Even for the insured, the cost of copays and other out-of-pocket expenses add up quickly, whether you’re single or have a family. If you’re feeling the pinch, you’re not alone – according to a recent Kaiser Family Foundation poll, 53% of respondents said they had cut back on their health care to try and save money.

Many respondents reported an increased use of over-the-counter medications or home remedies, rather than scheduling a visit to their doctor. Others said they didn’t fill prescriptions to save money; some even skipped treatment or tests that their doctor recommended.

Ignoring your doctor’s instructions could prove risky if you have a serious medical condition. But no matter health status, you can cut down on some of the costs of healthcare without having to neglect your health. What can you do?

• When you visit a doctor, make sure you’re prepared. Take along all the information the doctor might need, including paperwork and medical records if necessary. Take note of whether your health has changed recently, including energy or weight fluctuations. If you have any questions you want to ask, make a note so you don’t forget them. Being prepared for a doctor’s visit cuts down on the need for repeat visits, and helps save on copays.
• Get your test results over the phone. Most of the time you won’t need to return to your doctor to get test results, so there’s no reason to spend money on the copayment when it’s not necessary.
• Consider setting up a flexible spending account when open enrollment comes around. Flexible spending accounts let you put pre-tax dollars aside to fund certain types of medical expenses.
• Call an organization such as the Patient Advocate Foundation (800- 532-5274) if you have a chronic disease and want some help with getting the most out of your insurance plan.
• If you’re uninsured, then consider visiting a store clinic. In some locations, retailers such as Target and Wal-Mart now run clinics where you can receive routine medical care for about half the price of a doctor’s visit.
• Try and track down locations where you can receive free medical screening. Organizations such as the American Cancer Society and the Centers for Disease Control and Prevention can help you locate such programs.
• Request a quote for affordable health insurance here. Our system is able to connect you with leading health insurance carriers from across the country, and it could save you a lot of money on premiums or health care costs.

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According to the results of a new national survey, less than 2% of American hospitals have completely switched to an electronic medical record-keeping system.

Between 8% and 11% of hospitals have partial electronic systems in place, with at least one department in those hospitals having converted to a digital record-keeping system.

Dr. David Blumenthal, head of the Institute for Health Policy at Massachusetts General Hospital, says that American hospitals are at a “very low stage” of adoption of digital technology as compared to other countries. But with less than 2% of American hospitals completely digital, this seems to be a massive understatement.

American hospitals – and doctor’s offices, for that matter, with just 17% of American physicians using digital record-keeping technology – have a very long way to go.

Health Records, Health Insurance, and Saving Money

Previously, the Bush administration set a goal of 2014, by which time the entire country would (theoretically) have transferred to an electronic medical record-keeping system. This goal got a much-needed boost earlier this year when President Obama signed the economic stimulus package which includes $19 billion for converting physicians and hospitals to an electronic system. (Interestingly enough, the majority of the money is earmarked for incentives to encourage doctors and hospitals to use electronic systems.)

The money is certainly needed. A small hospital to convert to an electronic medical record-keeping system, around $20 million in capital is required. For a large academic hospital, that figure can range up to $200 million. For around 75% of hospitals, lack of funding is the main barrio towards updating their record-keeping systems. Approximately 44% also cited maintenance costs as a significant barrier.

Given the enormous cost, the survey results that show 98% of hospitals, and 83% of doctors are in need of an electronic updage, are somewhat sobering. Will $19 billion be enough to update the country’s antiquated medical record-keeping systems?

Photo credit: David Boyle in DC

One of the great ironies of the insurance system is that when you’re sick and need the protection of health insurance the most, you can expect to pay a lot more for your premiums. It’s practically one of the certainties of life, like death and taxes, that are invariably true for everyone. But is that about to change?

Health Plan Companies Consider Removing Pre-existing Condition Penalties

For the first time, the health insurance industry has been talking about the possibility of ceasing its practice of charging much higher premiums for health insurance applicants with pre-existing medical conditions or a history of medical problems.

The offer comes from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, and – make no mistake – this is a big deal.

In the wake of the Obama administration’s plans to reform America’s health care system to provide coverage for the estimated 48 million who are currently uninsured, these insurance industry groups have stated their willingness to make a start at charging fair premiums for all Americans.

In their letter to key senators, the two organizations spoke of their willingness to “phase out the practice of varying premiums based on health status in the individual market” if health coverage becomes mandatory for all Americans.

Why is this so important? Because it means these organizations are willing to move away from the risk-assessment factor of insurance premiums – meaning that people who have a history of medical problems won’t be penalized when it comes to getting health insurance.

It’s not all sunshine and roses, however. Insurance companies will still charge different premiums based on other factors such as sex, age, and location. And certain groups, such as small business owners, have been left out in the cold. Small business owners are often hit hard by risk-assessment, because if just one worker becomes seriously ill premiums can sky-rocket the following year.

Financial Motives of Changing the Pre-existing Condition Health Insurance Policy

And, of course, the motive for all of this is purely financial. Insurers are simply trying to gain political support in an attempt to stall the creation of a government insurance plan that would necessarily compete with private insurers.

But whatever the motive, the outcomes could certainly be positive. The insurance industry has already discussed support of a national goal to prevent insurance costs rising, and, in its bid to fend off the competition, has also offered to end its practice of outright denying health coverage to people with pre-existing conditions.

photo credit: SavaTheAggie

It’s not just the unemployed facing healthcare insurance problems, according to a new Robert Wood Johnson Foundation report compiling research carried out by the State Health Access Data Assistance Center at the University of Minnesota. Nearly 20% of American workers have no health insurance, up from around 14% in the mid-1990s.

During the mid-1990s, one in seven American workers had no insurance. Just ten years later, that figure has increased to one in five workers uninsured, or around six-million more people over the mid-1990s total.

What’s causing the high rates of uninsured workers?

What has caused the drop in insurance rates? The study notes that it’s likely due to an increase in the cost of insurance – premium costs for employer-sponsored healthcare have increased up to eight times faster than wages, meaning that fewer employers and fewer workers can afford the coverage.

Another fact the study notes is that many workers are newly uninsured, and the percentage of uninsured workers has risen sharply in the last couple of years. Finally, while up to 20% of workers no longer have insurance, around 90% of children are covered, as well as almost all retirees.

Criticism of the health insurance statistics

Some have criticized the statistics and the healthcare system on the basis of the disparity of insurance rates between workers and retirees – saying that workers are paying the bill for coverage for people who are no longer working. But is this really fair?

Today’s retirees – the people who are now on Medicare – are the taxpayers of the last generation. They’ve already paid for the healthcare they’re now receiving. And the current generation of tax-paying workers is paying now for the Medicare they’ll receive when they hit retirement age.

The real problem is that there just aren’t any insurance safety nets for working adults. SCHIP provides coverage for children and young people, while Medicare provides for seniors. For working adults, however, the options tend to be limited to employer-sponsored care, private insurance, or nothing at all.

More significant in terms of the study’s statistics is the fact that the mid-2000s figures were taken from Census 2007 results – and given current trends it’s likely that the number of uninsured workers is actually much higher than one in five.

photo credit: aflcio2008

Fibromyalgia is a devastating disease that causes chronic pain and other symptoms for those who are affected – but it’s a disease with no known cause and no standard treatment. Many people haven’t even heard of the condition, but if that’s the case it’s not because the drug industry isn’t trying hard enough.

Drug Companies’ Hundreds of Millions Help Raise Awareness of Fibromyalgia

Last year, drug industry giants Pfizer and Eli Lilly spent hundreds of millions of dollars in advertising to “raise awareness” of fibromyalgia. The companies donated more than six million dollars to non-profit organizations for educational campaigns and medical conferences, too.

That’s more than the companies donated for Alzheimer’s, and diabetes. And only donations made for cancer, depression, and AIDS were higher than the donations made to further the cause of fibromyalgia.

Why all this trouble for a disease nobody’s heard of, that some doctors don’t even believe exists? Simple. Pfizer and Eli Lilly are using their money and influence to “raise awareness” and get doctors prescribing fibromyalgia drugs for people with the disease.

Is Fibromyalgia Real? Why the Sudden Drug Company Interest?

Fibromyalgia is a real disease, especially to those people who are affected by it. But there’s no standard treatment – just a couple of drugs more commonly used to treat other conditions which improve symptoms for some people with fibromyalgia.

Pfizer markets a drug called Lyrica, which originally received FDA approval for the treatment of epileptic seizers. Eli Lilly’s drug, Cymbalta, was originally approved for depression. Both have now been FDA-approved to treat fibromyalgia symptoms and will probably soon be appearing on the formulary lists of prescription drug plans, if they haven’t already.

Sales of the Fibromyalgia Prescriptions since Big-pharma’s Campaign

Since the companies began marketing “awareness” for fibromyalgia, sales increased from $395 million to $702 million for Lyrica, and from $442 million to $721 million for Cymbalta, between 2007 and 2008. Each company spent just over $125 million in advertising its drugs in the first nine months of 2008.

Now this might not necessarily be a bad thing. After all, people with this chronic, painful condition are getting treatment that they need.

The problem, however, is that the underlying purpose for Eli Lilly and Pfizer is simply selling drugs, and some healthcare professionals are concerned that undue influence from the pharmaceutical industry will pressure doctors into diagnosing fibromyalgia more often, even if it might not be appropriate.

In addition, some doctors believe that fibromyalgia, while a real condition, isn’t necessarily physical – that there may also be a psychological or neurological component in the development of the disease. If that’s the case, the drugs that Pfizer and Eli Lilly are pushing may not be the best solution for people with fibromyalgia.

photo credit: ccox888

Japan’s overcrowded, understaffed hospitals are in danger – and so are the people who rely on those hospitals when they need emergency medical care. An elderly Japanese man who sustained head injuries after being struck by a motorcycle waited ninety minutes in an ambulance – while paramedics phoned fourteen different Tokyo hospitals, trying to find a hospital that would accept the man for treatment. All the hospitals refused to admit the injured man, saying they lacked the equipment and staff needed to treat him. The paramedics arrived at the accident site just a few minutes after the 69-year-old man was injured, but ninety minutes and fourteen hospitals later, the man died just a short time after paramedics finally located a hospital that would accept him for treatment. The man died from the shock caused by the loss of a large amount of blood – a condition which the man might have survived if he had received treatment earlier.

Stretching the Health Care System

This incident is only the latest in a list of recent cases occurring in Japan, where the emergency healthcare system is stretched thin due to staff shortages and the medical needs of an aging population. According to Japanese Health Minister Yoichi Masuzoe, the rapidly increasing number of elderly patients is a large part of the problem, with hospitals so full that there just isn’t room for emergency patients. While this particular incident clearly highlights the problems for Japan’s overburdened healthcare system, it is by no means an isolated occurrence. In 2007, more than fourteen thousand emergency patients were rejected three or more times by overcrowded hospitals before finally receiving treatment. The worst case so far was that of a woman who was rejected 49 times before finally receiving emergency treatment for breathing difficulties. Another high profile case, that of a pregnant woman who died eight days after being refused admission by nineteen different hospitals, finally prompted the government to establish a panel to investigate the issue.

What Tokyo is Doing to Change Things

Following the most recent incident, the city of Tokyo issued a directive that requires paramedics to coordinate with emergency call centers so that emergency patients can be accepted to a hospital within fifteen minutes. However, this doesn’t solve the most pressing problem of hospital overcrowding. Health Minister Yoichi Masuzoe has urged that the government develop a community support system to reduce the burden placed on hospitals. The Japanese government has also announced plans to improve coordination between hospitals and the emergency support system, and to increase doctor numbers in understaffed hospitals.

photo credit: udono

The big healthcare news from the Obama administration over the last few weeks has been that the State Child’s Health Insurance Program will be expanded, but another SCHIP-related change that happened around the same time hasn’t received as much attention.

This change is a reversal of enrollment rules imposed in August 2007 by the Bush administration. Controversial at the time, the new rules made it much more difficult for states to allow certain families to use SCHIP. For families whose income totaled more than 250% of the federal poverty line (that equates to around $50,000 per year for a family of four), it suddenly became all but impossible to use SCHIP. Several states actually sued the federal government over this change, including Maryland, Illinois and Washington.

In May 2008, Bush relented a little by reducing the income restriction to around 200% of the federal poverty line, or about $40,000 per year for a family of four.

Obama Lifts SCHIP Income Requirements

Now, President Obama has sent a memo to Health and Human Services, explicitly lifting those enrolment rules. In the memo, Obama states that since the 2007-2008 eligibility restrictions, “tens of thousands of children have been denied health care coverage.”

A different picture from Bush’s stated intention to prevent SCHIP providing healthcare for children who would otherwise be covered privately. But the 2007-2008 rulings simply didn’t work – with one single eligibility rule covering fifty states with widely different costs of living. Not to mention the fact that for any family with income at 250% of the federal poverty line to even be eligible, the state first had to cover 95% of children at less than 200%.

SCHIP Expansion Funded by Tobacco Revenue

Critics of Obama’s plans to expand SCHIP are mindful of the fact that funds for the scheme are coming from the tobacco industry in the form of a new consumer tax. Other criticism from the public includes that the new administration is needlessly expanding the government’s role in health care, and encouraging families with access to private insurance to rely on the government instead (however, the fact is that SCHIP will only be eligible to families who can’t afford insurance by any other means – families with insurance available through an employer won’t be eligible, for example.)

On the other hand, there are many advantages to expanding SCHIP that aren’t necessarily obvious. One is that covering kids will help provide more preventative health care for families who wouldn’t otherwise have access. Many people living below or near the poverty line simply don’t visit doctors, instead relying on emergency medical treatment. With the country’s emergency health care system already stretched to near breaking point, the possibility of easing the strain is a distinct advantage.

photo credit: Bah Humbug

The close ties between doctors and the drug industry are long-standing, but recently health policy experts have been saying that it’s about time those ties were cut. Over the years, many reports of drug companies providing financial and material perks for doctors has caused an erosion of public trust in medical professionals – and experts say that to repair that particular problem, it’s time for doctors to cut ties with the drug companies that provide the kick-backs.

A series of comments made by health policy experts in the British Medical Journal elaborate on the issue, saying that doctors might have to give up the freebies to win back public trust. From inexpensive prescription pads and pens to seminars at luxurious hotels, there are plenty of rewards for doctors who cultivate good relationships with drug companies.

Benefits of Winning Doctors’ Favor go to the Drug Industry

For the drug industry the benefits are obviously massive, especially so considering recent reports indicate that TV drug advertising is less effective these days than in the past at selling name-brand prescription drugs. That means drug companies are relying more than ever on doctors to prescribe the drugs the companies sell, and offering perks to doctors is the traditional method companies use to get more products sold.

Last year, however, concerns over the relationship between doctors and the drug industry increased after Iowa Senator Charles Grassley accused Harvard University psychiatrist Dr. Joseph Biederman, and other doctors, of failing to disclose payments they had received from certain drug companies.

Solutions to the Drug Industry Payola Problem

According to Dr. Marcia Angell of Harvard Medical School in Boston, the best solution is for doctors to simply cut their ties to the drug industry, once and for all – to stop accepting even the smallest gifts, and to recognize that their prescribing habits might be biased towards the companies they received those gifts from in the past.

Angell believes that instead of attending those cozy drug company-funded seminars, doctors should take personal responsibility for keeping up-to-date with their medical education. And, she says, professional associations shouldn’t allow drug companies to fund publications and meetings.

The meetings might be held in less luxurious surroundings, says Angell, but the results would be preferable, with more emphasis placed on impartial medical education rather than drug companies furthering their own agendas to sell more drugs.

photo credit: Navin75

After being accused of overcharging millions for health care insurance, one of America’s biggest insurers has agreed to a $50 million settlement pay-out.

Hundreds of people made complaints about charges made by Oxford Insurance, and its parent company UnitedHealth Group. The parent company claims that its reimbursement rates are based on “independent research from across the health care industry,” but an investigation by the New York Attorney General’s office revealed that it’s actually Ingenix, a research firm owned and operated by UnitedHealth Group, that supplies the data.

This isn’t just a case of conflict of interest, however – it gets much worse.

According to New York Attorney General Andrew Cuomo, Ingenix has been manipulating the data, allowing UnitedHealth Group’s Oxford Insurance to pay less for reimbursement of its customers.

Surprising Findings in the Health report

Cuomo’s report says that UnitedHealth Group has been under-reimbursing on an enormous scale, “to the tune of at least hundreds of millions of dollars:” in a “huge scam that affected hundreds of millions of Americans.”

In one example, Yonkers, New York, resident Mary Jerome ended up owing a whopping $46,000 for procedures that Oxford Insurance determined were not “usual, customary, or reasonable.”

So what were these unnecessary procedures – cosmetic surgery? No. Those procedures that the company decided did not require reimbursement were chemotherapy and other medications Mary Jerome needed to fight the ovarian cancer she was diagnosed with in 2006.

So far, only UnitedHealth Group and Oxford Insurance have been investigated. However, several other major insurance companies use data supplied by Ingenix. Among them are Aetna, CIGNA, and WellPoint/Empire BlueCross BlueShield.

UnitedHealth Group Response

UnitedHealth Group continues to deny the charges, saying instead that it agreed to the settlement only to solve the conflict, “We respectfully disagree with the New York Attorney General’s findings that we manipulated data … (or that our ownership of Ingenix was a conflict of interest.) We agreed to his settlement because it was an effective way to address any perceived conflict of interest.”

Ivestigations Continue

Cuomo’s investigations aren’t over. In light of the fact that several other large insurers use Ingenix data to determine patient reimbursement rates, the questions continue to pile up.

UnitedHealth Group’s $50 million settlement will be used in the creation of a non-profit, organization that will help determine reimbursement levels in a genuinely independent fashion.

photo credit: rick

Trees are good for your health – they suck up carbon dioxide and release oxygen, help reduce greenhouse gases and provide welcoming shade during the summer. But those aren’t the trees that have recently been in the news for helping to improve the health of many Americans. This time it’s family trees that are up for discussion – and electronic ones, at that.

Importance of Knowing Your Health History

The importance of knowing your family medical history can’t be emphasized strongly enough, according to Acting Surgeon General Steven Galson, whose office has been in charge of a new initiative to promote the use of a website where users can grow an electronic family tree to find out where their health risks lie.

The government’s new free service is hoping that people will compile their own family tree at home, and share the information with their families. Compiling an extensive and accurate family tree is even more useful than genetic testing to predict what your medical requirements might be in the future, experts say. It’s a highly useful tool for doctors, too, since it saves time and also provides lots of useful information about potential health risks. You can even use it as you’re applying, or looking into various family health insurance plans.

Significant Benefits of an Online Family Health Tree

The most significant benefit, perhaps, is that it’s likely to be more accurate than anything you remember off-the-cuff in a doctor’s waiting room. And by sharing the information with relatives from both sides of the family, it’s easier to compile an accurate family health tree that includes all the information that’s important.

The family health tree site at https://familyhistory.hhs.gov makes it easy to compile this information. The electronic tree you create can be easily mailed to relatives, who can add their own information into the tree. The information is entirely private, too. Information is downloaded to the user’s own computer, rather than being held on the web site.

Even more useful is the fact that a single click can “re-index” the tree to concentrate on showing the health risks of any relative on the tree – so it’s useful for everyone, not just the person who creates it.

Another benefit is the fact that environmental and lifestyle factors can be added to the tree – factors that are often forgotten during doctor’s visits. The family tree can be printed out or even emailed directly to your doctor, ensuring that none of that valuable information is lost.

photo credit: Wolfiewolf