Falling Behind: Americans' Access to Medical Care Deteriorates

UM Review RN, ASN, RN · Jun 27, 2008

A couple of the docs where I work were discussing this issue by way of noting that patients are delaying treatment, coming into the hospital much sicker than before, resulting in lengthier stays and more adverse outcomes.

The sad part is, most of our patient population is fixed-income retirees and they're delaying care because the ambulance is not covered by insurance plus the cost of gas. :crying2: It's so awful because so many of these problems are preventable with timely intervention.

VickyRN, MSN, DNP, RN · Jun 27, 2008

Thank you for bringing this very important research to our attention, herring. Truly our healthcare system is in serious trouble and in danger of imploding. I also am very impressed with this Health System Change website.

Katie82, RN · Jun 28, 2008

The sad part is, most of our patient population is fixed-income retirees and they're delaying care because the ambulance is not covered by insurance plus the cost of gas. It's so awful because so many of these problems are preventable with timely intervention.

You are correct that a lot of seniors have poor access to healthcare, despite the infrastructure of agencies that is in place to offer assistance. I know that these agencies work hard to get the message out that many services are available, but I am continually astounded at how many people do not take advantage. I worked for a short time for a company that was piloting a program sponsored by CMS that would provide Disease Management / Case Management to the Medicare population. It never ceased to amaze me how little folks know about what is available to them. People on Medicare are underserved. Insurance companies learned long ago that Disease/Case Management provided early intervention that saves both money and lives. CMS has big plans to provide these services to the Medicare folks, I just wish they's get on with it.

Mijourney · Jul 12, 2008

You are correct that a lot of seniors have poor access to healthcare, despite the infrastructure of agencies that is in place to offer assistance. I know that these agencies work hard to get the message out that many services are available, but I am continually astounded at how many people do not take advantage. I worked for a short time for a company that was piloting a program sponsored by CMS that would provide Disease Management / Case Management to the Medicare population. It never ceased to amaze me how little folks know about what is available to them. People on Medicare are underserved. Insurance companies learned long ago that Disease/Case Management provided early intervention that saves both money and lives. CMS has big plans to provide these services to the Medicare folks, I just wish they's get on with it.

One of the problems that I have faced will the Medicare population, especially the seniors, utilizing DM/CM services is the lack of trust of the insurers. Many insurers try to help the Medicare population "manage" their care, but the seniors want full authority in deciding what they want which is understandable. Insurers tend to like to dangle things on a rope. The purchasers of DM/CM services want to see a return on investment and do not want to see the insured fully in control of a situation. It's going to be interesting to see what the boomers do with DM/CM services. I really think that boomers will end up having alot of authority in getting the services they want.

Mijourney · Jul 12, 2008

A couple of the docs where I work were discussing this issue by way of noting that patients are delaying treatment, coming into the hospital much sicker than before, resulting in lengthier stays and more adverse outcomes.
The sad part is, most of our patient population is fixed-income retirees and they're delaying care because the ambulance is not covered by insurance plus the cost of gas. It's so awful because so many of these problems are preventable with timely intervention.

What's going to be worse is that if CMS goes through with this 10% reduction in reimbursement to physicians, it's going to get worse. Many are threatening not to see Medicare patients at all. The quality of life for seniors will be undermined due to low access to treatment and care.

allnurses Guide · Jul 12, 2008

the tv news showed senator kennedy's welcome but not the purpose.

senate passes medicare bill with kennedy's help
washington (reuters) - a medicare bill opposed by the white house won final congressional approval on wednesday with the help of sen. edward kennedy, who returned to the senate floor for the first time since brain surgery last month.
with kennedy's dramatic and surprise appearance, he and fellow democrats overcame a republican procedural hurdle and, on a voice vote, passed the measure earlier approved by the house of representatives....

..."win, lose or draw, i wanted to be here. i wasn't going to take the chance that my vote could make the difference," kennedy said after the vote.

the bill would cancel a scheduled 11 percent pay cut to doctors who treat medicare patients. it is largely funded by cutting about $13 billion in reimbursements to insurers such as unitedhealth group inc and aetna inc that contract with the medicare program.

the bush administration opposes any effort to trim payments to private health plans. ...

...last month, an effort to clear a republican procedural hurdle on the bill in the 100-member senate came up one vote short of the needed 60.
[after kennedy cast his vote to end the roadblock, nine republicans who had earlier opposed the measure voted for the popular election-year bill...

...the bill garnered a veto-proof majority of 69 in favor, with 30 opposed. republican sen. john mccain of arizona was the only member of the senate not to vote. he was campaigning as his party's presumptive presidential nominee. he told reporters traveling with him he would have opposed the measure....

http://www.reuters.com/article/rbssmanagedhealthcare/iduswbt00936220080709?sp=true

Simplepleasures · Jul 13, 2008

As a person on SSDI,thank goodness and Senator Kennedy that the new Medicare Bill is veto proof. MDs and clinics are declining to accept Medicare patients without the supplemental insurance or an Advantage plan. This takes away another $100 plus dollars out of the SS recipients monthly check, besides the $98.00 that it cost to have Medicare Part A and B .That $200.+ on a fixed income can and really does hurt seniors and the disabled on a fixed income. I haven't even mentioned the cost of Medicare part D here.Some find that their medications are cheaper from Walmart than the actual Medicare part D plan.

Having said that, I am grateful to have Medicare, I was using a free clinic for the past two plus years, I am so relieved to once again have my own doctor and clinic .

RN4MERCY · Jul 14, 2008

:uhoh3:

According to Dr. Don McCanne, Senior Health Policy Fellow of Physicians for a National Health Plan, "the Medicare Advantage plans are being paid about 12 percent more (17 percent for PFFS plans) than the costs of patients in the traditional Medicare program. Of the funds received, the plans use 13 percent for non-medical purposes including administration, marketing expenses, and profits.

We are paying the Medicare Advantage plans a lot of money for for administration and profits, but for what end? Merely to reduce premiums and cost sharing. The private plans waste a tremendous amount of our tax funds accomplishing this.

Why shouldn't everyone in Medicare receive the same relief as the privileged individuals who enroll in the private plans? Congress should end this Medicare Advantage shell game and take the money they are wasting on these plans and distribute it equitably so all Medicare participants can benefit."

Why should our government be subsidizing private insurance companies? Private insurers waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans' health dollars.

Thanks, Herring. I believe we can do better in America, and that we must end this injustice. A single-payer system of health care would put those precious dollars to work providing health care and medicine to all who need it.

allnurses Guide · Jul 17, 2008

[color=#394b6b]health care marketplace | u.s. spends more than twice as much on health care per person than most other industrialized nations, ranks last in preventable mortality, study finds

the u.s. spends twice as much on health care per capita than most other industrialized nations but ranks lower than those nations on a number of criteria, according to a report released on thursday by the [color=#394b6b]commonwealth fund, the [color=#394b6b]new york times reports (abelson, new york times, 7/17). ...

[color=#394b6b]http://www.kaisernetwork.org/daily_reports/rep_index.cfm?dr_id=53347

kjetski · Jul 18, 2008

Falling Behind: Americans' Access to Medical Care Deteriorates
The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change's (HSC) nationally representative 2007 Health Tracking Household Survey.
One in five Americans--59 million people--reported not getting or delaying needed medical care in 2007, up from one in seven--36 million people--in 2003.
While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people.
Moreover, access declined more for people in fair or poor health than for healthier people....
http://www.hschange.com/CONTENT/993/

It appears that HSC "tracking report" is based on self reporting. Self reporting is a lousy way to gather data.

A couple of years ago The Lancet published a so called study claiming mega-deaths in Iraq. Careful analysis revealed that The Lancet used self reporting. The result was about a 400% increase over the actual Iraqi civilian deaths. It may be higher. The study quickly went away.

kjetski · Jul 18, 2008

As a person on SSDI,thank goodness and Senator Kennedy that the new Medicare Bill is veto proof. MDs and clinics are declining to accept Medicare patients without the supplemental insurance or an Advantage plan. This takes away another $100 plus dollars out of the SS recipients monthly check, besides the $98.00 that it cost to have Medicare Part A and B .That $200.+ on a fixed income can and really does hurt seniors and the disabled on a fixed income. I haven't even mentioned the cost of Medicare part D here.Some find that their medications are cheaper from Walmart than the actual Medicare part D plan.
Having said that, I am grateful to have Medicare, I was using a free clinic for the past two plus years, I am so relieved to once again have my own doctor and clinic .

Walmart is probably the largest private health provider in the US. Those four dollar scrips have lowered the cost and increased the competition.

The marketplace works boys and girls.