While out-of-pocket costs for insulin was substantial, it accounted for just 18% of total out-of-pocket expenses for health care, according to the findings in JAMA Internal Medicine.
In fact, insulin accounted for less out-of-pocket spending than diabetes-related supplies, such as insulin pumps, syringes and continuous glucose monitors.” … Removing barriers to high-value care … “Several states and insurers imposed monthly caps on these [out-of-pocket] costs [for insulin] earlier in 2020. The Centers for Medicare and Medicaid Services just announced that many elderly Medicare beneficiaries will soon pay no more than $35 for a one-month supply of insulin. “ … More at the news release
Help for paying for diabetes medicine and supplies
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Patient Advocate Foundation – Co-pay Relief Provides direct financial assistance to qualified patients, assisting them with prescription drug co-payments their insurance requires relative to their diagnosis
Above note working? I will search for you. Email me at jmflahiff at yahoo
From the 25 May 2015 Lancaster University news release
Is your smartwatch spying on you? wearables by Alexey Boldin/shutterstock.com
26 May 2015 06:11
Now that the sun is shining and the temperature is rising, it’s officially sickie season: go to work, or get struck down with “flu”, a “24-hour virus”, or that faithful stand-by, the dodgy prawn takeaway.
Figures show that over a third of employees in the UK admit to pulling a sickie at some point or other. But things may be changing soon – wearable tech such as the Apple Watch, Microsoft Band, Fitbit, or Jawbone Up may become mainstream within a few years, bringing health monitoring capabilities that reveal how your body is performing. It’s not inconceivable that in time this same data could be used to prove how well, or unwell, you are – such as when phoning in sick.
Wearable health tech is still in its early days. These devices come with sensors that can record how many steps and how much exercise you’ve taken, how well and long you‘ve slept, stress levels, blood pressure, sun exposure, even what you’ve have eaten. Added together, all this could easily demonstrate that you’re not so sick after all.
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Using your data against you
What if employers and health insurance companies move in the direction that the car insurance industry has taken, where every health transgression (a boozy night out, a Christmas feast, or too many lazy days on the sofa) could increase your health premium rates? Such a scenario isn’t so far away, and this should concern us. Apple is clearly making a beeline for the health and fitness industry with Watch and its integrated HealthKit software, now integrated with its iOS mobile operating system, and it is the only firm to do so.
Earlier this month, Thomas Greaney explained the antitrust issuescomprehensively in Health Affairs. “Because each market is local, antitrust analysis would also require an assessment of the competitive overlap in each region,” he wrote. Greaney, is the Chester A. Myers Professor of Law and director of the Center for Health Law Studies at Saint Louis University School of Law.
There is no evidence that insurance or provider monopolies are good for consumers, he wrote, citing Boston and Pittsburgh as evidence that big is not necessarily better in health care or health insurance.
For a good review of the regulatory hurdles insurers face, see this thorough analysisi*** in The New York Times by Robert Cyran. Regulators are concerned about how reduced competition may drive up prices, he explained, writing, “Insurance markets are highly concentrated, and big mergers will make them even more so.”
***Excerpt from The New York Times article
“What’s more, the argument that a big merger would create competition for an even heftier rival has already failed in other industries. In 2011, for example, Sprint, the third-largest cellphone service provider at the time, defended its plan to buy T-Mobile US, the fourth-largest, as necessary to keep its rivals Verizon and AT&T in check. The Federal Communications Commission and the Justice Department rejected the contention, making clear that shrinking the market to fewer than two nationwide carriers would harm consumers.”
Insurers could also argue that a combination would create savings and improvements in technology that would redound to consumers’ benefit. Besides, they may point out, state insurance commissioners would have to approve any rise in insurance premiums. Yet the commissioners have often been reluctant to deny insurers rate increases, and insurance company mergers typically lead to higher premiums, according to a study by Leemore Dafny, former director of health care antitrust at the Federal Trade Commission.
So what might persuade the regulators?
The Affordable Care Act could be the answer. President Obama’s health care overhaul creates online exchanges for buying coverage, allowing insurers to expand into new markets without hiring expensive agents. The companies will still need the approval of state commissioners, but the lower barriers to entry should stir more competition – and, at least in the future, appease regulatory fears. It’s unclear whether that would be enough to counterbalance concerns over the top five insurers’ currently chunky market shares.”
New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.
BACKGROUND
The Affordable Care Act has transformed the health insurance options available to Americans who lack health benefits through a job. Numerous surveys have indicated that the law’s coverage expansions and protections have reduced the number of uninsured adults by as many as 17 million people.1
But Congress intended the Affordable Care Act to do more than expand access to insurance; it intended for the new coverage to allow people to get needed health care at an affordable cost. Accordingly, for marketplace plans, the law includes requirements like an essential health benefit package, cost-sharing subsidies for lower-income families, and out-of-pocket cost limits.2 For people covered by Medicaid, there is little or no cost-sharing in most states.
But most Americans—more than 150 million people—get their health insurance through employers.3 Prior to the Affordable Care Act, employer coverage was generally far more comprehensive than individual market coverage.4 However, premium cost pressures over the past decade have led companies to share increasing amounts of their health costs with workers, particularly in the form of higher deductibles.5
In this issue brief, we use a measure of “underinsurance” from the Commonwealth Fund’s Biennial Health Insurance Survey to examine trends from 2003 to 2014, focusing on how well health insurance protects people from medical costs. Adults in the survey are defined as underinsured if they had health insurance continuously for the proceeding 12 months but still had out-of-pocket costs or deductibles that were high relative to their incomes (see Box #1). The survey was fielded between July and December 2014. This means that we could not separately assess the effects of the Affordable Care Act on underinsurance because people who were insured all year in the survey had insurance that began before the law’s major coverage expansions and reforms went into effect. People who had new marketplace or Medicaid coverage under the Affordable Care Act would not have had that coverage for a full 12 months, as it would have begun in January 2014 at the earliest. Similarly, people with individual market coverage who were insured all year would have spent all or part of the period in plans that did not yet reflect the consumer protections in the law.6
Source:H. Lee Moffitt Cancer Center & Research Institute
Summary:The lesbian, gay, bisexual, transgender/transsexual, queer/questioning and intersex (LGBTQI) population has been largely understudied by the medical community. Researchers found that the LGBTQI community experience health disparities due to reduced access to health care and health insurance, coupled with being at an elevated risk for multiple types of cancer when compared to non-LGBTQI populations.
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The study highlights that LGBTQI populations face barriers to health insurance such as when partnerships and marriages are not legally recognized; concerns about disclosure in a health care setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised stress and distress of caregiving same-sex partners.
Additionally, there are higher rates of smoking and substance abuse and low screening rates resulting in poor patient outcomes and survival rates for LGBTQI populations. Her review, The Importance of disclosure: Lesbian, gay, bisexual, transgendered, queer/questioning, and intersex individuals and the cancer continuum, was published in the American Cancer Society’s journal, Cancer.
Researchers identified that the real or perceived limited access to care due to fear of discrimination and lack of sensitivity and knowledge of LGBTQI issues stood as roadblocks to patient care. In a study of family physicians only 1 in 80 reported routinely asking patients about sexual orientation, while the majority reported rarely or never asking. The National Institutes of Health and the Institute of Medicine now recognize gender identify and sexual orientation as vital aspects of a health history and the need for improved research in this population.
“For many years, physicians did not ask patients about their sexual orientation. The importance of recognizing gender identity and sexual orientation is critical to ensuring the best quality and evidence-based care is available to patients,” explained Quinn.
In recent weeks, the market has reacted to a few noteworthy headlines, all involved with or touching upon value-based discretionary actions, and many with the not-so-hidden question: What’s In It for Me or WIIFM?
CMS announced that by 2016 30% of fees in health care should be paid for through a value-based system, moving away from fee-for-service.
ACO results have shown ambivalent outcomes.
Outcomes-based contracts have permeated the Hepatitis C cost-nado (that’s a cost sharknado, the kind that fiercely defies cost controls and takes over all noise about payment reform and patient preferences).
Reference-based pricing is a good/bad troublemaker in the middle of the value-based travails.
The latest rampages have appeared on two national and highly-regarded blogs: The Health Care Blog [Value-Based Reform] and The Health Affairs Blog [Go Slow on Reference Pricing].
As one of the loudest proponents on value-based designs, I lift the curtain again to show the thinking behind the movement from fee for service to value-based designs. All of these items above discuss the message of payment reform, or system alignment, but they are intensely linked to the patient-consumer ability to make the right choices, choose the right sites for care, and pay the right amount for services rendered to achieve health security.
One person’s journey through an unhealthy health care system. Definitely not patient centered. Have had similar insurance problems, mostly because of errors in the insurance company erring in my personal identifiers.
Let me start this story by telling you the end: I am just fine. For those of you who like me, there is nothing to worry about and all is well. For those of you who don’t like me, sorry to disappoint you, but you’re stuck with me for a while.
I’m telling you these things—news to make you happy or disappointed, depending on your point of view about me—because this story is about my recent trip to the hospital, an unexpected journey that I wasn’t sure I was going to talk about publicly.
You sound true and authentic to me too. I am embarrassed as to how often we do screw up. The only excuse I think is that we have so much internal and external regulation that we become nervous nellies, unable to relax and enjoy what we are doing. You should go to a Pharmacy and Therapeutics meeting in a hospital and listen to the barrage of complaints from everyone to everyone. Wrong dose, wrong timing, wrong drug, wrong patient. I have walked out of these meetings because of the hostility. We would all do better if we could start some little village clinic in the Congo, without the interminable watching from a thousand eyes.
“I think the Affordable Care Act is actually doing quite well,” says Senior Fellow Alice Rivlin in this podcast. Rivlin, the Leonard D. Schaeffer Chair in Health Policy Studies and director of the Engelberg Center for Health Care Reform at Brookings, cited the expansion of medical insurance coverage, declining cost growth, and other positive factors for the ACA. She also reflects on continued political opposition to the law, the impending King v. Burwell Supreme Court case, and what it was like to stand up a new federal agency, the Congressional Budget Office, in 1975.
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Also in the podcast, Senior Fellow David Wessel, director of the Hutchins Center on Fiscal and Monetary Policy, offers his regular “Wessel’s Economic Update.”
Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA). Before the legislation was passed, insurers in the nongroup market regularly charged high premiums to people with chronic conditions or denied them coverage entirely. To address these problems, the ACA instituted age-adjusted community rating for premiums and mandated that plans insure all comers. In combination with premium subsidies and the Medicaid expansion, these policies have resulted in insurance coverage for an estimated 10 million previously uninsured people in 2014.1
There is evidence, however, that insurers are resorting to other tactics to dissuade high-cost patients from enrolling. A formal complaint submitted to the Department of Health and Human Services (HHS) in May 2014 contended that Florida insurers offering plans through the new federal marketplace (exchange) had structured their drug formularies to discourage people with human immunodeficiency virus (HIV) infection from selecting their plans. These insurers categorized all HIV drugs, including generics, in the tier with the highest cost sharing.2
Insurers have historically used tiered formularies to encourage enrollees to select generic or preferred brand-name drugs instead of higher-cost alternatives. But if plans place all HIV drugs in the highest cost-sharing tier, enrollees with HIV will incur high costs regardless of which drugs they take. This effect suggests that the goal of this approach — which we call “adverse tiering” — is not to influence enrollees’ drug utilization but rather to deter certain people from enrolling in the first place.
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We found evidence of adverse tiering in 12 of the 48 plans — 7 of the 24 plans in the states with insurers listed in the HHS complaint and 5 of the 24 plans in the other six states (see theSupplementary Appendix for sample formularies). The differences in out-of-pocket HIV drug costs between adverse-tiering plans (ATPs) and other plans were stark (seegraphAverage HIV-Related Costs for Adverse-Tiering Plans (ATPs) versus Other Plans.). ATP enrollees had an average annual cost per drug of more than triple that of enrollees in non-ATPs ($4,892 vs. $1,615), with a nearly $2,000 difference even for generic drugs. Fifty percent of ATPs had a drug-specific deductible, as compared with only 19% of other plans. Even after factoring in the lower premiums in ATPs and the ACA’s cap on out-of-pocket spending, we estimate that a person with HIV would pay more than $3,000 for treatment annually in an ATP than in another plan.
Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans. A recent analysis of insurance coverage for several other high-cost chronic conditions such as mental illness, cancer, diabetes, and rheumatoid arthritis showed similar evidence of adverse tiering, with 52% of marketplace plans requiring at least 30% coinsurance for all covered drugs in at least one class.3 Thus, this phenomenon is apparently not limited to just a few plans or conditions.
Adverse tiering is problematic for two reasons. First, it puts substantial and potentially unexpected financial strain on people with chronic conditions. These enrollees may select an ATP for its lower premium, only to end up paying extremely high out-of-pocket drug costs. These costs may be difficult to anticipate, since calculating them would require knowing an insurer’s negotiated drug prices — information that is not publicly available for most plans.
Second, these tiering practices will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.
New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014. Read the brief.
Citation:
S. R. Collins, P. W. Rasmussen, M. M. Doty, and S. Beutel, The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect, The Commonwealth Fund, January 2015.
It’s time to toss the whole business-as-usual model — for your own good and the good of your customers.
The emerging Default Model of health care — the “consumer-directed” insured fee-for-service model in which health plans compete to lower premiums by bargaining providers into narrow networks — not only does not work for health care’s customers, it cannot work. This is not because we are doing it wrong or being sloppy. By its very nature the Default Model must continually fail to bring our customers what they want and desperately need. Ultimately it cannot bring you, the providers, what you want and need.
Take a dive with me into the real-world game-theory mechanics of the health care economy, and you will see why. It’s time to rebuild the fundamental business models of health care.
The Default Model Health Care Game
It’s a little easier to find our way around an economic model by picturing it as a game and asking: “What defines winning for each player? What does each player need to do to win?”
Health plans: For health plans, winning means surviving, succeeding and growing as a business. But there are a couple of rule changes now. Health plans used to be able to stay more profitable by pushing down their medical loss ratio (MLR — the percentage of premiums actually paid out for medical care), by “rescinding” the plans of people who cost too much, and by refusing to cover anyone with pre-existing conditions.
Now they have to take everybody, can’t toss them out, and their MLR has to be at least 80 percent (or 85 percent for large customers). So their administrative expenses, advertising, executive salaries (and the profits and stock price of the for-profits) are all tied to a percentage of the actual costs of health care. Hmmm. If they were confronted with a way to make health care cost half as much, would they be interested? Would they make it a top priority? No. They have no incentive to actually drop the real costs of health care.
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Related articles
While I agree with the author of the above article, the selected related articles do include other viewpoints.
The comments about physicians/health care industry were overwhelmingly thought provoking and insightful.
Some excerpts from the comments…
What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame.
This did not happen in a vacuum. It happened in a culture where there is a lot of rage, sometimes uncontrolled, and easy access to guns. And it happened in a very broken healthcare system which is driven by greedy big business profit motive that results in anyone with money or good insurance getting very overtreated and anyone without money or good insurance getting severely undertreated. And yes, our system has bred a lot of mistrust and hopelessness.
“Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.”
In 1994, I was working at my first radiation oncology job in San Diego at Grossmont Hospital when I came into work to hear disturbing news. One of my colleagues in medical oncology, a compassionate man known for his gentle nature, had stayed late at the cancer center the evening before to finish up paperwork. With his back to his ever open door, he sat at his desk never once considering that he was in danger. A disgruntled relative of a former patient surprised him from behind and beat him viciously over the head and body causing broken bones and contusions, and leaving him for dead.
The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.
Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.
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Why? If you’re sick and able to pay, you will get the treatment in most cases. It’s worth the money–being able to afford medical treatment is one reason people like having money. Most people just aren’t that cheap when it comes to their health. But if you’re unable to pay, you won’t get treatment–even if you need it. The latter will lower healthcare costs–less fortunate people won’t get treatment–but so would shooting sick people in the head. And if you don’t believe me, those radicals at the Boston Federal Reserve seem to think so as well.
The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.
Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.
……
Why? If you’re sick and able to pay, you will get the treatment in most cases. It’s worth the money–being able to afford medical treatment is one reason people like having money. Most people just aren’t that cheap when it comes to their health. But if you’re unable to pay, you won’t get treatment–even if you need it. The latter will lower healthcare costs–less fortunate people won’t get treatment–but so would shooting sick people in the head. And if you don’t believe me, those radicals at the Boston Federal Reserve seem to think so as well.
Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.
Last month, journalists from the New England Center for Investigative Reporting raised serious questions about prenatal genetic screening tests, saying physicians and patients may not fully understand the results of these tests for fetal abnormalities.
In their reporting, the journalists exposed a symptom of what may be a bigger problem: the proliferation of genetic tests without a full understanding about what such testing can and cannot do. Even health insurers have struggled to understand how to pay for new genetic tests.
The stories also pointed out that federal regulators are wrestling with how to classify genetic tests. Many of these tests fall into the category of what pathologists call lab-developed tests or LDTs. These tests are not regulated by the FDA, as the NECIR journalists reported. In October, the FDA proposed regulating these tests as medical devices and clinical laboratories are pushing back, saying such regulations could interfere with the practice of medicine.
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 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.
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.
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.
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.
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).
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.
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.”
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.
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.
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.
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.
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.”
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.
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.
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, 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.
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.
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.”
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?
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_FactsOr 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}
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.
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.”
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.
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.
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.
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.
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 the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)
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)
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.
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.
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.
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
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!
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.
” 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,”
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.
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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.
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.
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.
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.
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.
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.
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 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……..
US consumers don’t understand health insurance, Carnegie Mellon research shows (Medical News Today, 2 August 2013)
“…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.”
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) (Photo credit: Wikipedia)
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.
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.
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.
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.
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)
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. …
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.
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.”
I am very concerned how federal funding for socioeconomic programs is going to be distributed equitably without relevant, current, and reliables statistical information….
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…
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.
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….
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area? Email me at jmflahiff@yahoo.com I will reply within 48 hours.
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
Publication Date:
Health and Medical News and Resources 
