Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Report] Surveying Health Care Quality & Value

Surveying Health Care Quality & Value

From the 24 November 2014 Robert Woods Foundation report

Recent years have brought numerous efforts to educate and engage Americans in what “quality” health care is, how to find it and how they can get better value for their dollars. To better understand the latest trends, the Robert Wood Johnson Foundation funded the AP-NORC Center for Public Affairs Research at the University of Chicago to conduct three surveys through the summer and fall of 2014.

The surveys each individually examined how consumers and employers, as purchasers, perceive health care quality and how they use quality information and performance data on health plans and providers. Learn more about the research and access links to the full reports with accompanying materials.

 

 A medical assistant checks a patient's blood pressure and pulse.

Consumer Awareness of Provider Quality and Value

A number of initiatives in recent years have aimed at engaging consumers in making informed health care decisions, including empowering patients and their caregivers with data on provider quality, performance, cost and value. The first in the series of surveys looks at the inroads these efforts have made.

Thirty-seven percent of respondents don’t believe that higher health care costs correlate with better quality care—but 48 percent think they do. The poll also found that more than two-thirds say finding a doctor or hospital that offers the highest quality at the lowest possible cost is important to them. The survey also showed getting Americans to find quality information and use it in their health care decisions remains a challenge, with only 11 percent of Americans reporting they have done so.

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Cost- and Coverage-Based Decision-Making

As more provisions of the Affordable Care Act (ACA) are implemented over the next decade, the government projects that approximately 12 million additional people younger than 65 will enter the private insurance market. The second in the series of surveys looks at consumer opinions on health care costs and coverage, and how it impacts their decision-making.

It shows that nearly a fifth of insured Americans report skipping a trip to the doctor when they’re sick or injured to save money, and only 36 percent are confident they can pay for a major, unexpected medical expense. Those enrolled in health plans with high deductibles are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major expenses, skip necessary medical treatment, and experience real financial burden when obtaining health care.

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Billboard Illustration for SHADAC ESI Report April 2013

Employers Use of Quality Information in Purchasing

As a group, employers represent the largest purchaser of care in the United States. Given this, it is critical that they demand good value for the money they spend, ensuring that the plans offered to employees be high quality. The third and final report in the series of surveys looks at the opinions of private sector employers, including small-, medium- and large-sized businesses.

It shows that American firms are hesitant to say they would pay more for higher quality care, and when it comes to measuring quality, 90 percent don’t know or don’t use independent quality information when deciding on what plans to offer employees. And while many employers are indeed providing wellness programs to benefit their employees’ health, relatively few are actively promoting those programs or offering incentives for participation.

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December 5, 2014 Posted by | health care | , , , , , , | Leave a comment

Online Health Care Data Sources | Brookings Institution

Online Health Care Data Sources | Brookings Institution.

 

From the Web site

This is a preliminary scan of publicly available online health care datasets, transparency websites and tools, gathered from expert recommendations and intensive review. Though this list is not exhaustive, we have attempted to include the most relevant sources for the purposes of this study. Each health data source is assigned an icon representing (1) who the source is useful to i.e. consumers or researchers; (2) what information the source includes i.e. data pertaining to quality of care or cost of care; and (3) who the source provides information on i.e. providers or payers.

December 2, 2014 Posted by | health care | , , , , , | Leave a comment

[News item] Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists

Parents skipping needed care for children, pediatricians say | Association of Health Care Journalists.

Joseph Burns

 

Photo: Alex Prolmos via Flickr

High-deductible health plans (HDHPs) discourage families from seeking primary care for their children, according to the American Association of Pediatricians. The problem is so severe that the federal government should consider limiting HDHPs to adults only, the AAP said in a policy statement published in Pediatrics.

“HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care,” the association said in its statement. Under the Affordable Care Act, preventive services are covered in full without charge.

This is the second time in as many months that a report has shown consumers skipping needed care because of the cost. Last month, we reported that out-of-pocket health care costs force one out of every eight privately insured Americans to skip necessary medical treatment, according to the survey from the AP-NORC Center, “Privately Insured in America: Opinions on Health Care Costs and Coverage.” The Robert Wood Johnson Foundation funded the survey. In a report earlier this month, “Too High a Price: Out-of-Pocket Health Care Costs in the United States,” the Commonwealth Fund expressed similar concerns.

In an article about the policy statement, Alyson Sulaski Wyckoff, associate editor of Pediatrics, quoted Budd Shenkin, M.D., the lead author of the AAP’s policy statement on HDHPs, saying parents are so concerned about the cost of care that they don’t bring in their children when they should. “They’re reluctant to come in, they seek more telephone care, they’re reluctant to complete referrals, and they’re reluctant to come back for appointments to follow up on an illness,” he said.

For children with chronic conditions, foregoing care can exacerbate illnesses, said Thomas F. Long, M.D., chair of the association’s Committee on Child Health Financing. “If it’s going to cost them out-of-pocket money, they may say, ‘Well, it’s just a cold, I don’t need to see the doctor.’ And ‘just a cold, turns into ‘just pneumonia,’” he added.

The problem of delaying necessary care is one Paul Levy addressed in his blog, Not Running a Hospital, about HDHPs. “Beyond the sad impact on individual families in any given year, I fear that the economic backlash of these policies will be a deferment of needed health care treatments and a resulting future bulge of cost increases. We’re playing Whac-A-Mole here,” he wrote.

For the Commonwealth Fund, researchers found that among privately insured consumers across all income groups, low- and moderate-income adults were most likely to skip the health care they need because of high out-of-pocket costs.

It’s no surprise that adults with the lowest incomes were most likely to skip needed care, the fund reported. Among consumers earning less than $22,890 annually, 46 percent cited at least one example of skipping needed health care because of copayments or coinsurance: 28 percent did not fill a prescription; 28 percent skipped a medical test or follow-up treatment; 30 percent had a medical problem but did not see a doctor; and 24 percent did not see a specialist when needed.

When deductibles are high relative to income, consumers tend to skip care as well, and low- and moderate-income adults had the most trouble, the report showed. Consumers whose deductibles represent 5 percent or more of their income cited at least one example of skipping needed health care because of their deductible: 29 percent skipped a medical test or follow-up treatment; 27 percent had a medical problem but did not go to the doctor; 23 percent skipped a preventive care test; and 22 percent did not see a specialist despite their physician’s advice.

For an article in Modern Healthcare, Bob Herman covered this topic well. He cited the case of a woman in Indiana who was searching for a health plan on HealthCare.gov. A single, 40-year-old nonsmoker, this woman could choose from 29 plans and 24 of them were considered HDHPs, he wrote.

Under IRS rules, (PDF) an HDHP in 2015 is defined as one that has an annual deductible of at least $1,300 for an individual and $2,600 for a family coverage and annual out-of-pocket costs that do not exceed $6,450 for individual or $12,900 for a family.

The Commonwealth Fund report showed that 13 percent of consumers with private health insurance had plans with a deductibles equivalent to 5 percent or more of their income; that figure includes 25 percent of adults with low incomes and about 20 percent of adults with moderate incomes ($11,490 to $45,960 a year for a single person).

November 28, 2014 Posted by | Consumer Health, health care | , , , , | Leave a comment

[Reblog]Technology and the doctor-patient relationship

Technology and the doctor-patient relationship.

From the 1 July 2014 KevinMD article

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

 

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

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July 9, 2014 Posted by | health care | , , , , , , | Leave a comment

[News article] Health Insurance, Death Rates and the Affordable Care Act

Health Insurance, Death Rates and the Affordable Care Act.

From the 12 May 2014 article at Pew State and Consumer Initiatives

The mortality rate in Massachusetts declined substantially in the four years after the state enacted a law in 2006 mandating universal health care coverage, providing the model for the Affordable Care Act. 

In a study released last week, Harvard School of Public Health professors Benjamin Sommers, Sharon Long and Katherine Baicker conclude that “health reform in Massachusetts was associated with a significant decrease in all-cause mortality.” 

 

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                                        A portion of the chart

The authors caution that their conclusions, published in Annals of Internal Medicine, may not apply to all states, and other studies have shown little correlation between having insurance and living longer. Nevertheless, the Harvard study adds to a growing body of evidence that having health insurance increases a person’s life expectancy.

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May 13, 2014 Posted by | Health Statistics | , , , | Leave a comment

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

 

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February 5, 2014 Posted by | health care | , , , , , , | Leave a comment

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution

Potential Effects of the Affordable Care Act on Income Inequality | Brookings Institution.

From the 27 January 2014 Brookings Institute post
The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

The Affordable Care Act (aka “Obamacare”) was designed to expand health insurance coverage and hold down the cost of insurance, but it will also change incomes of many Americans according to initial projections of Brookings Senior Fellows Henry Aaron and Gary Burtless.

In their new, preliminary paper “Potential Effects of the Affordable Care Act on Income Inequality,” Aaron and Burtless find sizeable income gains in the bottom quarter of the income distribution offset by small losses spread across higher income groups. Their estimates are highly sensitive to the definition of income. They discussed their paper in a recent event, joined by three other economists in a panel discussion.

January 30, 2014 Posted by | health care | , , , , | Leave a comment

Study: Providing dental insurance not enough to induce americans to seek care

Study: Providing dental insurance not enough to induce americans to seek care.

 

English: ADA/Dental Health on US postage stamp

English: ADA/Dental Health on US postage stamp (Photo credit: Wikipedia)

Providing people with dental insurance does not necessarily mean that they will use it and seek dental care, according to a new study from the University of Maryland School of Dentistry, published online in the American Journal of Public Health. The research suggests that outreach and education are needed to ensure that people value their dental health and use their coverage to seek appropriate dental care. The study has particular value in this era of health reform, and the researchers hope that policymakers will use the findings in designing future programs and initiatives, according to first author Richard J. Manski, DDS, MBA, PhD, professor and chief of Dental Public Health at the University of Maryland School of Dentistry.

 

Read entire article here

 

 

 

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January 22, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports…

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks | Full Text Reports….

 

From the 10 January 2014 Full Text Report

 

January 10, 2014

How Medicaid affects adult health — Study: Health insurance helps lower-income Americans avoid depression, diabetes, major financial shocks
Source: New England Journal of Medicine (via MIT)

Enrollment in Medicaid helps lower-income Americans overcome depression, get proper treatment for diabetes, and avoid catastrophic medical bills, but does not appear to reduce the prevalence of diabetes, high blood pressure and high cholesterol, according to a new study with a unique approach to analyzing one of America’s major health-insurance programs.

The study, a randomized evaluation comparing health outcomes among more than 12,000 people in Oregon, employs the same research approach as a clinical trial, but applies it in a way that provides a window into the health outcomes of poor Americans who have been given the opportunity to get health insurance.

“What we found was that Medicaid significantly increased the probability of being diagnosed with diabetes, and being on diabetes medication,” says Amy Finkelstein, the Ford Professor of Economics at MIT and, along with Katherine Baicker of Harvard University’s School of Public Health, the principal investigator for the study. “We find decreases in rates of depression, and we continue to find reduced financial hardship. However, we were unable to detect a decline in the incidence of diabetes, high blood pressure, or high cholesterol.”

 

 

 

 

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January 20, 2014 Posted by | health care | , , | Leave a comment

Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports…

Dental Care Coverage and Use: Modeling Limitations and Opportunities | Full Text Reports….

Source: American Journal of Public Health

Objectives.
We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.

Methods.
We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.

Results.
Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.

Conclusions.
Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.

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January 20, 2014 Posted by | health care | , , , , , | Leave a comment

STATISTICAL BRIEF #424: The Long-Term Uninsured in America, 2008-2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65

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STATISTICAL BRIEF #424: The Long-Term Uninsured in America, 2008-2011 (Selected Intervals): Estimates for the U.S. Civilian Noninstitutionalized Population under Age 65.

    From the Web page of the Medical Expenditure Panel Survey

November 2013
Jeffrey A. Rhoades, PhD and Steven B. Cohen, PhD

Highlights

  • Approximately 20.4 million people, 7.6 percent of the population under age 65, were uninsured for the four-year period from 2008 through 2011. The percentage of long-term uninsured exceeded 10 percent for some younger adult age groups.
  • Adults ages 18 to 24 and 25 to 29 were the most likely to be uninsured for at least one month (48.0 and 46.9 percent, respectively) during 2010-2011. Children under age 18 were the least likely to be uninsured for the full four-year period from 2008-2011 (2.3 percent).
  • Individuals reported to be in excellent or very good health status were the least likely to be uninsured for at least one month during 2010 to 2011 (26.6 and 31.1 percent, respectively).
  • Hispanics were most likely to be uninsured for at least one month during 2010 to 2011 (47.8 percent) and for 2008-2011 (17.4 percent).
  • Hispanics were disproportionately represented among the long-term uninsured. While they represented 18.2 percent of the population under age 65, they comprised 41.5 percent of the long-term uninsured for 2008-2011.
  • Individuals who were poor, near poor, and low income were represented disproportionately among the long-term uninsured. While poor individuals represented 16.8 percent of the population under age 65, they represented 29.9 percent of those uninsured for 2008-2011.

 

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January 12, 2014 Posted by | health care | , , , | Leave a comment

[Infographic] The Top Five Most Expensive Conditions Treated in US Hospitals, 2011

From the Agency for Healthcare Research and QualityScreen Shot 2013-12-16 at 7.55.18 AM

Related articles

December 16, 2013 Posted by | health care | , , , , , | Leave a comment

[Press release] A rising tide lifts all boats: Study links broader health insurance in Massachusetts with better health and care

From the University of Michigan Health System 10 December 2013 press release 

Compared with other New England states, health status & preventive care improved in Massachusetts after reform – especially for poor & near-poor

 

ANN ARBOR, Mich. — In 2006, Massachusetts was on the same brink that the entire nation is on today: the brink of expanding health insurance to cover far more people than before, through government-driven, market-based reform.

Now, a new study shows the health of residents in that one trailblazing state improved measurably, especially among the poor and near-poor, in just the first five years — compared with the health of residents in neighboring states. So did the use of some preventive care, specifically two tests designed to spot colon and cervical cancers early, and cholesterol tests to gauge heart disease risk. The study was led by a University of Michigan Medical School researcher.

Meanwhile, over those same five years, Massachusetts residents were increasingly likely to say they had health insurance and access to a personal doctor, and less likely to say that costs stood in the way of getting care, than other New Englanders. The changes occurred at similar rates for black, white and Hispanic residents.

Writing in the new issue of The Milbank Quarterly, the study’s authors note that they can’t be certain that all the population-wide differences between Massachusetts and its neighbors came directly from the expansion of insurance coverage. Other reforms likely had an impact, too. But theirdetailed statistical analysis, supported by the Commonwealth Fund, points firmly to a positive impact, especially among residents with the lowest incomes.

“Everyone has been looking over the past few years at Massachusetts, which was the first state to show the rest of the U.S. that near-universal coverage could be achieved,” says first author Philip Van der Wees, Ph.D., a Dutch researcher who was at Harvard University when the study was conducted. “We found that people have gained in general, mental, and physical health, and that some preventive measures improved. We would hope that this would be a blueprint for the rest of the U.S., though Massachusetts is not the average state, because it began from a higher level of insurance,” among the state’s residents than the current U.S. average.

Van der Wees worked on the study with John Z. Ayanian, M.D., MPP, formerly of Harvard Medical School and now director of the University of MichiganInstitute for Healthcare Policy and Innovation, and with Harvard health care statistics expert Alan Zaslavsky, Ph.D. Van der Wees at the time was a Commonwealth Fund Dutch Harkness Fellow in Health Care Policy and Practice; he is now at Radboud University Nijmegen Medical Center in the Netherlands.

John Ayanian

John Ayanian, M.D., MPP, director of the
U-M Institute for Healthcare Policy and Innovation

“Our results demonstrate the potential benefits of health care reform in Massachusetts that may also be achieved through the implementation of the federal Affordable Care Act,” says Ayanian.

“And, just as with the ACA, the impact of broader health insurance coverage in Massachusetts is intertwined with the effects of numerous efforts in the public and private sector to improve health care quality and contain costs,” he adds.

Statewide surveys reveal changes 

The data for the study came from annual random telephone surveys during 2001 through 2011 that asked 345,211 New Englanders questions about their general, physical and mental health, and their use of and access to health care services including cholesterol testing and screening for cancers of the breast, colon and cervix. The data were gathered by state health departments in conjunction with the federal Centers for Disease Control and Prevention.

The researchers used advanced statistical approaches to study the data collected between 2001 and 2011 as part of the CDC’s Behavioral Risk Factor Surveillance System. This allowed them to detect subtle differences in health status and behaviors, and to analyze these differences further by income and race/ethnicity.

While the research didn’t show huge jumps in any particular area of health, care, or access, the overall pattern is consistent with a positive impact from increased health insurance and other reforms, compared with states that didn’t embark on major reform efforts. Even when the researchers excluded data from Vermont and Maine, which launched smaller-scale reform efforts, Massachusetts showed greater improvements.

The authors note that the “rising tide” effect in Massachusetts compared with other states was greater among those whose incomes were within 300 percent of the federal poverty level. These poor and near-poor residents had a faster rise in measures related to health care access and health status. The rate of changes in health status, access and care were similar among white, black and Hispanic residents, which means that deeply entrenched disparities in health likely persisted.

By studying access to care and health outcomes for five years after health reform took effect in Massachusetts, the authors also were able to distinguish how access to care and health outcomes changed over time. Whereas improvements in insurance coverage and reduced cost barriers to care were seen within one year after health reform, access to personal doctors improved after two years and gains in health status became evident after four years.

These statewide findings counter prior anecdotal perceptions that access to primary care worsened in Massachusetts after more residents gained insurance coverage.

The editor of the Milbank Quarterly, U-M Medical School professor Howard Markel, M.D., Ph.D., calls the study an important contribution to understanding of the potential implications of the federal Affordable Care Act.

“In an era of demagoguery and exaggeration posing as “facts” it is essential to collect and analyze solid evidence on our nation’s health care policies,” says Markel, the George E. Wantz Distinguished Professor of the History of Medicine and Director of the Center for the History of Medicine at U-M. “Indeed, it is the only way I know to approach the Sisyphean task of reforming and improving health care access for all Americans. Publishing and disseminating articles like this one is a solid start in that direction.”

At the time of the study, Ayanian was at the Harvard Medical School and School of Public Health, and the Brigham and Women’s Hospital. Now as director of U-M’s IHPI, he leads a group of more than 400 researchers – many of them focused on evaluating the impact of the Affordable Care Act and other changes in health care policy and practice.

Reference: Milbank Quarterly, December 2013

 

December 11, 2013 Posted by | health care | , , | Leave a comment

[News Report] Cuts to Local Health Departments Hurt Communities

From the 14 November 2013 Science Daily Report

Local health departments (LHDs) can play pivotal roles in U.S. communities by helping to link people with medical services and assuring access to care when it is otherwise unavailable. However, a new study in the American Journal of Preventive Medicine finds that many LHDs aren’t able to meet these goals, which could spell trouble for the uninsured and underinsured.

“Our report shows that in 2010, about 28 percent of LHDs had not conducted any of the three targeted activities in our study,” which looked at how LHDs assessed gaps in care, increased access to health services and used strategies to meet the health needs of the underserved, said lead author Huabin Luo, Ph.D, former research fellow with the Centers for Disease Control and Prevention and assistant professor in the department of public health at the Brody School of Medicine at East Carolina University.

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http://www.sciencedirect.com/science/article/pii/S074937971300487X

In recent years, deep funding cuts have impacted local health departments. For example, between 2008 and 2009 alone, over 23,000 LHD jobs were eliminated. This combined with an increase in demand for health care services can mean an increase in health disparities for those who rely on community health care.

The study found that LHDs with larger budgets in bigger population centers were more likely to provide access to health services compared to smaller LHDs with fewer financial resources, where they may be needed more.

 

Hanen noted that as health insurance coverage becomes more widespread, LHDs will continue to identify and link people without health insurance to programs that provide health care services. “It cannot be overstated enough that poor housing, education, low income, unemployment and lack of transportation in a neighborhood are all interconnected and are all factors that determine health.”

Read the entire article here

November 16, 2013 Posted by | Public Health | , , , , , , , | Leave a comment

[Reblog] Healthcare Solutions

Health care systems and single payer

Health care systems and single payer (Photo credit: Wikipedia)

 

I have a nagging question…is it right that health care is basically a for-profit industry?
Realize I need to clarify and expand on this in order for it to make sense.
However, in the past 20 or so years, I’ve seen the rise of medical complexes,  “battles” among hospitals for market shares,  huge increases in medical/health care advertising, and yet what seems to be a decline in the overall average health of Americans.
So, I have to ask…is this for-profit model working? And if not, what is the answer?

 

 

 

From the 5 November 2013 item at ThePeaceResource

 

The math is not complex. Instead of doling out corporate welfare to insurance firms, we pay that money to deliver actual health care. As health improves, costs go down. “Single-payer allows citizens and businesses to win twice: — less money out of our individual budgets for health insurance, and — no government bureaucracy that gives our tax money to the less efficient health insurance companies through a variety of federal and state programs”http://www.medicareforall.org/pages/Terms_and_Facts health_care_reformOr we stick with corporate cons running the show and 31 million continue to suffer without health care.* This will raise costs of care and lead to more suffering. *{a report from the Congressional Budget Office (CBO) predicts that in the post-Obamacare world of 2023, 31 million, non-elderly Americans will remain uninsured.http://www.cbo.gov/publication/44190}

healthcare1

 

 

More resources on health care options:
ThePortlandAlliance.org/healthcare
health-careresource.blogspot.com/
writingresource.info/healthcare/
internationalpeaceresources.org/healthcare/
unionresource.blogspot.com/

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November 6, 2013 Posted by | health care | , , , , | Leave a comment

Corporate wellness programs fail both companies and patients

desk treadmill rendezblue-1

desk treadmill rendezblue-1 (Photo credit: healthiermi)

 

Corporate wellness programs fail both companies and patients.

 

From the 9 September 2013 article by Kevin Pho at KevinMD.com

 

This column was published in USA Today on September 9, 2013.

More patients are coming to my primary care clinic with forms from their employer, asking me to measure their blood pressure, or check their sugar and cholesterol levels. Companies requesting medical data drive employee wellness programs, a booming $6 billion business, with approximately half of large employers offering such plans.

Coaching and financial incentives are often offered to help employees meet certain health metrics, such as losing weight, lowering cholesterol or quitting smoking. The results of these tests are often tied to the cost of health insurance, with less healthy workers paying more. Under the Affordable Care Act, up to 30% of an employee’s premium in 2014 can be influenced by these programs, an average of$1,620 annually per worker.

 

Wellness programs are designed to lower costs for employers and keep workers healthy, but do they accomplish either goal?

True health cost savings?

Wellness plans are often promoted as saving $3 or more for every dollar invested. But a recent RAND Corporation analysis found that fewer than half of companies took the time to calculate whether these programs saved them money. If they did, the numbers might have startled them. That same study also concluded that wellness programs did not significantly reduce employer health costs.

Why? Health screenings generally promote more doctor visits, prescription medications or further tests. While this might benefit workers’ health, it doesn’t necessarily save money.

If there are no measurable savings, employers pass on the cost of these programs, as much as $500,000 per year, to workers by raising their insurance premiums.

Whether wellness programs improve health is also dubious. This year, the California Health Benefits Review Program, which advises the state’s legislature, found that employees’ blood pressure, blood sugar or cholesterol did not improve by participating in a corporate wellness plan. Weight loss was minimal, with the RAND researchers finding that workers lost about 1 pound annually for three years.

Furthermore, there was no improvement in the rate of hospitalizations and emergency room visits.

Some short-term benefits

While there was a short-term gain in the rate of smokers quitting, it came with a qualification. Fewer than half of employees participate in wellness programs, which are mostly voluntary. Those who participate are often the most motivated, making it hard to tell whether their smoking cessation was due to the wellness program or the employees’ motivation.

Wellness programs also require tests more frequently. For instance, many require blood sugar and cholesterol screens every year in healthy adults, far in excess of recommended guidelines, which call for checking these levels once every three and five years, respectively. Such over-testing doesn’t necessarily make patients any healthier and contributes to the $210 billion our health system spends annually in unnecessary care.

Because I want my patients to save money on their insurance premiums, I dutifully fill out their wellness forms and order the requested screening tests that might not be needed. But it’s doubtful I’m saving these companies money or making my patients healthier by doing so.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

 

 

 

October 26, 2013 Posted by | health care | , , , , , | Leave a comment

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly

Study: The Health Care Experiences and Expectations of Low-Income Californians – NPQ – Nonprofit Quarterly.

From the 24 October 2013 article BY ANNE EIGEMAN at NonProfit Quarterly

As the most recent update in an ongoing research project that began in 2011, this week, the Blue Shield Foundation of California released a report on the healthcare experiences and expectations of low-income Californians. Two central goals guided the project: 1) to help healthcare facilities—particularly California’s community health centers—successfully navigate the changes brought about by the ACA, and 2) to help community health centers identify the most effective ways of encouraging patients and providers alike to embrace primary care redesign and move closer toward the goal of patient empowerment. As key findings, the study points to the “wide range of positive outcomes” that come from successful communication between patients and providers and the “broad gap” that currently exists between the information patients possess and the information they want.

The study found that only 28 percent of low-income Californians feel they have easily comprehensible health information for decisions about care. In addition, almost 40 percent rely on media sources to address concerns—“a potential problem” according to the study, because “trust in information is much higher when it comes from a medical professional than from other sources.”

A central theme is the value to patients that comes from a strong patient-provider relationship, which can lead to improvement in a patient’s overall sense of being well informed about his or her health, the level of satisfaction with the quality of care at a specific facility, and trust of the information provided by doctors. In light of upcoming structural changes to healthcare systems from the ACA, the study’s note that “alternative communication approaches also show great promise in helping to improve patients’ relationships with their providers.” is significant. Examples of these new approaches include team based care, decision aids, health coaches, and online or smartphone-accessible health sites, all of which were found to “enhance, rather than diminish, the critical connection between patients and their providers.”

The study devotes considerable attention to the effect of the digital divide on healthcare for specific groups of low-income Californians. “While four in ten low-income Californians overall lack Internet access, that soars to 67 percent of Spanish-speakers, 63 percent of non-citizens, 62 percent of Latinas and 59 percent of those in only fair or poor health,” the study reports. In addition, the fact that 59 percent of low-income residents over 50 lack Internet access and 41 percent lack a text-capable phone makes this “vulnerable population particularly hard to reach with technology-based information and communications.”

 

 

Read the entire article here

 

October 26, 2013 Posted by | health care | , , , , , , | Leave a comment

Early Benefit Assessment for Pharmaceuticals in Germany: Lessons for Policymakers

From the overview (abstract) at the 16 October 2013 Commonwealth Fund posting

Since 2011, Germany’s Pharmaceutical Market Restructuring Act has mandated that all newly introduced drugs are subject to an assessment of their benefits in relation to a comparator, typically the current standard treatment. For drugs found to have some additional benefit, the manufacturer and the statutory health insurers negotiate a price. For drugs found to have no additional benefit, their price is set in reference to the price of the comparator. This new system is intended to reduce spending on expensive new drugs that are no more effective than existing treatments, while encouraging pharmaceutical companies to invest in innovative drugs that improve health outcomes. The German experience provides lessons for the United States, where comparative effectiveness research is publicly funded but public insurance programs are limited in their ability to use its findings to make coverage or pricing decisions.

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October 22, 2013 Posted by | health care | , , , | Leave a comment

[Gallup Poll] Two in Three Uninsured Americans Plan to Buy Insurance

From the 30 September 2013 Gallup Poll 

 

Less than half say they will use the state or federal exchanges

by Frank Newport and Kyley McGeeney

PRINCETON, NJ — Nearly two in three uninsured Americans say they will get insurance by Jan. 1, 2014, rather than pay a fine as mandated by the Affordable Care Act (ACA), while one in four say they will pay the fine. Less than half of the uninsured say they plan on getting health insurance specifically through a federal or state health insurance exchange.

Uninsured Americans' Plans Regarding Health Insurance

Gallup asked a nationally representative sample of 5,099 Americans between Sept. 17-26 about their awareness of several pending ACA provisions and their anticipated healthcare choices in the months ahead. The ACA requires that most Americans get insurance by Jan. 1, 2014, or pay a fine, and advocates of the ACA are urging the uninsured to take advantage of new federal and state health exchanges to obtain health insurance.

Overall, 83% of Americans are aware that most Americans will be required to have health insurance or pay a fine beginning January 2014. This awareness drops to 68% among those who are uninsured, and is at 69% among the vital group of 18- to 29-year-olds who are the most likely of any age group to be uninsured.

Americans' Awareness of the ACA

 

Although the uninsured’s awareness of the individual mandate component of the ACA remains below the national average, it is up by 12 percentage points from a June 20-24 survey, when 56% of uninsured Americans said they were aware of it.

Familiarity With Exchanges Is Low

One of the primary components of the ACA is the creation of government-run health insurance exchanges. These exchanges are essentially websites in each state that provide a central clearinghouse where individuals can review and then purchase health insurance. Consumers can also find out if they qualify, based on their income, for government subsidies of their health insurance premiums. These exchanges are a major part of the ACA and have been heavily featured in ACA promotion.

At this juncture, relatively few Americans — 37% — are familiar with the health exchanges, even though these insurance marketplaces officially open for business on Oct. 1. Familiarity with the exchanges is even lower among the crucial group of Americans who do not have health insurance. In fact, half of the uninsured say they are “not at all familiar” with the exchanges.

And young adults aged 18 to 29 are also less familiar with the exchanges than those who are older.

Americans' Familiarity With Healthcare Exchanges

This low level of familiarity with the exchanges may help explain the finding that less than half of the uninsured say they will get health insurance for 2014 specifically through a state or federal health insurance exchange.

Overall, 66% of the uninsured who plan on getting health insurance rather than pay a fine say they will get insurance through an exchange, leaving the rest who apparently are unsure about how they will get their insurance, or who will seek insurance perhaps through their employer, through Medicare or Medicaid, or buy a plan on their own outside of an exchange.

Implications

Although less than half of the uninsured say they plan on buying health insurance for 2014 through a federal or state exchange, this percentage may well rise in the months ahead for two reasons. First, almost-two thirds of the uninsured say they are more likely to get health insurance rather than pay a fine if they don’t, indicating a demand for insurance that will need to be fulfilled in some fashion over the next three months. Second, current familiarity with the health exchanges among the uninsured is low, and as awareness increases, willingness to use the exchanges may rise as well.

Survey Methods
Results for this Gallup poll are based on telephone interviews conducted Sept. 17-26, 2013, on the Gallup Daily tracking survey, with a random sample of 5,099 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia.

For results based on the total sample of national adults, one can say with 95% confidence that the margin of sampling error is ±2 percentage points.

For results based on the total sample of 4,427 adults with health insurance, one can say with 95% confidence that the margin of sampling error is ±2 percentage points.]

For results based on the total sample of 651 adults without health insurance, one can say with 95% confidence that the margin of sampling error is ±5 percentage points.]

Interviews are conducted with respondents on landline telephones and cellular phones, with interviews conducted in Spanish for respondents who are primarily Spanish-speaking. Each sample of national adults includes a minimum quota of 50% cell phone respondents and 50% landline respondents, with additional minimum quotas by region. Landline telephone numbers are chosen at random among listed telephone numbers. Cell phones numbers are selected using random digit dial methods. Landline respondents are chosen at random within each household on the basis of which member had the most recent birthday.

Samples are weighted to correct for unequal selection probability, nonresponse, and double coverage of landline and cell users in the two sampling frames. They are also weighted to match the national demographics of gender, age, race, Hispanic ethnicity, education, region, population density, and phone status (cellphone only/landline only/both, cellphone mostly, and having an unlisted landline number). Demographic weighting targets are based on the March 2012 Current Population Survey figures for the aged 18 and older U.S. population. Phone status targets are based on the July-December 2011 National Health Interview Survey. Population density targets are based on the 2010 census. All reported margins of sampling error include the computed design effects for weighting.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

For more details on Gallup’s polling methodology, visit www.gallup.com.

English: President Barack Obama's signature on...

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

 

 

October 21, 2013 Posted by | Health Statistics | , | Leave a comment

More than 900 Champions for Coverage Help Americans understand the Health Insurance Marketplace

Logo of the United States Department of Health...

Logo of the United States Department of Health and Human Services. The symbol represents the American People sheltered in the wing of the American Eagle, suggesting the Department’s concern and responsibility for the welfare of the people. The logo is the department’s main visual identifier; the seal is now used for mainly legal purposes. The color can be either black or reflex blue. More information here and here. (Photo credit: Wikipedia)

 

From the 30 September US Health and Human Services press release

 

Health and Human Services (HHS) Secretary Kathleen Sebelius today recognized more than 900 Champions for Coverage nationwide. These organizations and businesses have volunteered to help Americans without affordable insurance learn more and get coverage through the Health Insurance Marketplace, which opens for business tomorrow and will give consumers a whole new way to shop and purchase affordable, high quality health coverage.

“A network of volunteers on the ground in every state – health care providers, business leaders, faith leaders, community groups, advocates, and local elected officials – can help spread the word and encourage their neighbors to get enrolled,” said Secretary Sebelius.

Champions for Coverage include national and local businesses and organizations – bloggers, community health centers, hospitals, communities of faith, and civic organizations. They will use publicly available materials from the Centers for Medicare & Medicaid Services (CMS) – both digital and in print – to help members of their communities understand their new options through the Marketplace. There are many ways these organizations are helping, including providing information about the law in their office, hosting education events, or posting information on their website.

“We are both excited and thankful to have such a wide variety of businesses and organizations that want to get involved and help us spread the message about these new opportunities for people to access quality, affordable health insurance with open enrollment beginning tomorrow,” said CMS Administrator Marilyn Tavenner. “Coverage for those who enroll by December 15 will begin on January 1, 2014.”

The growing list of organizations includes:

  • American Academy of Family Physicians
  • American Nurses Association
  • Bon Secours Health System
  • Huntington’s Disease Society of America
  • Men’s Health Network
  • National Women’s Law Center
  • Lutheran Services in America
  • Thrifty White Pharmacy
  • YWCA USA

In all states, there will be people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names, depending on who provides the service and where they are located.  Using the “Find Local Help” tool, you can find information about assisters like Navigators, application assisters, certified application counselors, and government agencies.

Consumers can also find help at local community health centers and libraries. The Marketplace consumer call center is open 24 hours a day, 7 days a week at 1-800-318-2596 (hearing impaired callers using TTY/TDD can dial 1-855-889-4325), with translation services available in 150 languages. Visit HealthCare.gov or CuidadodeSalud.gov to learn more or participate in a live chat with a trained customer service representative.

Enrollment in the Health Insurance Marketplace continues for six months. Consumers can apply and choose a plan until the end of March, with coverage beginning as early as Jan. 1, 2014.

To see the list of Champions for Coverage visit: http://marketplace.cms.gov/help-us/champion.html.

To join the growing list of Champions for Coverage, visit: http://marketplace.cms.gov/help-us/champion-apply.html.

 

 

 

October 21, 2013 Posted by | health care | , , , , | Leave a comment

[Repost] Policy: Doctors Urged to Talk About Costs of Treatment & A Related Personal Story

Flashback— About 20 years ago I was in an urgent care center around 11 pm with a severe migraine.  The doctor was getting ready to give me a shot with appropriate medication.  At the time I was unemployed with little money. So I asked him if I could get a prescription for capsules/tablets instead, and how much the shot would be. He looked a bit startled, but looked up the information for me.  I opted for the capsules/ tablets. My mother, bless her, drove me to a nearby hospital so I could get the prescription filled. Was very grateful the medication kicked in within 10 minutes or so. Will never forget the compassionate professionalism of that physician.

Flashback II – About 25 years ago I had rather painful wrists (not carpal tunnel) and went to a doctor.  (From a temp job, basically keyboarding for hours at end.) Again, I was uninsured with little money.. Went to the doctor with a book from the library with exercises to relieve pain in the wrists.  Asked the doctor what he thought about them.  Told him I was uninsured and didn’t have much money. The doctor didn’t say much. Just directed me down the hall to a physical (occupational?) therapist.  The therapist gave me several pages of exercises and went over them with me.  I asked her what the additional charge for her services was. She said nothing.  Again, the doctor showed compassionate professionalism. Such a “business” where the staff communicated well and worked with each other for the customer’s benefit!  Oh, and the exercises worked, and I keyboarded with better ergonomics as outlined in the handouts given.

From the 18 October 2013 article at Concierge Medicine Today

by David Pittman, Washington Correspondent, MedPage Today

Oct 16, 2013 - Physicians need to broach discussions about out-of-pocket costs with patients the same way they discuss a treatment’s side effects, public policy professors wrote.

“Admittedly, out-of-pocket costs are difficult to predict, but so are many medical outcomes that are nevertheless included in clinical discussions,” Peter Ubel, MD, of Duke University’s School of Public Policy, and colleagues wrote.

They noted in a New England Journal of Medicine perspective published Wednesday that patients can experience considerable financial strain from out-of-pocket costs, with little or no discussion beforehand about potentially avoidable health-related bills.

“Because treatments can be ‘financially toxic,’ imposing out-of-pocket costs that may impair patients’ well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments’ side effects,” the authors wrote.

They gave the example of a colon cancer patient who receives bevacizumab (Avastin), which can help prolong life by 5 months over chemotherapy alone.

Many providers don’t mention that the drug can cost $44,000 for 10 months of therapy, Ubel and others wrote. A Medicare patient responsible for 20% of the cost can expect $8,800 in out-of-pocket costs on top of other treatment costs, doctor’s fees, and diagnostic tests. The out-of-pocket costs can be even higher for patients with high-deductible insurance plans.

“Most physicians insist on discussing the 2% risk of adverse cardiovascular effects associated with bevacizumab, but few would mention the drug’s potential financial toxicity,” the authors noted.

More than one in five patients covered only by Medicare (20.9%) reported some kind of financial burden, according to the National Center for Health Statistics data the authors cited. Even 30.4% of privately insured patients under age 65 reported some financial burden from medical care.

The authors suggested that taking the time to discuss what can be an uncomfortable topic may:

  • Enable patients to choose lower-cost treatments when available
  • Help patients who are willing to trade medical benefit for financial distress
  • Enable patients to seek financial assistance earlier and avoid duress

In addition, evidence suggests that considering costs as part of clinical decision-making might reduce long-term costs to society, the authors noted. For example, some physicians feel it’s their responsibility to provide the best care regardless of costs, and patients worry that inquiring about prices will pit them against doctor’s orders and open them to subpar treatment.

Physicians lack training in this area, and may feel uncomfortable or may not know what a patient’s costs will be since it depends on what health insurance plan they have. “It is often difficult to determine a patient’s out-of-pocket costs for any given intervention,” Ubel and colleagues wrote.

But insurance companies are developing ways to better estimate patients’ costs, the perspective stated. Furthermore, policymakers need to push for greater price transparency, especially when it comes to prices borne by patients.

“We can no longer afford to divorce costs from our discussion of patients’ treatment alternatives,” they wrote.

October 19, 2013 Posted by | health care | , , , , | Leave a comment

[Reblog] New IRS website provides health care law information for just about everyone

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From the 28 August 2013 post at Mountjoy Chilton Medley

Many provisions of the Patient Protection and Affordable Care Act of 2010 have recently gone into effect, and some significant provisions will do so in 2014 and 2015. To help individuals and families, employers (both large and small), and other organizations learn more about how they’ll be affected, the IRS has launched a new website: IRS.gov/aca. The site offers information on the tax benefits and responsibilities for various groups, such as:

  • Individuals and families — new additional Medicare taxes, changes to the itemized medical expense deduction and open enrollment for the Health Insurance Marketplace
  • Employers — determining whether you’re a large or small employer, shared responsibility payments for large employers, and the small business health care tax credit
  • Other organizations — tax provisions for insurers, certain other business types and tax-exempt and government organizations

Related Resources

August 30, 2013 Posted by | Consumer Health | , , , | Leave a comment

Useful Video For Understanding 2014 Health Care Changes and “Obama Care”

Great 7 minute overview, published by KaiserHealthCare. Really liked how the graphics (including Playschool like cartoon figures) outlined the major points without making me feel like a dummy!

From the 26 August 2013 post at Sara Zia Ebrahimi

Do you have a good sense of what the new health care options are starting 2014? The HR folks at work just shared this cute 7minute video that does a good job of clarifying what the options are and the advantages and disadvantages of each. I found it really useful and thought I’d pass it along.

Excerpts

  ” Individual exchanges in 34 states will be created via the federal government – but on July 5, it quietly granted another concession. The Department of Health and Human Services relaxed a requirement for the 16 other states and the District of Columbia to verify the income and health coverage status of applicants to those individual exchanges. These 17 exchanges will only check the income eligibility of applicants at random next year, and they will wait until 2015 to check if applicants are getting employer-sponsored health benefits.5″

Where do things stand state-by-state with the Medicaid expansion? Just 23 states and the District of Columbia have signed up for it. (You’ll recall that the Supreme Court allowed states to opt out of it when it ruled that the ACA was constitutional in 2012.) In these states and in Washington D.C., those with earnings of up to 138% of the federal poverty level may qualify for Medicaid (that works out to earnings of $15,856 for an individual and $32,499 for a family of four). The expansion of Medicaid in these states doesn’t require the federal government to recreate the wheel, but delays could happen in other ways. In Michigan, for example, state legislators have passed their own version of a Medicaid expansion requiring a 90-day federal review process, which will put Michigan weeks behind in enrolling participants in expanded Medicaid coverage.6,”

August 28, 2013 Posted by | health care | , , , , , , , , , | Leave a comment

North Carolina Just Made It A Lot Easier To Figure Out If Your Hospital Is Ripping You Off

From the 23 August 2013 Think Progress article

North Carolina Gov. Pat McCrory (R) has signed abill that will require the state’s hospitals and ambulatory surgical centers to publicly disclose how much they charge — and how much insurers pay them — for 140 common medical procedures. The information will be posted to the Tar Heel State’s Department of Health and Human Services website and provide consumers a way of knowing which hospitals are giving them the most bang for their buck.

….

The federal government took a small step towards addressing this lack of transparency by releasing charge records for the most common inpatient procedures at more than 3,300 hospitals across 306 locales in May. The numbers confirmed health care experts’ suspicions: the cost of U.S. medical care is essentially arbitrary, with even hospitals in the same county charging anywhere from $7,000 to $99,700 for the same procedure. And the hospitals charging the most money don’t even offer much better services. Reform advocates say these staggering fluctuations are a direct result of price opacity.

But North Carolina’s law actually goes further than the federal government did by giving consumers even more relevant information. The top-line charge data released by the government isn’t actually what insurers and patients pay hospitals. The actual payments are negotiated between the hospitals, insurers, and uninsured Americans. To address that, the North Carolina will require hospitals to disclose the actual prices paid by Medicare, Medicaid, and Americans without any health coverage for the procedures in question, as well as the average and range of prices paid by the top five insurers in the state.

Read the entire article here

 

August 25, 2013 Posted by | health care | , , , , , | Leave a comment

[Reblog] Six Questions About Obamacare Answered

Health Insurance Forum

Health Insurance Forum (Photo credit: Aaron Landry)

From the 6 August 2013 post at Learn in Health, Living and Insurance

As a late 20-something, I could very possibly be a member of the “young invincibles,” a label used to describe people between 18 and 34 who do not have health insurance because they think they’re, well… invincible (not to mention broke).
I lucked out in that five years ago, I somehow found myself working for the largest private statewide health foundation in California, dedicated to improving the health status of underserved populations in California. The ability for communities to have solid access to health care is one of our core values. As a reflection of this value, a variety of health insurance options are provided to our employees at a very affordable rate.
As most of us know, not everyone is so lucky. 

Recently, at a party during a “what do you do” conversation, a freelance screenwriter (struggling to make ends meet) asked me what he could do to get health insurance being single, unemployed, and having a few health issues to tackle. 

He, like many of us, will be required to have health insurance pretty soon. But beyond that, we don’t know much. 

So I spent some time today leafing through healthcare.gov and other sites with any 411 to get the quick down-and-dirty of what we all need to know going into January 1, 2014, when most of us will be required to have health insurance.
1. Who needs to have health insurance?


Read the entire article here
Related Resource
Visit USA.gov’s Health Insurance page to learn about the new Health Insurance Marketplace and other types of health coverage.

Starting October 1, 2013, you can fill out an application for health insurance through the Health Insurance Marketplace. You’ll be able to compare your options side-by-side and enroll in a plan that fits your budget and meets your needs. Coverage takes effect as early as January 1, 2014. 

USA.gov’s Health Insurance page includes:

  • A brief overview on health insurance and the Affordable Care Act.
  • Key dates for enrollment and coverage through the Health Insurance Marketplace.
  • Publications to help you prepare for enrollment through the Health Insurance Marketplace.
  • Information about Medicaid, Medicare, the Children’s Health Insurance Program, and COBRA.

 

August 16, 2013 Posted by | health care | , , | 1 Comment

[Reblog] The Uninsured Mentally Ill

From the 10 August 2013 post at League of Bloggers for a Better World

Here’s a scary fact: A single hospital admission for a mentally ill patient paid for by the taxpayer-financed state medical-assistance program costs more than a year of private outpatient care. It makes little financial sense, yet it happens every single day in America.

Everyday, a mentally ill person is admitted to an ER in the throes of a psychiatric emergency, desperately needing care and having nowhere else to go. No psychiatrist, no therapist, no case manager, no nothing. So they rely on ER doctors and nurses- and tax payers. But after the patient gets emergency care, they are back on their own. Until it happens again.

So why do these patients lack proper, long term psychiatric care that could provide regular treatment? Why do they end up in this endless cycle? The answer is simple, yet still disturbing- they have no health insurance.

Psychiatrist Christine Montross wrote an article,”The Woman Who Ate Cutlery,” about this quandary that many mentally ill people who lack health insurance face on a regular basis. The article was featured in the New York Times on August 3, 2013.

From NYTimes.com:

PROVIDENCE, R.I. — M is a 33-year old woman who swallowed silverware. Each time she ingested utensils, she went to the emergency room so that doctors could remove them from her esophagus and stomach.

Then the hospital transferred M to the psychiatric unit, where she was assigned to my care. When I met M she had already been hospitalized 72 times.

M’s case is dramatic. But she is one of countless psychiatric patients who have nowhere to turn for care, other than the E.R.

It is well known that millions of uninsured Americans, who can’t afford regular medical care, use the country’s emergency rooms for primary health care. The costs — to patients’ health, to their wallets, and to the health care system — are well documented. Less visible is the grievous effect this shift is having on psychiatric care and on the mentally ill.

How could this cycle of self-injury be disrupted? M and other psychiatric patients who turn to emergency rooms for care need regular outpatient appointments with a doctor they know and trust who can monitor their symptoms and assess the efficacy of their often complicated medication regimens.

Sadly, M’s history of recurrent hospital admissions is not uncommon. Recently I treated a 65-year-old man caught in a chronic cycle of homelessness and suicide attempts who had been in and out of the E.R. 246 times. If M had insurance, or enough money to pay out of pocket, she might see a therapist every week for an hour and a psychiatrist once or twice a month.

For full article, go to nytimes.com.

 

August 10, 2013 Posted by | health care, Psychiatry, Psychology | , , , , , | Leave a comment

Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns

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 Reblogged from 21st Century Library Blog:

While I’ve been busy with other things, I let this issue raised at ALA slip past unnoticed. Issues in library world don’t go unnoticed for very long, especially when they deal with government intrusion. Apparently, during ALA 2013 Conference a video was played in which there was a White House appeal to public librarians to help Americans understand the new Affordable Healthcare Act insurance system that goes into effect whenever – maybe.

Read more… 1,597 more words

I am hoping that the federal government can do a bit more to provide resources for librarians about ACA.

Back in my public library days, it wasn’t easy working with patrons when the topic was against my views!

However, I always tried to address people’s information needs without bias and as completely as possible with factual information.

“ObamaCare” questions are in the same arena.  While librarians cannot advise or fill out forms, they can at least lead folks to factual information. However, this would work best if the federal government would do everything possible to lighten the load for libraries.  This would include providing readable materials for consumers, as well as “pathways” for librarians.

Also, libraries can welcome trained volunteers and organizations to give in-depth information to folks. Many already do this around tax time with IRS trained volunteers.

Here in Toledo, folks from legal aid organizations “set up shop” in public libraries to assist folks. Representatives from the Ohio Benefit Bank do likewise. These volunteers screen people for government assistance programs as SNAP and the Medicare Savings Program.

It sure would be great if government employees and/or trained volunteers could do likewise for “ObamaCare”.  Areas could include the health exchange marketplace, Medicaid expansion, free preventative care, and more.

And with articles as this, there is a real need for information professionals, including librarians!

Ohio insurance department claims Obamacare premium rates to rise 41 percent (Cleveland Plain Dealer, August 1, 2013)

Ohio insurance regulators Thursday released rates for health insurance to be sold on the new state marketplace and said premiums for individuals will rise an average of 41 percent compared with 2013 rates.
That average brought immediate condemnation from critics of the Affordable Care Act, with U.S. House Speaker John Boehner, a southwest Ohio Republican, calling it “irrefutable evidence” that the law known as Obamacare is driving up costs and hurting the economy……..

Related articles

“…only 11 percent of respondents presented with a traditional insurance plan incorporating all four of these elements were able to compute the cost of a four-day hospital stay when given the information that should have enabled them to do so…

“”The ACA deals with the problem of consumer misunderstanding by requiring insurance companies to publish standardized and simplified information about insurance plans, including what consumers would pay for four basic services,” noted lead author Loewenstein. “However, presenting simplified information about something that is inherently complex introduces a risk of ‘smoothing over’ real complexities. A better approach, in my view, would be to require insurance companies to offer truly simplified insurance products that consumers are capable of understanding.”

August 2, 2013 Posted by | Consumer Health, health care, Librarian Resources | , , , , , , | Leave a comment

[Reblog]Reform creates new incentives in health care

An aside…
Twice a week I volunteer at a soup kitchen/clothing distribution center. And three times a week I make phone calls screening folks for the Social Security Extra Help program which helps very low income people with their prescription drug costs.

English: U.S. Health Insurance Status (Under 65)

English: U.S. Health Insurance Status (Under 65) (Photo credit: Wikipedia)

Many folks are hard pressed to come up with $4.00 copays.
Reblog From the 24 July 2013 article at Kevin MD

 | POLICY | JULY 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage.  Internists, pediatricians, family physicians are already working at full capacity in caring for the general health needs of a community. The poorest neighborhoods with the worse reimbursements already have a severe shortage of providers. More people with health care coverage, means more people will be seeking routine care, and we don’t have more providers ready to see them all.

For patients, this will mean longer waits to see a provider.  Or for providers, it will mean longer hours at work to see more patients.

Second, the ability to buy subsidized health insurance doesn’t automatically mean the ability to pay for health care.

I just learned that patients who are unable to pay their co-pays within 90 days may then need to face the entire medical bill on their own. How bad can a co-pay be, you may ask?

“When I say I have zero income, that means I have no money. None,” said one of my patients from the community health center where I work as a family physician on the South Side of Chicago, when I was encouraging him to buy generic medications at Walmart or Target. “$4 is too much for me,” he said.  “I’d need to steal to buy it. “

Zero income means an enormous challenge to pay anything, borrowing from a network of friends and relatives and searching out social programs for medical assistance. In some states, Medicaid will be expanded to cover everyone who is near the federal poverty line.  Other states are choosing not to expand coverage to young men.  Private insurance plans may effectively leave them unable to afford health care, even if they are able to afford subsidized health insurance on the state exchanges.

When patients who live on the financial edge, who currently don’t have health insurance miss their co-payments, they will become liable to pay the entire cost of the doctor’s visit.  After 90 days with no co-pay, then insurance companies would owe nothing.  The people who are poorest , who have the toughest time scraping together the money to cover their co-pays, may ultimately be responsible for paying not only their co-pay, but the entire medical bill, while also paying insurance premiums.

This would be unfortunate.

I wish we could turn back the clock and create a simpler system where everyone had access to care without needing to worry about who pays what.  Instead we have recreated pricing mechanisms that in effect result in tiered payments where the poorest patients continue to pay the most.

People are poised to buy into a broken system at the stroke of midnight announcing January 1, 2014.

The health insurance exchanges are coming—faciliating the buying and selling of imperfect products that promise access they can’t fully deliver, while potentially leaving vulnerable patients without full access to health care.

And still this is better than the alternative, where patients had no coverage at all, and the system wasn’t incentivized to find ways to become more efficient and more effective.

There will be new incentives in healthcare.  We’ll see what happens. The American healthcare system will need to continue to adjust to the needs of patients, to be responsive to the most vulnerable, in order to ensure a healthier America.

Kohar Jones is a family physician who blogs at Progress Notes.

  • The Math of State Medicaid Expansion (jflahiff.wordpress.com)
  • When considering health care costs, US physicians prioritize patients’ best interests (Medical News Today)
  • Viewpoints: Finding the benefits in reforming health care (sacbee.com)
  • Physician Skepticism About the Basic Doctrines of Health Care Reform: We’re In This Together and, by the way, More Believe In Care Management Than the EHR (diseasemanagementcareblog.blogspot.com)
  • Oregon medical community gears up for expansion (kansascity.com)
  • Cash-only doctors abandon the insurance system (money.cnn.com)
  • Railroading the health care law (kansascity.com)
  • My Family’s Obamacare (zocalopublicsquare.org)
  • Highmark forms alliance in bid to cut health costs (triblive.com)
  • Major Health Insurer Pulls Out of South Carolina, Two Other States, Because of ObamaCare (pjmedia.com)
  • Poll: only 11 percent of doctors think the ObamaCare exchanges will be ready (humanevents.com)
  • Views of US Physicians About Controlling Health Care Costs (Full Text Reports)
    July 24, 2013

    Views of US Physicians About Controlling Health Care Costs
    Source: Journal of the American Medical Association

    Importance
    Physicians’ views about health care costs are germane to pending policy reforms.

    Objective
    To assess physicians’ attitudes toward and perceived role in addressing health care costs.

    Design, Setting, and Participants
    A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.

    Main Outcomes and Measures
    Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.

    Results
    A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for “eliminating fee for service” (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the “uncertainty involved in patient care disconcerting” was negatively associated with cost-consciousness (β = −1.95; 95% CI, −2.71 to −1.18; P < .001).

    Conclusion and Relevance
    In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.

    The increasing cost of US health care strains the economy. Because physicians’ decisions play a key role in overall health care spending and quality, several recent initiatives have called on physicians to reduce waste and exercise wise stewardship of resources.1- 4 Given their roles, physicians’ perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general are increasingly germane to recent pending and proposed policy reforms.5 We surveyed US physicians about their views on several potential proposed policies and strategies to contain health care spending, assessed physicians’ perceived roles and responsibilities in addressing health care costs, and ascertained physician characteristics associated with those views.

July 25, 2013 Posted by | health care | , , | Leave a comment

Why Health Care is a Civil Right

Health care systems

Health care systems (Photo credit: Wikipedia)

 

I rarely overtly “get political” at my  blog.
However, this seems to go beyond politics to what living in a functional democracy or republic is all about.

 
From the 31 October 2012 article at Medical News Today

 

I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.

Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.

 

Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …

  • I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
  • I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
  • I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.

None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.

One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.

Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.

Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.

 

 

 

October 31, 2012 Posted by | health care | , , , , , | Leave a comment

Rational Rationing vs. Irrational Rationing

 

English: This image depicts the total health c...

English: This image depicts the total health care services expenditure per capita, in U.S. dollars PPP-adjusted, for the nations of Australia, Canada, France, Germany, Japan, Switzerland, the United Kingdom, and the United States with the years 1995, 2000, 2005, and 2007 compared. An ‘OECD Health Data 2010′ report is used for the information, which is available here. Note that there is additional information in this list. (Photo credit: Wikipedia)

 

Rational Rationing vs. Irrational Rationing By DAVID KATZ, MD in the 13 September 2012 article at The Health Care Blog

Excerpts

n a system of universal, or nearly universal health insurance such as in Massachusetts, decisions about what benefits to include for whom are decisions about the equitable distribution of a limited resource. If that is rationing, then we need to overcome our fear of the word so we can do it rationally. By design or happenstance, every limited resource is rationed. Design is better.

In the U.S. health care system, some can afford to get any procedure at any hospital, others need to take what they can get. Some doctors provide concierge service, and charge a premium for it. Any “you can have it if you can afford it” system imposes rationing, with socioeconomic status the filter. It is the inevitable, default filter in a capitalist society where you tend to get what you pay for.

That works pretty well for most commodities, but not so well for health care. As noted, failure to spend money you don’t have on early and preventive care may mean later expenditures that are both much larger, and no longer optional — and someone else winds up paying. If you can’t afford a car, you don’t get one; if you can’t afford care for a bullet wound — if you can’t afford CPR — you get it anyway, and worries about who pays the bill come later.

But those costs, and worries, do come later — and somewhere in the system, we pay for them.

By favoring acute care — which can’t be denied — our current system of rationing dries up the resources that might otherwise be used for both clinical preventive services and true health promotion. Fully 80 percent of all chronic disease could be eliminated if our society really rallied around effective strategies for tobacco avoidance, healthful eating, and routine physical activity for all. But when health care spending on the diseases that have already happened is running up the national debt, where are those investments to come from? The answer is, they tend not to come at all. And that’s rationing: not spending on one thing, because you have spent on another.

Nor is this limited to health care. The higher the national expenditure on health-related costs, the fewer dollars there are for other priorities, from defense, to education, to the maintenance of infrastructure. If cutting back on defense calls the patriotism of Congress into question, then classrooms get crowded and kids are left to crumble. Apparently, it is no threat to patriotism to threaten the educational status of America’s future. …

 

 

 

 

September 14, 2012 Posted by | health care | , , , , , , , | 1 Comment

Top Ten Myths of Medicare

 

From the Full Text Report abstract

Top Ten Myths of Medicare

August 26, 2012

Top Ten Myths of Medicare
Source: Social Science Research Network

In the context of changing demographics, the increasing cost of health care services, and continuing federal budgetary pressures, Medicare has become one of the most controversial federal programs. To facilitate an informed debate about the future of this important public initiative, this article examines and debunks the following ten myths surrounding Medicare: (1) there is one Medicare program, (2) Medicare is going bankrupt, (3) Medicare is government health care, (4) Medicare covers all medical cost for its beneficiaries, (5) Medicare pays for long-term care expenses, (6) the program is immune to budgetary reduction, (7) it wastes much of its money on futile care, (8) Medicare is less efficient than private health insurance, (9) Medicare is not means-tested, and (10) increased longevity will sink Medicare.

 

 

August 27, 2012 Posted by | health care | , , , , , | Leave a comment

Health Insurance: Those Who Are Covered, Recover

 

From the 7 August 2012 article at Science News Daily

Underinsured CVD patients die sooner than patients with private insurance, irrespective of race…

Insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease. A new study by Derek Ng, from the Johns Hopkins Bloomberg School of Public Health in the US, and his team shows that race is not linked to an increased risk of death but being underinsured is a strong predictor of death among those admitted into hospital with a serious cardiac event. Their work appears online in the Journal of General Internal Medicine, published by Springer…

g and colleagues looked at whether the risk of early death was associated with insurance status or race. They took into account the potential effects of neighborhood socioeconomic status and disease severity. They analyzed data from a sample of patients admitted to one of three Maryland hospitals for three specific cardiovascular events: 4,908 with acute myocardial infarction (or heart attack); 6,758 with coronary atherosclerosis (or furring up of the arteries); and 1,293 with stroke.

They found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.

The authors conclude: “Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”

 

August 8, 2012 Posted by | health care | , , , , | Leave a comment

Life After the American Community Survey?

I am very concerned how federal funding for socioeconomic programs is going to be distributed equitably without relevant, current,  and reliables statistical information….

From the 22 May 2012 article at Stateline Daily

The U.S. Senate is expected to vote next month on an appropriations bill that could end the U.S. Census Bureau’s survey of state and local population, income, health and other data. Known as the American Community Survey, the federally funded program continuously samples about 3.5 million households each year to produce crucial data used to divvy some $400 billion in government money to states and localities, according to the Census Bureau.

Medicaid is the biggest federal program that relies on American Community Survey data to shift funding when states’ average incomes rise or fall. At about $270 billion in federal funding and nearly a quarter of state budgets, the federal-state health insurance program for low-income people uses the survey’s income data to determine federal allocations that can have huge impacts on state budgets.

Allocation of education grants, highway money and other social services funding also rely on the data.  States also use the information to allocate state money to county and local governments. So far, it is unclear what data the federal government would use to allocate billions in grant money, if the survey is discontinued…

May 23, 2012 Posted by | Public Health | , , , , | Leave a comment

Planning for an Aging Nation: New Estimates to Inform Policy Analysis for Senior Health

Hillary Clinton Health care elderly

Hillary Clinton Health care elderly (Photo credit: Wikipedia)

From the excerpt at Full Text reports (with link to report)

This dissertation contains three papers on the health and welfare of the elderly population. Overall, these papers provide insights into the costs and challenges of providing health care to the elderly population. These papers help us understand the effects of obesity on longevity and health care, as well as better understand the benefits of social insurance. The first paper uses a micro-simulation model to estimate the longevity effects of poor health trends among younger Americans, and finds that difference in these trends can explain 92% of the difference between US and European longevity. The second paper estimates the welfare effects of Medicare Part-D from gains in market efficiency and dynamic incentives for pharmaceutical companies. It finds that these gains alone nearly cover the welfare cost of funding Medicare Part-D. The last paper presents and estimates a structural model of health, exercise, and restaurant consumption. It provides estimates for future welfare analyses of programs targeting obesity through restaurants and exercise in the elderly population. It also estimates the long run effects of making policies which make restaurant food healthier. It finds only minor effects of restaurant policies on health for the elderly. Overall, these papers further our understanding of the challenging objective of improving senior health while containing costs.

 

April 20, 2012 Posted by | health care | , , , , | Leave a comment

Employers Tie Financial Rewards, Penalties To Health Tests, Lifestyle Choices

From the 2 April 2012 Kaiser article

Once a year, employees of the Swiss Village Retirement Community in Berne, Ind., have a checkup that will help determine how much they pay for health coverage. Those who don’t smoke, aren’t obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductible…

…Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.

Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up healthcare costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.

Consumer Tips: Workplace Wellness Plans

More and more employers are tying financial reward and penalties to workers completing a set of medical tests. KHN’s Julie Appleby says the tests can include blood pressure, cholesterol and blood sugar. Watch the video.
Employee reaction has also been mixed….

..Some workers complain the programs are an intrusion into their private lives.

“They portrayed it as voluntary, which it isn’t, because if you don’t participate, they fine you every paycheck,” says Seff, the former Broward employee who is suing over the program. He has since retired on disability with back and neck problems. “I don’t think any employer should do it.”

In an effort to slow rising health care costs, Broward County in 2009 began asking workers to fill out a health information form and have a finger-stick blood test each year to check blood sugar and cholesterol levels, according to court filings. Workers who declined were docked $40 a month.

Those who did participate were offered disease management programs if they had asthma, high blood pressure, diabetes, congestive heart failure or kidney disease. The county stopped docking those who declined to participate Jan. 1, 2011, after Seff’s suit was filed, court documents say.

The lawsuit, which argues the county’s program violates the Americans with Disabilities Act, is likely the first of its kind in the nation, says Seff’s attorney Daniel Levine in Boca Raton, Fla. Without ruling on whether the wellness effort was voluntary, a federal district court judge backed the county in April, 2011, saying the plan fell under provisions of the law meant to protect bona fide benefit programs. The case is now on appeal. Broward County attorneys did not return requests for comment.

Some state lawmakers are also concerned about the potential for discrimination. ..

..Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high deductible policies, which shift more costs onto workers.

“We just don’t know how effective (incentives) are,” says Volpp. There is pretty good evidence they help smokers quit, he says, but less that they prompt workers to lose weight and keep it off.

Weight gain is partly a function of genes and environment, he says, so programs that tie incentives to achieving a particular weight range are “in essence, penalizing people for factors they can’t control or can only partly control” – either because they’ve failed to lose weight or haven’t participated in the program.

Volpp says the medical literature shows that incentives work best when participants have choices: get below a certain BMI, or lose 5 percent of current body weight, for example. And, he says, rewards should be immediate.

“If you want the employee to do a health assessment or (medical) screening, you should give them the reward right after they do it” he says.

At Jones Lang LaSalle, workers who make a pledge — on the honor system — that they don’t smoke, or will take a stop-smoking class, and achieve a healthy weight, get 10 percent off their contribution toward insurance premiums….

Read the entire article here

April 10, 2012 Posted by | health care, Workplace Health | , | Leave a comment

The Cost of Coercion [Yes, One Can Refuse Medical Procedures and Continue Health Care Insurance Coverage)(via The Health Care Blog)

From The Cost of Coercion (a February 28, 2012 posting at The Health Care Blog)

Dr. John Schumann dispels what seems to be an urban myth – if one refuses a procedure then one is responsible for any hospital charges not covered by one’s health insurance related to the decision to decline the procedure.

The case presented involves a person who did not wish to undergo an invasive (and expensive) medical procedure: cardiac catheterization. The intern told the patient that if she refused to undergo the procedure, “that she would have to sign out ‘against medical advice’ (AMA). To signify this she would have to acknowledge that leaving AMA could result in serious harm or death. In addition, Ms. DiFazio would bear responsibility for any and all hospital charges incurred and not reimbursed by her insurance due to such a decision.”

In the rest of the article, Dr. Schumann explains how he researched this and found quite the opposite – “that the idea of a patient leaving AMA [against medical advice] and having to foot their bill is bunk: nothing more than a medical urban legend.”

March 4, 2012 Posted by | health care | , , , , | Leave a comment

Question the price of drugs and medical procedures (Suggestions for Additional Resources Most Welcome!)

English: This image depicts the total health c...

This image depicts the total health care services expenditure per capita, in U.S. dollars PPP-adjusted, for the nations of Australia, Canada, France, Germany, Japan, Switzerland, the United Kingdom, and the United States with the years 1995, 2000, 2005, and 2007 compared.

February 18, 2012 Posted by | health care | , , | Leave a comment

Why we need to go from e-patient to i-patient (insurance savvy patient)

From the 3 February 2012 KevinMD column  by Jackie Fox

I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what the language would look like.)

 

My initial thought was what a shame it would be to lose that provision. But then my mind flipped to the e-patient movement and how it’s teaching people to be active participants in our medical care. That means learning as much as we can about our conditions and treatment options and sometimes questioning our doctors’ recommendations.

It occurred to me that when we focus only on doctors, we’re missing a very sizable forest for the trees.  One of the overriding concerns of health care reform is getting costs under control. …

This is where I think the “i-patient” needs to step up: “i” for insurance-savvy. We should be demanding to know what insurance companies’ decisions are based on when they deny a claim. My oncologist told me one of his denials was based on the assessment of a general practitioner hired by the insurance company. Without the specialized knowledge of blood markers an oncologist has, this doctor didn’t realize that the normal marker used as a basis for denial wasn’t a good indicator. Where does that leave my oncologist and his decades of experience?  Like he told me, “Medicine is not like taking a car to a shop.” Patients need to know about this. When selecting an insurance company, we should know which ones have the worst record of denying claims.

We also should be keeping a close watch on electronic medical records, beyond simply demanding access to our own records. I recently read a fascinating post by Adam Sharp, MD, founder of par80 & Sermo, called “Why EMR is A Four-Letter Word to Most Doctors.” He explained how EMRs were largely a top-down effort, allowing third parties to implement policies by simply removing options from the EMR.  “If you can’t select a particular treatment option, for all intents and purposes, it doesn’t exist or the red tape to choose it is so painful that there is little incentive to fight the system.”…

…We need an i-patient movement to make sure our voices are heard and our choices are preserved. We need to ensure those choices are made in partnership with our doctors, not handed down to both of us by some invisible third-party payer. We have a Society for Participatory Medicine (I’m a member); maybe it’s time we had a Society for Participatory Insurance. Because our doctors can’t fight this battle alone.

 

 

February 8, 2012 Posted by | health care | , , | Leave a comment

Short Animated Video on Current Health Care System Changes – Kaiser Health Reform

Health Reform Hits Main Street – Kaiser Health Reform

From the Kaiser Health Reform Source Web page

Confused about how the new health reform law really works? This short, animated movie — featuring the “YouToons” — explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Learn more about how the health reform law will affect the health insurance coverage options for individuals, families and businesses with the interactive feature “Illustrating Health Reform: How Health Insurance Coverage Will Work.”

January 31, 2012 Posted by | health care | , , , , | Leave a comment

When a colonoscopy (or other insurance approved screening ) might not be free

From the January 2012 blog posting ,Place the frustration of cost uncertainty on health insurers
by Kevin Pho at KevinMD.com

As we enter 2012, many patients will be changing to new insurance plans.

And for a few, deductibles will be rising.

One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”

However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.

From USA Today,

Bill Dunphy thought his colonoscopy would be free.

His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.

Then the bill arrived: $1,100.

The reason? During the procedure, polyps were found and rightfully removed. But in doing so, it changed the colonoscopy from a screening procedure to a diagnostic procedure, thus making it applicable to the patient’s deductible.

Such semantics are important, as insurance companies will seize them at every opportunity to pass on costs to both patients and hospitals….

Read the entire article by Kevin Pho

 

January 4, 2012 Posted by | health care | , , , , , , , | Leave a comment

AMA: New policies that will impact the future of medicine

AMA

 

From the 14 December article at KevinMD.com by 

The AMA adopted new policy that, among other things, supports legislation that would require manufacturers of all drugs and biologics to notify the FDA of any discontinuance, interruption or adjustment in the manufacture of a drug that may result in a shortage. The AMA will also advocate for the FDA and/or Congress to require drug manufacturers to establish a plan for continuity of the supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible.

With the implementation of the Affordable Care Act underway, health insurance exchanges have received significant attention as a new way for millions of Americans to obtain health insurance coverage from private insurers. New AMA policy supports using the open marketplace model for exchanges to increase competition and maximize patient choice. The policy also asks the AMA to advocate for the inclusion of actively practicing physicians and patients in health insurance exchange governing structures and for developing systems that allow for real-time patient eligibility information.

In addition to promoting the open marketplace model for health insurance exchanges, the AMA continued to endorse giving Medicare patients greater choice in seeing the physicians they want and need to see. The AMA reaffirmed support for the Medicare Patient Empowerment Act, which would eliminate current restrictions on private contracting with Medicare patients. New policy calls on the AMA to initiate and sustain a well-funded grassroots campaign to secure passage of the bill in Congress. This legislation ensures that if patients choose to see a physician that is not in the Medicare system they can still receive the benefits they have earned.

AMA delegates also recognized that onerous administrative burdens can divert a physician’s attention away from patient care. New policy calls on the AMA to work vigorously to stop implementation of ICD-10, a new code set for medical diagnoses. Currently, physicians use 14,000 diagnosis codes under ICD-9, but under ICD-10 the number of codes would grow by about 55,000.

Physicians are already working to integrate electronic health records into their offices, and the implementation of ICD-10 will place significant and costly burdens on the practice of medicine with no direct benefit to patients. At a time when we are working to get the best possible value for our health care dollars, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions….

 

 

Items included

 

December 15, 2011 Posted by | Health News Items | , , , , , , | Leave a comment

Department of Health and Human Services Updates HealthCare.gov Insurance Finder

HealthCare.gov

Take health care into your own hands

 

From the press release

HealthCare.gov Insurance Finder Gets Better for Consumers

On Monday, November 15, 2010, the Department of Health and Human Services updated the HealthCare.gov Insurance Finder with more information on private insurance plans.

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information about private and public health coverage options into one place to make it easy for consumers to learn about and compare their insurance choices.

HealthCare.gov and its Insurance Finder are critical new tools for consumers, making the health insurance market more transparent than it has ever been.

On October 1, the Insurance Finder added price estimates for private insurance policies for individuals and families, allowing consumers to easily compare health insurance plans – putting consumers, not their insurance companies, in charge and taking much of the guesswork and confusion out of buying insurance.

Insurance companies are also required to include two notable metrics never before made public:

  • The percentage of people who applied for insurance and were denied coverage.
  • The percentage of applicants who were charged higher premiums because of their health status.

Significant Increase in Options for Consumers to Compare & in Number of Health Insurance Companies in Finder

Today’s update represents a significant increase in the number of private insurance plans and the number of issuers represented:

  • On October 1, there were 4,400 plans for individuals and families listed in the Finder, and today’s update brings that number to over 8,500.
  • On October 1, there were 230 health insurance companies the individual and family market represented in the HealthCare.gov Insurance Finder, and today’s update brings the number of health insurance companies in the Finder to 299.

This update to HealthCare.gov further enhances the ability of Americans to find health care coverage that meets their needs and get the best value for their money.  And it represents a significant expansion in the transparency that HealthCare.gov is bringing to the insurance marketplace – transparency that leads to more competition between insurers and better value for consumers.

Posted: November 15, 2010

November 28, 2011 Posted by | Consumer Health, Public Health | , , , | Leave a comment

Consumers can have greater control over spending on health than previously thought

Consumers can have greater control over spending on health than previously thought.

From the blog Medcine-Blog-Health 4 October 2011 posting

The historic RAND Health Insurance Experiment found that patients had little or no control over their health carespending once they began to receive a physician’s care, but a new study shows that this has changed for those enrolled in consumer-directed health plans.

Patients with health coverage that includes a high deductible and either a health savings account or a health reimbursement arrangement reduced their costs even after they initiated care.

Overall, the study found about two thirds of the reduction in total health care costs was from patients initiating care less often and the remaining third was from a reduction in costs after care is initiated. The findings were published online by the journal Forum for Health Economics and Policy.

“Unlike earlier time periods, it seems that today’s consumers can have greater influence on the level and mix of medical services provided once they begin to receive medical care,” said Amelia Haviland, the study’s lead author and a senior statistician at the RAND Corporation, a nonprofit research organization. “We found that at least part of the savings in cost per episode reflects choices for less-costly treatments and products, not just a reduction in the number of services.”

Researchers from RAND, Towers Watson and the University of Southern California examined the claims experience of many large employers in the United States to determine how consumer-directed health plans and other high-deductible plans can reduce health care costs. The study was funded by the California HealthCare Foundation and the Robert Wood Johnson Foundation.

According to Haviland, at least three factors influenced the cost of care once the patient had initiated care: lower use of name-brand medications, less in-patient care and lower use of specialists. Researchers speculate that patients may talk to their doctors about their higher deductibles and ask them to help keep costs low.

Read the entire blog item

November 20, 2011 Posted by | health care | , | Leave a comment

How Human Services Programs and Their Clients Can Benefit from National Health Reform Legislation

urban institute nonprofit social and economic policy research

From the Report Summary (Urban Institute)

Human services programs-the Supplemental Nutrition Assistance Program, Temporary Assistance to Needy Families, subsidized child care, etc.-and their clients can benefit from national health reform. Millions of low-income health coverage applicants can be connected with human services programs, as the latter programs: (a) help health programs efficiently reach eligible consumers; (b) access unprecedented, time-limited federal funding for modernizing eligibility computer systems while limiting risks to current funding; (c) keep social services offices available as an avenue for seeking health coverage; and (d) use a forthcoming Medicaid expansion to accomplish core human services goals related to employment and child development.

 

 

November 17, 2011 Posted by | Public Health | , , , , , , | Leave a comment

Among The Poor Physical Functioning Declines More Rapidly

 

US residents without health insurance in %; U....

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From a November 9, 2011 article at Medical News Today

A new national study shows that wealthier Americans and those with private health insurance fare better than others on one important measure of health – and this health gap only grows wider as they age.

Researchers found that, when the study began, middle-aged and older Americans with more income and assets reported having less trouble with five activities of daily living: walking across a room, bathing, eating, dressing and getting in and out of bed. …

…The data in this study can’t answer the question of how socioeconomic status and private health insurance help protect people’s physical functioning, Richardson said. But the results fit with other studies that suggest that economically disadvantaged people may not be able to afford medications they need, or may take steps to make their prescriptions last longer, like cutting pills in half.

They may also skip diagnostic tests that could help identify disease earlier, when it is more treatable. This may be especially true for those who lack private health insurance that can help pay for expensive testing.

“One of the first questions many elderly adults ask when their doctors order tests is ‘will my insurance cover it?’ Richardson says.

Richardson said the findings suggest that our public health care policies need to consider how people’s economic resources will change their physical functioning as they age.

“Our policies need to incorporate a life course perspective. We need to find way to prevent the rapid deterioration in physical functioning that is more likely among those who have fewer resources.”

Read the entire article

November 12, 2011 Posted by | Consumer Health, Public Health | , , , | Leave a comment

   

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