Citizens’ Council on Health Care
CCHC HEALTH eNEWS
Wednesday, December 12, 2001
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Providing news and commentary on health care
policy,
health insurance issues, and medical confidentiality.
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ANNOUNCEMENTS:
1) CCHC President is Board Member of new Patient Safety Institute
2) CCHC letter was published in BusinessWeek (12/17/01)
- announcing CCHC’s medical privacy declaration
forms
NEWS:
* NYT: PATIENT SAFETY INSTITUTE
TO PROTECT PRIVACY/ALLOW DATA-SHARING
* NEW YORK TIMES DOESN’T LIKE CONSUMER-DRIVEN HEALTH
* ARE “BEST PRACTICES” ALWAYS BEST?
* MOVING TO “EVIDENCE-BASED MEDICINE”
NATIONAL DISEASE
SURVEILLANCE SYSTEM PROPOSED
* REFUNDABLE TAX CREDITS WOULD HELP THE UNINSURED
* CANADIAN SURVEY SHOWS MIXED OPINIONS
* UNSUSTAINABLE: EMPLOYER HEALTH BENEFITS ROSE
FIVE (5) TIMES THE RATE OF INFLATION IN 2001
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* CCHC Commentary included
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PATIENT SAFETY INSTITUTE TO PROTECT PRIVACY/ALLOW DATA-SHARING
An “unusual mix of technology companies, consumer advocates and
doctors is joining” together, says the Associated Press. These
groups plan to use confidential computer systems to link a limited
set of patient data at the point of care to prevent medical
errors.
At a press conference yesterday, the Patient Safety Institute
announced that $8 million had been raised to jump start the
project in one city next year, with plans for nation-wide
expansion.
Although experts have called for electronic linkage to reduce
errors, doctors and hospitals and technology companies have
previously not been able to agree on a compatible standard for
all computer systems. Patient privacy has been another obstacle.
PSI’s consumer advocates have pledged that PSI technology will
protect data and that PSI will never sell any identifiable data.
In addition, patients can opt-in and opt-out at any time.
Absent from the press conference was the American Medical
Association which has not yet given its endorsement. PSI is
governed by the heads of consumer groups, physician groups and
hospital groups. Hewlett-Packard, Avaya, Netegrity and other
technology groups have provided the initial funding for PSI.
Plans to provide access to anonymized data for research will
sustain PSI funding long-term.
Source: “Computer Project Links Medical Info,” The New York
Times, (by The Associated Press), December 12, 2001
http://www.nytimes.com/aponline/national/AP-Medical-Errors.html?ex=100916811
7&ei=1&en=2a68573adf5362c1
PSI Web site: http://www.ptsafety.org
-Citizens’ Council on Health Care
-December 12, 2001
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NY TIMES DOESN’T LIKE CONSUMER-DRIVEN HEALTH
The New York Times made quite a splash with its hatchet job on
consumer-driven health care this week. The front-page article by
health and business writer Milt Freudenheim was headlined, “A New
Health Plan May Raise Expenses for Sickest Workers.” To make the
point, Mr. Freudenheim uses a very remote scenario and implies it
is typical. He supposes a family of three is required to pay
$1,150 in premium, for a $5,000 deductible, with an employer-
funded “allowance” of $3,000. Prescription drugs in this
hypothetical case are not covered and are do not apply to meeting
the deductible. This poor family not only incurs medical expenses
of $5,000, but it also suffers from asthma, high cholesterol, and
mental illness severe enough to take Prozac, incurring another
$2,484 in expenses, without the insurance plan paying a penny in
benefits. Mr. Freudenheim’s comparison plan includes a family
deductible of only $900, coinsurance of only 10%, and very
generous prescription drug benefits, all of which costs the
family a mere $300 more in annual premium. Of course these are
fantasy numbers, but the article uses them as if they are real-
life scenarios. It implies this is just one example of the
horrendous cost-shifting that employers are using to hoodwink
their employees. The article goes on to quote Uwe Reinhardt and
Deborah Chollet as tsk-tsk-ing over employer and insurer greed.
Mr. Reinhardt is quoted as saying, “The insurance industry has
decided that is you are sick, you ought to eat the costs. It’s a
very dubious social policy.” Just amazing.
Source: http://www.nytimes.com/2001/12/05/business/05CARE.html
Source: taken directly from SCANDLEN’S HEALTH POLICY COMMENTS
National Center for Policy Analysis Monday, December 10, 2001
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ARE “BEST PRACTICES” ALWAYS BEST?
A recent study found a 24 percent noncompliance rate in the use
of best practice procedures by physicians treating patients with
type 2 (or adult onset) diabetes, but researchers say this does
not represent a deficiency in care but instead a deficiency in
the definition of what constitutes best practices.
”Best practices” are generally recommended treatment protocols
based on a consensus among physicians in a particular specialty
and approved by a professional association. Advocates of
adopting best practices claim it improves the quality of care,
while some physicians see it as an attempt to limit their options
in treating individual patients.
Researchers analyzed the treatment of 1,755 diabetics by 85
internists who volunteered for the study. Among the best
practices recommended by the American Diabetes Association for
type 2 diabetes patients are regular microalbuminuria screens,
retinal exams and foot inspections.
o Many physicians questioned the usefulness of the
microalbuminuria screen for patients who are already
receiving angiotensin-converting enzyme inhibitors.
o Also, some patients did not receive eye exams because they
were blind and there was no point to a retinal exam.
o In addition to conscious decisions by physicians, other
instances of noncompliance included patient nonadherence,
such as failing to modify diet or schedule appointments
with an ophthalmologist or podiatrist as recommended;
systems problems, such as lack of communication between
doctors or reports not being distributed; and oversight or
forgetfulness.
Researchers say that evidence-based best practice guidelines are
often based on studies in which the subjects are younger and
healthier, while the patients physicians actually see are older
and sicker, and long-term preventative strategies may not be
applicable to their immediate needs.
Source: Andis Robeznieks, “Study: Best Practices Not Always Best
for All,” American Medical News, December 3, 2001, American
Medical Association; based on Christel Mottur-Pilson, Vincenza
Snow and Kyle Bartlett, “Physician Explanations for Failing To
Comply with ‘Best Practices,’” Effective Clinical Practice,
September/October 2001.
For study text
http://www.acponline.org/journals/ecp/sepoct01/pilson.htm
For AMN text http://www.ama-assn.org/sci-pubs/amnews/pick_01/prsb1203.htm
Source: Taken directly from Daily Policy Digest HEALTH
WEEKLY,
National Center for Policy Analysis, 12/10/01
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MOVING TO “EVIDENCE-BASED MEDICINE”
Some experts estimate that “only 20 percent of medical practices
are based on rigorous research evidence” says an article in the
journal Patient Care. The rest could be considered folklore, what
doctors have always said should work but haven’t been tested
independently.
A new practice called evidence-based medicine (EBM) is overtaking
the practice of medicine. Run through rigorous scientific testing,
not all traditional treatments are found to be effective. Cast in
doubt now are mammograms, the placebo effect, and bed rest for
low-back pain. In fact the federal Agency for Healthcare Research
and Quality has place the no-bed-rest theory into its guidelines.
There is hope that the guideline will help to eliminate sick days.
EBM, which originated with six doctors in Canada, is the activity
of taking what some consider to be the most dependable studies and
placing them in a database accessible to all doctors and practitioners.
Source: “Evidence-Based Medicine,” Jack Hitt, The New York Times,
December 9, 2001
CCHC COMMENTARY: Politics and bottom line decision-making can
influence which studies are considered “evidence-based” and included
in the EBM database. HMOs and government agencies, the primary payers
of health care are also the primary advocates for EBM. There exists
potential for studies and “evidence” to be used to rationalize health
care rationing.
-Citizens’ Council on Health Care
-December 12, 2001
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NATIONAL DISEASE SURVEILLANCE SYSTEM PROPOSED
To better know when a virulent disease is emerging, the
House subcommittee on oversight and investigations held its
first hearing on public health surveillance. Currently health
departments rely on doctors to report cases of about 30 diseases,
including botulism, AIDS and anthrax, which are often submitted
in written form.
The federal Centers for Disease Control and prevention presented
a proposal to create a national surveillance system, called the
National Electronic Disease Surveillance System (NEDSS). It would
function as a “kind of electronic vacuum that will scan medical
records, lab test results and local vital statistics reports for
unusual cases or trends that might signal a public health crisis.”
CDC plans to implement NEDSS next year in 20 states.
Some say the government’s system is too complex. A web-based system,
called RSVP, has been proposed by Sandia National Laboratories, the
University of New Mexico and the New Mexico state health department.
Doctors would enter symptoms onto a web page which in turn would
provide them with guidance on how to treat the patient and automatic
notification of the health department.
Other approaches include tracking disease through insurance claims,
linking emergency rooms and hospitals with public health departments,
and tracking emergency room and hospital admissions for unusual
increases. Quintiles, a North Carolina firm, has access to 3 million
claims forms daily and for $5 - $10 million could adapt the system
for public health use.
Source: “Congress considers updated disease-warning systems,”
Steve Sternberg, USA TODAY, 12/06/2001
-Citizens’ Council on Health Care
-December 12, 2001
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REFUNDABLE TAX CREDITS WOULD HELP THE UNINSURED
People who get their health insurance through their employers are
not taxed for that cost. There are proposals in Congress to help
those who must buy their own insurance with after-tax dollars by
giving them a refundable tax credit (one that is paid regardless
of whether the recipient paid that much in taxes).
Two recent studies show that a $1,000 refundable tax credit (for
individuals) would substantially lower the numbers of uninsured
in the United States.
A study by the National Bureau of Economic Research found that,
with the credit:
o As many as 85 percent of the uninsured would buy health
insurance with a $1,000 deductible, a 20 percent
coinsurance requirement and a $2,000 limit on out-of-
pocket spending (see figure).
http://www.ncpa.org/pub/ba/ba381/ba381fig1.gif
o More than 25 percent of the uninsured could get the policy
without paying anything beyond the tax credit.
o Another 25 percent would have to pay no more than $168 a
year beyond the tax credit.
Using different assumptions, researchers found that between 50
percent and 75 percent of the uninsured population could purchase
individual coverage for no cost beyond the $1,000 tax credit if
they chose from the 10 percent of policies with the lowest
available premiums.
Another study, by FamiliesUSA, only considers the insurance a 25-
and 55-year-old woman could obtain—limited to policies
similiar to the most generous plan offered federal employees,
which is Blue Cross Blue Shield with a $250 deductible and
minimal copayments. But even that study found that healthy, non-
smoking, 25-year-old women could get coverage for $1,000 in all
but six states.
Since 79 percent of the uninsured are under 45 years old, the
Families USA study actually supports the conclusion of the NBER
study that something approaching 85 percent of the uninsured
would be able to purchase coverage with a $1,000 tax credit.
Source: Greg Scandlen (NCPA Senior Fellow in Health Policy), “Tax
Relief For The Uninsured: Scholarship vs. Political Hype,” Brief
Analysis No. 381, December 4, 2001, NCPA.
For Brief Analysis text
http://www.ncpa.org/pub/ba/ba381/ba381.html
For NBER text http://www.nber.org/papers/w8457
For Families USA text http://www.familiesusa.org
Source: Taken directly from Daily Policy Digest, National
Center
for Policy Analysis, 12/4/01 http://www.ncpa.org
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CANADIAN SURVEY SHOWS MIXED OPINIONS
We haven’t visited the North Country in a while, so let’s take a
peek at what our Canadian friends are up to these days. We have
quite a backlog of articles, but we aren’t always able to find
them on the Internet. We’ll give you the usual sourcing
information and wish you luck in finding the original articles.
The National Post conducted a new survey of Canadian public
opinion on a host of health care issues. The results are a
fascinating mix, including the following tidbits:
o Only 10% of Canadians think their health care services
have improved “over the last couple of years,” while 62%
think they have gotten worse. This is an improvement from
the last survey (February, 1999), when the numbers were 6%
and 79%, respectively.
o When asked which country has “superior” medical
technology, 57% said the U.S. and only 14% said Canada.
o When asked who is doing the best job in health care, the
top two categories were doctors in general practice (27%)
and registered nurses (20%). When asked who is doing the
worst job, the top two categories were the provincial
health ministry (24%) and the federal department of health
(17%).
o When asked if it was a “good idea” to add certain services
to the system, 90% supported more homecare, 84% supported
more “walk-in clinics,” and 73% supported going to nurse
practitioners rather than doctors “at the first sign of
illness.”
o When asked if it was “important” that Canada continue to
provide, “free access to a fairly wide range of services
for all or almost all,” 88% said it is and only 9% said it
is not.
o When asked if it was “important” that “provincial
governments exercise central control over the entire
health care system in great detail,” 71% said it is and
only 24% said it is not.
o Similarly, 60% disagreed with the idea that “patients
would be treated better if the money flowed through them.”
Yet 50% supported the idea of considering MSAs, while 45%
did not.
SOURCE: “Special Report: State of Health Care,” The National
Post. November 17, 2001.
Source: Taken directly from SCANDLEN’S HEALTH POLICY COMMENTS
National Center for Policy Analysis Monday, December 3, 2001
_________________________________________________________________
2001: EMPLOYER HEALTH BENEFITS ROSE 5 TIMES THE RATE OF INFLATION
The cost of employers’ health premiums rose 11.2% in 2001 to
an average of $4,924 for every worker, and will likely rise an
additional 12.7% next year, according to a new nationwide survey of
2,800 large and small businesses by the consulting firm William M.
Mercer (Freudenheim, New York Times, 12/10).
The increase was roughly five times the overall rate of inflation,
and marked the fourth straight year of premium increases (Loyd,
Philadelphia Inquirer, 12/10). Blaine Bos, a Mercer principal
and co-author of the survey, said, “We’re going to be looking at a
period of about four years of double-digit inflation” (Martinez,
Wall Street Journal, 12/10). Surveys released earlier this fall
by the consulting firms Milliman USA and Watson Wyatt Worldwide
predicted 16% and 13.6% premium increases next year, respectively
(Kaiser Daily Health Policy Report, 11/12).
A Growing Employee Burden
As a result of the premium increases, many employers are
looking to increase employee cost-sharing next year, the New York
Times reports. The new survey found that 40% of employers with 500
or more employees—a group whose costs rose 12.1% this year, to
$5,162 per employee—said they would require employees to pay a
greater share of their health expenses next year (New York Times,
12/10).
That increase will follow a year in which the median
”in-network” deductible among preferred provider plans—now the
most popular type of managed care plan—rose from $250 to $500
(Wall Street Journal, 12/10). Seventeen percent of small employers—those with
fewer than 500 employers—required PPO deductibles of
$1,000 or more (Silber, Contra Costa Times, 12/10). The previous
largest median deductible increase in the 16 years the survey has
been conducted was $50, Bos said.
He added that employees can expect to pay an average of 18% more
in premiums in 2002. More employers also said they are looking to
introduce defined contribution plans, in which employees receive a
fixed yearly sum to spend as they wish on their health care, giving
them a greater incentive to seek cheaper alternatives such as
generic drugs and less expensive providers.
In the Mercer survey, 29% of employers with more than 20,000 workers
said they were “somewhat or very likely” to adopt this type of plan
within the next two years (Wall Street Journal, 12/10). The survey
also found that 23% of large employers offered supplemental health
coverage to Medicare-eligible retirees this year, down from 24% last
year and 41% in 1995.
[...]
Around the USA
The following is a quick look at some state- and local-level
coverage of the Mercer survey:
*California: Among large employers in Northern California, health
costs increased 13.5% to $5,480 per employee (Colliver, San Francisco
Chronicle, 12/10).
*Connecticut: Employers expect a 14% increase in costs next year,
slightly higher than the national average (Levick,
Hartford Courant, 12/10).
*New Jersey: The 66 large state employers surveyed by Mercer said
they expected an average 11% premium increase next year (Fitzgerald,
Newark Star-Ledger, 12/10).
*North Carolina: The state’s 13.5% increase in health costs this
year “le[d] a wave of increases across the South that lost the region
its longtime reputation as the nation’s most affordable health care
market” (Fisher, Raleigh News and Observer, 12/10).
*Virginia: Employers reported a 12% rise in health costs this year
(Rayner, Richmond Times-Dispatch, 12/10).
Source: Taken directly from: “Employers Paid 11.2% More in 2001 Than
2000 for Employee Health Benefits, Survey Says,” KAISER DAILY HEALTH
POLICY REPORT, 12/10/01
http://www.kaisernetwork.org/dailyreports/healthpolicy
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NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
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