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Health Policy

Moral Hazards – an Economist Weighs in on Health Policy

Scholarly articles that test behaviors in the real world are fascinating and of potential value if their findings are acted or, or studied further.

This article sites such a study where the impact of co-pays on compliance and on the general issue of compliance when the symptoms of a significant disease are silent or delayed.

We are of mixed mind in considering the implications of social engineering on people’s behavior. On the one hand, adults should take responsibility for doing the right thing, or pay the price when they don’t. On the other hand, paying the price in real terms with respect to poor health decisions, often means that society at large, as well as innocent family members, pay the price of individual ignorance and/or stupidity.

The larger point in this article is that incentives and skin in the game matter with respect to both taking appropriate health measures, as well as avoidance of waste in terms of treatment or diagnostics.

…And the other 367,000 babies born that day

On a quick trip to the grocery store I couldn’t help but notice the dozen or so smiling faces of the Duchess of Cambridge with her new baby while I was waiting in line to make my purchase. But it was this article in Slate.com that MCNtalk found interesting to read – UNICEF statistics and the Slate.com author’s thoughts on childhood diseases, access to secondary education, clean drinking water – things all parents of newborns worldwide ponder to varying degrees.

While it’s all very exciting that this particular baby was born—and I do wish him well—I can’t help but wonder about the estimated 367,000 babies born (roughly 4.3 born a second) around the world on the same day the most important baby ever came to be. While many of those commoner babies were also born into a world of relative privilege and safety—though not royal family levels of privilege, by any means—many of them were not. Many of the babies born that Monday are inheriting a world that is dangerous and even deadly, often for reasons that could easily be prevented.

Medical Tourism – Another Example of a Seriously Flawed US System

This article on hip replacement costs and the experiences of a medical tourist in Belgium highlights any number of issues. Yet most readers would yawn at the obvious – that we pay in the US multiples more for equal or lower health outcomes. The story describes a patient who was quoted a price of $78,000, NOT including surgeons fees for a hip replacement from a local US hospital. The patient was able to receive the same operation INCLUDING round trip air, for $13,660 at a private hospital in Belgium, including the surgeon’s fee. And the hip joint was made by the same US company that sells the device in the US for more than the cost of the entire procedure in Belgium.

Interest groups and politics (including partisan bickering), lack of courage at confronting and tackling the matter,  government indifference, and lack of economic skin in the game by patients mean we all get less for more. Government interference is decried by many, but it seems to work in the case of Belgium and others in Europe and elsewhere that regulate the medical market. The alternatives in settings like the US where healthcare is largely regarded as “free” by those who receive it has resulted in what we in America experience. We patients pay little more than a copay or deductible with the rest covered by private or government insurance. We have no incentive to shop, price compare and demand price transparency. But the cost borne by government and private payers is very real and the billions of dollars in excess GDP means that these funds are not available for other productive uses.

If cars, electronics or food were five times the price in the US than Europe, regardless of the logic, there would be a grey market and a hue and cry by those individuals footing the bills. Where is the outrage at the metrics described in this article? It is inconvenient and in the case of emergent situations, impossible to get on a plane and travel abroad for much cheaper care. And the patient who has no economic driver to do so has little reason to consider it.

In the end, we all pay via lower salaries, higher taxes, or both – fueling a bloated health care system enabled by indifference and ignorance.

Childhood obesity rates improve

As noted in The American Medical News  online, The Centers for Disease Control and Prevention has reported that more than a third of adults and 17% of children ages 2 to 19 are considered obese. But at least in the childhood obesity area, signs of declines in those rates are taking place in numerous cities, counties and states, said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation.

“The good news is coming from places large and small,” Dr. Lavizzo-Mourey said. “It’s coming from rural North Carolina, New York City and Philadelphia. When I see that, I’m thrilled because what this tells us is we can reverse this epidemic. It tells us that we don’t have to accept 23 million children being overweight or obese.” The foundation has a goal to reverse the epidemic of childhood obesity by 2015.

Reducing obesity rates is a challenging goal, Dr. Lavizzo-Mourey acknowledged.

“Although the rates are coming down in some places, they’re still far too high. And the progress that we’ve seen has not been shared equally,” she said. Most advances in reducing obesity rates have taken place among white children in affluent communities, with fewer successes seen among African-American, Latino and low-income children. “Frankly, that’s not OK. The benefits of being healthy have to be within the reach of all of our children,” she said.

Read more…

Outing a Problem with Our Industry – Once Again

A recent posting on Workers Comp Insider by  Lynch Ryan, a prominent Workers’ Compensation Defense firm, exposes shameful behavior on the part of a small but prolific minority of consultants and companies in our field. The posting speaks for itself. It also references the NY Times 2009 expose on problems in the Northeast and links to a plaintiff attorney blog that expands upon the issue.

MCNTalk posted the original NY Times articles and expanded upon ethics and standards in this posting from March 2011.

We were naively hopeful back then that exposure of such practices would lead to their end. We were apparently wrong. The company cited in the article has since renamed itself and continues with similar practices. Certain physicians continue to behave in entirely unacceptable manners, with impossibly brief examinations, use of boiler plate, and other questionable practices.

The end result is a regional ecosystem that is tainted by cynicism and scandal. Those who behave honestly and attempt to provide an ethical product are at a disadvantage when medical bucket- shops operate and charge unrealistically low prices for products that do not meet basic medical and legal standards. There are at least several large carriers whose regional offices have grown accustomed to using these entities and paying fees that ethical companies and physicians can’t match.

One should not have to rely upon external forces to do the right thing, but this situation suggests that expecting integrity for its own sake is not always realistic. We continue to hold out hope that those who buy these services become aware of what they are buying, if they are not already in the know, and that these questionable practices no longer have a market. We also hope that continuing to shine a light on this issue by multiple means, including the regulatory and legal arenas, will bring these abuses to a halt.

We at MCN are not going to just go along or get along when we see behaviors in our backyard and our industry that we can neither  defend nor tolerate. We hold ourselves to a higher standard and will not stop until others in our industry stop dishonoring themselves, the medical profession, our industry clients, and claimants. We ask our clients to support us in this industry challenge and ask tough questions of those you are doing business with.

Worldwide Decline in Ancient Scourges

We in the US fight about our bloated health-care system and the extraordinary waste and inflated prices that are emblematic of the problems and challenges we face.

While we engage in these squabbles there are millions in the world who are helped by simple, inexpensive interventions, leading to restoration of life or meaning of life.

Nicholas Kristof of the NY Times illustrates examples of these in his recent column. The column and his work are useful and enlightening, as are the comments of readers in the online version we are linking to.

The State of US Health

This important article from the Journal of the American Medical Association outlines the state of health in the US, comparing and contrasting it to other countries. Given our health spend, the data is not pretty, nor is it surprising. The US News and World Report article summarizing the study notes that our lifestyle is a major culprit contributing to morbidity and disability. As the author Harvey Fineberg MD said:

 “We spend, on average, twice as much as the rest of the countries. Approximately 30 percent of all health expenditures in the United States, which would amount to $750 billion a year, don’t actually contribute to better health…We have a big job ahead of us to create a health care system that really adds value and doesn’t just cost and waste a lot of money.”

This editorial in the Journal of American Medical Association provides further context and thought on the situation.

(Don’t) Forget to Take Your Vitamins

This Opinion piece in The New York Times earlier this month makes some interesting – and disturbing – points on the vitamin industry.

Several studies over the past two decades indicate that some consumers have suffered adverse health effects from the over-consumption of vitamins: In a study published in The New England Journal of Medicine in 1994, 29,000 Finnish men, all smokers, had been given daily vitamin E, beta carotene, both or a placebo. The study found that those who had taken beta carotene for five to eight years were more likely to die from lung cancer or heart disease.

Two years later the same journal published another study: 18,000 people who were at an increased risk of lung cancer because of asbestos exposure or smoking received a combination of vitamin A and beta carotene, or a placebo. Investigators stopped the study when they found that the risk of death from lung cancer for those who took the vitamins was 46 percent higher.

If over-consumption of vitamins is as dangerous as these and other referenced studies suggests, what’s the Food and Drug Administration’s stance on regulating intake? Well, in December 1972,  the F.D.A. announced a plan to regulate vitamin supplements containing more than 150 percent of the recommended daily allowance. Vitamin makers would have to prove that these “megavitamins” were safe before selling them. However, legislation was introduced preventing the FDA from regulating megavitamins; it became law in 1976. Read more…

Learning from the Swedish Health Care System

This short article describes a health care system that works according to the article. It costs half as much, is not for profit, engages in entirely different financial incentives, is not employer based, and is associated with better health outcomes. Note this last fact being one of association not causation, as Sweden has a population who engages overall in healthier lifestyles.

The naysayers make a lot of noise about life as we know it being incompatible with fundamental system change. The question is do they seek input that might not support their beliefs, are they curious, do they travel with open eyes, and do they really enjoy spending so much of their hard earned dollars on health care? The US is not Sweden to be clear, but just as imitation is the norm in so many endeavors, when it leads to improvement, does it not make sense to analyze and study other systems with eyes open, learn and adapt? Read more.

More News in the Global Obesity Crisis

 According to the AMA, obesity is now a disease. Setting aside the particular condition, this decision reminds us that the concept of “disease” is complex, as are the social constructs attached to the disease label.

For example, the disease label may imply responsibility or lack of same by the person who has it. And in fact the person with a disease often attains the label of “patient.” Being a patient implies to many that they are passive recipients of care by the health care system rather than personally responsible for engaging in choices and behaviors that reduce or eliminate the condition. Diseases often carry with them stigma and shame, legal exculpation from responsibility, employer obligation to accommodate, insurer/government obligation to pay for and so on.

Expect this decision to generate considerable debate, emotions, and both intended and unintended consequences. Read more…