|
|
|
|
THE PRIVATE LIFE OF HEALTH CARE
In just 10 years, the health system many were dreading has arrived. Spurred by the Government's campaign to push Australians into private health insurance and exacerbated by difficulties in finding care in public hospitals, the balance has tipped in favour of private hospitals.
In the past decade, a clear division of labour has evolved: public hospitals are now dominant in emergency surgery and medicine, while private hospitals rule in elective surgery, accounting for 55.7 per cent of all operations [profitable procedures]. "Since 1982-83, Australia's hospital system has witnessed a massive shift of activity to the private sector," Bill Nichol, an assistant director in the federal Department of Health, writes in the study.
A disturbing trend to emerge despite the establishment of Australian Medicare in 1983 (Australia's UHC system) is the widening disparity between the well-off and the poor in mortality rates from avoidable diseases. The Australian way of death means the prosperous are significantly less likely to die from avoidable disease than those on low incomes.
In 1986 the rate of death from "avoidable" causes such as treatable and preventable conditions like heart disease among the have-nots was 50 per cent higher than for the haves. By 2002 that difference had stretched to a twofold gap, according to research published in the International Journal of Epidemiology. The report concludes that "advantaged people have obtained a disproportionate benefit of health care, contributing to widening relative health inequalities".
The Health Minister, Tony Abbott, having presided over multibillion- dollar infusions into the private sector through Medicare payments to private doctors and the private insurance rebate, acknowledges states are bearing a larger share of public hospital costs. But he says that if there is an equity problem, it's for state governments to fix. "It may sound like I am playing the blame game, but state governments are responsible for public hospitals," Abbott says.
"The real question is, is this the health system that we want, that people desire?"
To find this article from The Sydney Morning Herald of April 6, 2007 By Ruth Pollard and Mark Metherell CLICK HERE
|
QUESTIONING CLAIMS ON MEDICARE PRESCRIPTION DRUG BENEFIT
An Oct. 4, 2006 Wall Street Journal editorial "implies that the private sector is more efficient than Medicare," but "Medicare trustees suggest the opposite," Rep. Pete Stark (D-Calif.) wrote to the editor of the Journal. According to Stark, Medicare trustees have found that administrative costs for private plans offered under the Medicare prescription drug benefit "average 12% -- six times Medicare's historic ratio of 2%." The editorial also maintains that "'competition' is responsible for a decline in the drug program's cost," he writes, adding, "But these reductions are primarily a result of a trend of lower drug spending that is unrelated to Medicare." In addition, Stark writes the editorial maintains that the Department of Veterans Affairs prescription drug program "limits drug access." However, according to Stark, "the VA covers 16,000 prescription drugs on its formulary and ensures access to other drugs when necessary." He writes, "At the behest of Republicans, the government now pays Medicare-sponsored HMOs and other private plans 11% more than would be spent in the traditional fee-for-service program," adding, "If the private sector is so efficient, why do we have to pay it more to do the job?" (Stark, Wall Street Journal, 10/11). [EINO: and why do taxpayers subsidize insurers with 11% of their costs so that they can offer medicare advantage policies which are lucrative for them anyway?]
Go to the Kaiser website to look up this Kaiser Daily Health Policy Report for Oct 11, 2006 CLICK HERE
|
LURING CUSTOMERS FROM MEDICARE
For years, private insurers have offered alternatives to the federal Medicare program that are [supposedly] meant to give patients lower-cost options than the government coverage provides [and which magically have provided unusually strong profits to the private insurers offering such plans at the same time]. But suddenly a type of private insurance plan is gaining ground that looks very similar to the basic coverage long available to anyone with a federally issued Medicare card. And the government is paying the private insurance industry a subsidy of 11% per patient, on average, to provide it. The fee-for-service plans, the focus of the current controversy, are in many ways similar to the government's own Medicare. Under the industry version, patients have the right to choose their own doctors and hospitals - as they have long been able to do with their federally issued Medicare cards.
And as with the federal program, enrollees in the private fee-for-service plans typically pay a monthly $88.50 premium to the government.
Under the industry plans, moreover, the hospitals and doctors receive the same rates as when they are paid through the basic federal Medicare program. Many see the private fee-for-service Medicare plans as mainly a feeder program in which insurance companies hope to gradually convert members into even more complex, more profitable private Medicare offerings that the government also subsidizes.
The more lucrative plans, like Medicare health maintenance organizations or doctor-network managed care programs, which have been available longer, can yield profits in the 10% range, analysts say [modest maybe, BUT that's a profit of 3 to 4x the administrative cost Medicare would have, not to mention the private insurer's administrative cost!!].
While insurers do run a risk of losing money on a patient if he or she has unexpectedly large health costs, the companies can consult county-by-county Medicare cost data and decide where to offer coverage and which high-cost areas to avoid. [Oh excuse me, I thought the risk part was why we were paying them!] Around the nation, depending on local medical costs and the health profile of Medicare-eligible residents, the monthly federal subsidy to the insurance company can range from $400 to $2,500, said Dr. Scott Latimer, a Humana executive based in Tampa, Fla.
To view this article or request a copy from the archives of THe New York Times, Sep 22, 2006 By Milt Freudenheim, CLICK HERE
|
NO LONGER A NATION'S SHAME, VETERAN CARE IS ACING COMPETITORS
Until the early 1990s, care at VA hospitals was so substandard that Congress considered shutting down the entire system and giving ex-G.I.s vouchers for treatment at private facilities. Today it's a very different story. The VA runs the largest integrated health-care system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed health-care program--socialized medicine on a small scale--is beating the marketplace. For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index, based on patient surveys on the quality of care received. The VA scored 83 out of 100; private institutions, 71. Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs, according to a study published in the April edition of Medical Care.
And all this was achieved at a relatively low cost. In the past 10 years, the number of veterans receiving treatment from the VA has more than doubled, from 2.5 million to 5.3 million, but the agency has cared for them with 10,000 fewer employees. The VA's cost per patient has remained steady during the past 10 years. The cost of private care has jumped about 40% in that same period.
The roots of the VA's reformation go back to 1994, when Bill Clinton appointed Kenneth Kizer as the VA's under secretary for health. Kizer decentralized the VA's cumbersome health bureaucracy and held regional managers more accountable. Patient records were transferred to a system-wide computer network, which has made its way into only 3% of private hospitals. When a veteran is treated, the doctor has the vet's complete medical history on a laptop. In the private sector, 20% of all lab tests are needlessly repeated because the doctor doesn't have handy the results of the same test performed earlier, according to a 2004 report by the President's information technology advisory committee.
Private hospitals, which make their money treating people who come to them sick, don't profit from heavy investments in preventive care, which keeps patients healthy [with single payer health care the government and whole system would however have an incentive to save by keeping people healthier and fully funding public health programs]. But the VA, which is funded by tax dollars, "has its patients for life," notes Kizer, who served in his post until 1999. So to keep government spending down, "it makes economic sense to keep them healthy and out of the hospital." Kizer eliminated more than half the system's 52,000 hospital beds and plowed the money saved into opening 300 new community clinics so vets could have easier access to family-practice-style doctors. He set strict performance standards that graded physicians on health promotion.
Veterans' groups understandably want the health-care system expanded to accommodate vets with higher incomes and no service-related ailments. Tom Bock, commander of the American Legion, has another idea: allow elderly vets not in the system who are drawing Medicare payments to spend those benefits at a VA facility instead of going to a private doctor, as is now required by Medicare.
But conservatives fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector. [Fearing we could cover the health care needs of the whole nation, NO UNINSURED, for what we are already spending today].
For the original news paper article By DOUGLAS WALLER see the NYTimes archives of Sunday, Aug. 27, 2006
|
PRIVATE NOT MUCH QUICKER FOR TREATMENT
Hospital consultants in Ireland have questioned the benefits of paying for private health insurance. Some claim going private does not necessarily ensure a fast-track to the operating table and that chronically ill patients are often better off in the public system. Citing the reduction in procedure waiting times under the National Treatment Purchase Fund (NTPF), the private sector's inability to treat patients and the escalating cost of health insurance, they believe the benefits of having private health insurance are diminishing.
Consultant neurologist Dr. Orla Hardiman, director of neurology at Beaumont, and a medical adviser to the Neurological Alliance of Ireland, said that in some instances her public waiting list is actually shorter than her private waiting list. "There are times when the private sector can offer quicker access for patients looking for specific procedures, but the benefits are not as clear-cut for chronically ill patients. There is no huge advantage in these patients having private cover as the services are not available in private hospitals," said Hardiman. Other consultants have had similar experiences.
"I'm wondering should people bother having private insurance, and having double taxation, unless they have a fast-track. "Because if you are waiting for three months, you can get into the same hospital under the NTPF and end up in a bed alongside somebody who has paid thousands in extra taxes (subscriptions)," he said.
For this article from The Sunday Business Post (Ireland), Jul 30, 2006, By S Mitchell and N Matthews CLICK HERE
|
MEDICARE PROSPECTIVE PAYMENT AND THE SHAPING OF US HEALTH CARE
Contrary to conventional wisdom and whole libraries of books and articles that point to managed care as the biggest "change agent" in American medicine in the last twenty years - the private sector neither initiated this battle nor provided the critical innovation that transformed health care in the USA. Instead, it was Medicare's transition to a prospective payment system (PPS) that triggered and repeatedly intensified the economic restructuring of the US health care system. With prospective payment, "Medicare sets prospectively the payment amount (rates) providers will receive for most covered products and services and providers agree to accept them as payment in full" according to the Medicare Payment Advisory Commission (MedPAC).
Medicare payment reforms have empowered the federal government, making it somewhat similar to health care systems in other Western countries. They have given the US government control over the price of most medical care and ended the era - dating back to the 1920s - in which doctors and hospitals' authority over medical prices and decision making went virtually unquestioned. The key to Medicare's role as the leading catalyst for change in the US health care system is the program's immense size and influence. As the single largest buyer of health care and the "first mover" in the annual payment game between those who provide medical care and those who pay for it, Medicare invariably drives the behavior of medical providers and private payers.
Medicare's prospective payment systems have created a stable funding base for the nation's providers. They have led to important changes in how providers deliver care, producing improved quality and efficiency that have spilled over to better the care provided to Americans. Medicare can shape health care in other ways as well - such as improving access to care, expanding individuals' protection against the cost of illness, and lowering administrative costs - if allowed to do so. [In other words we could continue our approach towards health care systems existing in the civilized industrial world if we extend Medicare to our whole population.]
For this book from The Johns Hopkins University Press, 2006 CLICK HERE
|
One might say that the HMO's specialize in care for the well (basically they are wonderful in premium collection).
From: JAMA 1996 276:1039
|
The Outcome
for Stroke Patients who are either in and HMO or Covered by Fee-for-Service
|
Fully 50% more patients are discharged to a nursing home rather than home if they are in an HMO.
From: JAMA 1997 278:1992
|
With Managed Care nearly 1/3 Fewer
Patients have Depression Diagnosed
|
And of those with such diagnosis nearly 25% fewere have their depression appropriately treated. From data of JAMA 1989 262:3298 and Arch Gen Psych 1993 50:517
|
|
|
|
|
|
|
Physicians are seeing significantly more patients per hour with the advent of mangaged care, than the average practice. They order the commonly needed diabetes tests much less often for their diabetes patients.
From: Arch Int Med 1999 159:294
|
|
|
The overwhelming majority of physicians agree that capitation is unethical, whether one surveys physicians working under capitation (CAP) or not (NOT).
From: Am J Man Care 1997 3:1497
|
PERCENT OF CORONARY BYPASS GRAFT PATIENTS
Who are sent to "high morality hospitals"
That’s more about one-third more if private HMO coverage is added to "enhance" one’s medicare.
From JAMA 2000 283:1976
|
PHARMACEUTICAL INDUSTRY'S STAGGERING PROFITS
From the Fortune 500 rankings for 1995-2002.
The pharmaceutical industry is ranked first among all Fortune 500 industry groups (every year).
Here the enormous profits of the drug industry are compared to the profits in the other Fortune 500 groups for individual years. Total drug company profits for 2002 were $37.4 BILLION
|
DRUG COMPANIES’ COSTS
The amount the industry spends on drug promotion (miseducation) exceeding $10 BILLION/ year
is more than is spent in our nation on yearly on training medical students
From CMS and the Health Care Industry Market Update: Pharmaceuticals, Jan 10 2003
|
MEDICAL JOURNAL ARTICLES PER CAPITA BY NATION
Number of articles in medline per capita 1990-98
Is our greater health care expense due to the higher intensity of US research and all the new findings with which we supply the rest of the developed world?
From Lancet 1999 Vol 354:517, plus data supplied by author D. Roseselli
|
TAX MONEY FUNDS THE LION’S SHARE OF RESEARCH
Isn’t it proper that industries profit enormously from their involvement in health care, given the risk and investment they are taking to push the frontiers in US research? Actually we already pick up support for 80% of the research through the taxes we pay. Most of the "product" from that research (useful to making someone money off of the findings) is given away free or cheaply to favored corporations.
From Harvard University Factbook, FY 2002
|
QUALITY OF CARE IN FOR-PROFIT AND NOT-FOR-PROFIT HEALTH PLANS ENROLLING MEDICARE BENEFICIARIES
EC Schneider, AM Zaslavsky, AM Epstein
The quality of care was lower in for-profit health plans than not-for-profit health plans on all 4 measures we studied (10% lower for breast cancer screening, 18% for diabetic eye examination, 16% for beta-blocker medication after myocardial infarction, and 30% lower for follow-up after hospitalization for mental illness). Adjustment for sociodemographic case-mix and health plan characteristics reduced but did not eliminate the differences, which remained statistically significant for 3 of the 4 measures. Different geographic locations of for-profit and not-for-profit health plans did not explain these differences.
The American Journal of Medicine
Volume 118, Issue 12 , December 2005, Pages 1392-1400
|
CHILDREN SUFFER AND DIE NEEDLESSLY IN AMERICA
Children in Florida who enter the hospital without health insurance are more than twice as likely to die there as children with private or public insurance, according to a report released by All Children’s Hospital and USF Health. Of the nearly 11,000 children hospitalized in Florida with injuries in 2002, 131 died. About 18% of those deaths were uninsured patients, even though those patients were only 8.5 % of hospitalizations (St. Petersburg Times, 10/4/05).
About 19.4 million children (29 % of all children) were covered by Medicaid in 2004, up from 22 % in 1999. Over the same period, the percentage of children covered by private insurance fell from 65 % to 59 % . While Medicaid is an important source of coverage for children, like SCHIP it is an unstable source due to the vagaries of state rules and funding. For example, 21,500 kids in Missouri were due to lose coverage at the end of 2005 because their families failed to pay the newly-mandated by the state legislature.(Cauchon, USA Today, 8/02)
|
ERODING ACCESS AMONG NONELDERLY ADULTS WITH CHRONIC CONDITIONS: TEN YEARS OF CHANGE
As the number of working-age adults who have major chronic conditions grew between 1997 and 2006, those without health coverage in this group experienced substantial erosion in access to health care, The number of working-age adults who reported having at least one of seven major chronic conditions grew 25% since 1997, to a total of nearly 58 million by 2006. Besides overall growth in the adult population, the increase over the period reflects rising rates of chronic disease prevalence among nonelderly adults. The research focused on nonelderly adults with chronic conditions because their greater health needs make them particularly sensitive to changes in the economy and the health care system. Studies have found that people with chronic conditions disproportionately account for three-quarters of all personal medical spending in the USA. As the nation struggles with unchecked health care costs, growth in the chronically ill population and the potential consequences of their unmet needs for care is cause for concern.
While large differences in access to care between uninsured and insured adults with chronic conditions existed in 1997, the insurance divide grew even wider by 2006. In general, the proportions of Medicaid enrollees and privately insured people having problems getting care were similar, and both proportions were much lower than the proportion of the uninsured who experienced problems getting care. Regular monitoring and continuity in a person’s care are important in managing a chronic condition effectively. Yet the authors found that more uninsured adults with a chronic condition reported not having a usual source of care between 1997 and 2006 (growing from 29% to 34%) and not having seen a health professional at all during the year (growing from 21% to 26%). Also, by 2006, more of this group was not seeing medical specialists.
In general, more of both the privately insured and uninsured with chronic conditions reported having an unmet need for care because of its cost over the period, while those with Medicaid coverage experienced no change. Still, the insurance divide remained wide, with the uninsured being more than four times as likely as the privately insured to have an unmet need for care (35% versus 8%).
ERODING ACCESS AMONG NONELDERLY ADULTS WITH CHRONIC CONDITIONS: TEN YEARS OF CHANGE" Tuesday, July 22, 2008 Original Article
|
HEADED IN THE WRONG DIRECTION: THE 2008 NATIONAL SCORECARD ON U.S. HEALTH SYSTEM PERFORMANCE J
Belief in economic and scientific progress is deeply engrained in the American way of life. As residents of a "can do" nation, Americans expect that our children will be better off than their parents, and that scientific breakthroughs will eventually conquer disease. Evidence that health care in this country is slipping backward is, therefore, deeply troubling. The first Scorecard was published in 2006. The new Scorecard, published July 2008, finds disturbing evidence that the health system is on the wrong track. In nearly every category measured, the health system performs worse than two years ago .
The Scorecard also found evidence that the billions spent on US health care far more than any other industrialized country are often squandered on administrative costs, inefficient systems, wasteful care, or treatment of preventable conditions. The U.S. also failed to keep up with advances in health outcomes, falling from 15th to 19th among industrialized nations in terms of the number of premature deaths that could potentially have been prevented by timely access to care.
If the U.S. health system achieved benchmark levels of performance, there would be real benefits in terms of health, patient experiences, and savings. For example: Thirty-seven million more adults would have an accessible primary care provider, and 70 million more adults would receive all recommended preventive care. 100,000 fewer people would die from causes that could have been prevented by good care. The Medicare program could potentially save at least $12 billion a year by reducing readmissions or reducing hospitalizations for preventable conditions. If we could lower the administrative costs of health insurances to the level found in Germany, which like the U.S. has a blended public-private health system, we could save $51 BIL a year. Reaching levels achieved in the best performing countries would save an estimated $102 BIL per year.
HEADED IN THE WRONG DIRECTION: THE 2008 NATIONAL SCORECARD ON U.S. HEALTH SYSTEM PERFORMANCE July 17, 2008 Commonwealth Fund Original Article
|
HIGH-RISK INSURANCE POOLS: A FLAWED MODEL FOR REFORM
Under conservative plans for health care reform, many more Americans with pre-existing conditions would find it even more difficult to obtain reasonably priced care. High-risk pools are state-sponsored associations that offer health insurance to the "medically uninsurable" or individuals who are unable to obtain coverage in the private market due to their medical history. High-risk pools have been around for over 30 years and currently exist in 35 states, but they only cover about 207,000 Americans. The biggest barrier to enrollment is cost. High-risk pools are inevitably expensive because all of the enrollees have medical conditions that could potentially result in costly medical bills, which means the pools cannot spread costs across low-risk and high-risk individuals. Despite attempts to cap premium rates, the coverage is still unaffordable for many. In fact, a recent study found that premiums for high-risk pools are unaffordable for about one-third of eligible individuals. High premiums and high deductibles are often a greater burden on individuals with expensive medical conditions who have already spent large amounts of their income on health care.
Some proponents refer to high-risk pools as "safety nets," but in reality, the pools do not provide a guarantee of coverage. Most have an exclusion period some period of time during which an insurer can exclude coverage for certain medical conditions that exist before the insurer issues coverage. These exclusion periods can last anywhere from 90 days to 1 year. Some pools cannot afford to admit more individuals; they either have waiting lists or are completely closed to new enrollees. In the meantime, individuals with costly conditions must go without coverage.
HIGH-RISK INSURANCE POOLS: A FLAWED MODEL FOR REFORM By Morgan Mulveon, Karen Davenport, Ellen-Marie Whelan | September 29, 2008
|
PRIMARY HEALTH CARE - NOW MORE THAN EVER
The World Health Report 2008 critically assessed the way that health care is organized, financed, and delivered in rich and poor countries around the world. The WHO report documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance.
Inequities in access to care and in health outcomes are usually greatest in cases where health is treated as a commodity and care is driven by profitability. The results are predictable: unnecessary tests and procedures, more frequent and longer hospital stays, higher overall costs, and exclusion of people who cannot pay.
Even in the United States, its exceptionalism stems not from lower public expenditure... but from its singularly high additional private expenditure. The persistent under-performance of the USA health sector across domains of health outcomes, quality, access, efficiency and equity, explains opinion polls that show increasing consensus of the notion of government intervention to secure more equitable access to essential health care.
PRIMARY HEALTH CARE - NOW MORE THAN EVER World Health OrganizationOctober 14, 2008 The World Health Report 2008
|
HEALTH PLANS RAMP UP HOSPITAL-PHYSICIAN PRICE AND QUALITY TRANSPARENCY TOOLS
While health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools’ pervasiveness and usefulness are limited, according to a study released in late August 2008 by the Center for Studying Health System Change (HSC). The information provided by health plans lacks specificity about individual providers, and its availability is often limited to enrollees in specific geographic areas. Likewise, few plans provide price information on services in physicians’ offices.
When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims. Many large employers view price and quality transparency as key to a broader consumerism strategy, where employees take more responsibility for medical costs, lifestyle choices and treatment decisions. "None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part, because few have incentives in their benefit structures to encourage cost comparisons," said co-author Ann Tynan.
HEALTH PLANS RAMP UP HOSPITAL-PHYSICIAN PRICE AND QUALITY TRANSPARENCY TOOLS August 28, 2008 from Robert Woods Johnson Foundation Original Article
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
References
FOR-PROFIT HC's
"benefits"
TOP
|
|
|
OUR WEALTHY NATION THE USA
Well aren't a lot of Americans better off with "For-Profit" (also known as "market-drive")?
|
PERCENT CHANGE IN FAMILY INCOME
From US Census Bureau
And how we are all benefiting from advancing an unresticted for-profit system of caring for the sick.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
REFERENCES
TOP
THIS PAGE |
|
JAMA
(Journal of the American Medical Association)
|
|
American J Man Care
Health Affairs
|
|
Health Care Financial Review Statistical Supplement
|
*1 Authors Reinhardt, Hussey and Anderson conclude that health insurance will become increasingly unaffordable to lower-income workers, forcing lawmakers to choose between some form of universal health care and a system in which there is a stark difference in the quality of care based on ability to pay. Health Affairs: http://www.healthaffairs.org/ (This journal does not allow us to summarize and link their articles for the public.)
|
*2 "Health Crisis Index Rose 37 Percent 1987 - 2003, A. Sager and D. Socolar, Health Reform Program, Boston University, School of Public Health (published March 2005) www.healthreformprogram.org
|
|
