obtain for the same service from Medicare plans in their geographic region, according to a survey conducted by health care consultant Dyckman & Associates on behalf of America’s Health Insurance Plans. Those included US$4500 for an office visit for which Medicare would have paid $134, and US$40 000 for a hip replacement for which Medicare would have paid $1558 (www.ahipresearch.org/PDFs/ValueSurvey/AllStatesReport.pdf).

Caregiver allowance: Nova Scotia has unveiled a program that will provide up to $400 a month to low-income people who spend at least 20 hours a week providing care for a family member or a friend so they don’t have to enter a long-term care facility. The recipient must have “a high level of disability or impairment.” To qualify, a caregiver who is single or widowed must earn less than $18 785 a year, while married couples must have an annual net household income under $35 570.

Fewer foreign doctors: The proportion of foreign-trained physicians practising in Canada has decreased in recent decades, from 33% in the 1970s to 22.4% in 2007, according to a report from the Canadian Institute for Health Information (http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2354_E&cw_topic=2354&cw_rel=AR_3050_E). In the 1970s, most international medical graduates hailed from Britain and Ireland, and the mass retirement of these physicians is partly responsible for the overall decrease. Foreign-trained doctors are now more likely to have been trained in South Africa or India. The report also found that foreign-trained doctors who began practising in the 1990s are significantly more likely to move between provinces and equally likely to leave the Canadian workforce within a decade.

Fraud settlement: In the largest criminal fine ever imposed in the United States, Pfizer Inc. will shell out US$1.195 billion as part of a US$2.3 billion settlement with the US Department of Justice over fraudulent marketing of Bextra, an inflammatory drug that a subsidiary, Pharmacia & Upjohn Company Inc., was flogging for “off-label” use as a painkiller. A settlement also includes US$1 billion to offset payments that federal Medicare and state Medicaid plans made as a result of Pfizer’s fraudulent, off-label marketing of four drugs: Bextra, the antipsychotic Geodon, the antibiotic Zyvox and the antiepileptic Lyrica. Pfizer also entered a five-year “expansive corporate integrity agreement” that will see the US Department of Health and Human Services monitor future marketing activities (www.usdoj.gov/opa/pr/2009/September/09-aag-900.html0).

Mental health strategy: The Ontario government plans to integrate mental health and addiction services with other health services so they will no longer be the “distant cousins of the health care system,” according to a 10-year strategy outlined in a discussion paper (www.ofcmhap.on.ca). The strategy, which also includes integrating people with mental illnesses and addictions into their communities, is based on the principle that people with mental health problems should be active partners in their own recovery.