Consumer-Driven Health Care: The Changing Role of the Patient

Studies | Health

No. 276
Tuesday, May 10, 2005
by Devon M. Herrick, Ph.D.


Notes

  1. Regina E. Herzlinger, ed., Consumer-Driven Health Care: Implications for Providers, Payers, and Policymakers (San Francisco, Calif.: Jossey-Bass, 2002), page xvii.
  2. The Rand Health Insurance Experiment tested this theory extensively. See Joseph page Newhouse, Free for All?: Lessons from the Rand Health Insurance Experiment (Cambridge Mass: Harvard University Press, January 1994).
  3. Katharine Levit, et al., “Trends in U.S. Health Care Spending, 2001,” Health Affairs, Vol. 22, No.1, January/February 2003, pages 154-164.
  4. Don R. Powell, “Implementing a Medical Self-Care Program,” Employee Benefits Journal (International Foundation of Employee Benefit Programs), September 2003.
  5. Gina Kolata, “Annual Physical Checkup May Be an Empty Ritual,” New York Times, August 12, 2003.
  6. See Occupational Health Management, “Self-Care Can Save Millions in Health Costs: Unnecessary Visits to ED, other Costs Avoided,” Occupational Health Management, November 2001.
  7. John C. Goodman, “Health Savings Accounts will Revolutionize American Health Care,” National Center for Policy Analysis, Brief Analysis No. 464, January 15, 2004.
  8. Cristiano Antonelli, Aldo Geuna and W. Edward Steinmueller, “Information and Communication Technologies and the Production, Distribution and Use of Knowledge,” International Journal of Technology Management, Vol. 20, No. 1/2, 2000, pages 72-94.
  9. Susannah Fox and Deborah Fallows, “Internet Health Resources,” Pew Internet and American Life Project, July 16, 2003.
  10. In 1999, Bob Pringle, president of health content provider Inteli-health, estimated 15,000 to 20,000 Web sites dedicated to health-related content. See Robert McGarvey, “Online Health’s Plague of Riches,” The Tech Insider, September 29, 1999. The Internet Healthcare Coalition claims more than 20,000 Web sites dedicated to health care. See “Tips for Healthy Surfing Online,” Internet Healthcare Coalition, 2002. This is consistent with estimates from the Journal of Medical Internet Research. See Roberto J. Rodrigues, “Ethical and Legal Issues in Interactive Health Communications: A Call for International Cooperation,” Journal of Medical Internet Research, Vol. 2, No. 1, 2001.
  11. Mary Chris Jaklevic, “Medical Data Accessible on Internet,” Modern Healthcare, Vol. 26, No. 19, May 2, 1996, page 82.
  12. Joseph A. Diaz, Rebecca A. Griffith, James J. Ng, Steven E. Reinert, Peter D. Friedmann, and Anne W. Moulton, ”Patients’ Use of the Internet for Medical Information,” Journal of General Internal Medicine, Vol. 17, No. 3, March 2002, pages 180-85.
  13. Joel S. Weissman et al., “Patient Encounters Involving Direct-To-Consumer Advertising,” Health Affairs, Web Exclusive, April 28, 2004.
  14. Meredith B. Rosenthal et al., “Promotion of Prescription Drugs to Consumers,” New England Journal of Medicine, Vol. 346, No. 7, February 14, 2002, pages 498-505.
  15. Alan F Holmer (Pharmaceutical Research & Manufacturers of America), “Pharmaceutical Careers in the USA,” Available online at www.medical-colleges.net/pharmaceutical4.htm. Access verified on February 23, 2005.
  16. Due to many of the advances in treatment of heart disease mentioned in the text, the age-adjusted death rate from heart disease has fallen by 56 percent since 1956. Death rates from stroke have fallen by 70 percent since 1950. See Centers for Disease Control and Prevention, “Achievements in Public Health, 1900-1999: Decline in Deaths from Heart Disease and Stroke -- United States, 1900-1999, Morbidity and Mortality Weekly Report, Vol. 48, No. 30, August 6, 1999, pages 649-656. For a history of advances in treating heart disease, see David M. Cutler, Your Money or Your Life: Strong Medicine for America’s Health Care System (New York: Oxford University Press, 2004).
  17. The American Heart Association has a wealth of information available to patients and practitioners alike on its Web site www.AmericanHeart.org.
  18. Pharmaceutical Research and Manufacturers of America, “Two Decades of Progress in Heart Disease Medicines Improving Cardiovascular Health,” Press Release, February 03, 2005.
  19. Grace L. Johnson and Arkalgod Ramaprasad, “Patient-Physician Relationships in the Information Age,” Marketing Health Services Vol. 20, No. 1, Spring 2000, pages 20-27. Also see Ben S. Gerber and Arnold R. Eiser, “The Patient-Physician Relationship in the Internet Age: Future Prospects and the Research Agenda,” Journal of Medical Internet Research, Vol. 3, No. 2, 2001.
  20. Johnson and Ramaprasad, “Patient-Physician Relationships in the Information Age,” pages 20-27.
  21. Ruth Larson, “Medical Advances Can Outpace Doctors; Retraining Not Enforced, Critics Say,” Washington Times, March 21, 1999.
  22. Physicians admitted to the board prior to a certain date are grandfathered in and exempt from periodic examination. See Sandra G. Boodman, “Study: Veteran Doctors Not Staying Current,” Washington Post, February 22, 2005, page HE01.
  23. Kimberly S. H. Yarnall, et al., “Primary Care: Is There Enough Time for Prevention?” American Journal of Public Health, Vol. 93, No. 4, April 2003. For the latest report on preventative screen guidelines see U.S. Preventive Services Task Force, “Guide to Clinical Preventive Services, 3rd Edition: Periodic Updates,” Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Report of the U.S. Preventive Services Task Force, October 2002. Available online at http://www.ahrq.gov/clinic/gcpspu.htm.
  24. Sally Trude, “So Much to Do, So Little Time: Physician Capacity Constraints, 1997-2001,” Center for Studying Health System Change, Tracking Report No. 8, May 2003.
  25. Kevin Patterson, “What Doctors Don’t Know (Almost Everything),” New York Times Magazine, May 5, 2002, pages 74-77.
  26. For examination of the literature on doctor-patient communication, see Ronald M. Epstein, Brian S. Alper and Timothy E. Quill, “Communicating Evidence for Participatory Decision Making,” Journal of the American Medical Association, Vol. 291, No. 19, May 19, 2004.
  27. K. Binns and Q. Homan, “Consumers Demand Personalized Services to Manage Their Health,” ADVANCE for Health Information Executives, Vol. 5, 2001, page 88.
  28. See Ronald M. Epstein, Brian S. Alper and Timothy E. Quill, “Communicating Evidence for Participatory Decision Making,” Journal of the American Medical Association, Vol. 291, No. 19, May 19, 2004.
  29. Robert J. Blendon, et al., “Views of Practicing Physicians and the Public on Medical Errors,” New England Journal of Medicine, Vol. 347, No. 24, December 12, 2002, pages 1933-40.
  30. For a discussion, see James G. Anderson, “How the Internet Is Transforming the Physician-Patient Relationship,” Medscape TechMed eJournal, Vol.1, No. 3, 2001.
  31. See Barbara Starfield, “Is Primary Care Essential?” Lancet 344, No. 8930, October 22, 1994, pages 1129-33.
  32. Matthew K. Wynia, et al., “Do Physicians Not Offer Useful Services Because Of Coverage Restrictions?” Health Affairs, Vol. 22, No. 4, July/August 2003, pages 190-197.
  33. Alain Enthoven and Sara J. Singer, “The Managed Care Backlash and the Task Force in California,” Health Affairs, Vol. 17, No. 4, July/August 1998, pages 95-110. Also see Robert J. Blendon, et al., “Understanding the Managed Care Backlash,” Health Affairs, Vol. 17, No. 4, July/August 1998, pages 80-94.
  34. Kimberly Blanton, “Putting a Premium on Healthy Behavior,” Boston Globe, February 17, 2005.
  35. “Employer Health Benefits 2004 Annual Survey,” The Kaiser Family Foundation and the Health Research and Educational Trust, September 9, 2004.
  36. “U.S. Health Benefit Costs Rises 7.5% in 2004, Lowest Increase in Five Years,” Mercer Human Resource Consulting, Press Release, November 22, 2004.
  37. Ibid.
  38. Ken Terry, “Tame Your Health Insurance Costs: Here are Some Practical Ways to Cut Your Premiums and Help your Employees Pay Theirs. But Don’t Expect Rates to Level Off Anytime Soon,” Medical Economics, February 4, 2005.
  39. “Healthcare Coverage; Insurance Company Launches New Health Plans and Health Savings Accounts,” Managed Care Weekly Digest, February 28, 2005.
  40. Jon R. Gabel, Anthony T. Lo Sasso, and Thomas Rice, “Consumer-Driven Health Plans: Are They More Than Talk Now?” Health Affairs, Web Exclusive, November 20, 2002.
  41. “Growth of HSAs, HDPHs Could Translate to Shrinking Health-Plan Revenues, Report Says,” Inside Consumer-Directed Care,” Vol. 3, No. 6, March 18, 2005.
  42. This section is based on John C. Goodman, “Health Savings Accounts Will Revolutionize American Health Care,” National Center for Policy Analysis, Brief Analysis No. 464, January 15, 2004.
  43. Revenue Procedure 2004-71, Internal Revenue Service, U.S. Department of the Treasury, November 19, 2004.
  44. For a comprehensive guide to how HSAs work, see Dan Perrin, “HSA Road Rules: for Consumers, Employers, Insurers, Banks, Credit Unions and Administrators,” The HSA Coalition, December 7, 2004. Available online at http://www.hsainsider.com/HSA%20Road%20Rules%20Dec%207th.pdf.
  45. This section is based on Michael F. Cannon, “Three Avenues to Patient Power,” National Center for Policy Analysis, Brief Analysis No. 430, January 30, 2003.
  46. Devon M. Herrick, “The Internet and Non-Profit Disease Advocacy: An Empirical Analysis,” Ph.D. dissertation, University of Texas at Dallas, 2003, unpublished.
  47. Joan Stephenson, National Library of Medicine to Help Consumers Use Online Health Data, The Journal of the American Medical Association, Vol. 283, No. 13, April 15, 2000, pages 1675-76.
  48. Leslie Miller, “Guidelines Offer Cures for Web Confusion,” USA TODAY, July 15, 1999.
  49. Susan J. Landers, “Rx Isn’t Just Medication Anymore,” American Medical News, May 24/31, 2004.
  50. For more information, see the Center for Information Therapy, Web site www.informationtherapy.org.
  51. Susan J. Landers, “Web Sites Can Give Patients Info They Need for Decisions,” American Medical News, January 26, 2004. For more information on shared decision making, see Peter Briss, et al. (Task Force on Community Preventive Services), “Promoting Informed Decisions about Cancer Screening in Communities and Healthcare Systems,” American Journal of Preventive Medicine, Vol. 26, No. 1, January 2004, pages 67-80; Stacey L. Sheridan, et al., “Shared Decision Making about Screening and Chemoprevention: A Suggested Approach from the U.S. Preventive Services Task Force,” American Journal of Preventive Medicine, Vol. 26, No. 1, January 2004, pages 56-66; Robert M. Kaplan (Editorial), “Shared Medical Decision Making: A New Tool for Preventive Medicine,” American Journal of Preventive Medicine, Vol. 26, No. 1, January 2004, pages 81-83.
  52. Based on a poll of 1,001 people taken by Harris Interactive between May 26, 2000, and June 10, 2000. For data on what they are seeking, see “ Evolution of Internet Use for Health Purposes - Feb/Mar 2001,” Health on the Net Foundation.
  53. “Patients Want Online Communication With Their Doctors,” Medscape Medical News, April 17, 2002 and “Patient/Physician Online Communication: Many Patients Want it, Would Pay for it, and it Would Influence their Choice of Doctors and Health Plans, Harris Interactive Healthcare News, Vol. 2, No.8, April 10, 2002.
  54. Sandra G. Boodman, “Calling Doctor Dappen,” Washington Post, September 9, 2003. Also see Mike Norbut, “Doctor Redefines Visits with Phone, E-mail,” American Medical News, October 20, 2003.
  55. Of the 14 percent who reported e-mail exchanges with their physician, 12.7 percent said it was occasional. Slightly less than 37 percent of physicians report e-mail contact with patients “occasionally” and about 8 percent report e-mail contact frequently. See data from “Evolution of Internet Use for Health Purposes - Feb/Mar 2001,” Health on the Net Foundation.
  56. Christine Wiebe, “Doctors Still Slow to Adopt Email Communication,” Medscape Money & Medicine, Vol. 2, No. 2, 2001.
  57. Milt Freudenheim, “Digital Rx: Take Two Aspirins and E-Mail Me in the Morning,” New York Times, March 2, 2005.
  58. Ibid.
  59. David Koenig (Associated Press), “A Few Doctors Seeing Patients Online,” Akron Beacon Journal (Ohio.com), December 21, 2003.
  60. A billing code is a standardized charge facilitating reimbursement for physician services and payment by insurers or patients. These codes are used for record-keeping purposes as well. For instance, the billing code (and the amount paid) for a physician e-mail exchange would be different than the code for an in-person office visit. See David Koenig (Associated Press), “A Few Doctors Seeing Patients Online,” Akron Beacon Journal (Ohio.com), December 21, 2003.
  61. Warner V. Slack, “A 67-Year-Old Man Who e-Mails His Physician,” Journal of the American Medical Association, Vol. 292, No. 18, November 10, 2004, pages 2255-2261.
  62. Mike Norbut, “Doctor Redefines Visits with Phone, E-mail,” American Medical News, October 20, 2003.
  63. For a discussion, see Michael Johnsen, “Swifter Rx-to-OTC Switches are Hot Topic at CHPA Meeting,” Drug Store News, Dec 16, 2002.
  64. For a discussion of in-home diagnostic laboratory tests in layman’s terminology, see Sarah Tippit, “Home Medical Tests,” Better Homes & Gardens, January 1997.
  65. Pan Demetrakakes, “Health Kit Packaging Helps Consumers Feel at Home with Self-Care: Packaging for Home Health Monitoring Devices Combines Health-Care Concerns with Appeal to both Consumers and Retailers,” Food & Drug Packaging, February 2003.
  66. Price and availability confirmed August 8, 2004 at “Always 1 Dollar Store,” Mesquite, Texas.
  67. Charlotte LoBuono, “Taking Advantage of Home Testing and Monitoring,” Patient Care, February 15, 2000.
  68. Maureen Donohue, “OTC Home Kits Provide New Diagnostic Options,” Family Practice News, February 15, 2001.
  69. W. Fred Miser, “To Treat or not to Treat Otitis Media — that’s just one of the Questions,” Journal of the American Board of Family Practice. Vol. 14, No. 6, 2001, pages 474-476.
  70. Tom Ferguson, “Ear Infection Detector,” Whole Earth, Winter 2002.
  71. Tom Ferguson, “Home Strep Test Kit,” Whole Earth, Winter 2002.
  72. Doug Brunk, “FDA Approves Home Test Kit for Menopause: Experts Question its Value,” OB/GYN News, January 15, 2002. Also see Mary Duenwald, “Over-the-Counter Menopause Test Kits Offer Few Answers,” New York Times, August 17, 2004.
  73. Ann Donahue, “Firm Unveils Device that Tests Blood,” Los Angeles Business Journal, January 3, 2000.
  74. Wilson, Kevin, “Online Access to Test Results for Doctors and Patients,” MLO: Medical Laboratory Observer, Vol. 32, No. 3, March 2000, page 8.
  75. Information obtained from the HS Labs Web site www.BloodWorksUSA.com.
  76. Information obtained from the Direct Laboratory Services, Inc. Web site www.DirectLabs.com.
  77. Anne Harding, “Do it Yourself Cancer Gene Testing Raises Concerns,” British Medical Journal, Vol. 330, No. 7492, March 19, 2005, page 617.
  78. John J. Paris, “Ethical Issues in Cybermedicine: Patent-Medicine Salesmen did not go out of Style with the Conestoga Wagon,” America, Vol. 184, No. 4, February 23, 2001, pages 15-24.
  79. For a discussion of patient attitudes and potential risks, see Lisa M. Schwartz et al., “Enthusiasm for Cancer Screening in the United States,” Journal of the American Medical Association, Vol. 291, No. 1, January 7, 2004, pages 71-78.
  80. Susan J. Landers, “Full-body Scans: Buying Peace of Mind,” American Medical News, September 3, 2001.
  81. Roger Jones, “Self Care” British Medical Journal Vol. 320, No. 7235, March 4, 2000, page 596.
  82. Roger Jones and D Murfin, ed. Gastrointestinal Problems in General Practice (Oxford: OUP, 1993).
  83. Ted R. Tyson, “The Internet: Tomorrow’s Portal to Non-Traditional Health Care Services,” Journal of Ambulatory Care Management, Vol. 23, No. 2, April 2000, pages 1-7.
  84. “Fact Sheet: The Use of Over-the-Counter Medicines,” National Council on Patient Information and Education, January 2002.
  85. Simon Rottenberg, “Unintended Consequences: The Probable Effects of Mandated Medical Insurance,” Regulation, Vol. 13, No. 2, Summer 1990, pages 27-28.
  86. Nancy K. Lowe and Nancy M. Ryan-Wenger, “Over-the-Counter Medications and Self-Care,” Nurse Practitioner, December 1999. See, “Ingredients & Dosages Transferred From Rx-to-OTC Status (or New OTC Approvals) by the Food and Drug Administration Since 1975,” Consumer Healthcare Products Association, July 2003. Available online at http://www.chpa-info.org/web/advocacy/general_issues/switch/switch_list.pdf.
  87. Ibid.
  88. Sandra Levy, “Health Plans Pleased with Allergy Drug’s OTC Switch,” Drug Topics, December 16, 2002.
  89. FDAnews, “OTC Claritin to Hit Markets by Mid-December,” FDAnews Daily Bulletin, FDAnews.com, December 3, 2002.
  90. Chemical Market Reporter, “Claritin Receives OTC Status, Chemical Market Reporter, December 2, 2002.
  91. Time period for sales of antihistamines was September 2001 to September 2002. See Michael Johnsen, “Redefined Rx-to-OTC Switch Model May Reshape Sales Landscape,” Drug Store News, January 20, 2003.
  92. “OTC Prilosec One Step Closer in US,” Pharmafocus News, June 26, 2002; “Prilosec OTC Launch Delayed, Pharmafocus News, November 4, 2002.
  93. “At-Home Defibrillator in Stores Soon,” WebMD Medical News, November 13, 2002. Also see Daniel DeNoon, “FDA Panel OKs No-Prescription Sales of Home Defibrillator,” WebMD Medical News, August 6, 2004.
  94. Associated Press, “FDA Approves Defibrillator for At-Home Use,” USA Today, November 11, 2002. The discounted price at Drugstore.com was $1,495 in 2005.
  95. Devon Herrick, “Shopping for Drugs: 2004, National Center for Policy Analysis, NCPA Policy Report No. 270, October 11, 2004.
  96. Gerard Anderson et al., “Chronic Conditions: Making the Case for Ongoing Care,” Partnership for Solutions (The Robert Wood Johnson Foundation and Johns Hopkins University), September 2004. Available online at http://www.partnershipforsolutions.com/DMS/files/chronicbook2004.pdf.
  97. Benjamin Druss et al., “Comparing the National Economic Burden of Five Chronic Conditions,” Health Affairs, Vol. 20, No. 6, November/December 2001, pages 233-241.
  98. “Heart Disease and Stroke Statistics — 2005 Update,” American Heart Association, 2005.
  99. David M. Cutler, Your Money or Your Life: Strong Medicine for America’s Health Care System (New York: Oxford University Press, 2004).
  100. Randal S. Stafford and David C. Radley, “The Potential of Pill Splitting to Achieve Cost Savings,” American Journal of Managed Care, Vol. 8, No. 8, August 2002, pages 706-12.
  101. “Diuretics Proved to be Superior to other, more Expensive Anti-hypertensive Drugs,” Healthfacts, January 2003.
  102. ALLHAT Collaborative Research Group, “Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT),” Journal of the American Medical Association, Vol. 288, No. 23, December 18, 2002, pages 2981-2997.
  103. Mitchel L. Zoler, “Home HT Monitoring Cuts Office Visits by 27%, “Family Practice News, January 1, 2000.
  104. Philip B. Gorelick, “Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients,” Journal of the American Medical Association, Vol. 289, No. 22, June 11, 2003, pages 2947-2957.
  105. Price comparisons were obtained from DestinationRX.com. A patient taking two (250mg) tablets per day purchased in quantities of 60 tablets per month would spend $63.60 per month at AARP.
  106. American Diabetes Association, “Improved Diabetes Control Yields ‘Zest for Life’,” PRNewswire, June 14, 2000.
  107. “Diabetes Statistics,” U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, NIH Pub. No. 96-3926, 1995.
  108. Patti Bazel Beil and Laura Hieronymus, “Money-Saving Tips: Supplies, Nutrition, and Exercise,” Diabetes Self-Management, March/April 1999.
  109. “Economic and Health Costs of Diabetes,” Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Healthcare Cost and Utilization Project Highlights, No. 1, AHRQ Pub. No. 05-0034, January 2005.
  110. Susan L. Norris, Michael M. Engelgau and K. M. Venkat Narayan, “Effectiveness of Self-Management Training in Type 2 Diabetes,” Diabetes Care, March, 2001.
  111. Teresa Pearson, “Getting the Most From Health-Care Visits,” Diabetes Self-Management, March/April 2001.
  112. “Self-Monitoring of Blood Glucose,” Clinical Diabetes, Winter 2002.
  113. Patti Bazel Beil and Laura Hieronymus, “Money-Saving Tips: Supplies, Nutrition, and Exercise,” Diabetes Self-Management, March/April 1999.
  114. Prices found on www.Froogle.com, www.devinemedical.us and www.walgreens.com.
  115. eBay auction March 14, 2005.
  116. Joe A. Florence and Bryan F. Yeager, “Treatment of Type 2 Diabetes Mellitus,” American Family Physician, Vol. 59, No. 10, May 15, 1999.
  117. For techniques to lower one’s drug bill, see Devon M. Herrick, “Shopping for Drugs: 2004,” National Center for Policy Analysis, NCPA Policy Report No. 270, October 2004.
  118. Patti Bazel Beil and Laura Hieronymus, “Money-Saving Tips: Supplies, Nutrition, and Exercise,” Diabetes Self-Management, March/April 1999.
  119. Tjard R. Schermer, et al., “Randomized Controlled Economic Evaluation of Asthma Self-Management in Primary Health Care,” American Journal of Respiratory and Critical Care Medicine Vol. 166, No. 8, August 2002, pages 1062-1072. For an evaluation of direct medical treatment costs for asthma, see Michael T. Halpern, et al., “Asthma: Resource Use and Costs for Inhaled Corticosteroid vs Leukotriene Modifier Treatment—a Meta-Analysis,” Journal of Family Practice, May 23, 2005.
  120. “Asthma Overview,” Asthma and Allergy Foundations of America, Internet. Available online at http://www.aafa.org/display.cfm?id=8&cont=5.
  121. Li Yan Wang, Yuna Zhong and Lani Wheeler, “Direct and Indirect Costs of Asthma in School-age Children,” Preventing Chronic Disease, Vol. 2, No. 1, January 2005.
  122. Ibid. Implementation costs were mostly incurred in year one and amounted to about $200.
  123. See “Take Control - Q&A to Having a Self Management Plan,” AsthmaAssistant.com. For instance, an asthma self-management plan could stipulate that if a patient’s “peak airflow” falls to 80 percent of their personal best peak airflow, they should increase medications at a pre-established rate and schedule a physician appointment. Patients should go to the emergency room if their peak airflow falls below 50 percent.
  124. For information see http://www.asthmaassistant.com.
  125. Joseph Finkelstein and Manuel R. Cabrera, “Internet-Based Home Asthma Telemonitoring,” Chest (American College of Chest Physicians), Vol. 117, No. 1, January 2000, pages 148-155.
  126. Bruce Jancin, “Warfarin Home Self-Monitoring,” Family Practice News, April 1, 2000.
  127. National Headache Foundation Fact Sheet, January 8, 2003.
  128. The direct medical cost of headaches (including migraines) and absenteeism from headaches is estimated at $50 billion per year. In addition, consumers spend $4 billion per year on over-the-counter pain relievers for headaches. See National Headache Foundation Fact Sheet, January 8, 2003.
  129. “5 Effective Strategies for Migraine Management,” National Headache Foundation, undated. Available online at http://www.headaches.org/consumer/presskit/NHAW04/Five_Steps.pdf.
  130. When combination therapy was taken at the first sign of a migraine headache. See Patrice G.W. Norton, “OTC Product Beats Sumatriptan for Early Migraine: Study of 171 Patients - Clinical Rounds,” OB/GYN News, September 15, 2003.
  131. Nine tablets cost $147 at RxUSA.com for the 25mg, 50mg and 100mg dose.
  132. U.S. National Library of Medicine, Drug Information, Available online at http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601116.html.
  133. See Ben Wheatley, “Medicaid Disease Management: Seeking to Reduce Spending by Promoting Health,” Academy for Health Service Research and Health Policy, State Coverage Initiatives, Issue Brief, August 2001 and Robert E. Mechanic, “Disease Management: A Promising Approach for Health Care Purchasers,” National Health Care Purchasing Institute, May 2002.
  134. For a good discussion of this issue, see Roger Lowenstein, “The Quality Cure,” New York Times, March 13, 2005.
  135. Ben Fireman, Joan Bartlett, and Joe Selby, “Can Disease Management Reduce Health Care Costs by Improving Quality?” Health Affairs, Vol. 23, No. 6, November/December 2004. For a commentary see Francis J. Crosson and Philip Madvig, “Does Population Management of Chronic Disease Lead To Lower Costs Of Care? Health Affairs, Vol. 23, No. 6, November/December 2004.
  136. Roger Lowenstein, “The Quality Cure,” New York Times, March 13, 2005.
  137. Gerard Anderson, “Chronic Conditions: The Cost and Prevalence of Chronic Conditions are Increasing. A Response is Overdue,” National Institute for Health Care Management, Expert Voices, Issue 4, January 2002.
  138. The AMA has come out against prescribing medication over the Internet prior to a physical examination. Richard F. Corlin, President, American Medical Association (Letter to the editor ). “AMA to The Wall Street Journal: Shut Down Illegal Internet Pill Pushers,” The Wall Street Journal, November 6, 2001.
  139. Laws vary by state. Some “cyber docs” skirt the law by rendering only second opinions. For a discussion on e-practice patterns, see Tom Ferguson, “From Doc-Providers to Coach-Consultants: Type 1 vs. Type 2 Provider-Patient Relationships,” The Ferguson Report, Number 7, September 2001.
  140. Mike Norbut, “Doctor Redefines Visits with Phone, E-mail,” American Medical News, October 20, 2003.
  141. Data from survey “Evolution of Internet Use for Health Purposes - Feb/Mar 2001,” Health on the Net Foundation, 2001.
  142. Andrew Pollack, “Who’s Reading Your X-Ray?” New York Times, November 16, 2003. To read more about the benefits of outsourcing, see Douglas Irwin, “Outsourcing is Good for America,” Wall Street Journal, January 28, 2004.
  143. National Center for Health Statistics, cited in “Many Patients Receiving Medication,” USA Today Snapshots, USA Today, January 31 - February 2, 2003.
  144. Frank Lichtenberg, “Benefits and Costs of Newer Drugs: An Update,” National Bureau of Economic Research, Working Paper No. 8996, June 2002.
  145. Devon Herrick, “Patient Power: Access to Drugs,” National Center for Policy Analysis, Brief Analysis No. 500, February 10, 2005.
  146. Devon Herrick, “Shopping for Drugs: 2004,” National Center for Policy Analysis, NCPA Policy Report No. 270, October 11, 2004.
  147. Tufts Center for the Study of Drug Development, “Switching drugs from prescription to OTC status on rise in U.S. and EU,” Impact Report, Tufts Center for the Study of Drug Development, Tufts University, Vol. 5, No. 5, September/October 2003.
  148. Food and Drug Administration, “Over-the-Counter Drug Products; Public Hearing,” Food and Drug Administration, Department of Health and Human Services, (Docket No. 00N-1256) April 26, 2003.
  149. Holly M. Spencer, “The Rx-to-OTC Switch of Claritin, Allegra, and Zyrtec: An Unprecedented FDA Response to Petitioners and the Protection of Public Health,” American University Law Review, Vol. 51, No. 5, June 2002, pages 999-1050.
  150. Tufts Center for the Study of Drug Development, “Switching drugs from prescription to OTC status on rise in U.S. and EU,” Impact Report, Tufts Center for the Study of Drug Development, Tufts University, Vol. 5, No. 5, September/October 2003.
  151. Elizabeth Mechcatie, “FDA Panels Reject Making Low-Dose Statins Available OTC,” Family Practice News, September 1, 2000.
  152. For a discussion of over-the-counter access to Mevacor, see Devon M. Herrick, “Patient Power: Access to Drugs,” National Center for Policy Analysis, Brief Analysis No. 500, February 10, 2005.
  153. Eric J. Topol, “Intensive Statin Therapy — A Sea Change in Cardiovascular Prevention,” New England Journal of Medicine, Vol. 350, No. 15, April 8, 2004, pages 1562-1564; Penny KrisEtherton and T. A. Pearson, “Over-the-Counter Statin Medications: Emerging Opportunities for RDs,” Journal of the American Dietetic Association, October 2000.
  154. Lisa Jarvis, “Rx-OTC Switches Provide Strategy Against Expiry - Over the Counter Drugs,” Chemical Market Reporter, December 4, 2000.
  155. Drug makers think the prospects for an OTC statin are improving. See Associated Press, “Drug Makers Propose OTC Cholesterol Drugs,” Aetna Intelihealth, Health News, (intelihealth.com), May 14, 2004.
  156. Shaoni Bhattacharya, “Heart Wonder Drug goes Over-the-Counter,” New Scientist New Service (NewScientist.com), May 13, 2004.
  157. Rory Collins et al. (Heart Protection Study Collaborative Group), “MRC/BHF Heart Protection Study of Cholesterol Lowering with Simvastatin in 20,536 High-Risk Individuals: A Randomised Placebo-Controlled Trial,” Lancet, Vol. 360, No. 9326, July 6, 2002, pages 7-22.
  158. Over the last 20 years, Europe has switched about four times the number of prescription drugs to OTC status as the United States. See Tufts Center for the Study of Drug Development, “Switching drugs from prescription to OTC status on rise in U.S. and EU,” Impact Report, Tufts Center for the Study of Drug Development, Tufts University, Vol. 5, No. 5, September/October 2003.
  159. Jeffrey M. Drazen, Michael F. Greene and Alastair J.J. Wood, “The FDA, Politics and Plan B,” New England Journal of Medicine, Vol. 350, No. 15, April 8, 2004, pages 1561-1562.
  160. Elizabeth Mechcatie, “Panel Backs OTC Switch for Plan B: Emergency Contraception,” OB/GYN News, January 15, 2005.
  161. Mary Ellen Schneider, “GOP Opposes OTC Status - Policy & Practice,” OB/GYN News, February 15, 2004.
  162. See an argument against OTC access to cholesterol-lowering drugs because consumers are not in a position to self-diagnose and treat high cholesterol, in Sidney Goldstein, “Over-the-Counter Statins?” Family Practice News, September 1, 2000.
  163. A model for this is discussed in Tom Ferguson’s “Looking Ahead: Online Health & the Search for Sustainable Healthcare,”The Ferguson Report, Number 9, September 2002. See alsoKevin Patterson, “What Doctors Don’t Know,” pages 74-77.
  164. John W. Jones, Jr., “Liability for Electronic Medical Communications,” Physician’s News Digest, May 2000.
  165. “Guidelines for Physician-Patient Electronic Communications,” American Medical Association, June 2002. Available online at http://www.ama-assn.org/ama/pub/category/2386.html.
  166. Beverley Kane and Daniel Z. Sands (AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic--Patient Electronic Mail), “Guidelines for the Clinical Use of Electronic Mail with Patients,” Journal of the American Medical Informatics Association, Vol. 5, No. 1, Jan/Feb 1998.

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