Submitted via IRC for Bytram
A stitch in time saves nine?
High-Deductible Health Policies Linked To Delayed Diagnosis And Treatment
A study published last month in Health Affairs examined claims data from a large national insurer for 316,244 women whose employers switched insurance coverage from low-deductible health plans (i.e., deductibles of $500 or less) to high-deductible health plans (i.e., deductibles of $1,000 or more) between 2004 and 2014.
The study group consisted of women who were in low-deductible plans for one year, then switched to a high-deductible plan for an additional one month to four years. The control group consisted of women who remained in low-deductible plans.
In particular, the researchers looked at the relative effects of such plans on women who have low incomes versus those with higher incomes.
Women with low incomes who had high-deductible insurance plans waited an average of 1.6 months longer for diagnostic breast imaging, 2.7 months for first biopsy, 6.6 months for first early-stage breast cancer diagnosis and 8.7 months for first chemotherapy, compared with low-income women with low-deductible plans.
In some cases, delays of that length might lead to poorer health outcomes, says J. Frank Wharam, an internist and specialist in insurance and population health, who led the study. More research needs to be done to confirm that, he says.
Interestingly, women with high incomes who relied on high-deductible health plans were not immune to such delays — they experienced lags of 0.7 months for first breast imaging, 1.9 months for first biopsy, 5.4 months for first early-stage breast cancer diagnosis and 5.7 months for first chemotherapy, compared with high-income women with low-deductible plans.
The researchers also found that having a high-deductible health plan was linked to delays in care whether the women lived in metropolitan areas or not and whether they lived in neighborhoods that were predominantly white or predominantly nonwhite.
"In general, we are finding that the effects of modern high-deductible plans on access to care are sometimes predictable but often surprising," Wharam explains.
(Score: 3, Insightful) by Anonymous Coward on Tuesday April 23 2019, @11:37AM (12 children)
Seems a bit sexist they only looked at women. I wonder if the effects are the same, greater or lesser for men.
As men we are frequently encouraged to "just suck it up" and only see a Dr when we get to the point we can't deal with it anymore.
Or at least that has been my experience as a male. This cultural ideal that men must simply suffer through it, delays a lot of diagnoses and I can vouch for the idea that delayed diagnosis leads to poorer outcomes.
I know with my own cancer diagnosis I wasn't even permitted to take time off in order to get the initial and follow up tests to confirm. I had to use vacation time because I used my sick days being sick.
Once I was diagnosed my employer dropped me like a hot rock, literally saying they couldn't afford the insurance premium if I stayed (small employer less than 50 employees). Once the paycheck ended so did the insurance and now I can't afford treatment despite paying into the health insurance system my entire working career of 30+ years and literally never using it once. I earned too much last year to qualify for medicaid or any subsidies. So my options are to expatriate to a country with nationalized health care or wait it out here for a year and hope I can qualify for some medicare, but I'll have to remain unemployed to afford it.
(Score: 2) by Runaway1956 on Tuesday April 23 2019, @01:24PM
I have the same question. Seems like men would be doing near about the same thing - it doesn't seem to make a lot of sense to see a doctor, until you need the doctor, if you have to pay a large chunk of the bill. If you don't have to pay much, or even none of the bill, well, sure, run down to the doctor for every little thing. Stubbed toe? Better go to ER to see if it's broken!!
Of course, I still haven't had my first mammogram, have you? Maybe these people set things up through an ob-gyn association, so women were easier to get to than men? Ehhhh . . .
(Score: 3, Interesting) by opinionated_science on Tuesday April 23 2019, @01:51PM (8 children)
Is it legal to be fired for having an expensive disease?
Or did you quit?
(Score: 2) by DannyB on Tuesday April 23 2019, @01:58PM (1 child)
Maybe you weren't fired. You were simply made redundant by the hiring of your replacement.
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(Score: 0) by Anonymous Coward on Tuesday April 23 2019, @03:03PM
Moving his desk to the basement was a clear indication of his lack of red Swingline status.
(Score: 0) by Anonymous Coward on Tuesday April 23 2019, @03:10PM (5 children)
I thought the same thing. Turns out "at will" means they can terminate you for any reason or no reason.
In my case, the official line was "we're just eliminating your job", but when I pressed as to why and specifically cited my medical issue the boss came clean and said a meeting was had and keeping me would cause their insurance to skyrocket, so they were letting me go.
Because the organization is smallish, the normal labor laws that apply to organizations with hundreds or thousands of employees and millions in revenue are waived because "small business".
I've tried applying at larger orgs, but the fact I was let go seems to be a barrier. Had I walked away it might be easier, but I stayed put for 10 years gaining progressively more experience and responsibilities, then got dropped. My resume isn't getting me anywhere with companies that want younger, cheaper, even if I were to accept a pay cut in order to rejoin the workforce.
(Score: 2) by RS3 on Tuesday April 23 2019, @04:44PM (4 children)
Did you consult an employment attorney? (hint: if not, please do. If nobody fights this, they will continue to get away with it.)
(Score: 2, Informative) by Anonymous Coward on Tuesday April 23 2019, @07:26PM (3 children)
Yes as a matter of fact I did, three different attorneys. The universal response was basically, "Did you actually record them saying this? If not then it will be your word vs theirs and their officially documented claim was only that they were eliminating your position." One lawyer also explained that at a certain size, its perfectly legal to terminate me in order to save the premiums, it's just a small business protection baked into the ACA.
What it came down to is money vs return. I could take them to court, try to prove my case and then? The judge might order them to give me my job back, but then they could fire me at any time, next day if they wanted.
The judge might order lost wages though and maybe some penalties. But again I'd have to prove my case. They aren't a large organization, so unless this becomes a systemic thing with multiple people all making the same claim, it would just be me vs them and honestly I'm too sick to deal with this.
I may actually be able to take the insurance company to court for not giving me a COBRA offer, allowing my insurance to continue at least while I am seeking work. However even that is a long shot. I didn't know about COBRA before and it's been 6 months since coverage was ended, same day as my last paycheck.
(Score: 2) by SomeGuy on Tuesday April 23 2019, @08:32PM (1 child)
Where is the +1 Mortifying mod when you need it?
(Score: 2) by RS3 on Wednesday April 24 2019, @02:09AM
Yeah, that dose of reality. Isn't it nice to know that We the People have representatives in govt. who make sure the system is fair for us too?
(Score: 3, Insightful) by RS3 on Wednesday April 24 2019, @02:26AM
OMG, thank you for all the info, as depressing as it is. Well, you certainly would not want to work there again. I'm not sure who is supposed to let you know about COBRA- company HR, insurance?
I've talked to a couple of attorneys who were more optimistic, that on a witness stand, when asked the right questions, people know the penalty for perjury and they "crack". In my perfect world, the company would be investigated, everyone involved deposed, then subpoenaed (hey, I spelled that right first try), and companies would be less inclined to behave sphincterally.
By far the most and similar involvement I've had: about 12 years ago laid off (horrible job anyway), or so I thought. Words were: "this is the end of the road". There was no more work for me- I had gotten so far ahead. I was actually happy, applied for unemployment compensation, they were so nice and helpful, got a couple of checks, then one of the worst letters of my life saying I might have committed fraud, had to return all the money, etc. I went through several levels of appeals which was a complete farce. It finally came to a hearing in front of a "referee" (judge) and I fried the ahole (I should have been a lawyer). I probably could have sued them too but I was just so happy to have won and be rid of them (again, worst job of my life). Moral: a real hearing might win, but not if you're sick- the stress might do you in.
You just helped me (indirectly). I've never hired a lawyer before but need to (totally unrelated subject) and there are thousands and you helped me figure out something- basically I need to look for optimism- a desire to help. Thanks and I hope somehow things work out for you. Do your best to research your health problem and any and all possible treatments. Misdiagnosis is too common. Many people have multiple simultaneous (parallel) diseases, conditions, etc., that can really make diagnosis difficult. I wish I had gone to med school... Seek nurse navigators. Again, I hope things improve for you.
(Score: 2) by PiMuNu on Tuesday April 23 2019, @02:42PM
Make it happen:
https://en.wikipedia.org/wiki/Labour_movement [wikipedia.org]
(Score: 1, Interesting) by Anonymous Coward on Tuesday April 23 2019, @03:10PM
Because they wanted to focus on a specific disease, with an established treatment path. Breast cancer fit perfectly. It's one of the most common cancers. But men don't get breast cancer (usually).
(Score: 4, Insightful) by SomeGuy on Tuesday April 23 2019, @12:27PM (6 children)
This must be an old study if they think a "$1,000" deductible is high. Most plans, at least the ones who's premiums are low enough for you to buy food too, have deductibles of $5,000-$7,500.
Increasingly people are just dropping health insurance, because the simple fact is simply WON'T be there when you need it anyway. You are just throwing money at some rich CEO for jokingly empty promises.
Welcome to America, where if you get sick, your health care benefits consist of a piece of rope and a fancy knot.
(Score: 2) by c0lo on Tuesday April 23 2019, @01:53PM
Oh, man... you mean the soap is an out-of-pocket expense?
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 3, Insightful) by RS3 on Tuesday April 23 2019, @05:07PM (4 children)
I'm not sure where to post this- should be everywhere here.
It's not just the "outcomes"- it's the magnitudes higher costs when (if) the person finally goes for treatment. I don't understand why nobody seems to think this way- they certainly don't act that way.
Healthcare in USA is so badly screwed up I don't see a fix. Huge concessions will need to be made across the whole system. It's a huge cash-cow, every day there are new companies popping up based on some new way to make $ off Medicare, Medicaid, insurance, etc. The economy simply can not support it, and it's only going to get worse and worse.
Between insurance, drug companies, FDA, HIPAA, lawsuits, profits, on and on, doctors are leaving, the quality of care is down down down. The only hope anyone has is: 1) somehow stumble onto a really really good proactive doctor, and 2) anyone can google symptoms and annoy the doctors and nurses- really study and learn and be your own guide. Look for medical case managers / care coordinators / nurse navigators, but even then, someone's got to manage the whole thing, especially when you start going to specialists, and if you're sick, or even given a "heavy" diagnosis, you might not be in a good mental state to manage your own care and treatment. And, you'll be getting bills from some entity in an entirely different state, who you've never heard of, but it turns out they own the CT machine in the hospital you were in, and you get billed separately. It's just insane, and all driven by profit. Who's going to pull the bone out of the hungry pitbull's mouth?
(Score: 0) by Anonymous Coward on Tuesday April 23 2019, @06:23PM (3 children)
Universal Healthcare, simple idea but admittedly it would be a tough transition since health insurance is such a massive industry. Shouldn't be too hard to figure out a phased approach that prioritizes health insurance employees for positions in the new system.
The real trouble is preventing the billionaires from messing it all up.
(Score: 2) by RS3 on Tuesday April 23 2019, @07:20PM (2 children)
I postulate that _any_ system which uses some form of money- a thing that represents a perceived value of goods and / or services, will behave in ways that can be studied, and comes under the category "economics". And frankly the concepts of economics apply to barter systems also, but money (and greed) adds a big dimension.
We in USA live in a somewhat limited / regulated form of free market economy. Regardless, in grades K-12, both private and public schools, I don't remember 1 lesson in economics. That's a Bad Thing. (Yes MDC, I say that like it's a bad thing!) We have a nation of people buying and selling and investing and divesting and few of us really understand economics. Somehow I got interested in economics and took 3 elective courses in college. It all made sense to me. Huge arguments will ensue regarding the various theories and theorists. I mostly abstain- I'm more of a realist, empirical-ist. It's not difficult to study real-world economics when you have an understanding of some of the basics.
As DannyB mentioned elsewhere here, greed is one of the biggest factors.
I've been somewhat in favor of some kind of universal healthcare, but as long as money is being given to profit-making entities, IMHO some will be wasted. If / when the government makes $ available for _anything_, there are greedy people who will grab. There are increasing layers and layers of administrative people whose jobs are to just analyze numbers, payments, procedures, tests, need, profit, outcomes, etc., and not just insurance and govt., but all healthcare providers. Doctors used to be in charge, but now their hands are so tied (by the entire system) they are dropping out- completely if not just mentally.
It's not just billionaires, it's anyone who sees $ and comes up with a way to make $.
I think, and I'd love positive helpful discussion (yes, I know it's SN, sigh) about whether a mandate forcing _all_ healthcare providers, insurance, drug companies, to be non-profit could work. Obviously could not be done overnight, but they don't seem to be self-limiting. IE., they're charging huge $ and making huge profits. I've seen many investigative news reports of people getting charged $4000 for something Medicare only pays $700. You know, the old "suggested list price" but special people get big discounts. And we've all seen and know about the drug price increases (epi-pen et al).
There are those who say the system only works because people will only invest in something profitable. I'm not sure what that's called, but it's definitely a logical fallacy of verbal communication: sweeping generalization? Specious? Red herring? Strawman? Idiocy? The fact is, there are many reasons to invest. You may be wealthy and your wife, child, etc., may be very ill and you may donate to a hospital, drug company, etc. You may start a treatment center, or biotech research company. I know many people who work in healthcare and don't make much money but truly want to help people get well. I'm looking into it. I know people who work in healthcare because a relative got sick. The world is not all driven by far-removed hedge fund managers. Get them out of the equation and things might start righting themselves.
As I wrote elsewhere in this discussion, I think the biggest problem is delayed treatment. A simple treatable removable tumor grows, spreads, and a $10K thing quite literally turns into $millions, years, suffering, and loss to everyone (like it or not, we're all paying).
(Score: 1, Insightful) by Anonymous Coward on Wednesday April 24 2019, @12:53AM
OK, so let's talk mandates.
Short answer: No.
Some reasons:
First, "non-profit" is just a tax rule. It doesn't mean that profits aren't made, nor that the people in charge aren't corrupt bastards (see the SPLC's massive self-harm).
Second, many people will fight it tooth and nail for a variety of reasons, not least being the question of how doctors are supposed to live if they can't make a profit to pay themselves a wage, let alone enough for all the malpractice insurance, study debt, continuing study and so on that's part and parcel of the career.
Third, while it's all very well to run single payer systems (such as the VA) or payment back ends (such as Medicare/Medicaid) and establish nonprofits and cooperatives to do medical things, it's far from clear that forcing it as a structure is even constitutional - one of the problems with the Dems' latest single-payer call to action.
Fourth, in the field of private enterprise, ROI is important. No profit, and you miss out on the R part of ROI. There may well still be investment (especially if tax-motivated) but it will be a drop in the bucket compared to what we see now. Sure, you get lots of dedicated folks who are in medicine (and also teachers, firefighters and so on) but happythoughts and justiceboners aren't negotiable currency as far as the manufacture and supply of MRI machines is concerned.
Fifth, this doesn't even strike at the heart of the problem: the cost/availability question. Sure, it attacks cost but does nothing for pushing availability.
There are other approaches that may be considered:
First, try enforcing transparency in pricing. No secret deals, subject to massive fines for both counterparties.
Second, ensure equal deals. No sweetheart deals for insurance companies or special setups.
Third, require strict definition of and enforcement of what constitutes a good faith contract in insurance, and make sure that it includes things like penalties in cases of unjust withholding of benefits. The insurance market isn't bad as such; it's doing its job overall, but it does need to be regulated for parity.
Fourth, offer public backing and support for cooperatives, nonprofits with limited surpluses and similar makers, including things such as mandatory, reasonable and nondiscriminatory licensing of patents to makers of generic drugs and equipment. This along with a "public option" sort of system will help keep a cap on price growth.
Fifth, remove the AMA's ability to choke the growth of new entrants, not to mention other rent-seeking behaviour on the part of the profession.
Those are a few thoughts for starters.
(Score: 2) by bzipitidoo on Wednesday April 24 2019, @03:29AM
It may be that the for-profit health insurance industry has at last irreversibly discredited themselves, and Medicare for All has become a real possibility. The stock market thinks so, and the stocks of private health insurers has taken a beating recently.
(Score: 1, Insightful) by Anonymous Coward on Tuesday April 23 2019, @01:24PM (8 children)
Can someone please tell to a non-American what a "high-deductible" and a "low-deductible" health plan means?
(Score: 3, Informative) by DannyB on Tuesday April 23 2019, @01:55PM
A deductible is an annual amount you must pay out of pocket BEFORE insurance will kick in and start paying. So, if you had a deductible of ${X}, then you would have to pay out of pocket for your first ${X} worth of health care in 2019 before insurance starts paying anything at all.
What a high deductible health plan means is that your deductible is so high that you might be completely unable to pay it without being financially wiped out before you die in that plan year.
What a low deductible health plan means is that once you have met your deductible for this year, insurance plan begins to pay, according to the terms and conditions, which are designed to ensure your speedy passing if it looks as though you might actually require any health care instead of just paying on the insurance payments and staying healthy.
I hope that helps clarify.
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(Score: 3, Informative) by c0lo on Tuesday April 23 2019, @02:06PM
https://www.firstquotehealth.com/health-insurance-news/high-low-deductibles [firstquotehealth.com]
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 2) by RS3 on Tuesday April 23 2019, @05:10PM (4 children)
They also coined (pun intended) terms like "co-pay", "co-insurance", "individual responsibility", "fees" and more fees.
Some deductibles are not annual- they can be per incident, per disease, per treatment, per hospital stay, a given number of days or months, etc. Any way they can grab more $.
The problem: good old econ 101- supply / demand.
(Score: 2) by DannyB on Tuesday April 23 2019, @05:54PM
The problem: good old greed.
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(Score: 1, Insightful) by Anonymous Coward on Tuesday April 23 2019, @09:03PM
Not supply/demand. Regulatory capture.
(Score: 2) by bzipitidoo on Wednesday April 24 2019, @11:39AM (1 child)
Don't forget "pre-existing condition", one of the few bits of the US health insurance bullcrap that Obamacare stopped.
But the health insurance industry is still up to their old tricks. Classifying things and making rules and delays so that you still have to pay out of pocket for all kinds of care even though you are supposedly insured and covered.
(Score: 2) by RS3 on Wednesday April 24 2019, @02:37PM
I fully agree. It's unbridled greed. This stuff is being exposed constantly, including major news investigations (20/20, 60 Minutes, etc.) and nobody's doing anything about it.
> Don't forget "pre-existing condition", one of the few bits of the US health insurance bullcrap that Obamacare stopped.
I was very grateful for that when it happened, but I thought at least some insurance companies were back to doing that?
(Score: 0) by Anonymous Coward on Wednesday April 24 2019, @03:20AM
A high-deductible means if you get sick, you are fucked.
A low-deductible means every month when you get your astronomically high insurance bill, you are fucked.
In the US, only rich people can afford health insurance.
(Score: 2) by HiThere on Tuesday April 23 2019, @05:18PM
If they'd asked me before they did the study, I'd have predicted about those results. The details are different, of course, as I wouldn't attempt to predict the average time delay, but I'd have predicted a large one. Also that while poverty would make the delay more extreme, even wealthy people would delay. This is true for nearly every thing people do. If it costs more, people are more reluctant.
That said, it's a worthwhile study to document that the expected result is what happens. But
"In general, we are finding that the effects of modern high-deductible plans on access to care are sometimes predictable but often surprising," Wharam explains.
doesn't seem correct, at least from what's reported in the summary. Nothing surprising was reported.
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(Score: 1, Troll) by Anonymous Coward on Tuesday April 23 2019, @05:48PM
I have 11 kids. I'm not worried about hitting a deductible. Of course I hit it!
For me, the important factor is the yearly out-of-pocket limit. If somehow I'm not near it in December, then I might delay healthcare until January. If I've hit the limit already, then I will try to get lots of healthcare done before the end of the year.
There was surgery this spring and a baby due in summer. That is enough. For the rest of the year: "Hey, does anybody want major surgery? It's free until the end of the year. Wouldn't you like surgery?"
(Score: 2) by darkfeline on Wednesday April 24 2019, @02:57AM
Studies are good, but obvious things are obvious. High deductible plans only cover preventative care, not diagnostic care. Doctor listens to your heart with a stethoscope, that's preventative care. Doctor hears an anomaly and orders some extra exam, that's diagnostic care, that'll be $10k USD please. You tell the doctor you feel mild pain in your arms, that's diagnostic care, that'll be $5k USD please, even if the doctor tells you it's probably nothing. You tell the doctor that you feel this lump in your breast, that's diagnostic care, that'll be $20k USD please.
So yeah, people hold off on getting scans or mentioning problems, because that could bankrupt them.
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