Entries Tagged as 'health policy'

Oligopoly and Regulatory Capture

This is what oligopoly and regulatory capture looks like2012 Cost per US Hospital Day:

Health Insurance Russian Roulette

Half of the [United States] insured population uses virtually no health care at all. The 80th percentile uses only $3,000 [the 95th percentile has] only $11,487 in costs. It’s the 99th percentile, the people with over $35,000 of medical costs, who represent fully 22% of the entire nation’s medical costs … An individual adult insurance plan is roughly $7,000 … It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesn’t make a lot of sense for the insurance company to take the nuclear option of blowing up the policy. $11,487 in claims is less than two years’ premium … If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% … If, as I suspect, rescission is targeted toward the truly bankrupting cases – the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier – then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two. You have three times better odds playing Russian Roulette.

A Plague of Doctors

El Paso County, eight hundred miles up the border, has essentially the same demographics … Yet in 2006 Medicare expenditures … in El Paso were $7,504 per enrollee—half as much as in McAllen … Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Alms Enforcement

Buried on Page 31 of the [US Senate Finance Committee's policy reform document] was a proposal to “Modify the Requirements for Tax-Exempt Hospitals,” which would require nonprofit hospitals to maintain minimal levels of charitable activity, limit aggressive collections, and restrict charges to the uninsured and indigent. The proposed penalties for noncompliance are severe: Hospitals that can’t prove their “community benefit” will lose the tax benefits associated with nonprofit status … $93.5 billion in federal subsidies are provided every year in the form of tax breaks. But research shows that nonprofit hospitals behave no differently from for-profit ones.

Sick Grade

The U.S. fell to last place among 19 industrialized nations on mortality amenable to health care—deaths that might have been prevented with timely and effective care. Although the U.S. rate improved by 4 percent between 1997–1998 and 2002–2003 (from 115 to 110 deaths per 100,000), rates improved by 16 percent on average in other nations, leaving the U.S. further behind.