Category: Health Care Access

Regulation of Telemedicine Costs Lives

Jason Shafrin writes:

In response to concerns about tele-medicine’s effect on patient safety, many states have begun prohibiting physicians from prescribing drugs without conducting a prior physical examination. In fact, more than 30 states have instituted this type of rule since 1998.

A paper by Cotet and Benjamin investigates this regulation which they call the physical examination requirement (PER).

The findings:

The adoption of PER is associated with a 1% rise in disease-related mortality rates the equivalent of 8.5 deaths per 100,000 people, presumably because it raised the implicit cost of, and thus reduced access to, medical care. In addition, the adoption of the PER is associated with a 6.7% reduction in injury-related mortalities, the equivalent of 2.5 deaths per 100,000 people. Thus, the reduction in injury mortality is smaller than the elevation of disease-related mortality, yielding a rise in overall mortality.

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May 18, 2012 | 8 comments | by

HSAs Under Attack

Three separate provisions in the statute, and regulations implementing the law, will reduce access to HSA plans:

  1. ObamaCare’s essential health benefits package contains new restrictions on deductibles and cost-sharing, which will prevent at least some current HSA plans from being offered.
  2. ObamaCare’s medical loss ratio regulations also impose new restrictions that studies show will hit HSA plans particularly hard, and could force individuals to change their current form of coverage.
  3. The ObamaCare statute does not specify that cash contributions made to an HSA will be counted towards the new federal actuarial value standards.  And a February bulletin released by HHS in advance of upcoming rulemaking indicates that under the Administration’s approach, not all contributions into an HSA will count towards the new minimum federal standards – meaning some HSA policies will not be considered “government-approved.”

More from Chris Jacobs on ObamaCare’s negative effect on health coverage.

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May 15, 2012 | 6 comments | by

Shopping for Care

Castlight Health [is a] nascent health care start-up…with the goal of giving insurance subscribers meaningful information on health care costs. Castlight, in the simplest terms, wants to bring comparison shopping to health care.

It launched, last year, a Web site where employees on [Health Saving Account] plans can compare what doctors charge for the same service. The site…also includes other patients’ quality rankings of doctors, alongside information on what remains in an individual’s account.

More from Sarah Kliff at Ezra Klein’s blog.

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May 02, 2012 | 2 comments | by

Not All Community Health Centers are Alike

At Oakhurst Medical Center here [in Stone Mountain, Georgia], just 20% of children have received all their recommended immunizations by age 2…

Fewer than half of its diabetics and a little more than a third of those with high blood pressure had their conditions under control in 2010 — far below national averages…

But 65 miles east of here in Greensboro in rural central Georgia…at TenderCare Clinic, almost all children get the appropriate immunizations, and eight out of 10 diabetics have normal blood sugar levels.

Full USA Today article on the performance variation within community health centers.

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May 01, 2012 | 4 comments | by

Licensed to Heal

This is David Henderson quoting Richard Thaler:

Pharmacists must be the most underemployed professionals. Lots of schooling to count pills. In France they actually do stuff.

David adds:

Milton Friedman … almost single-handedly, in the economics profession [the other one was the late Reuben Kessel] got the case against health-care licensing treated seriously with his chapter on it in Capitalism and Freedom.

Economists’ poll on health care licensing.

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Apr 25, 2012 | 5 comments | by

Liberating the Nurses

We find that allowing nurse practitioners to operate independently and provide prescriptions on their own is associated with a 2 to 10 percent increase in hourly wages for nurses and as much as a 14 percent increase in earnings for physicians. Our estimates…show that changing licensing to permit more tasks by nurses lowers permitted prices by 3 to 16 percent.

Full research worth reading.

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Apr 10, 2012 | 8 comments | by

WOW: New Evidence on Access to Care

Study: Expanding public insurance doesn’t increase access to care. Paying doctors more does increase access.

Principal Findings:  Children’s Health Insurance Program [CHIP] had a major impact on the extent and nature of children’s insurance coverage. However, it is not associated with any change in the aggregate quantity of physician services, and its associations with indicators of access are mixed. Increases in physician fees are associated with broad-based improvements in indicators of access.

Conclusions: The findings suggest that (1) coverage expansions, even if they substantially reduce patient cost sharing, do not necessarily increase physician utilization, and (2) increasing the generosity of provider payments in public programs can improve access among low-SES children, and, through spillover effects, increase higher-SES children as well.

Think about the devastating implications of this for ObamaCare! More below the fold. HT: Jason Shafrin.

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Mar 01, 2012 | 8 comments | by

PepsiCo Tries Medical Tourism

Employees of PepsiCo, the world’s second-largest food and beverage business, now have the option to travel to Johns Hopkins Medicine in Baltimore for cardiac and complex joint replacement surgeries. The travel surgery benefit has been extended to PepsiCo’s domestic employees and their dependents – almost 250,000 people.

PepsiCo, which sponsors its own self-funded medical plans, will waive deductibles and co-insurance for those who elect to have their surgery at Johns Hopkins. The company will also cover the travel and lodging expenses to Baltimore for the patient and a companion.

Hopkins is offering the procedures in a “bundled” rate, an all-inclusive rate for hospital and physician charges and certain preoperative testing.

From Hopkins Medicine (Winter 2012 issue).

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Mar 01, 2012 | 3 comments | by

Have Robotic Clinical Guidelines Claimed Another Victim?

The Daily Mail reports that Mercedes Curnow, a 23-year-old Englishwoman, has died of cervical cancer. Since 2003, the National Health Service has denied routine Pap tests to women under 25. Her grieving mother believes that an earlier Pap test would have saved her daughter’s live, and has started the Mercedes Curnow Foundation for the Detection of Cervical Cancer. Its goal is to bring back routine Pap testing for women at age 20.

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Jan 24, 2012 | 4 comments | by

Cookbook Medicine in the Air

We were above Dublin. “Hon, you’re looking pale,” my mom said. It’s not like I could call my doctor—or could we? Again we buzzed the attendant, who returned with a satellite phone. I said, “Thank you, now I can call my physician.”

She looked at me sternly. “You’re not calling your doctor,” she said. “I’m calling our doctor.” We were stunned…

“I have a Nexium,” a male voice said from two rows back.

I exhaled. “You are a life-saver,” I said.

“You can’t give it to her,” the flight attendant told the man.

I turned to Nexium Man. “You’re going to give it to me, right?” I pleaded.

“No.”

“No?”

“No. I’m a pilot for this airline and whatever she says…goes.”

Read the full story here.

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Jan 18, 2012 | 6 comments | by
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