Access To Care: Fact or Fiction?

Insurance is a huge piece of the overall health care puzzle. Make no mistake about that. As with any puzzle, there are many many other pieces that need to be put in place in order to complete it. eMax Health went undercover in the land of red tape and now share what they have found:

When interviewers posing as Medicaid patients called doctors’ offices that participate in the Florida Medicaid program, they were met in some cases by disconnected numbers, phone trees and time on hold before they could find out about scheduling an appointment.

How many of you, our readers, find that eerily familiar? With insurance (i.e. Medicaid) access to care is supposed to be assured. At least that is the common perception. Many low income families who rely on Medicaid would probably point out that it can often feel like access in name only.

Weekend and evening appointment times in some instances were scarce and some providers who said they were willing to take new patients proved to be less willing when they found out the new patient was part of the Medicaid program.

Hardly a surprise is you do some digging and see how low the actual reimbursement from Medicare to providers is. Do a little Googling, the results will probably shock you.

The study, which occurred in 2004, found that nearly 87 percent of the doctors in Florida’s Medicaid primary care case management program (MediPass) program told the interviewers that they would accept new patients, but only 68 percent said they were accepting new Medicaid patients.

While each of these problems might seem relatively small compared to the lack of insurance that keeps some patients away from regular care, Allyson Hall, Ph.D., and colleagues at the University of Florida argue that they can affect access to health care in significant ways.

“If an individual has a particularly difficult time getting in to see the usual physician, we could reconsider whether that physician is actually acting as a regular source of care for that patient,” the researchers write in the May 2008 issue of the Journal of Health Care for the Poor and Underserved.

The article goes on to examine aspects of the report in more depth, even bringing in some complementary data from a 2007 study done in Oregon. I predict that this is far from the last article we will see on this subject as election season progresses.

This issue is one that points out two major and related problems: the actuality of health care access and the reticence of providers who many times operate at a loss due to reimbursement rates from government plans. While profit may be vulgar to bring up, keeping a business (or medical practice) viable does require making more than you spend. For doctors this is a major sticking point. At the same time there is the plight of the low income American, lucky enough to have insurance but frequently stymied when attempting to use it.

Thank you for calling the United States. If you are experiencing a health care emergency please press "1"...

SOURCE: "Insured, Low-Income Patients Face Hurdles To Health Care Access" 05/08
photo courtesy of fuzzcaminski, used under its Creative Commons license

With This Ring I Do Thee Insure

As a relatively recently married man, I remember well the vast array of concerns and issues that revolved around both the decision to get hitched and the process itself. One factor that did contribute somewhat to our decision was the fact that my wife had health insurance through her work at a major university. As a freelance writer and blogger, I did not.

While for us it was a tertiary concern, a recent study shows that a small but significant percentage of the population base their decision to marry on the issue of health insurance. Ricardo Alonso-Zaldivar of The Houston Chronicle shares the results of this intriguing survey:

In a poll released Tuesday, 7 percent of Americans said they or someone in their household decided to marry in the past year so they could obtain health care benefits via their spouse.

"It's a small number, but a powerful result, because it shows how paying for health care is reflected not only in family budgets, but in life decisions," said Drew Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on health care.

Now as I said, it was one factor among many for my wife and I. Not a deal breaker or deal maker, but worthy of consideration. That said, I know two couples that did finally decide to tie the knot because of health care and insurance issues. A situation that is vexing to say the least. Maybe I am just a romantic at heart, but I do not think that health care should have to be a factor when deciding whether or not to purchase a wedding ring.

It's not just marriage that is being impacted either:

The survey found that the costs of health care outranked housing expenses, rising food prices and credit card bills as a source of concern.

Of those surveyed, 28 percent said they had experienced serious problems because of the cost of health care, nearly tied with 29 percent who had problems getting a job or a raise.

The state of health care in the United States is truly at a crisis point. What this nation needs is health care reform, and we need it now.

SOURCE: "Poll: 7% of Americans marry for health insurance" 04/29/08
photo courtesy of babasteve, used under this Creative Commons license

211: Hotline to Care

211. That's the number Detroit residents who lack insurance will soon be able to call for health care assistance. Patricia Anstett, medical writer for the Detroit Free Press, reports the details:

The Safety Net Resource Center is to begin operations within the next few weeks, run by the Detroit Wayne County Health Authority and 25 community organizations.

Callers to United Way's 211 hotline will receive information on where to find free care, said Chris Allen, chief executive officer of the health authority. The authority, which helps coordinate information on uninsured and underinsured people in the area, is able to offer the additional help because federal and state funds have helped the agency's budget grow from $2 million several years ago to $8 million today, Allen said.

With the millions of uninsured in the U.S., it is surprising that this is the first time I have run across an initiative of this nature. One of the objectives is to connect patients with a "medical home," a place where their medical care needs are centralized. Allen is quoted as saying of medical homes, "It's where they belong, not in the emergency department."

The 90,000 uninsured of Detroit's east side are the initial primary target of the program.

SOURCE: "211 hotline to free care nears" 04/28/08
photo courtesy of tj_scenes, used according to its Creative Commons license

Mind The Gap: The Insurance Gap

Michelle Singletary shares her perspective on why the plight of the American uninsured affects all of us in her column for The Courier-Journal in Louisville, KY:

The cost for those with coverage is escalating in part because the number of uninsured Americans keeps rising, said Ron Pollack, executive director of Families USA, a nonprofit organization that advocates high-quality, affordable health care for all Americans.

Using data from the Census Bureau, the federal Agency for Healthcare Research and Quality, and the National Center for Health Statistics, Families USA determined that the unpaid expenses for the uninsured added an average of $922 in 2005 to the premiums for employer-provided family health insurance. That extra cost could rise to $1,502 in 2010.

Increasingly, employers are shifting a larger portion of their health premiums to employees. You may be able to afford your policy today, but it's possible you may not in the future.

In pure and simple terms, the unpaid balances do not disappear. Instead, they get added to the balances paid by those with insurance. It is not exactly a slow process either. Singletary reports an increase of 78% in family premiums just since 2001!

She also explodes the myth that the uninsured are mostly poverty stricken. According to her reports, eight out of ten are employed, often at multiple jobs just trying to make ends meet. They are workers who fulfill important roles in our communities as caregivers and in small businesses.

The plight of the uninsured does not occur in a vacuum. Its economic impact alone touches every American in every socio-economic strata.

SOURCE: "Health-care insurance gaps affect all of us" 03/30/08
Photo courtesy of fabio, used under its Creative Commons license

Wal-Mart Makes Health Care Announcement

In an announcement today Wal-Mart Stores, Inc. stated that it has experienced a drop of more than 20 percent in uninsured employees over the past year.

Businessweek gives us a breakdown:

The world's largest retailer said only 7.3 percent of its workers reported being uninsured, down from 9.6 percent the year before. Wal-Mart, which union groups have targeted over health care, said more than half of its eligible employees received coverage under its health care plans, a first in recent reporting. [...]

Linda Dillman, an executive vice president of benefits and risk management for Wal-Mart, told reporters on a conference call Tuesday that the increased enrollment likely came from the company's new health care plan. The plan, which allows employees to customize their coverage, includes premiums as low as $5 a month and access to $4 prescription drugs.

"Everybody in this company is on the same set of plans," Dillman said. Wal-Mart president and CEO "Lee Scott made the same selection the newest part-time cashier at Wal-Mart did."

According to the interview, 50.2 percent of employees made use of the company's health care plan this year, an increase from 47 percent last year (46 percent in 2006, and 43 percent in 2005). The increase is attributed to positive changes made in Wal-Mart's health plan, changes which include lowered premiums and copays for Prescription drug, coverage for the children of part time workers and a shortened eligibility period.

State lawmakers have criticized Wal-Mart for allowing its workers to take part of state-funded health care for the poor. A confidential 2006 state study in Washington state showed Wal-Mart had 3,194 workers on Medicaid and the state's Basic Health Plan, more than any other private employer.

Dillman said the retailer had seen a slight drop-off in the number of employees saying they took part in state-sponsored health care coverage, but said the percentages stayed roughly the same.

"We did get some movement off of the plan, but we didn't see much change in terms of the total percentage," Dillman said.

As of this time Meghan Scott, a spokeswoman for WakeUpWalMart.com, a union-backed website critical of the company's shortcomings on this issue declined to comment.



SOURCE: "Wal-Mart says more workers insured" 01/2/08

photo courtesy of Code Poet, used under this Creative Commons license