SoylentNews is people
SoylentNews
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 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.