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Tuesday, June 17, 2008

Access to Health Care

Ben Bernanke on Challenges for Health-Care Reform:

Access to health care is the first major challenge that health-care reform must address. In 2006, a total of 47 million Americans, or almost 16 percent of the population, lacked health insurance. ...[T]he evidence ... indicates that uninsured persons receive less health care than those who are insured and that their health suffers as a consequence. Per capita expenditures on health care for uninsured individuals are, on average, roughly half those for fully insured individuals. People who are uninsured are less likely to receive preventive and screening services, less likely to receive appropriate care to manage chronic illnesses, and more likely to die prematurely from cancer--largely because they tend to be diagnosed when the disease is more advanced. One recent study found that uninsured victims of automobile accidents receive 20 percent less treatment in hospitals and are 37 percent more likely to die of their injuries than those who are insured.

Update: More on health care from Dean Baker:

Insurance fraud, by Dean Baker: The health insurance system in the United States works great, as long as you stay healthy. It's only people who need medical care who have problems.

The basic story is that however bad the system might look on paper – we pay twice as much per person as people do in other wealthy countries, yet have worse health outcomes, and still have 47 million people without insurance - it is much worse in practice.

Let's start at the most basic level. You go to the doctor, paying directly, and then send your bill to the insurance company for reimbursement. The insurance company sends you a form letter rejecting the claim. It happens all the time.

Persistent people call their insurer and demand to know the reason the claim was rejected. ...

Very persistent people call the insurer and demand to know the reason the claim was rejected. ...

Extremely persistent people call the insurer and demand to know the reason the claim was rejected. ...

OK, my wife and I actually enjoyed this set of exchanges with our insurer. At the end of the day, we ... were reimbursed as provided under our plan. But, we are extremely persistent, well-educated people who know our rights under the insurance contract.

Suppose the denial had gone to someone who is not very well educated, speaks poor English or does not have the physical or mental wherewithal to fight back? That person might just have assumed that the insurance company was right to turn down their claim and not contested the issue. Or, if they contested it once, they might have let it drop after the first round or the second.

From the standpoint of the insurance company, the denial of a claim is almost a no-brainer. For the price of a letter, they can save themselves reimbursements that can run into the thousands of dollars. In the worst case, they encounter persistent people... In that case, they only end up paying what they would have shelled out in the first place... They don't face any fines or penalties for wrongly denying claims.

Insurers don't generally give out the basis under which they deny claims. Nor do they generally reveal how often they deny claims. How can a person intelligently decide between insurers if they don't even know how likely they are to see a claim denied? ...

The current law basically gives insurers a free hand to abuse patients. ...

The next president must have healthcare reform at the top of the domestic agenda. Reform should ... make healthcare affordable to all. ...

Reform should also include more balanced regulation of the private insurance system. Insurers should be forced to disclose the treatments they cover and under what circumstances, ... and they should be publicly accountable for the conditions under which and the frequency with which they deny claims. ...

    Posted by on Tuesday, June 17, 2008 at 12:24 AM in Economics, Fed Speeches, Health Care | Permalink  TrackBack (0)  Comments (40)


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