Tag: "consumer driven health care"

Greed

Greedy doctors.

This guy is getting a chemotherapy regimen for colon cancer that we stopped using about 15 years ago. His medical oncologist was practicing the best medicine of the late 1980s, but we were in 2006. The other drugs he was being prescribed were totally unnecessary. But the doctor could get a substantial markup and make a substantial amount of money by selling them.

Greedy patients.

Another patient of mine had early colon cancer. Three doctors had told her she should not get chemotherapy. She decided she wanted it, and she went doctor-shopping until she found a doctor who would give it to her.

Greedy everybody.

I blame patients, I blame doctors, I blame hospitals, I blame drug companies, I blame insurance companies.

Interview about Otis Webb Brawley’s “How We Do Harm: A Doctor Breaks Ranks About Being Sick In America” (St. Martin’s Press).

May 24, 2012 | 6 comments | by

What Sick People Think About the Health Care System

Poll results:

Thirteen percent of sick Americans thought they were given the wrong diagnosis, test, or treatment. About 15% of sick Americans thought they got tests they didn’t need and 18% thought they didn’t get the tests they did. More than a quarter of sick Americans thought they were not well managed.

Aaron Carroll generally deploring the results.

May 23, 2012 | 7 comments | by

Insurance Companies: Without a Mandate We Are Going to Get Creamed

AHIP today released the first in a series of four state case studies examining states’ experiences with implementing market reforms without getting everyone covered. The first case study examines Washington State’s experience and shows that consumers experienced higher premiums and loss of choice following the enactment of guarantee issue without an individual mandate in the 1990′s. The full study can be viewed here and an accompanying press release can be found here. We will be releasing the next three state case studies over the course of the next several weeks.

This is from AHIP.

May 14, 2012 | 5 comments | by

Employer as Big Brother

WellPoint nurses and case managers pore over patient records and claims histories to see whether patients are following doctors’ orders…

Express Scripts this summer plans to roll out a program…to identify and intervene with patients less likely to take their prescriptions correctly…

Patients identified as likely to be noncompliant then receive tailored interventions to help overcome their specific hurdle. Some patients will receive over-the-phone pharmacist consultations and help signing up for auto-refills and other programs that simplify adherence.

More on the approach from health care players to improve health care quality and costs in the WSJ.

May 03, 2012 | 5 comments | by

Do Smoking Bans Improve Health?

No. This is a 2010 NBER paper that I previously overlooked:

U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller regional studies, we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature.

More on the study on cigarettes and lifetime risks by HT: John Dunn.

May 02, 2012 | 3 comments | by

Headlines I Wish I Hadn’t Seen

Berwick: Letting patients control their own health care dollars is a “vicious idea.”  HT: Avik Roy.

Chicken has E. coli half of the time.

Study: obese workers cost employers $1,850 a year; smokers cost $1,275.

Apr 17, 2012 | 5 comments | by

Obama’s War on HSAs

This is the latest from Roy Ramthun:

HHS has consistently tilted the playing field against consumer-driven plans. The first step was via final regulations implementing the ACA’s new minimum medical loss ratio (MLR) standards. As written, these regulations make it impossible for consumer driven plans to qualify as Bronze plans under the ACA’s new state insurance exchanges. If forthcoming final rules on “essential benefits” and “actuarial value” requirements are just as discriminatory, these affordable plans will vanish and insurance costs on state exchanges will skyrocket. Along the way, millions of Americans with policies that could qualify as Bronze plans today will be forced to change or drop their coverage. A minimum MLR sounds like a good idea — ensure that consumers get good value from their insurance policies. But MLR standards (currently set at 80 percent for the individual and small group markets) effectively act as price controls, limiting the cost of insurance by controlling the portion of the premium that is available to be spent on administrative expenses and profit (i.e., the remaining 15 or 20 percent of the premium collected)….

The threat to HSAs was validated by a recent analysis of the MLR rules by Milliman Inc. for the American Bankers Association.

Apr 02, 2012 | 7 comments | by

Myth Busters #16: How the Individual Mandate Came About

The current controversy over past Republican support of an individual mandate needs some clarification. Many Republicans did indeed support this approach in the past. They proposed it as an alternative to what they saw as more onerous Democratic proposals for either single payer or an employer mandate.

There was an intense debate over the idea in conservative/libertarian circles and the libertarian perspective has won the argument. But this has been an honest and legitimate debate over an idea that had some merit but far more flaws. This is exactly the way public policy is supposed to proceed. No one should be ashamed of past support for the idea if they have learned from the process.

In our Myth Busters series we have gone from the early 1970s to the early 1990s — twenty years of catastrophic failure in public policy, at least in health policy. Every crazy idea was enacted into law, with large amounts of money appropriated, and the health system thrown into constant turmoil without any positive results whatsoever.

Dec 14, 2011 | 12 comments | by

Insurance Reform Goes Crazy

While the National Association of Insurance Commissioners (NAIC) was rolling out a set of model laws for the states to consider in reforming their small group insurance laws, a handful of states decided to go much, much, further.

The NAIC models were focused on keeping the market working while ensuring access to coverage and preventing excessive rating variations between groups. It also proposed two alternative forms of risk sharing between carriers so no one insurance company would be hit too hard by a surge of high-risk enrollees. Almost all of the states adopted some variation of the rating restrictions but none adopted the risk-sharing provisions. A few years later the federal government adopted its own version of these requirements by enacting the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These laws would go on to severely damage the market for small group coverage throughout the United States. We’ll come back to that in a future post.

Nov 23, 2011 | 18 comments | by

Cookbook Medicine Update

Will physicians fire noncompliant patients to meet quality measurements? It may come to that:

According to participants at AHRQ’s National Advisory Council forum, as more payers are instituting pay-for-performance programs, patients are becoming increasingly engaged in medical decision making and at times challenging official recommendations.

As a result, physicians ultimately may “fire” noncompliant patients from their practices, push back against quality-improvement initiatives, and minimize patient empowerment efforts, CQ HealthBeat reports. Some physicians already are “firing” unvaccinated patients, noting that they pose a risk to others and reflect a lack of trust for physicians’ medical advice.

Nov 18, 2011 | 9 comments | by
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