Health Care and Missing Benefits

Did you know that a significant number of small businesses don't offer health coverage to employees? Where you aware that about a very large percentage of companies in the U.S. have no health benefit offer for their workers? And, according to AISHealth.com, only 71% of large employers offer retiree health benefits; plus, only a few current US workers will ever become eligible for retiree health benefits according to NewsObserver.com. AISHealth also recently reported that a surprising 72% of Mississippi employers with less than 50 workers--one of the poorest states in the country--have no coverage for employees. The Center for Mississippi Health Policy has released this statistic from a recent survey of companies in that state.

Many small to mid-size employers are limiting their benefit offers to health insurance only, while others are dropping benefits altogether. Rising Healthcare costs – outstripping the ability of many workers and employers to afford health insurance premiums – have been the major cause of a long-term decline in job-based coverage according to a study released by the UCLA Center for Health Policy Research. So, the average American worker in a small company is faced with making some serious choices related to health care. Going solo with no way to pay for medical treatment is a very scary option, especially if there is no catastrophic care coverage. With no cap on expenses, one trip to the hospital could force most families into personal bankruptcy.

More and more middle- and low-income workers are being priced out of job-based health coverage each year because they can’t afford their share of the cost. In addition to that,
only 41% of Hispanics have job-based insurance according to La Raza. Historically, ethnic groups have a lower average of benefits than white employees. Many employers with small businesses holding less than 50 workers have a difficult time paying for health benefits, and often those who are on the low end of the income scale suffer the most with no insurance. According to a report by the Employee Benefit Research Institute in March, 2008, only 71% of all workers have a health plan that is employment based, and access to health insurance varies by company size.

The EBRI also reported that of the 20.5 million employees who have no insurance, about 50% of them are either working for a company with 25 or less employees or are self-employed. And, companies with 9 or less workers show that about a third of them have no health insurance. The contrast against companies with over 500 employees shows that only 10% of these workers go without a health plan sponsored by the employer. Their report was based on information supplied by the Census Bureau Current Population Survey.

Additionally, the Consumer Health Coalition (a non-profit organization that helps uninsured Americans get benefits) stated in February, 2008, that employees working for small businesses are less likely to have health coverage. When large companies negotiate with insurance companies, they have significant negotiating power because they have more employees to offer. A larger group of workers means better rates and richer benefits for a lower cost to the employer based on economies of scale. Conversely, many small companies often cannot afford health insurance as a benefit. A crisis currently exists in America with small businesses as indicated by reports from all over the country. Station WPXI in Pittsburgh is one more source reporting recently on the issue of uninsured workers. Insurance rates are based on the number of employees a company has, and many small businesses run into problems with a smaller risk pool and higher premiums.

One way to help out small businesses would be to set up guidelines limiting rate increases. Insurance commissioners in each state would need to approve the request to raise costs for a health plan by insurance companies before the rates were increased. Some states have rules in place to accommodate for these requests, but some do not. Surprisingly, the Pennsylvania insurance commissioner has limited power to regulate health insurance rates based on feedback from the Consumer Health Coalition. Also, discrimination based on pre-existing conditions or utilization should be prevented. Although these issues should be factored into the decision by the insurance company as part of the rate increases, they should not be the sole determining factors to raise the cost of a health plan.

On a federal level, the call for universal health care continues to be trumpeted by many politicians and other proponents who wish to nationalize the insurance and health care industries. Those who wish to have a national insurance czar who would oversee how every American would access medical providers are beating the drum loudly on this issue. However, it is a pretty scary thought to consider having the government dictate what doctor to see and when you can go for treatment. Although there are millions of uninsured people living in the U.S., there are options available that provide access to the health care system that are now in place without having to totally re-invent the health care wheel. The market place can adjust to provisions made in both the private and public sectors that will help anyone who needs access to treatment. Before sliding down the slippery slope of government controlled health insurance, the players in the American health care industry need to work toward better solutions.

Until next time. Let me know what you think.

Health Care and Transparency

Do you like a bargain? Almost everyone does. How can you tell when you are getting a good deal? Does price matter? What about quality and service? Where do you go to get the best bang for your buck? These questions and more are what all Americans want answered when they make a purchase, and this is especially true for health care and insurance. Transparency in health care is a not a new concept; but it is a new practice that has only recently attracted the attention of the healthcare marketplace, government, and consumers.

More and more health care providers and companies are reporting what medical treatments cost. More and more insurance companies are giving out information about how their plans work and how to compare their plan to another plan offered by another company. Many health care providers are providing information online to patients about what actual costs are for procedures.

Transparency is one of the new health care buzzwords that has long been needed in the industry. In order for consumers to find out if they are getting what they are paying for, more information is required to make informed decisions. Often, this feedback is not made available unless the patient or customer continually persists in asking for the answers. "Every American should have access to a full range of information about the quality and cost of their health care options," as expressed recently by HHS Secretary Mike Leavitt. The Health and Human Services government website states "Consumers deserve to know the quality and cost of their health care. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value. Providing reliable cost and quality information empowers consumer choice. Consumer choice creates incentives at all levels, and motivates the entire system to provide better care for less money. Improvements will come as providers can see how their practice compares to others."

When consumers have this information they can make decisions that are more informed and are better for them. Consumers should share in the savings. That can take shape in the form of lower premiums and more effective care. Americans can win at the health care game when they take an active role in health care decisions. According to USA Today, growing amounts of information on hospital performance are a mouse-click away, thanks to the Internet's limitless capacity and a bold consensus that transparency serves hospitals and consumers.

Transparency is a broad-scale initiative enabling consumers to compare the quality and price of health care services, so they can make informed choices among doctors and hospitals. In cooperation with America's largest employers and the medical profession, this initiative is laying the foundation for pooling and analyzing information about procedures, hospitals and physician services. When this data foundation is in place, regional health information alliances will turn the raw data into useful information for consumers. USAToday also reports that although not everyone is releasing the same amount of information, the movement toward transparency is spreading quickly through the USA. Among the leaders: the federal government, a handful of states, leading hospitals and such groups as the Hospital Quality Alliance and National Quality forum, two membership organizations working with the federal government to set national standards for performance measurement and reporting.

The Federal Government has outlined 4 key steps to accomplish transparency in health care:

1.) The federal government, individual private employers and health plans commit to sharing information on price and quality in health care. Together, the government and major employers provide health care coverage for some 70 percent of Americans.

2.) The federal government and individual private employers commit to quality and price standards developed with the medical community. This will help guarantee a fair and accurate view of the quality of care delivered by individual providers, as well as providing consistent measures for quality.

3.) The federal government and individual private employers commit to standards for health information technology (IT). Health IT will be important for gathering and using the best information for consumers. These standards are also crucial to the goal of achieving electronic health records for all Americans.

4.) The federal government and individual private employers commit to offering plans that reward consumers who exercise choice based on high quality of care and competitive price for health care services.

According to the Commonwealth Fund, transparency and better public information on cost and quality are essential for three reasons: 1) to help providers improve by benchmarking their performance against others; 2) to encourage private insurers and public programs to reward quality and efficiency; and 3) to help patients make informed choices about their care. Also, transparency is also important to level the playing field. The widespread practice of charging patients different prices for the same care is inherently inequitable, especially when the uninsured are charged more than other patients.

Americans want more detailed information and deserve more accurate information for health care choices. The Commonwealth Fund proposes more sweeping action to help consumers find the answers they need. Health care decisions are often made under emergency conditions and emotional stress. Both the insurance industry and the health care delivery sector are highly concentrated, and often patients are left with few genuine choices. Americans currently are missing all the conditions required for perfectly competitive markets do not exist in health care. As the Heritage Foundation reports, America has the greatest health care in the world. We have the best hospitals, doctors, and researchers. We lead in the development of new medicines, devic­es, and procedures. Our health care companies have the freedom to compete.

But as good as our health care system is, it can be even better. A more transpar­ent market can allow Americans to get better quality care, with fewer errors, for a lower cost. As the Heritage Foundation has indicated, President Bush signed an executive order to aid in health care transparency. The executive order directs federal agencies that administer or sponsor federal health insurance programs to:
Encourage adoption of interoperable health information technology standards,
Increase transparency in quality,
Increase transparency in pricing, and
Provide options that promote quality and effi­ciency in health care.

So here we are, three months into 2008 and staring at the second quarter squarely in the face. All the recommendations are great, but we need progressive action on the part of all players--private insurance, medical and health providers, business leaders, consumers, and the government. Everyone should take an active role to help Americans find out how much health care really costs so we can make a great system even better--more cost effective and more efficient for the patient and for the medical community. Everybody wins.

Until next time. Let me know what you think.

Health Care and Mental Wellness

Political correctness is on everyone's mind these days. We over emphasize the need to not offend anyone based on race, religion, gender, and a host of other reasons. We never wish to make fun of anyone related to appearance or behavior, and to be socially bereft of feelings will make you an outcast quicker than a snowball's chance of survival in summer. But have you ever been called "crazy" or "nuts" or "insane" even in jest? However, there are plenty of people that truly are. And what about those news stories we hear about when someone has "gone postal?" Yet, in most cases, we should try to keep our feelings to ourselves when confronted by someone who truly is "looney tunes;" and instead, we should try to help them if at all possible.

Most of us try to avoid unpleasant situations when we meet somebody who is not normal by our accepted social standards. We feel awkward when we are exposed to someone with abnormal mental capabilities. Our personal radar is set off when we are around anyone who acts out of the ordinary when we are in a public setting such as a store, sporting event, restaurant or other place where crowds are gathered. We feel that there may be security or safety issues that could cause us personal harm or injury, or worse. Most of us are not sure how to handle one of these scenarios and become extremely uncomfortable when approached by someone who is "off his rocker". We have a "fight or flight" mechanism that kicks in automatically, and most of us want to choose the flight option.

Unless someone is a trained professional in the healthcare industry or is active in a security position such as police, armed guard, or military, it is unwise to attempt resolution of a situation where a mentally unstable person is making a scene. The best option is to remove yourself from the area as quickly as possible and inform someone immediately about addressing the issue. Personnel who are educated and prepared to address this type of mental health problem are best suited to help out with someone in a stressful state. Many times, the person who is causing the scene may be unaware of their actions due to a heightened state of mental anxiety exacerbated by any number of reasons.

Data gathered in the Global Burden of Disease study (conducted by the World Health Organization, the World Bank, and Harvard University) revealed that mental illness, including suicide, ranks second in the burden of disease in established market economies, such as the United States. Nearly two-thirds of all people with diagnosable mental disorders do not seek treatment according to a report issued by the Surgeon General. The World Health Organization report also stated that in developed countries, the ten leading causes of lost years of healthy life at ages 15-44 were: (1) Major Depressive Disorder, (2) Alcohol Use, (3) Road Traffic Accidents, (4) Schizophrenia, (5) Self-Inflicted Injuries, (6) Bipolar Disorder, (7) Drug Use, (8) Obsessive-Compulsive Disorders, (9) Osteoarthritis, (10) Violence.

It is pretty obvious that mental health is a major concern on a global basis. About 877,000 people die every year from suicide per their statistics. Hundreds of millions of people worldwide are affected by mental, behavioural, neurological and substance use disorders. For example, estimates made by WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from epilepsy and 24 million from Alzheimer and other dementias.

The World Health Organization also has a huge amount of data on file addressing mental health issues. One in four patients visiting a health service has at least one mental, neurological or behavioural disorder but most of these disorders are neither diagnosed nor treated. Mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Untreated, they bring about unhealthy behaviour, non-compliance with prescribed medical regimens, diminished immune functioning, and poor prognosis. Cost-effective treatments exist for most disorders and, if correctly applied, could enable most of those affected to become functioning members of society. Barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services. Policy makers, insurance companies, health and labor policies, and the public at large – all discriminate between physical and mental problems.

Many people try to control their mental instability by using medications. Unfortunately, when someone taking a controlled substance for mental health reasons goes off prescriptions, there can be serious repercussions. Now, it can take several weeks for patients and psychiatrists to figure out if an antidepressant is working properly. According to information released online by HealthDay News, only about 30 percent of depression patients will respond to a specific drug. Also, according to USAToday, there is no one size fits all method for treating depression. Exercise will work wonders for some, while not positively affecting the moods of others.

The USAToday article also reported this month that a person’s genetic makeup undoubtedly plays a role in what types of therapies will be beneficial, whether that is exercise, antidepressant medication, psychotherapy, and other treatments. Additionally, there exists a large body of research suggesting that exercise can impact negative moods, and can often be just as effective as psychiatric medications in treating depression. Other studies have found that when people stop exercising, they are more likely to get depressed; and that the more exercise someone got, the less his risk of having a mental health problem. The bottom line is that there is no definitive, cookie cutter answer to treat mental illness. People react differently to various medications and treatments.

Pretty scary stuff! The good news is, though, that there is a huge amount of resources available for anyone to use. A plethora of materials and information is available online, and many resources are available from local and national assistance, including government agencies and private and public mental health facilities and providers. Although mental health conditions run the gamut from mild depression to alzheimers to suicide and more, treatment is available for those who need it.

Until next time. Let me know what you think.

Health Care and Savings

Over the past few years, Consumer Directed Health Care plans have been slow to take off in popularity. In early March, 2008, Financial Week online has reported that only 7% of American companies now offer a CDHP to their employees as consumers and employers seek ways to offset the rising cost of health care. This represents only a 1% increase since last year. According to the report, many companies are planning to offer them this year as the popularity of Consumer Directed plans increases on an ongoing basis.

Companies are always seeking any and every option to reduce costs, especially with health care expenses and insurance. Financial Week also said that 41% of large corporations--those with over 20,000 employees--now offer either an HRA or an HSA. The primary reason for the 4% increase since last year was to lower the cost of benefits. Mercer and the AAPPO have discovered that about 12.5 million people are covered by some version of a CDHP. That is about a 25% increase since 2006.

There is a lot of pressure also for increasing transparency, more user friendly consumer-based tools, greater technological capabilities, and cooperation with health carriers to participate. New initiatives to increase the capacity of customers using CDHPs has been discussed by the federal government, private business, the media, and employers. So far, the take rate, although positive, has been slow. Additionally, there has been some criticism from several groups including some consumer advocacy organizations, organized labor, and some health care providers. Those who don't favor this model fear that not enough information from results and experience has been made available to justify a wholesale movement toward consumer driven care.

Those who criticize CDHPs feel that the savings are not validated because only healthy employees sign up to use these plans. Additionally, those with chronic health issues will not seek medical attention because they must pay out of pocket for several thousand dollars before their plan kicks in. By that time, the minor health problem may manifest itself into a major medical issue. Lots of confusion still exists in the market place as information is lacking in some cases, and a gap exists for credible decision making when employers are analyzing various plans. There is a critical need for comparison data against traditional health plans.

Several solutions to making significant inroads with Consumer Driven Health have boiled to the surface over the past couple of years. One of those is to make sure that the plans deliver a real value, not just a perception of savings. Will a lower premium and a higher deductible make a difference? Secondly, customer satisfaction will need to be greater than what normally would be seen in a traditional health plan. Convenience and ease of plan design should also be considered as a third key to the success of CDHPs. Can the plan's members use a debit card to access their savings? Accountability for the plan management needs to be a highly important factor when considering various plan designs. What features are most important as modules of the plan? What does the IRS say about the plan structure? And finally, will the employees buy into the plan? How do they benefit from a consumer driven plan? Will they be satisfied with the structure, benefits, and cost?

One thing is for sure. The cost of insurance and health care continues to go up every year. Consumer Driven Health is a concept and a practice that should be promoted as a great option to help keep the price of staying healthy at a decent cost relative to traditional insurance. Those who support these plans know that smart consumers will shop for the best deal, not the cheapest alternative. Patients, when supplied with sufficient information, will make better choices for health care and be aggressive to find treatment that is cost effective. Competition breeds better results in price and plan design, and unnecessary procedures with related costs will be avoided.

Until next time. Let me know what you think.