Health Blog : Safety Net Frays as Hospitals Shift Resources From Poor

Health Blog : Safety Net Frays as Hospitals Shift Resources From Poor:

“An increase in the number of uninsured patients and competition from well-heeled hospitals is putting pressure on safety net hospitals to reduce services for the poor, according to a report by the Center for Studying Health System Change published online today in the journal Health Affairs. [cmhmd:requires subscription]

The analysis, taken from the Center’s ongoing survey of 12 metropolitan areas, comes as nonprofit hospitals are under increasing scrutiny for the amount of free care they provide for the poor. Some critics charge nonprofit hospitals enjoy billions of dollars in tax exemptions without providing offsetting amounts of charity care.”

And yet, if you ask the typical advocate for the status quo, we have no access problems, no rationing of healthcare here in the US.


Go to the WSJ blog for the rest, it covers things nicely.

Public Views on U.S. Health System Organization: A Call for New Directions

Public Views on U.S. Health System Organization: A Call for New Directions:

“Overview

On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed a random sample of 1,004 U.S. adults (age 18 and older) to determine their experiences and perspectives on the organization of the nation’s health care system and ways to improve patient care. Eight of 10 respondents agreed that the health system needs either fundamental change or complete rebuilding. Adults’ health care experiences underscore the need to organize care systems to ensure timely access, better coordination, and better flow of information among doctors and patients. There is also a need to simplify health insurance administration. There was broad agreement among survey respondents that wider use of health information systems and greater care coordination could improve patient care. The majority of adults say it is very important for the 2008 presidential candidates to seek reforms to address health care quality, access, and costs.”

Click on the link to dig into the details…

AMA president-elect sees more stresses on stressed-out system

AMA president-elect sees more stresses on stressed-out system: “What is the AMA’s position on nationalized health care or having the government be the single payer for health care?
(The AMA’s concern has been), if you had the federal government paying, you would have the federal government deciding, and patients would no longer have a choice. … The AMA supports everyone having health insurance, but not that the government is a single payer. You need to change the tax code so that as an individual you get the same tax benefit as the employer. If you make more than $100,000, you should be required to purchase your own health care insurance … and if not, you have a tax liability. If you make below $100,000, you get a tax credit … to purchase your health insurance.”

AMNews: June 23/30, 2008. What’s in their wallets? Health plan executives bring home the bucks … American Medical News

AMNews: June 23/30, 2008. What’s in their wallets? Health plan executives bring home the bucks … American Medical News:

“In its analysis of S&P 500 companies, Equilar found median total compensation for the CEOs was $8.8 million. The six publicly traded health plans that are a part of the S&P 500 index all paid their CEOs more than that median: from $9.1 million for WellPoint’s Angela Braly to $25.8 million for Cigna’s H. Edward Hanway. The highest-paid executive in the S&P 500 2007 was John Thain, CEO of Merrill Lynch, who took home $83.8 million, most of it in stock options and stock awards granted at his hiring last year, Cwirko-Godycki said.

Of the largest publicly traded health plans, only Health Net’s Jay M. Gellert was below the median, at $3.7 million. His company is not part of the S&P 500.

Heidi Toppel, JD, senior executive compensation consultant for human resources consulting firm Watson Wyatt, said health plan CEOs’ pay isn’t out of line by Wall Street standards. ‘I would not consider the levels of pay to be stratospheric,’ she said.

But she and other experts acknowledge that pay is a thorny issue for health plans, particularly as physicians question why their reimbursement should be under pressure and why they need to jump through hoops to get care paid for while health plan executives take home large paychecks.”

So what is the usual, customary and reasonable compensation for limiting healthcare access and reimbursement?

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….

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.

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.