Wednesday, June 6, 2007

Health Care Reform - Myths and Facts

Finally, after almost 15 years, Health Care Reform is back in vogue. With the upcoming election, our country might be poised to actually address this issue. The California Healthcare Foundation has released some myths and facts that readers of EverythingHealth will find interesting.

- The uninsured can get care when they need it.
FACT- Almost half of uninsured individuals will not seek care when they have a medical problem, compared to 15% of patients with insurance. Uninsured patients consistently have worse health outcomes. Accident victims without insurance have 37% higher mortality rates. Uninsured patients with breast and colon cancer have 50% higher mortality rates. Because uninsured patients lack routine care, their chronic conditions are often poorly managed

MYTH-People without job-based health insurance could buy insurance if they wanted to, but they choose not to.
FACT-Consumers can be denied coverage outright, can be charged higher premiums or be offered more limited benefits based on their health status. For example, many people who have had cancer or have heart disease are denied coverage. See my prior post on one such case. Even for individuals or families who can get coverage, it may be available only at prices that are unaffordable. The individual insurance market is a viable choice for only a subset of the uninsured.

MYTH-Voluntary purchasing pools lower the cost of health insurance premiums.
FACT-Establishing a voluntary purchasing pool will not automatically reduce premiums to an affordable level. Only if the pool is structured so that its enrollment is stable, only if its target population is required to use the pool will the pool have the potential to achieve economies of scale and negotiate effectively with health plans. The California sponsored purchasing pool - Pac Advantage- recently ceased operations.

The dialog about health care in America has begun and dispelling myths is the first step toward solving complicated problems. We are the only industrialized nation without universal access to basic health care.


Dave said...

Toni -

Thanks for directing me over here from Paul's blog. I am curious to talk more about your thoughts on market-driven approaches and learn more about this either on the blog or in email.

The question I was focusing on was why can't an organization focus on what it does well (and in high enough volumes to have a standard 'cost' when measured across providing a certain bundled service over time).

Why can't an ED, Skilled Nursing or OB be run in such a way? Is it a failure to reimburse actual costs, or a lack of efficiency and productivity brought into these areas? I've seen advertisemens in the Boston area for ER's with 15 minute wait times or less, versus my own experience being in an ER for 5 hours, and 2 of those hours just waiting to be let go while the hospital had been on diversion..

Where am I missing the boat? Many people cite complexity of care, coordination of services, etc. but with automation and process change it seems many of these bottlenecks could be improved to make these endeavors efficient, break-even and nay even profitable while still maintaining (or raising) quality/value to the patient...?

~ Binky, Marivic, & Joy ~ said...

My current job helps these uninsured folks to some access to care that they would otherwise be unable to afford. You are right on target on your statistics! Thanks!