Category: Access to Treatment

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times

Health Net ordered to pay $9 million after canceling cancer patient’s policy – Los Angeles Times:

“Calling Woodland Hills-based Health Net’s actions ‘egregious,’ Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.

‘Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured,’ Cianchetti wrote in a 21-page ruling.

Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.

Then, ‘I thanked God,’ she said. ‘I praised the Lord.’

Bates called the arbitration judge ‘an angel . . . a real stand-up kind of judge.’

When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.

Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.

At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.”It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the judge wrote.”

Of course, this will get reduced substantially on appeal, but at least this tort case got the attention of the insurer to improve policy (for the time being, anyway).

Daily Kos: Cheers and Jeers: Wednesday

Daily Kos: Cheers and Jeers: Wednesday:

“It’s very simple, really You’re sick. Very sick. Maybe life-threateningly sick. And your health insurance company has just rejected your claim. What will you do? What will you do???

Thankfully, Parade magazine is here to help. Sunday they published an article called Fight for Your Health Care. That’s right: Fight. Just what every sick person enjoys doing between bouts of vomiting and dizziness and organ failure and trips to the hospital. But never fear…the process is simple, and I’ll give you the lowdown here.”

Nicely snarky piece on how lucky we are to live in the country with the Greatest Healthcare System in the World.(TM)

A satisfying update to WSJ Editorial on US/UK liver transplantation results..

Thanks to Maggie Mahar for doing the work on this. I was willing to accept Dr. Gottlieb’s facts at face value and make my case, but Mahar went the extra mile to show that, not only is the argument bogus, so are the facts! Here’s the prime of the post:

But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.

So “equilibrated” wasn’t just a dodgy piece of jargon; it was inaccurate. When researchers checked on patients more than a year after they had the transplant, outcomes in the U.K/Ireland and the U.S. weren’t in perfect balance (or in equilibrium) with results in the U.S. Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second —assuming that if you go through the trauma of a liver transplant, the outcome you are hoping for is to live more than a year, rather than just 90 days.

Why is chronic care better in the U.K. in the years following surgery? Because the “primary care infrastructure” is stronger in the U.K. and Ireland, the article explains. Add in the fact that patients have “equal access” to health care and that the cost of care is “lower,” and this helps explain superior long-term results. As the researchers point out, “the 2002 Commonwealth Fund International Health Policy Survey found that sicker adults in the US are far more likely than those in the UK to forgo medical care and fail to comply with recommended follow-up and treatment because of costs. In the U.S., it seems, outcomes tend to turn on whether the patient has money.

Finally, what about outcomes after five years? What Gottlieb forgot to mention is that survival rates for patients who had originally suffered from chronic liver disease were similar in the two countries, while mortality rates for patients suffering from acute liver disease were higher in the U.K. and Ireland.

Thanks, Maggie!

WSJ.com – Commentary: Edwards and Organ Transplants

Argues that because Americans are more likely than Europeans to get a transplant, and more likely to survive it too, that this would not be possible in an American Single Payer system.

The author argues that, “Organ transplantation, like many areas of medicine, provides a poor basis for his political thesis that single-payer health care offers a more equitable allocation of scarce resources, or better clinical outcomes.”

He is partially correct; a high tech treatment like organ transplant is not a good way to decide how to reform American Health Care. The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine’s ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than “conservatives” wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our “American specialty” of bleeding edge healthcare.

Yet, the point about a single payer system not offering a more equitable allocation strikes me as intuitively, obviously false, and I don’t believe the author tries to refute the point other than pointing out that we do more liver transplants in the US than elsewhere. A strange point is also made about the threat of the government deciding who gets the organs. I think most of us would gladly take a standard set of criteria developed by the NIH, UNOS, or other agency, applied fairly and equitably across all socioeconomic and ethnic categories by a Medicare-like agency, rather than the inherently conflicted interests of a private insurer!

And finally, since we spend twice as much on healthcare, shouldn’t we do twice as much of everything, not just liver transplants? Preventive care and prescription drug benefits come to mind immediately, but you can pick your own favorite.

Cheers,

read more digg story

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!: “We [Crooks & Liars] posted this story yesterday with an update to the heartbreaking result. While battling CIGNA for a new liver, her family and friends fought and protested until CIGNA finally gave in, but it was too late—the seventeen-year-old Nataline Sarkisyan died.”

Although U.S. Spends Twice as Much…- Kaisernetwork.org

Coverage & Access Although U.S. Spends Twice as Much as Other Industrialized Nations on Health Care, More in This Country Have Access Problems, Survey Finds – Kaisernetwork.org:

“The article notes that the U.S. spent $6,697 per capita, or about 16% gross domestic product, on health care in 2005. Other nations in 2005 spent less than half that amount per person on health care. The survey found that respondents in Canada and the U.S. often visit emergency departments for routine care and that those in the U.S. ‘were most likely to have gone without care because of cost and to have high out-of-pocket costs.’

In addition, the survey found that 37% of all respondents in the U.S. and 42% of those with chronic diseases ‘had skipped medications, not seen a doctor when sick, or forgone recommended care in the past year because of costs — rates well above all other countries.’ In contrast, respondents in Britain, Canada and the Netherlands ‘rarely report having to forgo needed medical care because of costs,’ according to the survey. Respondents in New Zealand and Britain had the least confidence in the quality of care that they received, and those in Germany and the U.S. had the most access to elective surgeries, the survey found.

Commonwealth Fund President Karen Davis said, ‘The survey shows that in the U.S., we pay the price for having a fragmented health care system,’ adding, ‘The thing that struck me in this survey is the trouble that Americans have in getting to see their own doctors'”

Public Citizen | Publications – Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822)

Public Citizen Publications – Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822):

The states that had the lowest ratios and therefore had the highest
disparities in Medicaid and Medicare payments in 2003 now have the following
Medicaid-to-Medicare ratios:
Medicaid-to-Medicare Fee Ratios for Selected Primary Care Procedures,
Low-Parity States, 2007

New York .29
New Jersey .31
Rhode Island .40
Pennsylvania .42
District of Columbia .48

Read the full report to get the idea, but what we in healthcare have known all along is that Medicaid is de facto rationing. It is a severe economic disincentive to serve this population. And it is worth noting that, depending upon where you practice, Medicare is likely your lowest payer to begin with, so these numbers become even more tragic.

Census Shows a Modest Rise in U.S. Income [BUT]- New York Times

Census Shows a Modest Rise in U.S. Income – New York Times:
“Census officials attributed the rise in the uninsured — to 47 million from 44.8 million in 2005 — mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005.”

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do:

“Some doctors say the problem lies not with a doctor shortage, but with an uneven distribution of MDs. New doctors gravitate toward more lucrative specialties, such as sports medicine. Specialties that require surgery, such as ophthalmology, also attract doctors because Medicare and insurers reimburse surgical procedures at a far higher rate than evaluations. Cooper said young doctors are turning to these profitable specialties at the expense of Medicare patients, who largely suffer from diabetes and arthritis and are in need of endocrinologists and rheumatologists. Medical school students also may be dissuaded from primary care. Dr. David Krasner, who works at Family Practice Associates in Wilmington, said the existing reimbursement system pays too little for cognitive evaluations by primary care physicians. ‘For physicians to go into primary care in this day and age, it’s akin to committing financial suicide,’ he said. ‘The shortage in my opinion won’t get better until Medicare changes the way it reimburses.'”

Please click on some of the tags below: physician income, in particular to learn more about this topic…