News In Healthcare

Health insur­ance is clearly a neces­sity but where do we go to choose what is right for us? Sounds like many young Amer­i­cans are in the same quandary when it comes to this ques­tion. A recent study reported by Dow Jones Newswire shows that young Amer­i­cans do not feel they have the infor­ma­tion needed to make the right deci­sion about health insur­ance cov­er­age. The poll fur­ther found that while the indi­vid­u­als were will­ing to research their options, many felt they lacked the proper resources.

Watch out friends! If you are con­duct­ing research online be sure you know who is shar­ing this infor­ma­tion with you. Many insur­ance com­pa­nies want you to believe you are get­ting tremen­dous cov­er­age for small monthly pre­mium pay­ments but hid­den in the pol­icy they will make a por­tion of the claims your responsibility.

To share a per­sonal exam­ple, just a year ago Trilogi, Inc. my employer, polled the staff to choose between two health plans: one plan that cost a bit more monthly but pro­vided greater cov­er­age includ­ing lower deductibles and out-of-pocket costs, and a sec­ond plan that cost less each month but that pro­vided less cov­er­age and had a higher deductible. At the time, the staff was rel­a­tively new in deal­ing with health insur­ance issues so a major­ity opted for the “cheaper” monthly pre­mium. After a year of fol­low­ing up with insur­ance car­ri­ers and see­ing just how much insur­ance car­ri­ers are leav­ing as patient respon­si­bil­ity, we polled the same group of indi­vid­u­als to see which type of plan they would choose now and to no sur­prise, the group stated they would rather pay a few dol­lars more each month for bet­ter cov­er­age in the long run.

We all know that there is a grow­ing cost to med­ical providers ren­der­ing ser­vices to the unin­sured pop­u­la­tion — approx­i­mately $42.7 bil­lion went unpaid last year.  We also know that some­one has to be con­tribut­ing to pay­ing for that care.  But did you know that that cost is being cov­ered through a hid­den tax on the pre­mi­ums of peo­ple with insur­ance?  Accord­ing to today’s USA Today, the aver­age U.S. fam­ily and their employ­ers paid an extra $1,017 in health care pre­mi­ums last year to com­pen­sate for the uninsured.

What is miss­ing from the stud­ies done and the state­ments made at the con­gres­sional hear­ings is that on top of pay­ing a “hid­den tax” on our pre­mi­ums, most insureds are actu­ally “under­in­sured” and end up foot­ing most of their health­care expenses because of high deductibles or insur­ance denials.  To be pay­ing a tax on top of that for health­care ser­vices not ren­dered to those indi­vid­u­als is just one more rea­son why the cur­rent health insur­ance indus­try needs imme­di­ate reform.

Well at least that is Pres­i­dent Bush’s way of deal­ing with the “frus­tra­tions” of the health care cri­sis.  In a round­table dis­cus­sion with small busi­ness own­ers ear­lier this week, Pres­i­dent Bush con­tin­ued to try to sell peo­ple on the idea that through tax incen­tives, peo­ple will be able to get afford­able health care cov­er­age.  He fur­ther stated that small busi­ness own­ers should be able to cross state lines to pool risk with other employ­ers in other states in order to afford bet­ter insur­ance.  Noth­ing really new or excit­ing came out of his dis­cus­sion.  We are still wait­ing on a solution.

Can you believe that another insurer has received cita­tions by the Cal­i­for­nia Depart­ment of Insur­ance for wrong­fully can­celling mem­bers health insur­ance poli­cies?  The L.A. Times reports that BC Life & Health, owned by Well­point, can­celled 1,880 indi­vid­ual poli­cies in 2004 and 2005.  After a review of 83 sam­ple cases, the CDI issued 49 cita­tions against the insurer which could lead to fines of up to $10,000 a piece.  Blue Cross of Cal­i­for­nia has already been fined for improp­erly can­celling poli­cies.  Blue Shield of Cal­i­for­nia, Aetna, Health­net, and Cigna are cur­rently being inves­ti­gated by the CDI for improper can­cel­la­tion of policies.

Cell phones were always taboo in the med­ical indus­try: no cell phones in hos­pi­tals or in physi­cians offices.  How­ever, times are a chang­ing.    Researchers now see the ben­e­fits of wire­less tech­nol­ogy as a means of mon­i­tor­ing chronic dis­eases such as dia­betes, obe­sity, hyper­ten­sion and asthma.  Pic­ture home-glucose meters hooked up to cell phones so daily read­ings can be sent imme­di­ately to the physi­cians’ offices.  Results can be sent as a text mes­sage.   This form of com­mu­ni­ca­tion is not far off in the dis­tance.  Clin­i­cal tri­als of cell-phone mon­i­tor­ing tech­nol­ogy are already undeway.

Well maybe health­care facil­i­ties aren’t quite tak­ing the Domino’s approach but it is close.  MSNBC recently reported on tac­tics health sys­tems are tak­ing to ease the pain of long waits in hos­pi­tal emer­gency rooms.  One hos­pi­tal issued movie tick­ets to patients wait­ing over 30 min­utes to see a doc­tor while another hos­pi­tal gave away tick­ets to the local base­ball game.  One hos­pi­tal in Illi­nois is promis­ing no wait­ing at all.  It seems that patients can skip the wait­ing room and go right up to a pri­vate room and be seen by a physi­cian or a nurse. 

Do you want to know how your state ranks in terms of health cov­er­age?  Check out Kaiser Fam­ily Foundation’s state-by-state syn­op­sis of what per­cent­age of your pop­u­la­tion is cov­ered by dif­fer­ent sources.  The infor­ma­tion was recently updated to show sta­tis­tics through 2005.

There have been many arti­cles on the suc­cess or fail­ure of Health Sav­ings Account.  See the Wichita Eagle for a recent arti­cle.  Remem­ber, HSAs were pro­moted by Pres­i­dent Bush in his State of the Union Address as a fix for the health­care cri­sis in Amer­ica.  But what all of those arti­cles are not tying together is that in order to have an HSA, the indi­vid­ual must have a high-deductible health plan.  In order for an HSA to be a suc­cess, you must have the funds to put into the HSA so that way you can pay your high-deductible.  Every­one can say that HSAs are not catch­ing on because of a lack of edu­ca­tion as to how they work.  How­ever, from the point of view of some­one who has a funded HSA, the rea­son they are not catch­ing on is because they must be funded in order to work and if peo­ple didn’t have funds to buy a reg­u­lar health plan, they prob­a­bly don’t have the funds to put into a health sav­ings account.  When the choice comes down to set­ting aside money monthly for future health expenses or pay­ing the elec­tric bill and buy­ing gro­ceries, peo­ple will usu­ally choose the latter.

Can you believe that health­care is fol­low­ing the lead of appli­ance man­u­fac­tur­ers?  Well, one med­ical group in Penn­sy­la­nia is doing just that in an effort to encour­age hos­pi­tals and doc­tors to ren­der high qual­ity care and minimizing/eliminating costly mis­takes.  The New York Times reports that Geisinger Health Sys­tem is exper­i­ment­ing with a flat fee for surgery approach.  With that flat fee, the patient has 90 days of follow-up treat­ment for free — even if the patient suf­fers com­pli­ca­tions.  Geisinger is only test­ing this with one insurer at this point — which just hap­pens to be its own insur­ance unit.   After one year, Geisinger reported a reduc­tion in patients return­ing to ICU and fewer days in the hos­pi­tals.  While it still remains to be seen whether there is any merit to this approach, it is def­i­nitely one to watch.

On May 7, 2007, we wrote about a report that some sales peo­ple for Medicare Advan­tage plans were engag­ing in wrong­ful and decep­tive prac­tices in order to get indi­vid­u­als enrolled.  Well, now Con­gress is look­ing into the mat­ter.  A hear­ing was held today by the Sen­ate Spe­cial Com­mit­tee on Aging to get to the bot­tom of the issue.  We will report back as to the out­come of the hearing.