Dying in prison, paying cash for cheaper care, and barriers to health in Baltimore

February 18, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

Join the conversation: Post your comments in our section at the bottom of this page.




Ann Neumann explores in The Atlantic this week the complexities of dying in prison. She writes, “Pain management in a facility where drug use is rampant—and, indeed, a major cause of incarceration—is problematic.” Concerns about illicit drug trafficking of narcotics, the “macho” prison culture, and the belief that “pain is punishment” all may color treatment decisions about pain management in hospice care of prison populations. Inmates and their families often distrust medical personnel. According to the article, “in 55 percent of prisons, patients must sign DNR orders before they can enter hospice, and a climate of deprivation, ill will, and doubt about the facility’s objectives can grow.” Unfortunately the same is true among homeless people in need of hospice care; a recent STAT piece describes how few options are available for homeless people who are nearing death. As these vulnerable populations age, meeting their increasing health and social needs will require more sustainable, far-reaching solutions than what we have now.


“In the Alice-in-Wonderland world of health-care prices… patients who pay up front in cash often get better deals than their insurance plans have negotiated for them,” writes Melinda Beck of the Wall Street Journal. Beck recounts the experience of a Colorado woman who learned that an X-ray she needed would cost $600 out of pocket with her high-deductible insurance, or just $70 if she paid the hospital cash up front. Price shopping for needed health care gets even more complicated when comparing prices across institutions; “A colonoscopy in San Francisco is $600 at one surgical center and $5,500 at another,” according to ClearHealthCosts, a startup that publishes health care prices for consumers.  Increased price transparency, both for self-pay and insurance-negotiated rates, is one potential way to help patients navigate the complex world of health care and health insurance, and it will take more than nonprofit consumer advocacy organizations to lead this effort.


Life expectancy for residents of West Baltimore, MD is only 69 years, a decade less than the rest of the nation. In this city—the setting for the hit TV series, The Wire—diabetes, heart disease, asthma, HIV, and poverty are epidemic, along with distrust of the medical establishment. Roots of this distrust, according to PBS NewsHour, may trace back to Henrietta Lacks, an African-American cancer patient whose tissue cells were used in experimentation without permission in the 1950s, and to stories of “night doctors” kidnapping black children for medical experiments in the 1800s. But distrust is only one part of the poor health equation; social determinants are the other. Chronicled in this PBS segment is one patient’s journey to acquire a blood pressure cuff prescribed by her physician; her seven-mile trip ended after five and a half hours and four bus rides to the pharmacy. Baltimore and places like it all over America need comprehensive approaches to improving the health of their citizens, says Jay Perman, MD, president of the University of Maryland, which is in Baltimore. “As a profession, as an industry, we have not sufficiently appreciated, let alone done something about, the impact of social determinants,” he said. Maryland State requirements and the ACA have put some pressure on Baltimore hospitals to view social determinants of health as part of their responsibility. Is it enough? Healthcare professionals must also take responsibility. In Perman’s view, “[Doctors and nurses] can easily say, ‘I made the correct diagnosis. I wrote a proper prescription, I’m done.’ What I say to my students is, if you think you’re done—if ‘done’ means the patient is going to get better—you’re fooling yourself.”



  • Just posted! The agenda for our 4th Annual Lown Conference, April 15-17 in Chicago. It’s going to be another must-attend event. Space is limited, so after you review the agenda, please register. You don’t want to miss out because you waited too long!




Public health


Social determinants




Patient experience


Women’s health


End of life


Dr. Lown


Emergency preparedness


Cost of care




Med ed






Behavioral health


RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.