Page 1

May/June 2004

Compassionate Caring of the Underserved

In This Issue • • • •

An Orthopedic Odyssey Tanzanian Health Care Advocating for Children Minnesota Health Access Survey


“PLEASE COPY, DISTRIBUTE AND POST FOR ALL CLINIC EMPLOYEES”

To all HENNEPIN AND RAMSEY MEDICAL SOCIETY members, their employees and their families. A HASSLE-FREE Auto Discount Buying Service!

All Makes and Models! Ne New w or Used! Purchase or Lease! Local Dealer Deliv Delivery! ery! IT’S YOUR ONE-STOP BUYING SERVICE For Cars, Trucks, Rv’s, Suv’s, Boats and much, much more……… Simply pick out the vehicle of choice, and WE Do All The Rest… from locating and negotiating the best price on the vehicle to providing discounts on financing and warranties.

For Special Pricing, Contact: Ty Reed Log on to www.vehicleadvantage.com • E-mail info@vehicleadvantage.com

or Call: 612-242-1385 Access Code: HRM-905 “PLEASE COPY, DISTRIBUTE AND POST FOR ALL CLINIC EMPLOYEES”


$OCTORS -ETRO$OCTORS 4(%*/52.!,/&4(%(%..%0).!.$2!-3%9-%$)#!,3/#)%4)%3

0HYSICIAN#O EDITOR92ALPH#HU -$ 0HYSICIAN#O EDITOR4HOMAS"$UNKEL -$ 0HYSICIAN#O EDITOR0ETER*$EHNEL -$ 0HYSICIAN#O EDITOR#HARLES'4ERZIAN -$ -ANAGING%DITOR.ANCY+"AUER !SSISTANT%DITOR$OREEN-(INES (-3#%/*ACK'$AVIS 2-3#%/2OGER+*OHNSON 0RODUCTION-ANAGER3HEILA!(ATCHER !DVERTISING2EPRESENTATIVE"ETSY0IERRE #OVER$ESIGNBY*ANNA.ETLAND,OVER -ETRO$OCTORS)33.  ISPUBLISHEDBI MONTHLYBYTHE(ENNEPINAND2AMSEY-EDICAL 3OCIETIES 'ODWARD3TREET.% "ROADWAY 0LACE7EST 3UITE -INNEAPOLIS -. 0ERIODICALPOSTAGEPAIDAT-INNEAPOLIS -INNESOTA0OSTMASTER3ENDADDRESSCHANGESTO -ETRO$OCTORS (ENNEPINAND2AMSEY-EDICAL 3OCIETIES 'ODWARD3TREET.% "ROADWAY 0LACE7EST 3UITE -INNEAPOLIS -.  4OPROMOTETHEIROBJECTIVESANDSERVICES THE (ENNEPINAND2AMSEY-EDICAL3OCIETIESPRINT INFORMATIONIN-ETRO$OCTORSREGARDINGACTIVITIES ANDINTERESTSOFTHESOCIETIES2ESPONSIBILITYIS NOTASSUMEDFOROPINIONSEXPRESSEDORIMPLIEDIN SIGNEDARTICLES ANDBECAUSEOFTHEFREEDOMGIVEN TOCONTRIBUTORS OPINIONSMAYNOTNECESSARILY REmECTTHEOFlCIALPOSITIONOF(-3OR2-3 3ENDLETTERSANDOTHERMATERIALSFORCONSIDERATION TO-ETRO$OCTORS (ENNEPINAND2AMSEY-EDICAL 3OCIETIES 'ODWARD3TREET.% "ROADWAY 0LACE7EST 3UITE -INNEAPOLIS -. % MAILBAUERFAMILY EARTHLINKNET &ORADVERTISINGRATESANDSPACERESERVATIONS CONTACT"ETSY0IERRE %ASTWOOD#IRCLE -ONTICELLO -. PHONE   FAX   E MAILBETSY PIERREPRODUCTIONSCOM -ETRO$OCTORSRESERVESTHERIGHTTOREJECTANY ARTICLEORADVERTISINGCOPYNOTINACCORDANCEWITH EDITORIALPOLICY .ON MEMBERSMAYSUBSCRIBETO-ETRO$OCTORS ATACOSTOFPERYEARORPERISSUE IFEXTRA COPIESAREAVAILABLE&ORSUBSCRIPTIONINFORMA TION CONTACT$OREEN(INESAT  

#/.4%.43 6/,5-% ./-AY*UNE



0(93)#)!.33/!0"/8

)TSTHEh3YSTEMvNOTh0OOR1UALITYv4HAT!ILS-EDICINE



#/,,%!'5%).4%26)%7

-ARC7-ANLEY -$ -0(

     

2ESULTSFROMTHE-INNESOTA(EALTH!CCESS3URVEY

 

!NGELAS3TORY!N/RTHOPEDIC/DYSSEY ˆ 2OCKY-OUNTAIN(IGHˆ4ANZANIA 0ORTICO(EALTHNET!N!NSWERFORTHE5NINSURED #OMMUNITY%DUCATION!DVOCATINGFOR#HILDREN 0AY FOR 0ERFORMANCE7ONT)MPROVE 1UALITYOR2EDUCE#OSTSFOR-OST3ERVICES )NDEXTO!DVERTISERS 'OVERNMENT0RESCRIBEDh"EST0RACTICESvˆ .OT7HATTHE$OCTOR/RDERED

 

!4RIBUTETO$EMETRE-.ICOLOFF -$

2!-3%9-%$)#!,3/#)%49

 

0RESIDENTS-ESSAGE



  

./4%7/24(9

#ARING(EARTSFOR(OMELESS0EOPLE#ALLFOR2ESOLUTIONS .EW-EMBERS)N-EMORIAM 2-3*OINS2AMSEY4OBACCO#OALITION 2ESULTSOF2-30HYSICIAN6OLUNTEER7ORK1UESTIONNAIRE (%..%0).-%$)#!,3/#)%49

#HAIRS2EPORT .EW-EMBERS)N-EMORIAM

(-3!WARDED4OBACCO&REE#OMMUNITES'RANT #ALLFOR2ESOLUTIONS



(-3!LLIANCE

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

/NTHECOVER0HYSICIANSREACH OUTTOTHEUNDERSERVED!RTICLES BEGINONPAGE

-AY*UNE




0(93)#)!.g33/!0"/8

)TSTHEh3YSTEMvNOTh0OOR1UALITYv 4HAT!ILS-EDICINE

,

,!34-/.4(!,%')3,!4/230%!+).'TOAGROUPOFDOCTORS ALLEGEDTHAThPOORQUALITYCAREvISACAUSEOFMEDICALINmATION&INDING hBESTPRACTICESvANDhPAYINGFORQUALITYPERFORMANCEvWOULDBETHE REMEDY)FONLYTHINGSWERESOSIMPLE ORTHATTHEREMEDYWOULDHAVE ANYEFFECTONINmATION 4HEREAREMANYCAUSESOFMEDICALINmATION BUTPOORQUALITYOF CLINICCAREISNOTONEOFTHEM)TISOFTENSAIDTHATOURCURRENTSYSTEM OFMANAGEDCAREIShBROKENv)TSHARDTODISAGREE ANDTHATISWHEREWE SHOULDLOOK 4HEROADTOMEDICALINmATIONINTHE53BEGANWITHSUBSIDIZED HEALTHINSURANCEFORWORKERSIN7ORLD7AR)) FOLLOWEDINWITH INSURANCEFORTHEOLDANDOFlCIALPOOR4HISPIECEMEALVERSIONOFA .ATIONAL(EALTH)NSURANCEPROGRAMRESULTEDINDEMANDINmATIONASSER VICESAPPEAREDTOBENEARLYhFREEvANDhTHEBOSSPAIDFORITv4OAVERTTHE POLITICALRISKOFREPEALINGPOPULARSUBSIDIESDRIVINGDEMAND REGULATORY RATIONINGMEASURESWEREDEVISEDTOCONTROLUSEOFMEDICALCARESUPPLIES &EDERALREGULATIONOFSUPPLIESBEGANWITHlXINGPRICESIN CERTIlCATESOFNEEDDEFUNCTSINCE HOSPITAL$2'SIN AND PASSAGEOFTHE(-/!CTIN4HIS!CTALLOWEDCOMMERCIALINSUR ANCECORPORATIONSGENERICALLY-ANAGED#ARE/RGANIZATIONSOR-#/S THEUNPRECEDENTEDANDPERVERSE POWERTOCONTROLUSEANDDELIVERYOF THEBENElTSTHEYINSURED"Y -#/SCONTROLLEDPERCENTOFTHE COMMERCIALHEALTHINSURANCEMARKET)TWASALLEGEDTHATCOSTOFCARE WOULDDECREASEWHENPROlTMOTIVESDROVETHE-#/CORPORATIONSTO hMAINTAINHEALTHvBYPRACTICINGhWELLCAREvINSTEADOFhSICKCAREv "UTMARKETINGSLOGANSCONTAINEDNOSECRETREMEDYTOMAINTAIN HEALTHORCONTAINCOSTSˆINmATIONISRAMPANT4HEUNRECOGNIZEDmAW CAUSINGREGULATORYFAILUREISTHEFATALCOMBINATIONOFPATERNALISTIC HEALTHSERVICEREGULATIONANDhFREECAREv-ANAGERSFAILBECAUSETHEYARE ECONOMICALLYBLINDWHENATTEMPTINGTOALLOCATERESOURCESFROMAlXED BUDGETINTHEABSENCEOFORDINARYMARKETINFORMATIONFURNISHEDBYTHE PURCHASESOFMILLIONSOFPRUDENTPRICE SENSITIVECUSTOMERS3UDDENLYWE AGAINHEARECHOESOFSMARKETINGSLOGANSh(EALTHMAINTENANCEv ISECHOEDBYhBESTPRACTICESvANDPROlTSFORhWELLCAREvISECHOEDBY INCENTIVEhPAYFORQUALITYPERFORMANCEv0OPULATION CENTEREDSTATISTICS ANDSLOGANSEMPTYOFREALEFlCACYMAYMEETTHENEEDSOFTHOSEWANTING ANINmATIONSCAPEGOATOROFTHOSEBAFmEDBYINmATION BUTWILLNOTFUR NISHTHEMEANSNEEDEDTOCONTROLINmATIONORIMPROVEQUALITYPATIENT CENTEREDCAREITSTIMELINESS PERSONALIZATION CONTINUITY ANDACCESSTO EXPERTISE

,AWRENCE#ASALINOOFTHE5NIVERSITYOF#HICAGO HASVOICED CONCERNWHENQUALITYISDElNEDANDREWARDEDINTERMSOFWHATCAN BECOUNTEDORMEASUREDBYSELF INTERESTEDINSURANCEEXECUTIVESAND ACCREDITINGAGENCIES!FEWHIGHPROlLEDISEASESMEASUREDBYhREPORT CARDSvCANINAPPROPRIATELYSKEWRESOURCESTOhCOMPLIANCE vANDTHEN AREALLEGEDTOREmECTTHEQUALITYOFALLCLINICCARE-OSTOFWHATDOCTORS DOISNOTMEASURABLE$OCTORSEACHDAYLISTENCAREFULLYTOAGREATVARIETY OFPATIENTSFORSUBTLECLUESINTHEIRSYMPTOMSANDINCOMFORTINGTHOSE WHOHURTINBODYANDMIND#ORPORATESTATISTICIANSANDACCOUNTANTS RARELYlNDSUCHTIME CONSUMINGQUALITYACTIVITIESINTERESTING 5NLIKEWIDGETPRODUCTION MEDICALQUALITYASSESSMENTLOOKSAT ACOMPLEXMOVINGTARGET#LINICSHAVELITTLECONTROLOVERCHANGEIN DISEASESASPATIENTSAGE ORPATIENTCOMPLIANCEANDLIFESTYLES9ETTHESE FACTORSCANINPARTINmUENCEhREPORTCARDSvFORCLINICREWARDSANDPUN ISHMENTS 4HERECANBEREALVALUEINSTATISTICALSTUDIESOFPOPULATIONSWHEN DONEWITHINDEPENDENTREVIEWBOARDEVALUATIONS CAREFULPROTECTIONOF PATIENTPRIVACY ANDTHEUSEOFDATAFORDIRECTINGINVESTMENTTOWHERE PATIENTSARETREATED IE CLINICSYSTEMS TECHNOLOGY ANDCONTINUOUS EDUCATIONINRAPIDLYCHANGINGMEDICALINNOVATIONS"EFORETHEhQUALITY FORCOSTCONTROLvFADBECAMEAPOPULARSLOGAN EVIDENCE BASEDSTUDIES OFSENIORSINTRADITIONAL-EDICARE ASWELLASOFTHEGENERALPUBLICAT ALLAGES HAVESHOWNEXCELLENTQUALITYOFCAREIMPROVEMENTSOVERSHORT PERIODSOFTIME%CONOMISTSRECKONEDTHISWASSTRIKINGEVIDENCEOFTHE CONSEQUENCESOFIMPROVEDMEDICALCARETECHNOLOGY -ANYHAVEPOINTEDOUTTHATTHEPROBLEMSOFQUALITYMEDICALCARE ANDOFERRORSAREMORETHERESULTOFBADSYSTEMSTHANOFBADAPPLES4HE INSPECTIONMODELOFQUALITY hNAME BLAME SHAME vDOESNOTPREVENTOR lXSYSTEMFAILURES1UALITYMEANSPROPERINVESTMENT NOTCORPORATEOR STATECOMPLIANCETHREATSOFlNANCIALLOSS ADVERSEhREPORTCARDvPUBLICA TION ANDOTHERPUNISHMENTSYETTOBEANNOUNCED )NmATIONANDPATIENTDISSATISFACTIONWITHQUEUESARENOTSYMP TOMSOFPOORQUALITYMEDICALCARE BUTSYMPTOMSOFADYSFUNCTIONAL REGULATORYSYSTEM4HEEVIDENCEISTHATGIVENTHETOOLSANDFREEDFROM HARASSMENT OURHIGHLYTRAINEDMEDICALPROFESSIONALSATALLLEVELSDOC TORS 2.S TECHNICIANS ANDSOFORTH CANPERFORMCOMPLEXPATIENTCARE WITHEXCELLENCE 4HEINmATIONCULPRITIGNOREDBYSOMELEGISLATORSISAPATERNALISTIC REGULATORYSYSTEMTHATISINDEEDBROKENˆANDBEYONDREPAIR4HEREISA BETTERWAYU

"92/"%247'%)34 -$

2OBERT7'EIST -$ ISARETIREDUROLOGISTRESIDINGIN.ORTH/AKS

-AY*UNE

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


#/,,%!'5%).4%26)%7

-ARC7-ANLEY -$ -0(

%DITORS.OTE-ARC7-ANLEY -$ -0( ISTHEEXECUTIVEDIRECTOR #ENTERFOR4OBACCO2EDUCTIONAND(EALTH)MPROVEMENT "LUE#ROSS AND"LUE3HIELDOF-INNESOTA(EISRESPONSIBLEFORTHEDEVELOPMENT IMPLEMENTATION ANDEVALUATIONOFALLCENTERPROGRAMS WHICHAREDE SIGNEDTOREDUCETOBACCOUSE PREVENTHEARTDISEASE ANDPREVENTCANCER $R-ANLEYRECEIVEDHISMEDICALDEGREEFROMTHE5NIVERSITYOF7ASH INGTON 3EATTLE ANDAMASTERSINPUBLICHEALTHFROM4HE*OHNS(OPKINS 5NIVERSITY3CHOOLOF(YGIENE0UBLIC(EALTH "ALTIMORE -ARYLAND (EISBOARDCERTIlEDIN0UBLIC(EALTHAND0REVENTIVE-EDICINE

1 !

9OUCAMETO"LUE#ROSSAND"LUE3HIELDOF-INNESOTA FROMTHE.ATIONAL#ANCER)NSTITUTElVEYEARSAGO7HAT ATTRACTEDYOUTO"LUE#ROSSANDTO-INNESOTA )TWASOBVIOUSTOMETHAT"LUE#ROSSHADANUNSHAKABLECOMMITMENT TOREDUCINGTOBACCOUSEANDIMPROVINGHEALTH4HATCOMMITMENTFROM THECOMPANYSLEADERSWASMYTOPREASONFORCOMINGHERE)HADWORKED IN THE FEDERAL GOVERNMENT FOR  YEARS AND ) WAS EXCITED ABOUT THE CHANCETODEVELOPHEALTHIMPROVEMENTPROGRAMSINACORPORATESETTING )TALLOWEDMETOTACKLEDIFlCULTPUBLICHEALTHPROBLEMSWITHTHEHELPOF BUSINESSPEOPLE COMMUNICATIONSPROFESSIONALSANDOTHERSWITHIN"LUE #ROSS!LSO )ALREADYKNEWMANYPEOPLEINTHE-INNESOTAPUBLICHEALTH COMMUNITY AND)WASHONOREDTOJOINTHEM/NAPERSONALLEVEL MY WIFEAND)WEREGLADTOCOMETO-INNESOTABECAUSEWEKNEWITWOULD BEAGREATPLACETORAISEOURSONS

(OWDOESTHE#ENTERFOR4OBACCO2EDUCTIONAND(EALTH )MPROVEMENTANDITSPREVENTIONFOCUSlTINWITHTHEREST OF"LUE#ROSS "LUE#ROSSHASALWAYSBEENAMISSION DRIVENORGANIZATION)THASAUNIQUE STATEMANDATETOhPROMOTEAWIDER MOREECONOMICALANDTIMELYAVAIL ABILITYOFHEALTHSERVICESxANDTHEREBYADVANCEPUBLICHEALTHANDTHE ARTANDSCIENCEOFMEDICALANDHEALTHCAREv4HEWORKOFTHE#ENTERFOR 4OBACCO2EDUCTIONAND(EALTH)MPROVEMENTยˆWHERE)MTHEEXECU TIVEDIRECTORยˆISONEOFSEVERALWAYS"LUE#ROSSISMAKINGAHEALTHY DIFFERENCEINOURSTATE4HE#ENTERFOCUSESONPREVENTINGTHELEADING CAUSESOFDEATHANDDISABILITYINTHESTATEBYADDRESSINGTHEIRUNDERLYING CAUSESยˆINCLUDINGTOBACCOUSE PHYSICALINACTIVITY ANDPOORNUTRITION -ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

/UR #HIEF %XECUTIVE /FlCER -ARK "ANKS IS A FELLOW PHYSICIAN AND DEEPLYSUPPORTSTHEWORKWEDOINTHE#ENTER)AMLUCKYTOWORKINAN ORGANIZATIONTHATREALLYVALUESPREVENTION

4ELLUSABITABOUTTHE#ENTER /URWORKINTHE#ENTERISADIRECTRESULTOF"LUE#ROSSLAWSUIT AGAINSTTHETOBACCOCOMPANIES7HENTHATLAWSUITWASSETTLEDIN WEWONIMPORTANTPUBLICHEALTHCONCESSIONSINCLUDINGTHERELEASEOF PREVIOUSLY SECRET TOBACCO COMPANY DOCUMENTS "LUE #ROSS AND OUR CO PLAINTIFF THE STATE OF -INNESOTA WERE AWARDED SEPARATE lNANCIAL SETTLEMENTS4HE"LUE#ROSSFUNDSARESTILLHELDUPINCOURT BUTOUR HEALTHIMPROVEMENTWORKISALREADYUNDERWAY 7E FOCUS ON REDUCING TOBACCO USE AND OTHER HEART DISEASE AND CANCER RISK FACTORS FOR OUR MEMBERS AND ALL -INNESOTANS7E TAKE A COMPREHENSIVE SCIENCE BASEDAPPROACHTHATINCLUDESCLINICALINTERVEN TIONS PUBLICAWARENESSCAMPAIGNS COMMUNITYPOLICYINITIATIVES AND OUTREACHTOHIGH RISKGROUPS/NEOFOURMOSTVISIBLEPROGRAMSISTHE "LUE0RINTFOR(EALTHยงSTOP SMOKINGPROGRAMFOR"LUE#ROSSMEMBERS 4HROUGHITWEVECOUNSELEDTHOUSANDSOFSMOKERSOVERTHEPASTFEWYEARS ANDHELPEDMORETHAN SUCCESSFULLYQUIT 7E ALSO HAVE BEEN WORKING TO INCREASE THE STATES EXCISE TAX ON TOBACCO AND TO HELP COMMUNITIES PROTECT PEOPLE FROM SECONDHAND SMOKEยˆBOTH OF THESE STRATEGIES HELP SMOKERS QUIT AND IMPROVE HEALTH 4WOYEARSAGO WERANASUCCESSFULPUBLICAWARENESSCAMPAIGNABOUT THEDANGERSOFHIGHBLOODPRESSURE INWHICHWEENCOURAGED-INNESOTANS TOKNOWTHEIRBLOODPRESSURENUMBERSANDGETHELPIFTHEYWERE ORHIGHER *UST NOW WEVE LAUNCHED A TERRIlC NEW CAMPAIGN TO PROMOTE PHYSICALACTIVITY7EREPILOTINGTHEhDOvCAMPAIGNINPARTNERSHIPWITH THE!MERICAN(EART!SSOCIATIONIN$ULUTHAND"ROOKLYN#ENTER USING INNOVATIVEMESSAGESANDSTREETMARKETINGTOHELPPEOPLElNDEVERYDAY OPPORTUNITIESFORADDINGPHYSICALACTIVITYTOTHEIRLIVES #ONTINUEDONPAGE

-AY*UNE




#OLLEAGUE)NTERVIEW #ONTINUEDFROMPAGE

(OWDOESTHE#ENTEREVALUATEITSPROGRAMS %VALUATIONISAKEYPARTOFOURWORK7EMONITORTOBACCOPREVALENCE RATESTHROUGHABROADANDRIGOROUSPOPULATION BASEDSURVEY ANDCONDUCT EVALUATIONSOFOURMAJORPROGRAMCOMPONENTS7ESHAREOURRESULTS THROUGHLOTSOFPRESENTATIONSANDPUBLICATIONS7EHAVEWORKEDCLOSELY WITHTHE-INNESOTA$EPARTMENTOF(EALTH 5NIVERSITYOF-INNESOTA AND-INNESOTA0ARTNERSHIPFOR!CTION!GAINST4OBACCOTOPROVIDESCI ENTIlCALLYVALIDDATAON-INNESOTASKNOWLEDGE ATTITUDES ANDBEHAVIORS CONCERNINGADULTTOBACCOUSEANDEXPOSURETOSECONDHANDSMOKEINORDER TOSUPPORTPOLICYDEVELOPMENT ADVOCACY ANDPROGRAMPLANNING

7HATDOESSUCCESSLOOKLIKEFORYOUANDTHE#ENTER &OR STARTERS WE ARE COMMITTED TO ACHIEVING LOWER SMOKING RATES AND INCREASEDLEVELSOFPHYSICALACTIVITY"YREDUCINGTHESEKEYRISKFACTORS -INNESOTA WILL END UP WITH LESS CANCER LESS HEART DISEASE AND LOWER HEALTHCARECOSTS4HOSEBIGGOALSWONTBEACHIEVEDOVERNIGHT SOWE HAVEINTERIMMEASURESTOGAUGEOURPROGRESS"UTULTIMATELY THOSEARE THEGOALSWEAREAFTER

(OWIS"LUE#ROSSHELPINGMEMBERSQUITSMOKING 7EATTACKTHEPROBLEMFROMANUMBEROFDIFFERENTANGLES7EREWARD PHYSICIANSWHOTREATSMOKERSEFFECTIVELY7EOFFERˆANDADVERTISEˆA PHONECOUNSELINGPROGRAMTHATHASPROVENEFFECTIVEFORTHOUSANDSOF"LUE #ROSSMEMBERS4HATS   FORANYREADERWHOWILLDOUS THEGREATFAVOROFREFERRINGPATIENTS 7EOFFERTHEFULLRANGEOFCESSATION MEDICATIONSTOOURFULLYINSUREDMEMBERS ANDMANYOFOURSELF INSURED GROUPSALSOCHOOSETHATCOVERAGE7EDEVELOPEDANINNOVATIVEPUBLIC EDUCATIONCAMPAIGNSPECIlCALLYAIMEDATCOLLEGESTUDENTSWHOSMOKE 4HELISTGOESON BUTTHOSEAREAFEWOFOURMAJORINITIATIVES

7HYISTOBACCOCONTROLSTILLIMPORTANT7HYHAVENTWE SOLVEDTHEPROBLEM 4OBACCOCONTROLISIMPORTANTBECAUSETOBACCOISTHELEADINGCAUSEOF PREVENTABLEDEATHANDDISABILITYINTHENATION7HYHAVENTWESOLVEDTHE PROBLEM#ANDIDLY WEARENTSOLVINGTHEPROBLEMBECAUSETHETOBACCO INDUSTRYHASMOREWILLANDRESOURCESTOPROMOTETOBACCOTHANTHEREST OFSOCIETYHASTODISCOURAGEIT!MOUNTAINOFRESEARCHHASSHOWNUS HOW TO REDUCE TOBACCO USEˆSIGNIlCANTLY INCREASE THE CIGARETTE TAX CREATE MORE SMOKE FREE AREAS TREAT TOBACCO ADDICTION AND INVEST IN PREVENTION7E ASASOCIETY JUSTHAVENTHADTHECOLLECTIVEWILLTOTACKLE THEPROBLEMAGGRESSIVELY!SARESULT MILLIONSCONTINUETODIEWHOLLY PREVENTABLEDEATHSANDTHEHEALTHCARECOSTS CONTINUETOMOUNT

7HATARETHEBIGGESTOPPORTUNI TIESFOR-INNESOTATOBACCOREDUC TIONINTHENEXTFEWYEARS

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

    +&;  

 35*1&.05*(58.7&00.2&(31   :::&00.2&(31

-AY*UNE

%VERYONEISTRYINGTOlGUREOUTHOWTOCONTROL HEALTHCARECOSTS)NOURSTATEWIDE-INNESOTA $ECIDESTOWNHALLMEETINGSAFEWYEARSAGO -INNESOTANSTOLD"LUE#ROSSTHATTHEYVALUE ANDWANTMOREEMPHASISONPREVENTION3O ANY SERIOUS THOUGHTFUL DISCUSSION OF HEALTH CARECOSTSSHOULDLEADTOAREINVIGORATEDEM PHASISONTOBACCOREDUCTION7EWILLMAKEA LOT OF PROGRESS CONTROLLING HEALTH CARE COSTS IFWETAKEATLEASTTHREESTEPS&IRST INCREASE THE CIGARETTE EXCISE TAX BY A DOLLAR PER PACK ORMORE WHICHWILLREDUCETHESMOKINGRATE 3ECOND CREATEMORESMOKE FREEENVIRONMENTS INCLUDING RESTAURANTS AND BARS4HIRD FUND STATEWIDETOBACCOPREVENTIONPROGRAMSATTHE LEVELRECOMMENDEDBYTHE#ENTERSFOR$ISEASE #ONTROL4HERESEARCHTELLSUSWHATWORKS SO WEJUSTHAVETODOIT4HATSANEXCITINGOP PORTUNITY ANDTHESEAREEXCITINGTIMESU

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


6ARIATIONSINTHE5SEOF(EALTH3ERVICES IN-INNESOTABY)NSURANCE3TATUS 2ESULTSFROMTHE-INNESOTA(EALTH!CCESS3URVEY

4

4(%2%!2%-!.9490%3/&"!22)%23THATCANPREVENTPEOPLE

FROMHAVINGACCESSTOAPPROPRIATEANDTIMELYHEALTHCARE/FTHESEBAR RIERS ALACKOFHEALTHINSURANCECOVERAGEISONEOFTHEMOSTSIGNIlCANT 4HEPURPOSEOFTHISISSUEBRIEFISTOPRESENTlNDINGSONACCESSANDTHE USEOFHEALTHCARESERVICESAMONGUNINSURED-INNESOTANSCOMPAREDTO PEOPLEWITHPRIVATEHEALTHINSURANCECOVERAGE 4HE ANALYSIS IN THIS ISSUE BRIEF IS BASED ON DATA FROM THE  -INNESOTA(EALTH!CCESS3URVEYTHATWASCONDUCTEDBYTHE-INNESOTA $EPARTMENTOF(EALTHINCOLLABORATIONWITHTHE5NIVERSITYOF-INNE SOTA 3CHOOLOF0UBLIC(EALTH $IVISIONOF(EALTH3ERVICES2ESEARCHAND 0OLICY4HE-INNESOTA(EALTH!CCESS3URVEYISTHELARGESTANDMOST COMPREHENSIVEHEALTHINSURANCESURVEYCONDUCTEDIN-INNESOTATODATE 4HISSURVEYWASFUNDEDBYAGRANTFROMTHE53$EPARTMENTOF(EALTH AND (UMAN 3ERVICES (EALTH 2ESOURCES AND 3ERVICES !DMINISTRATION (23!  5SUAL3OURCEOF#ARE (AVINGAUSUALSOURCEOFCAREÂ&#x2C6;APLACETHATAPERSONGOESTOWITHNEW HEALTHPROBLEMSREQUIRINGADOCTORSATTENTIONÂ&#x2C6;ISAKEYINDICATOROF ACCESSTOPRIMARYCAREANDWHETHERAPERSONISLIKELYTOHAVECONTINUITY OFCARE!S4ABLESHOWS THELIKELIHOODOFHAVINGAUSUALSOURCEOFCARE VARIESSIGNIlCANTLYBYHEALTHINSURANCESTATUS5NINSURED-INNESOTANS AREBETWEENTHREEANDlVETIMESMORELIKELYTOLACKAUSUALSOURCEOFCARE THANPEOPLEWITHPRIVATEINSURANCE.EARLYHALFPERCENT OFPEOPLE UNINSUREDFORAYEARORMORE IE THELONG TERMUNINSURED DIDNOTHAVE AUSUALSOURCEOFCARE COMPAREDTOABOUTONEQUARTERPERCENT OF PEOPLEUNINSUREDFORLESSTHANAYEAR)NCONTRAST FEWERTHANPERCENT OFTHEPRIVATELYINSUREDLACKEDAUSUALSOURCEOFCARE

4ABLE 0ERCENTAGEOF-INNESOTANS7ITHA5SUAL3OURCE OF#ARE BY(EALTH)NSURANCE3TATUS (AVEA5SUAL3OURCEOF#ARE 9ES

.O





'ROUP#OVERAGE





)NDIVIDUAL#OVERAGE









5NINSURED9EAROR-ORE





5NINSURED,ESSTHAN9EAR





0RIVATE#OVERAGE/VERALL

5NINSUREDATTHE4IMEOF3URVEY

.UMBERSINBOLDINDICATEASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHERATEOFTHEPRIVATELYINSUREDOVERALL 'ROUP COVERAGE IS COVERAGE THROUGH AN EMPLOYER )NDIVIDUAL COVERAGE IS PURCHASEDINTHEINDIVIDUALMARKET

3INCEHAVINGHEALTHINSURANCECOVERAGEISASTRONGDETERMINANTOFHAVING AUSUALSOURCEOFCARE WEEXPECTTHEMAINREASONSFORLACKINGAUSUAL SOURCEOFCARETOBERELATEDTOWHETHERORNOTAPERSONHASHEALTHINSURANCE COVERAGE4ABLESHOWSTHATTHISIS INFACT THECASE/FTHOSEUNINSURED ANDLACKINGAUSUALSOURCEOFCARE NEARLYPERCENTREPORTEDBEING UNINSUREDASONEOFTHEMAINREASONSFORNOTHAVINGAUSUALSOURCEOF CARE!NADDITIONALPERCENTOFTHEUNINSUREDREPORTEDOTHERlNANCIAL REASONSFORLACKINGAUSUALSOURCEOFCAREITISLIKELYTHATFORSOMEPEOPLE THISANSWERREFERREDTOTHECOSTOFHEALTHINSURANCE&ORBOTHTHEINSURED ANDTHEUNINSURED THEMOSTCOMMONREASONGIVENFORNOTHAVINGA USUALSOURCEOFCAREWASTHATTHEYFELTTHEYDIDNOTHAVEANEEDFORONE BECAUSETHEYWERERARELYSICKPERCENTOFPEOPLEWITHPRIVATEINSURANCE ANDPERCENTOFTHEUNINSURED )NSUMMARY WHILEITISCOMMONFOR #ONTINUEDONPAGE

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

-AY*UNE




-INNESOTA(EALTH!CCESS3URVEY #ONTINUEDFROMPAGE

4ABLE

PEOPLEWHODONOTHAVEAUSUALSOURCEOFCARETOREPORTTHATTHEYHAVE NONEEDFORONE ITISMORELIKELYAMONGTHEUNINSUREDTHATTHEREASON FORLACKINGAUSUALSOURCEOFCAREISNOTVOLUNTARY 4ABLEALSOSHOWSANINTERESTINGVARIATIONBETWEENTHERESPONSES OFTHOSEWITHGROUPINSURANCEANDTHOSEWITHINSURANCECOVERAGEPUR CHASEDINTHEINDIVIDUALMARKET!SIGNIlCANTLYHIGHERPROPORTIONOF THEINDIVIDUALLYINSUREDPERCENT THANTHOSEWITHGROUPINSURANCE PERCENT REPORTLACKINGAUSUALSOURCEOFCAREBECAUSETHEYCANNOT AFFORDONE/NEREASONFORTHISDIFFERENCEISLIKELYTHEFACTTHATPEOPLE WITH INDIVIDUAL COVERAGE HAVE LESS COMPREHENSIVE INSURANCE BENElTS THANPEOPLEWITHGROUPCOVERAGEÂ&#x2C6;FOREXAMPLE THEYUSUALLYHAVEPOLI CIESWITHHIGHERDEDUCTIBLES#ONSEQUENTLY THEUP FRONTCOSTTHATTHE INDIVIDUALLYINSUREDHAVETOPAYOUTOFPOCKETMAYPOTENTIALLYACTASA DETERRENTTOMAINTAININGAUSUALSOURCEOFCARE

0ERCENTAGEOF-INNESOTANS7ITHOUTA5SUAL 3OURCEOF#ARE BY)NSURANCE4YPEAND $EMOGRAPHIC'ROUP

/VERALL2ATE

5NINSURED

0RIVATE #OVERAGE





!GE  





 





 





 





 





-ALE





&EMALE





,OWINCOME





(IGHERINCOME





7HITE





.ON 7HITE





53





.OT53





'REATER-INNESOTA





4WIN#ITIES





'ENDER

4ABLE -AIN2EASONFOR.OT(AVINGA 5SUAL3OURCEOF#ARE 0RIVATE#OVERAGE 5NINSURED

!LL0RIVATE #OVERAGE

&INANCIALREASONSNOTAFFORDABLE



.OINSURANCECOVERAGE

)NCOME

'ROUP #OVERAGE

)NDIVIDUAL #OVERAGE















.ONEED BECAUSERARELYGETSICK









4IMEANDTRANSPORTATIONBARRIERS









,ANGUAGEANDTRUSTBARRIERS





























2ACE

2ECENTCHANGESWITHDOCTORSOR HEALTHPLAN /THERREASONS





.UMBERSINBOLDINDICATEASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHEDISTRIBUTIONOFTHEPRIVATELYINSUREDOVERALL *USTASTHERATESOFINSURANCECOVERAGEVARYBYDEMOGRAPHICCATEGORY SO DOESTHELIKELIHOODOFLACKINGAUSUALSOURCEOFCARE4ABLESHOWSTHOSE VARIATIONSBYAGE GENDER RACE ANDINCOMEANDCOMPARESTHERATESFOR DIFFERENTDEMOGRAPHICGROUPSTOTHEOVERALLPOPULATIONOFTHEUNINSURED ANDTHEPRIVATELYINSURED 7HILETHEPERCENTOF-INNESOTANSWHOLACKAUSUALSOURCEOFCARE VARIESSIGNIlCANTLYBYINSURANCETYPE SOMECONSISTENTPATTERNSACROSS DEMOGRAPHICGROUPSAREEVIDENT ASSHOWNIN4ABLE!MONGTHEUN INSURED CHILDRENYOUNGERTHANARETHELEASTLIKELY ANDMALESTHE MOSTLIKELY TOLACKAUSUALSOURCEOFCARE!MONGTHEPRIVATELYINSURED FEMALESARELEASTLIKELY ANDADULTSBETWEENANDAREMOSTLIKELYTO LACKAUSUALSOURCEOFCARE

-AY*UNE

#OUNTRYOF/RIGIN

2EGION

.UMBERSINBOLDINDICATEASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHEOVERALLRATESOFTHEUNINSUREDORTHEPRIVATELYINSUREDh,OWINCOMEv ISDElNEDASOFPOVERTYORBELOW4HISIS FORAFAMILYOF FOURACCORDINGTOTHE&EDERAL0OVERTY'UIDELINE h(IGHERINCOMEvIS ABOVEOFPOVERTY

3OURCESOF#ARE )NADDITIONTOBEINGLESSLIKELYTOHAVEAUSUALSOURCEOFCARE THEUNINSURED ALSOREPORTBEINGLESSHEALTHYTHANTHEPOPULATIONASAWHOLE!BOUT PERCENTOFTHEUNINSUREDREPORTBEINGINFAIRORPOORHEALTH COMPARED WITHONLYPERCENTOFTHEPRIVATELYINSURED ADIFFERENCETHATISSTATISTI CALLYSIGNIlCANT$ESPITEBEINGLESSHEALTHYONAVERAGE THEUNINSURED USEFEWERHEALTHSERVICES 4HEREARESOMESIGNIlCANTDIFFERENCESINTHEWAYSTHATTHEUNINSURED ACCESSHEALTHCARESERVICESCOMPAREDTOPEOPLEWITHPRIVATECOVERAGE -ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


4HOSEDIFFERENCESFORPEOPLEWHOHAVEAUSUALSOURCEOFCAREARESHOWN IN4ABLE7HILEBOTHPOPULATIONGROUPSRELYMOSTLYONCLINICSANDDOC TORSOFlCESTOOBTAINCAREPERCENTOFTHEUNINSUREDANDPERCENTOF THOSEWITHPRIVATECOVERAGE THEUNINSUREDAREMORELIKELYTOUSEPUBLIC HEALTHORCOMMUNITYCLINICSPERCENTCOMPAREDWITHPERCENT AND LESSLIKELYTOUSEPRIVATECLINICSTHANTHOSEWITHPRIVATEHEALTHINSURANCE COVERAGEPERCENTCOMPAREDWITHPERCENT &URTHER THEUNINSURED AREALSOMORELIKELYTHANTHEPRIVATELYINSUREDTORELYONEMERGENCYROOM ANDURGENTCARESETTINGSPERCENTCOMPAREDWITHPERCENT  4HEREARETWOPRIMARYIMPLICATIONSOFTHEGREATERRELIANCEOFTHE UNINSUREDONEMERGENCYROOMSANDURGENTCARE&IRST SERVICESDELIVERED INTHESESETTINGSAREMOREEXPENSIVETHANCOMPARABLESERVICESPROVIDED ATPHYSICIANCLINICS4HISHIGHERCOSTISEITHERBORNEBYTHEUNINSURED THEMSELVESORSHOWSUPASUNCOMPENSATEDCAREFORHEALTHCAREPROVID ERS3OMEOFTHISUNCOMPENSATEDCAREISPAIDFORTHROUGHHIGHERPRICES CHARGEDFOROTHERPATIENTS SOMEISABSORBEDBYTHEPROVIDERASFORGONE INCOME ANDSOMEISPAIDFORBYTAXPAYERSTHROUGHPUBLICSUBSIDIES 3ECOND PATIENTSWHORELYONTHEEMERGENCYROOMFORTHEIRPRIMARY CARENEEDSARELESSLIKELYTORECEIVEPREVENTIVECARESERVICESANDMORELIKELY TOLACKCONTINUITYOFCARE!SARESULT THEYMAYDELAYSEEKINGNEEDED CAREANDPRESENTWITHGREATERCOMPLICATIONSORATANADVANCEDPOINTIN THEIRILLNESS

4ABLE ,OCATION7HERE-INNESOTANS7ITHA5SUAL3OURCEOF#ARE /BTAIN(EALTH#ARE3ERVICES 5NINSURED %25RGENT#ARE

0RIVATE #OVERAGE









0UBLICHEALTHCOMMUNITYCLINIC





(OSPITALOUTPATIENTCLINC





0RIVATECLINICDOCTORSOFlCE





/THER





(OSPITAL





3OMEOTHERPLACE









#LINIC$OCTORSOFlCE

4OTAL

.UMBERSINBOLDINDICATEASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHEDISTRIBUTIONFORTHEPRIVATELYINSUREDRESPONDENTS #ONlDENCEIN!BILITY TO'ET#ARE 4ABLEDEPICTSTHERELATIVECONlDENCEOFSURVEYRESPONDENTSINBEING ABLETOOBTAINCAREWHENNEEDED!SEXPECTED PEOPLEWITHPRIVATEHEALTH INSURANCECOVERAGEAREMORECONlDENTINTHEIRABILITYTOOBTAINNEEDED CARETHANTHEUNINSURED!BOUTPERCENTOFPEOPLEWITHPRIVATECOVER AGEAREEITHERSTRONGLYORSOMEWHATCONlDENTTHATTHEYCANOBTAINCARE WHENNEEDED)NCONTRAST ONLYABOUTTWO THIRDSOFTHEUNINSURED PERCENT ARESIMILARLYCONlDENTINTHEIRABILITYTOGETNEEDEDCARE4ABLE ALSOSHOWSANOTHERDISTINCTIONBETWEENTHERESPONSESOFTHEUNINSURED -ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

ANDTHEPRIVATELYINSURED4HEPRIVATELYINSUREDAREMUCHMORELIKELYTO BESTRONGLYCONlDENTOFTHEIRABILITYTOOBTAINCARETHANTHEUNINSURED !BOUTPERCENTOFTHEPRIVATELYINSUREDRESPONDENTSARESTRONGLYCON lDENT COMPAREDWITHONLYONE THIRDOFTHEUNINSURED

4ABLE #ONlDENCEIN!BILITYTO/BTAIN#ARE h)AMCONlDENTTHAT)CANGETTHECARE)NEEDWHEN)NEEDITv 0RIVATE#OVERAGE 5NINSURED

!LL0RIVATE 'ROUP #OVERAGE #OVERAGE

)NDIVIDUAL #OVERAGE

!GREE STRONGLYAGREE









SOMEWHATAGREE









SOMEWHATDISAGREE









STRONGLYDISAGREE













$ISAGREE





.UMBERSINBOLDINDICATEASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHEDISTRIBUTIONFORTHEPRIVATELYINSUREDOVERALL 7HENSTUDYINGREPORTEDCONlDENCEINBEINGABLETOOBTAINCAREBYAGE GROUP ONECATEGORYSTANDSOUTÂ&#x2C6;RESPONDENTSONBEHALFOFUNINSURED CHILDRENARE WHENCOMPAREDWITHUNINSUREDOVERALL MORECONlDENT INTHEIRABILITYTOOBTAINCAREWHENTHECHILDRENNEEDIT$ESPITESIG NIlCANTBARRIERSTOOBTAININGHEALTHSERVICES PERCENTOFCARETAKERS OFUNINSUREDCHILDRENARECONlDENTABOUTBEINGABLETOGETNEEDEDCARE FORTHEIRCHILDREN COMPAREDTOPERCENTFORTHEUNINSUREDOVERALL 3TILL THISLEVELOFCONlDENCEISLOWERTHANFORPRIVATELYINSUREDCHILDREN PERCENT  5SEOF3ERVICES 4HISSECTIONPROVIDESANOVERVIEWOFTHEUSEOFHEALTHSERVICESAMONG THEPRIVATELYINSUREDANDTHEUNINSUREDBYREPORTINGTHENUMBEROFDOC TORVISITS THENUMBEROFINPATIENTVISITSANDTHEVOLUMEOFEMERGENCY ROOMUSE &IGURE  DEPICTS THE VARIATION IN THE NUMBER OF PHYSICIAN VISITS INTHETHREEMONTHSPRIORTOTHESURVEYBYTYPEOFINSURANCECOVERAGE $ESPITETHEFACTTHATTHEUNINSUREDREPORTPOORERHEALTHSTATUS THEYARE SIGNIlCANTLYLESSLIKELYTOINDICATETHATTHEYHAVESEENAPHYSICIANTHAN PEOPLEWITHPRIVATEINSURANCE!SIGNIlCANTLYGREATERPROPORTIONOFTHE UNINSUREDDIDNOTHAVEANYPHYSICIANVISITINTHETHREEMONTHSPRIORTO THESURVEY COMPAREDTOTHEPRIVATELYINSUREDPERCENTANDPERCENT RESPECTIVELY 4HISRESULTISCONSISTENTWITHOTHERRESEARCHTHATSHOWS THATTHEUNINSUREDUSEFEWERHEALTHSERVICES DESPITETHEIRLESSFAVORABLE HEALTHSTATUS)TISUNCLEARTOWHATEXTENTTHISDIFFERENCEISTHERESULTOF lNANCIALBARRIERSTHEUNINSUREDFACEOROFHIGHERUTILIZATIONOFSERVICES BYPEOPLEWITHINSURANCECOVERAGE #ONTINUEDONPAGE

-AY*UNE




-INNESOTA(EALTH!CCESS3URVEY #ONTINUEDFROMPAGE

&IGURE .UMBEROF0HYSICIAN6ISITS)NTHE,AST 4HREE-ONTHSBY)NSURANCE4YPE



  













 



MORETHAN6ISITS





TO6ISITS TO6ISITS

 



TO6ISITS





6ISIT



.O6ISITS

 

5NINSURED

&OOTNOTES

0RIVATE)NSURANCE

)NDICATESASTATISTICALLYSIGNIlCANTDIFFERENCELEVEL FROMTHEDISTRIBU TIONFORTHEPRIVATELYINSURED !SSHOWNIN4ABLE THEREISNOSTATISTICALLYSIGNIlCANTDIFFERENCEBETWEEN THEUSEOFINPATIENTCAREANDEMERGENCYROOMSERVICESOFTHEUNINSURED ANDTHEPRIVATELYINSURED4HISMAYBEBECAUSETHEUSEOFEMERGENCY ROOMSANDINPATIENTHOSPITALIZATIONSAREUSUALLYNOTDISCRETIONARYSER VICES ANDTHEREFOREWEEXPECTTOSEESMALLERDIFFERENCES)NADDITION A HOSPITALIZATIONORSERIOUSILLNESSWOULDLIKELYBEANEVENTTHATWOULDCAUSE UNINSUREDPEOPLETOSEEKCOVERAGEOPTIONS'IVENTHATALARGESHAREOF THEUNINSUREDABOUTTWOTHIRDS AREPOTENTIALLYELIGIBLEFORINSURANCE COVERAGE ITISATLEASTSOMEWHATLIKELYTHATPEOPLEWHOAREUNINSURED ANDEXPERIENCEANILLNESSREQUIRINGHOSPITALIZATIONWILLBEABLETOOBTAIN INSURANCECOVERAGE

4ABLE 0ROPORTIONOF0OPULATION5SING(OSPITAL3ERVICES BY)NSURANCE4YPE 5NINSURED

0RIVATE #OVERAGE

)NPATIENT#ARE /NEORMOREVISITS





.OINPATIENTVISITS









/NEORMOREVISITS





.OEMERGENCYROOMUSE









$IFFERENCESBETWEENTHEPRIVATELYINSUREDANDTHEUNINSUREDARENOTSTATISTI CALLYSIGNIlCANT

 ! SUBSET OF RESPONDENTS TO THIS HOUSEHOLD SURVEY CONDUCTED BY TELEPHONE WERE ASKEDABOUTTHEAVAILABILITYOFAUSUALSOURCEOFCARE THELOCATIONOFTHATCARE AND THEVOLUMEOFINPATIENTANDOUTPATIENTVISITS3PECIlCALLY POPULATIONSWHORECEIVED THESEUSEQUESTIONSINCLUDEDALLOFTHEUNINSUREDPARTICIPATEDINTHESURVEY  ALLTHOSEWITHINDIVIDUALCOVERAGE  ANDASUBSETOF-INNESOTANSWITHGROUP COVERAGE    &OR MORE DETAIL ON THE SURVEY METHODOLOGY SEE -$( (EALTH %CONOMICS0ROGRAM h-INNESOTAS5NINSURED&INDINGSFROMTHE(EALTH !CCESS3URVEY v!PPENDIX!  3TARlELD" 0RIMARY#ARE "ALANCING(EALTH.EEDS 3ERVICES AND4ECHNOLOGY /XFORD5NIVERSITY0RESS .EW9ORK  2ESULTSPERTAININGTORESPONSESFROMPEOPLEWITHINDIVIDUALORGROUPCOVERAGEARE UNLESSNOTEDOTHERWISE REPORTEDINAhPRIVATECOVERAGEvCATEGORY4HISISDONEBE CAUSERESULTSFORPEOPLEWITHINDIVIDUALCOVERAGE INMOSTCASES TRACKCLOSELYTHOSE FORPEOPLEWITHGROUPCOVERAGE  ! FORTHCOMING STUDY BY THE (EALTH %CONOMICS 0ROGRAM REPORTS THAT THE MEDIAN DEDUCTIBLESFOR-INNESOTANSWITHINDIVIDUALCOVERAGEWAS PERPERSON4HIS COMPARESTORECENTLYPUBLISHEDNATIONALDATA SHOWINGTHEAVERAGEANNUALDEDUCTIBLE FOREMPLOYER BASEDSINGLECOVERAGETOBE4HE+AISER&AMILY&OUNDATIONAND (EALTH2ESEARCHAND%DUCATIONAL4RUST%MPLOYER(EALTH"ENElT !NNUAL3URVEY P   3EEFORMOREDETAIL-INNESOTA$EPARTMENTOF(EALTH (EALTH%CONOMICS0ROGRAM    4HE+AISER#OMMISSIONON-EDICAIDANDTHE5NINSURED h3ICKERAND0OORER 4HE#ONSEQUENCESOF"EING5NINSURED vP  )NSTITUTEOF-EDICINE #OMMITTEEONTHE#ONSEQUENCESOF5NINSURANCE #ARE 7ITHOUT#OVERAGE4OO,ITTLE 4OO,ATE .ATIONAL!CADEMY0RESS 7ASHINGTON$# P  7HERETHETARGETEDRESPONDENTWASACHILD APARENTWASASKEDABOUTHISORHER CONlDENCEWITHBEINGABLETOGETNEEDEDCAREFORTHECHILD  )NSTITUTEOF-EDICINE #OMMITTEEONTHE#ONSEQUENCESOF5NINSURANCE 3TUDIES ALSOREPORTTHATTHEUNINSUREDAREMORELIKELYTODELAYNEEDEDCARE(OWEVER WE CANNOTTESTTHISFOR-INNESOTAASWEDIDNOTASKTHATQUESTIONINOURSURVEY  .OTE THEGREATERRELIANCEONEMERGENCYROOMANDURGENTCARESETTINGREPORTEDIN 4ABLEREFERSONLYTOUNINSUREDWHOHAVEAUSUALSOURCEOFCARE)NCONTRAST THIS ANALYSISINCLUDESEVERYUNINSUREDPERSON

%MERGENCY2OOM5SE

-AY*UNE

3UMMARY 4HISISSUEBRIEFSHOWSTHATTHEUNINSUREDARELESSLIKELYTOHAVEAUSUAL SOURCEOFCARE LESSLIKELYTOUSEHEALTHCARESERVICES MORELIKELYTORECEIVE CAREINANURGENTCARESETTING ANDLESSCONlDENTINTHEIRABILITYTOGET CAREWHENTHEYNEEDIT!LLOFTHESEISSUESHAVEPOTENTIALCONSEQUENCES FORTHEHEALTHSTATUSOFTHEUNINSUREDANDHEALTHOUTCOMESWHENTHEYDO RECEIVECARE)NARECENTSUMMARYOFRESEARCHONTHISTOPIC THE)NSTITUTE OF-EDICINENOTEDTHATWORKING AGE!MERICANSWITHOUTHEALTHINSURANCE AREMORELIKELYTO v RECEIVETOOLITTLEMEDICALCAREANDRECEIVEITTOOLATE v BESICKERANDDIESOONERAND v RECEIVEPOORERCAREWHENTHEYAREINTHEHOSPITALEVENFORACUTESITU ATIONSLIKEAMOTORVEHICLECRASH 'IVENTHATHEALTHINSURANCEANDHAVINGAUSUALSOURCEOFCAREARE ASSOCIATED WITH BETTER HEALTH AND IMPROVED HEALTH OUTCOMES POLICY MAKERSSHOULDCONTINUETOEXPLOREWAYSTOENSURETHATALL-INNESOTANS HAVEACCESSTOAFFORDABLE HIGHQUALITYHEALTHINSURANCECOVERAGEU

 -INNESOTA$EPARTMENTOF(EALTH (EALTH%CONOMICS0ROGRAM P  )NSTITUTEOF-EDICINE #OMMITTEEONTHE#ONSEQUENCESOF5NINSURANCE 2EPORT 3UMMARY P

2EPRINTEDWITHPERMISSIONFROM(EALTH%CONOMICS0ROGRAM)SSUE"RIEF   &EBRUARY -ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


$QJHOD·V6WRU\

$Q2UWKRSHGLF2G\VVH\

)

).*5.% )42!6%,%$WITHMYWIFE ,U,U ANDMYFOURCHILDREN 4ALIA 4RICIA -I CHAEL AND 0ATRICK TO (ONDURAS TO VOLUNTEER AT AN ORPHANAGE !T THE hRANCHv  CHILDREN RECEIVETHELOVE CARE ANDEDUCATIONTHEYNEEDTO DEVELOPINTOSELF SUSTAININGADULTS!SISCOMMON INTHEVOLUNTEERSEXPERIENCE WEWEREALLMORE PROFOUNDLYCHANGEDTHANWERETHOSEWITHWHOM WEMADECONTACT ) HAD VOLUNTEERED PREVIOUSLY THROUGH AN EXCELLENT ORGANIZATION /RTHOPEDICS /VERSEAS BUT VOLUNTEER ACTIVITIES FOR MY CHILDREN WERE NOT AVAILABLE AND THERE WAS NOT A SECURE AREA WHEREWORRYINGOFTHEIRWHEREABOUTSWOULDNOT BEANISSUE)WASLOOKINGFORANEXPERIENCEFORMY ENTIREFAMILY!T.UESTROS0EQUENOS(ERMANOS .0(Â&#x2C6;hOUR LITTLE BROTHERS AND SISTERSv THE OPPORTUNITY FOR WHICH )D BEEN SEARCHING WAS FOUND )T IS NESTLED IN THE CENTER OF ITS   ACREWOODEDPROPERTY  FEETABOVESEALEVEL AMONGROLLINGHILLS %ACHMORNING)SETOUTONAlVEMILERUN WITHTWOYEAROLDVOLUNTEERSFROM'ERMANY) SPENTMOSTOFTHEDAYATTHEhCLINICAEXTERNAvÂ&#x2C6;A CLINICRUNBYAVOLUNTEERPRIMARYCAREPHYSICIAN OR NURSE PRACTITIONER ON THE .0( PROPERTY WHICHSERVEDINDIGENTADULTSANDCHILDRENFROM THESURROUNDINGCOUNTRYSIDE)TINVOLVEDMOSTLY PRIMARY CARE DIABETES (4. ETC AND HAD A REASONABLY WELL STOCKED PHARMACY ROOM )TS MISSIONWASTOSERVETHEINDIGENT ANDTHEYSAW APPROXIMATELYPATIENTSADAY !S AN ORTHOPEDIC SURGEON ) DIDNT HAVE ANIDEALOPPORTUNITYTOUSEMYSKILLS BUTTHERE WASANOTHERCOMPONENT!GROUPOF(ONDURAN PHYSICIANS HAD ASSISTED .0( IN CONVERTING A SEMI TRUCKTRAILERINTOASMALLOPERATINGROOM )T WAS EQUIPPED WITH AN ANESTHESIA MACHINE ANDTHERESTOFTHEBARENECESSITIES)WASABLETO

"90%4%2*$!,9 -$

PERFORMSEVERALOUTPATIENTPROCEDURESWITHTHE HELPOFALOCALANESTHESIOLOGIST.0(ISINTHE PROCESSOFBUILDINGAPERMANENTOUTPATIENTSUR GERYCENTERNEXTTOTHECLINIC ANDPLANSTOSERVE THESURROUNDINGHILLSIDECOMMUNITIES/NCETHAT ISINPLACE SURGEONSCOULDMORESPECIlCALLYOFFER THEIRSERVICES)TISCURRENTLY ANDWILLCONTINUE TOBE ANEXCELLENTVOLUNTEEROPPORTUNITYFORTHE PRIMARYCAREPHYSICIAN -EANWHILE MY CHILDREN WERE KEEPING BUSYDIGGINGDITCHES READINGANDPLAYINGWITH THE TODDLERS IN THE hBABY HOUSE v AND HELPING SKINCHICKENSINTHEKITCHEN4HEYALSOHELPED MYWIFE,U,U APEDIATRICNURSE PERFORMWELL CHILDCHECKUPSONMOSTOFTHESMALLERCHILDREN /NEOFMYFAMILYSHIGHLIGHTSWASCLEANINGTHE CHILDRENSEARS3EVERALSMALLINTERESTINGOBJECTS WERE RETRIEVED FROM THEIR EXTERNAL EAR CANALS 4HE(ONDURANCHILDRENENJOYEDTHEATTENTION SOMUCHTHATTHEYKEPTGETTINGBACKINLINETO BEEXAMINED4HEIRÂ FOOTFRAMES LARGEBROWN EYES ANDINFECTIOUSSMILESALLSTARTEDLOOKINGTHE SAME&INALLY ,U,UHADTOMARKEACHHANDTO KNOWIFTHEYHADBEENSEENBEFORE ! SPECIAL TWIST OF FATE OCCURRED WHEN ) EVALUATEDA YEAR OLDGIRLONTHERANCHNAMED !NGELA4HREEYEARSEARLIER .0(HADTAKENHER IN ALONGWITHANOLDERSISTERANDYOUNGERBROTHER WHENTHEIRMOTHERDIEDOF!)$34HEIRFATHER HAD SUCCUMBED TO !)$3 A FEW YEARS BEFORE &ORTUNATELY NONE OF THEIR CHILDREN CONTRACTED THEDISEASE !NGELAWASBORNWITHANUNCOMMONCONDI TIONCALLEDCHONDROECTODERMALDYSPLASIA)TISA TYPEOFDWARlSMTHATINVOLVESSHORTLIMBSAND NORMALTRUNKLENGTH)TINCLUDESHYPOPLASTICNAILS ONTHEHANDSANDFEET POLYDACTYLY!NGELAHAD ANEXTRADIGITONEACHHANDANDFOOT ANDLATERAL PROXIMALTIBIALGROWTHPLATEDYSPLASIARESULTING INASYMMETRICOVERGROWTHOFTHENORMALMEDIAL ASPECTOFTHEKNEE4HISGROWTHPATTERNCAUSESA VALGUSKNOCK KNEE DEFORMITYATTHEKNEES

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

!NGELABEFOREHERSURGERY

7ITHAPPROPRIATEWELL CHILDCHECKUPS THIS CONDITIONWOULDHAVEBEENRECOGNIZEDEARLYAND ALLOWEDBALANCINGHERKNEEALIGNMENTASANINFANT WITHANEPIPHYSIODESISGROWTHPLATEARRESTONTHE OVER GROWINGMEDIALSIDE TOPREVENTDEFORMITY 3INCESHELACKEDROUTINEMEDICALCARE !NGELAS KNOCK KNEEALIGNMENTMEASUREDDEGREESON EACHSIDENORMALDEGREES 3HEHADTOSCISSOR ONELEGINFRONTOFTHEOTHERTOSTANDORWALK 'IVENTHEDISTORTEDBIOMECHANICSOFHERGAIT SHE WASDESTINEDTODEVELOPPREMATUREARTHRITISASA YOUNGADULT ANDWASUNABLETOKEEPUPWITHTHE ACTIVITIESOFHERPEERS ) RECOGNIZED THAT A SINGLE REALIGNMENT OSTEOTOMY A CONTROLLED FRACTURE TO STRAIGHTEN THE LIMB WITH PLATES AND SCREWS TO MAINTAIN THE CORRECTION COULD NOT BE PERFORMED SINCE ABRUPT STRAIGHTENING WOULD DAMAGE THE SHORT ENEDNERVESINTHELIMB3HENEEDEDACOMPLEX GRADUALRECONSTRUCTIONWITHANEXTERNALlXATION SYSTEMOFPINSANDWIRESANDADJUSTABLETENSION COMPRESSIONSTRUTS4HISWOULDYIELDAGRADUAL CORRECTION OVER THREE MONTHS WHICH WOULD ALLOWTHENERVES VESSELS ANDOTHERSOFTTISSUES TO ACCOMMODATE TO THE NEW SKELETAL ANATOMY 4HE PROCESS WOULD INCLUDE THE INITIAL SURGERY TO APPLY THE APPARATUS4HEN WE WOULD NEED SOMEONE TO TURN ADJUSTABLE STRUTS ONE TO TWO MILLIMETERSEVERYSIXHOURSAROUNDTHECLOCKFOR THElRSTTHREEMONTHS7EEKLYX RAYSANDDAILY PIN SITE CARE WOULD ALSO BE NEEDED /NCE THE LIMBSWERESTRAIGHT THEFRAMESWOULDBELEFTON #ONTINUEDONPAGE

-AY*UNE




!NGELAS3TORY #ONTINUEDFROMPAGE

FORANADDITIONALTWOMONTHSTOALLOWTHEBONES TOCONSOLIDATEMATUREHEALINGOFTHEOSTEOTOMIES INTHEIRNEWPOSITION4HENTHEFRAMESWOULDBE REMOVED AND THE TASK OF PHYSICAL THERAPY AND ACHIEVINGKNEEMOTIONWOULDBEGIN ) KNEW THAT THIS SURGICAL PROJECT WITH ITS TEDIOUSFOLLOW UPWASNOTAVAILABLEIN(ONDU RAS4HE DIRECTOR OF THE ORPHANAGE ASKED ME THE OBVIOUS QUESTION OF HAVING IT DONE IN THE 5NITED3TATES4HROUGHASERIESOFMANYWONDER FULPEOPLEWHOANSWEREDhYESvMANYTIMESOVER !NGELANOWHASSTRAIGHTLEGS$R-ARK$AHLAND) PERFORMEDTHESURGERYAT'ILLETTE#HILDRENS(OS PITALIN3T0AULON3EPTEMBER 'IVEN THEANTICIPATEDPOST OPCAREHOWEVER THESURGERY WASONLYTHESTART -YWIFE ,U,U WASKINDENOUGHTOAGREE TOBETHEPRIMARYCAREGIVERFORTHISYOUNGCHILD THROUGHTHEARDUOUSPROCESSOFHERORTHOPEDIC ODYSSEY3HEOPENEDHERHEARTANDOURHOMETO !NGELA3HEDIDTHEJOBOFTURNINGTHOSESTRUTS AROUNDTHECLOCK KEEPINGHERPINSITESCLEAN AND TRANSPORTINGHERTOWEEKLYAPPOINTMENTSFORX RAYS3HEALSOFEDANDBATHEDHER"UT MOSTOF ALL SHEGAVE!NGELAASTEADYDIETOFLOVEANDCARE THATONLYAMOTHERCANGIVE)CANNOTTHANKHER ENOUGH FOR ALL THE SACRIlCES SHE HAS MADE FOR !NGELA ,U,U HAS BEEN THE BEST EXAMPLE OF A HUMANITARIANTHAT)HAVEEVERENCOUNTERED3HE HASBEENAMENTORFORMEANDFOROURFOURTEENAGE CHILDREN

$R$ALYANDHISWIFE ,ULU PROVIDE!NGELAWITHSOME WALKINGASSISTANCE

-AY*UNE

!NGELAPROUDLYSHOWSOFFHERSTRAIGHTLEGS

!NOTHERPLAYERINTHISDRAMAHASBEEN-AR TA ASECONDYEARMEDICALSTUDENTFROM(ONDURAS WHOVOLUNTEEREDTOACCOMPANY!NGELA-ARTA GREWUPINTHEORPHANAGEIN(ONDURAS ANDIS A BEAUTIFUL EXAMPLE OF THE SUCCESSFUL FORMULA FORRAISINGTHECHILDRENTHERE4HECHILDRENON THERANCHCANNOTBEADOPTED ASWEINTHE53 WOULD CONSIDER OF AN ORPHANAGE 2ATHER THEY AREPROVIDEDANEDUCATION+THROUGH FED ANDCLOTHED ANDTAUGHTATLEASTONETRADETHAT WILLENSURETHEIREMPLOYABILITY!SINANYFAMILY THEYAREALSOTAUGHTHOWTOBEhFAMILYvTOEACH OFTHEIRMEMBERS4HISINCLUDESGIVINGAYEAROF SERVICEONCETHEYREACHTOYEARSOLD BEFORE THEYhLEAVEHOMEvTOMAKETHEIRWAYINTHEWORLD 3UCHSERVICEMAYINCLUDEASSISTANTTEACHINGINTHE CLASSROOMS LABORINGANDCARINGFORTHELIVESTOCK ORASSISTINGWITHTHEFARMING)FTHECHILDWANTS TOGOONTOFURTHEREDUCATIONANDCANPASSTHE APPROPRIATEEXAMS THEORPHANAGE LIKEANYOTHER FAMILY WILLHELPPAYFORTHEIREDUCATION(ENCE -ARTAISINMEDICALSCHOOL 4HEINSPIRINGPARTOF-ARTAWASHERWILLING NESSTOGIVEUPASEMESTEROFHERMEDICALSCHOOL CURRICULUMTOHELP!NGELAANDACCOMPANYHERTO -INNESOTA(OWMANYOFUSWOULDHAVEMADE THESAMESACRIlCE-ARTAALSOLIVEDWITHOURFAM ILYUNTILHERRETURNTO(ONDURASTHISPAST*ANUARY )WASHAPPYTOLEARNTHATHERTIMEHERESTRENGTH ENEDHERRESOLVETOBECOMEAPHYSICIAN3HEWAS AGREATHELPTOALLOFUS INCLUDINGMYCHILDREN ANDTHEIR3PANISHCLASSHOMEWORK4HINKOFTHE EFFECTSONOURSOCIETYIFWEWERETOREQUIREAYEAR OFSERVICEFROMALLOUR YEAR OLDSBEFORETHEY MOVEDON)WOULDLIKETOATLEASTAPPLYITTOMY OWNFAMILYÂ&#x2C6;BUTPLEASEDONTTELLMYCHILDREN YET)NEEDTOPLANMYNEGOTIATIONS

/URCURRENTEXPERIENCEWITH!NGELAISDRAW INGTOACLOSE7EWILLTRAVELBACKTO(ONDURAS WITHHERIN-AYANDGETHERSETTLEDINTOLIFEON THERANCHWITHHERTWOBIOLOGICSIBLINGSANDHER MANYOTHERhSIBLINGSvTHATMAKEUPTHELOVING ANDCARINGENVIRONMENTATTHISSPECIALPLACE!S YOUCANTELL OURLITTLETWO WEEKVOLUNTEERTRIPTO (ONDURASHASEVOLVEDINTOQUITEANADVENTURE !LTHOUGHMYWIFEANDKIDSSUSPECTACONSPIRACY )HADNOPLANSFORALLTHIS "UT)THINKTHATISTHEMAGICOFVOLUNTEER ISM3TEPPINGOUTOFYOURWORLDINTOSOMEONE ELSESWORLD WITHOUTTHEEXPECTATIONOFREMUNERA TION YIELDS MANY SURPRISES HOPEFULLY MOST OF THEMPLEASANT)TDELIVERSNEWPERSPECTIVESTOYOUR THINKING)TALLOWSYOUTOFEELANDTOUCHOTHER LIVESINAWAYTHATCANNOTBEACHIEVEDBYSIMPLY DONATINGTOACHARITY4HElNANCIALSUPPORTOF CHARITIESISOBVIOUSLYNECESSARYANDGOOD BUTIT DOESLACKTHEPARTICIPATORYASPECTTHATPERSONAL VOLUNTEERISMPROVIDES )KNOWTHAT)AMADIFFERENT ANDHOPEFULLY BETTERPERSONFROMTHISEXPERIENCE)HAVELEARNED THATMYPATIENTSIN-INNESOTASUFFERJUSTASMUCH ASTHOSEINADEVELOPINGCOUNTRY(OPEFULLY)AM ABLETOKEEPSOMEOFTHATALTRUISTICmAMEBURNING AMIDSTTHECHALLENGESOF53MEDICINE(ASSLES WITH PAPERWORK 265S POOR REIMBURSEMENT RISING OFlCE OVERHEAD COSTS ELECTRONIC MEDICAL RECORDUPGRADES ETCAREENOUGHTOERODEANYONES FERVORFORMEDICINE6OLUNTEERINGCANBEAHELPFUL SALVETOTHESEWOUNDS)WOULDENDORSEVOLUNTEER INGATANYLEVEL BUTMEDICALVOLUNTEERISMCAN BEPARTICULARLYREWARDING)FYOUWOULDLIKETO LEARNMOREABOUTTHEORPHANAGEIN(ONDURAS VISIT ITS 7EB SITE AT WWWNPHHONDURASORG 9OU COULD ALSO CALL -INNESOTA &RIENDS OF THE /RPHANS AT    OR E MAIL ME AT PDALY SUMMITORTHOCOMU

!NGELAAND$R$ALYENJOYINGTHEIRTIMETOGETHER

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


2OCKY-OUNTAIN(IGHÂ&#x2C6;4ANZANIA

4

4(2%%(/523&2/-$/$/-! 4ANZA

NIA WEWEREATTHEFOOTHILLSOFTHEMOUNTAINS SOUTHOF+IBAKWEDEEPINTHE-PWAPWAVALLEY HEADEDFOR,UFUATTHERIDGEOFTHISMOUNTAIN RANGE /UR4OYOTA ,AND#RUISER HAD ALREADY BEENCHALLENGEDSNAKINGITSWAYTHROUGHTRACKS ALONG MAIZE PATCHES AND THROUGH DRIED GUL LEYS/UR-ASAAIEVANGELISTWOULDPOINTTHE WAY ANYTIME THAT WE QUESTIONED THE ROUTE AHEAD7E THEN STARTED ASCENDING THE CRUDE SWITCHBACKS UP THE MOUNTAINSIDE TO ,UFU &ROMTHEHEIGHTOFTHEGRASSOVERTHETRACKS OFTENREACHINGABOVETHEHEIGHTOFTHEHOOD ) lGUREDWEWERETHElRSTMOTORIZEDVEHICLEUP THISTRAILWITHINTHEYEAR4WOHOURSLATERWE HADLITERALLYANDlGURATIVELYSHOOKSOMUCH THATWEWERESLAP HAPPYONLYTOCOMEUPONA SMALLBRIDGEOVERAGULLEYMADEOFROUGHLOGS HAPHAZARDLY LAID ACROSS TWO WOODEN BEAMS /NEOFOURPARTYWALKEDAHEADTOTAKEAVIDEO OFTHISCROSSING)lGUREASANEXCUSETOGUAR ANTEEHISSURVIVAL #ROSSINGSAFELYWEENTERED THE SMALL HAMLET OF ,UFU HIGH ON THE RIDGE OFTHISMOUNTAINRANGEMEASURING FEET ELEVATIONBYOURHAND HELD'03 WITHACLEAR VIEWOFTHE-PWAPWAVALLEYTOTHENORTHAND THE)RINGAVALLEYTOTHESOUTH 7HY WOULD "OBBY A RETIRED BIO TECH EXECUTIVE FROM -INNESOTA 7ALLY A DENTIST FROM/REGONANDME AN%2PHYSICIANFROM THE-AYO(EALTH3YSTEMlNDTHEMSELVESTO GETHERONTHISDISTANTMOUNTAINTOP4HEAN SWERMAYBETHREE FOLD&IRST ARECROSS CULTURAL RELATIONSHIPS"OBBYHADSTRUCKACLOSEFAMILY BONDTOTHE,UTHERANBISHOPOFTHE$ODOMA $IOCESEÂ&#x2C6;$R0ETER-WAMASIKA4HISBRINGS USTOTHESECOND $R0ETER-WAMASIKASVI SION FOR IMPROVED HEALTH CARE FOR HIS mOCK HISDIOCESEPOPULATEDBYTHEPOORESTANDLEAST

SERVED PEOPLE OF4ANZANIA ALREADYONEOFTHEPOOREST COUNTRIES IN THE WORLD4HE THIRD IS THE SHARED #HRISTIAN CALL AMONGST THE FOUR OF US TOSERVETHEPOOR4HEBISHOP HAD SPENT HIS EARLY YEARS AS BISHOP OF THIS DIOCESE DRIV ING TO THE REMOTEST ENDS OF THE TRAILS ON HIS MOTORBIKE THUSDISCOVERING,UFU7ALLY AND)HADWORKEDTOGETHERAS DENTALANDMEDICALMISSIONAR IES YEARS AGO IN -ADAGASCAR "OBBYHADRUNINTOMEWHILEPRESENTINGHIS VISIONFORA,UTHERANHEALTHCENTERIN$ODOMA TOTHEEXECUTIVECOMMITTEEOF'LOBAL(EALTH -INISTRIES ANON PROlTIN&RIDLEY -.THAT SUPPORTS ,UTHERAN HEALTH CARE OVERSEAS !S PRESIDENT OF '(- UPON HEARING THE PRO POSAL ) WAS CAUGHT WITH THE CALL TO MISSION AGAIN3HORTLYTHEREAFTER )RESIGNEDMYPOST ASPRESIDENTOF'(-ANDCALLEDMYBUDDY 7ALLY TOJOINMEINTHISVENTURE "ACKTO,UFU)TWASCLEARTHATNOTICEOF OURARRIVALHADNOTMADEITUPTHEMOUNTAIN 7E STARTLED AN OLD LADY DRYING HER RECENTLY HARVESTED MAIZE ON DRIED GOAT SKINS4HE DISPENSARY NURSE QUICKLY APPEARED TO GREET USINTOTHEDISPENSARYCOMPLEXMADEUPOFA TWOROOMMUDBRICKBUILDINGWITHATINROOF ANDHERSMALLHOUSEADJACENTOFSIMILARSTRUC TURECOMPLIMENTEDBYASMALLCHICKENHOUSE 3OMEONEARRIVEDWITHSODAPOPANDCRACKERS ASAGREETINGhTEAv7ALLYAND)HADFUNSHARING OURCRACKERSWITHTHERAPIDLYGROWINGAUDIENCE OF CHILDREN SURROUNDING THE BUILDING ) NO TICEDTHATTHEMAJORITYHADGENERALIZEDSCABIES TESTIMONYTHATTHEREWASNOWELLORACCESSTO

"9*/(.-4/3/ -$

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

#ONTINUEDONPAGE

*OHN4OSO -$ SECONDFROMLEFT AND7ALLY ADENTIST FROM/REGONSECONDFROMRIGHT WITHTRAVELINGPARTNERS

   (/,0"/ " 0 00)(#++0+"

 +.&1#/&/0+

0 +1 0++0.*

$/0/1// /+

 10/1/##(00)#(2$

$0.$((+

2$ (00)/(0+

+/0).* +0+

1( 0! /. '-

 ,(

        *0(+/ 0*( (0)+

  (( ," "  (("

$0/0),

+/ 00) ++++ /+

1(0-0

- /!%'0)1(0+

 (#. )0)0)1(0+

-AY*UNE




4ANZANIA #ONTINUEDFROMPAGE

:(%(5

/$:2)),&( )RFXVLQJRQWKH OHJDOQHHGVRIWKH KHDOWKSURIHVVLRQDO Â&#x2021;/LFHQVXUH Â&#x2021;(PSOR\PHQW/DZ Â&#x2021;7ULDO:RUN Â&#x2021;:LOOVDQG(VWDWHV Â&#x2021;5HJXODWRU\&RPSOLDQFH

0LFKDHO-:HEHU-' Â&#x2021;)RUPHU$WWRUQH\IRUWKH %RDUGRI0HGLFDO3UDFWLFH Â&#x2021;2YHU6L[<HDUVDVDQ $VVLVWDQW$WWRUQH\*HQHUDO

 ZZZZHEHUODZFRP ´&RPPLWWHGWRWKH%HVW /HJDO2XWFRPH3RVVLEOH7KURXJK 'LOLJHQFHDQG5HVRXUFHIXOQHVVµ

  

      

 

         



    -AY*UNE

WATERINCLOSEVICINITY7ALLYAND)ASKEDPER MISSIONTOHAVEALOOKATTHEMOUTHSOFTHOSE THATHADGATHERED4HETEETHUPTOADULTHOOD APPEAREDINGOODCONDITIONSUGGESTINGGOOD NATURALmUORIDE&ROMTHAT AGEUPSHOWEDVARIOUSDE GREESOFDECAYANDNEGLECT 7E THEN WERE TAKEN ON A TOUROFTHEDISPENSARY4HE PATIENTHOLDINGROOMHAD ONLY ONE PIECE OF FURNI TUREÂ&#x2C6;A CRUDE BED MADE UP OF A FRAME OF ROUGH TIMBERS WITH CRISS CROSSED SISAL ROPE WITHOUT A MAT TRESS4HE NEXT ROOM HAD ATABLEANDCHAIR ALOCKED CUPBOARDWITHSOMEBASIC MEDICATIONS AND A HAND WRITTENPOSTERLISTINGTHE TOPDISEASESEXPERIENCEDAT THIS CENTER !FTER VIEWING ANEARBYFAILEDATTEMPTATAWELLWETHANKED OURHOSTSFORTHEIRASSISTANCEANDCLOSEDWITH PRAYERSFOR'ODTOBLESSOUREFFORTSTOIMPROVE THEHEALTHOFTHISDISTANTCOMMUNITY !S WE HEADED DOWN THE MOUNTAIN MY OVER RIDINGTHOUGHTWAS h7HEREDOWESTARTv 4HEYNEEDMOSTEVERYTHINGANIMPROVEDROAD FORACCESS AWELLFORPOTABLEWATER ACOMMU NITY SURVEY TO ASSESS THE REAL AND PERCEIVED NEEDS OF THE COMMUNITY ADEQUATE TRAINING FOR DISPENSARY STAFF IMPROVED FACILITIES WITH BASICLABORATORYCAPABILITIES ABUSINESSPLAN SUBSIDIESTOASSURESUSTAINABILITYx 4HElRSTPRIORITYAFTERTHEREQUISITEGOV ERNMENTPERMITSWILLBEACOMMUNITYSURVEY OFEACHVILLAGESERVEDBYTHESIXDISPENSARIES CLINICS IN THIS $ODOMA AREA 7E HOPE TO COMPLETE THIS OVER A SIX MONTH PERIOD WITH AN!MERICANVOLUNTEERASSISTINGA4ANZANIAN PUBLICHEALTHNURSEVISITINGTHESIXCLINICS4HIS WILLALLOWUSTOESTABLISHCRITICALRELATIONSHIPS WITHTHELEADERSHIPOFTHEAREAS SHARPENOUR VISIONOFTHEIMPROVEMENTSNEEDEDINHEALTH CARE AND ALLOW US TO SHARE WITH THE DIOCESE EVANGELISTS 4HESECONDPRIORITYWILLBETODEVELOPTHE ARCHITECTURALPLANSFORTHE$ODOMA#HRISTIAN -EDICAL#ENTER$#-# WITHHOPESOFBREAK INGGROUNDTHISSPRINGANDEVENTUALCOMPLETION

OFTHEINITIALBEDCOMPLEXTHEFALLOF !S THE $ODOMA GOVERNMENT HOSPITAL AND THENEARBY!NGLICAN-VUMIHOSPITALCANNOT KEEPUPWITHTHENEEDSOFTHISLARGEPROVINCE $#-#WILLCOMPLEMENTTHEHOSPITALNEEDSOF THEPROVINCE PROVIDEABASEOFSUPPORTFORTHE

"ISHOP-WAMASIKAANDHISWIFEWITHRURALWOMEN

SIXEXISTING,UTHERANDISPENSARIES ANDPROVIDE HIGH END DENTAL CARE AND TRAINING ORTHOPE DICS ANDPLASTICSMAXILLO FACIALSURGERYÂ&#x2C6;ALL OFWHICHARENOTAVAILABLEINCENTRAL4ANZANIA !NYREVENUEFROMTHISSPECIALTYCAREWILLASSIST INTHESUSTAINABILITYOFTHEPRIMARYCARESERVICES OFTHEMEDICALCENTERANDCLINICS 4HETHIRDANDPOSSIBLYMOSTIMPORTANT PRIORITYWILLBETOESTABLISHAPARTNERSHIPWITHA LARGERHEALTHCAREORGANIZATIONINTHE53 THUS ALLOWINGSHARINGOFCROSS CULTURALPROFESSIONAL EXPERIENCESANDCREATINGANEEDEDAWARENESSTO THE53PARTNEROFTHEDISPARITYINHEALTHACCESS INSUB 3AHARAN!FRICA/NEGOODEXAMPLEOF THISNEWPARADIGMINTHIRDWORLDHEALTHCARE PARTNERINGIS3AINT-ARYS$ULUTH#LINICSRELA TIONSHIPWITH.GAOUNDERE,UTHERAN(OSPITAL IN#AMEROON3UCHPARTNERINGCANONLYRENEW OURCOMMONCALLINGASHEALTHCAREPROVIDERSTO SERVETHEPOOR ANDGOALONGWAYINCOUNTERING THETHIRDWORLDOFTENDEEP ROOTEDSUSPICIONS OFTHETRUEINTENTIONSOFTHE53INTHEWORLD TODAYU *OHN-4OSO -$ISASONOF,UTHERANMIS SIONARIESTO-ADAGASCAR FAMILYPHYSICIANTRAINED AND NOW WORKING IN THE -AYO (EALTH 3YSTEM AS AN %2 PHYSICIAN AND INTERNATIONAL HEALTH CONSULTANT

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


0ORTICO(EALTHNET !N!NSWERFORTHE5NINSURED

/

/6%2 4(% 0!34 3%6%2!, MONTHS YOU

HAVELIKELYREADABOUTTHENEWRESTRICTIONSON THEELIGIBILITYGUIDELINESFOR-INNESOTASHEALTH CARE PROGRAMS -ANY PEOPLE HAVE PREDICTED ARESULTANTSPIKEINTHENUMBEROFUNINSURED PEOPLEINOURCOMMUNITY0ORTICO(EALTHNET 0ORTICO A4WIN #ITIES BASED HEALTH CARE SAFETY NETPROGRAM ISALREADYEXPERIENCINGA DELUGEOFNEWINQUIRIESFROMPEOPLEAFFECTED BYTHESECHANGES4HEGOODNEWSISTHATDESPITE THEGROWINGNUMBERSOFUNINSUREDPEOPLE 0OR TICOANDOTHERCOMMUNITYORGANIZATIONSARE WORKINGHARDTOREDUCETHENUMBEROFPEOPLE WITHOUTCOVERAGEFORHEALTHCARESERVICES 3INCE 0ORTICO(EALTHNET FORMERLY -ETRO%AST 0ROGRAM FOR (EALTH HAS HELPED     UNINSURED PEOPLE EACH YEAR CONNECTTOHEALTHCOVERAGEPROGRAMS&UNDED BYAVARIETYOFSOURCESTHATINCLUDElVEMAJOR HOSPITAL PARTNERS 0ORTICO ACCOMPLISHES THIS IN TWO WAYS  0ORTICOS OUTREACH WORKERS IDENTIFYUNINSUREDCOMMUNITYMEMBERSAND PROVIDEPERSONALIZEDASSISTANCEWITHAPPLICA TIONSANDENROLLMENTIN-INNESOTASHEALTHCARE PROGRAMSAND FORLOW INCOMEINDIVIDUALS AND FAMILIES WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS 0ORTICO OFFERS A UNIQUE PROGRAM THAT PROVIDES ACCESS TO PREVENTIVE PRIMARY ANDSPECIALTYMEDICALCARE )TSURPRISESMANYTOKNOWTHATNEARLY PERCENTOFADULTSWHOTURNTO0ORTICO(EALTH NETFORHELPHAVEJOBS4HEYAREOFTENINTEM PORARYSITUATIONSTHATHAVELEFTTHEMWITHOUT HEALTH COVERAGE /THERS WHO SEEK ASSISTANCE FROMTHEPROGRAMARENEWERIMMIGRANTS4HE -INNESOTA$EPARTMENTOF(EALTHREPORTSTHAT ADISPROPORTIONATENUMBEROFPEOPLEWITHOUT HEALTHINSURANCEAREFOUNDINTHE,ATINO !FRI CAN!MERICAN AND!SIAN !MERICANCOMMUNI TIES)NRESPONSETOTHISGROWINGNEED 0ORTICO "9$%"2!(/,-'2%. -3

HASBEENSEEKINGOPPORTUNITIESTOINCREASEITS OUTREACHEFFORTSINTHESECOMMUNITIES )N *ULY  THE #HILDRENS $EFENSE &UND-INNESOTARECOGNIZED0ORTICOSSUCCESS INASSISTINGPEOPLEWITHlNDINGHEALTHCOVER AGEANDINVITEDTHEORGANIZATIONTOINITIATEA PILOTPROJECTASPARTOFTHEIR#OVER!LL+IDSAND &AMILIES #+& GRANT &UNDED IN LARGE PART BY THE 2OBERT 7OOD *OHNSON &OUNDATION #+&ISANATIONALHEALTHCAREACCESSINITIATIVE WITHPROJECTSINMOSTEVERYSTATE4HEGOALOF 0ORTICOS #+& PILOT WITH #HILDRENS $EFENSE &UND-INNESOTAISTOREACHMOREUNINSURED FAMILIESWITHCHILDRENINTHEEASTMETROPOLITAN ,ATINOCOMMUNITY 4HE COLLABORATION HAS BEEN A PERFECT MATCH4WOOFTHEMAJORGOALSFOR-INNESOTAS #+& PROJECT ARE TO SIMPLIFY AND COORDINATE THE APPLICATION PROCESS FOR FAMILIES SEEKING HEALTHCOVERAGE!SAGRANTEEOFTHE-INNE SOTA$EPARTMENTOF(UMAN3ERVICES(EALTH #ARE0ROGRAM/UTREACH0ROJECT 0ORTICOHAS NEARLYSEVENYEARSOFEXPERIENCEHELPINGFAMI LIESNAVIGATETHROUGHTHEAPPLICATIONPROCESS FOR-INNESOTASHEALTHCAREPROGRAMS /VERTHEYEARS #HILDRENS$EFENSE&UND -INNESOTATHROUGHITSWORKONTHE#+&PROJ ECTHASMADEGREATSTRIDESINWORKINGWITHTHE STATE LEGISLATURE TO SHORTEN AND SIMPLIFY AP

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

PLICATIONSFORHEALTHCOVERAGEPROGRAMS%VEN SHORTERANDLESSCOMPLICATEDFORMS HOWEVER CANSTILLBEIMPOSINGTOFAMILIESWHOAREJUG GLINGMULTIPLESTRESSESANDRESPONSIBILITIES!DD THEFACTTHATMANYPOTENTIALAPPLICANTSDONOT SPEAK%NGLISHASTHEIRlRSTLANGUAGE ANDTHE COMPLICATIONSSEEMINSURMOUNTABLE0ORTICOS DIVERSEANDMULTILINGUALSTAFFHASTHEEXPERI ENCE AND TRAINING TO HELP FAMILIES THROUGH THE ENTIRE APPLICATION PROCESS UNTIL THEY ARE SUCCESSFULLYENROLLEDINANAPPROPRIATEHEALTH CAREPROGRAM4HOSEINELIGIBLEFOR-INNESOTAS HEALTHCAREPROGRAMSAPPLYTO0ORTICOSCOVER AGEPROGRAM 7ITH A VARIETY OF TARGETED OUTREACH EFFORTS THE #+& PILOT PROJECT HAS BEEN EX TREMELYSUCCESSFULINREACHING,ATINOCHILDREN ANDPARENTSWHOAREWITHOUTHEALTHINSURANCE 0ORTICOSOUTREACHWORKERSHOLDOFlCEHOURSIN THE LOBBY OF THE 3T 0AULÂ&#x2C6;2AMSEY #OUNTY $EPARTMENTOF0UBLIC(EALTHOFlCEON#EDAR 3TREETTWICEWEEKLYANDTWOEVENINGSAMONTH TOASSISTFAMILIESWITHHEALTHCAREPROGRAMAP PLICATIONS$URINGTHEMONTHSOF!UGUSTAND 3EPTEMBER OUTREACHWORKERSASSISTFAMILIESAT THE3T0AUL0UBLIC3CHOOLS3TUDENT0LACEMENT #ENTER /UTREACH WORKERS ALSO MAKE WEEKLY VISITS TO THE !LLINA 5NITED &AMILY 0RACTICE #ENTERAND(EALTH%AST3T*OSEPHS(OSPITAL #HEMICAL$EPENDENCY5NITIN3T0AUL "UILDING "RIDGES IS ANOTHER SUCCESSFUL 0ORTICO OUTREACH EFFORT THAT DRAWS ON THE EXISTINGSYSTEMSOFSEVERALSCHOOLDISTRICTS!S FAMILIES ARE IDENTIlED AS UNINSURED THROUGH EARLY CHILDHOOD SCREENINGS THEY ARE REFERRED TO0ORTICO(EALTHNETFORASSISTANCEINAPPLYING FORHEALTHCARECOVERAGE 4HESEOUTREACHEFFORTSAREJUSTAFEWOF THESTRATEGIES0ORTICOEMPLOYSTOREACHFAMILIES INNEEDOFHEALTHCOVERAGE4HEONLYPROBLEM #ONTINUEDONPAGE

-AY*UNE




0ORTICO(EALTHNET #ONTINUEDFROMPAGE

             # # # # #

"    "          !                     

      # # # # #

!        " "        !             "    "  "    " 

%#"    "#     ''' !"& $"

   -6 % #2-7)( 364-7%0 &%6)( 3874%7-)27 '0-2-' 7,%7 -6 %''5)(-7)( &< 7,) 1)5-'%2'%()1<3*%-2%2%+)1)27%2(-6%**-0-%7)(:-7, 663'-%7)( 2)67,)6-303+-676  %2( 4539-()6 '3145),)26-9) 6)59-')6 *35 -2(-9-(8%06 );4)5-)2'-2+ ',532-' 4%-2 ",) '0-2-' 3**)56 % 9%5-)7<3*-27)59)27-326-2'08(-2+2%5'37-'1%2%+)1)27-2.)'7-327,)5%4-)6 46<',303+-'%0%66)661)27%2(6844357%'8482'785)%2(&-3*))(&%'/

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

     *%;  

35)1%-05)'58-7%00-2%'31 :::%00-2%'31  

-AY*UNE

IS NOTALLFAMILIESAREELIGIBLEFOR-INNESOTAS HEALTHCAREPROGRAMSANDNEWRESTRICTIONSON ELIGIBILITYFOR-INNESOTA#ARE -EDICAL!SSIS TANCE AND'ENERAL!SSISTANCE-EDICAL#AREARE LEAVINGMOREFAMILIESWITHOUTCOVERAGE4HIS ISWHERE0ORTICOSCOVERAGEPROGRAMCANOFTEN HELP 0ORTICO(EALTHNETSCOVERAGEPROGRAMIS ANONPROlTMODELFORDELIVERINGCAREMANAGE MENT AND PRIMARY PREVENTIVE AND SPECIALTY HEALTHCARESERVICESTOUNINSUREDFAMILIESAND INDIVIDUALS WHO CANNOT AFFORD HEALTH INSUR ANCEANDDONOTQUALIFYFORPUBLICLYSPONSORED HEALTHCAREPROGRAMS0ORTICOSCOVERAGEPRO GRAMISNOTANINSURANCEPROGRAMNORISITAN (-/ ALTHOUGHITDOESPAYFORMEDICALSER VICESANDPRESCRIPTIONDRUGS0ORTICODOESNOT GUARANTEECOVERAGEFORITSPARTICIPANTSORPAY FORHOSPITALIZATION7HEN0ORTICOPARTICIPANTS AREHOSPITALIZED THEIRCAREMANAGERASSISTSTHEM WITHTHEPROCESSOFAPPLYINGFOR-EDICAL!S SISTANCEOR'ENERAL!SSISTANCE-EDICAL#ARE )N ALMOST ALL CASES THEIR INCOME AND ASSET LEVELSFALLINTOACATEGORYTHATQUALIlESTHEM FORTEMPORARYASSISTANCE 5NINSUREDPEOPLEWHORESIDEIN2AMSEY 7ASHINGTONOR$AKOTACOUNTIES HAVEHOUSE HOLDINCOMESTHATFALLBELOWPERCENTOF FEDERALPOVERTYGUIDELINES ANDARENOTELIGIBLE FOR-! AREELIGIBLEFORTHE0ORTICO(EALTHNET COVERAGE PROGRAM 0ORTICO IS ALSO WORKING DILIGENTLYTOATTRACTNEWHOSPITALPARTNERSTO ENABLETHEORGANIZATIONTOEXPANDITSSERVICE AREATOOTHERCOUNTIES 0ORTICO PARTICIPANTS RECEIVE ONE TO ONE CAREMANAGEMENTTHATINCLUDESEDUCATIONON PREVENTIVECAREPRACTICES HELPWITHESTABLISH INGHEALTHRELATEDGOALS EDUCATIONONHOWTO NAVIGATETHEHEALTHCARESYSTEMINCLUDINGAD VOCACYSUPPORTWHENNEEDED REFERRALSTOOTHER COMMUNITYSUPPORTS INTERPRETERSERVICES AND TRANSPORTATION TO MEDICAL APPOINTMENTS AS NEEDED 0ORTICOPAYSFORPARTICIPANTSVISITSTOPRI MARYCARECLINICS PRESCRIPTIONDRUGS VISITSTO SPECIALTYCARECLINICS EYEEXAMSANDEYEGLASSES OUTPATIENTMENTALHEALTHSERVICES ANDOUTPA TIENT HOSPITAL SERVICES INCLUDING DIAGNOSTICS ANDTREATMENT %ACH HOUSEHOLD THAT JOINS THE 0ORTICO (EALTHNETPROGRAMMEETSONE TO ONEWITHA LICENSEDSOCIALWORKERORhCAREMANAGERvWITHIN

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


 DAYS OF ENROLLING IN THE PROGRAM4HESE MEETINGS SERVE AS AN IMPORTANT OPPORTUNITY TOBEGINFORGINGARELATIONSHIPANDCOMMU NICATIONSTRUCTUREBETWEENTHECAREMANAGER ANDTHEPARTICIPANT4HISRELATIONSHIPISKEYTO PROPERUTILIZATIONOFTHEPROGRAMSSERVICES !TTHEINITIALMEETING PARTICIPANTSCOM PLETEA&AMILY(EALTH!SSESSMENT&(! WITH THEIRCAREMANAGER4HISTOOLWASDEVELOPED BY0ORTICOTOCAPTUREINFORMATIONABOUTTHE FAMILYTOBETTERUNDERSTANDTHECURRENTHEALTH SITUATIONOFEACHFAMILYMEMBER ANDTOIDEN TIFYHEALTH RELATEDGOALS4HE&(!ALSOCAPTURES OTHERINFORMATIONTHATCANAFFECTTHEFAMILYS HEALTH%XAMPLESOFQUESTIONSONTHESURVEY TOOL INCLUDE h(OW MANY TIMES IN THE PAST YEARHAVEYOUORONEOFYOURFAMILYMEMBERS VISITEDTHEEMERGENCYROOMvh$OYOUHAVE CONCERNSWITHSTRESSvORh$OYOUHAVEISSUES WITHHOUSINGv )N ADDITION TO THE &(! PARTICIPANTS COMPLETE AN 3&  SURVEY AT ENROLLMENT 4HISISANATIONALLYUSEDSELF ASSESSMENTTOOL THATIDENTIlESTHEPARTICIPANTSPERCEPTIONOF THEIRHEALTH0ARTICIPANTSCOMPLETETHESURVEYS INITIALLY AFTER SIX MONTHS AND THEN ANNUALLY THEREAFTER $URINGTHEINITIALMEETING CAREMANAGERS HELPTHEFAMILYORINDIVIDUALCHOOSEAPRIMARY CARECLINICANDEXPLAINHOWTOACCESSMEDICAL SERVICESTHROUGHTHEPROGRAM!KEYCOMPO NENTINTHELEARNINGPROCESSISTHEMONTHLY FEE THAT EACH PARTICIPATING HOUSEHOLD PAYS 4HIS FEE ESTABLISHES CONTEXT FOR PEOPLE WHO AREUNFAMILIARWITHHEALTHINSURANCEFORLATER SUCCESSWHENTHEYMOVEINTOMOREPERMANENT HEALTHCOVERAGESOLUTIONS#AREMANAGERSALSO EXPLAINWHATMEDICALSERVICESTHEPROGRAMMAY COVER 0ORTICOS CARE MANAGEMENT MODEL REAPS GREATRESULTSFORITSPARTICIPANTS!FTERAYEAROF ENROLLMENTPARTICIPANTSEMERGENCYROOMVISITS AREREDUCEDBYPERCENTASCOMPAREDTOTHE NUMBEROFVISITSTHEYMADEPRIORTOJOINING THEPROGRAMNEARLYPERCENTOFPARTICIPANTS REPORTHAVINGUPDATEDIMMUNIZATIONSANDON AVERAGETOPERCENTOFPARTICIPANTSWHO LEAVE THE PROGRAM DO SO BECAUSE THEY HAVE FOUND PERMANENT HEALTH COVERAGE 3OME LEAVEWITHOUTREPORTINGAREASON 4HE -INNESOTA $EPARTMENT OF (EALTH CURRENTLYESTIMATESTHATAPPROXIMATELY  PEOPLEINTHEEASTMETROPOLITANAREAHAVENO HEALTHINSURANCE/FTHOSE APPROXIMATELY PERCENTMAYBEELIGIBLEFOR-INNESOTASHEALTH

CAREPROGRAMS4HATLEAVES PEOPLEIN THEEASTMETROAREATHATCOULDBESERVEDBYTHE 0ORTICOCOVERAGEPROGRAM !LTHOUGH 0ORTICO (EALTHNET RECEIVES GENEROUS SUPPORT FROM ITS HOSPITAL PARTNERS ANDHASAHISTORYOFLOWMEDICALCOSTS PERMEMBERPERMONTH THATINCLUDEMEDICAL PRESCRIPTIONSANDINTERPRETERSERVICES 0ORTICO HASALIMITEDAMOUNTOFFUNDSTOPROVIDESER VICES#URRENTLY 0ORTICOHASFUNDINGTOCOVER PARTICIPANTOPENINGSATANYGIVENTIME!S THEPROGRAMSTRIVESTOMOVEPEOPLEONTOMORE PERMANENTHEALTHCOVERAGEPROGRAMS 0ORTICOS COVERAGEPROGRAMTYPICALLYSERVESABOUT  UNINSUREDPEOPLEPERYEAR ORPERCENTOFEAST METRORESIDENTSINNEED 4HE0ORTICO(EALTHNETPROGRAMISAmEX IBLEMODELTHATCANBEREPLICATEDINANYPART OFTHESTATEORINOTHERPARTSOFTHECOUNTRY)T WASDEVELOPEDTOSERVEASMORETHANAFUNDING MECHANISMTOPROVIDEHEALTHCARESERVICESFOR ITSPARTICIPANTS!STHEPOPULATIONSERVEDBY THEPROGRAMISOFTENINAPERIODOFTRANSITION FACINGMULTIPLEBARRIERSTOSUCCESS THEYREQUIRE MORETHANAMEREMEDICALCARDTOACCESSHEALTH CARESERVICESAPPROPRIATELYANDEFlCIENTLY )FPUBLICPROGRAMSCONTINUETOBETARGETS FOR lNANCIAL CUTS THE HEALTH CARE SAFETY NET WILL NEED TO BE STRENGTHENED -ORE PEOPLE WILL BE UNINSURED AND IN NEED OF PROGRAMS LIKE 0ORTICO (EALTHNET IN ORDER TO REMAIN HEALTHYANDCONTINUETOCONTRIBUTETOSOCIETY &ORMOREINFORMATIONONHOWYOUCANBECOME INVOLVEDWITH0ORTICO(EALTHNET ORFORGENERAL INFORMATIONABOUTTHEPROGRAMCONTACT   (ISTORYOF0ORTICO(EALTHNET )N  (EALTH%AST #ARE 3YSTEM INVITED A GROUPOFINTERESTEDPARTIESTODISCUSSIDEASFOR DEVELOPINGAHEALTHCARESAFETYNETMODELTO MITIGATETHEHIGHNUMBEROFUNINSUREDPEOPLE WHO WENT TO HOSPITAL EMERGENCY ROOMS FOR HEALTHISSUESTHATCOULDBEBETTERTREATEDAND MOREINEXPENSIVELYINAPRIMARYCARESETTING !FTERMONTHSOFPLANNING THE-ETRO%AST 0ROGRAMFOR(EALTHPILOTMODELNOW0ORTICO (EALTHNET WASDEVELOPED 7ITH A MISSION hTO REDUCE THE NUMBER OF PEOPLE WITHOUT COVERAGE FOR HEALTH CARE SERVICESv AND A TRACK RECORD FOR DOING SO JUST FOUR YEARS LATER 0ORTICO ATTRACTED SUP PORTFROMALLOFTHEMAJOREASTMETROPOLITAN HOSPITALSANDHEALTHSYSTEMS(EALTH%AST#ARE 3YSTEM 2EGIONS (OSPITAL 5NITED (OSPITAL

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

AND#HILDRENS(OSPITALSAND#LINICS)N 0ORTICOADDED,AKEVIEW(OSPITALIN3TILLWATER ASAlFTHPARTNER4HEHOSPITALSREAPTWOMAJOR BENElTSFROMTHEIRPARTNERSHIPWITH0ORTICO  ANOPPORTUNITYTOPROVIDEATANGIBLECOM MUNITYSERVICEAND ANEFFECTIVEMETHODTO REDUCETHENUMBEROFCHARITYCARECASESSERVED BYTHEIREMERGENCYDEPARTMENTS )NADDITIONTOBEINGAMEMBEROF0OR TICOS 0ARTNERS 'ROUP THE 2AMSEY -EDICAL 3OCIETYPLAYEDAMAJORROLEDURINGTHEPILOT PHASE OF THE PROGRAM )N  THE 2OBERT 7OOD*OHNSON&OUNDATIONAWARDED0ORTICO (EALTHNETANDTHE2AMSEY-EDICAL3OCIETYA  FOUR YEARGRANTTODEVELOPAVOLUN TEERPHYSICIANNETWORKFORUNINSUREDPEOPLE INTHECOMMUNITY4HISPILOTPROJECTENABLED 0ORTICO(EALTHNETTOINCORPORATESPECIALTYCARE SERVICESEARLYINTHEDEVELOPMENTSTAGESOFTHE PROGRAM4ODAY SPECIALTYCARESERVICESREMAIN ANINTEGRALSERVICE0ORTICOOFFERSTOENSURETHAT PARTICIPANTSSTAYHEALTHYU $EBRA(OLMGREN -3 ISPRESIDENTEXECUTIVE DIRECTORFOR0ORTICO(EALTHNET

Solitude Found on Wilson Lake

Build your dream lake escape on this end-of-the-road lot on beautiful Wilson Lake. Located in the Superior National Forest near Schroeder, only 20 minutes from Lake Superior. This large wilderness feeling lake has clear water and predominantly public land protecting its shore. Youâ&#x20AC;&#x2122;ll experience unmatched privacy, access to millions of acres of forest land, easy year-round access, power to your lot, and close proximity to the scenic North Shore. This lot has 312 feet of shoreline with 5.3 acres. Price: $206,500. Gail Englund, Realtor P.O. Box 938 Grand Marais, MN 55604 e-mail: Info@RedPineRealty.com 800/387-9599 / 218/387/9599 www.RedPineRealty.com

-AY*UNE




#OMMUNITY%DUCATION !DVOCATINGFOR#HILDREN

-

-5#()3#522%.4,9+./7.ABOUTTHE

DEVELOPMENTOFTHEBRAININCHILDREN.EURONS FROMBIRTHTOAGEORGENERATETWICEASMANY DENDRITESTHANTHEYWILLEVERNEED4HUS THE POSSIBILITYFORLEARNINGISTREMENDOUS4HEN AROUNDAGE THEMETABOLICRATEOFTHEBRAIN REMAINSHIGHASTHENEURALNETWORKSBEGINTO PRUNETHECIRCUITSTHATHAVENOTBEENSTIMU LATED OR USED4HIS PRUNING CONTINUES UNTIL THE lNAL ADULT BRAIN CIRCUITRY IS ESTABLISHED AROUNDAGE)TISALSOKNOWNTHATALTHOUGH THEREISANABUNDANCEOFNEURALNETWORKSIN THE BRAIN IN CHILDHOOD NOT ALL AREAS OF THE BRAINDEVELOPATTHESAMETIME&OREXAMPLE THEPREFRONTALCORTEX THEAREARESPONSIBLEFOR CRITICALTHINKING ISTHELASTTODEVELOP0&# DEVELOPMENT BEGINS AROUND AGE  OR  AND HERALDSADOLESCENCE 7E AS PHYSICIANS ARE INVITED INTO THE CENTEROFTHATBRAINDEVELOPMENT7EGUIDE PARENTSINTHEPHYSICALANDSOCIALDEVELOPMENT OFTHEIRCHILDREN7EARETHEREINILLNESS CRISES ANDCELEBRATION7EWATCHTHEPAINFULFAMILY DYNAMICSOFADDICTIONSANDDEPRESSION7HAT MAKESUSUNIQUEASCAREPROVIDERS ISTHATWE CANUNDERSTANDTHENEUROBIOLOGYBEHINDTHE BEHAVIORSOFCHILDHOODANDADOLESCENCEAND THEREFORE GIVEPARENTSANEUROBIOLOGICALFRAME WORKTOHELPTHEIRDECISION MAKING4HEREIS SCIENCEBEHINDTHEANTICIPATORYGUIDANCEWE PROVIDE(OWEVER OURCURRENTCULTUREHASBE COMEAVERYCOMPLEXINmUENCEINTHEHEALTH OFCHILDRENANDPRESENTSNEWCHALLENGESTOUS FORHOWTOADVOCATEONTHEIRBEHALF 4HE PURPOSE OF THIS DISCUSSION IS TO HIGHLIGHTRECENTlNDINGSINTHENEUROSCIENCE RESEARCH AND CONSIDER HOW THEY IMPACT THE MANNER IN WHICH WE ADVOCATE FOR CHILDREN

"9-!29%::/ -$

-AY*UNE

!LTHOUGH CAUSE AND EFFECT ASSOCIATIONS ARE DIFlCULTWHENACHILDSBRAINCHEMISTRYISIN mUENCEDBYSOCIALFACTORS ITISWORTHDISCUSSING SOMEOFTHEMOREWORRISOMERESEARCHlNDINGS 4HEFOURAREASTHATWILLBEDISCUSSEDARE 46 AND MEDIA  MUSIC  ADDICTIONS AND  DOMESTICABUSE 46AND-EDIA -OSTPHYSICIANSAGREETHAT46ISNOTANEUTRAL FORCEINBRAINDEVELOPMENT4HE!MERICAN!S SOCIATIONOF0EDIATRICSHASISSUEDSEVERALCONSIS TENTSTATEMENTSPERTAININGTOTHEADVERSEHEALTH EFFECTSOF46INCHILDREN4HEGROWINGBODY OFRESEARCHSUGGESTSTHAT46CHANGESTHENEU ROCHEMISTRYOFTHEBRAININWAYSTHATWEDONT YETCOMPLETELYUNDERSTAND7EARECONCERNED ABOUTNEURALPATHWAYSTHATWILLNOTDEVELOP ADEQUATELYWHENCHILDRENSPENDLARGEAMOUNTS OFTIMEINFRONTOFTHE46ASWELLASDIRECTEF FECTSOF46ONBRAINCHEMISTRY /FTHEPOTENTIALADVERSEEFFECTSOF46 WE ASPHYSICIANSHAVEHEARDTHEMOSTABOUTTHE EFFECTSOF46VIOLENCEONAGGRESSIVEBEHAVIORS )N THE!MERICAN!CADEMYOF0EDIATRICS STATEDTHAThMORETHAN SCIENTIlCSTUDIES AND REVIEWS CONCLUDE THAT SIGNIlCANT EXPO SURE TO MEDIA VIOLENCE INCREASES THE RISK OF AGGRESSIVE BEHAVIOR IN CERTAIN CHILDREN AND ADOLESCENTS DESENSITIZES THEM TO VIOLENCE AND MAKES THEM BELIEVE THAT THE WORLD IS A MEANERANDSCARIERPLACETHANITISv 4HOSE WHODISAGREEDCHALLENGEDTHE!!0SlNDINGS BYSUGGESTINGTHATMANYOFTHESESTUDIESSUF FEREDFROMRECALLBIASÂ&#x2C6;THATISTHATTHEhDOSEv OF46WATCHINGWASOFTENASSESSEDBYASKING PARTICIPANTSTORECALLTHEAMOUNTTHETIMETHEY SPENTINFRONTOFTHE46INYEARSPAST#LEARLY WHATWASNEEDEDWASAPROSPECTIVESTUDYIN WHICHCHILDRENS46WATCHINGWASRECORDEDAS ITWASPRESENTLYHAPPENING

)NFACT THERESULTSOFJUSTSUCHA YEAR PROSPECTIVESTUDY PUBLISHEDIN AFlRMED THE!!0SCONCLUSIONS!FTERFOLLOWINGPARTICI PANTS FROM EARLY ADOLESCENCE TO ADULTHOOD THE STUDY CONCLUDED THERE WAS A SIGNIlCANT ASSOCIATIONBETWEENTHEAMOUNTOFTIMESPENT WATCHING TELEVISION DURING ADOLESCENCE AND EARLY ADULTHOOD AND THE LIKELIHOOD OF SUB SEQUENTAGGRESSIVEACTSAGAINSTOTHERSv4HIS ASSOCIATION REMAINED SIGNIlCANT EVEN WHEN CONTROLLINGFOROTHERRISKFACTORSFORVIOLENCE INCLUDINGPREVIOUSAGGRESSIVEBEHAVIOR CHILD HOOD NEGLECT FAMILY INCOME NEIGHBORHOOD VIOLENCE PARENTALEDUCATION ANDPSYCHIATRIC DISORDERS -ORE RECENTLY PHYSICIANS HAVE SEEN A GROWINGLITERATUREONTHEASSOCIATIONBETWEEN NUMBEROFHOURSSPENTINFRONTOFTHE46AND BODY MASS INDEX "-)  %VER SINCE A SMALL STUDY IN  SUGGESTED THAT THE METABOLIC RATEDROPSDURING46VIEWING THE46 OBESITY CONNECTION HAS OFTEN BEEN OVER SIMPLIFIED AS A COMBINATION OF INACTIVITY AND HIGH FAT INTAKE (OWEVER A RECENT 3TANFORD 5NIVERSITY STUDYSUGGESTSTHEPATHWAYSAREMORECOMPLEX ANDMULTIFACETEDTHANWASINITIALLYTHOUGHT )NTHISRANDOMIZEDCONTROLLEDTRIAL CHILDREN IN TWO GROUPS WERE SIMILAR AT BASELINE ON NUMBEROFHOURSOF46 "-) ANDAVARIETY OFDEMOGRAPHICFACTORS/NEGROUPRECEIVED ANEDUCATIONALINTERVENTIONTHATRESULTEDINA REDUCEDAMOUNTOF46WATCHING.OTSURPRIS INGLY KIDSTHATWATCHEDLESS46HADADECREASE IN"-)3URPRISINGLY HOWEVER THECHANGEIN "-)OCCURREDWITHOUTCONCURRENTCHANGESIN THEAMOUNTOFHIGHFATFOODINTAKE AMOUNT OFMODERATETOVIGOROUSPHYSICALACTIVITY OR NUMBEROFMEALSINFRONTOFTHE464HISRE SEARCHSUGGESTSTHATTIMEINFRONTOFA46MAY INITSELFAFFECTTHECHEMISTRYOFTHEBRAINAND

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


RESULT IN OBESITY IRRESPECTIVE OF ACTIVITY LEVEL ANDFOODINTAKE 7HATISITABOUT46WATCHINGTHATME DIATESCHANGESINPSYCHOLOGICALANDPHYSICAL HEALTH OUTCOMES (OW CAN KNOWLEDGE OF BRAINDEVELOPMENTANDLEARNINGTHEORYHELP US UNDERSTAND WHAT IS GOING ON /NE UNI FYING EXPLANATION FOR HOW46 VIEWING CAN RESULT IN ADVERSE PSYCHOLOGICAL AND PHYSICAL HEALTHOUTCOMESFOCUSESONTHEWAYTHEBRAIN PERCEIVESMOVEMENTONASCREEN%ARLY%%' OBSERVATIONSSUGGESTTHATTHEBRAINPERCEIVES MOVEMENTONASCREENINTHESAMEWAYASIT PERCEIVESMOVEMENTINAROOM4HISMEANS THATASTHEMOVEMENTCALLSOURBRAINTOATTEN TION WEWILLRESPONDBYACTIVATINGOURATTEN TIONMECHANISMSANDTHESYMPATHETICNERVOUS SYSTEM 46PROGRAMMINGISDESIGNEDTOCONTINU ALLYGRABOURATTENTIONANDKEEPUSWATCHING 4HESIGHTANDSOUNDSTIMULATEUSANDJOLTUS BACK TO ATTENTION 0ROGRAMS BECOME LOUDER MOREGRAPHIC MOREVIOLENT ORMORESEXUALIN ORDERTOKEEPUSWATCHING$R$AVID7ALSH AT THE .ATIONAL )NSTITUTE FOR -EDIA AND THE &AMILYEDUCATESUSTHATGRABBINGATTENTIONIS

THEBASICMECHANISMOF4646PROGRAMSNEED TOKEEPUSWATCHINGTOhSELLOUREYEBALLSTOAD VERTISERSv7HILEMOSTOFTHERESEARCHFOCUSES ON46 THEREISAGROWINGCONCERNTHATOTHER MEDIA SUCHASCOMPUTERANDVIDEOGAMES CAN ELICITTHESAMEATTENTIONALEXCITEMENT -ECHANISMS OF ATTENTION ARE COMPLEX TOUNDERSTAND BUTTHEYAREMEDIATEDBYNOR EPINEPHRINE RELEASE FROM THE LOCUS CERULEUS .ORMALLY WHENWEAREJOLTEDTORELEASENOREPI NEPHRINEINTHEmIGHTORlGHTRESPONSE THERE IS AN OBLIGATORY RELEASE OF CORTISOL FROM THE ADRENALGLANDSTOMAINTAINOURSTATEOFREADI NESS4HISTHEORYSUGGESTSTHATTHISSTIMULATION OFTHEHYPOTHALAMIC PITUITARY ADRENAL(0! AXIS MAY ACCOUNT FOR SOME OF THE UNDERLY INGCHEMICALCHANGESTHAT46CREATESINTHE BRAIN !SCORTISOLISRELEASEDIN(0!AXISACTIVA TION ITHASASENSITIZINGEFFECTONNEURONS)N LOWANDMODERATEDOSES CORTISOLASSISTSNEU RONFUNCTIONANDHELPSTHENERVECELLlREMORE EASILY)TMAKESITEASIERTOINDUCELONG TERM POTENTIATION,40 #ORTISOL THEREFORE POTEN TIATESLEARNING)TISNOWONDERTHATCHILDREN EASILYLEARNFROMPROGRAMSTHATHOLDTHEMIN

ATTENTION-OREOVER IFWECONSIDERTHEAND UNDERAGEGROUP WEAREREMINDEDTHATNEURAL NETWORKS ARE BEING CREATED IN ABUNDANCE AND THAT THERE ARE MORE POTENTIAL LEARNING PATHWAYS DURING THIS TIME THAN WILL EVER BE AVAILABLE AGAIN IN LIFE4HIS RAPID LEARNING TAKESPLACEWITHOUTTHEDISCRIMINATORYGUID ANCEOFTHE0&# WHICHISNOTDEVELOPEDYET 4HEREFORE CHILDRENWITHTHEIRABUNDANCEOF POTENTIAL LEARNING TRACKS AND LACK OF CRITICAL THINKING SKILLS ARE PARTICULARLY VULNERABLE TO LEARNINGMEDIAMESSAGES"UT UNFORTUNATELY ACTIVATINGTHE(0!AXISHASMUCHLARGERHEALTH IMPLICATIONSTHANSIMPLYLEARNINGMEDIAMES SAGES #ERTAINLYTHEREISNEEDFORMORESTUDIES ONTHEROLEOF(0!AXISACTIVATIONANDCORTI SOLINTHEMANYWAYS46-EDIAAFFECTHEALTH 7ENEEDTOREADRESEARCHLOOKINGFORPOSSIBLE DEEPERBIOCHEMICALASPECTSOFTHElNDINGS&OR EXAMPLE ACROSS SECTIONALSTUDYSHOWED ANASSOCIATIONBETWEENSERUMCHOLESTEROLLEV ELSANDTELEVISIONVIEWING(IGHDURATION46 VIEWERSWERETWICEASLIKELYTOHAVEHIGHCHO #ONTINUEDONPAGE

7KH%XLOGLQJ%ORFNVRI6XFFHVV  $"'#$!  &+!%'$!%"#$"(%#$"#$&+ !%'&+!%'$!#$"'&%! $!"&!""+#$"'&%!%$(% "$&$#$"($%

"$ "$!"$ &"! "'$%%$#$%!&&(& - - -"$(%&'%& )))

$"'#"

 %&&!-, . *!&

'%!%%$&!$%"' !$'%&

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

-AY*UNE




#OMMUNITY%DUCATION #ONTINUEDFROMPAGE

LESTEROL AND MODERATE DURATION VIEWERS WERE TIMESMORELIKELYTOHAVEHIGHCHOLESTEROL 7HILEITISTEMPTINGTOEXPLAINTHISAWAYBY DIETARYCONSUMPTIONHABITS WESHOULDNOTFOR GETTHATCHOLESTEROLISTHESUBSTRATEMOLECULE REQUIREDFORALLSTEROIDMETABOLISMINCLUDING CORTISOL4HUS ANINCREASEDDEMANDFORCOR TISOLWILLALSOCREATEANINCREASEDNEEDFORITS SUBSTRATE CHOLESTEROL -USIC -USICISALSOAPOWERFULMODULATOROFNEURO CHEMICALBALANCE-USICTHERAPYISRECOGNIZED FORITSBENElCIALHEALTHEFFECTSBECAUSEITCAN AFFECTTHENEUROCHEMICALBALANCE0%4SCANS DEMONSTRATE THAT MANY AREAS OF THE BRAIN PROCESSMUSICINCLUDINGTHEPREFRONTALCORTEX -USICBECOMESADOMINANTINmUENCEINADOLES CENCEASTHEIRDEVELOPING0&#PROVIDESTHEMA GREATERCAPACITYFORPROCESSINGMUSIC )NTWOSOCIALRESEARCHERS 4OOKAND 7EISS PRESENTEDTHECONCEPTOFh(EAVY-ETAL 3YNDROMEv (EAVY -ETAL 3YNDROME OCCURS AMONGHIGHDURATIONLISTENERSTOHEAVYMETAL

MUSIC)TPRESENTSITSELFINACONSTELLATIONOF BEHAVIORS WHICHINCLUDESASMOLDERINGCONmICT WITHPARENTS LOWERACADEMICPERFORMANCEAND MOST CONCERNING A VULNERABILITY TO SUICIDE 4HEYREPORTEDAHIGHERTHANAVERAGEPROPOR TIONOFSUICIDEATTEMPTSINTHELASTSIXMONTHS AMONGHEAVYMETALUSERSWHENCOMPAREDTO GENERALYOUTH4HEYRECORDEDSUICIDEATTEMPTS INPERCENTOFMALEANDPERCENTOFFE MALEHEAVYMETALUSERSCOMPAREDTOSUICIDE ATTEMPTSIN  PERCENT MALESAND  PERCENT FEMALESAMONGGENERALYOUTH 4HERESEARCHERSPOSEDAQUESTIONTOTHEIR COLLEAGUES)STHERELATIONSHIPWEAREOBSERVING BETWEENHEAVYMETALRAPMUSICANDADOLESCENT TURMOILREALORARTIFACT)NOTHERWORDS DOES HEAVY METAL MUSIC CONTRIBUTE TO ADOLESCENT TURMOILANDANTISOCIALBEHAVIORSORMERELYRE mECTMUSICALCHOICESBYYOUTHWHOAREALREADY INTURMOIL 4HE ANSWER MAY BE hBOTHv /BVIOUSLY CAUSE EFFECTRELATIONSHIPSAREDIFlCULTTOPROVE ANDWEAREREPEATEDLYREMINDED hASSOCIATION DOESNOTMEANCAUSATIONv(OWEVER THECUR RENTNEUROBIOLOGYOFHEAVYMETALMUSICSUG GESTSITCANACTIVATETHENORADRENERGICSYSTEM

(EAVYMETALMUSIC LIKETECHNO MUSIC ISFAST TEMPOMUSIC4ECHNOMUSIC FOREXAMPLE IS COMPUTERGENERATEDATARATEOF BEATS PER MINUTE BPM  "Y COMPARISON CLASSICAL MUSICHASATEMPOOFBPM4HEBOTTOM LINEISTHATFASTTEMPOSACTIVATETHE(0!AXIS BYRELEASING.%FROMNERVES 3EVERALSTUDIESAREINGENERALAGREEMENT THATFASTMUSICISABLETOACTIVATETHENORADREN ERGICSYSTEMANDTHE(0!AXISMORETHANSLOW MUSIC%LEVATIONOF.%ANDCORTISOLAFFECTSOUR EMOTIONALSTATE)TISIMPORTANTTORECOGNIZE THATTHISCHANGEINBRAINCHEMISTRYCANCOME BOTH FROM THE SOCIAL TURMOIL AND THE MUSIC ITSELF $EPRESSION WHICH IS IN QUESTION WITH THE HIGH RATE OF SUICIDE ATTEMPTS IS OFTEN ASSOCIATED WITH ELEVATED CORTISOL h-ANY PA TIENTSWITHMAJORDEPRESSIONSHOWEVIDENCEOF OVER ACTIVATIONOFTHEHYPOTHALAMIC PITUITARY ADRENALAXIS ASEVIDENCEDBYHYPERCORTISOLISM ANDADRENALHYPERPLASIAv4HEINmUENCEOF CORTISOLONDEPRESSIONISSOSIGNIlCANTTHATITIS STIMULATINGNEWRESEARCHINTOTHEPOSSIBILITYOF CORTISOL RECEPTORBLOCKERSASANTI DEPRESSANTS $EPRESSION ITSELF IS COMPLEX AND ALSO MEDI

                    

        *3",/$",,9/7.&%".% /0&2"4&%$/-0".9/''&2*.(2&.4",".%$,&".*.(3&26*$&3 /'-&%*$",("2-&.43!)&*2/2(".*:"4*/.*34/0./4$)7*4) 15",*49 02/%5$43 ".% 3&26*$&3   ".%   -&-#&23 2&$&*6&"%*3$/5.4/2"'2&&02*$&15/4&$/.4"$4 4&6& &6&23/.'2/--&2*2*%&"4   



  2&$&.4,90"24.&2&%7*4) ".% 4//''&2 4)&2&15*2&% $/-0,*".$&42"*.*.('/2/52 -&-#&23".%4)&*234"''352-&-#&232&$&*6&" %*3$/5.4!/-&&4/2&8$&&%4)&*..&3/4" ".% 4)& &%&2",   2&15*2&-&.43 4",+ 7*4) "'&3352& /.35,4".4*-&4&23/."4 

  /2 6*3*44)&*27&#3*4&"4 7773"'&"3352&$/-

   *3 "6",5&%0"24.&2/' ".% ".% /''&2/52-&-#&23504/ /''/'4)&*27*%& "22"9/'$/''&&".%)/4#&6&2"(&3&26*$&3'9/5"2& *.4&2&34&% *. 429*.( 4)&*2 3&26*$& $/.4"$4 /# *,,9 "4   '9/5"2&".&8*34*.($534/-&2/' &229/''&& &26*$&#&352&4)"49/5"2& 2&$&*6*.(4)&%*3$/5.4&%02*$*.(

      /''&23 -&-#&23*.%*6*%5",".%(2/50#&.&'*43 -&%*$", %&.4", ,*'& %*3"#*,*49 "3 7&,, "3 )5-". 2&3/52$& 3500/24 3&26*$&3 &8&$54*6& #&.&'*43 2&4*2&-&.4 02/(2"-3   $/-0,*".$& ".% #&.&'*4"%-*.*342"4*/.!/'*.%/54-/2&*.'/2-"4*/. $/.4"$4*-2*&3"4   /26*3*44)&*2 7&#3*4& "4 7773$)7"2:7*,,*"-3$/-

      -AY*UNE

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


ATEDBYGENETICSANDAVARIETYOFOTHERFACTORS (OWEVER WHENITISPRESENT HYPERCORTISOLISM AFFECTSTHENUCLEUSACCUMBENS THEVERYCENTER OFOURPLEASUREREWARD PATHWAY BYINHIBITING DOPAMINE SYNTHESIS AND TURNOVER THERE )F HIGH RISKKIDSALREADYHAVEANINCREASEIN(0! AXISACTIVATIONTHENADDITIONALSTIMULATIONWITH FASTTEMPOMUSICFUELSADANGEROUSlRE !DDICTIONS 2ECENT ADVANCES IN NEUROSCIENCE ALSO HELP US UNDERSTAND WHY THE ADOLESCENT BRAIN IS UNIQUELYVULNERABLETOADDICTION&IRST ASTHE PREFRONTALCORTEX0&# STARTSTOWIRE UP THERE ISANINCREASEINIMPULSIVITYTHATENCOURAGES RISK TAKINGANDEXPLORATIONOFNEWHORIZONS )NTERESTINGLY THIS IMPULSIVITY AS THE 0&# DEVELOPS IS SEEN IN OTHER ANIMAL SPECIES 3ECONDLY THEREWARDPATHWAYBEGINSMAKING ITSCONNECTIONSWITHTHE0&#ANDNEWDOPA MINERECEPTORSAPPEAR4HISDEVELOPINGNEURAL NETWORK WILL BE INmUENCED BY THE MILIEU OF CHEMICALSINTHESYNAPSE)NTHEPRESENCEOF DRUGS OR ABUSE DOPAMINE RECEPTORS MAY BE ASKED TO PREMATURELY DOWN REGULATE IN THE DEVELOPINGREWARDPATHWAY4HESETPOINTOF THENEURONISCHANGEDBEFOREITHASCOMPLETELY DEVELOPED 4HISISANADOLESCENTWINDOWOFNEURO LOGICALVULNERABILITYTHATTOOEASILYTRANSLATES INTOLIFE LONGADDICTIONDUETOPREMATUREDOWN REGULATIONOFDOPAMINERECEPTORS'RANTAND $AWSONS  NATIONAL SURVEY OF   ILLUSTRATES THIS hYOUNG PEOPLE WHO BEGAN DRINKINGBEFOREAGEWEREFOURTIMESMORE LIKELYTODEVELOPALCOHOLDEPENDENCEALCOHOL ADDICTION COMMONLY KNOWN AS ALCOHOLISM THANTHOSEWHOBEGANDRINKINGATAGEv !MONGTHOSEWHOBEGANDRINKINGATAGE THERE WAS A  PERCENT LIFETIME PREVALENCE ALCOHOLDEPENDENCE 0ARENTSNEEDTOBEREPEATEDLYINSTRUCTED ABOUT THIS UNIQUE VULNERABILITY TO ADDICTION DURINGADOLESCENCEANDTHEIMPORTANCEOFTHE ROLETHEYCANPLAYINPREVENTINGIT!PROSPEC TIVEGENETICSTUDYOFTWINSFOUNDTHATPARENTAL MONITORINGANDASUPPORTIVEHOMEATMOSPHERE WEREAMONGTHEFACTORSTHATPREDICTEDWHETHER ACHILDWOULDDRINKORABSTAINFROMALCOHOLAT AGE !NOTHERCONCERNISPORNOGRAPHYADDIC TION)NTERNETPORNOGRAPHYISNOWWIDELYAVAIL ABLEANDMINIMALLYRESTRICTEDFROMYOUTH)T

ISCREATINGANINCREASINGPROBLEMAMONGOUR ADOLESCENTS -ORE CASES OF CHILDHOOD SEXUAL ABUSE ARE REPORTED WITH TEENS THAT ARE HEAV ILY INVOLVED IN )NTERNET PORNOGRAPHY AS THE PERPETRATORS 4HEREAREMANYSOCIALEFFECTSOFPORNOG RAPHYUSE"UTFROMTHENEUROSCIENCEPERSPEC TIVE WE MUST CONSIDER WHAT THE DEVELOPING BRAIN IS LEARNING ABOUT SEXUAL AROUSAL &OR EXAMPLE IFSEXUALAROUSALISLEARNEDINNEURAL CIRCUITSBATHEDINAPLETHORAOFPORNOGRAPHY WHATHAPPENSTOTHENEURALCIRCUITRYOFAMORE RELATIONSHIP BASEDAROUSAL!RETHESEPATHWAYS DOWN REGULATEDANDPRUNEDDURINGTHISCRITICAL TIMEINBRAINDEVELOPMENTWHENTHESEXUALRE SPONSEISBEINGLEARNED7EARETHEGENERATION OFPHYSICIANSASKEDTODEALWITHTHISCOMPLEX ISSUEALMOSTASQUICKLYASTHEINFORMATIONIS AVAILABLE TO US 7E NEED TO BE TALKING WITH PARENTSANDKIDSABOUTWHATISKNOWNABOUT PORNOGRAPHYUSE $OMESTIC6IOLENCE &INALLY WECANADVOCATEFORCHILDRENBYMAK ING INTERVENTIONS IN THE HOMES OF DOMESTIC VIOLENCESTANDARDANDROUTINE#URRENTNEU ROBIOLOGYRESEARCHSUGGESTSTHATCHILDRENWHO WITNESSDOMESTICABUSEORVIOLENCEINTHEHOME MANIFESTSIMILARPSYCHOLOGICALEFFECTSTOTHOSE CHILDRENWHOAREDIRECTLYABUSED2ESEARCH SUGGESTSTHATWATCHINGDOMESTICVIOLENCECRE ATESTHESAMEHIGHNOREPINEPHRINELEVELSWITH SUBSEQUENTELEVATEDCORTISOLTHATISEVIDENCED INPOST TRAUMATICSTRESSDISORDER043$ INTHE ABUSEDPERSON4HESECHILDRENAREATGREATER RISKFORANXIETYANDDEPRESSION OPPOSITIONAL BEHAVIOR ANDLOWERACADEMICPERFORMANCE )NCLOSING )AMREMINDEDOFTHEOLDADAGE THATTRUTHISAMANY FACETEDDIAMOND ANDITIS IMPOSSIBLEFORONEPERSONTOSEEALLTHEFACETS ATONCE4HISISPARTICULARLYTRUEWHENWEARE TALKINGABOUTSOMETHINGASCOMPLEXASTHESO CIETALINmUENCESONNEUROBIOLOGYANDBEHAVIOR ANDOURROLEINTHEEDUCATIONOFCHILDRENAND PARENTS%ACHSPECIALTYCONTRIBUTESADIFFERENT PERSPECTIVEOFTHATDIAMOND#URRENTCULTURE CREATESNEWCONCERNSANDCHALLENGESFORUSAS PHYSICIANS)WELCOMEDIALOGUEWITHOTHERIN TERESTEDPHYSICIANSTOBRINGOURKNOWLEDGEAND EXPERIENCESTOGETHERINORDERTOADVOCATEWISELY ANDCOURAGEOUSLYFORTHEHEALTHOFCHILDRENU

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

-ARY%ZZO -$ ISAFAMILYPHYSICIANATTHE !LLINA-EDICAL#LINICIN3HOREVIEW -.E MAIL EZZOX TCUMNEDU

&OOTNOTES  !MERICAN!CADEMYOF0EDIATRICS #OMMITTEEON 0UBLIC%DUCATION h#HILDREN !DOLESCENTSAND 4ELEVISION v0EDIATRICS     !MERICAN!CADEMYOF0EDIATRICS#OMMITTEEON 0UBLIC%DUCATION h-EDIA%DUCATION v0EDIATRICS  6OL    *OHNSON*' #OHEN0 3MAILES%- +ASEN3 "ROOK *3 h4ELEVISIONVIEWINGANDAGGRESSIVEBEHAVIOR DURINGADOLESCENCEANDADULTHOODv3CIENCE -AR    2OBINSON4. h2EDUCINGCHILDRENSTELEVISIONVIEW INGTOPREVENTOBESITYARANDOMIZEDCONTROLLED TRIALv*!-!/CT    (EALY *ANE %NDANGERED-INDS.EW9ORK4OUCH STONE P  .ATIONAL)NSTITUTEON-EDIAANDTHE&AMILY WWWMEDIAFAMILYORG   OR    $R.ORMAN7EINBERGERATTHE5NIVERSITYOF#ALI FORNIA)RVINEHASCREATEDANINTERESTINGDATABASEOF MUSICRESEARCHATWWWMUSICAUCIEDU  4OOK+*AND7EISS$3 h4HERELATIONSHIPBETWEEN (EAVY-ETALAND2AP-USICAND!DOLESCENT4UR MOIL2EALOR!RTIFACTv!DOLESCENCE6OL     'ERRA' :AIMOVIC! &RANCHINI$ETALh.EUROEN DOCRINERESPONSESOFHEALTHYVOLUNTEERSTO@TECHNO MUSICRELATIONSHIPSWITHPERSONALITYTRAITSAND EMOTIONALSTATEv)NT*0SYCHOPHYSIOL      $INAN4 h.OVEL!PPROACHESTOTHETREATMENTOF DEPRESSIONBYMODULATINGTHEHYPOTHALAMIC PITU ITARY ADRENALAXIS v(UM0SYCHOPHARMACOL *AN    0ACAK+ 4JURMINA/ 0ALKOVITS- 'OLDSTEIN$3ET ALh#HRONICHYPERCORTISOLEMIAINHIBITSDOPAMINE SYNTHESISANDTURNOVERINTHENUCLEUSACCUMBENS ANINVIVOMICRODIALYSISSTUDY v.EUROENDOCRINOLOGY 3EP    3PEAR ,h-ODELING!DOLESCENT$EVELOPMENTAND !LCOHOL5SEIN!NIMALSv !LCOHOL2ESEARCHAND (EALTH 6OL .O    .)(.EWS2ELEASEWWWNIAAANIHGOV  2OSE2* $ICK$- 6IKEN2* 0ULKKINEN, +APRIO *h$RINKINGOR!BSTAININGATAGE!GENETIC EPIDEMIOLOGICALSTUDY v!LCOHOL#LIN%XP2ES .OV    *AFFE0' (URLEY$* 7OLFE$h#HILDRENS/BSERVA TIONSOFVIOLENCE)#RITICAL)SSUESINCHILDDEVELOP MENTANDINTERVENTIONPLANNING#AN*0SYCHIATRY    *AFFE0' (URLEY$* 7OLFE$h3IMILARITIESINBEHAV IORALANDSOCIALMALADJUSTMENTAMONGCHILDVICTIMS ANDWITNESSESTOFAMILYVIOLENCE v!M*/RTHOPSY CHIATRY    2HEA-( #HAFEY+( $OHNER6! 4ERRAGO2h4HE SILENTVICTIMSOFDOMESTICVIOLENCEnWHOWILL SPEAKv*#HILD!DOLESC0SYCHIATR.URS   

-AY*UNE




0AY FOR 0ERFORMANCE7ONT)MPROVE 1UALITYOR2EDUCE#OSTSFOR-OST3ERVICES

)

).352!.#% #/-0!.)%3 AND MANAGED

CAREADVOCATESHAVELATELYBEGUNTOPROMOTEA METHODOFPAYINGDOCTORSKNOWNAShPAYFOR PERFORMANCEv,ASTYEAR THE#ENTERSFOR-EDI CAREAND-EDICAID3ERVICESANNOUNCED UNDER AMANDATEFROM#ONGRESS ITWOULDCONDUCTA THREE YEARPAY FOR PERFORMANCEDEMONSTRATION PROJECT STARTING IN  !LSO IN  THE )NTEGRATED(EALTHCARE!SSOCIATION ACOALITION OFSEVEN#ALIFORNIAPLANS ANNOUNCEDAPAY FOR PERFORMANCEPROJECTTHATWILLISSUEITSlRST REPORTCARDSONPHYSICIANSIN)N-IN NESOTA THELARGESTFOURHEALTHPLANSHAVEALL ANNOUNCEDPAY FOR PERFORMANCEPROGRAMS 4HEPHRASEhPAYFORPERFORMANCEvISUSU ALLYUSEDTOMEANhPAYINGDOCTORSTOIMPROVE QUALITYOFCAREv(OWEVER INSURANCEINDUSTRY OFlCIALSOFTENDElNETHEPHRASETOMEANNOT ONLYPAYINGTOIMPROVEQUALITYBUTALSOhPAYING TODENYSERVICESv)NTHISARTICLE PAY FOR PER FORMANCE0&0 ISASSUMEDTOMEANPAYINGTO IMPROVEQUALITYONLY !LTHOUGH0&0ISTOUTEDASAQUALITY IM PROVEMENT TOOL ITS PRIMARY ATTRACTION TO ITS PROPONENTSISITSALLEGEDABILITYTOCONTROLCOST !S$AN-C,AUGHLINAND"RIAN#AMPIONPUT ITINANARTICLEINTHE/CTOBER-INNESOTA 0HYSICIAN h!DVOCATESSAYTHATPAY FOR PERFOR MANCEPROGRAMSxCANGENERATEBOTHSAVINGS ANDIMPROVEDPATIENTOUTCOMESv"UTATTHIS DATE THEREISVERYLITTLEEVIDENCETHAT0&0CAN IMPROVEQUALITY MUCHLESSREDUCECOST4HERE ARESEVERALREASONSFORTHIS THEMOSTIMPOR TANTOFWHICHISTHEVERYLOWPROBABILITYTHAT EXPERTSWILLEVERDEVELOPACCURATEREPORTCARDS FORMOSTMEDICALSERVICES4HEREASONACCURATE REPORTCARDSAREREQUIREDFOR0&0ISOBVIOUS !N INSURER CANNOT PAY DOCTORS FOR BETTER OR

"9+)035,,)6!.

-AY*UNE

WORSEPERFORMANCEUNLESSTHEINSURERCANGRADE PERFORMANCE 2EPORT CARDS ARE BASED ON ONE OR BOTH OFTWOTYPESOFQUALITYMEASURESMEASURESOF OUTCOMES ANDMEASURESOFPROCESSESUSEDIN TREATMENT!NEXAMPLEOFANOUTCOMEMEA SURE IS MORTALITY RATES AMONG PATIENTS WHO HADCORONARYARTERYBYPASSSURGERY!NOTHER EXAMPLEISCHOLESTEROLLEVELS WHICHFALLSINTOA CATEGORYLABELEDBYSOMEAShINTERMEDIATEOUT COMESv%XAMPLESOFPROCESSMEASURESINCLUDE PRESCRIBINGBETABLOCKERSFORPATIENTSWHOHAVE SUFFEREDAHEARTATTACK ANDORDERINGBLOODTESTS TOCHECKCHOLESTEROLLEVELSINDIABETICS /UTCOMEMEASURESAREVERYEXPENSIVEIN TERMSOFDOLLARSANDLOSTPRIVACY BECAUSETHEY HAVE TO BE ADJUSTED TO REmECT DIFFERENCES IN PATIENTHEALTHANDOTHERFACTORSBEYONDPHYSI CIANCONTROL APROCESSCOMMONLYCALLEDhRISK ADJUSTMENT vANDLESSCOMMONLYCALLEDhCASE MIX ADJUSTMENTv 0ROCESS MEASURES ARE USU ALLYEXPENSIVEBECAUSETHEYREQUIREAGREEMENT ONSTANDARDSOFCARE WHICHDONOTEXISTFOR THOUSANDSOFMEDICALSERVICES3OMEPROCESS MEASURESMUSTALSOBERISK ADJUSTED 2EPORTCARDSBASEDON OUTCOMEMEASURES /UTCOMEMEASURESAREEXPENSIVEANDINVADE PATIENT PRIVACY BECAUSE THEY MUST BE RISK ADJUSTED IN ORDER TO BE ACCURATE !DJUSTING FORDIFFERENCESINPATIENTHEALTHNEARLYALWAYS REQUIRESACCESSTOPATIENTMEDICALRECORDSAS OPPOSEDTOhADMINISTRATIVEDATA vTYPICALLYDE lNEDASDATAFOUNDINCLAIMFORMSCOLLECTEDBY INSURERSANDORDISCHARGEREPORTSPREPAREDBY HOSPITALS 4HE.EW9ORK3TATE$EPARTMENT OF(EALTHREPORTCARDONCARDIACSURGEONSISA GOODEXAMPLEOFANOUTCOME BASEDREPORTCARD THATREQUIRESRISKADJUSTMENT)TUSESMORTALITY RATES FOLLOWING CORONARY ARTERY BYPASS GRAFTS

ANOUTCOMEMEASURE ASTHEMEASUREOFQUAL ITY ANDITADJUSTSFORRISKUSINGPATIENTMEDI CALRECORDS%XAMPLESOFhPATIENTRISKFACTORSv THATARETAKENINTOACCOUNTBYTHE.EW9ORK $EPARTMENTOF(EALTHINCLUDEEJECTIONFRAC TION HEARTATTACKWITHINTHELASTSEVENDAYS CONGESTIVEHEARTFAILURE ANDTHEPRESENCEOF SEVERALCOMORBIDITIESINCLUDINGDIABETESAND OBESITY  2ISK ADJUSTMENT OF OUTCOME MEASURES THATWILLBEUSEDTOPUNISHORREWARDPHYSI CIANSEITHERWITHADJUSTMENTSTOREIMBURSE MENTORTOMARKETSHARE ISNECESSARYPRIMARILY TOPROTECTPATIENTS ANDSECONDARILYTOENSURE FAIRTREATMENTOFDOCTORS)FRISKADJUSTMENTIS INSUFlCIENTLYACCURATE ORIFITISEVENPERCEIVED BYPHYSICIANSTOBEINSUFlCIENTLYACCURATE PHY SICIANSWILLBEUNDERPRESSURETOAVOIDSICKER PATIENTS(OWEVER FEWOFTHEREPORTCARDSNOW TOUTEDBYTHEINSURANCEINDUSTRYANDLARGEEM PLOYERGROUPSAREADJUSTEDFORANYTHINGOTHER THANAGEANDSEX 4HE FEW RELIABLE STUDIES THAT HAVE IN VESTIGATEDTHEIMPACTOFPOORLYRISK ADJUSTED REPORTCARDSHAVECONlRMEDWHATTHEORYAND COMMONSENSEPREDICTINACCURATEREPORTCARDS PUTGREATPRESSUREONHEALTHCAREPROFESSIONALS TOCHERRYPICK9UJING3HENREPORTEDIN(EALTH 3ERVICES 2ESEARCH THAT PROVIDERS OF SUBSTANCE ABUSETREATMENTAVOIDEDSICKERPATIENTSFOLLOW ING-AINESIMPLEMENTATIONOFhPERFORMANCE BASEDCONTRACTING vASYSTEMTHATTHREATENED LOW SCORINGPROVIDERSWITHLOSSOFTHEIRCON TRACTSANDPROMISEDHIGH PERFORMINGPROVIDERS MOREFUNDING4HESCORESTHAT-AINEUSEDTO ASSESSPERFORMANCEWERENOTADJUSTEDFORRISK "UTEVENREPORTCARDSWITHSOPHISTICATEDRISK ADJUSTMENTMAYCAUSESOMEPROVIDERSTOAVOID THESICKESTPATIENTS4HE.EW9ORKREPORTCARD ONHEARTSURGEONS ASSOPHISTICATEDASITIS MAY NOTBEACCURATEENOUGHTOTAKETHEPRESSUREOFF

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


SURGEONSTOCHERRYPICK)NANYCASE SOMEHEART SURGEONSIN.EW9ORKTHINKITISNOT AND AS A RESULT THERE IS SOME EVIDENCE THAT QUALITY OFCAREFORTHESICKESTPATIENTSHASDECLINEDAS SURGEONSWHODONOTTRUSTTHERISK ADJUSTMENT METHODOLOGYlNDWAYSTOAVOIDSICKPATIENTS INORDERNOTTOHAVETHOSEPATIENTSDRIVETHEIR MORTALITYRATESUP 3OME EXPERTS HAVE SUGGESTED THAT OUT COMESCANNOTBEMEASUREDACCURATELYENOUGH TOELIMINATETHEINCENTIVETOREJECTSICKERPA TIENTS(OFERETALEXAMINEDTHEACCURACYOFAN OUTCOMEMEASURECOMMONLYUSEDINPHYSICIAN REPORTCARDSTODAYÂ&#x2C6;HEMOGLOBIN!#(GB !C LEVELSINPATIENTSWITHTYPEDIABETES!F TERADJUSTINGTHE(GB!CLEVELSFORDIFFERENCES INPATIENTHEALTHANDSOCIOECONOMICSTATUSAD JUSTMENTSFARMORESOPHISTICATEDANDEXPENSIVE THANTHOSEUSEDBYTHEAVERAGEINSURERTODAY THEINVESTIGATORSFOUNDTHATPHYSICIANSWOULD STILL BE BETTER OFF GETTING RID OF THEIR ONE TO THREESICKESTPATIENTSOUTOFANAVERAGEDIABETIC BASEOFABOUTPATIENTSPERDOCTOR $OING SOWOULDIMPROVETHEIRSCOREhDRAMATICALLY v SAIDTHEAUTHORSh4HISADVANTAGEFROMGAM INGCOULDNOTBEPREVENTEDBYEVENDETAILED CASE MIXADJUSTMENT vTHEYCONCLUDED 2EPORTCARDSBASED ONPROCESSMEASURES 0ROCESS MEASURES EG DID THE SURGEON PRESCRIBE A BETA BLOCKER FOR THE HEART ATTACK PATIENT OFTENDONOTREQUIRERISKADJUSTMENT AND FORDIAGNOSESFORWHICHASTANDARDOFCARE HASBEENREACHED ARETHEREFORELIKELYTOBELESS EXPENSIVETHANOUTCOMEMEASURES4HISISTRUE HOWEVER ONLY WHERE THE PATIENT POPULATION EXAMINEDISLIMITEDTOPATIENTSWHOACTUALLY SAWADOCTOR&OREXAMPLE APROCESSMEASURE THAT MEASURED WHETHER A DOCTOR ADVISED A PATIENTTOQUITSMOKINGWOULDNOTNEEDTOBE RISKADJUSTEDASLONGASTHESTUDYWASLIMITEDTO PATIENTSWHOVISITEDTHEDOCTOR"UTAPROCESS MEASURE THAT USED ALL PATIENTS ASSIGNED TO A CLINICBYAN(-/ASTHEDENOMINATORWOULD HAVETOBERISKADJUSTEDFORBOTHHEALTHAND SOCIOECONOMICFACTORSTHATINmUENCEPATIENTS ABILITYANDINCLINATIONTOSEEADOCTOR4HESE FACTORS ARE PARTIALLY OR WHOLLY OUTSIDE THE DOCTORS CONTROL AND IF UNCONTROLLED COULD BIASPHYSICIANhSCORESv (OWEVER EVENPROCESSMEASURESTHATDO NOTREQUIRERISKADJUSTMENTPRESENTAHURDLE

THATISALMOSTASDAUNTINGASRISKADJUSTMENT NAMELY THENEEDFORANAGREED UPONSTANDARD OFCARETHATAPPLIESTOALLPATIENTSWITHAGIVEN DIAGNOSIS2ELATIVETOTHETHOUSANDSOFMEDICAL SERVICESRENDEREDIN!MERICATODAY EVIDENCE BASED STANDARDS ARE FEW4HE PROPORTION OF MEDICAL SERVICES FOR WHICH A SCIENCE BASED CONSENSUSONSTANDARDOFCAREEXISTSISAPPAR ENTLYNOMORETHANTOPERCENT!CCORDING TOANARTICLEBY,ANDONETALINAEDITION OF*!-! h;&=EWMEDICALSPECIALTIESHAVEAN EVIDENCEBASETHATISROBUSTANDCOMPREHENSIVE ENOUGHTOSUPPORT0#0!;PHYSICIANCLINICAL PERFORMANCEASSESSMENT=v 2EPORTCARDSBASEDON PATIENTSURVEYS -ANYADVOCATESOFREPORTCARDSHAVEEXPRESSED THEHOPETHATPATIENTSURVEYSWILLPROVETOBE AN INEXPENSIVE ALTERNATIVE TO REPORT CARDS BASEDONRISK ADJUSTEDOUTCOMEMEASURESOR PROCESS MEASURES )T IS NO DOUBT TRUE THAT MOST OF THE SURVEY BASED REPORT CARDS BEING PUBLISHED TODAY ARE RELATIVELY INEXPENSIVE BUT UNFORTUNATELY THEYARENOTACCURATEAND SHOULDNOTBEUSEDBYPATIENTS3URVEYSFACE THESAMEPROBLEMSOUTCOME ANDPROCESS BASED REPORTCARDSFACE)FTHESURVEYQUESTIONSEEKS INFORMATIONONOUTCOMES THEhGRADEvHASTOBE RISKADJUSTED THATIS THERESPONDENTSHEALTH STATUSMUSTBETAKENINTOACCOUNT)TISWELL ESTABLISHEDTHATSICKERPATIENTSAREMORECRITICAL OFTHEIRCAREGIVERS)FTHESURVEYQUESTIONSEEKS INFORMATIONABOUTPROCESSESOFCARE THEPROCESS BEINGMEASUREDMUSTBESHOWNTOHAVEAROBUST RELATIONSHIPWITHHIGH QUALITYOUTCOMES)TIS NOTCLEARTHATQUESTIONSCOMMONLYASKEDIN PATIENT SURVEYS MEET THESE CRITERIA )N SUM PATIENT SURVEYS DO NOT PROVIDE A LOW COST METHODOFDERIVINGACCURATEREPORTCARDSON PHYSICIANSERVICES #ONCLUSIONS 4HE PRIMARY OBSTACLE OUTCOME BASED REPORT CARDSMUSTOVERCOMEISTHEDIFlCULTYOFACCU RATERISKADJUSTMENT4HEPRIMARYPROBLEMWITH PROCESSMEASURESISTHATTHEYREQUIRECONSENSUS ONSTANDARDSOFCARE ANDSUCHCONSENSUSDOES NOTEXISTFORTHEGREATMAJORITYOFMEDICALSER VICES-OREOVER SOMEPROCESSMEASURESMUST BE RISK ADJUSTED &INALLY PATIENT SATISFACTION SURVEYSARENOTASHORTCUTTOACCURATEREPORT CARDS4HEYTOOMUSTBERISKADJUSTED

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

&ORTHESEANDOTHERREASONS MANYEXPERTS BELIEVE THAT ACCURATE PHYSICIAN REPORT CARDS FOR MOST MEDICAL SERVICES WILL NEVER APPEAR !S,ANDONETALPUTITINAEDITIONOF *!-! h!TTHECURRENTTIME GIVENTHESTATEOF TECHNOLOGYANDTHEEXISTINGINFRASTRUCTURETO SUPPORTPERFORMANCEASSESSMENT BROAD BASED MANDATORYCLINICALPERFORMANCEASSESSMENTFOR INDIVIDUALPHYSICIANSASAMEANSOFDETERMINING THECOMPETENCEOFINDIVIDUALPHYSICIANSxAP PEARSTOBEINFEASIBLEv)FACCURATEREPORTCARDS FORMOSTSERVICESARENOTFEASIBLE THATMEANS 0&0FORMOSTSERVICESISNOTFEASIBLE4HATIN TURNMEANS0&0CANNOTIMPROVEQUALITYFOR MOSTSERVICES WHICHINTURNMEANS0&0CANNOT REDUCECOSTSFORMOSTSERVICESU +IP 3ULLIVAN IS A MEMBER OF THE BOARD OF THE -INNESOTA0HYSICIAN 0ATIENT!LLIANCE(EISTHE AUTHOR OF SEVERAL REPORTS BY -00! INCLUDING APAPERONPAY FOR PERFORMANCE4HESEMAYBE VIEWED AT WWWPHYSICIAN PATIENTORG (E HAS WRITTENEXTENSIVELYABOUTHEALTHPOLICY

-AY*UNE )NDEXTO!DVERTISERS !LLINA(EALTH3YSTEMS  !LLINA(EALTH3YSTEMS  !LLINA(EALTH3YSTEMS  #RUTCHlELD$ERMATOLOGY  (EALTHCARE"ILLING2ESOURCES  -EDICAL"ILLING0ROFESSIONALS  --)#  -INNESOTA(EALTHCARE.ETWORK  0ARENT0ROFESSIONAL0ROPERTIES,,#  2APID2ETURN )NSIDE"ACK#OVER 2#-3 )NC  2ED0INE2EALTY  5OF-#-% /UTSIDE"ACK#OVER 6EHICLE!DVANTAGE )NSIDE&RONT#OVER 7EBER,AW/FlCE  7HITESELL-EDICAL,OCUMS ,TD 

-AY*UNE




'OVERNMENT0RESCRIBEDh"EST0RACTICESv .OT7HATTHE$OCTOR/RDERED

-

-)..%3/4!,%')3,!4/23APPEARDETER

MINEDTOCREATEASTATEGOVERNMENTCOOKBOOK OFMEDICINE)FTHEPROPOSEDBILLSBECOMELAW PHYSICIANSWILLESSENTIALLYWORKFORTHEGOVERN MENTlRSTANDTHEPATIENTSECOND (OUSE&ILE"RADLEY 2 2OCHESTER AND3ENATE&ILE"ERGLIN $ -PLS AU THORIZESTATEGOVERNMENTTOISSUEALISTOFhBEST PRACTICESvFORPATIENTCARE STARTINGWITHDIABE TESANDCONGESTIVEHEARTFAILURE4HROUGHCOL LABORATIONWITHHEALTHPLANSANDTHE)NSTITUTE FOR#LINICAL3YSTEMS)MPROVEMENT)#3) STATE HEALTHOFlCIALSWILLTRACKANDPUBLICLYREPORT PHYSICIANADHERENCETOTHISLISTOFGOVERNMENT PRESCRIBEDMEDICALTREATMENTS0AYMENTWITH HOLDSBASEDONADHERENCEWILLBEALLOWEDFOR PHYSICIANSTREATINGPUBLICASSISTANCEPATIENTS 4HE(OUSEHASALREADYPASSEDTHEBILL 4HIS IS DANGEROUS LEGISLATION h)T IS NOT STRETCHINGTHINGSTOOFARTOSAYTHATWHOEVER CONTROLSPRACTICEPOLICIESCONTROLSMEDICINE v CAUTIONS$-%DDYIN*!-!0RACTICEGUIDE LINESAREUSEFULTOPHYSICIANSANDPATIENTSAS LONGASGUIDELINESAREONLYGUIDELINES!SSOON ASTHEYBECOMEENFORCEABLEBYLAW GUIDELINES BECOMEGOVERNMENTDIRECTIVES 4HELEGISLATIONDOESNOTDElNEhBESTPRAC TICES vLEAVINGTHE-INNESOTA$EPARTMENTOF (EALTHTOWRITEITSOWNDElNITION4HISISAN INVITATIONTODISASTER-EDICALPRACTICEWILLBE DElNEDBYTHOSEWITHTHEMOSTPOWERTOPER SUADESTATEOFlCIALS ALLOWINGPOLITICALAGENDAS RATIONING SCHEMES AND DISCRIMINATORY VALUE JUDGMENTSTOSETTHESCOPEANDPARAMETERSOF PATIENTCARE 0ATIENTS MAY NOT UNDERSTAND THE TERM hBEST PRACTICES v BUT ONCE THEY LEARN THAT IT MEANS THEIR PHYSICIAN IS TAKING ORDERS FROM

"947),!"2!3% 2. 0(.

-AY*UNE

SOMEONEELSE THEIRTRUSTINTREATMENTDECISIONS WILLBESHAKEN 'OVERNMENT DIRECTED MEDICAL PRACTICE CONTINUESTOHAVEBROADSUPPORTIN#ONGRESS 0RACTICE GUIDELINES WERE PART OF THE  #LINTON (EALTH 0LAN4HE  -EDICARE !CT INCLUDES A PAY FOR PERFORMANCE PROJECT AUTHOREDBY3EN.ORM#OLEMAN2 -.  !ND  FEDERALLY FUNDED EVIDENCE BASED PRACTICE CENTERS ARE CHURNING OUT PRACTICE GUIDELINES 4HE)NSTITUTEOF-EDICINE)/- PRIMAR ILYFUNDEDBY#ONGRESS SUPPORTSTHEDISSEMI NATIONOFMEDICALPRACTICEGUIDELINESTHROUGH A.ATIONAL(EALTH)NFORMATION)NFRASTRUCTURE .()) #LINICALDECISIONSUPPORTSYSTEMSARE AN ESSENTIAL ELEMENT ACCORDING TO A RECENT )/-REPORTONPATIENTSAFETY.OTONLYWILL hEVIDENCE BASEDvGUIDELINESBETRANSMITTEDTO EXAMROOMCOMPUTERS THE.())CANINmUENCE MEDICALDECISION MAKINGBY v LINKING PATIENT OUTCOMES WITH THOSE RE SPONSIBLEFORTHOSEOUTCOMES v MEASURINGPHYSICIANPERFORMANCE v MONITORING COMPLIANCE WITH BEST PRAC TICES v RANKINGDOCTORSANDHOSPITALS v PROVIDINGlNANCIALREWARDSBASEDONPER FORMANCEAND

v PERMITTING STATE AND FEDERAL GOVERNMENT HEALTHSURVEILLANCE 3TATE3ENATOR,INDA"ERGLINLIKESTHEIDEA 3&WILLREQUIREALLCLINICS HOSPITALSAND HEALTHPLANSTOHAVEAGOVERNMENT APPROVED ELECTRONICMEDICALRECORDSYSTEMBY 4HE MICROMANAGEMENT OF TREATMENT THROUGHESTABLISHMENTANDMONITORINGOFhBEST PRACTICESvISPROBLEMATICFORSEVERALREASONS &IRST BIASABOUNDS4HE)/-ACKNOWL EDGES h4HEREAREGAPSANDINCONSISTENCIESIN THEMEDICALLITERATURESUPPORTINGONEPRACTICE VERSUSANOTHER ASWELLASBIASESBASEDONTHE PERSPECTIVEOFTHEAUTHORS WHOMAYBESPECIAL ISTS GENERALPRACTITIONERS PAYERS MARKETERS OR PUBLICHEALTHOFlCIALSv 3ECOND hEVIDENCE BASED MEDICINEv %"- Â&#x2C6;THE PURPORTED UNDERGIRDING OF hBEST PRACTICESvÂ&#x2C6;REMAINS CONTROVERSIAL !S 3EAN ,YNCH WRITES h) FEEL THAT THE @!CHILLES (EEL OF SOME CURRENT USES OF %"- IS THE SELECTIONOFTHEEVIDENCEANDWHETHERCERTAIN DATAORSTUDIESCONSTITUTEEVIDENCEv 4HIRD MONITORINGPHYSICIANSMAYPROVE COUNTERPRODUCTIVE4HE )/- WARNS THAT A hCYCLE OF FEARv MAY LEAD TO PHYSICIAN DEFEN SIVENESS GAMING THE SYSTEM OR SYSTEMATIC MANIPULATIONOFTHEDATA0RACTICEGUIDELINES BASEDONSKEWEDDATAWILLBEUNRELIABLEAND UNSAFE !NDlNALLY hBESTPRACTICESvREQUIREMENTS MAYLEADTOAMYOPICFOCUSONSPECIlEDCONDI TIONSWITHINSUFlCIENTATTENTIONTOTHEOTHER PRESSINGNEEDSOFPATIENTS)N THE)/- RECOMMENDEDPRIORITYAREASFOREVIDENCE COLLECTION PRACTICEGUIDELINECREATIONANDPER FORMANCEMEASUREMENTDEVELOPMENT-YRIAD CONDITIONS ANDMYRIADITERATIONSOFCONDITIONS EXPERIENCEDBYPATIENTS ARENOTONTHELIST -INNESOTAS GOVERNOR AND POWERFUL SPECIAL INTEREST GROUPS SUPPORT GOVERNMENT

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


PRESCRIBEDhBESTPRACTICESv)NHIS3TATEOFTHE 3TATEADDRESS 'OVERNOR4IM0AWLENTYSAIDHIS ADMINISTRATIONWOULDhFORCEHEALTHCAREPRO VIDERSTOUSEBESTPRACTICESv!NDACCORDING TOANE MAILFROM2EP"RADLEY h4HEPROVI SIONSARESUPPORTEDBYTHE-INNESOTA-EDICAL !SSOCIATION 4HE-INNESOTA(OSPITAL!SSOCIA TION 4HE-INNESOTA#HAMBEROF#OMMERCE 4HE"USINESS0ARTNERSHIP ANDAWIDEVARIETY OF EMPLOYERPROVIDERHEALTH PLANCONSUMER GROUPSv(EALTHPLANSUNDOUBTEDLYHOPETHAT GOVERNMENT ISSUEDPRACTICEDIRECTIVESWILLSERVE ASAPROTECTIVESHIELDAGAINSTMEDICALMALPRAC TICELITIGATION /N-ARCH THE#ITIZENS#OUNCILON (EALTH#ARE##(# HELDAPRESSCONFERENCE TO ANNOUNCE THAT MORE THAN  PHYSICIANS HAD ALREADY SIGNED THE ##(# 0HYSICIAN 0ETITION TO OPPOSE THE LEGISLATION /N !PRIL  2EP-ARK/LSON2 "IG,AKE ATTEMPTED TODELETEhBESTPRACTICESvANDhDISEASEMANAGE MENTvFROM(&(ISAMENDMENTFAILED   4HE-INNESOTALEGISLATUREHASDECIDEDTO MAKEGOVERNMENT PRESCRIBEDhBESTPRACTICESv THE LAW OF THE LAND4HE NEWS MEDIA HAVE REFUSEDTOINFORMTHEPUBLIC(OWPHYSICIANS RESPONDNOWWILLDETERMINETHEINTEGRITYOF MEDICALPRACTICEFORGENERATIONSTOCOMEU 4WILA"RASE 2. 0(. IS0RESIDENTOFTHE#ITI ZENS#OUNCILON(EALTH#ARE A3T0AUL BASED INDEPENDENT FREE MARKET HEALTH CARE POLICY ORGANIZATION4HE 0HYSICIAN 0ETITION IS ONLINE ATHTTPWWWCCHCONLINEORG &OOTNOTES  h%DDY$-#LINICALDECISION MAKINGFROMTHEORYTO PRACTICE0RACTICEPOLICIESnGUIDELINESFORMETHODS *!-!    4ITLE 6 3UBTITLE ! h1UALITY -ANAGEMENT AND )M PROVEMENTv(EALTH3ECURITY!CTND  4HE-EDICARE!CT3 INCLUDES3ENATOR.ORM #OLEMANSh-EDICARE0AYMENTFOR1UALITYAND6ALUE !CTOFv3   h0ATIENT3AFETY!CHIEVINGA.EW3TANDARDFOR#ARE v #OMMITTEEON$ATA3TANDARDSFOR0ATIENT3AFETY )N STITUTEOF-EDICINEOFTHE.ATIONAL!CADEMIES  P  3EAN ,YNCH 2ESEARCH &ELLOW 0ENINSULA -EDICAL 3CHOOL %XETER h%VIDENCE BASED MEDICINE %"- OR PREJUDICED BASED MEDICINE 0"- v "RITISH -EDICAL *OURNAL2APID2ESPONSES ONLINE $ECEMBER  !CCESSED  h0ATIENT3AFETY!CHIEVINGA.EW3TANDARDFOR#ARE v #OMMITTEEON$ATA3TANDARDSFOR0ATIENT3AFETY )N STITUTEOF-EDICINEOFTHE.ATIONAL!CADEMIES  P  'OVERNOR4IM0AWLENTY3TATEOFTHE3TATE!DDRESS P&EBRUARY   "RADLEYFORMLETTEREMAILTOOPPONENTS -ARCHAND !PRIL 

                         

      

                



         

-JGFJTEFNBOEJOHFOPVHI 'JOEJOHUIFCFTUQMBDFUPCSJOHZPVSTLJMMTTIPVMEOUCF "U "MMJOB )PTQJUBMT  $MJOJDT  XF XBOU UP NBLF ZPVS DBSFFS FYQMPSBUJPO FOMJHIUFOJOH BOE FOSJDIJOH5IFHPBMPGPVSEFEJDBUFEBOEQSPGFTTJPOBMTUBGGJTUPBDUBTZPVSDFOUSBMSFTPVSDFÂ&#x2030; GJOEJOHUIFSJHIUGJUGPSZPVBUUIFSJHIUUJNF8FXBOUUPFOTVSFUIBUZPVSQSBDUJDFTUZMF HPBMT BOEDSFEFOUJBMTXJMMCFCFTUNBUDIFEXJUIUIFQPTJUJPOTXFPGGFS TPUIFPQQPSUVOJUZZPVBSFHJWFO JTUIFPOFUIBUXJMMGJUZPV ZPVSGBNJMZBOEZPVSMJGFTUZMF

0VSDPNQSFIFOTJWFTFSWJDFTGPSDBOEJEBUFTXIPBSFJOUFSFTUFEJO"MMJOBJODMVEF t*OEFQUIBOBMZTJTBOEFWBMVBUJPO PGZPVSQSBDUJDFTFBSDIOFFETBOEHPBMT  BMMXJUIJOZPVSUJNFMJOF t*EFOUJGJDBUJPOPGUIFNPTU DPNQBUJCMFQSBDUJDFPQQPSUVOJUJFT t%JTUSJCVUJPOPGZPVS$7UPZPVSDIPTFOTJUFT t*OUFSWJFXTDIFEVMJOHBOEDPPSEJOBUJPO t5SBWFMBOEUSBOTQPSUBUJPOBSSBOHFNFOUT t$PNNVOJUZ DVMUVSBMBOETDIPPMUPVST

t3FMPDBUJPOBTTJTUBODF t*NNJHSBUJPOBTTJTUBODF t-JDFOTJOH DSFEFOUJBMJOHBOE QSJWJMFHJOHQSPDFTTBTTJTUBODF t*OGPSNBUJPOPOFNQMPZNFOU USBJOJOHBOE WPMVOUFFSPQQPSUVOJUJFTGPSGBNJMZNFNCFST t1SPGFTTJPOBMDBSFFSEFWFMPQNFOUUSBJOJOH JODMVEJOH$7QSFQBSBUJPOBOESFWJFX  BOEJOUFSWJFXJOHTUSBUFHJFT

1IZTJDJBO3FDSVJUNFOU4FSWJDFTBU"MMJOB)PTQJUBMT$MJOJDT $BMMVTUPEBZ BOEEJTDPWFSUIF"MMJOBEJGGFSFODF "MMJOB1IZTJDJBO3FDSVJUNFOU4FSWJDFT $JUZ$FOUSF%SJWF 8PPECVSZ ./ 1IPOF'BY &NBJMSFDSVJU!BMMJOBDPN&0&

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES

-AY*UNE




./4%7/24(9

!4RIBUTETO $EMETRE-.ICOLOFF -$ !UGUST n!UGUST  ).!5'534OF THE4WIN#ITIESAREAAND THESTATEOF-INNESOTA MOURNEDTHEPASSINGOF $EMETRE-.ICOLOFF -$ 0H$ATAGE $URINGHIS YEAR TENURE HESERVEDINBOTH THEACADEMICANDPRIVATE PRACTICEOFCARDIOVASCULARANDTHORACICSURGERY GARNERINGAREPUTATIONAS-INNESOTASPREMIER CARDIOVASCULARSURGEON(ETHRIVEDASABUSI NESSMANANDINVENTOR SERVEDHUMANITYWITH MANYVOLUNTEERACTIVITIESANDINVENTEDNUMER OUSDEVICESTOIMPROVETHEHUMANCONDITION !FAMILYMAN $R.ICOLOFFKNOWNBY ALLAS.IC WASMARRIEDFORYEARSTOHIS WIFE !RDE SHARINGAMUTUALLYSUPPORTIVEAND LOVINGRELATIONSHIPRAISINGTHREECHILDREN !LEX 3TEPHANIEAND-ARK !SAPHYSICIAN $R.ICOLOFFPERFORMED OVER OPEN HEARTSURGICALPROCEDURESON PATIENTSRANGINGINAGEFROMONEDAYTOOVER YEARS(EWASAMASTEROFBOTHCONGENITAL ANDACQUIREDCARDIACDISEASE(EALWAYSMADE TIMEANDWASNEVERTOOBUSYTOCAREFORA PATIENT"ECAUSEOFHISCARINGATTITUDEANDHIS ABILITYTOLISTEN MANYOFHISPATIENTSBECAME MORETHANPROFESSIONALACQUAINTANCESFOLLOWING THEIRSURGICALINTERVENTION(ESERVEDASTHE FOUNDERANDLEADEROFASURGICALPRACTICETHAT BECAMEONEOFTHELARGESTINTHECOUNTRYAND SETTHETONEFORQUALITYOFCAREANDINTELLECTUAL CURIOSITY(EWASAFOUNDINGPARTNEROFTHE 3T0AUL(EARTAND,UNG)NSTITUTEANDTHE -INNEAPOLIS(EART)NSTITUTEORGANIZATIONSTHAT EPITOMIZEQUALITYCARDIACCARE !SATHINKER HISABILITYTODISSECTA PROBLEM ELIMINATENONESSENTIALELEMENTSAND FOCUSONTHECOREISSUETOCREATEASOLUTIONWAS LEGENDARY4HISABILITYNOTONLYEXTENDEDTO SOLVINGACADEMICPROBLEMS BUTALSOTOSOLVING PROBLEMSOFDIAGNOSTICSANDTHERAPEUTICSINTHE COURSEOFTHETREATMENTOFHISPATIENTS DEALING WITHBUSINESSANDETHICALISSUESINTHEMOST UP HANDEDFASHION ANDCREATINGNEWIDEAS FORMEDICALDEVICESOROPERATIVEPROCEDURES (ISLEADERSHIPSKILLSWERESOUGHTBYMANYIN HISVARIEDINTERESTSOFMEDICINE BUSINESSAND ADMINISTRATION SERVINGINTHEMANAGEMENT ANDBOARDSOFDIRECTORSOFMEDICALINSTITUTIONS PUBLICCORPORATIONSANDNON PROlTCHARITABLE ORGANIZATIONS

-AY*UNE

!SANINVENTOR $R.ICOLOFFSACCOMPLISH MENTSHADGLOBALIMPACT(EWASCO INVENTOR OFTHE3T*UDE-EDICALHEARTVALVE WHICHHAS SETTHESTANDARDFORARTIlCIALHEARTVALVESAND HASBEENIMPLANTEDINOVER  PATIENTS OVERNEARLYYEARS(EDESIGNEDTHEPERMA mOWGRAFTRESEARCHEDTHROUGH0OSSIS-EDICAL #ORPORATIONTOPROVIDENEWCARDIACCIRCULATION INELIGIBLEPATIENTS(ESERVED DESIGNEDAND FOSTEREDTHEDEVELOPMENTOFMULTIPLESURGICAL PROCEDURESANDPUBLISHEDOVERMANUSCRIPTS INTHEMEDICALLITERATUREASWELLASTWOFULLTEXTS !SABUSINESSMAN $R.ICOLOFFSERVED ONTHEBOARDOFDIRECTORSOFRESEARCHADVISORY BOARDSFORNUMEROUSCORPORATIONS DIRECTING THEIRBUSINESSTOTHEBETTERMENTOFHISPATIENTS DESIGNINGANDIMPROVINGMEDICALDEVICES CONDUCTINGMEDICALRESEARCH ORDRIVINGTHE ACCEPTANCEOFMEDICALDEVICESANDPROCEDURES TOIMPROVEPATIENTCARE(EWASACO FOUNDER OFSEVERALPROMINENT-INNESOTACORPORATIONS INCLUDING3T*UDE-EDICALAND!43-EDICAL DIRECTEDANEQUITIESMUTUALFUND ANDSERVEDAS ADIRECTOROFOTHERINVESTMENTFUNDS !SAHUMANITARIAN $R.ICOLOFFPLAYEDA ROLEINOUTREACHININTERNATIONALAIDPROGRAMS (ECONTRIBUTEDTOMEDICALRESEARCHANDSERVED ASPRESIDENTFORMANYLOCALANDREGIONAL SOCIETIESINCLUDINGTHE-INNESOTA!CADEMY OF-EDICINE !MERICAN(EART!SSOCIATION -INNESOTA!FlLIATE THE-INNEAPOLIS3URGICAL 3OCIETYANDTHE3T0AUL3URGICAL3OCIETY(E LEDFOURMEDICALMISSIONSTO#HINA BRINGINGA SURGICALTEAMANDSUPPLIESTOCORRECTCONGENITAL HEARTDEFECTSINCHILDRENANDWASASUPPORTEROF OTHERMISSIONSTHROUGH#HILDRENS(EART,INK ASWELLASBEINGCHAIRPERSONOFTHE#HILDRENS (EART,INKORGANIZATION 7EHAVELOSTASPECIALPERSONTHISYEAR 6ERYFEWMENOFSUCHCHARACTERANDVITALITYARE FOUND ANDFORTHOSEOFUSWHOKNEWHIM WE AREGRATEFULFORTHISOPPORTUNITY7EARELEFT WITHHISLEGACYINOURCOMMUNITY INSPIREDBY HISTEACHINGOFEXCELLENTSURGICALTECHNIQUE CREATIVETHINKINGANDTHEAPPLICATIONOFNEW SURGICALTECHNIQUESANDTECHNOLOGYTOTHEBET TERMENTOFOURPATIENTS $R.ICOLOFFWASAMEMBEROFTHE-IN NESOTA-EDICAL!SSOCIATIONANDTHE2AMSEY -EDICAL3OCIETYU 7RITTENBY2OBERT7%MERY *R -$ #ARDIAC 3URGICAL!SSOCIATES

0AWLENTY!PPOINTS4HREETO "OARDOF-EDICAL0RACTICE 'OVERNOR4IM0AWLENTYRECENTLYANNOUNCED THEAPPOINTMENTOF$RS2EBECCA*(AFNER FAMILYPHYSICIAN !VON"RADLEY3*OHNSON FAMILYPHYSICIAN 7OODBURYAND%RNEST7 ,AMPE )) GENERALSURGEON -ANKATO TOTHE "OARDOF-EDICAL0RACTICE 4HE"OARDOF-EDICAL0RACTICEISRESPON SIBLEFORLICENSINGANDDISCIPLININGPHYSICIANS ASWELLASTHEREGULATIONOFACUPUNCTURISTS ATHLETICTRAINERS PHYSICIANASSISTANTS AND RESPIRATORYCAREPRACTITIONERS4HEBOARDIS MADEUPOFMEMBERSAPPOINTEDBYTHE 'OVERNORU 'OT4IX (AVEYOUEVER FOUNDYOURSELF WITHTICKETSTOAGAME CONCERT ORTHEATER PERFORMANCETHATYOUCOULDNTUSE.OBODY LIKESTOLETTHOSEEXPERIENCESGOTOWASTE .OW THEREISANEASYWAYFORYOUTOMAKE GOODUSEOFTHOSETICKETSWHILEMAKINGA WORTHWHILECONTRIBUTIONTOTHECOMMUNITY 4IXFOR4OTSISA3T0AUL BASEDNONPROlT ORGANIZATIONTHATGETSUNUSEDTICKETSTOCHIL DRENINNEEDINTHE4WIN#ITIESAREA9OUR CONTRIBUTIONCANENABLEADISADVANTAGED CHILDTOMARVELATTHE-ETRODOME MEET 'OLDY'OPHER ORDELIGHTINTHEMAGICAND WONDEROFTHETHEATER 4HEPROCESSISSIMPLE9OUCANMAIL YOURTICKETSTO4IXFOR4OTSAT0/"OX 3T0AUL -.)TISPREFERREDTHAT TICKETSARRIVESEVENDAYSPRIORTOTHEEVENT BUTTICKETSAREWELCOMETOBERECEIVEDASLATE ASTHEDAYPRIORTOTHEEVENT4IXFOR4OTSWILL PLACEYOUREVENTTICKETSWITHONEOFMORE THANPARTNERORGANIZATIONSSERVINGNEEDY CHILDRENINTHE4WIN#ITIESCOMMUNITY9OU WILLRECEIVEARECEIPTOFYOURTAX DEDUCTIBLE CONTRIBUTIONINTHEMAIL-OREIMPORTANTLY YOUWILLGIVETHEOPPORTUNITYTOEXPERIENCE NEWWORLDSTOCHILDRENWHOMAYOTHERWISE NEVERGETTHECHANCE&ORMOREINFORMATION VISITWWWTIXFORTOTSORGU

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES


6OLUNTEERS.EEDEDFOR 0ROJECT#52% !SPARTOFITSCOMMUNITYLEADERSHIPPROJECT ASEVEN MEMBERTEAMFROMTHE3AINT0AUL !REA#HAMBEROF#OMMERCES,EADERSHIP 3AINT0AULPROGRAMWILLBEASSISTINGINTHE LAUNCHOF0ROJECT#52%S4WIN#ITIES OPERATIONS0ROJECT#52%ISTHEREGIS TEREDTRADEMARKOFTHE"ENEVOLENT(EALTH CARE&OUNDATION AC  NON PROlT HUMANITARIANRELIEFORGANIZATIONTHATCOLLECTS MEDICALSURPLUSANDDONATESITTODEVELOP INGCOUNTRIES3INCE 0ROJECT#52% HASDELIVEREDDONATEDMEDICALSUPPLIESAND EQUIPMENTTOTHEMOSTDESPERATELYILLAND NEEDYPEOPLELIVINGINMORETHANCOUN TRIESAROUNDTHEWORLD0ROJECT#52%IS CURRENTLYTHEWORLDSLARGESTDISTRIBUTOROF DONATEDMEDICALSUPPLIESANDEQUIPMENT 0ROJECT#52%)NTERNATIONAL(EADQUARTERS OFlCEISIN#ENTENNIAL #OLORADO#OLLEC TIONAND$ISTRIBUTION#ENTERSARELOCATED IN$ENVER #/(OUSTON 48,OS!NGELES #!.ASHVILLE 4.0HOENIX !:,ONDON 5+ANDNOW-INNEAPOLIS3T0AUL -. 4HISYEAR 0ROJECT#52%ANTICIPATES DELIVERINGMORETHANCARGOCONTAIN ERSVALUEDATMORETHANMILLIONTO THEWORLDSMOSTNEEDYPEOPLE/NEDAY ONEHOSPITAL ONEPATIENTATATIME 0ROJECT #52%ISCHANGINGTHEWORLD

'LOBAL(EALTH-INISTRIES 'LOBAL(EALTH-INISTRIESHASAYEAR HISTORYOFSUPPORTFORHEALTHCAREPROGRAMS OFTHE,UTHERAN#HURCHESINDEVELOP INGCOUNTRIESTHROUGHSHIPPINGOFNEEDED MEDICALSUPPLIESANDEQUIPMENT FUNDINGOF PROJECTSANDRECRUITMENTOFNEEDEDPERSON NEL0RESENTLYTHEREAREPARTNERSINMORE THANCOUNTRIES)NRESPONSETOGROWING DEMANDINRECENTYEARS THEORGANIZATIONHAS DOUBLEDTHENUMBEROFSHIPMENTSINSUPPORT OFHOSPITALSANDCLINICSINCOUNTRIESSUCHAS ,IBERIA 4ANZANIA )NDONESIA -ADAGASCAR 0APUA.EW'UINEA 4HAILAND #AMEROON AND"ANGLADESH)NADDITION 'LOBAL(EALTH -INISTRIESWILLFUNDPROJECTSTHISYEAR TOTALINGNEARLY INASSISTANCETO SUSTAINSERVICESTOTHEPOORANDSTRATEGICALLY ENHANCETHECAPACITIESOFHEALTHCARESYSTEMS %ACHSHIPMENTFROM'LOBAL(EALTH -INISTRIESISBASEDONACOMPREHENSIVE ASSESSMENTOFSUPPLIESANDEQUIPMENT NEEDEDTOSUSTAINHEALTHCAREDELIVERYANDTO ENHANCETHELEVELOFCARE4HEDONATEDSUP PLIESSAVETHEPARTNERSCONSIDERABLEEXPENSE

6OLUNTEERS.EEDEDINTHE4WIN#ITIES 0ROJECT#52%VOLUNTEERSÂ&#x2C6;MORETHAN  INTOTALÂ&#x2C6;ARECRITICALTOEVERYSTEPOF THEPROCESS!SORTINGDISTRIBUTIONCEN TERIN3T0AULHASBEENOPENEDANDSEEKS INDIVIDUALSANDGROUPSOFALLAGESANDLEVELS OFEXPERIENCETOSERVEASVOLUNTEERS!LSO 0ROJECT#52%SEEKSTOlLLSEVERALVOLUN TEERMANAGERIALPOSITIONSINTHEFOLLOWING AREASFUNDRAISING VOLUNTEERCOORDINATION DEVELOPMENT PROCUREMENT WAREHOUSING TRANSPORTATION ANDOPERATIONS &ORMOREINFORMATIONABOUT0ROJECT #52% VISITWWWPROJECTCUREORGOR TOINQUIREABOUTVOLUNTEEROPPORTUNI TIES PLEASECONTACT2ICHARD"RUNKOWAT RICHARD PROJECTCUREORGOR  U

-ETRO$OCTORS4HE*OURNALOFTHE(ENNEPINAND2AMSEY-EDICAL3OCIETIES



-AY*UNE

2004mayjune  

In This Issue • An Orthopedic Odyssey • Tanzanian Health Care • Advocating for Children • Minnesota Health Access Survey May/June 2004

Read more
Read more
Similar to
Popular now
Just for you