Author: cmh

Candian Medical Association Looks to Europe to Improve Health System

Letter to members kicks off CMA debate:

The Canadian Medical Association is looking at European health systems for ways to improve.

The CMA won’t launch its online consultation about transforming Canada’s health care system until April 6, but if the initial response to President Robert Ouellet’s March 6 letter announcing the endeavour is any indication, the consultation website should be a busy place.

Within five days of emailing the letter to members and posting it on cma.ca, the CMA had received 149 emails, many containing lengthy comments.

In his letter, entitled Status quo, or transformation?, Ouellet suggested that if Canada wants ‘a sustainable, universal health care system, we have to transform the one we have.’ It was first emailed to 45,000 members and posted on cma.ca, and then sent by regular mail to a further 25,000 members.

The link the the letter is at their website, and a few choice comments are there, and here:

  • “I kindly disagree with you. The problems in our system will not be solved by privatizing the most lucrative parts of it. Canadian doctors want to practise medicine, not run businesses.”
  • “I was delighted with your comments. The constant arguments that any changes in our system will make us like the US have been misleading and frustrating.”
  • “It is about time care and money be patient based. Bring on the new system you suggest – it cannot come soon enough for me.”
  • “I’m baffled how we are like sheep and accept the wait times in our country when other countries far surpass our achievements.”

It’s funny, isn’t it? Canada has the sense to look past the end of its collective nose for solutions, while we continue to try to tweak our system as it continues on its glide-path into the mountain.

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com

Insurers shun those taking certain meds – Costs of Care – MiamiHerald.com:

“Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

“This confidential information on some insurers’ practices is available on the Web — if you know where to look.

“What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

“These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won’t be rejected for insurance.”

No surprises here, just documenting.

But it does make an interesting contrast to a letter written to the New York times on their piece on a public insurance option by a rather alarmist (and ill informed) physician:

“The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve.”

Rationing, in America! God forbid.

Support Growing for Major Changes to Health-Care System

Support Growing for Major Changes to Health-Care System:

Most notably, the group, known as the Health Reform Dialogue, calls for creating an ‘individual mandate’ that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.

‘We should seek to ensure coverage for all,’ the group concluded after six months of private, professionally facilitated negotiations.

The results are noteworthy because it is the first time that such a varied mix of special interests — ‘strange bedfellows,’ in the words of one participant — have coalesced around significant changes to the U.S. health system. The signers include the American Medical Association, the National Federation of Independent Business, two hospital groups, AARP and the liberal
consumer advocacy group Families USA.

‘We’re narrowing the range of disagreement,’ said Karen Davis, president of the Commonwealth Fund, a nonprofit private health-care foundation that was not involved in the effort. It is striking, she observed, that the Health Reform Dialogue and influential lawmakers have all but ruled out the prospect of a European-style single-payer system, opting instead to build on the existing employer-based insurance arrangements.

Equally striking, however, were the fundamental questions left unaddressed by the group of health-care heavyweights.

‘A day late and a dollar short,’ said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.

The coalition’s report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage.”

….

“A government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan,” said Nick Simpson, spokesman for Rep. Roy Blunt (R-Mo.).

I love that last bit by Rep. Blunt. If by push, he means that by being cheaper, more efficient and consumer friendly, public plans would be able to out compete the very inefficient private insurers, then yeah, they’ll be “pushed.”

RAND | (Technical) Reports | Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review

RAND (Technical) Reports Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review:

This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting. In addition to cost-containment measures, the review also examined what was known about effects on health status, satisfaction, fairness and the macro-economic situation. The review describes the health economics theory of consumer choice, the methodology for the literature review, the German health system, and studies on consumer choice of insurers and providers, and reflects on their relevance on the German system. This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting.

The full document is here.

The Public Option Favored by the Public

Robert Creamer at Huffington Post has a piece about a poll conducted by the Lake Research “found that a whopping 73% of voters want everyone to have a choice of private health insurance or a public health insurance plan while only 15% want everyone to have private insurance. “

Follow the link to read the rest. (I cannot find a link to the actual polling, sorry.)

This post also gives me a chance to link to
THE CASE FOR PUBLIC PLAN CHOICE IN NATIONAL HEALTH REFORM
KEY TO COST CONTROL AND QUALITY COVERAGE
By Jacob S. Hacker, Ph.D.*

From the executive summary:

This policy brief sets out the argument for public plan choice. The core argument is that public insurance has distinct strengths and thus, offered as a choice on a level playing field with private plans, can serve as an important benchmark for private insurance within a reformed health care framework. This is not an argument for a universal Medicare program, but instead for a “hybrid” approach that builds on the best elements of the present system—large group plans in the public and private sectors—while putting in place a new means by which those without access to secure workplace insurance can choose among health plans that provide strong guarantees of quality, affordable coverage. The case made in this brief is that this menu of health plans must include a good public plan modeled after Medicare if the broad goals of reform—universal insurance and improved value—are to be achieved.

A Healthy Blog » Payment Reform Commission Looks At Payment Systems

A Healthy Blog » Payment Reform Commission Looks At Payment Systems:

“The Payment Reform Commission held its fourth meeting on Tuesday, February 24th. The Commission discussed episode-based payment models and evidence-based purchasing at length. Meeting materials are available here. Our full report is below the fold.

“Consultant Michael Bailit began the meeting by updating the Commission on feedback received from stakeholder input sessions. Bailit, Commissioner Iselin and Administration and Finance staff are conducting three rounds of meetings with stakeholders to gather feedback on the payment reform process.”

This is a nice introduction to payment reform, including a section at the end discussing the potential uses of Comparative Effectiveness Research, and also of possible backlash against such work.