When Health Deductibles Rise, Men Delay Emergency Care
By ANN CARRNS
Here’s a situation that may sound familiar to you: A man visits his doctor’s office with his wife, who laments how stubborn he is about seeking medical care.
Frank Wharam, a doctor and researcher at Harvard Medical School, says he often hears these words, “My wife made me come.”
That gender dynamic may provide fodder for stand-up comics, but it can have serious health implications, especially given the increasing use of high-deductible health insurance plans.
Men, it turns out, are more likely to delay treatment for serious conditions under high-deductible plans, in contrast to women, who tend to be more selective and cut back care for minor ailments only.
That’s according to a recent study led by Katy Kozhimannil, a researcher at the University of Minnesota’s school of public health. (Dr. Wharam was a co-author.)
Such plans generally have lower monthly premiums than traditional health plans but higher out-of-pocket costs — sometimes, $4,000 or $5,000 for a family, or even higher. About a third of workers now have such plans. And that number is likely to grow, since lower-cost plans on the new health care marketplaces created by the Affordable Care Act are likely to have relatively high deductibles.
Other studies have shown that low-income people also tend to put off care under such plans. But Ms. Kozhimannil says her study is the first to examine the different impact of such plans on men and women.
The study compared emergency room visits for about 12,000 people — roughly half men and half women — for a year before, and two years after, they were involuntarily switched by their employers to a high-deductible plan.
Selling Health Care Reform
By THE EDITORIAL BOARD
The long years of Republican obstruction and obfuscation on health care reform have taken their toll. More than half of Americans still say they don’t know how they and their families will be affected by the Affordable Care Act, according to a new Kaiser Family Foundation poll, about the same percentage as in 2010. More Americans have a negative view of the act than a positive one.
But now the Obama administration, which has been outshouted by its opponents, is fighting back. It recently announced it will pay $67 million to more than 100 community groups and health care providers to evangelize for the program and help people navigate its complexities in preparation for the opening of health care exchanges on Oct. 1. President Obama, Vice President Joseph Biden Jr. and their spouses are preparing an extensive road trip in the next few weeks to encourage enrollment.
And on Wednesday, former President Bill Clinton — described by Mr. Obama as “the secretary of explaining stuff” — was deployed to give the first in a series of speeches describing the law’s importance to public health and to those now unable to obtain or afford insurance. Speaking at his library in Little Rock, Ark., he made a forceful case:
“This does give us the best chance we have to achieve nearly universal coverage, provide higher quality health care and lower the rate of cost increases, which we have got to do in a competitive global economy.”
The public relations effort is desperately needed. The Republican Party has spent the last few months trying to dampen enthusiasm for enrollment with misinformation and opportunism. (House Speaker John Boehner, for example, falsely claimed the law would raise the nation’s health care costs.) The Senate minority leader, Mitch McConnell, has promised to make it the single biggest issue in next year’s midterm elections. One presidential hopeful, Senator Ted Cruz of Texas, spent his summer on a “Defund Obamacare” tour, cynically aware that it would be far more successful at bringing him name recognition and dollars than at achieving its purported goal.
Hi, It’s Your Doctor
By EZEKIEL J. EMANUEL
MY father, a pediatrician, kept all his medical equipment in a black leather bag. He used to take it on house calls. My brothers and I would frequently tag along to watch him treat patients. He would remove stitches from over an eye or look into a throat and ears, providing a few pills to start a regimen of antibiotics for an ear infection.
Sometime in the late 1960s, he stopped making house calls. Instead, my father began routinely sending patients to the hospital emergency room.
And he wasn’t alone. In 1930, house calls accounted for 40 percent of physician interactions. By 1980, that number had dropped to 1 percent.
But after a half-century, the house call is making a comeback. The available data on house calls are spotty at best. But one study estimated that in 2010, about 4,000 physicians conducted more than two million house calls. Some do what my father did: attend to urgent but not emergency situations, taking care of people with stomach pain, fever, cuts needing stitches and the like. These kinds of urgent-care problems are best treated by a house call, but account for about 40 percent of the nearly 130 million annual visits to emergency rooms.
Companies like Microsoft and Costco provide similar house calls to their employees in the Seattle area. Carena, a private company under contract for the service, sends out doctors or nurse practitioners to assess the situation with the assistance of computer software. The software uses algorithms to help them differentiate between cases that are safe to handle at home and those that require the emergency room.
Companies like Microsoft and Costco provide similar house calls to their employees in the Seattle area. Carena, a private company under contract for the service, sends out doctors or nurse practitioners to assess the situation with the assistance of computer software. The software uses algorithms to help them differentiate between cases that are safe to handle at home and those that require the emergency room.
New Health Insurance Marketplace is breeding ground for scammers
Posted Sept. 05, 2013, at 1:35 p.m.
People on Medicare are a coveted group. Scammers thrive on them, stopping at nothing to separate these beneficiaries from their Medicare numbers. In a word, it’s criminal.
And it’s about to get worse. The new Health Insurance Marketplace is a breeding ground for scammers who are trying to convince Medicare beneficiaries to enroll in a “new marketplace policy” or “a better Medicare.” You may be told by a scammer that if you do not answer the questions, “you could be left out and have no coverage at all.” Or that your Medicare benefits are “changing because of the Marketplace.”
None of this is true. According to the Centers for Medicare and Medicaid Services, the Health Insurance Marketplace is designated to help people who do not have health insurance. This means that people on Medicare do not need a plan from the Marketplace nor are they even eligible for one.
Open enrollment for the Health Insurance Marketplace is Oct. 1, 2013 to March 31, 2014. The timing may be confusing for some because Medicare Part D, prescription drug coverage, open enrollment is Oct. 15, 2013 to December 7, 2013.
Even though the timing overlaps, the two are not connected. Medicare Part D and the Health Insurance Marketplace are completely different things, although scammers will try their hardest to convince you otherwise.
Do not fall for it.
After A Decade, Congress Moves To Fix Doctors' Medicare Pay
Hear the words health care and Congress, and you think fight, right?
And you'd be forgiven, particularly because the House has now voted some 40 times in the past two years to repeal or otherwise undo portions of the Affordable Care Act.
But something unusual happened just before Congress left for its summer break. The House Energy and Commerce Committee voted 51-0 for a bill that would overhaul the way Medicare pays doctors.
The bill would, among other things, repeal something called the sustainable growth rate formula, or SGR, and eventually replace it with a system that would pay doctors based on how healthy they keep their patients.
The current formula has threatened to cut physician pay, often by double-digit rates, for each of the past dozen years.
"Since its passage in 1997, SGR has bred uncertainty and frustration," said Energy and Commerce Chairman Fred Upton, R-Mich., during the panel's consideration of the bill. "Doctors have been forced to endure 11th hour fixes, sometimes on a monthly basis, which clearly have stymied physicians' abilities to run their practices."
High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power
HSC Research Brief No. 27
September 2013
Chapin White, Amelia M. Bond, James D. Reschovsky
September 2013
Chapin White, Amelia M. Bond, James D. Reschovsky
Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients are much higher than Medicare payment rates and vary widely across and within markets, according to a study by the Center for Studying Health System Change (HSC) based on claims data for about 590,000 active and retired nonelderly autoworkers and their dependents. Across the 13 communities, average hospital prices for privately insured patients are about one-and-a-half times Medicare rates for inpatient care and two times what Medicare pays for outpatient care. Within individual communities, prices vary widely, with the highest-priced hospital typically paid 60 percent more for inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient care, with the highest-priced hospital typically paid nearly double the lowest-priced hospital. In contrast to the wide variation in hospital prices for privately insured patients across and within markets, prices for primary care physician services generally are close to Medicare rates and vary little within markets. Prices for specialist physician services, however, are higher relative to Medicare and vary more across and within markets.
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