Jun
20
AMA hands out health insurance report cards.
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The Health Insurance Industry Convention is currently well underway in San Francisco this week and even though its only been one day record numbers of protesters are showing up to rally against the current healthcare system in the USA. This is occurring in the same week as the American Medical Association released its health insurance report card to individual insurers. All in all, it’s been a difficult week for American insurance companies.
Among the insurers rated by the report are companies like Aetna, Anthem BCBS, CIGNA, Coventry, Health Net, Humana, United Healthcare (UHC), and Medicare; and while the report has no ‘grades’ per-se, it does reveal some interesting facts about some of the country’s top insurance providers. The major focus of the report is with relation to how quickly doctors are receiving payment form insurers for services rendered to policyholders and the consensus is that most insurers are too slow.
According to some AMA members physicians are spending approximately 14% of their annual income simply to receive payment from insurance companies. And in the current economic climate, this is simply an issue that will not stand with the AMA. Paying out claims is a key issue, and failure to complete payments in a timely and efficient manner is resulting in a large amount of unrest among primary caregivers.
According to the AMA the worst offender when it comes to paying claims at the contracted rate is United Healthcare (UHC), with only 62% of all claims being paid, while Medicare was the best with a 98% completion record. While some insurers are able to follow through on Doctors payments with limited hassle many insurance companies are simply dropping the ball.
This is leading to a number of Doctors starting ‘boutique’ medical clinics in an effort to remove themselves from the world of insurance. With boutique clinics patients will typically pay a monthly, or annual, retainer under which they are entitled to 24/7 access to their caregiver. In addition to this Boutique medical practices are focusing on a more personalized form of medicine by only working with a limited number of patients, something which is paying off as many people in the
There is a problem though, Boutique practices, due to the level of attention and care provided are only accessible by patients who are relatively wealthy, meaning that the majority of the American population is unable to use these services, which brings us back to the insurance companies. As mentioned previously, the Health Insurance Industry Convention has been rocked by large numbers of protesters clamoring for a single payer healthcare system. Single payer healthcare was supported by a number of politicians running in the presidential primary elections, most notably Senator Hillary Clinton, however with John McCain and Barrack Obama sealing their relative party nominations this proposal has a very limited chance of being established.
With the presidential election coming up in November the issue of healthcare is becoming ever more important to the American Public. With a number of proposals being floated to address the current problems in the system it is clear that there will have to be a fairly radical reassessment of healthcare in the
With a number of insurers failing to meet their requirements towards primary healthcare providers it is clear that something must be done to address the system. When the domestic insurer who has the best record in settling claims is the one that is administered by the government then maybe it is worth looking at initiatives that would see the government prop up the local market. All that remains clear at the moment is that this crisis of care will not end anytime soon and that everyone in the American healthcare industry needs to be looking at viable options for the future. Whether this is in regards to improved claims handling, better insurance policy coverage, subsidies for prescribed medicines, or simply looking to lower the cost of healthcare, something must be done, otherwise there may not be the standard of quality healthcare that exists in the
Jun
12
Underinsurance; A catastrophe in the making
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We’ve talked quite a bit about the worrying amount of uninsured individuals in the
But what’s the issue? Many commentators will say that these underinsured individuals, while not being comprehensively covered by an insurance policy, still have some protection, and due to their above average incomes will be able to contribute towards the cost of any medical treatment that they receive with very little trouble. This may have been true 20 odd years ago, but in the modern world this could be considered slightly delusional.
With the levels medical inflation during the 1990’s and early 21st century, specifically in the
Now an onlooker may say, sure – but that’s individuals with no insurance – people who have insurance should be able to afford this coverage. And they would be right; to a point. The study defined underinsurance as anyone who has an annual health insurance but still contributes 10% of annual income towards medical costs, and whose deductibles were equal to a further 5% of their annual income. Low income individuals who spent 5% of their income on health insurance or deductibles also qualified for this bracket.
Think about that for a second, in the midst of a global credit crisis and worsening economic fortunes for the average American citizen, many of these individuals are spending between 10 and 15 % of their total annual income on healthcare, and for many of these people this is without having ever seen a doctor! Compound the actual deductibles and co-pays on top of this and the situation starts to look extremely grim indeed.
With medical inflation reaching levels never seen before many domestic insurance companies are scaling back coverage, without also scaling back premiums. This is understandable, however it leaves the average policyholder woefully unprotected. International insurance companies are realizing, however, that increased coverage is most definitely needed as the costs continue to rise. A great example of this would be seen with IHI Danmark’s travel insurance; over the last year IHI saw the increased need that travelers have for comprehensive protection and raised the overall maximum benefit of the policy to ‘Unlimited’. This means that under the new IHI travel policy there is no coverage limit, and this move has seen the company increase the number of policyholders obtaining these short term travel medical insurance policies.
Now obviously the above example would only work for individuals who are planning on being outside of their home country for a period of time, but the idea is clear. In a time when domestic health insurance companies in the
The point is this, increasing premiums and healthcare costs in conjunction with lowered coverage is leading to more and more Americans finding themselves in a position where they are simply unable to access, or afford, the healthcare that they need. With a 60% increase in the number of underinsured Americans in the last 4 years, and the total number of Americans who are either uninsured or underinsured at 75,000,000, its not hard to see how this situation will worsen in the years to come.
May
16
Private v.s. Public Healthcare: The UK Question
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The
While the National Health Service still has the biggest share of the healthcare services in
This comes as the British government is considering tax reforms that would see young British workers contribute to a new social security initiative benefiting the nation’s elderly. Following on from this comes the fact that a growing number of young professionals in the
So what’s going on?
Younger people in the
According to the Association of British Insurers (ABI) more companies than ever before are taking out private medical insurance in a bid to offer competitive benefits packages to prospective employees, and if the national service was all that it is cracked up to be, then this would not be a serious issue.
However, the fact that BUPA, the
In addition to the NHS’ bureaucracy there is a serious lack in qualified medical professionals, such as nurses, large amounts of overcrowding, poorly maintained treatment facilities and a virtual mountain to climb for treatment access. Is it any wonder that more and more individuals are choosing to go private over this public behemoth? And the situation won’t improve for the NHS, especially if a proposed imitative to give tax credit to organizations that provide private medical coverage to their employees goes through; a proposal remarkably similar to one made by Representative Ron Paul in the
And all of this comes at the same time as politicians on the other side of the
There are no hard and fast answers when considering health. However the trends in recent years, especially in countries like the
May
5
Health Care Troubles for the Insured?
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According to a recent New York Times article, America has an estimated 48 million uninsured citizens and this number may soon increase due to the economic downturn being felt across the country right now. Not only is this downturn pushing people out of being insured, but it is also dramatically affecting the insured population.
An increasing reality for many of the 158 million citizens that are insured through their employers is that medical costs are becoming unaffordable. Rising prices for food and gasoline are making many Americans think twice about their spending on health care. From another perspective, rising insurance premiums, narrower coverage, and bigger deductible and co-pay requirements are pushing health care prices through the roof. It follows that many insured Americans are not financially prepared for the costs of emergency room visits and necessary surgeries. They are choosing to pay for food and gasoline over necessary doctor visits.
According to consulting and accounting firm Deloitte, nearly one fifth of the average household’s spending goes to health care. Since 2001, health care premiums for families have risen to $3,300 from $1,800 while incomes have not increased enough to cover this change. Another survey by Deloitte points out that less than 10% of American feel they are financially prepared for their future health care needs.
Employers are also feeling the effects of a soft economy. Expenses for health care are skyrocketing and as a result, many employers are passing on these increased costs to their employees. Many have begun pushing for consumer-driven plans where lower premiums come in the form of higher annual deductibles. According to the New York Times article, nearly 6 million Americans are now enrolled in such plans.
With Presidential Elections coming later this year, it should be very interesting to see what remedies each candidate puts for and how the nation responds.
Apr
22
USA healthcare system under serious pressure
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Its no secret that the American healthcare system has some serious issues, from massive underinsurance to high treatment costs, the general outlook is pretty grim, which is why the issue has been a key point in the presidential election race. However, despite the rosy promises from the 3 main candidates the problems are about to get a whole lot worse. The issue is this, 78 million baby boomers (individuals who were born between 1946 and 1964) across the USA are about to reach retirement age and are entering a geriatric healthcare system that is simply not prepared for the patient load that it is about to receive.
As individuals age their propensity for developing a serious illness or chronic condition rise enormously, it is a simple truth that older people need more medical care than younger individuals. With this being common knowledge one would assume that the healthcare system would have adequately prepared for this eventuality, yet the reverse is true; doctors, medical facilities, and most importantly the domestic insurance industry, do not have access to the services required by geriatric patients.
An example of this upcoming fiasco can clearly be seen in
Add to this, already grim scenario, the shortfall in social security, the limited coverage offered by Medicare, and future budget cuts (expected to begin in July of this year), and essentially you are left with a healthcare system that is leaving a large proportion of Americans without the coverage, or treatment, that they deserve, but it doesn’t end there. As the healthcare system struggles to address the problem with the baby boomers other parts of the population will have services denied to them.
So what are the options? How can the system possibly cope with a patient load of this magnitude that will require constant care and attention without suffering? A good start would probably be to totally re-examine the system as it exists today. With millions of individuals either underinsured or with no insurance coverage whatsoever, the highest costs associated with medical treatment in the world, doctors with insufficient training, a high patient to doctor ratio, and a patient load that will increase every year, especially with regards to care intensive conditions (approximately 18% of the baby boomer population, or 14 million people, are expected to develop Alzheimer’s in their lifetime), it is difficult to see what can be done to resolve the matter of a system that is unable to cope with the burdens required of it.
One of the proposed solutions in to create a universal healthcare system that would be heavily subsidized by the government, however with the myriad of problems that currently exist in the system (namely healthcare in the USA being incredibly over burdened already) a universal healthcare service would be incredibly hard to implement. Add to this the wide ranging medical budget cuts, and it becomes evident that there is simply no room to create a national healthcare service providing low-cost, available care, despite the fact that this is tremendously appealing to the American public.
One, potentially, workable idea would be to subsidize the primary physicians as on of the major factors contributing to this situation arising is the extremely poor pay that frontline medical staff receive (half of the medical professionals providing care for the elderly receive less than US$ 9.56 an hour). If this is not workable, then perhaps low cost training could be used as an incentive to bring more qualified professionals to the field, as the training and qualification structure exists right now many doctors and nurses have to undergo extensive testing and, in some states, more than 150 hours on the job practice in order to be considered ‘geriatric qualified’; that’s a lot to ask for such poor reimbursement.
However, when looking at the reasons for this crisis and how it developed, a large amount of the blame seems to lay with Medicare, Medicaid, and the rest of the low-cost, ‘budget’, government backed insurers. By not providing quality coverage, creating absurdly low limits, and placing long lists of exclusions on many policies, these organizations don’t seem to have the interests of their policyholders, or the American public, at heart. Many elderly patients require care from a team, rather than just one medical professional, yet this extremely valuable service is not an included benefit under a Medicare plan, depriving these older policyholders the treatment that they need.
There is no easy or quick fix for the present medical nightmare that is about to hit the USA, all the proposed solutions, and even the possible solutions, will require a large amount of money and a complete shift in the way that Americans obtain their healthcare. All that can be done now is to wait for the major problems to start and address them as they happen, that or purchase an insurance policy from a company not linked to the US government.
