Subject: Studies in the News 05-30 (September 8, 2005)


CALIFORNIA RESEARCH BUREAU
CALIFORNIA STATE LIBRARY
Studies in the News
Health Care Supplement


Contents This Week

Introductory Material HEALTH
   Advances in treatment for sickle cell disease
   Halting the spread of HIV
   Memory recovery in Alzheimer's patients
   State agencies can cut medicine costs
   Consolidation of work and non-work healthcare claims
   Creating a global health resource tracking system
   Community health centers
   National healthcare quality report
   Health insurance and low-income families
   Personal health insurance costs
   Private health insurance spending
   Healthcare insurance rules
   Delays in acute treatment
   Industrial exposure to salt
   Physicians fear malpractice awards
   Rising medical malpractice insurance premiums
   Lower number of malpractice claims
   Higher Medicaid co-payments
   Healthcare costs for Medicaid patients
   Opinion poll on Medicaid
   High-cost medicare beneficiaries
   Quality of health care through medicare
   Medicare drug benefit
   Nursing home deficiencies
   Prices for brand name drugs
   Average Medicaid drug rebate
   Smallpox vaccinations
   Characteristics of the uninsured
   Impact of immigration on health insurance coverage
   Declining job-based health coverage
   Millions underinsured
   Higher insurance premiums due to uninsured
   Young adults uninsured
   Regular physician care lacking for many
   Hidden cache of stem cells in bone marrow
PREVIOUSLY IN STUDIES IN THE NEWS
   Studies in the News, July-August 2005
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • California State Employees may contact the State Information & Reference Center (916-654-0206; cslsirc@library.ca.gov) with the SITN issue number and the item number [S#].

  • All other interested individuals should contact their local library - the items may be available there, or may be borrowed by your local library on your behalf.

The following studies are currently on hand:

HEALTH

AFRICAN AMERICANS

"Dysregulated Arginine Metabolism, Hemolysis-Associated Pulmonary Hypertension, and Mortality in Sickle Cell Disease." By Claudia R. Morris and others. IN: JAMA: Journal of the American Medical Assoication, vol. 294, no. 1 (July 6, 2005) pp. 81-90.

["An amino acid deficiency contributes to severity of sickle cell anemia and death.... Over the past several years, scientists have shown that patients with sickle cell anemia often die from pulmonary hypertension -- an incurable lung disease.... This study ... supports the notion that new drugs or nutritional supplements to boost arginine levels could help people with sickle cell anemia live longer."]

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AIDS

Cases of HIV Infection and AIDS in the United States, 2003. By the National Center for HIV, STD, and TB Prevention. (Centers for Disease Control and Prevention, Atlanta, Georgia) March 14, 2005. Various pagings.

Full Text at: www.cdc.gov/hiv/stats/2003SurveillanceReport.htm

["An estimated 1,039,000 to 1,185,000 Americans were living with HIV at the end of 2003.... Forty-seven percent were black ... 67 percent of the black men in the group did not know they were infected before participating in the study.... Providing ... high-risk subgroups with testing and prevention services was a key step to halting the spread of HIV." Reuters (June 13, 2005) 1.]

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ALZHEIMER'S DISEASE

"Tau Suppression in a Neurodegenerative Mouse Model Impoves Memory Function." By K. SantaCruz and others. IN: Science, vol. 309, no. 5733 (July 15, 2005) pp. 476-481.

["A study suggests some memory recovery may be possible in the early stages of Alzheimer's disease.... A mutant protein named tau that is poisoning brain cells and blocking its production may allow some of those affected neurons to recover." Los Angeles Times (July 16, 2005) 1.]

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DRUG PRICES

Pharmaceuticals: State Departments That Purchase Prescription Drugs Can Further Refine Their Cost Savings Strategies. California State Auditor, California Bureau of State Audits. (The Bureau, Sacramento, California.) May 2005. 130 p.

Full Text at: www.bsa.ca.gov/pdfs/reports/2004-033.pdf

["In an audit that examines drug buying practices by three major state agencies, the Department of General Services was praised for securing the lowest upfront prices for medicines compared with the Health Services Department and the California Public Employees' Retirement Systems. However, General Services had the highest state costs for several medications bought by all three agencies after rebates, dispensing fees, co-payment and third-party payments were included.... The state's procurement arm buys medicine for state prison inmates, the institutionalized mentally ill and troubled youths." Sacramento Bee (May 31, 2005) 1.]

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HEALTH CARE

Assessment of 24-Hour Care Options for California. By Donna O. Farley and others, RAND Institute for Civil Justice. (RAND, Santa Monica, California) 2005. 80 p.

Full Text at: www.rand.org/pubs/monographs/2004/RAND_MG280.pdf

["The term 24-hour care refers to the consolidation of health care benefits and, possibly, disability benefits for both work-related and non-work-related claims, so that services are delivered by the same group of providers under a coordinated insurance package."]

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The Challenges of Creating a Global Health Resource Tracking System. By Elisa Eiseman and Donna Fossum, RAND. (RAND, Santa Monica, California) 2005. 141 p.

Full Text at: www.rand.org/pubs/monographs/2005/RAND_MG317.pdf

["This assessment asked the following: 1) What are the purposes and contents of existing health resource tracking systems that focus on developing countries? 2) What are the strenghts and limitations of these systems? 3) What characteristics must a truly global health resource tracking system have in order to meet the needs of potential users and to address the limitations of current system?"]

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Community Health Centers: An Update. By Laura Tobler and Hy Gia Park, National Conference of State Legislatures. NCSL Legisbrief. Vol. 13, No. 1 (NCSL, Denver, Colorado) 2005. 2 p.

["Since the first one opened its doors 40 years ago, community health centers have specialized in providing affordable primary and preventive care services to our nation's poor and underserved people, regardless of insurance status or ability to pay.... This year the White House Office of Management and Budget cited the health center program as one of the 10 most successful federal programs and the most successful one in the U.S. Department of Health and Human Services."]

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State Snapshot 2004: From the National Healthcare Quality Report. By the Agency for Healthcare Research and Quality. (The Agency, Rockville, Maryland) 4 p.

Full Text at: www.qualitytools.ahrq.gov/qualityreport/state/pdf/snap/2004_state_snap_CA.pdf

[Each snapshot shows two areas in which the health care system of a particular state is doing well and two in which it might be able to improve. The examples are chosen from those measures for each state that score above average and below average, respectively, relative to all reporting states."]

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HEALTH INSURANCE

Health Insurance: Can Californians Afford It? By California HealthCare Foundation. (The Foundation, Oakland, California) 2005. 22 p.

Full Text at: www.chcf.org/topics/download.cfm?pg=insurance&fn=HealthInsuranceAffordability%2Epdf&pid=416324&itemid=110807

["How affordable is health insurance for California's businessess and workers? And how well is health insurance providing the financial protection it is supposed to assure? To help answer these questions, this snapshot focuses on two insurance markets -- individual and small business -- where the greatest number of currently uninsured Californian's would get their insurance, if they thought they could afford it."]

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The Most Affordable Cities for Individuals to Buy Health Insurance. By eHealthInsurance. (eHealthInsurance, Mountain View, California) June 28, 2005. 14 p.

[“The Bay Area is among the most affordable places in the country to buy individual health insurance, according to a survey…. San Jose, San Francisco and Oakland tied for fifth place among the 50 largest cities in the country for lowest-cost insurance, with an average premium of $58 a month. Those who buy their own health insurance and are not covered through work are estimated to make up less than 10 percent of the population nationwide. The percentage, however, is greater in some Bay Area counties due to high numbers of independent contractors and people who lost job-based coverage.“ San Francisco Chronicle. (June 23, 2005) 1.]

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"The Rising Prevalence of Treated Disease: Effects on Private Health Insurance Spending." By Kenneth E. Thorpe and others. IN: Health Affairs (June 27, 2005) pp. 317-325.

["To contain spending, the U.S. health care system needs to address rising rates of treated disease instead of requiring higher cost sharing with consumers."]

[Request #S53011]

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Rules Governing California’s Individual Health Insurance Market. By Deborah Reidy Kelch, Kelch Associates Consulting. (California HealthCare Foundation, Oakland, California) April 2005. 11 p.

Full Text at: www.chcf.org/documents/insurance/RulesGoverningCAIndividualInsuranceMarket.pdf

["This issue brief examines the state and federal laws that apply to the individual health insurance market in California. It provides a comprehensive overview of the differences between individual and group coverage and explains the basic rules that apply to individual policies, including treatment for pre-existing conditions, guarantees on renewal, protections for higher-risk individuals who maintain their coverage, and regulations governing the transition from group to individual coverage."]

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HEART DISEASE

"Relationship Between Time of Day, Day of Week, Timeliness of Reperfusion, and In-hospital Mortality for Patients with Acute St-Segment Elevation Myocardial Infarction." By David J. Magid and others. IN: JAMA, vol. 294, no. 7. (August 17, 2005) pp. 803-812.

["Patients treated during off hours had a 7% greater chance of dying in the hospital. Doctors say longer delays can mean more damage to the heart, which increases the odds of a patient developing heart failure.... But the study found that most patients actually had their heart attacks during off hours -- between 5 p.m. and 7 a.m. on weekdays or on weekends -- raising the issue of whether hospitals are set up to meet the needs of heart attack patients.... If angioplasty is used, patients should be treated within 90 minutes, according to national standards. However, the study found the average treatment time was 95 minutes during regular hours and 116 minutes during off hours." Milwaukee Journal Sentinel (August 16, 2005) 1.]

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HIGH BLOOD PRESSURE

"Risk of High Blood Pressure in Salt Workers Working Near Salt Milling Plants: A Cross-sectional and Interventional Study." By Kripa Ram Haldiya1, Desert Medicine Research Centre in Jodhpur, India, and others. IN: Environmental Health (July 25, 2005) [online.]

Full Text at: www.ehjournal.net/content/pdf/1476-069x-4-13.pdf

["The present study provides new data suggesting that inhaling large amounts of salt particles has the same effect as consuming a salty diet and increases blood pressure considerably, thus putting workers in salt factories around the world at risk of high blood pressure. This study represents the first demonstration of an occupational hazard linked to table salt." Science Daily (July 26, 2005) 1.]

[Request #S53014]

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MALPRACTICE

"Effects of the Malpractice Crisis On Access to and Incidence of High-risk Procedures: Evidence from Florida." By David Dranove and Anne Gron. IN: Health Affairs, vol. 24 no.3 (May/June 2005) pp. 802-80.

Full Text at: content.healthaffairs.org/cgi/content/full/24/3/802

["The average malpractice claim payout rose about 4% a year from 1991 to 2003. The increases slowed to less than 2% a year from 2000 to 2003. Physicians and insurers may fear multimillion-dollar jury awards, but the average court judgment in 2003 was $461,000, said Amitabh Chandra, a Dartmouth College economist and one of the authors." Los Angeles Times (June 1, 2005) 1.]

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Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry. By Jay Angoff, Roger Brown & Associates, and others. Prepared for the Center for Justice and Democracy. (The Center, New York, New York) July 2005. 25 p.

Full Text at: www.centerjd.org/ANGOFFReport.pdf

["The rates insurers charge physicians for medical malpractice coverage rose dramatically over the past five years, but the amount insurers paid out in claims did not. The study ... found that malpractice rates increased by 120 percent from 2000 through 2004, while the amount of money paid in claims went up by 5.7 percent." Associated Press (July 7, 2005) 1.]

[Request #S53016]

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Medical Malpractice Law in the United States. By Peter P. Budetti and others. Kaiser Family Foundation. (The Foundation, Santa Monica, California) May 26, 2005. 31 p.

Full Text at: www.kff.org/insurance/upload/53241_1.pdf

["A study [found] that total malpractice payments rose an inflation-adjusted 3.8% a year from 1991 to 2003. The study also found that a slight increase in the number of claims paid through settlements or jury awards from 1991 to 2003 was far outpaced by the growth in the number of practicing physicians. As a result, the average number of malpractice claims per physician fell." Los Angeles Times (June 1, 2005) 1.]

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MEDICAID

The Effect of Increased Cost-Sharing in Medicaid: A Summary of Research Findings. By Leighton Ku, Center on Budget and Policy Priorities. (The Center, Washington, DC) May 31, 2005. 9 p.

Full Text at: www.cbpp.org/5-31-05health2.pdf

["Higher co-payments often force low-income beneficiaries to cut back on essential care. Higher premiums have led to fewer low-income people enrolling in health insurance programs –- and may result in poorer health among vulnerable families." Connect for Kids (June 6, 2005) 1.]

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Out-of-pocket Medical Expenses for Medicaid Beneficiaries are Substantial and Growing. By Leighton Ku and Matthew Broaddus, Center on Budget and Policy Priorities. (The Center, Washington, DC) May 31, 2005. 6 p.

Full Text at: www.cbpp.org/5-31-05health.pdf

["Poor Medicaid Beneficiaries are Paying More Out of Pocket: Medicaid provides low-cost health care coverage to roughly 53 million adults and children, and it’s expensive.... A new study finds that adults in Medicaid spend more than three times as much of their income on health care as middle-class adults with private insurance." Connect for Kids (June 6, 2005) 1.]

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National Survey of the Public’s Views About Medicaid. By the Kaiser Family Foundation. (The Foundation, Menlo Park, California) June 2005. 23 p.

Full Text at: www.kff.org/medicaid/upload/National-Survey-of-the-Public-s-Views-About-Medicaid-Chartpack.pdf

["Public has praise -- and wants protection -- for Medicaid.... While two-thirds of the public think their state has major budget problems, a majority of them are reluctant to cut Medicaid to balance state budgets. Many think the federal government should maintain or increase spending on Medicaid.... In addition, if they needed health care and were eligible, nearly 80 percent Americans would be willing to enroll in Medicaid, despite political party identification." Connect for Kids (August 22, 2005) 1.]

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MEDICARE

High-cost Medicare Beneficiaries. By Congressional Budget Office. (The Office, Washington, DC) May 2005. 24 p.

Full Text at: www.cbo.gov/ftpdocs/63xx/doc6332/05-03-MediSpending.pdf

["Total Medicare spending exceeded $300 billion in 2004 and is expected to grow significantly in the coming decades. In response to those financial pressures, policymakers have considered a number of strategies for slowing the growth of Medicare spending, including increasing the share of spending paid by beneficiaries and enhancing competition in the provision of services. This ... paper ... explores an additional approach: focusing on the small group of beneficiaries that accounts for a large share of the program's spending. Possible intervention strategies would aim to reduce that spending."]

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Quality of Health Care for Medicare Beneficiaries: A Chartbook. By Sheila Leatherman and Douglas McCarthy, (The Commonwealth Fund, New York, New York) May 2005. Various pagings.

Full Text at: www.cmwf.org/publications/publications_show.htm?doc_id=275195

["This report provides a comprehensive portrait of Medicare's performance on multiple measures of quality, including effectiveness, patient safety, access and timeliness, and capacity to improve with a set of 60 charts." Moving Ideas (May 10, 2004) 1.]

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Medicare Drug Benefit: Implications for California. By California HealthCare Foundation. (The Foundation, Oakland, California) April 2005. 15 p.

Full Text at: www.chcf.org/topics/download.cfm?pg=&fn=MedicareDrugBenefitOverviewIB%2Epdf&pid=415326&itemid=110596

["This issue brief provides an overview of the new Medicare drug benefit and a timeline for its implementation. In addition, it highlights the special characteristics of California that will affect introduction of the benefit and identifies and organizes numerous policy issues that state lawmakers and program officials must consider."]

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NURSING HOMES

Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1998 Through 2004. By Charlene Harrington and others. National Citizens' Coalition for Nursing Home Reform. (The Coalition, Washington, DC) 2005. Various pagings.

Full Text at: www.nccnhr.org/public/245_1267_11874.cfm

["Some findings in this year's report include: The number of nursing homes certified to take both Medicare and Medicaid residents increased by six percent. The number of nursing homes operated by hospitals declined by 34 percent. The average number of deficiencies increased by 43 percent. At the same time, the percent of facilities that were issued serious deficiencies for causing harm or jeopardy declined by almost half."]

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PRESCRIPTION DRUGS

Prices for Brand-name Drugs Under Selected Federal Programs. By Congressional Budget Office. (The Office, Washington, DC) June 2005. 24 p.

Full Text at: www.cbo.gov/ftpdocs/64xx/doc6481/06-16-PrescriptDrug.pdf

["This Congressional Budget Office paper describes the processess by which drug prices paid to manufacturers are determined and the relative average prices that result under many federal programs."]

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The Rebate Medicaid Receives on Brand-name Prescription Drugs. By Congressional Budget Office. (The Office, Washington, DC) June 21, 2005. 12 p.

Full Text at: www.cbo.gov/ftpdocs/64xx/doc6493/06-21-MedicaidRebate.pdf

["The Congressional Budget Office has prepared the analysis, which discusses the Medicaid Drug Rebate Program and provides estimates of the average rebate received by Medicaid for brand-name prescription drugs."]

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SMALLPOX

Will Smallpox Vaccinations Save Lives. By Center for Domestic and International Health Security. (Rand Corporation, Santa Monica, California) 2005. 4 p.

Full Text at: www.rand.org/publications/RB/RB4554-1/

["For most scenarios, vaccinating health care workers will probably save lives. But vaccinating the general public will probably not save lives."]

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UNINSURED

Characteristics of the Uninsured: A View from the States. By the State Health Access Data Assistance Center, University of Minnesota. Prepared for the Robert Wood Johnson Foundation. (The Foundation, Princeton, New Jersey) May 2005. 49 p.

Full Text at: www.rwjf.org/files/research/Full_SHADAC.pdf

["A new study examines rates of uninsured Americans by state, and finds that Minnesota has the lowest rate of uninsured adult residents (8.3 percent) and Texas has the highest (30.7 percent). Many uninsured state residents have jobs, according to the study." Connect for Kids (May 2, 2005) 1.]

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"The Impact of Immigration on Health Insurance Coverage in the United States." IN: Employee Benefit Research Institute, vol. 26, no 6 (June 2005) pp. 1-8.

Full Text at: www.ebri.org/notepdfs/0605notes.pdf

["Immigrants account for about a quarter of the nation's uninsured population -- and more than one in every four uninsured immigrants lives in California." Sacramento Bee (June 14, 2005) D1.]

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Falling Apart: Declining Job-based Health Coverage for Working Families in California and the United States. By Arindrajit Dube and others, Labor Center, University of California, Berkeley. (The Center, Berkeley, California) 2005. 12 p.

Full Text at: laborcenter.berkeley.edu/healthcare/falling_apart.pdf

["One in four adults statewide will be uninsured by 2010 if health premiums keep increasing by more than 10 percent a year. Hardest hit by rising health costs will be workers at the low and middle rungs of the wage ladder." Sacramento Bee (June 3, 2005) 1.]

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"Insured But Not Protected: How Many Adults Are Underinsured?" By Cathy Schoen and others. IN: Health Affairs (June 14, 2005) pp. w5-289-w5-302.

["Health insurance is in the mist of a design shift toward greater financial risk for patients.... The shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19-64 were underinsured in 2003.... These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage."]

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Paying a Premium: The Added Cost of Care for the Uninsured. By Families Foundation USA. (The Foundation, Washington, DC) June 2005. 40 p.

Full Text at: www.familiesusa.org/site/DocServer/Paying_a_Premium.pdf?docID=9241

["This study quantifies the dollar impact on private health insurance premiums when doctors and hospitals provide health care to uninsured people. In 2005, premium costs for family health insurance coverage provided by private employers will include an extra $922 in premiums due to the cost of care for the uninsured; premiums for individual coverage will cost an extra $341."]

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Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help. By Sara R. Collins and others, the Commonwealth Fund. (The Fund, New York, N.Y.) May 2005. 12p.

Full Text at: www.cmwf.org/usr_doc/649_Collins_ritepassage_2005update.pdf

["Between 2000 and 2003, the number of 19-to-29-year-olds lacking health coverage rose by 2.2 million, to 13 million. This brief suggests several policy changes that could extend coverage to uninsured young adults and prevent others from losing it." Moving Ideas (May 10, 2005) 1.]

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A Standardized National Community Needs Index for the Objective High-level Assessment of Community Health Care. By Richard Roth and others, Catholic Healthcare West. (Catholic Healthcare West, San Francisco, California) 2005. 30 p.

Full Text at: www.chwhealth.org/stellent/groups/public/@xinternet_con_sys/documents/webcontent/084757.pdf

[“Some patients in the Sacramento region are twice as likely as others to be hospitalized for preventable health problems that should have been treated in a doctor's office, a new study shows. People are least likely to get regular physician care when they are uninsured and live in low-income neighborhoods where fewer residents own homes, graduate from high school or speak fluent English.” Sacramento Bee (March 10, 2005) 1.]

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WOMEN

"Oocyte Generation in Adult Mammalian Ovaries by Putative Germ Cells in Blood Marrow and Peripheral Blood." By Joshua Johnson and others. IN: Cell, vol. 22 (July 29, 2005) pp. 308-315.

["Woman may possess a hidden cache of stem cells in the bone marrow that constantly replenish the overies with new eggs, a study suggests. The idea contradicts long-established scientific dogma that holds that a woman in born with a complement of eggs that must last throughout her reproductive life." New York Times (July 28, 2005) 1.]

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PREVIOUSLY IN STUDIES IN THE NEWS
[This section links to items in Studies in the News since the last Health Care Supplement.]

HEALTH CARE POLICY

"Health." IN: Studies in the News, (July-August 2005).

[Includes: "Employment based health insurance;" "Health care costs increasing for the uninsured;" "Orange County hospital shortage;" "Medical marijuana;" "Medi-Cal expenditures and long-term forecasts;" "California nursing homes snapshot;" "Proposition on abortion notification;" "Agricultural air quality enforcement;" "Medicaid managed care;" "Medical marijuana laws;" "Obesity and HMOs;" "Proposition on prescription drugs;" "Emergency preparedness and public health;" "Unsolved issues on emergency preparadness;" "Cigarette tax boost revenues and decreases smoking;" "Budget crisis and medicaid;" "Government funding for health care;" "Medicaid's new payment system;" "Medi-Cal expenditures and long-term forecasts;" "Mental health care needs of youth in foster care;" "States react slowly to obesity crisis;" and "Overpaying for prescription drugs and Medicaid."

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