Last week I wrote about the poor results – specifically for children – on the Colorado Health Report Card. Governor Ritter has issued an explanation about the poor results, detailing how the numbers used in the report card are largely outdated (from 2007), and that many improvements have since been made in terms of the health of Colorado children. […] I’m hopeful that the next Colorado Health Report Card will show a big improvement across the board, but especially in the area of children’s health.
Health Care Goodies
Poor Results On The Colorado Health Report Card
The 2009 Colorado Health Report Card was just released, and the score for healthy children slipped from a C- in 2008 to a D+ in 2009. I find it particularly interesting that our state ranks at the very top of the list in terms of the percentage of adults who are obese (we’re the only state in the nation with less than a 20% adult obesity rate) and yet our kids aren’t even close to the top of the list, with 22 states having lower childhood obesity rates. […]
More On Overutilization
David Williams has written an excellent article about the overuse of mammography screening in older women with cognitive impairment. When you read his article, especially the part about how women with a higher net worth are more likely to be screened, it’s obvious that money is playing a large role when it comes to determining who should get mammograms. […]
Overuse Of Medical Imaging
[…] What if we implemented a system whereby doctors could not be compensated for ordering medical imaging for their patients? The imaging equipment could be strategically located throughout each city and state, but not in doctors’ offices, and not run by doctors who order the tests. If a doctor were to have no financial incentive one way or the other, we could probably assume that imaging would only be ordered when it was deemed medically necessary, and we would expect to see roughly the same rate of imaging use from one doctor to the next.
Rush Limbaugh Advises His Listeners To Go Uninsured
There are plenty of valid complaints against the current health care reform bills. Those who say that the bills don’t do enough to address the root problem of ever-increasing health care costs have a very good point. But take it with a grain of salt when a multi-millionaire with the ability to pay cash for any medical treatment he might need rails against reform that might make medical care more affordable for average people and talks […]
A Good Alternative To Mandatory Health Insurance
[…] there wouldn’t be an incentive for people to remain uninsured and wait until they got sick to purchase health insurance. The choice to be uninsured would come with consequences, but it would still be a legal choice. This would allow people to make their own decisions, but would also protect health insurance companies and people who maintain continuous coverage.
Transparency Lacking In Final Health Care Negotiations
Both of the Senators from Colorado are calling for more transparency in the way congressional leaders are working to hash out a health care reform plan that combines the versions passed last year by the House and Senate. Senators Udall and Bennet, both Democrats, are unimpressed with their own party’s actions in keeping the final negotiations secret. […]
Cavalcade Of Risk – The New Year Edition
Welcome to the first Cavalcade of Risk in 2010. There is a lot of great reading in this one; let’s start the party with something fresh and new… healthcare […]
Comparing Health Care Costs And Outcomes
van Falchuk has written a very thoughtful article about a recent graph created by National Geographic. At first glance, the implications of the graph are startlingly obvious: the US spends way too much on health care, a view that has been widely repeated throughout the health care reform debate. But Evan’s detailed analysis of the graph does make one pause to consider whether the graph might be over-simplifying things. […]
Lowering Demand For Health Care Through Prevention
[…] But the government can create policies that make the good choices easier and less expensive than the bad choices, and that just might make a difference. Perhaps the next step in health care reform should be working to make Americans healthier to begin with, rather than trying to figure out how to fix us after we get sick.
Socioeconomic Status And Wait Times For Health Care
Critics of the current health care reform efforts have consistently pointed to the longer wait times to see a specialist when one is ill in Canada or Europe, compared with the US (of course, for people with no health insurance at all, wait times are probably considerable here too). Jason Shafrin has written an interesting article about wait times to see a specialist in Europe, and the role that socioeconomic status plays. […]
Pilot Programs Might Be The Key To Cost Control
[…] It’s easy to criticize the length of the health care reform bills (and I would agree that it would be more helpful if they were written in plain English), but perhaps they are so long simply because there is such a wealth of ideas contained within them. It will take the test of time to determine which of those ideas are true winners, but without including them in the language of the bills, we’ll never know.
Health Is About More Than Health Insurance
[…] Data like this indicates that simply providing health insurance to everyone is not the key to actually improving our overall health (which should really be the end goal of health care reform). Providing real access to health care should indeed be the first step, but it is far from the last step. Personal responsibility plays a huge part in protecting our health, but so do government policies. Hopefully health care – and the real preservation of health – will continue to be a priority.
Dentists And HIV Screening
[…] Even if the cost of the test is only counted towards a patient’s deductible (as might be the case if the patient has an HSA qualified plan, for example), just knowing that it will be billed to the health insurance company might make a patient more likely to get the test. In addition, billing the test to a health insurance company is likely to result in a lowered final price for the patient based on network negotiated rates. All around, it makes sense for dental offices that provide HIV screening to be able to bill a patient’s health insurance company for the test.
Lessons From The Taiwanese Health Insurance System
[…] job of convincing people that we really don’t need a lot of the health care services that are currently viewed as essential. 16% of our GDP is spent on health care, tens of millions of Americans have no health insurance and have to rely on free clinics and crowded emergency rooms for care, more than half of all bankruptcies in this country stem from medical problems… all of this, and our life expectancy is only a few weeks longer than that of people in Taiwan.
Surtax Not That Much Of A Burden
[…] But let’s look at the actual impact of the tax as it’s currently written in the Senate bill. It wouldn’t take effect until the beginning of 2013, so wealthy Americans would have three years to squirrel away savings before they had to start paying a little extra in taxes. And the actual amount of the tax is set at half of a percent of income above the $200,000 threshold. Let’s consider a CEO who earns a million dollars a year, filing on his own. $800,000 of her income would be subject to the healthcare surtax, at a rate of 0.5 percent. Half of one percent is not a large chunk of anything. In this case, it would amount to $4,000 ($800,000 times 0.005). So we would be asking a person earning a million dollars a year to kick in an extra $4000 to help pay for healthcare. My vote? That is perfectly fair. Her million dollar a year salary puts her above nearly every other American in terms of earnings, and $4000 doesn’t make much of a dent in a million dollars. […]
An Office Visit In France
The Healthcare Economist’s Jason Shafrin has written an interesting article about how the French healthcare system utilizes hyperbolic discounting in order to avoid moral hazard. Basically, their system requires the patient to pay up front for a visit to the doctor, but then health insurance reimburses the patient 70% of the cost. This has two advantages over a system like ours which only requires the patient to pay their copay at the time of service. First, it conveys the value of the visit. Here in the US, people who have health insurance with copays for office visit are often unaware of the actual cost of the visit. They pay their copay and the rest is billed to the health insurance company. People who read their EOBs will see the actual billed amount and the amount that the insurance company paid, but I doubt that everyone reads their EOBs […]
Addressing The Problem Of Cost
Ezra Klein recently interviewed George Halvorson, Chairman and CEO of Kaiser Permanente (which operates our largest HMO here in Colorado). Both the questions and answers were insightful and on target in terms of addressing the cost conundrum that is so often glossed-over in the health care reform debate.
Mr. Halvorson pointed out that while many developed countries have some form of private health insurance, they also have medical fee schedules that are set by the government and are far lower than average costs for the same procedures in the US. When average fees for various medical procedures in several countries are shown on graphs, the US bar looks like a giraffe standing in a herd of gazelles.
But Halvorson acknowledged that while fees in other countries are even lower than Medicare reimbursement amounts here in the US, half of hospitals here are losing money, and do so especially when they treat Medicare patients. So it’s not as simple as just saying that we need to create set fee schedules that are more in line with those of other countries […]
Grand Rounds Vol. 6 No. 8
How To Cope With Pain brings us a truly amazing video. It’s a reminder to be thankful for all that we have, and for the things in life (like this video) that inspire us. It’s well worth the five minutes it takes to watch it.
Amy Tenderich of Diabetes Mine shares a “would you rather…?” moment from her 9-year old daughter. It’s a poignant reminder, seen through the eyes of a child, that all of the parts of our lives – even the bad parts – combine to make us who we are […]
Health Wonk Review
Welcome to the Health Wonk Review. 2009 has been an exciting year for health care reform, and last Saturday’s passage of HR3962, the Affordable Health Care for America Act, has given us plenty to talk about. For anyone who hasn’t kept up on the details of the House reform bill, I want to start things off with a four-part series from Tim Jost, who holds the Robert L Willett Family Professorship of Law at the Washington and Lee University School of Law. His articles were published at Health Affairs Blog, and amount to an excellent primer, written in plain English, for people who want to understand HR3962, but don’t have time to read all 1990 pages […]
Accepting Grand Rounds Submissions
We will be hosting Grand Rounds, the weekly collection of great health and medical blogging, on Tuesday, November 17th. Please send me your article to louise (at) healthinsurancecolorado (dot) net, indicating Grand Rounds in the subject. Please do so before midnight on Sunday, November 15th, mountain time.
Optional theme, because of the upcoming Thanksgiving holiday, will be articles about something you’re thankful for.
The theme is optional. Grand Rounds will include all other important topics you write about. Looking forward a thankful edition!
Colorado Premiums Rising Faster Than National Average
Across the US, employers will see a 9% increase in health insurance premiums next year. But in Colorado, the increase will be an average of 11.8%. The Lockton Group has released its 2010 Colorado Employer Benefits Survey Report, and it indicates that Colorado will see bigger premium increases than the country as a whole. This puts Colorado businesses at a disadvantage in terms of direct operating expenses, as health insurance makes up a large portion of business overhead. It also makes it harder for Colorado businesses to compete for the best employees, since premium increases are being passed along to employees in the form of higher premiums and fewer benefits. Not surprisingly, Colorado businesses are much less likely to offer pricey HMOs than they were a decade ago (32% now, versus 89% in 2000), and far more of them are offering HSA qualified, high deductible health insurance policies (which have lower premiums) for their employees (27% now, versus only 3% in 2003).
Colorado residents tend to be healthier than the average American. We’re thinner, and have lower incidence of hypertension and diabetes than most of the rest of the country. So why would health insurance rates be rising faster here than in the rest of the country? My guess is that it has something to do our higher-than-average percentage of the population without health insurance. 17.2% of Colorado residents are uninsured, compared with national numbers that tend to be in the 15 – 16% range. When uninsured patients are treated by our health care providers (emergency rooms are a good example of this), the providers have to recoup their losses somehow. This usually translates into higher reimbursement rates being negotiated with health insurance companies. The insurance companies pass on their higher costs to customers in the form of higher premiums and/or reduced benefits. […]
Imaging And Primary Care Doctors
[…] When Jay hurt his knee a couple years ago, an MRI was done prior to surgery. We have an HSA qualified health insurance policy, and at the time our deductible was $3000. So we paid for the MRI ourselves, and it amounted to more than a third of the deductible. And that was after Humana reduced the bill to the network negotiated amount. MRIs have helped to make medicine a much more exact science, but they are not cheap.
It seems that any system that pays physicians – directly or indirectly – to order additional testing will end up with excessive testing, adding to the overall cost of health care. Even doctors with the best of intentions are likely to be swayed by the knowledge that they can boost their paychecks by adding a few MRIs here and there.
I believe that the number of tests a doctors orders should not impact his or her income. And it seems that adding more medical imaging facilities in primary care offices will only increase our already burgeoning health care costs […]
Conflicts Of Interest In Health Care
[…] Hospitals are in business to make money, just like most of the other players in the health care industry. And hospitals have boards of directors. We know this, but do we know what they do, or who they are? Dr. Roy Poses of Health Care Renewal has written an article about hospital boards that might make your blood pressure rise a notch or two. […]
Reducing Demand For Health Care
Dr. William Foster has written a very thoughtful editorial about the state of our health care system, and it’s well worth reading. He points out that as a society, we’re always looking for the latest and greatest in health care, but at the same time we want it to be more affordable. We run more tests and perform more procedures than ever before – and our health care costs reflect this. […]