June 2008

You are currently browsing the monthly archive for June 2008.

Medicare more likely to deny claims than commerical health insurers

June 30, 2008 in Health Insurance, Medicaid/Medicare | 11 comments

According to an article on TheHill.com, Medicare denies more claims than commercial insurers.

“Medicare was the most likely to deny any part of a claim, with a 6.9 percent rate. Aetna was a close second at 6.8 percent while the others ranged from 2.7 percent to 4.6 percent.

Coventry Health had the fastest median turnaround between receiving a claim and responding, at four days, according to the AMA. Medicare and CIGNA took a median 14 days; Humana and Aetna, 13 days; Health Net, 11; United Healthcare, 10 and Anthem, seven.”

Why is this? It could be the case that commercial health insurers have more efficient claims processing centers. While economists generally believe that the private sector is more efficient, in the case of health insurance claims firms make more money when they deny more claims. Thus, I am not sure that the profit motive is leading to more private-sector claims approvals.

Competition between insurers may increase claims approvals. Most physicians and hospitals must take Medicare because it represents so large a share of the helathcare spending. On the other hand, physicians may only accept patients whose insurance companies have prompt payment with fewer denials. This leads to some incentive for insurance companies to decrease claims denials.

Another reason for the differential claims denial rates is the demographics of Medicare and commercial insurance enrollees. Almost all Medicare enrollees are over 65, while commercial insurers have enrollees who are of varying ages. Since older individuals are more likely to demand high cost medical procedures, if high cost medical procedures are the ones that are more likely to be denied then Medicare’s higher denial rate may simply be due to the composition of its enrollees.

Whatever the reason, the fact that Medicare denies more claims than commercial insurers should dispel the myth that the government is simply a benevolent entity, while commercial insurers are ruthless, profit-hungry wolves. The truth–as always–lies not in the black nor the white but in the gray.

Tags: , , ,

NHS Constitution

June 29, 2008 in Current Events, International Health Care Systems | Permalink

The Telegraph reports that Britain’s National Health Service (NHS) has enacted a constitution.  “[The constitution] will set out the rights and responsibilities for patients and what they can expect from the NHS in the 21st century.  It is being seen by ministers as a chance to reiterate the founding principles of the health service, emphasising that care should be universal, free at the point of access and based on clinical need, not ability to pay.”

The document includes a list of patient responsibilities which includes keeping appointments and treating minor ailments at home.  The question is, what will happen if a person does not keep an appointment?  Will there be a charge?  Sometimes missing an appointment may mean the patient is irresponsible, while other times there may be a family emergency or a child who needs to be picked up from school.  There is no sense of responsibility unless there is some reprocussion to missing an appointment.

Will the constitution significantly change how health care is provided in the UK?  I doubt it.  The constitution does not explicitly determine what services, drugs, operations and treatments the NHS will provide.  Thus, if the NHS does not provide a given service to a patient, the patient will still not have legal remedy. If the NHS Constitution is simply a wish list of how health care within the NHS should look, it may serve as a motivating mission statement for employees and politicains.

The document will only be powerful if a patient can receive a remedy when their rights are violated.  For instance, if there is a long wait for services, will the NHS pay for treatment overseas?  The consitution allows patients the right to register with a GP, but will this be a true choice or will there be a long wait to register with all the best GPs?

In 1991, John Major instituted the Patient’s Charter which also set out a number of rights entitled to NHS patients, however the Patient’s Charter was ineffective since it had no power.

NHS Blog Doctor write about how the NHS Constitution creates an illusion of choice.

Tags: ,

Sight-saving Charity

June 29, 2008 in Health Care in Developing Nations | Permalink

An estimated 1.6% of Ethiopia’s the population is blind, with approximately 12% of this blindness caused by trachoma.  Trachoma is a highly infectious disease; it is spread through contact with an infected person’s hands or clothing, or by flies that have come in contact with the discharge from an infected eye or nose.  One good piece of news is that trachoma is entirely preventable.

ORBIS International has been working to try to save the sight of many of those who are suffering from eyes diseases such as trachoma.

For more information on ORBIS, see:

Tags: ,

Vacation!

June 14, 2008 in Miscellaneous | Permalink

I will be in Thailand with my lovely fiancée for the next 2 weeks.  Posting will resume June 30th.

Tags: ,

Is Obesity a Problem?

June 14, 2008 in Obesity | 5 comments

There is much evidence that has shown that over time for most developed countries, people have been getting fatter. Obesity rates are especially high in the U.S., but a trend towards increased obesity is similar in most developed countries. Are obesity rates “too high?”

In a recent NBER working paper, Philipson and Posner argue that obesity rates may be too high if one’s goal is to maximize health. However, the authors wisely note that:

“From an economic standpoint, the proper maximand is of course not health but utility, in which good health is only one argument. Rational persons constantly trade off health for competing goods, such as pleasure, income, time, and alternative consumption possibilities. Intervention that considers such tradeoffs unworthy of consideration is paternalistic. This is recognized in such areas as highway safety—no one proposes to shut down highways in order to reduce traffic deaths, or to force automobile manufacturers to equip their cars with engines that limit top speed to 25 miles per hour—but the principle that legitimizes trade-offs involving life and health is equally applicable to obesity.”

One argument in favor of trying to reduce obesity is that obese individuals have higher annual medical expenses. With the public–through Medicare and Medicaid–footing much of this bill, maybe the government should enact policies to reduce these “insurance externalities.” Philipson and Posner respond by stating that these insurance externalities

“…are an argument for experience-rating health insurance, so that groups with above-average expected medical expenses pay higher insurance premiums…There is no reason to single out obesity as a basis for higher insurance costs, since there are other, equally or more, risky “life style” choices that increase expected medical costs.”

Tags:

High Quality Hospitals Near You

June 13, 2008 in Current Events | Permalink

Which hospitals in your areas are considered high quality hospitals?  The NetDoc.com website integrates hospital ratings metrics and Google Maps in a very user friendly way.  Here is a sample for the San Diego.

Hat tip to the HealthCare Management Blog.  The blog also has an interesting post on physician rankings.

Aviodable Mortality in 3 world cities: London vs. New York vs. Paris

June 13, 2008 in International Health Care Systems | Permalink

A recent paper by Wesiz et al. (Eur J Pub Health 2008) attempts to compare mortality rates and avoidable mortality rates in the urban core of 3 world cities: London (Inner London); New York (Manhattan) and Paris. Mortality

The authors find that Paris has the lowest mortality rates and New York has the highest mortality rates with London in between.

Avoidable Mortality

Avoidable mortality is death from diseases such as tuberculosis, septicemia, hypertension, influenza, peptic ulcer, appendicitis, etc. Paris also has the lowest avoidable mortality rates while London has the highest and New York in between. The authors also find that the difference between Paris and New York is higher when measuring avoidable mortality than total mortality. Avoidable mortality rates are higher within poor areas of each city.

Interpretation

The authors interpret these findings as avoidable mortality is due to a lack of access to care, especially for the poor. Government provided health insurance is far less prevalent in the U.S. than in the other countries so this access to care in the U.S. may be lower than in other countries. However, it could also be the case the physician practices are better in Paris than in the New York or London. Further, Great Britain also has a national health insurance system yet avoidable mortality is higher in London than in New York. It is possible that the frequency with which the population visits a doctor is culturally different in the three cities in a way that is unrelated to insurance coverage. Thus, while Paris should be celebrated for having the lowest avoidable mortality rate, the cause of their success is unclear from this study and what steps New York or London could take to decrease avoidable mortality are also unclear.

Tags: , , , , ,

Kaiser Fast Facts

June 12, 2008 in HC Statistics | Permalink

The Kaiser Fast Facts website is a useful tool for any health researchers who need basic statistical information regarding medical care in the U.S.  The numerous slides filled with information-filled charts and graphs.

Tags: ,

Few Dentists are accepting Medicaid

June 12, 2008 in Medicaid/Medicare, Supply of Medical Services | Permalink

According to a report by the The Colorado Health Institute, 68 percent of rural and 74 percent of urban dentists do not accept Medicaid patients.  Even for those dentists who do accept Medicaid, many are not accepting new Medicaid patients.  The full report is available here.

Tags: ,

The Health Wonk Review is up

June 12, 2008 in Carnivals | Permalink

The latest edition of the Health Wonk Review has been posted at the Health Affairs Blog.  This edition of the HWR focuses on the healthcare reform, and mentions the annual research meeting of AcademyHealth, of which I am a member.

Tags:

« Older entries