Unbiased Analysis of Today's Healthcare Issues
What percentage of your prescription drug costs should your insurance company cover? You may say “100%, of course!” However, if health insurance cover all pharmaceutical costs this will drive up premiums. One solution to this problem is reference pricing. If generics are available for $10 and name brand drugs are available for $100, the…
Wisconsin’s Medicaid plan covers children from 0-5 years old whose parents have income below 150% of the poverty line. Sixty percent of Massachusetts residence receive coverage through their employer compared to 53% nationwide. Forty-six percent of Californian firms with less than 50 employees offer health insurance compared to the national average of 43%. How did…
For many illnesses, Medicare pays physicians a lump sum for the entire episode of care. This is known at the prospect payment system (PPS). But how does Medicare determine the payment amount? How should Medicare determine the payment amount? Medicare generally looks at 1) what treatments are generally used on average to treat a patient…
Medicare was implemented in 1965 to cover the medical costs of the oldest members in society. In 1965, the U.S. life expectancy was only 70 years old. Now, however, life expectancy at birth is over 78 years. Medicare is now not just covering the oldest of the old, it also covers the “moderately” old since…
Recently, the San Diego Union Tribune reported that the Sharp Grossmont Hospital in eastern San Diego county was cited for a number of preventable deaths. Reporter Cherl Clark found numerous problems, which included: “staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition,…
The U.S. is in a huge amount of debt. This will only worsen in the short- to medium-term as the the baby boomers retire and Medicare and Social Security budgets balloon. Here’s a movie about it. “This country has started consuming more than it produces.” – Warren Buffet
The controversy as to how much Medicare should pay doctors is continuing to brew (see N.Y. Times article). Congress passed a law overriding a pay cut to Medicare doctors. Although the president vetoed the bill, Congress garnered enough support to override the veto. Dr. Rich of The Covert Rationing Blog claims that the Medicare reimbursement…
As I noted in an earlier post, choosing a Medicare part D plan is difficult. However, there are resources to help people choose a Medicare Part D plan based on which prescriptions they are taking and where they live. Medicare has its own Personalized Plan Search. The private sector also has come up with user-friendly…
According to an article on TheHill.com, Medicare denies more claims than commercial insurers. “Medicare was the most likely to deny any part of a claim, with a 6.9 percent rate. Aetna was a close second at 6.8 percent while the others ranged from 2.7 percent to 4.6 percent. Coventry Health had the fastest median turnaround…
According to a report by the The Colorado Health Institute, 68 percent of rural and 74 percent of urban dentists do not accept Medicaid patients. Even for those dentists who do accept Medicaid, many are not accepting new Medicaid patients. The full report is available here.