July 31, 2007
Fighting Your Insurance Company to Stay Alive
From NYTimes.com:
Gordon Hendrickson was sick.
Five years ago, when Mr. Hendrickson was 66, routine blood work found something amiss with his liver. One test led to another, and then to an awful diagnosis: pancreatic cancer, one of the deadliest kinds.
But he was lucky. The cancer was caught early enough that perhaps it could be cured with surgery. He needed a Whipple procedure.
However, there were no experts in his hometown.
Albuquerque’s population was less than half a million, and the entire state of New Mexico had fewer than two million people, not enough to give local surgeons much practice with a relatively uncommon operation.
An experienced surgeon and hospital can significantly increase the odds of survival for people with pancreatic cancer, studies have found. Lower complication rates can also minimize the cost.
Mr. Hendrickson found a cancer center in Houston and an internist he was comfortable with. However his insurance, the Presbyterian Health Plan, refused to cover the procedure in Houston.
Mr. Hendrickson decided that his life was the most important thing so using a credit card to pay the deposit (since he would be having the procedure without insurance) he signed the paperwork and had the surgery.
[The surgery] went well. But he was left with more than $80,000 in medical bills, which Presbyterian Health Plan refused to pay.
Two appeals later and a trip to the state appeals board found Mr. Hendrickson acting as his own lawyer. The insurance company was represented by two lawyers.
Mr. Hendrickson won his case by showing that the five doctors recommened by his insurance company had performed this type of surgery only five times in five years. Presbyterian Health Plan paid the total cost of the surgery.
A spokesman for Presbyterian said the case had led the company to allow more patients to be treated at high-volume centers if there was evidence that the results would be better.
Strange, I thought we knew that going in.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 31, 2007
|
Category: Health Care
July 25, 2007
Got Medicaid? The Doctor Might Not See You
Last week the Wall Street Journal (subscription req'd) published an article explaining how more and more doctors are no longer accepting Medicaid.
Here are a few excerpts:
In a 2006 report from the Center for Studying Health System Change, a nonprofit research group based in Washington, nearly half of all doctors polled said they had stopped accepting or limited the number of new Medicaid patients.
That’s because many Medicaid programs, straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors. That in turn is driving many doctors, particularly specialists, out of the program.
In Michigan, the number of doctors who will see Medicaid patients has fallen from 88% in 1999 to 64% in 2005. Many of those doctors tightly cap how many they’ll see or refuse to take on new Medicaid patients. At the same time, enrollment in the program in Michigan has risen more than 50% to nearly 1.6 million since 1999.
“At this point, I have to pay money out of my own pocket to take care of that [Medicaid] patient, and it’s only going to get worse,” says AppaRao Mukkamala, president of the Michigan State Medical Society and a radiologist in Flint, Mich. There, auto-industry layoffs have helped push one in five people onto Medicaid or into the ranks of the uninsured.
For every chest X-ray Dr. Mukkamala performs, for instance, Medicaid pays him $20. Commercial insurers such as Blue Cross pay about $33 and Medicare pays $30. But with technicians, film and other equipment, his costs are about $29 per X-ray, he estimates. Medicaid patients he sees at Hurley Medical Center in Flint make up 28% of his work there.
Higher costs are forcing state Medicaid programs to cut reimbursement rates. These lower rates force care providers to accept a lower percentage of Medicaid patients. In some cases, the providers move out of the area completely. This leaves Medicaid patients with access to care issues.
In Benton Harbor, more than 300 patients lost access to counseling services after the main provider of Medicaid mental-health services, Riverwood Center, stopped accepting payments from Medicaid HMOs. Riverwood says the reimbursements it was receiving from the Medicaid HMOs for outpatient sessions didn’t cover their costs.
As the city’s middle class dwindled, most doctors, along with the hospital, relocated in the late 1980s and early 1990s across the St. Joseph River to its much more affluent twin, St. Joseph, a picturesque lake-resort town. Most of those doctors are listed in HMO networks but many don’t accept Medicaid patients in their offices. Instead, many spend an afternoon every one or two weeks seeing Medicaid patients at a clinic set up in a building that once housed Benton Harbor’s hospital.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 25, 2007
|
Category: Health Disparities
July 20, 2007
The Young Invincibles
NYMag.com has an excellent feature on the lives of working but uninsured New York twenty-somethings.
One interesting paragraph shows how one individual conceptualizes health insurance in terms of cell phone cost.
Andrew Kuo, a 29-year-old painter, told me he made a vow to be insured by the time he turned 30. “But that was when 30 seemed like a ways away,” he added. “Now I find myself making all these stupid calculations. Like, it would cost me around $3,000 a year to have insurance, right? Okay, isn’t that about what it would cost out of pocket if I broke my wrist? Chances are I’m not going to break my wrist once a year, so why not save the money for that onetime emergency?” Like many I spoke with, Kuo said he’d happily pay for insurance, if only the cost-benefit analysis tilted more in its favor. “What’s ironic is that I would never live without my cell phone, but I won’t consider buying health insurance. It sounds ridiculous to say that out loud, but the fact is insurance is just too expensive. If it was the same price as my phone”—$150 a month sounded reasonable to him—“I’d buy it in a second.”
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 20, 2007
|
Category: Health Care
July 19, 2007
New Strategy for Screening Children for Lead Poisoning
WKYC recently covered a press conference given by Ash Sehgal MD. Dr. Sehgal is the Co-Medical Director Physician of the Cleveland Department of Public Health as well as Director of the Center for Reducing Health Disparities.
You can view of video of the WKYC report here. (Note - will open in Windows Media Player.)
Additional background on the issue of lead can be found in this Free Times article.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 19, 2007
|
Category: Health Care
July 18, 2007
Quality and Disparity in Care Across States
JAMA has a short article about a recent Commonwealth Fund report. (Note: pdf file)
From JAMA:
Many factors likely contribute to health disparities, some within the health care delivery system, some (such as educational status and health behaviors) outside the system (Lurie N and Dubowitz T. JAMA. 2007;297[10]:1118-1120). The report, released on June 13 by the Commonwealth Fund, a private foundation that supports independent research on health care issues, features a scorecard ranking states on 32 indicators of health care access, quality, potentially avoidable use of hospitals and costs of care, equity, and the ability to live long and healthy lives.
The authors estimated that if all states could do as well as the top-performing states, there would be 90 000 fewer deaths before age 75 years annually, 22 million currently uninsured adults and children would have health insurance coverage, and Medicare could save at least $22 billion per year.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 18, 2007
|
Category: Health Disparities
July 17, 2007
Race in a Bottle
ScientificAmerican.com has a new article about race specific medicine.
The entire article is well worth the read. Here are a few excerpts:
BiDil was also hailed as a means to improve the health of African-Americans, a community woefully underserved by the U.S. medical establishment. Organizations such as the Association of Black Cardiologists and the Congressional Black Caucus strongly supported the drug’s approval.
A close inspection of BiDil’s history, however, shows that the drug is ethnic in name only. First, BiDil is not a new medicine—it is merely a combination into a single pill of two generic drugs, hydralazine and isosorbide dinitrate, both of which have been used for more than a decade to treat heart failure in people of all races.
After the FDA’s rejection of BiDil, Cohn went back to the V-HeFT results from the 1980s and broke down the data by race, examining how well African-Americans had responded to the competing treatments. Such retrospective “data dredging” can yield useful insights for further investigations, but it is also fraught with statistical peril; if the number of research subjects in each category is too small, the results for the subgroups may be meaningless. Cohn argued that H/I worked particularly well in the African-Americans enrolled in the V-HeFT studies. The clearest support for this claim came from V-HeFT I, which placed only 49 African-Americans on H/I—a tiny number considering that new drug trials typically enroll thousands of subjects. In 1999 Cohn published a paper in the Journal of Cardiac Failure on this hypothesized racial difference and filed a new patent application. This second patent was almost identical to the first except for specifying the use of H/I to treat heart failure in black patients. Issued in 2000, the new patent lasts until 2020, 13 years after the original patent was set to expire. Thus was BiDil reinvented as an ethnic drug.
Researchers using race to develop drugs may be motivated by good intentions, but such efforts are also driven by the dictates of an increasingly competitive medical marketplace. The example of BiDil indicates that researchers and regulators alike have not fully appreciated that race is a powerful and volatile category. When used to bolster the commercial value of a drug, it can lead to haphazard regulation, substandard medical treatment and other unfortunate unintended consequences. The FDA should not grant race-specific approvals without clear and convincing evidence of a genetic or biological basis for any observed racial differences in safety or efficacy. Approving more drugs such as BiDil will not alleviate the very serious health disparities between races in the U.S. We need social and political will, not mislabeled medicines, to redress that injustice.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 17, 2007
|
Category: Health Care
July 09, 2007
Mental Health Not Guaranteed with Insurance
[Debi] Evans has worked in the industry since 1991.
Back then, "if a woman came in and said 'I'm thinking of killing myself,' I would admit her to the hospital, then I'd call and get insurance company approval."
Now, Evans said, she has to convince the insurance company first.
Full story at HamptonRoads.com/PilotOnline.com.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 09, 2007
|
Category: Health Disparities
July 05, 2007
Phosphorus and the Accuracy of Nutrient Databases
Research Dietitian Cathy Sullivan, MS, RD, LD, had a paper accepted for publication in an upcoming issue of the Journal of Renal Nutrition.
The paper, Phosphorus containing food Additives and the accuracy of nutrient databases, was accepted as-is.
Continue reading below for the abstract.
Phosphorus containing food Additives and the accuracy of nutrient databases: implications for DIALYSIS patients
Abstract
Objective: Phosphorus containing additives are increasingly added to food products. We sought to determine the potential impact of these additives. We focused on chicken products as an example.
Methods: We purchased a variety of chicken products, prepared them according to package directions, and performed laboratory analyses to determine their actual phosphorus content. We used ESHA Food Processor SQL Software to determine the expected phosphorus content of each product.
Results: Of 38 chicken products, 35 (92%) had phosphorus containing additives listed among their ingredients. For every category of chicken products containing additives, the actual phosphorus content was greater than the content expected from nutrient database. For example, actual phosphorus content exceeded expected phosphorus content by an average of 84 mg/100g for breaded breast strips. There was also a great deal of variation within each category. For example, the difference between actual and expected phosphorus content ranged from 59 to 165 mg/100g for breast patties. Two 100 g servings of additive containing products contain an average of 440 mg of phosphorus, or about half the total daily recommended intake for dialysis patients.
Conclusion: Phosphorus containing additives significantly increase the amount of phosphorus in chicken products. Available nutrient databases do not reflect this higher phosphorus content, and the variation between similar products makes it impossible for patients and dietitians to accurately estimate phosphorus content. We recommend that dialysis patients limit their intake of additive containing products and that the phosphorus content of food products be included on nutrition facts labels.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 05, 2007
|
Category: Nutrition
Rich Countries Should Care about the World's Least Healthy
Lawrence O. Gostin, JD, writing in JAMA.
It is well known that the poor experience extreme hardship, certainly much more than the rich. Unfortunately, this is also true with respect to global health. What is less often known is the degree to which the poor unnecessarily have increased morbidity and mortality. The global burden of disease is shouldered by the poor disproportionately, such that health disparities across continents render a person's likelihood of survival drastically different based on where he or she is born. These inequalities have become so extreme and the resultant effects on the poor so dire that health disparities have become a defining issue of modern society.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 05, 2007
|
Category: Health Disparities
Who Lives Better?
Timothy Egan writing in the New York Times. (subscription required)
With Independence Day just passed, a good nationalist shouldn’t be afraid to answer those questions. So, who lives better, us or them?
In Italy, this was a regular parlor game when friends came to visit. Inevitably, after a few days of taking in our new world — a village public school for the kids, neighbors who opened the doors of their ancient homes to us, a lengthy siesta every afternoon — our houseguests would side with the Italians. I would counter for the U.S.A., to keep the argument alive.
The Italians won on health, family and food. The United States was better on race and opportunity.
If you don't have full access to the Times, a web search might help you locate the full text.
Send news items related to health disparities to ReduceDisparity(AT)case.edu
Posted by: David Porter on July 05, 2007
|
Category: Health Disparities