Tag: "Health Care Access"

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

MLR Killing Off Business, Hurting Consumers, NAIFA Survey Says

Agent commissions have declined dramatically since the medical loss ratio (MLR) provision of the health care reform law went into effect, forcing many agents to reduce their services to clients, consider charging fees for services they had been providing at no additional charge and in some cases, laying off employees and leaving the health insurance market.

That’s according to a survey by the National Association of Insurance and Financial Advisors (NAIFA) of 861 of its members who sell health insurance. Seventy percent of respondents who sell health insurance have seen a decrease in commissions.

Almost a third are ready to leave the market. The survey reports that 30% say that if commissions remain depressed they will stop selling and servicing individual health policies and 22% say they will stop selling all health insurance.

How’s it going in your area?

Full article by Elizabeth Festa in LifeHealthPro.

May 17, 2012 | 11 comments | by

Cost Shifting is Real

Roughly half of Medicare beneficiaries under age sixty-five are also eligible for Medicaid. These “dual eligibles” have been the subject of much research because of their low income and poor health status. Previous studies suggest that some states seek to shift costly health care services for this group out of state-run Medicaid programs and into the federally funded Medicare program—for example, replacing nursing home care with hospital care. Using state-level data on dual eligibles under age sixty-five, we found support for this hypothesis. In states with below-average per capita Medicaid spending, corresponding Medicare spending was above average. These state-level estimates also revealed a nearly threefold difference in total—Medicare plus Medicaid—price-adjusted spending per person, ranging from $16,309 in Georgia to $43,587 in New York.

Study on state spending on “dual eligibles” in Health Affairs.

May 17, 2012 | 4 comments | by

Mass: Insurance Doesn’t Lead to More Care

As did the Affordable Care Act, the Massachusetts reform incorporated substance abuse services into the essential benefits to be provided all residents. Prior to the law’s enactment, the state estimated that a half-million residents needed substance abuse treatment. Our mixed-methods exploratory study thus asked whether expanded coverage in Massachusetts led to increased addiction treatment, as indicated by admissions, services, or revenues. In fact, we observed relatively stable use of treatment services two years before and two years after the state enacted its universal health care law.

Full Health Affairs study on why expanded coverage alone will not increase treatment use.

May 17, 2012 | 7 comments | by

Insurance Matters: Children

Children with public insurance (Medicaid or CHIP) or who had no coverage are at least 22 percent less likely than those with private insurance to receive testing or to undergo procedures when they visit the hospital emergency departments, researchers from Children’s Hospital Boston found. In addition, children with no insurance are less likely to receive any medication than children with public or private insurance.

That disparity did not hold true for kids diagnosed with a significant illness, who had the same odds of being admitted to the hospital regardless of insurance status.

Full study in the Journal of Pediatrics. KHN summary by Jenny Gold.

May 15, 2012 | 3 comments | by

Why Men Are Readmitted to Hospitals More than Women

At the 30-day follow-up telephone call, fewer males reported understanding their follow-up appointments after leaving the hospital as compared to females (78 percent and 87 percent, respectively). In addition, at 30 days post-discharge, females reported visiting their primary care provider at a higher rate within the 30 days after their hospital discharge (57 percent) as compared to men (49 percent).

Full article by Stone Hearth News worth reading.

Apr 27, 2012 | 4 comments | by

Employers Get Tough

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 deductibles.

Julie Appleby’s article in USA Today.

Apr 05, 2012 | 4 comments | by

Medicare Managed Care?

Prior authorization is a common tool that managed care organizations use to reduce patient utilization of medical services. Some physicians believe that prior authorization creates barriers to effective care, but other commentators believe that prior authorizations can be implemented in a more efficient manner. Either way, prior authorizations are a form of rationing care.

Although Medicare typically has not required patients to seek prior authorizations to use specific services, this may be changing with the start of the Prior Authorization for Power Mobility Devices Demonstration.

More from Jason Shafrin at the Healthcare Economist.

Apr 02, 2012 | 5 comments | by

How Big Is the Welfare State?

In Europe, governments offer health care directly. In the U.S., we give employers a gigantic tax exemption to do the same thing. European governments offer public childcare. In the U.S., we have child tax credits… These tax expenditures are hidden but huge… If you had included those preferences as government spending, then the federal government would have actually been one-fifth larger than it appeared…

When you include both direct spending and tax expenditures, the U.S. has one of the biggest welfare states in the world. We rank behind Sweden and ahead of Italy, Austria, the Netherlands, Denmark, Finland and Canada. Social spending in the U.S. is far above the organization’s average.

Full article on the U.S. vs. the European welfare state by David Brooks in The New York Times.

Mar 06, 2012 | 7 comments | by
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