Friday, July 25, 2008

They Know What's in Your Medicine Cabinet

They Know What's in Your Medicine Cabinet:
"That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. 'It's making it harder to find insurance for people,' says Jay Horowitz, an independent insurance agent in Overland Park, Kan."

This would be funny if it weren't so disturbing.

We've been having a running joke at our house that our pharmacist is going to think I'm the most diseased man on the planet because I keep getting medications from my local grocer's $4 drug list for my dog!

I've been getting him antibiotics, oral and ophthalmic and topical, in a wide variety, steroids, and other stuff in my name because paying for these is far cheaper than at the vet's! Now none of these have been charged to my insurer, I strictly pay cash, but clearly my name will be in the databases with all these drugs. So next time I have to switch plans....

Sphere: Related Content

Thursday, July 24, 2008

Need Some Botox With that Flu Shot? : NPR

Need Some Botox With that Flu Shot? : NPR:

"Primary care doctors say they're having more and more trouble making ends meet. They're drowning in required paperwork and getting paid less than specialists. So, a growing number of general practitioners are adding cosmetic procedures to their offerings as a way to bring in more money."

No surprizes in this story, except at the end there is a bit of discussion of the reimbursement differential among procedure-based specialties and the rest of us.

And NPR really seems to be giving healthcare the full coverage blitz lately. Lots of stories about healthcare including
this one on Morning Edition documenting the travails of two patients with MS. The first in the "new and improved" NHS in Britain and the other, a man in Philadelphia who thought he had good healthcare insurance.

And here is a link to their
"Health Care for All" home page.

Sphere: Related Content

Wednesday, July 23, 2008

Keeping German Doctors On A Budget Lowers Costs : NPR

Keeping German Doctors On A Budget Lowers Costs : NPR:

"How Doctors Get Paid

Nearly all hospital-based doctors are salaried, and those salaries are part of hospital budgets that are negotiated each year between hospitals and 'sickness funds' — the 240 nonprofit insurance companies that cover nearly nine out of 10 Germans through their jobs. (About 10 percent, who are generally higher income, opt out of the main system to buy insurance from for-profit companies. A small fraction get tax-subsidized care.)

Office-based doctors in Germany operate much like U.S. physicians do. They're private entrepreneurs who get a fee from insurers for every visit and every procedure they perform. The big difference is that groups of office-based physicians in every region negotiate with insurers to arrive at collective annual budgets.

Those doctor budgets get divided into quarterly amounts — a limited pot of money for each region. Once doctors collectively use up that money, that's it — there's no more until the next quarter.

It's a powerful incentive for doctors to exercise restraint — not to provide more care than is necessary. But often, the pot of money is exhausted before the end of the quarter."

Interesting piece from over the Fourth holiday. It was mostly about the last paragraph above: Namely that physicians have to decide whether to continue to provide service until the end of the quarter when the budget is already exhausted. Seems bizarre to physicians here, except that we do the same thing, only play the game differently.

The way we do it is not quarterly, but on an ongoing basis. Most of our patients have insurance that pays us (more or less) what we expect, but a certain percentage have Medicaid or are uninsured altogether or have crappy insurance that doesn't cover whatever you just took care of, and so on. So the net effect is similar.

But another intersting tidbits is the salaried nature of hospital based physicians. It would be interesting to see what the contracts look like in terms of benefits, vacation, salary, etc.

Sphere: Related Content

Sunday, July 20, 2008 - Health-care matchup finds Ohio falls short - Health-care matchup finds Ohio falls short

From the article, which is a nice overview of US (Ohio) vs. Canadian (Ontario)

To explore how Ohio compares to the nation and the world, the Beacon Journal looked 60 miles across Lake Erie to the Canadian province of Ontario.
How does Ohio measure up to its neighbor?
Not very well:
• A 65-year-old Ontario resident can look forward to living about 20 more years — three years more than an Ohioan the same age can expect. At birth, the difference in life expectancy is greater — 76.4 years for Ohioans, compared to 80.7 years in Ontario.
• In Ohio, nearly eight of 1,000 newborns die each year — significantly higher than the U.S. rate of 6.8 deaths. In Ontario, the infant mortality rate is 5.5
• Ontario also has lower death rates for each of the top six causes: heart disease, cancer, stroke, emphysema and other chronic lower respiratory diseases, diabetes and accidents.
Overall, the gap in these key health-care yardsticks was wider between Ohio and Ontario than between the two nations as a whole in all but two categories: strokes and accidents.
That difference was striking because the state and the province are so similar demographically.
While the 300 million people in the United States are nine times more than Canada's head count, Ohio and Ontario are close in population, overall economic size and demographic measures such as median age, average household and family size, and education.
Ohio and Ontario also have similar economies, with almost the same percentage of both work forces employed in manufacturing and retail and wholesale trade — the two largest industry categories. Wages and salaries also are comparable.

Sphere: Related Content

Thursday, July 17, 2008

While the U.S. Spends Heavily on Health Care, a Study Faults the Quality -

While the U.S. Spends Heavily on Health Care, a Study Faults the Quality -

"In some cases, the nation’s progress was overshadowed by improvements in other industrialized countries, which typically have more centralized health systems, which makes it easier to put changes in place.

The United States, for example, has reduced the number of preventable deaths for people under the age of 75 to 110 deaths for every 100,000 people, compared with 115 deaths five years earlier, but other countries have made greater strides. As a result, the United States now ranks last in preventable mortality, just below Ireland and Portugal, according to the Commonwealth Fund’s analysis of World Health Organization data. The leader by that measure is France, followed by Japan and Australia.

Other countries worked hard to improve, according to the Commonwealth Fund researchers. Britain, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease. The success is related to “really making a government priority to get top-quality care,” Ms. Davis said."

The Commonwealtth Fund's Report is here:
Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008July 17, 2008 Volume 97
The Commonwealth Fund Commission on a High Performance Health System

Sphere: Related Content

Tuesday, July 15, 2008

Doctor shortage worsens as student debt rises

Doctor shortage worsens as student debt rises:

"the debt burden on graduates is daunting, especially given that they must spend at least three more years on post-graduate residency training that pays about $44,000 to $45,000 for the first year, according to the Association of American Medical Colleges.

While in their residencies, many future doctors choose to defer their school loan payments, so their arrears grow even larger as they accrue interest, Black said.
That option will be gone, however, beginning in July 2009, when the U.S. Department of Education ends medical school payment deferment -- a move that could further put aspiring doctors in a financial bind, said Chromy, who helped author the resolution.

'We're required to do this residency, but we can't defer,' she said. 'If we're trying to increase the supply of physicians, the answer is not to make it harder to make physicians.'

The resolution estimates that the average monthly payment on debt of about $160,000 starts at $1,400 a month on a 25-year repayment plan -- or about 50 percent of the post-tax income of a resident's salary.

In his two years of medical school at Wayne State, Joseph Khouri has racked up about $140,000 in debt, a figure that includes out-of-state tuition and loans to pay for living expenses.

'I mean, this is ridiculous,' said Khouri, who is from Cleveland. 'Medicine isn't about money and it never was about it for me. But graduating $280,000 in debt is intimidating.'

It could be worse for future medical students at Wayne State Medical School. One report by the medical college association projects debt for graduates could rise to about $750,000 by 2033."

This is the new social contract we have accidentally made. We tell our students to suck it up and pay extraordinary tuition to become doctors. Then we tell them they should be going into primary care, where they would be doing the most good caring for patients, but will never catch up to their peers in income, accumulation of home equity, retirement funds or wealth in general.

The saying that "it's just as easy to fall in love with a rich man as a poor man" comes to mind. While in training, it is just as easy to fall in love with a handsomely reimbursed specialty as it is a poorly reimbursed one.

Sphere: Related Content

Thursday, July 10, 2008

Kennedy leads renewed effort on universal healthcare - The Boston Globe

Kennedy leads renewed effort on universal healthcare - The Boston Globe:

"Kennedy is not alone in trying to get a head start on the healthcare debate. Senator Max Baucus, a Democrat from Montana and chairman of the Senate Finance Committee, held a healthcare summit in mid-June, and a bipartisan proposal to make private insurance accessible to all Americans has been put forward by Senator Ron Wyden, a Democrat from Oregon, and Robert Bennett, a Republican from Utah."

The "Big Mo" building just in time for a new, Democratic President in 2009...

Sphere: Related Content

Miles Mogulescu: Why Not Single Payer? Part 6: New "Health Care For America Now" Coalition May Reflect Divisions in the Movement for Universal Healthcare - Politics on The Huffington Post

Miles Mogulescu: Why Not Single Payer? Part 6: New "Health Care For America Now" Coalition May Reflect Divisions in the Movement for Universal Healthcare - Politics on The Huffington Post

We all saw sicko, but many of us also saw Frontline's Sick Around the World program :

Certainly Single payer can work and might be the best system possible, but I don't think the Bismarkian systems of Germany, Switzerland and others can be dismissed out of hand. If you go to the frontline website and watch the show, be sure to read the supplementary materials, especially he interview with Uwe Reinhardt.

I had not given Bismarkian systems much thought until I heard a representative from the Stark Raving Loonie Party (Sorry, that's Python - I meant the Fraser Institute of Canada) actually confess that he could see working with reform along the Bismarkian lines:

Further, Sen. Ron Wyden and others have introduced a plan along these lines, so HR 676 isn't the only ball in play at the moment.
Wyden Press release:
Other commentary:

So I guess I'd say not to discount the Wyden plan out of hand as not being "pure" single payer. because we have examples of this system working as well as single payer can.


Sphere: Related Content