Pages

Thursday, September 11, 2014

Health Care Reform Articles - September 11, 2014

Worried about health insurance? That's common!

By  • Bankrate.com
Despite the health reforms of Obamacare, more than half of all Americans worry that they won't be able to afford health insurance or pay future medical bills, according to the latest Bankrate Health Insurance Pulse survey.
Among those surveyed, 55 percent said they were either very or somewhat worried that they might not have health insurance in the future. An equal percentage expressed similar concern that medical bills may one day overwhelm their finances.
Highlights:
  • 46% of those who identify themselves as Democrats are either very or somewhat worried about winding up without affordable health insurance, versus 63% of Republican respondents and 62% of independents.
  • 60% of women are worried about their future health insurance, compared with 50% of men.
  • 60% of Americans between ages 30 and 64 are very or somewhat worried that they won't have affordable health coverage at some point, versus 49% of those in other age groups.

http://www.bankrate.com/finance/insurance/health-insurance-poll-0814.aspx

Narrow Health Networks: Maybe They’re Not So Bad

Margot Sanger-Katz
Lots of people shopping in the new health caremarketplaces this year picked health plans that limited their choice of doctors and hospitals. The plans were popular because they tended to cost less than more conventional plans that covered nearly every health care provider in a region.
The proliferation of these more limited plans, called narrow networks, has worried consumer advocates and insurance regulators. The concern is that people will struggle to find the care they need if their choices are limited.
Maybe we don’t have to worry so much. A new study suggests that, done right, a narrow network can succeed in saving money and helping certain patients get appropriate health care. The study, published as a working paper with the National Bureau of Economic Research, looked at a program that used financial incentives to steer workers into narrow plans. Those that chose the plans saved their employer money, saw their primary care doctors more and used the emergency room less. That doesn’t mean that narrow networks are the right choice for every health care consumer, but it all sounds like good news for the type of patient who wants such a plan. Done right, a smaller choice of doctors may have some advantages.

'Market forces' create bloated hospital bureaucracies: international study

By Markus Mannheim
The Canberra Times (Australia), Sept. 9, 2014
United States hospitals spend a quarter of their budgets on administration, more than twice as much as some other countries, an international study has found.
Meanwhile, separate data suggests Australian public hospitals may be only marginally more efficient than American hospitals.
The latest issue of Health Affairs journal reported on the eight-nation study, which found "bureaucracy" - e.g. central administration, IT and marketing - took up 25.3 per cent of US hospital budgets in 2011.
By comparison, administrative costs were only about 12 per cent in Scotland and Canada, countries with simpler, publicly funded health systems.
Hospitals in nations with some elements of private funding, such as Germany and France, had intermediate administrative expenses, while those shifting to "market-oriented payment systems", such as the Netherlands (19.8 per cent), faced costs closer to the US's.
The study attributed the high costs of the mostly private US system to the complexity of billing, given the need to deal with a wide range of health insurers and payments.
However, it also said the "entrepreneurial imperative" to make a profit undermined efficiency, by encouraging hospitals to "divert personnel and dollars to marketing, to cherry-picking profitable patients and services (and avoiding unprofitable ones), and to expensive computer systems and consultants to game the payment system".
Lead author Professor David Himmelstein, of Hunter College's school of urban public health, said US hospitals wasted $US300 billion a year on insurance companies' overheads "and the paperwork they inflict on doctors".
Another author, Steffie Woolhandler, said the result of America's market-oriented healthcare policies had created "the world's costliest healthcare, and our life expectancy is years shorter than in most other wealthy nations".
"It's time to admit that, when it comes to caring for sick people, markets don't work."

We’re No. 1, Not In A Good Way: Highest Hospital Administrative Costs

By Alvin Tran
WBUR CommonHealth blog, Sept. 8, 2014
When it comes to hospital administrative costs, a new Health Affairs study finds, our country is No. 1 and we’re way ahead of the curve — unfortunately.
In the study, researchers analyzed hospital accounting data to compare administrative costs across eight countries: Canada, England, France, Germany, the Netherlands, Scotland, the United States and Wales. They found that administrative costs accounted for more than 25 percent of total U.S. hospital expenditures — far ahead of the pack.
“We were surprised by just how big the differences have grown. The U.S. is in another league than every other country,” said Dr. David Himmelstein, the study’s lead author and a professor at the City University of New York’s School of Public Health.
Himmelstein and his colleagues also found that countries operating under a single-payer health system, such as Canada and Scotland, had the lowest administrative spending, and calculated that the U.S. could save $150 billion a year if it had a system like theirs.
Based on Medicare Costs Report data from 2011, hospital administrative spending in the U.S. amounted to $667 per capita — more than double what the Netherlands and England spend.
In the Netherlands, administrative costs consumed just 19.8 percent of hospital budgets — compared to 25.3 percent in the U.S. —  and in England, just 15.5 percent.
In a phone interview, Himmelstein said American hospital administrative costs have doubled over the last decade. “We anticipate that they’ll continue to go up because we’re continuing to pursue health policies that stimulate administration,” he added.
Uwe Reinhardt, a health economist and professor at Princeton University, sees high hospital administrative costs as a moral question. “You’re pulverizing all this money on something that does not make people better — doesn’t improve their health,” he said.
Reinhardt, who said he had once believed the new federal health law would lower administrative costs, now thinks Obamacare has become too challenging and complex, especially with the addition of navigators and health exchange administrators.
“I think the administration of the American health system has outpaced our ability to cope with it. Even the best IT people cannot cope with it anymore,” he said, adding that “Obamacare, if anything, adds to the administrative overhead.”
http://www.pnhp.org/print/news/2014/september/we’re-no-1-not-in-a-good-way-highest-hospital-administrative-costs


A Comparison of Hospital Administrative Costs in Eight Nations: U.S. Costs Exceed All Others by Far

Synopsis

Administrative costs account for 25 percent of total U.S. hospital spending, according to a new study that compares these costs across eight nations. The United States had the highest administrative costs; Scotland and Canada had the lowest. Reducing U.S. per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011.

The Issue

Even as all nations struggle with rising health care costs, the United States remains an outlier. Several factors help explain higher costs in the U.S., among them, higher physician fees, a focus on specialist services at the expense of primary care, and greater use of advanced technology in medicine. Some studies also have noted the substantial administrative costs incurred by U.S. health insurers and providers, including costs associated with coding, billing, and similar activities. In this Commonwealth Fund–supported study, researchers sought to compare hospital administrative costs in the U.S. with those in Canada, England, Scotland, Wales, France, Germany, and the Netherlands, using data obtained for 2010 or 2011.

Key Findings

  • Administrative costs accounted for 25 percent of hospital spending in the United States, more than twice the proportion seen in Canada and Scotland, which spent the least on administration. Administrative costs were notably higher in the Netherlands (20%) than in other European nation.
  • In the U.S., the share of costs devoted to administration were higher in for-profit hospitals (27%) than in nonprofit (25%) or public (23%) hospitals. Teaching hospitals had lower-than-average administrative costs (24%), as did rural facilities
  • U.S. hospital administrative costs rose from 23.5 percent of total hospital costs ($97.8 billion) in 2000 to 25.3 percent ($215.4 billion) in 2011. During that period, the hospital administration share of national gross domestic product (GDP) rose from 0.98 percent to 1.43 percent
  • Reducing U.S. spending on a per capita basis to Canada’s level would have saved $158 billion in 2011
  • There was no apparent link between higher administrative costs and better-quality care.
  • In countries where hospitals receive global, lump-sum budgets, garnering operating funds requires little administrative work. Per-patient billing, on the other hand, requires additional clerical and management staff and special information technology systems. In countries where there are multiple payers, as in the United States, billing is even more complex, since each hospital must negotiate payment rates separately with each payer and conform with a variety of requirements and billing procedures. Also factoring into administrative costs is how hospitals obtain their capital funds. The combination of direct government capital grants and separate global operating budgets—the approach taken in Canada and Scotland—was associated with the lowest administrative costs.
  • http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs


Time to end co-pays

They are one of many reasons US health care has the world’s highest overhead costs
September 8, 2014 9:45AM ET
by David Cay Johnston
American hospitals spend a huge and growing share of their revenue on overhead, a study published today in Health Affairs shows. Getting those costs down should be a national priority.
U.S. hospitals on average spend 25.3 cents out of each dollar of revenue on overhead, with for-profit hospitals spending 27 percent and nonprofits a bit below the average.
By contrast, the Netherlands and England, which have the next highest overhead costs, spend 19.8 percent and 15.5 percent, respectively. Both are moving toward market-based financial models, so, as with the U.S., overhead costs are likely to rise.
Compare Canada and Scotland, which have single-payer health care systems. Their hospital administrative costs are half those in the United States. 
The new study helps explain why for every $1 the 33 other countries with advanced economies spend per person on universal health care, the United States spends $2.64 — and yet more than one-fifth of Americans have no or poor health insurance.  A significant reason the U.S. health care system is so expensive and inefficient turns out to be those annoying co-pays. 

Co-pays do harm


In theory, as taught by Chicago School free-market economists, co-pays are supposed to help patients develop awareness of the costs of their health care as a control on overuse. In reality, co-pays are just a make-work program that discourages many people from seeing their doctor or filling prescriptions.
Dr. Steffie Woolhandler, a co-author of the new hospital overhead study, said she would prefer to waive her patients’ co-pays but can’t.
“You don’t have a choice,” she said. “I used to have a blanket policy of not collecting co-pays from low-income people, but it turned out I could be prosecuted for insurance fraud because the insurers require you to collect them.”
Woolhandler and Dr. David U. Himmelstein, both professors at the City University of New York School of Public Health at Hunter College and lecturers at Harvard Medical School, say the co-pay system does much more harm than commonly believed and lacks evidence it does any good.
Himmelstein says the U.S. is “squandering $150 billion each year on hospital bureaucracy and $300 billion more is wasted each year on insurance companies’ overhead and the paperwork they inflict on doctors.”

Do Workplace Wellness Programs Work? Usually Not

The Upshot

By Austin Frakt and Aaron E. Carroll
Most news coverage of the new Kaiser Family Foundation annual survey on employer-sponsored health plans has focused on the fact that growth in premiums in 2013 was as low as it has ever been in the 16 years of the survey. But buried in the details of the report are some interesting insights into how employers think about controlling health care costs. One example is that they’re very fond of workplace wellness programs. This is surprising, because while such programs sound great, research shows they rarely work as advertised.
Wellness programs aim to encourage workers to be more healthy. Many use financial incentives to motivate workers to monitor and improve their health, sometimes through lifestyle-modification programs aimed at lowering cholesterol or blood pressure, for instance. Some programs offer a carrot, like discounts on health insurance to employees who complete health-risk assessments. Others use a stick, penalizing poor performance, or charging people more for smoking or having a high body mass index, for example.
Wellness programs are popular among employers. An analysis by the RAND Corporation found that half of all organizations with 50 or more employees have them. The new survey by the Kaiser Family Foundation found that 36 percent of firms with more than 200 workers, and 18 percent of firms over all, use financial incentives tied to health objectives like weight loss and smoking cessation. Even more large firms — 51 percent of those with 200 workers or more — offer incentives for employees to complete health risk assessments, intended to identify health issues.
Medium-to-large employers spent an average of $521 per employee on wellness programs last year, double the amount they spent five years ago, according to a February report by Fidelity Investments and the National Business Group on Health. The programs are generally offered not directly by insurance companies, but by specialist firms thattell employers they will reduce spending on employees’ care by encouraging the employees to take better care of their health.
Wellness programs have grown into a $6 billion industry because employers believe this. In fact, asked which programs are most effective at reducing costs, more firms picked wellness programs than any other approach. The Kaiser survey found that 71 percent of all firms think such programs are “very” or “somewhat” effective, compared with only 47 percent for greater employee cost sharing or 33 percent for tighter networks. (Recent research on public employee plans in Massachusettsfound that tighter networks were associated with large savings.)

Health Chief Seeks to Focus on Insurance Site

By 
WASHINGTON — Sylvia Mathews Burwell, the secretary of Health and Human Services, said Monday in her first major speech that she wanted to move beyond the politics of health care and work with members of both parties to improve the management and operation of HealthCare.gov, the website used by millions of people to sign up for insurance coverage.
“What I’ve told my team is that we’re not here to fight last year’s battles,” she said. “We’re here to fight for affordability, access and quality.”
With midterm elections two months away, Ms. Burwell said she wanted to shift the conversation to areas of potential agreement. Polls consistently show that the public remains more negative than positive on the Affordable Care Act, but that Americans want Congress to improve the law rather than to repeal it.
“The American people are sending a very clear message that they want us to work together on health care,” Ms. Burwell said, in remarks at George Washington University.
Ms. Burwell said that since she took office in June, she has heard the same message from many people: “Enough already with the back and forth on the Affordable Care Act. We just want to move forward.”
The next open enrollment period begins Nov. 15 and runs through Feb. 15, half as long as the first sign-up period.
Shortly after Ms. Burwell finished her speech, she announced that the Obama administration was awarding $60 million in grants to 90 organizations that would counsel consumers on health insurance. Such counselors, also known as navigators, were indispensable in helping consumers use balky federal and state websites in the first enrollment period, which ran from October of last year through March of this year.
Last year the government awarded $67 million in navigator grants to 105 organizations, many of which had subcontractors.

New V.A. Secretary Says Hiring Spree Is Needed to Meet Patient Demand

By 
WASHINGTON — The new secretary of Veterans Affairs said Monday that the department needed to hire “tens of thousands of new doctors, new nurses, new clinicians” — emphasizing the significance of a shortage of employees who are directly involved in treating patients, a factor many experts said was a main driver in the waiting-list scandal that rocked the agency this year.
Yet the new secretary, Robert A. McDonald, a former chief executive of Procter & Gamble, who was unanimously confirmed by the Senate six weeks ago after the resignation of Eric Shinseki in May, acknowledged that it would be difficult to fill many of those slots.
“I am worried about our ability to recruit and retain talent,” Mr. McDonald said at his first news conference at the department’s office in Washington. “The issue now is, we have to find the people.”
Mr. McDonald broadly outlined other plans to fix the department’s problems, but he did not offer many specifics or go much beyond remedies that had already been outlined by the deputy secretary, Sloan D. Gibson, in the weeks after Mr. Shinseki’s departure.
In addition to hiring more doctors and nurses, Mr. McDonald pledged to flatten the department’s hierarchical structure; to continue to eliminate benchmarks that had created unintended incentives to manipulate waiting-time data; to transform what some officials called a vindictive and retaliatory management culture so that it “embraces constructive dissents and welcomes critical feedback”; and to take steps to make it easier for veterans to receive care. In response to a question, Mr. McDonald even gave a room full of journalists his cellphone number.
All that may prove less difficult than finding the new doctors and nurses the department needs to handle the demand from service members returning from Iraq and Afghanistan, as well as from aging veterans of Vietnam and previous wars. At the same time, the department must still fill both existing vacancies and new positions created by a $17-billionplan approved by Congress this summer to stabilize the agency.
The precise number of clinician slots the department already has the money to fill is not clear. In July, the department told Congress that it had almost 36,000 “clinical provider vacancies” — including more than 9,000 registered nurse vacancies and almost 4,000 physician vacancies. Over all, there were almost 46,000 vacancies across the entire veterans health care system, a vacancy rate of 15.5 percent.


   

Curb your enthusiasm about those Medicare savings

by Robert J. Samuelson - The Washington Post

Contrary to some media reports, the Medicare monster hasn’t been tamed. But it has been made a little less unruly. To be precise: Spending is regularly falling below projections, creating the prospect of hundreds of billions of savings over decades. “It’s a pretty big deal,” says Tricia Neuman of the Kaiser Family Foundation, a health-care think tank, “because the slowdown has been sustained year after year.”
Here are the startling numbers. In 2014, average spending per Medicare recipient is expected to be $1,048 lower than the Congressional Budget Office (CBO) projected in 2010, says Neuman. With today’s trends, the gap widens to $2,369 in 2019. The cumulative savings are impressive. For 2011 to 2020, CBO thinks Medicare spending will total $715 billion less than reckoned in 2010.
This has prompted some loud applause. “Medicare: Not Such a Budget-Buster Anymore,” headlined a New York Times story. The savings in 2019, it said, would be “greater than what the government is expected to spend that year on unemployment insurance, welfare and Amtrak — combined. . . . Widely discussed policy changes, such as raising the estate tax, would generate just a tiny fraction” of Medicare’s savings.
Let’s not get carried away.
True, the savings are significant. Still, they don’t alter the nation’s central budget problem: Rising spending on the elderly is dictating government’s priorities. It’s squeezing other programs — from defense to medical research — while feeding big deficits and creating pressure for higher taxes.
Let’s go back to the numbers.

Employer health rates rise 3%, worker deductibles top $1,200

contact the reporter
The price of employer health insurance rose a modest 3% this year, a major survey shows, but workers will be paying more when they get sick as deductibles soar.
Annual insurance premiums for families increased 3%, on average, to $16,834, according to the survey released Wednesday by the Kaiser Family Foundation and the Health Research & Educational Trust.
Those results reflect a recent trend of slower growth in healthcare costs. But many employers and health-policy experts predict bigger increases for 2015 and beyond as the economy recovers.
"Large employers are skeptical the current low trends will continue for a variety of reasons," said Bill Kramer, executive director for national health policy at the Pacific Business Group on Health, which represents large employers such as Boeing Co. and Walt Disney Co.
"Historically, periods of slow growth have always been followed by rapid increases," Kramer said.
Insurance offered by employers is the primary source of health coverage for Americans, providing benefits to about 150 million people. Most employers will begin open enrollment for 2015 plans in the coming weeks.
Even modest changes in medical costs have been difficult to absorb for many businesses and workers hurt by the Great Recession. Many employers have cut their financial exposure by foisting more costs on to workers.
The average employee deductible has increased 47% since 2009 to $1,217 annually. Eighteen percent of workers face a deductible of at least $2,000. Workers typically must pay that amount before most medical services are covered by their health plan.
Some health-policy experts credit higher deductibles with helping hold down medical costs by discouraging people from getting care or motivating them to be savvier shoppers. But throwing up barriers to cost-saving preventive care is a potential downside.
"Higher deductibles may be good if you're relatively young and healthy," said Drew Altman, chief executive of the Kaiser Family Foundation in Menlo Park, Calif. "But they may be a bad thing if you are lower or moderate income or chronically ill. This can be a real burden on the family budget."

Virginia governor unveils modest Medicaid expansion plan to cover 25,000 Virginians

By Reuters,
Posted Sept. 08, 2014, at 2:05 p.m.
Democratic Governor Terry McAuliffe proposed a plan on Monday to provide medical insurance for 25,000 uninsured Virginians, a move that falls short of his vow to expand coverage to 400,000 people despite Republican objections.
McAuliffe said in June after losing a fight with the Republican-controlled legislature over Medicaid, the federal-state healthcare program for the poor, that he would close the gap without lawmakers’ help.
The 25,000 Virginians who would get insurance group about 20,000 people who are mentally ill and 5,000 children of state employees, the governor said in a statement.
The insurance expansion is part of a 10-point health care program that would affect more than 200,000 people, mostly by improving care for those already in Medicaid and boosting efforts to sign up Virginians who qualify for it but are not enrolled.
McAuliffe, who took office in January, said he would use $40 million in leftover state health care funds to provide coverage for the mentally ill.
Virginia also can include children of state employees because the 2010 Affordable Care Act lifted a ban against enrolling them in the federal program, he said.
McAuliffe, a former head of the Democratic National Committee, campaigned in 2013 on increasing Medicaid coverage, a measure he said would create 30,000 jobs in Virginia.
McAuliffe had linked the state’s budget to Medicaid expansion. Republican state lawmakers inserted last-minute language into Virginia’s two-year budget in June to block McAuliffe’s proposed expansion to cover 400,000 uninsured Virginians.
McAuliffe had contended that accepting $2 billion in federal funds to expand Medicaid under the Affordable Care Act would create jobs, raise state salaries and bolster pensions.
Republican lawmakers opted not to accept the funds.


Surprise In Mass. Primary: 21 Percent For Single-Payer Candidate Berwick

By Carey Goldberg
WBUR's CommonHealth blog, Sept. 10, 2014
Note to politicians: Backing “Medicare for all” is looking less and less like electoral poison. If, deep in your heart, you believe American health care would be better off with a Canadian-style, single-payer system, you might now consider coming out of the closet. (In Democratic primaries in blue states, at least.)
That’s my suggested takeaway from the striking Massachusetts Democratic primary showing of Dr. Donald Berwick, who rocketed from near-zero name recognition among general voters to 21 percent at the polls. Catch him saying forcefully in the video above: “Let’s take the step in health care that the rest of the country hasn’t had the guts to take: single payer. Medicare for all.”
Now, Vermont not only has a mainstream politician who backed a single-payer system — Gov. Peter Shumlin — it’s actually translating the idea into practice as we speak. But let’s put it this way: This seems to be the first time that a candidate in a mainstream political party in a state that is not a verdant utopian duchy has run on a single-payer platform. And though he did not defeat the longtime familiar faces, he did surprisingly well.
Of course, we knew that Massachusetts voters tend to like the idea of single payer. As recently as 2010, 14 fairly middle-of-the-road districts voted in favor of a non-binding ballot measurecalling for “creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts.”
Analysts projected that the results meant a statewide majority in support of a single-payer system. The single-payer idea had polled well in non-binding ballot measures before, as well. But now we’ve seen that sentiment translated into support for a candidate.
Other politicians, including President Obama, have backed the general idea of a single-payer system, but they always add a “but,” said Dr. Steffie Woolhandler, who helped found Physicians for a National Health Program.
“And the ‘but’ usually has to do with the political situation,” she said. “But it’s actually important to say what’s the right thing to do and to really work toward the right solution, and that’s what Don [Berwick] has been willing to do, to say, ‘We need single payer and skip the ‘but,’ let’s just say we need single payer and that we need to start working toward it.’”
Will Dr. Berwick’s strong showing change the playing field for other candidates? Dr. Woolhandler says yes: “Politicians understand votes. Unfortunately, they also understand money. But they do understand votes, and I think other politicians will see that voters are behind the idea of single payer.”
I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, “That sounds right to me. Let me tell you my story.”
“I remember a carpenter in Hingham,” he said. “I don’t think he would have said he was a progressive — he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess — embarrassingly, to me — I was expecting some pushback. But he immediately said, ‘I’ve got to tell you a story.’ And he told me about his struggle to get health insurance.
“He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered — to his dismay — that the deductible did not apply to the year, it applied to each separate episode. So this guy, who’s working with his hands and trying to just get through and have his family’s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, ‘Enough of this!’ He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.”
http://www.pnhp.org/print/news/2014/september/surprise-in-mass-primary-21-percent-for-single-payer-candidate-berwick
Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)