February 3, 2005
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Study: Illness, Medical Bills Cause Half of Bankruptcies
Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a new Harvard University study.
Researchers from Harvard's law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.
"Unless you're Bill Gates, you're just one serious illness away from bankruptcy,'' said Dr. David Himmelstein, the study's lead author and an associate professor of medicine. "Most of the medically bankrupt were average Americans who happened to get sick.''
The study, published online by the journal Health Affairs, distributed questionnaires to 1,771 bankruptcy filers in 2001 in California, Illinois, Pennsylvania, Tennessee and Texas. That year, there were 1.46 million personal bankruptcies in the United States.
More than 900 of those questioned underwent more detailed interviews about their financial and medical circumstances for what the authors say is the first in-depth study of medical causes of personal bankruptcies, which have risen rapidly in recent years.
Illness and medical bills were cited as the cause, at least in part, for 46.2 percent of the personal bankruptcies in the study. Himmelstein said the figure rose to 54.5 percent when three other factors were counted as medical-related triggers for bankruptcies: births, deaths and pathological gambling addiction.
The study estimates medical-caused bankruptcies affect about 2 million Americans each year, counting debtors and their dependents, including 700,000 children.
Most of those seeking court protection from creditors had health insurance, with more than three-quarters reporting they had coverage at the start of the illness that triggered bankruptcy. The study said 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy, with illness frequently leading to the loss of both a job and insurance.
Out-of-pocket medical expenses covering co-payments, deductibles and uncovered health services averaged $13,460 for bankruptcy filers who had private insurance at the onset of illness, compared with $10,893 for those without coverage. Those who initially had private coverage but lost it during their illness faced the highest cost, an average of $18,005.
"We need to rethink health reform,'' said Dr. Steffie Woolhandler, a study co-author and associate professor of medicine at Cambridge-based Harvard. "Covering the uninsured isn't enough. We also must upgrade and guarantee continuous coverage for those who have insurance.''
Susan Pisano, a spokeswoman for America's Health Insurance Plans, representing nearly 1,300 health insurance providers, said the study did not adequately explore the role that disability income protection plans and personal savings can play in helping someone with a medical problem avoid bankruptcy.
"It's very important to ask questions about what the financial stressors are for American families, but we don't think this study digs deeply enough,'' Pisano said.
The findings indicate medical-related bankruptcies hit middle-class families hard — 56 percent of the filers owned a home, and the same number had attended college.
"Families with coverage faced unaffordable co-payments, deductibles and bills for uncovered items like physical therapy, psychiatric care and prescription drugs,'' Himmelstein said.
The study, funded by the Robert Wood Johnson Foundation, did not examine how many bankruptcy filers were from dual-income families where both partners had insurance, Himmelstein said.
Jeff Morris, resident scholar at the American Bankruptcy Institute, founded by Congress in 1982 to analyze bankruptcy trends, said the Harvard findings roughly mirror those of a 1996 ABI study in which 57 percent of bankruptcy filers cited medical problems as a primary bankruptcy cause. Respondents in that study were more likely to cite three other factors as primary causes, including easy access to credit, job loss and financial mismanagement.
Morris said he was aware of no data indicating that the Harvard study, which was based on 2001 bankruptcy filings, does not accurately reflect current trends in medical-related bankruptcies.
"Medical coverage is becoming more for catastrophic loss than for intermediate expenses,'' Morris said.
Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.-
Blockbuster brands generate generic goals.
M2 Presswire; 2/2/2005
London - Despite being the current gold standard and sales heavyweight of the antipsychotic market, with $4billion in global* sales, Eli Lilly`s Zyprexa (olanzapine) is facing legal action in the US over alleged side effects and along with other blockbuster drugs in the market, may also run into intense competition from generics earlier than expected, according to a new report by independent market analyst Datamonitor**.
Today, the antipsychotic market is one of the largest and most commercially attractive central nervous system (CNS) markets, with annual revenues of $10.4 billion in 2003 and a growth rate of 24.1%, says Datamonitor CNS analyst Alistair Sinclair. "There are two main classes of antipsychotics: the older conventional dopamine antipsychotics, first launched in 1950`s; and the new second-generation antipsychotics (SGAs), which currently drive the antipsychotic market, yielding revenues of over $9.5 billion in 2003, with a 93.3% market share."
Zyprexa (an SGA) leads the market with 2003 revenues of $4.1 billion across the seven major markets, a CAGR of 24.3% and market share of 39.3%. The success of Zyprexa comes from a combination of its second-to-market status, impressive efficacy, range of formulations and aggressive marketing tactics by Lilly. It was also Zyprexa that spearheaded the penetration of SGAs into the bipolar disorder market, being one of the first drugs to be recognized as suitable for maintenance therapy since the approval of lithium over 30 years ago, Sinclair says. "However, 2004 has been a bad year for Zyprexa, with fourth quarter revenues down by 5% from the year-ago quarter to $1.1 billion, while US sales of the drug fell by 19% over the previous quarter"
The future outlook for Zyprexa is also being hampered by the ongoing patent challenges from numerous generic drug manufacturers. Although the trial proceedings ended in February 2004, a final verdict has still yet to be given.
"Datamonitor expects a judge`s decision during the current financial quarter, although a delay of this length has to have a reason, and must continue to worry Lilly," Sinclair says.
"Whatever the outcome of patent litigation, revenues from Zyprexa are forecast to continue to decline as Lilly also faces numerous lawsuits in the US stemming from diabetes and other alleged side effects from Zyprexa."
Generics want piece of the action
With Johnson and Johnson`s Risperdal (risperidone) and AstraZeneca`s Seroquel (quetiapine) also blockbusters in the SGA class, and Bristol Myers Squibb`s Abilify (aripiprazole) forecast to attain blockbuster status in 2005, the extreme interest in this market from generics manufacturers is unsurprising, Sinclair says. "Risperdal is approved for schizophrenia and bipolar mania and because it is available in numerous formulations, there is significant off-label usage of the drug. However looming patent expires from 2006 onward present a significant threat."
"Likewise, Seroquel faces patent expiries in the EU and Japan in 2007, although it is protected in the US until 2011."
Although the antipsychotic market has up until now had relatively low exposure to generics, the future entrance of generic risperidone and quetiapine from 2007 onwards, plus the increasing drive towards generic prescribing as a cost-saving measure means that brand companies will find it increasingly difficult to avoid the effects of generic erosion on their revenues, Sinclair says.
"SGAs are generally acknowledged by payers as a cost concern, and with rising general and mental healthcare costs, governments are now increasingly looking towards cost-containment measures, including reducing the amount spent on medications and thereby encouraging physicians to prescribe cheaper generics."
Notes for editors
*In this case, global is defined as the seven major pharmaceutical markets, which are: France, Germany, Italy, Japan, Spain, the UK, the USA
** Commercial Insight: Antipsychotics - From Blockbuster Brands to Billion Dollar Generics
Alistair Sinclair, Datamonitor CNS analyst and report author is available for comment
Datamonitor plc (DTM.L) is a premium business information company specialising in industry analysis. We help our clients, 5000 of the world's leading companies, to address complex strategic issues. Through our proprietary databases and wealth of expertise, we provide clients with unbiased expert analysis and in-depth forecasts for six industry sectors: Automotive, Consumer Markets, Energy, Financial Services, Healthcare, Technology. Datamonitor maintains its headquarters in London and has regional offices in New York, San Francisco, Sydney, Tokyo, Frankfurt, Shanghai and Hong Kong. See www.datamonitor.com for further details.
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