Unintended consequences of insuring the uninsured
In the things-to-consider-for-the-sake-of-considering-them category, take a gander at this story from the May 27 edition of The Boston Globe:
After healthcare reform was made law in Massachusetts in 2006, the number of newly insured patients in the state started to grow, and so did the demand for care. The demand, coupled with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform as well as area medical professionals.
About 80 percent of the new patients at a community health clinic who are covered under the state’s new health insurance program were formerly uninsured, a clinic supervisor told the newspaper. The result is a lengthy waiting list.
Clinics the newspaper contacted have had difficulty recruiting doctors.
‘What Chapter 58 has done is highlighted the crisis and the problem that we have with the primary-care workforce,’ said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week. …
Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, said John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the healthcare law. …
Healthcare advocates and providers say that the real problem is that the state underestimated the number of residents without health insurance. …
According to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, which administers the new health law, 340,000 people who had been mostly uninsured were covered through the state’s program as of Jan. 1. Of that number, about 110,000 have bought private insurance through Commonwealth Choice. But, he said, the remaining 230,000 people have MassHealth or Commonwealth Care, the state’s subsidized health insurance programs.
One thing that’s unclear is why the formerly uninsured choose the types of clinics mentioned in the story when it looks although they could go to any doctor. Maybe they can’t, or maybe the story didn’t address it.
Either way, the unintended consequences of insuring hundreds of thousands of people are worth considering.
Thoughts? Leave a comment on this blog.
Jeff Raymond, Medical Writer
The cost to retire
Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.
A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.
The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.
Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.
The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.
And health care costs show no signs of flattening or decreasing.
Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.
Fidelity recommends:
- Creating an individual retirement plan
- Starting early and maximizing opportunities to save
- Assessing health status and becoming a smarter consumer of health care
- Determining details of any employer-sponsored coverage
- Understanding the financial impact of health care costs on Social Security income
Jeff Raymond, Medical Writer
Checking on those who give check-ups
If you’re interested in keeping tabs on your doctor, HealthGrades now offers a notification service.
The Web site, www.healthgrades.com, is best known for its hospital ratings. But given the information it compiles, a physician notification service is a natural addition.
The “Watchdog” e-mail alert service costs $4.95 a month.
Notification items include board certification, disciplinary actions, malpractice suits and patient safety reviews.
Would you monitor your doctor? Would you pay to have someone notify you of lawsuits and other information of interest? Leave a comment at The Medicine Bag blog at http://blog.newsok.com/health. I’d like to hear what you think.
HealthGrades maintains quality profiles on almost every practicing physician in the country. The profile includes information on the doctor’s medical training, patient ratings, state and federal sanctions, malpractice judgments (in 15 states), procedure costs and hospital affiliations.
Subscribers to the service receive e-mail alerts when a physician’s information changes. Comprehensive physician profiles cost $29.95.
Jeff Raymond, Medical Writer
Keeping men healthy
Statistically speaking, men will die six years sooner than women. We have higher death rates for the 15 leading causes of death.
Here are some stats from the National Center for Health Statistics:
- In 1950 the age-adjusted death rate per 100,000 men was 1,647.2.
- For women it was 1,236.
- In 2000 the rate for men was 1,053.8.
- For women it was 731.4.
- In 2004 the rate for men was 955.7.
- For women it was 679.2.
- In 1950 the death rate among men from heart disease was 697.
- For women it was 484.7.
- In 2000 the rate for men was 320.
- For women it was 210.9.
- In 2004 the rate for men was 267.9.
- For women it was 177.3.
The numbers, whether taken together or broken down by cause of death, show that while age-adjusted death rates of men and women have made huge strides, men still trail.
Check out the rest of the document here.
I bring this up to spotlight Integris Health’s annual Men’s Health University Men’s Fit Club. The program appropriately began the day after the Super Bowl. It is a weight-loss class offered just for men, of all ages. It focuses on eating habits and increasing fitness.
Men-U is a series of events throughout the year to educate men and their loved ones on how to take care of their health. Health checks such as prostate cancer screenings are featured, and then there’s the Man Card, from Integris and WWLS The Sports Animal. Cardholders earn points that can be redeemed for prizes.
The class runs through April 17 and will be every Monday from 5:30 to 7:30 p.m. at Integris Pacer Fitness Center. The cost is $240 — less for those with a Man Card. Call (405) 951-2277 or (888) 951-2277 for more information.
One reason men die earlier may be because they avoid going to the doctor. A 2007 survey of more than 1,000 men for the American Academy of Family Physicians showed almost one-third wait as long as possible before seeking medical attention.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Hospital tally approaches $1 trillion
U.S. hospitals charged $873 billion in 2005 — a nearly 90 percent increase from the $462 billion charged in 1997 — according to the Agency for Healthcare Research and Quality. The inflation-adjusted 2005 bill represents the amount charged for 39 million hospital stays.
With an average annual growth rate in hospital charges of 4.5 percent, researchers predict the bill will reach $1 trillion by 2008.
AHRQ also found:
-Medicare paid $411 billion of the national bill, followed by private insurance ($272 billion) and Medicaid ($124 billion).
-The uninsured accounted for $38 billion.
This is taken from the AHRQ report:
|
Table 1. Top 20 most expensive conditions treated in U.S. hospitals, 2005 |
||||
|
Rank |
Principal diagnosis |
Total national hospital bill (millions) |
Percentage of national hospital bill |
Number of hospital stays (thousands) |
|
1 |
Coronary artery disease |
$45,985 |
5.3% |
1,110 |
|
2 |
Mother’s pregnancy and delivery |
$43,925 |
5.0% |
4,712 |
|
3 |
Newborn infants |
$35,316 |
4.0% |
4,429 |
|
4 |
Acute myocardial infarction (AMI, heart attack) |
$31,946 |
3.7% |
662 |
|
5 |
Congestive heart failure (CHF) |
$30,230 |
3.5% |
1,090 |
|
6 |
Pneumonia |
$29,535 |
3.4% |
1,355 |
|
7 |
Osteoarthritis |
$26,157 |
3.0% |
738 |
|
8 |
Complication of device, implant or graft |
$25,291 |
2.9% |
616 |
|
9 |
Sepsis |
$24,801 |
2.8% |
538 |
|
10 |
Back pain (spondylosis, intervertebral disc disorders, other back problems) |
$20,327 |
2.3% |
647 |
|
11 |
Respiratory failure, insufficiency, arrest (adult) |
$19,723 |
2.3% |
336 |
|
12 |
Cardiac dysrhythmias |
$17,224 |
2.0% |
697 |
|
13 |
Acute cerebrovascular disease (stroke) |
$17,060 |
2.0% |
526 |
|
14 |
Rehabilitation care, fitting of prostheses, and adjustment of devices |
$13,848 |
1.6% |
517 |
|
15 |
Complications of surgical procedures or medical care |
$13,316 |
1.5% |
463 |
|
16 |
Gall bladder disease |
$11,719 |
1.3% |
456 |
|
17 |
Chronic obstructive pulmonary disease (COPD) |
$11,506 |
1.3% |
630 |
|
18 |
Diabetes mellitus with complications |
$11,171 |
1.3% |
491 |
|
19 |
Hip fracture |
$10,869 |
1.2% |
317 |
|
20 |
Nonspecific chest pain |
$10,027 |
1.1% |
825 |
|
Total for top 20 conditions |
$449,976 |
51.5% |
21,155 |
|
|
Total for all hospitalizations |
$873,236 |
100.0% |
39,164 |
|
|
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2005. |
||||
For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
ER payments decrease
Emergency room payments declined over an 8-year period, with Medicaid paying less overall than do uninsured patients, a recent study in the Annals of Emergency Medicine reported.
In a news release, researcher Dr. Renee Hsia of the University of California at San Francisco said the “falling reimbursements” were a “consistent trend” over the study period.
“What surprised us was that uninsured patients actually pay a higher proportion of their emergency department charges than Medicaid does,” she said.
According to the release, 35 percent of charges for uninsured visits were paid in 2004, compared to 33 percent for Medicaid visits.
Researchers studied charges and payments for 43,128 emergency department visits from 1996-2004. Nationally, the overall proportion of charges paid for outpatient emergency room visits declined from 57 percent to 42 percent.
“Declining reimbursement ratios will cut into the ability of emergency departments to recover their actual costs of providing care,” Hsia said.
Jeff Raymond, Medical Writer
A shared health care burden?
A recent policy brief from the Kaiser Family Foundation intriguingly dealt with the effects of well-documented medical insurance premium increases and cost sharing on senior citizens and young workers.
“This analysis examines the relative burdens of out-of-pocket spending on seniors and younger adults,” the Kaiser Web site said. “Seniors consistently spent a larger share of their income out of pocket on health care than younger people. Given the persistent differences between young and old, it suggests that even with Medicare’s prescription drug benefit, significantly narrowing the wide gap between seniors and younger adults in their out-of-pocket spending burdens is unlikely.”
Some things the report mentions:
- From 2000-05, average in-network deductibles for PPOs (as opposed to HMOs), almost doubled, while average monthly premiums for family coverage rose by two-thirds.
- During the same time frame, median (the point at which half of all families earn more and half earn less) family income rose by about 10 percent.
- During the same time frame, Medicare Part B premiums rose by 72 percent, while premiums rose by 35 percent for a popular “Medigap” plan.
- In 2003, median per-capita health care expenditures were five times higher for seniors than for others.
“Our findings document a persistent gap in financial burden between young and old which could have important implications for ongoing policy discussions in several areas, including the generosity of coverage for working age adults, rising health care costs, entitlements and more fundamental questions about the appropriateness of shifting more costs onto consumers,” the report states.
The main thing to keep in mind is that this cost growth shows no signs of stopping. Any thoughts? E-mail me below.
Opting out
I spoke to Steve Anderson, a research fellow with the Oklahoma Council of Public Affairs, today about Census data released this morning that showed an increase in Oklahoma’s poverty rate.
Part of the American Community Survey, which, to my understanding, replaced the Census ”long form” so many Americans loathed, the “poverty report,” as one Tulsa advocacy group called it, is an annual assessment of cities and states’ income. A related report included statistics on health insurance.
Anyway, if you read Wednesday’s paper, or check the Web, you’ll get all this.
What interested me most about the conversation with Anderson, a certified public accountant with a wide knowledge of state government, was his assertion that the rate of uninsured Oklahomans may not be as accurate as is normally portrayed — either numerically or qualitatively.
Anderson said the Census didn’t count American Indians who receive tribal health care. Nor did it reflect those who choose not to have health insurance — the young and fearless, for example. Or those who just aren’t responsible.
I haven’t been able to research his tribal health care claims, and if I have run across statistics on people shunning health plans they can afford, I have long since lost them. However, the bigger picture is more important: Are we making a public-policy crisis out of a problem? If so, to what end?
I’m not weighing in one way or the other. I just think it’s wise to consider things we repeat and take as truth sometimes have shaky foundations. The more we repeat them, the more ingrained they become.
That many Americans are uninsured is undeniable. That they cost a lot of time, money, efficiency and are less healthy than those with insurance is also, in my opinion, undeniable. What is debatable are the scope of the problem and its solution.
On an unrelated note, if you have ever had trouble managing your cholesterol but tried to make a real effort to do better nonetheless, I’d like to talk to you. Please e-mail me by clicking on my name or call me at (405) 475-3364.
Some hope for health care costs?
I don’t want to announce victory in the earliest stages of a long fight, but I’m encouraged by the steps taken so far to deal with the uninsured in Oklahoma.
Baby steps, to be sure, but steps nonetheless.
The Oklahoma Department of Insurance is soliciting input from around the state about health care priorities and needs to present to a task force that may draft a core benefits plan for residents.
I know, I know … reports, task forces, blue ribbon committees … shuffle paper here, shuffle paper there, talk a lot and change little — at least that’s how I often perceive them.
Under the clever name of Oklahoma CHAT (Choosing Healthplans All Together), Insurance Commissioner Kim Holland plans to collect information from 31 communities across the state using the CHAT computer simulation.
“The CHAT program will assess how people prioritize what health benefits are important to them when the resources are insufficient to purchase every type of coverage,” according to a news release.
I imagine the research has already been done to some extent, but the way this appears to be designed looks genuine to me.
Now, maybe I’m uncritically giving up my skepticism. After all, solving the problem of the social and economic toll of the state’s 600,000 uninsured won’t happen over night. But, I figure, from where else than a state with a glaring, vexing problem will an innovative solution arise?
OK, Massachusetts notwithstanding.
They have beaten us to common-sense health insurance reform, but I consider the South more of a peer group.
I guess I’ve concluded that philosophical differences should not keep us from doing something; that what we do doesn’t have to break the bank and may even save money, again, philosophical differences aside; and that some sort of mandatory enrollment in some sort of plan, while it goes against my libertarian sympathies, will be needed.
Just like with 401K plans, people, even those of adequate means, won’t choose to participate in sufficient numbers for society at large to gain unless at least nudged that way, if not pushed.
At this point, I know the reform movement is more of a Doolittle Raid than an Iwo Jima, but acknowledging something must be done, even if we can’t agree on what, is a step in the right direction. And the sponsors of Holland’s project are an impressive bunch that includes Integris Health, the OU College of Public Health, the Oklahoma Hospital Association, the Oklahoma State Department of Health and The State Chamber of Oklahoma.
Strange bedfellows? Maybe. Or maybe not. It depends how you look it at.
The press conference is Tuesday at 10:30 a.m. in the Governor’s Blue Room at the Capitol.
In March, a group called Health Alliance for the Uninsured bemoaned the number of uninsured who turn to emergency rooms because free clinics were full. Or just turned to emergency rooms for basic care, which is costly in time and money and is hugely wasteful in terms of hospital utilization.
“Our 16 free clinics are overwhelmed and do not have the resources they need,” Dr. Murali Krishna, chairman of the alliance and president of Integris Mental Health, said at the time. “That leaves the uninsured with no choice but to go to the emergency room for routine medical care.”
A study presented then showed 53 percent of emergency room visits in Oklahoma County were for nonemergency symptoms.
Among clinics’ problems are getting specialists to volunteer, finding free- or low-cost drugs and locating radiology services.
Because of its location, St. Anthony Hospital deals with a number of poor, transient patients. As such, it has received assistance to put together a system to find these people a “medical home” so that they visit a general practitioner for routine care rather than the emergency room. For a patient with an HMO policy, this is a given. For the uninsured, it’s innovative, at least for Oklahoma.
I haven’t followed up on the project for some time, but it has intrigued me from the start. Will it work? I aim to find out.
As always, please e-mail me or comment on this blog. If you agree, disagree or think I’ve gone off the deep end, let me know one way or the other.
