When your dry cleaner messes up a garment, you expect them to clean and press it again – for no additional charge.

But it doesn’t work that way in health.  Often, when a doctor or hospital messes up, they collect double, once for the initial (but wrong) procedure and again for the procedure to fix it.

Now, the double-pay-for-mistakes system is starting to change. Private insurers and Medicare are beginning to refuse to pay for so-called “never events” – medical errors that shouldn’t happen if the care provider exercises normal precautions.  For example, Blue Cross and Blue Shield of Illinois announced recently it will refuse to pay for serious medical errors, as reported in the Chicago Tribune.

CWA’s Health Care Campaign believes it is possible to improve quality at the same time costs are better controlled.  Reimbursing doctors and hospitals better for doing things right – sometimes called “pay for performance” or “pay for quality” is one promising idea that’s beginning to be tested. 

– 08/08/08

Many Americans with chronic diseases aren’t getting treated because they don’t have health insurance – that’s according to a study in the medical journal Annals of Internal Medicine.

Those findings are similar to those in another study by researchers from the Kaiser Commission on Medicaid and the Uninsured. That study found that the number of people with chronic diseases is rising – now up to about 58 million.  Even if their income is high, those with chronic diseases are increasingly uninsured – at least in part because health insurers don’t want to offer coverage to those with medical problems. 

The studies are important because managing chronic conditions is seen as a key to controlling health costs. Such conditions – diabetes, high blood pressure and asthma, for example – can often be kept under control with regular visits to doctors and with medications, such as insulin for diabetes. Without regular care, however, the conditions can worsen, requiring more drastic and more expensive treatment. Some studies estimate that more than 75 percent of medical costs in the United States are run up by patients with chronic diseases.

The new Annals of Internal Medicine study estimates about a third of the uninsured in the country have chronic health problems. That would mean that about 16 million of the 47 million uninsured have health problems which need treatment. For them, “access to care seems to be unobtainable; many may face early disability and death as a result,” the authors, who are affiliated with Harvard Medical School, wrote.

– 08/06/08

Recently, we shared a story about health insurance companies canceling policies on people with health problems. Well, that is only the beginning.  Now we have learned that health insurers are combing through databases of prescriptions to determine whether to sell or deny insurance policies to individuals.  This was revealed in a Washington Post story earlier this week.

Sometimes called “health credit reports,” the prescription data allows insurers to project which people are likely to incur high health costs – and decide not to sell them coverage.   Using the database, insurance companies can make judgments based on how many prescriptions and the type of prescriptions a prospective policy holder has. It is anticipated that people with a higher number of prescriptions or with prescriptions used to treat serious and expensive medical conditions, like cancer, will have higher health costs, now or sometime in the future. The ability to deny coverage based on information from the health credit reports enables insurance companies to save money by avoiding likely expensive policy holders.

One Louisiana woman said was denied insurance because she was taking medications for swollen ankles and for trouble sleeping, according to this report in Business Week.    

Denial of coverage to individuals is one factor contributing to the growth of the number of uninsured in the country, now about 47 million.  As fewer employers offer coverage, people are left to seek individual policies, but won’t necessarily be able to get them – especially if they really need them.  

– 08/06/08

CWA's health care campaign is seeking to change the system to both improve quality and cut costs.  Aren't those goals contradictory?


Actually, costs can be saved without erecting barriers to care -- for example, requiring insurance companies to spend more on patients and less on excessive profits, as Barack Obama's health plan does.
 

Obama also wants to stress programs to keep people healthy -- and a new study shows how those programs can save money and help people feel better.

Spending just $10 per person per year on community programs to keep people healthier could generate $16 billion in annual medical savings, according to a report by the Trust for America's Health (TFAH).  That represents more than $5 saved for every dollar spent on disease prevention programs.

"The findings provide hard numbers for what experts have been saying for years: Simple measures to promote wellness and control health problems early can prevent costly visits to emergency rooms," the Miami Herald reported. "Two-thirds of Americans are overweight, one in five doesn't exercise at all and one in five adults smoke, the survey reported. Those conditions can lead to massive health problems, including high blood pressure, diabetes and cancer."

The TFAH report looked a prevention programs which don't require medical treatment and are aimed at entire communities, such as making healthier foods available, requiring nutrition labeling on food packages, raising tobacco taxes and adding parks and sidewalks.

Of the potential $16 billion in annual savings, the report said, Medicare could save more than $5 billion a year and Medicaid nearly $2 billion. Private insurers would save the remaining $9 billion, the study said. Those savings projections are for medical costs alone, the study said; there could be added savings from such benefits as increased productivity.

– 07/31/08