Health care - administrative incompetence

Gandalfs Beard said:
Well, he's an old fashioned Centrist, before the Centre was moved from the 50 yard line to the 20 yard line at the Right end of the field (which makes him a raging Liberal nowadays). Can't expect him to be a full on Lefty when he's not. I'm pragmatic that way. ;)


GB
Click to expand...

I don't expect him to be anything. I simply critiqued his stance on the PPACA.
 
bookitty said:
I know, I know, you hear all the jokes but honestly, my mom in law was great. A seriously awesome individual. So I'd really rather you didn't refer to her as waste.

The private sector had incentive (profit) to drop her. They did. It's impossible to tell how much the stress and anger of fighting the private sectors paperwork had to do with her death but I believe it contributed. The government also contributed stress but at least it gave her the treatment she'd been paying for.

Here's what gets me. The insurance companies had to change the system in order to get away with ditching waste. They had to lobby for it, hire lawyers, create entire new divisions that do nothing but cut waste like my MIL and her expensive treatment. All that money they spent could have been used to pay for her treatment.

Of course, she's only one person. They've amortized that cost over 1000's of people. That's how business works.
Click to expand...

:(
 
Garrison0fMars said:
I don't expect him to be anything. I simply critiqued his stance on the PPACA.
Click to expand...

Don't get me wrong, I agree with you on that score.

I'm just saying the US would be a lot better off if HE was Obama's Economic Adviser instead of the Wall St Bankers that screwed us to begin with.

GB
 
Gandalfs Beard said:
Don't get me wrong, I agree with you on that score.

I'm just saying the US would be a lot better off if HE was Obama's Economic Adviser instead of the Wall St Bankers that screwed us to begin with.

GB
Click to expand...

I vote for Dean Baker or Michael Hudson. Both, ideally. I'm sure they could find a consensus.
 
Tatyana said:
Actually...............

http://www.nejm.org/doi/full/10.1056/NEJMp0906618

When the current government came to power in 1997, it recognized that health care spending was inappropriately low (Britain's total expenditure on health was 6.6% of its GDP, as compared with 13.4% in the United States at that time).1 In the intervening decade, Britain has made major investments in its health care system, raising the total expenditure to 8.4% of the GDP in 2007, as compared with 16% in the United States.

These funds, which effectively doubled NHS spending, from $75 billion to $159 billion per year, have been used to build new hospitals, hire more nurses and doctors, provide an improved base for physicians' salaries linked loosely to productivity, and enhance the research infrastructure in order to generate a stronger evidence base for clinical care guidelines.

The prevailing political philosophy was that introducing competition and patient choice into this monolithic market would be the best means of raising standards — an intellectually appealing concept that was diluted somewhat by the British public's apathy toward becoming health consumers and perhaps by the government's failure to equip people with the necessary information to “shop for health.”


And
http://jnci.oxfordjournals.org/content/99/5/346.full
Governments Move To Improve Quality and Cut Costs


http://www.rsm.ac.uk/media/downloads/j06-09diabetes.pdf
Diabetes management in the USA and England:
comparative analysis of national surveys

SUMMARY
Objectives To compare diabetes management in adults
between England and the United States, particularly focusing on
the impact of a universal access health insurance system.
Design Analysis of the nationally-representative surveys Health
Survey of England, 2003 (unweighted n =14 057) and the
National Health and Nutrition Examination Survey, 2001–2002
(unweighted n =5411).
Setting and participants Adults 20–64 years of age;
individuals 465.
Main outcome measures Glycaemic, lipid and blood pressure
control and medication use among individuals with
previously diagnosed diabetes.
Results Among those aged 20–64 the prevalence of diagnosed
diabetes was lower in England (2.7%) than in the USA
(5.0%). The proportion with diabetes receiving treatment was
similar for the two countries. However, the mean HbA1c in
England was 7.6%: in the USA it was 7.5% for those with
insurance and 8.6% for those without insurance. The proportion
of individuals on ACE inhibitors in England was 39%: in USA it
was 39% for those with insurance, and 14% for those without.
Conclusions Individuals in a healthcare system providing
universal access have better managed diabetes than those in a
market based system once one accounts for insurance.
Click to expand...

He'll ignore this, even though it's at least the third time he's been told. Why? Because it allows him to cite 10-11 year old papers written by right-wing free-market lobby organisations as "proof" that the NHS is somehow failing.

You'll notice that he's still not come up with other clinical indicators that he prefers to life exepctancy and infant mortality, notwithstanding that this was raised about 3-4 days ago.

Likewise we're still waiting for evidence that untreated Strep Throat is killing us all over the rest of the world. I don't think we should be expecting it soon.

The simple fact, as we've all realised, is that XjX isn't really going to let the practicality of healthcare systems at half to two-thirds US costs for comparable medical outcomes sway his view because it's not a "free market" solution. He'd rather pay through the nose than accept "socialism".
 
Architect said:
He'll ignore this, even though it's at least the third time he's been told. Why? Because it allows him to cite 10-11 year old papers written by right-wing free-market lobby organisations as "proof" that the NHS is somehow failing.
Click to expand...

It's more like the 6th time he's been told. That's why I called it willful ignorance.
 
xjx388 said:
UncaYimmy said:
As I read it, all three members have to exceed the $7,500 deductible. It doesn't look like just one person having $50K in health care would qualify. That is truly catastrophic.
Click to expand...

The most you would be out of pocket in a given year in that plan is 22k. And that's only if some really :rule10:ed-up :rule10: went down. An HSA (or savings account) could take care of your out of pocket expenses.

Now, what's the next issue yer going to bring up . . .
Click to expand...


And how does this help the working poor who are on $8/hour with the median net worth for a renting household of $4k in 2004 (the latest figures I could find)?

Could you also explain specifically how the free market could make high-tech treatment affordable to such people?

More specifically:

  • What annual income you think surgeons and anaesthetists should be on?
    The free market won't reduce the time needed to perform the surgery, so to reduce labour costs, either the income of the medical staff needs to fall, or they need to work for longer. You have stated that they "do surgery in the mornings 6-12ish then see patients in their office in the afternoon. That's pretty typical." Is this actually time in theatre? 5-days a week? Even a 30-hour week actually in theatre performing seems pretty impressive.
  • How about the labour costs associated with other medical staff?
  • How would the depreciation costs of medical equipment reduce?
    Would you propose lower-spec equipment? Or that the equipment is used for longer? Or that medical suppliers decide to reduce the cost of purchase despite the fact that they also can sell to the rest of the world?
  • How would the costs of the theatre reduce?
    You could try improving utilisation rates, but I see no new driver to optimise these compared to the current system.



I have shown very conservative figures showing that such treatment is inherently expensive, and the only "reform" I have seen you "propose", is the non free-market one of increasing the pay of doctors, which would make this increase.
 
Architect said:
He'll ignore this, even though it's at least the third time he's been told. Why? Because it allows him to cite 10-11 year old papers written by right-wing free-market lobby organisations as "proof" that the NHS is somehow failing.

You'll notice that he's still not come up with other clinical indicators that he prefers to life exepctancy and infant mortality, notwithstanding that this was raised about 3-4 days ago.

Likewise we're still waiting for evidence that untreated Strep Throat is killing us all over the rest of the world. I don't think we should be expecting it soon.

The simple fact, as we've all realised, is that XjX isn't really going to let the practicality of healthcare systems at half to two-thirds US costs for comparable medical outcomes sway his view because it's not a "free market" solution. He'd rather pay through the nose than accept "socialism".
Click to expand...

There are the cancer survival rates. :p

http://scienceblog.cancerresearchuk...careful-when-comparing-us-and-uk-cancer-care/
We need to be careful when comparing US and UK cancer care

‘Breast cancer kills more frequently in the UK’

One stat that we were asked to comment on is a statistic comparing breast cancer death rates in the two countries:

Breast cancer kills 25 percent of its American victims. In Great Britain …breast cancer extinguishes 46 percent of its targets.

We don’t know where this figure has come from. However, according to GLOBOCAN – an international comparison carried out in 2002 and probably the most recent comparable figures, the age-standardised figures are 24 deaths per 100,000 Britons, and 19 per 100,000 Americans – not nearly so dramatic a difference.

‘Fewer prostate cancer patients survive five years’

Another fact that has been widely quoted relates to prostate cancer. As the Guardian wrote:

A Lancet Oncology global study last year found that 91.9 per cent of Americans with the disease were still alive after five years compared to just 51.1 per cent in the UK.

On the face of it, these figures are indeed valid. They come from the CONCORD study, which we helped fund, and compared 5-year survival rates between many different countries.

But just comparing the US and the UK, and saying that the bigger number is ‘better’, misses a deeper truth.

As we’ve written before, the US uses the PSA blood test far more widely than we do in the UK – despite questions over how effective it is at spotting cancers that would actually kill, as opposed to those that cause no symptoms.

As a result, the USA has one of the highest recorded rates of prostate cancer in the world.

So although it’s undoubtedly ‘better’ at spotting prostate cancers, it’s also fair to say that some of these Americans will never die from their disease.

This ‘overdiagnosis’ inflates the survival statistics, at the expense of ‘overtreating’ men – which is expensive and can cause long-term side effects (which can need further treatment).

So you might just as well argue that the ‘91 per cent’ survival figure could be due to a system that overdiagnoses and overtreats prostate cancer, as opposed to saying our 51 per cent stat is due to poor healthcare in the UK.

Bigger is not always better.

Finally, if you look at UK survival rates for early stage prostate cancer, a different picture emerges – men in the UK have a 98.6 per cent five-year survival rate. Clearly, whatever controversies surround the diagnosis of the disease, the NHS is doing a pretty good job of managing it when it’s detected early.
Click to expand...

http://www.ncbi.nlm.nih.gov/pubmed/12081758
BJU Int. 2002 Jul;90(2):162-73.
Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: international comparisons.

Quinn M, Babb P.

National Cancer Intelligence Centre, Office for National Statistics, London, UK. mike.quinn@ons.gov.uk
Abstract

The international patterns and trends in prostate cancer incidence, survival, prevalence and mortality were examined. Age-standardized incidence and death rates among men in a variety of countries worldwide were obtained from various sources, survival rates from European sources and elsewhere, and prevalence estimates from the EUROPREVAL study.

Results from many published studies were summarized. The incidence of prostate cancer varies widely around the world, with by far the highest rates in the USA and Canada. There has been a gradual increase in the incidence of prostate cancer since the 1960s in many countries and in most continents; there were large increases in the late 1980s and early 1990s in the USA, but increases have also occurred in countries with comparatively low incidence, e.g. India.

Survival from prostate cancer improved during the 1970s and 1980s; further increases in the 1990s may be largely a result of earlier diagnosis. There were wide differences in survival across Europe, with rates in the UK well below the average, but all European rates were far below those in the USA.

There was wide variation in the prevalence of prostate cancer in Europe; in some countries with high incidence and high life-expectancy, prostate cancers formed approximately 15% of all prevalent cancers in men.

Mortality from prostate cancer has also increased in many countries, but to a lesser extent than incidence; this is consistent with the observed trends in survival. Mortality decreased slightly in the mid to late 1990s in several countries, including the USA, Canada, England, France and Austria.

Part of the apparent increases in the incidence of prostate cancer has been associated with diagnostic artefacts (particularly detecting preclinical tumours through the increased use of transurethral resection) which may also have had an effect on death certification through the incorrect attribution of prostate cancer as the underlying cause of death. However, the greatest effect on the registration of new cases of prostate cancer has been the increased availability of prostate specific antigen testing during the early- to mid-1990s. Possibly, in addition to the effect of attribution bias, the earlier diagnosis of prostate cancers has contributed to the recent slight decreases in mortality. However, this is unlikely to account for much of the reduction, given the slow development of the disease from onset to death. Changes in disease management are probably more important. There are many strong arguments against introducing population-based screening for prostate cancer.
Click to expand...

Just a little emphasis from a previous argument, that the NHS was not doing its job because we didn't insist on a PSA for every single man when they present in a GP surgery.

It just really isn't very good as a screening test. Very few tumour markers are.

It is just a statistical function that the more tests you run, the more likely you are going to find someone that deviates from the normal distribution in the population in one or more parameter, however, our reference ranges only cover 95% of the 'normal' population.

Anyone you has had any basic training in medicine or statistics would know this.
 
Last edited:
Tatyana said:
Let me see if I understand this.

This plan covers a family of four for a year for $ 3180 (is there tax on this?).

If one of the members of the family is sick or injured, initially, you have to pay $ 7 500.

If the entire family is sick or injured (for example, a car crash), then the maximum you have to pay is more or less for three family members, or $ 22 500.

You basically have to pay for all of your prescription medications up to $ 1000 for the year, and then after you have paid $ 1000, the costs are:
Once you've met your deductible, then you pay a copay:
••$15 / level 1: low-cost generic and brand-name drugs
(These drugs are covered before meeting your deductible)
••$40 / level 2: higher cost generic and brand-name drugs
••$65 / level 3: high-cost, mostly brand-name drugs
••35% / level 4: some drugs you inject and other high-cost drugs
($5,000 out-of-pocket maximum per person per calendar year on level 4 drugs)

If you go to an emergency room, there is an additional $ 125 fee.

You do not have to pay for a general check up, a well-baby check up, or a gynaecological screen (I would think this is a cervical screen and/or mammogram).

All of this is subject to:



If you have a road traffic accident out of your network area and you are taken to an ER outside your network area, then you will have to pay costs up to $ 10 000 for the individual or $ 30 000 for the family.

This doesn't cover any ante-natal, labour or post-natal coverage.

Have I got this more or less correct?
Click to expand...

I sure wish I had all those "freedoms" the USA folk have!
 
Tatyana said:
xjx388 said:
Our employees have the same coverage at the same or lower prices. We contribute into their savings accounts as well as provide their catastrophic insurance. It's out there, but no one bothers to look. They'd rather whine about how unfair everything is.

I posted earlier a catastrophic plan for a family of four that would cost ~$260. I've attached a PDF. This was from ehealthinsurance.com. I'm sure there are conditions, etc. but it proves the point.
Click to expand...

Let me see if I understand this.

This plan covers a family of four for a year for $ 3180 (is there tax on this?).

If one of the members of the family is sick or injured, initially, you have to pay $ 7 500.

If the entire family is sick or injured (for example, a car crash), then the maximum you have to pay is more or less for three family members, or $ 22 500.

You basically have to pay for all of your prescription medications up to $ 1000 for the year, and then after you have paid $ 1000, the costs are:
Once you've met your deductible, then you pay a copay:
••$15 / level 1: low-cost generic and brand-name drugs
(These drugs are covered before meeting your deductible)
••$40 / level 2: higher cost generic and brand-name drugs
••$65 / level 3: high-cost, mostly brand-name drugs
••35% / level 4: some drugs you inject and other high-cost drugs
($5,000 out-of-pocket maximum per person per calendar year on level 4 drugs)

If you go to an emergency room, there is an additional $ 125 fee.

You do not have to pay for a general check up, a well-baby check up, or a gynaecological screen (I would think this is a cervical screen and/or mammogram).

All of this is subject to:

IMPORTANT NOTICES AND DISCLAIMERS
THE BENEFITS MATRIX IS A SUMMARY FOR INFORMATIONAL PURPOSES ONLY.
REVIEW THE EVIDENCE OF COVERAGE AND INSURANCE POLICY (PLAN CONTRACT)
FOR A DETAILED DESCRIPTION OF COVERAGE BENEFITS, LIMITATIONS, AND
EXCLUSIONS. ONLY THE TERMS AND CONDITIONS OF COVERAGE BENEFITS LISTED IN THE POLICY ARE BINDING.

The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.


The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.

Each insurance carrier may have unique Notices, Disclaimers, and Fees.

Please check below for information regarding the plans and carriers you selected.

The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history(pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date.


The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification
Click to expand...

If you have a road traffic accident out of your network area and you are taken to an ER outside your network area, then you will have to pay costs up to $ 10 000 for the individual or $ 30 000 for the family.

This doesn't cover any ante-natal, labour or post-natal coverage.

Have I got this more or less correct?
Click to expand...

But if you are in the financial position that xjx388 claims to be in, this is probably pretty good for insurance.

But the US median income is a lot lower than this, and the excess would make it worthless for many people as they'd go bankrupt before using any of the services.
 
Darat said:
Yeah if you redefine what the word "good" means i.e. "best of a bad job"! :)
Click to expand...

I wondered italicising the "for insurance" bit...

And this is on top of the tax dollars spent on healthcare.

So for a family with the 2008 median household income of $52 029, this is an extra 6% of their income spent on a plan that doesn't pay out until an individual has spent a further 14% of their household income, per person.

doesn't look too good to me.


As an aside, I have just phoned (at 8:40 this morning) to make a GP's appointment for my daughter, and have got a 4pm slot.


This is a non-emergency appointment.
 
xjx388 said:
You think I don't know this?

Again, are you in the industry somehow? If so, I find it amazing that you don't understand the true extent of fraud and abuse in the medical industry. Ask these bloggers you hang out on.
Click to expand...


What about denying someone cancer treatment because they had acne as a pre-existing medical condition?

There are mistakes and errors, and when they are discovered, people kick up merry hell, and heads roll. The horror stories are used to rectify bad practice. In the US, this often doesn't even make the news and the tricks that have been used to deny treatment are shocking to me: (US congress report - PDF here)


Insurance companies rescind coverage even when discrepancies are unintentional or caused by others. In one case reviewed by the Committee, a WellPoint subsidiary rescinded coverage for a patient in Virginia whose insurance agent entered his weight incorrectly on his application and failed to return it to him for review. The company's Associate General Counsel warned that the agent's actions were "not acceptable" and recommended against rescission, but she was overruled.

• Insurance companies rescind coverage for conditions that are unknown to
policyholders. In 2004, Fortis Health, now known as Assurant, rescinded coverage for a policyholder with lymphoma, denying him chemotherapy and a life-saving stem cell transplant. The company located a CT scan taken five years earlier that identified silent gall stones and an asymptomatic abdominal aortic aneurysm, but the policyholder's doctor never informed him of these conditions. After direct intervention from the Illinois Attorney General's Office, the individual's policy was reinstated.

• Insurance companies rescind coverage for discrepancies unrelated to the medical conditions for which patients seek medical care. In November 2006, a Texas resident with a policy from WellPoint was diagnosed with a lump in her breast. The company initiated an investigation into the patient's medical history and concluded that she failed to disclose that she had been diagnosed previously with osteoporosis and bone density loss. The company rescinded her policy and refused to pay for medical care for the lump in her breast.

• Insurance companies rescind coverage for family members who were not involved in misrepresentations. When a UnitedHealth subsidiary determined in 2007 that a policyholder in Michigan failed to disclose his abnormal blood count and other conditions, the company also rescinded coverage for his spouse and two children. When his spouse called to find out "[w]hy we dropped whole family instead of husband," the company official "[c]alled her back told her coverage was voided to medical history not on app."

• Insurance companies automatically investigate medical histories for all
policyholders with certain conditions. WellPoint and Assurant informed the
Committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and even becoming pregnant with twins. UnitedHealth was unable to explain specifically how its investigations are triggered, claiming that it utilized a computer program so complex that no single individual in the company could explain it.

• Insurance companies have evaluated employee performance based on the amount of money their employees saved the company through rescissions. The Committee obtained an annual performance evaluation of the Director of Group Underwriting at WellPoint. Under "results achieved" for meeting financial "targets" and improving financial "stability," the review stated that this official obtained "Retro savings of $9,835,564" through rescissions. The official was awarded a perfect "5" for "exceptional performance."
Click to expand...
 
jimbob said:
I wondered italicising the "for insurance" bit...

And this is on top of the tax dollars spent on healthcare.

So for a family with the 2008 median household income of $52 029, this is an extra 6% of their income spent on a plan that doesn't pay out until an individual has spent a further 14% of their household income, per person.

doesn't look too good to me.


As an aside, I have just phoned (at 8:40 this morning) to make a GP's appointment for my daughter, and have got a 4pm slot.


This is a non-emergency appointment.
Click to expand...

You did check the GP was in your network? Presumably you'll be paying for her co-pay out of the money her grandparents sent her for Christmas?
 
You must log in or register to reply here.

Back
Top Bottom