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Tag: cost of healthcare

Harvard Ideas on Health Care Hit Home, Hard

For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.

The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

“Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”

In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven by health care reform,” in the form of the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.

Read the full article http://www.nytimes.com/2015/01/06/us/health-care-fixes-backed-by-harvards-experts-now-roil-its-faculty.html.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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The Health Insurance Letter You Never Want to Get

I was reading the December 18th issue of Inside Health Insurance Exchanges and came across an article entitled, “New Kids on the Block Come Out Swinging; Co-Ops Lower Rates for Many Health Plans.”

The gist of the article had to do with the success a number of Obamacare insurance co-ops have had in charging lower rates and getting lots of market share by “[underpricing] more established players inside and outside of the public insurance exchanges.”

The article went on to point out that some traditional competitors are beginning to complain that the co-ops have unfair advantages.

This quote from the CEO of CoOpportunity––the market leading Iowa and Nebraska Obamacare funded co-op that enrolled 120,000 people in 2014––stood out:
For Blues plans and other carriers “with deep reserves, booming stock prices and market entrenchment to plead for relief from these nimble, undercapitalized start-ups is ludicrous and insulting,” counters CoOpportunity Health CEO Cliff Gold. He says his company has been successful in attracting customers in two states despite not having the lowest cost products anywhere in Iowa or the most populous part of Nebraska. “At the end of the day, in the long term, success is determined by a company’s ability to create value for customers, he tells HEX. “That critical but elusive combination of price, product features, provider network, and customer service is what separates competitors.”

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Discussions With Your Physician Article Series: : Drugs, Effective for the Few, Prescribed to the Many

Most of us trust, or at any rate hope, that the benefits of a drug our doctor prescribes will outweigh the side effects. Why else would we take it? We would probably be shocked to learn that most drugs don’t do anything good for the majority of the people who use them. That’s probably because we picture a simple cause-and-effect relationship, like antibiotics curing an infection.

“But most chronic diseases involve a complex chain of biochemical interactions,” says Dr. Jonathan St. George, assistant professor of emergency medicine at Weill Cornell Medical College. “The idea that you’re going to take one drug that affects one pathway and dramatically change the course of the illness is just pie in the sky.” The statistical measure that crystallizes this inconvenient truth is the NNT, or “number needed to treat” – that is, the number of people who have to take a drug in order for one person to benefit. There are plenty of popular drugs with NNTs over 50, and a drug with an NNT of five or fewer might fairly be considered a wonder drug – for instance, sumatriptan for migraines or steroids for kids with croup. “But if I told my patients that the drug I was prescribing them had only a 20 percent chance of working,” St. George says, “they’d look at me like I was crazy.”

The reason you’ve probably never heard of the NNT is that the pharmaceutical industry ignores it when marketing its wares to the public. According to Newman’s website, thennt.com, which crunches the best available research data to arrive at NNTs for common tests and therapies, statins have an NNT of 60 – meaning 60 people would have to take a statin drug for five years to prevent one person from having a nonfatal heart attack. Not one heart attack death would be prevented.

Picture a similar effect this way: a study in which a control group of 1,000 people taking no heart medication suffered 24 heart attacks over a five-year period, while the group on statins suffered 16. Because these numbers are small, even relatively minor differences between the incidence of heart attacks translate into an impressive-sounding difference, when you measure it as a percentage – the so-called relative risk. Now you’ve got the makings of a pharmaceutical ad campaign: “Statins reduce heart attacks by 33 percent.”

It gets worse. Stanford epidemiologist John Ioannidis got the medical world’s attention in 2005 with a journal article titled “Why Most Published Research Findings Are False.” In it he notes that 80 percent of published drug studies are funded by the drug industry, and that some 30 percent of all drug studies are never published, presumably mostly the negative results that never enter into the final cost-benefit reckoning.

Read the full article here.

It’s important to keep in mind that while we criticize and critique our health care system, we should not minimize the value of the persons who have dedicated themselves to the study of medicine. When we or one of our love ones are sick we are often beholden to the artful and skilled physician. However, as a patient or concerned loved-one asking good questions should always be encouraged.

The Men’s Health article Drugs, Effective for the Few, Prescribed to the Many is worthy of your review.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Discussions With Your Physician Article Series: When to Say No To Your Doctor

It’s been a couple of years, so you decide to see your primary-care physician for a physical.

You feel fine, but it’s the responsible thing to do. You get your blood pressure measured and your blood drawn. Within a few days you’ll get the lab report that will give you the readout on the amount of cholesterol and sugar in your blood. (This drill is so routine that you and your doctor don’t even discuss the implications of a possible bad test result.) If you’ve entered your middle years, he’ll probably ask if you want the lab to test your blood for PSA, a screening test that can tell you if you’re at an elevated risk for prostate cancer.

You figure it’s probably good to get out in front of these things, so you nod yes. Insurance covers it anyway.

Congratulations – you’ve just stepped onto a conveyor belt pulling you into a broken system that delivers disappointing results at ever-increasing cost. To wit: The United States spends roughly twice as much per capita as most of the nations of Western Europe, whose citizens on average outlive us by a couple of years. Our own national Institute of Medicine says we waste $210 billion annually on treatments of no or marginal benefit. In a study last year, researchers from the Mayo Clinic went through 10 years of the New England Journal of Medicine, from 2001 through 2010. Of the established tests and procedures reevaluated in studies in the journal, 40 percent were found to be worthless.

Read the full report here.

It’s important to keep in mind that while we criticize and critique our health care system, we should not minimize the value of the persons who have dedicated themselves to the study of medicine. When we or one of our love ones are sick we are often beholden to the artful and skilled physician. However, as a patient or concerned loved-one asking good questions should always be encouraged.

The Men’s Health article When to Say No to Your Doctor is worthy of your review.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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A Misleading Debate on Health-Care Costs

David Leonhardt of the New York Times has offered up a misleading defense of the Affordable Care Act (ACA) — i.e., Obamacare. Like several others, he celebrates the slowdown in health-care-cost escalation and suggests that the ACA is one reason for the deceleration. Specifically, he suggests that key ACA provisions — which he describes as nudging “the health care system away from paying for the quantity of medical care rather than the quality” — have already played a role in making the health system better and more efficient.

It would be an effective argument for the ACA if it were true. Unfortunately, it isn’t.

Leonhardt is responding to the recent government announcement that national health spending rose 3.6 percent in 2013. That’s certainly a low growth rate — well below the long-term trend over the past several decades. But it isn’t a trend that began with passage of the ACA.

In 2001, national health spending rose 8.5 percent. The following year it rose 9.6 percent. But then the annual growth rate began to drop, and by 2008 health spending was rising just 4.8 percent. Put another way, the growth rate of national health spending was cut in half during the time of the Bush presidency. Did the ACA cause this?
In the first two years of the Obama administration, health spending growth remained moderate. In 2009, health spending rose just 3.8 percent, and in 2010 it rose 3.9 percent. The ACA wasn’t enacted until March 2010.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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