JustCare

Tag: Cost

  • US continues to spend more for poorer quality care than other developed countries

    US continues to spend more for poorer quality care than other developed countries

    Once again, The Commonwealth Fund is out with a report showing that we spend way more than other developed countries for our health care and yet get far less for our money. We spend more per person on health care than every other country and more as a percentage of our gross domestic product. And, unlike every other country, we don’t have guaranteed health care for everyone. 

    We live shorter lives, with average life expectancy of  77 , the lowest life expectancy at birth by three years than other wealthy nations. Black Americans live shorter lives than white Americans, averaging 74.8, as compared to 78.8. And Native Americans still shorter, averaging 71.8. Hispanic Americans have higher life expectancies at birth, 81.9. And Asian American life expectancies are higher still, 85.6.

    Our people have multiple chronic conditions at the highest rate of all nations. We also have higher death rates for conditions that are preventable or can be treated. We have the third highest suicide rates. We have the highest infant and maternal mortality rates. We have 5.4 deaths per 1,000 births and 24 maternal deaths for every 100,000 births. And, we have the highest obesity rates.

    Not surprisingly, more people in the U.S. die from assaults, including gun violence.

    While our government’s focus is on overtreatment, we have far fewer physician visits than people in other countries. We also have proportionately fewer physicians and hospital beds than other developed countries. 

    As a percentage of GDP, we spend about twice as much as the average of other developed countries on health care, at nearly 18 percent. That percentage is growing as prices continue to rise, our population ages, and new technologies for treating patients are developed. 

    On a per person basis, we spend twice as much on total healthcare costs as Germany, the next highest-spending country. And, we spend close to four times as much as most other developed countries.

    Though other developed countries guarantee health care for all, through public health insurance, they generally also offer their residents the right to buy private health insurance. In the US, more than 26 million people—8.6 percent have no insurance at all, and tens of millions more are underinsured, often unable to afford care even though they have insurance. 

    Affordable care for everyone is critical to reining in costs and addressing these terrible quality of care US rankings. Right now, even with insurance, almost half of US residents skipped or delayed getting needed care because of the cost. In addition to reining in health care costs, we must ensure well-coordinated care, including primary care, starting with investing in more primary care providers. 

    Here’s more from Just Care:

  • Poll: Many more older adults delayed care because of cost in 2022

    Poll: Many more older adults delayed care because of cost in 2022

    Nearly four in ten Americans reported that they or a family member delayed health care last year because of the cost. That’s an all-time high and a huge increase from the year before. Even with Medicare, many more older adults also report delaying care.

    The Gallup poll shows a 12 percent increase in Americans skipping health care in 2022 from 2021. There was no change in people’s response to the question of whether they or a family skipped care between 2020 and 2021. But, 2022 was  a year of tremendous inflation, which has made life even more difficulty for most adults.

    Even more troubling is that Americans reported that they or their family members often delayed treatment for serious conditions in 2022. Of the 38 percent who reported delays in care, 27 percent said that the delays were for very serious or somewhat serious treatments.

    Not surprisingly, people with annual incomes under $40,000 were more likely to say that they or a family member had delayed care for a serious health condition (34 percent) than people with incomes above $100,000 (18 percent). And, 12 percent more people with lower incomes delayed care for serious conditions in 2022 than in 2021. People with incomes between $40,000 and $100,000 delayed care almost as much as people with incomes under $40,000 (29 percent).

    Women and younger adults also were more likely to report delays in getting medical treatments for serious conditions for themselves and family members. Almost one in three women (32 percent) reported delaying care in sharp contrast to one in five men. That’s an increase of 12 percentage points for women in just one year.

    About one in eight (13 percent) people with Medicare reported delaying care in 2022. That’s nearly double– a six percent increase–those reporting delays in care just a year earlier. Still, people with Medicare were less likely to report delaying care because of cost than working people and young adults.

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  • HCA hospital system is charged with overtreating patients to maximize its profits

    HCA hospital system is charged with overtreating patients to maximize its profits

    Last week, I wrote about a hospital that incorrectly charged a patient for a costly service it did not render and only corrected the charge a year later, as a result of intensive efforts on the part of the patient’s wife. Now, Kaiser Health News reports on HCA, a for-profit hospital system that is charged with overtreating and overcharging patients and insurers. The government needs to hold hospitals accountable for inappropriate bills and other bad acts.

    Kaiser Health News reports on a patient with Covid-19 who went to a hospital emergency room to get checked out at her PCP’s direction. Instead of sending her home after seeing her, the hospital admitted her as an inpatient for three days and charged her $40,000. Of that amount, her insurer charged her $6,000. In this case, the hospital was HCA, the largest hospital system in the country.

    In this case, the patient’s PCP did not believe his patient should have been admitted to the hospital. But, hospitals control these decisions. To maximize their profits, some hospitals might provide incentives for their doctors to refer ER patients for an inpatient stay, even when not medically necessary, according to some experts.

    Congressman Bill Pascrell of New Jersey is hoping for the government to investigate HCA to determine whether it is engaged in Medicare fraud. The claim is that HCA requires its doctors to meet hospital admission targets and admit patients even when patients don’t need to be admitted. The result is both financial harm and potential health risks for patients.

    The Service Employees International Union (SEIU) released a report earlier this year documenting the issues particular to HCA. SEIU argues that overcharges to Medicare over the last ten years amount to nearly $2 billion. But, HCA is not the only culpable hospital according to SEIU. SEIU has made similar claims against Community Health Systems and Health Management Associations. Both hospitals systems settled, for $98 million and $262 million respectively.

    It’s not easy to prove that a patient was overtreated and did not receive appropriate care. You need the doctor to speak out, as one doctor did against an HCA hospital in Miami. This doctor claims that HCA told him that he would lose his job if he did not move more ER patients into the inpatient unit of the hospital. The government refused to investigate and to speak to a reporter about why it refused.

    HCA profits were nearly $7 billion in 2021.

    Here’s more from Just Care:

  • How to ensure your hospital bill is correct

    How to ensure your hospital bill is correct

    Most of us do not check our health care bills too carefully. We do as we are told by the doctors and hospitals and pay our insurance deductibles and copays largely without questioning the bills. It can be difficult to make sense of the bills, let alone to figure out if a health care bill is correct.

    Bram Sable-Smith reports for Kaiser Health News on a billing expert who saved her family a lot of money by questioning her husband, Dr. Bhavin Shah’s, medical bill. The hospital charged Shah more than $3,000 out of pocket. It took more than a year for the hospital to recognize that the procedure it claimed to have performed had never been performed and correct its bill. It could afford to delay as it pays no penalty for billing errors. During the hospital’s extended bill review time, Shah’s bill was sent to debt collections.

    Here’s what you can do to ensure you are not overpaying for your medical care in hospital 

    1. When you receive a bill, immediately call the hospital and ask for an explanation of all the charges. Make sure that the bill is itemized, with standardized billing codes.
    2. Focus on the services with the biggest charges and compare the charges for those billing codes with charges for the same billing codes at other hospitals in your area. All hospitals are required to disclose this information. You can visit fairhealthconsumer.org for information on typical hospital charges in your area. You can also check Medicare’s online tool. You should be able to see whether your bill is comparable to bills at other hospitals or completely out of line.
    3. If your hospital charges a lot more than other hospitals, contact the hospital and challenge its charges. Also, complain to your health insurer. Or, if that doesn’t work, complain to your state attorney general’s office.
    4. Ask for your medical records. You might find that the medical records do not show evidence of services for which you were billed.
    5. To protect your credit score and avoid more hassle, ask the hospital to hold off sending the bill to a debt collector while it is being disputed.

    And, if your income is low, keep in mind that non-profit hospitals are required to offer some charity care.

    Here’s more from Just Care:

  • You can now buy hearing aids at the drugstore

    You can now buy hearing aids at the drugstore

    Finally, the day has come when you can buy hearing aids at the drugstore, as well as Walmart and other big box stores. No need for a visit to the audiologist or a prescription, reports Phil Galewitz for Kaiser Health News. And, no need to pay thousands of dollars in order to hear properly, at least for the millions of people with mild to moderate hearing loss.

    It’s shocking that it has taken so long for government to make it relatively easy and far more affordable for people to get hearing aids. Medicare still does not cover them. (Some Medicare Advantage plans cover a part of the cost.) The only explanation is that the hearing aid industry has had a lock on Congress.

    When Congress was considering covering hearing aids for people with Medicare during the debates around the Build Back Better Act, the administration and Democratic leaders insisted that they would only support the legislation if Medicare paid the full retail price for hearing aids! No bulk purchasing, competitive bidding or price negotiation. Insanity. In so doing, they killed this provision in the legislation because it was so costly.

    Hearing aids do not cost anywhere near the $3,000 to $6,000 people often pay for them to produce. The Veterans Administration is able to buy hearing aids for $500 a pair. And, you can be sure that the hearing aid manufacturers make money on their sales to the VA.

    Now, people can buy high quality hearing aids, without a prescription, directly from Walmart and other retail outlets for under $1,000 and as low as $199. Experts believe that the price of these hearing devices will continue to fall as more competitors enter the hearing aid market.

    Of course, some of these devices will work better than others, and some of the ones that work well will serve you better than others. Any hearing aid you buy will likely require your patience and need adjusting to work effectively. Before buying any of these new devices, talk to your doctor. Find out which ones make the most sense for you.

    Here’s more from Just Care:

  • Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment: Beware of Bad Actors  

    Medicare Annual Open Enrollment begins on October 15 and runs through December 7. You have many choices to make and you should take the time needed to make them, for both your physical and your financial health. A smart choice could save you money and steer you away from bad actors.

    Five things to keep in mind:

    Access to care: Health insurance is about your care needs today and unforeseeable needs down the road. Your Medicare plan should cover all medically necessary care if you’re diagnosed with cancer, heart disease or stroke, fall and break a bone, or are in a serious accident.

    Cost:  Many older adults skip needed care because of high out-of-pocket costs.

    • Traditional Medicare covers virtually all your out-of-pocket inpatient and outpatient costs, so long as you have supplemental coverage—Medicaid, retiree benefits, or Medigap, which you buy in the individual market for about $2,500 a year.
    • Medicare Advantage plans charge deductibles and copays that average around $5,000 a year and can be as high as $7,550. Each one charges different amounts for in-network care and most do not cover out-of-network care.

    Fraud: Some providers and Medicare Advantage plans have histories of engaging in fraud.

    Incentives: Beware of physicians and insurers that profit from denying or delaying your care.

    • Traditional Medicare pays for each service you receive, so physicians have no incentive either to withhold care you need or to keep you from seeing top specialists.
    • Medicare Advantage plans are paid a flat upfront fee, so they have a financial incentive to keep you from getting costly care. The less care you get, the more they profit.
  • 2022: Health care costs threaten the well-being of many Americans

    2022: Health care costs threaten the well-being of many Americans

    Fewer Americans are uninsured than ever–almost half the number before the Affordable Care Act took effect. But, rates of underinsurance are high, with millions of people having gaps in their coverage, millions skipping care and millions falling into medical debt because they cannot pay their health care bills. The Commonwealth Fund surveyed Americans and found that, too often, health care costs threaten their well-being.

    The big takeaways:

    • More than four in ten adults under 65 (43 percent) did not have adequate health insurance. People without insurance, people with gaps in insurance coverage during the year, and people who could not afford their care are included in this group.
    • Nearly three in ten people with employer coverage (29 percent) and more than four in ten people with coverage they bought in the individual market (44 percent) were underinsured.
    • Close to half of all people (46 percent) said that they had not gotten care or delayed getting care because of the cost. More than four in ten (42 percent) struggled to pay medical bills or were in medical debt.
    • Half of people surveyed (49 percent) said they could not afford to pay an unexpected medical bill of $1, 000 within 30 days, primarily people with low incomes (68 percent), Black adults (69 percent), and Latin/Hispanic adults (63 percent).

    Large numbers believe health care costs should be a top priority for the Biden administration and Congress. Democrats (68 percent), Independents (55 percent), and Republicans (46 percent).

    “Underinsured” is defined for people living above twice the federal poverty level as out-of-pocket health care costs over 12 months, excluding premiums, representing at least 10 percent of household income and for people living under twice the federal poverty level, representing at least 5 percent of household income ($27,180 for an individual and $55,500 for a family of four in 2022). Or, people whose health care deductible represented at least five percent of household income.

    People who lacked health insurance for at least a year tended to be young, poor, with one or more chronic conditions, living in the South, Latin/Hispanic. Undocumented individuals are not able to get affordable coverage.

    Because the US lacks a national health insurance program or even a national health insurance enrollment program, a lot of people who might be eligible for coverage based on their age, income and needs, go without coverage. More than half the people surveyed (56 percent) who had employer coverage but had been uninsured at some point during the year did not know that they were eligible to enroll in their state health insurance exchange plans because they lost their coverage.

    Americans likely would pay a lot less for their health care if the government set rates for all health care providers, as it does for people with Medicare. Because the US does not set provider rates–as all other wealthy countries do–these high rates drive high cost-sharing. Physician and hospital prices in the US are higher than anywhere else in the world.

    Close to one in four people with chronic conditions, such as diabetes, are not filling their prescriptions regularly because of the out-of-pocket cost.

    Of note, nearly one in four people with bills in collection said the bills stemmed from a mistake in billing. More than half of people with medical debt (56 percent) owed at least $2,000.

    Medical bills from out-of-network doctors at in-network hospitals represented almost half of all cost issues. These surprise bills are no longer permissible under the No Surprises Act, which took effect January 2022. But, the survey included a timeframe before then.

    When the public health emergency is declared over, likely in 2023, states will lose their improved federal matching funds. Inevitably, with less money, they will reconsider Medicaid eligibility and restrict coverage.

    Here’s more from Just Care:

  • Cancer patients face particularly severe medical debt

    Cancer patients face particularly severe medical debt

    Noam Levey reports for Kaiser Health News on the particularly severe medical debt people with cancer often bear. Levey profiles a breast cancer patient who faces $30,000 of debt, along with constant threats from collection agencies. She, like many people with cancer, must make tradeoffs that no one should have to make to pay off the debt.

    Cancer kills hundreds of thousands of Americans each year. People with and without insurance, young and old. New treatments are saving more lives but at an extremely high price. More than six in ten people with cancer have had to reduce their spending on necessities like food and clothing because of the high cost of their treatment. One in four of them have been pushed into bankruptcy, been evicted from their homes or had their homes foreclosed on them.

    According to the National Cancer Institute, treating someone with cancer can cost more than $1 million in the first year. On average, it costs $42,000 in the first year. People with Medicare are not spared high out-of-pocket costs. Those with blood cancer typically pay $17,000 of their own money for treatment in year one.

    About 100 million Americans have medical debt. Having cancer has been found to increase your likelihood of medical debt by 71 percent. It also makes it more than twice as likely that you will declare bankruptcy than people without cancer. And, the data show that those with cancer in bankruptcy were more likely to die than those not in bankruptcy.

    People with cancer are more likely than other people with medical debt to owe a lot of money and are also more likely to believe they will never be able to afford to pay off the debt. A Kaiser Family Foundation poll found that about 20 percent of people with cancer who face medical debt owe more than $10,000.

    High out-of-pocket costs leave patients making unconscionable choices. Many end up forgoing life-saving treatment so as not to incur more costs. Research shows that 18 percent of people on chemotherapy stop treatment. Of those, nearly half stop treatment when their costs rise above $2,000.

    Here’s more from Just Care:

  • Poll: Prescription drug prices in 2022

    Poll: Prescription drug prices in 2022

    The Kaiser Family Foundation recently polled Americans for their views on prescription drug prices. Here’s what they learned:

    What proportion of the US population takes prescription drugs?

    • Most Americans–62 percent–take at least one prescription drug.
    • One in four Americans take at least four prescription drugs.
    • More than eight in 10 (83 percent) Americans say prescription drug costs are unreasonable.
    • Nearly seven in 10 (69 percent) Americans who take prescription drugs say that they have no trouble affording them.

    Are prescription drugs affordable?

    A recent report in NBER found that thousands of people with Medicare die of stroke, heart attacks and other diagnoses each year because they stop filling their prescriptions when the copays rise as little as $10.40.

    • Affordability of prescription drugs is harder for people who are taking four or more medicines.
    • Nearly one in three people (32 percent) who take four or more medicines struggle to pay for their prescription drugs.
    • Only about 2o percent of people who take up to three prescriptions struggle to pay for them.
    • At least a third of people with yearly incomes under $40,000 (35 percent) and people with chronic conditions (33 percent) also have more difficulty affording their prescription drugs.
    • One in five people over 65 (2o percent) say they struggle to afford their prescription drugs.

    How many people do not fill their prescriptions because of the cost? 

    • Three in ten people did not fill all their prescriptions in the last year, as a result of the cost.
    • One in six (16 percent) did not fill a prescription for a specific drug because of the cost.
    • More than one in five (22 percent) substituted a non-prescription drug for their prescription.
    • More than one in eight (13 percent) cut their pills in half or skipped doses.

    Do people understand that drug company profits are the largest reason for high costs in the US?

    • The overwhelming majority of the public (82 percent) understands that pharmaceutical company profits are the largest reason drug prices are so high.
    • Nearly seven in ten people (68 percent) wrongly believe that research and development costs are responsible for high drug prices.
    • More than half of people (52 percent) mistakenly think that marketing and advertising drive drug prices as high as they are.

    Most Americans would like to see more drug price regulation, including a majority of Democrats, Republicans and Independents.

    What drug price proposals do Americans favor?

    • Nearly nine in ten Americans (88 percent) would like it to be easier for generics to come to market.
    • Nearly nine in ten Americans (88 percent) would like Congress to limit drug price increases to the rate of inflation (which does nothing to keep the launch price of a drug reasonable.)
    • Eighty-five percent would like Medicare to limit out-of-pocket drug costs (which does nothing to lower drug costs, gives drug companies greater freedom to raise prices since people don’t directly feel the increase, and allows insurers to shift drug costs to everyone through higher premiums and other out-of-pocket costs.)
    • More than eight in ten Americans (83 percent) would like the government to regulate drug prices.
    • Nearly eight in ten Americans (78 percent) support legalizing drug imports from Canada (though there is no reason not to open the borders to drugs from verified pharmacies around the world.)

    Here’s more from Just Care:

  • Medicare hospice benefit has become a luxury

    Medicare hospice benefit has become a luxury

    For many years, Medicare has covered palliative or non-curative care at the end of life through its hospice benefit. The benefit is intended to allow people, with six months or less to live to die peacefully in their homes rather than in an institution. But, as Alexis Drutchas et al. describe in Health Affairs, the Medicare hospice benefit has become a luxury because only a privileged few can arrange for all the requisite at-home care that Medicare does not pay for under the hospice benefit.

    A large portion of older adults and people with disabilities cannot afford to take advantage of the Medicare hospice benefit and are forced to die in hospital or in a nursing home. They do not have friends or family to care for them and they cannot afford to pay for the in-home caregiving they need in order to take advantage of the Medicare hospice benefit. Without family or friends to supplement the care that Medicare covers or the resources to pay for caregivers, Medicare hospice providers generally will not step in.

    Medicare pays hospice providers about $203 a day to provide limited routine care to people at the end of life. And, it caps spending on hospice care to $31,297 a person. For this money, people can only receive a small amount of care from nurses and home-health aides. Hospice providers do not want to take on patients who are at risk living on their own without caregivers at home.

    Talk to your doctor about your health care wishes at the end of life and, specifically, about the Medicare hospice benefit during your annual wellness visit, which Medicare covers. If you might be interested in hospice, find out whether there’s a hospice in your community that you would want to use. Keep in mind that one in five hospices suffer from severe deficiencies. 

    Be aware that for-profit hospice agencies might be very different from non-profit agencies. Two in three hospice agencies are now for-profit, owned by private equity and public companies. They might step in to provide hospice, such as addressing pain or helping with activities of daily living, but not to deliver the rich array of at-home benefits people need at the end of life. And, data on average hours agencies spend delivering care are not easily accessible.

    Hospice patients often get just 30 minutes of care each day or three and a half hours a week. Thirty minutes a day is not enough to assist people with even the simplest of needs, such as help taking medicines, going to the bathroom and bathing,

    Medicare is now spending an average of $80,000 on individuals in the last year of life. It spends whatever amount necessary for curative treatments and treatments for people with chronic conditions, even if there is no hope of a person’s survival. But, it limits spending for palliative care at home for people at the end of life.

    To serve the needs of people with disabilities and older adults, Medicare should not put tight constraints on what it spends for hospice care at home. And, it must insist on collecting data on the amount of time hospice agencies spend with patients and how, more broadly, these hospice agencies spend the money Medicare pays them.

    When choosing a hospice, people should know how many hours of care a particular agency provides from nurses and home health aides. Hospice Compare, the Medicare hospice comparison tool, does not provide this information.

    Here’s more from Just Care: