This post comes from the Wausau Daily Herald. Imagine how many deaths lack of health insurance contribute to in California if there are this many in Wisconsin. ” Having health insurance isn’t a nicety — it might be a matter of life and death, according to a new report.

Nearly five people between the ages of 25 and 64 die each week in Wisconsin because they lack health insurance coverage, according to a new report by Families USA, a national organization promoting the interests of health care consumers.

“Our report highlights how our inadequate system of health coverage condemns a great number of Wisconsinites to an early death, simply because they don’t have the same access to health care as their insured neighbors,” said Ron Pollack, executive director of Families USA. “The conclusions are sadly clear — a lack of health coverage is a matter of life and death for many Wisconsinites.”

Though the report did not examine the role of not having enough insurance plays in premature death, insufficient health coverage likely increases the death toll because people might delay or forego health care because of the cost, said Robert Kraig, program director for Citizen Action of Wisconsin.

Read the fully story in tomorrow’s print and online editions of the Wausau Daily Herald.”

AP - Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed.”Costs are soaring in this area, quality concerns are mounting and safety concerns are mounting,” said Karen Ignagni, chief executive officer of the trade group America’s Health Insurance Plan.

Health insurers are requiring more pre-authorizations before patients can receive these scans, and setting other restrictions including mandating that the imaging equipment and medical staff operating it be credentialed in advance.

Insurers fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray. Sometimes scans are repeated because the first ones were not done properly, using outdated equipment or by poorly trained technicians.

Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren’t needed or are ordered as “defensive medicine” to protect against possible lawsuits. There also is concern that a small number of unscrupulous doctors without adequate expertise are referring patients for tests in their own offices or imaging facilities in which they have a financial interest.

“There is a definite concern that in-office imaging could lead to scanning for dollars,” said Dr. Robert Hendel, a heart specialist who sits on American College of Cardiology panels focused on quality and appropriateness of imaging.

But doctor experts say the bigger problem with medical imaging tests is the insurance red tape needed to get them.

“Is this a preauthorization process or are these (insurance) companies practicing medicine?” asks Dr. Arl Van Moore, board chairman at the American College of Radiology, the specialists in medical imaging.

Moore cited another reason for increasing costs: Doctors sometimes order a diagnostic test that doesn’t need preauthorization — even if it provides less-helpful information than the one they prefer — then seek approval for a more advanced test if the first one shows it’s needed.

Worse yet, sometimes patients end up getting a riskier, more invasive test than what they really need, said Hendel. For example, cardiologists wanting to assess blood flow and blockages inside a patient’s heart arteries would prefer a nuclear cardiology test. With that, a small amount of a radioactive substance is injected in the blood and tracked using a camera.

Some doctors will instead order a cardiac catheterization, which doesn’t require advance authorization, Hendel said. But that involves threading a catheter through a blood vessel up into the patient’s heart — and carries a 10-times higher risk of complications such as a heart attack or stroke, he said.

The two doctor specialist groups are fighting improper use of scans by supporting accreditation of the machines and doctors using them and by publicizing criteria for quality and appropriateness of various imaging tests.

“There is substantial evidence that these types of techniques, when used appropriately — and I want to emphasize the word ‘appropriately’ — can keep the lid on expenses and improve outcomes,” such as by catching cardiac problems early enough to prevent a heart attack, Hendel said.

Patients who are inconvenienced tend to blame the doctor and office staff, Hendel noted.

“They (patients) show up expecting a test to be performed. We’ve booked a slot,” and then discover the problem, Hendel said. “We have no choice but to reschedule. Are they upset? Yes!”

He said use of strategies to hold down imaging costs was fairly limited until last year, when it really ramped up, triggering the growth of a new industry of insurance consultants called radiology benefit managers.

A recent study by the Center for Studying Health System Change, which is funded by the Robert Wood Johnson Foundation of Plainsboro, N.J., the nation’s biggest health care charity, also found that limitations on use of MRIs, CT scans, PET scans and nuclear cardiology imaging became widespread last year. The report was based on visits and interviews in 2007 with officials of health plans, hospitals, doctors’ practices, major employers and others in 12 metropolitan areas.

The report noted use of CT scans in the U.S. nearly doubled between 2000 and 2005, from 12 scans per 100 people to 22 per 100. That’s partly because improved technology has made the imaging machines, which can cost $1 million to $2 million each, useful for diagnosing more problems.

“The hospitals and physicians purchase it, and then there’s a strong incentive to use the equipment,” said Ignani, the insurance trade group CEO, adding that manufacturers aggressively market the machines.

Revenues from the tests, which can run $500 to $1,000 or more apiece, can be tempting to financially struggling hospitals and doctors squeezed by shrinking reimbursements from government health programs and commercial insurers. At least one medical education firm is pitching a training conference titled: “Practice Expansion for Primary Care Physicians: How to Grow Your Income by Adding In-Office Imaging!”

The insurer restrictions seem to be working: After one health plan that was seeing 20 percent annual jumps in advanced imaging use began requiring preauthorization, its growth rate plunged. Yet the insurer said only 1.5 percent of requests were being denied, indicating doctors were ordering fewer tests, according to the report.

“Most health plans believe it’s been successful,” said Ann Tynan, the study’s lead author.

Insurers are looking at ways to put similar restrictions on other high-cost areas, and some already are doing so for stomach-reduction surgery and very expensive medications, she said.

Doctors see some hopeful signs, though, after passionate arguments by physician groups reversed changes they were fighting.

The Medicare program is trying to find ways to hold down its spending on imaging services after the annual cost jumped from $6 billion in 2000 to $12 billion in 2005. It had proposed no longer paying for cardiac CT scans unless patients were enrolled in a study of their effectiveness. In mid-March, it said it would continue to cover the scans.

And Horizon Blue Cross Blue Shield of New Jersey, the state’s biggest insurer, recently halted a plan to require preauthorization for relatively inexpensive EKGs, or echocardiograms, even though it is starting to require advance approval for expensive cardiac imaging.

On the Net:

• Study by Center for Studying Health System Change: http://hschange.org/CONTENT/968/

This post comes from AAFP.

“The health care proposals put forth by the leading presidential candidates may differ sharply in their approaches to health care reform, but the common factor among them is that none of the plans represents a profound or fundamental change to the nation’s health care system.

“Neither party is focusing on fixing the structure of health care, so it would be a big mistake to think this is a debate around structurally re-changing health care,” said Robert Blendon, Ph.D., professor of health policy and political analysis at the Harvard School of Public Health in Cambridge, Mass. “It is a debate about offering people more insurance choices, better insurance choices or some insurance choices. It is not a debate about restructuring the health care system.”

“The idea that we are going to rebuild the health care system in one sweeping piece of legislation is not on this election’s agenda,” added Blendon, who directs both the Harvard Opinion Research Program and the Henry J. Kaiser National Program on the Public, Health and Social Policy.” Click here to read the rest of this article.

This article is from The Washington Post.

People leaving a workplace group-insurance plan have some options that others in the individual market do not. First, under COBRA, which applies to workers at companies with 20 or more employees, you have the right to continue on your employer’s plan for up to 18 months, and in some cases longer. This means you can keep the coverage you had and don’t need to worry about being turned down because of illness or a “pre-existing condition.”

The hitch is that you no longer pay just the employee share that you probably had to cover when you were on the job. Now you’ll have to pay the entire premium and perhaps a 2 percent administrative fee allowed by the law. The amount can top $1,000 a month for a family, based on the average cost to employers of nearly $12,000 per employee for health insurance last year. It’s not surprising that only about 20 percent of workers eligible for COBRA coverage take it.

However, if you had a good plan at work, experts said, it’s likely to be better than anything you can get in the individual market. Sign up “if you can possibly swing it, especially if you have a pre-existing condition,” said Nancy Metcalf of Consumers Union. Not only do you get the coverage you are used to but it also “preserves your right to buy insurance” in the individual market when your COBRA benefit runs out, she said.

Continuing in a group plan, which you do under COBRA, makes you “HIPAA-eligible” when you enter the individual market. HIPAA requires states to have at least two policies available without pre-existing condition exclusions. If a state doesn’t have those two policies available, then it must set up an assigned risk pool, which is an arrangement under which insurers in the state share the coverage for people unable to buy a policy on the open market. However, HIPAA doesn’t regulate what the carriers of the policies can charge, though some states do.

One of the big differences among governments in the Washington area is that while the District and Virginia have opted to have certain carriers offer HIPAA-eligible policies, which are expensive, Maryland offers a state-sponsored assigned-risk pool, called the Maryland Health Insurance Plan.

MHIP has four policies: two PPOs (preferred provider organizations), one with a $500 deductible and the other with a $1,000 deductible; a health-maintenance organization; and a high-deductible plan that can be used with a tax-deductible health-savings account. Premiums range widely, depending on the plan, and rise with age. For parents in their 30s and 40s, monthly premiums for several family plans are in the $400 to $600 range (cheaper for the higher-deductible plan).

MHIP is open to Maryland residents who have lost group coverage and exhausted their COBRA benefits, as well as to residents with certain diseases or who have been turned down by private insurers in the individual market. For details, go to http://www.marylandhealthinsuranceplan.state.md.us.

Finally, when considering COBRA and HIPAA options, remember that there are deadlines to be met. You have a right under the law to COBRA benefits, but you lose that right if you fail to exercise it within 60 days of the termination of your group coverage. You have 63 days from the expiration of COBRA coverage to apply for HIPAA-eligible coverage.

This post comes from CNNMoney.

Consumer-directed health plans are gaining traction among America’s largest employers - and their workers - as evidence emerges about the potential costs savings, according to a survey released Thursday.

Around half of large U.S. employers - 47% - now offer a CDHP, up from 39% last year. By 2009, 54% of companies plan to offer a CDHP, according to study by consulting firm Watson Wyatt and the National Business Group on Health, or NBGH, a nonprofit association of nearly 300 large employers, including General Motors Corp. (GM) and Wal-Mart Stores Inc. (WMT).

CDHPs are aimed at lowering insurance premiums for individuals and employers by giving consumers more control over - and a bigger stake in - health spending. CDHPs pair a high-deductible health plan with personal health savings accounts - typically a health savings account, or HSA - that can be used to fund medical expenses not covered under the plan on a tax-free basis. The Bush administration says such arrangements can make health care more affordable for American families.

Enrollment in CDHPs is increasing as a larger number of employers offer these types of plans and employees becomes more comfortable with these relatively new products. Around 15% of workers at employers that offer CDHPs are currently enrolled in such plans, up from 10% in 2007, according to the WW/NBGH survey. The survey involved 435 companies employing about 8.4 million workers in the U.S.

Faced with inflation-topping health-care cost increases, American employers are looking for ways to reduce medical expenses. Overall, companies with a CDHP saw healthcare costs increase by 5.5% over the past two years - a lower rate than the 7% increase experienced by companies without a CDHP. Enrollment rates in CDHPs “are strongly linked” to lower health-care cost trends, according to the study. Employers with at least half of their workforce enrolled in a CDHP had a two-year median cost trend of 3.6%, almost half that of companies without a CDHP. The survey didn’t examine the cost-benefits to employees.

“A CDHP offers a way for companies to control costs while increasing employee accountability for health care decisions,” said

Ted Nussbaum, Watson Wyatt’s director of group and health care consulting in North America.

The study’s authors note that the slowdown in cost increases is likely to be more pronounced during the first few years of adoption of a CDHP and might not reflect a sustainable trend. Educating workers about their health-care options and dedicating more resources to wellness programs that nip health problems in the bud before they develop into costly chronic conditions is another important factor.

Companies with more than 20% or more of their workers enrolled in CDHPs are more likely to offer employees to manage their own health than businesses who don’t offer these plans. Such tools include side-by-side plan and healthcare- provider comparisons and personalized reminders for preventive procedures, such as annual physicals.

“Actively involving more workers in their health care and giving them the resources to make educated decisions can be a challenge, but it should be embraced. The end result can be a mutually beneficial system for both companies and their workers,” says NBGH President

Helen Darling.

Counting The Cost

CDHPs have lower premiums than traditional types of plans, but enrollees have to pay more out-of-pocket before their insurance kicks in. Employees can offset these out-pocket expense with funds saved in their HSAs. Health status, income and any employer contributions are important factors to consider when deciding whether a CDHP is the right choice.

For instance, such arrangements tend to favor the young and healthy, those who receive employer contributions to their HSAs or those who can afford to cover out-of-pocket medical expense while fully funding their HSAs. HSAs are less favorable for lower-income unhealthy people because out-of-pocket expenses increase with the amount of health-care services you use, and the tax advantages aren’t as great for people in lower brackets. In this scenario, paying more up front in premiums is likely to be a more cost-effective option, financial advisors say.

Typically, employers offer CDHPs as an option alongside traditional types of insurance plans, such as preferred-provider organizations, PPO, and health maintenance plans, HMOs. Only 6% of companies report 100% enrollment in a CDHP, but that number is expected to rise to 9% in 2009.

This article comes from The New York Times.

After more than a decade of struggle, the House on Wednesday passed a bill requiring most group health plans to provide more generous coverage for treatment of mental illnesses, comparable to what they provide for physical illnesses.

The vote was 268 to 148, with 47 Republicans joining 221 Democrats in support of the measure.

The Senate has passed a similar bill requiring equivalence, or parity, in coverage of mental and physical ailments. Federal law now allows insurers to discriminate, and most do so, by setting higher co-payments or stricter limits on mental health benefits.

“Illness of the brain must be treated just like illness anywhere else in the body,” said Speaker Nancy Pelosi, Democrat of California. Supporters of the House bill, including consumer groups and the American Psychiatric Association, said it would be a boon to many of the 35 million Americans who experience disabling symptoms of mental disorders each year.

Insurers and employers supported the Senate bill. Many opposed the House version, saying it would drive up costs.

President Bush endorsed the principle of mental health parity in 2002. But on Wednesday, the White House opposed the House bill, saying it “would effectively mandate coverage of a broad range of diseases.”

Both bills would outlaw health insurance practices that set lower limits on treatment or higher co-payments for mental health services than for other medical care. Click here to read the rest of this article.

This article comes from Healthy Times Online.

“Healing is a matter of time, but it is sometimes also a matter of opportunity.”
Hippocrates, Precepts, Greek physician (460 BC - 377 BC)

Did you ever wonder why the flu or a cold can afflict almost everyone in the office and one person just never seems to come down sick? Why does someone get the sniffles while another person is miserable for weeks?

Like the growth of any living thing, a disease needs a hospitable environment in which to prosper. When a person’s immune system is up to the job, the infection is fought off without difficulty. If the strength of a person’s immune system is not up to the job, then the person gets “sick.” The lack of sickness in a person often has more to do with the power of the person’s health and less to do with what “bugs” they may encounter.

Our capacity to live and grow is sometimes known as vitality. Vitality is the energy and healthy capacity for activity that each one of us possesses. It is not just the absence of disease but a natural active force present in all living forms. It is difficult to define vitality because vitality is measured only indirectly by its effects. Sort of like measuring electricity – when we press the light switch on we know electricity is present by the way in which the lights go on or not. The same works with the vitality present in our bodies. If we have enough, everything works well.

Modern medical science has even developed a separate field of study, called psychoneuroimmunology, which examines the integration of the mind and the body in the defense against infection. Excessive strain on our minds (something we all know as stress) can affect our health in the same way as too much damage to parts of our body. Both situations can leave us open to poor health. What modern medical study is discovering is that there are many complicated factors that comprise the “health” of a person. Click here to read the rest of this article.

Are you interested in learning more about your current state of fitness? Wait no more! Take a fitness quiz or check out the 2008 National Body Challenge courtesy of Discovery Health and Fallbrook Hospital.