Private insurance, most efficient , cost effective funding of Healthcare ?

wowza · Jun 21, 2009

I think many of the insurance companies don't want the competition mainly because the gov't can just change the rules as it sees fit. The gov't can just stop paying hospitals for indigent care (part of the proposed Obama plan). It can cut doctor reimburesements based on automatic controls to keep costs reigned in (tried to do this last year). It can stop paying hospitals for bounce backs despite the fact that these are not bounce backs from poor care but the natural progression of some chronic disease (already scheduled to happen).

Who knows, maybe this gov't plan will force insurance companies to drastically lower their prices. Frankly all I see it doing is raising taxes and then creating even more of a cluster-fvck than our health system already is.

Anyone who has worked at a VA and a normal hospital knows what happens when the gov't tries to get invovled in healthcare. The VA is not exactly a bastion of effeciency or quality care.

HM2VikingRN, RN · Jun 21, 2009

Anyone who has worked at a VA and a normal hospital knows what happens when the gov't tries to get invovled in healthcare. The VA is not exactly a bastion of effeciency or quality care.

The data says otherwise:

Over the last decade or two, the VHA system has become a worldwide leader in both the adoption and the invention of health-information technology, and it has leveraged its innovations into quantifiable gains in quality of care. As Harvard's Kennedy School noted when awarding the VHA its prestigious Innovations in American Government prize:
[The] VHA's complete adoption of electronic health records and performance measures have resulted in high-quality, low-cost health care with high patient satisfaction. A recent RAND study found that VHA outperforms all other sectors of American health care across the spectrum of 294 measures of quality in disease prevention and treatment. For six straight years, VHA has led private-sector health care in the independent American Customer Satisfaction Index.
Indeed, the VHA's lead in care quality isn't disputed. A New England Journal of Medicine study from 2003 compared the VHA with fee-for-service Medicare on 11 measures of quality. The VHA came out "significantly better" on every single one. The Annals of Internal Medicine pitted the VHA against an array of managed-care systems to see which offered the best treatment for diabetics. The VHA triumphed in all seven of the tested metrics. The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. As Phillip Longman, the author of Best Care Anywhere, a book chronicling the VHA's remarkable transformation, explains: "Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals."

http://prospect.org/cs/articles?article=the_health_of_nations

The VA isn't perfect but nothing created by man can ever be perfected. (Full disclosure I work for a VAMC).

My point is that providers should be able to directly compete for patients on the basis of quality and efficiency. Our current system has insurance companies rewarding providers for unnecessary/ineffective care not necessarily for keeping patients healthy.

elkpark · Jun 21, 2009

Private insurance and pharm companies are scared because they've been able to "write their own ticket" in the US all these decades (on the backs of the US public) and make profits as big as they feel like making, and they don't want to give that up. Personally, I'd like to see the private-for-profit insurance companies eliminated from healthcare entirely. They are just draining badly needed resources from the system in order to line their shareholders' pockets, while (BY) denying people care that they need and (foolishly! :)) believe that they were entitled to because of all those premiums they paid.

blue note · Jun 21, 2009

Personally, I'd like to see the private-for-profit insurance companies eliminated from healthcare entirely. They are just draining badly needed resources from the system in order to line their shareholders' pockets, while (BY) denying people care that they need and (foolishly! :)) believe that they were entitled to because of all those premiums they paid.

:yeah: All the back and forth, and backtracking by the politicians (and I am looking at you, Dem Senators) is purely because they are trying to protect the precious interests of the health insurance companies at the expense of the people they are supposed to represent and serve. This is the same murder-by-spreadsheet industry which has admitted to killing sick Americans. Check out the health care reform Death Clock: "Since 9/11/2001, 175,560 have died due to lack of health care. That's the same as 59 9/11s."

All the hand-wrangling over costs, and talk of a public option with a trigger, is only because they refuse to consider simply doing away with the health insurance industry. Just eliminating it would save $4 trillion in one fell swoop. Instead, they want to keep the vast private insurance bureaucracy that is running up unacceptable administrative costs in place. On Bill Moyers' Journal, one doctor pointed out that in the last 30 years, there has been 2.5 - 3 times more doctors and nurses, which is in proportion to the rate of population growth. But in the same period, there has been 30 times more health administrators. These are people whose job description is to deny care. A strong public option needs to be part of the reform, and I say, make universal health care the trigger, not the public option!

nicurn001 · Jun 22, 2009

I think many of the insurance companies don't want the competition mainly because the gov't can just change the rules as it sees fit. The gov't can just stop paying hospitals for indigent care (part of the proposed Obama plan). It can cut doctor reimburesements based on automatic controls to keep costs reigned in (tried to do this last year). It can stop paying hospitals for bounce backs despite the fact that these are not bounce backs from poor care but the natural progression of some chronic disease (already scheduled to happen).
Who knows, maybe this gov't plan will force insurance companies to drastically lower their prices. Frankly all I see it doing is raising taxes and then creating even more of a cluster-fvck than our health system already is.
Anyone who has worked at a VA and a normal hospital knows what happens when the gov't tries to get invovled in healthcare. The VA is not exactly a bastion of effeciency or quality care.

Surely aren't the Insurance corporations already doing the things you described in the first paragraph already ?.Plus many other things to deny coverage to the premium payers .

As to the insurance companies , lowering their premiums , the trigger would be the overnment option !,without it I will not hold my breath , in anticipation of a quick reduction in my premiums . All the changes in provision of healthcare while I have lived in the USA ( since '88 ), were meant to do that , but it hasn't worked .

As to increases in taxes to pay for the new system , I would propose that an employee and employers healthcare contributions be added to an employees hourly rate of pay ( no extra cost there , as already being paid , if necessary with an adjustment to the employer for any additional taxes upon the employer [ I'm not sure , but I believe an employer can deduct the cost or at least part of the cost of employees healthcare benefit ]).So the extra taxes would be offset by the increase in employees income and not having to pay the private insurers .

HM2Viking has addressed the point about the VA .

blue note · Jun 23, 2009

More on the ridiculous administrative costs necessitated by the health insurance industry

Physician practice interactions with health plans cost $31 billion a year

A new national survey finds that:

physicians on average are spending the equivalent of three work weeks annually on administrative tasks required by health plans, while nursing staff spent more than 23 weeks per physician per year, and clerical staff spent 44 weeks per physician per year interacting. More than three in four respondents said the costs of interacting with health plans have increased over the past two years. These activities include prior authorization, pharmaceutical formularies, claims and billing, credentialing, contracting, and collecting and reporting quality data.
Physicians - especially primary care physicians - in a solo or two-person practice spent significantly more hours interacting with health plans than physicians in practices with 10 or more physicians.
Across practices, physicians and their staffs spent substantially more time on authorization, formularies, claims and billing and credentialing than they did on submitting quality data or reviewing quality data provided by health plans.
physician practices report that overall the costs of interacting with insurance plans is $31 billion annually and 6.9 percent of all U.S. expenditures for physician and clinical services.

"Because many providers care for patients insured by numerous private and public plans, they must contend with multiple payment schedules, claims forms and credentialing requirements. These complicated requirements create wasteful excess costs and do little to improve the quality of care," said Commonwealth Fund President Karen Davis. "A high performing health care system is only possible with improved coordination and elimination of waste - not only between physicians and insurers but in all parts of the health care delivery system."

allnurses Guide · Jun 23, 2009

Primary practitioners, clinics, hospitals, and other facilities pay coders and billers. This is a profession whereby smart people do nothing except try to get the most out of insurance companies.

The VA electronic medical records work so well because they are clinically based.

What most of our facilities use is budget based.

I know a nurse who was told not to chart a narrative because the checkoffs can bill for hours of nursing care but it takes too long to go over the chart to bill for what the nurse wrote in words.

wowza · Jun 23, 2009

The data says otherwise:
http://prospect.org/cs/articles?article=the_health_of_nations
The VA isn't perfect but nothing created by man can ever be perfected. (Full disclosure I work for a VAMC).
My point is that providers should be able to directly compete for patients on the basis of quality and efficiency. Our current system has insurance companies rewarding providers for unnecessary/ineffective care not necessarily for keeping patients healthy.

You didnt read the actual study, did you? You just took what the magazine said the study found without actually analyzing the data yourself. First the magazine that wrote that article is terribly biased. Here is the first line from their mission statement: "the American Prospect was founded in 1990 as an authoritative magazine of liberal ideas, committed to a just society, an enriched democracy, and effective liberal politics." Of course not only are they going to cherry pick articles, but they are going to skew the data in their favor.

SO looking at the actual article there are a few huge flaws:

1) It is an article about outcomes (quality of care) YET THEY DO NOT MEASURE A SINGLE OUTCOME. Instead they use the Quality Assessment Tools system which measures among other things effective use of screening tests, use of different medications based on guidelines, time to follow up etc. Not exactly the greatest measure, although not terrible. It is dependent on adequate medical records and since there were major differences in how the records were obtained between the 2 groups the results are questionable.

2) Instead of comparing the VA pts only to patients with insurance, include the uninsured. Of course people without insurance are going to get fewer screening tests, will not be on appropriate medications and will not be following up. That however does not prove that the VA is a better heath system, just that it is better than nothing (which I'm not going to argue against)

3) They recruited the non-VA patients by phone. This leads to a selection bias. Those who are home during the day are going to more likely be unemployed and thus not have insurance. Why not create a study that compares the employment rate of the VA patients to the american public by taking a random sampling of the people in line to sign up for food stamps?That would probably give us an accurate representation of the American public...:icon_roll

4) Many of the issues on the Quality Assessment Tools system relies on good documentation. The VA patients already had records (and EMR at that- one thing I will give the VA is that they have good documentation) but the non-VA patients' records had to be obtained from multiple different physicians. Incomplete/less complete documentation would lead to a lower score on the QATS when there was actually no difference in care. A huge flaw the authors even admit to.

5) VA patients had more records and more visits. It took one and a hlaf times longer to go through the VA pts' charts. This is a major confounder. The authors also admit to this. Also VA patients also go to a single location. Easier follow up, less switching doctors etc. This also skews the data

6) The different measures in the QAT were not weighted differently. For instance, if a person with unstable angina did not get an EKG when they came in this was scored the same as someone who had depression but the note didnt docuement whether they used alcohol or drugs. These are not exactly the same in terms of quality of care. One would get you sued, the other, no one would even notice.

Don't get me wrong, the study is thought provoking but the major flaws in the design make it so no clear conclusion can actually be drawn.

From personal experience at the VA and a major university hospital, I can tell you that there is an incredible difference in the kind of care you get in the hospital at the VA compared to the other university hospital. And it's not just me. I have not heard a single medical student, resident or physician who works at both systems say they view the care to be better at the VA. I have heard probably 50 times just this year just how slowly things move and how the care just isnt as good at the VA.

I agree that the preventative health care that you get at the VA is much better than nothing. But if every system worked like the VA we would just be bringing good parts of our health care system down to the lowest common denomenator.

Perhaps though, just the VA that I work at sucks

blue note · Jun 30, 2009

who's afraid of public insurance?

full article at national journal

the writer discusses several recent surveys and polls showing high support for a public option - check out the consumer assessment of healthcare providers and systems survey he mentions.

cahps is an initiative of the department of health and human services that developed a standardized survey questionnaire used by virtually all health insurance plans -- public and private -- to assess patient satisfaction. most private insurers use the cahps questionnaire and disclose the data to the national committee for quality assurance in order to receive their accreditation. so thanks to cahps, we have a massive collection of data comparisons of how patients experience and rate medicare, medicaid and private insurance.

those comparisons show the depth of medicare's popularity. according to a national cahps survey conducted by the centers for medicare and medicaid services in 2007, 56 percent of enrollees in traditional fee-for-service medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. similarly, 60 percent of seniors enrolled in medicare managed care rated their plans a 9 or 10. but according to the cahps surveys compiled by hhs, only 40 percent of americans enrolled in private health insurance gave their plans a 9 or 10 rating.

more importantly, the higher scores for medicare are based on perceptions of better access to care. more than two thirds (70 percent) of traditional medicare enrollees say they "always" get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in medicare managed care plans and only 51 percent of those with private insurance.

he also suggests two reasons why people are so easily talked out of expanding the medicare experience:

first, younger americans not enrolled in medicare do not share the enthusiasm of seniors for the program. six years ago, the kaiser foundation asked a national sample of adults to rate the medicare program. medicare was hugely popular among those aged 65 or greater. eighty percent rated medicare favorably. similarly, more than half of seniors (62 percent) considered medicare "well run" compared to only 28 percent willing to say the same of "private health plans such as ppos and hmos that people get through their jobs."

those under 65, however, had very different views. only 45 percent rated medicare favorably. only 36 percent considered it well run, as compared to 47 percent who said the same about private health plans. while 73 percent of those over 65 said medicare allowed patients to choose any doctor, only 28 percent of those under 65 agreed.

second, the older americans who like medicare see little to gain from the public option since they like the coverage they have now. democratic pollster stanley greenberg finds "little support among seniors" for reform. a recent survey conducted by greenberg's democracy corps found a narrow plurality among all voters favoring "president obama's plan to change the health care system" (43 percent to 38 percent), but net opposition among seniors (34 percent to 50 percent).

so, the americans experienced with "government-run" health insurance like what they have and don't want to change it, and younger americans enthusiastic for change don't know what they're missing.

K98 · Jul 1, 2009

Our government has just spent trillions of dollars that we don't have. Now they are printing new dollars at an alarming rate. This is the model of efficiency that some people want at the helm of our healthcare system? Heh. They way things are going in Washington, we will likely have bigger problems than healthcare funding. Soon.

blue note · Jul 2, 2009

CDC: Private health care coverage at 50-year-low

The percentage of Americans with private health insurance has hit its lowest mark in 50 years, according to two new government reports. About 65 percent of non-elderly Americans had private insurance in 2008, down from 67 percent the year before, according to preliminary data released Wednesday by the U.S. Centers for Disease Control and Prevention.
"It's bad news," said Kenneth Thorpe, a health policy researcher at Emory University.
In the 1970s and early 1980s, nearly 80 percent of Americans had private coverage, according to CDC officials.
Some experts blamed the faltering economy and corporate decisions to raise health insurance premiums-or do away with employee coverage-as the main drivers of the recent data. They say coverage statistics for 2009 may look even worse.
However, public coverage of adults is rising in some states, due to programs like Medicaid expanding eligibility. So not all the adults without private coverage are uninsured, Thorpe said.
Indeed, the CDC estimated that about 44 million Americans were uninsured last year-nearly the same as CDC estimates for other recent years.
The CDC is one of at least three U.S. agencies that estimate the number of Americans without health insurance.
The U.S. Census Bureau puts out what is perhaps the best-known number, but that agency's 2008 estimate is not due out until August.
Like the Census Bureau, the CDC's estimate is based on a survey. The CDC interviewed about 75,000 Americans last year, asking if they were uninsured at the time. About 15 percent said yes, leading to the estimate that about 44 million Americans were uninsured.
The drop in non-elderly adults with private health insurance was statistically significant, but the drop in children without private coverage was not. Health officials noted that public coverage of children has risen dramatically in the last ten years, and now more than one in three children are covered by a public plan.
The CDC also reported on insurance coverage in the 20 largest states, and found the percent of uninsured people ranged from 3 percent in Massachusetts to 23 percent in Texas. Lack of health insurance was greatest in the South and West.
Private coverage rates for people under age 65 ranged from 79 percent in Massachusetts to 56 percent in Florida, the CDC reported.