Re: US health care system
From: D. Ashley Hill (dahmd@cfl.rr.com)
Sun Mar 11 10:08:04 2007
Nice review. One significant problem with Medicaid and Medicare is that
very often reimbursement rates for these programs are much less than
"private" insurance plans. This depends on the diagnosis and procedure
and geographic region of the country. As our government tries to save
money it finds ways to decrease reimbursement here and there, or, in
some cases, as a wholesale percentage drop. One cardiology group in our
area showed me data that their bare-minimum equipment expenses exceeded
what Medicare would provide them for invasive cardiology procedures. For
this reason (and because the paperwork is challenging) many physicians I
know choose not to participate when possible (of note, I participate in
both plans). Thanks,
Ashley
t Sun, 11 Mar 2007, Jamie wrote:
>
>There are two publicly funded medical programs. Medicare is for the
>elderly and certain disabled persons, regardless of income. One piece
>is provided without cost to the patient, other pieces can be purchased
>(fairly costly, but this population would find it difficult to purchase
>private insurance at all). It was created at a time when care was most
>likely to be done inpatient, and is weighted in that direction a bit
>(hospitalization covered in that part that is provided free, patients
>have to pay for coverage for outpatient and prescriptions). Until
>recently, it provided for no medications. Now, prescription coverage is
>one of those pieces that can be purchased.
>
>Medicaid is income based, and available to pregnant women, children, and
>elderly and disabled persons, to cover the gap between Medicare and the
>care they actually need. All recipients have to meet income guidelines
>(and have no significant savings or other assets). The availability and
>quality of providers who accept Medicaid vary according to location. In
>my area, most providers accept it b/c it's a poor area and they wouldn't
>have enough private patients to survive. Most things are covered at
>near 100%, but there are some restrictions-mostly IME some medications
>that aren't covered. Medicaid patients sometimes face a negative
>attitude when they seek care, especially if they attempt to make choices
>about their care.
>
>Both Medicare and Medicaid are now largely or wholly (depends on the
>state) managed by private insurance companies. Patients can choose from
>a few different plans in some cases. Anyone not covered by one of these
>programs must have private insurance or pay out of pocket. Private
>insurance varies a lot. It tends to be connected to employment for most
>of us, b/c employers provide all or more often part of the cost as a
>benefit. The cost to the employee, both in terms of their part of the
>premium, and in their part of care, varies a lot as well. Buying
>insurance directly from the company is cost prohibitive for many.
>Employers tend to choose plans based on cost to them rather than service
>to their employees, so quality and availability of care varies a lot. My
>husband once had a job that provided insurance we basically couldn't use
>b/c there were no providers within several hours' drive. Low wage
>employees may be unable to afford their part of the premiums, so may opt
>out of coverage. (If that's the case their children may qualify for
>Medicaid, but the adults will often just forego needed care). There's a
>fairly large group of uninsured in the U.S. They either can not afford
>or can not obtain private coverage, and do not qualify for Medicaid.
>They tend to go to the emergency room for nonemergent care (b/c they
>don't have to pay upfront) or wait until the situation has become truly
>emergent. The care, of course, is substandard b/c emergency rooms are
>not meant to provide primary care. And the cost is huge. A lot of
>those emergency room bills go unpaid-the hospitals eat the cost and the
>patients end up bankrupt.
>
>You asked about cost of private insurance. My husband's company
>provides what are considered excellent benefits. We pay about
>$200/month to cover the entire family (excellent rate b/c we have a
>large family). Physician copay is $15, ER copay is $50, hospitalization
>$250, outpatient surgery $35, presciptions from $10 to $40 depending on
>the medication. We are extremely fortunate. Some families pay hundreds
>more in premium, and have higher copays.
>
>At Sun, 11 Mar 2007, Melissa wrote:
>>
>>What is the public (? Medicaid) system like? How much does private
>>insurance cost and does it fully cover the cost of hospitalization?
>>
>>In Oz, the public system is quite good (and free). Private insurance
>>(single) can cost around $AU800 - $1,600 pa. Then you pay an excess of $200
>>- $1000 her hospitalization.
>>
>>--
>>Melissa.
>>
>>____________________________
>>Melissa Maimann
>>____________________________
>>____________________________
>>____________________________
>>RM RN BN Grad Dip Midwifery MBA Candidate
>>m: 0400 418 448
>>Pregnancy and Birth Consultant
>>Essential Birth Consulting
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr
>>Eberhard Lisse
>>Sent: Sunday 11 March 2007 20:57
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: Was Bilateral dermoids Now EL's view of US health care system
>>
>>Dan,
>>
>>on 3/10/07 8:53 PM R. Daniel Braun said the following:
>>
>>>>Infant mortality, maternal mortality, teenage pregnancies are neither on
>>>>the top in absolute figures, nor in relative figures, taking expenditure
>>>>into account. Access to health care? Disposable income by Ob&Gyns?
>>
>>> Infant Mortality: Great measure of how well parents can take care of an
>>> infant once it goes home. Not worth a hoot at measuring quality of
>>> Medical care. BTW, when measured on a bitrht weight to birth weight
>>> basis, the US perinatal mortality is quite a bit better than anyone
>>> else's. The overall problem is the incidence of preterm delivery. This
>>> seems to be a socio-religious problem, since it seems to arise from
>>> teenage and otherwise unwanted prgnancies.
>>
>>If I applied myself hard enough I could probably find a statistical
>>figure where Namibia shines. However, I stand by my statement. In
>>particular since I haven't found nowhere that only the affluent and
>>educated are allowed to have children.
>>
>>Never mind that I seem to have mentioned teenage pregnancies :-)-O
>>
>>> Maternal Mortality: I didn't know that 8/100,000 pregnancies was so
>>> bad. especially when all deaths of pregnant women and women who have
>>> been pregnant in the last year are included in that number.
>>> Teen age pregnancies are a social religious problem and have little if
>>> anything to do with medical care.
>>
>>I didn't say it was so bad, *HE* said the US health (and implied the OB)
>>system was the best in the world. And that just ain't so. We have been
>>over the figures, before. 8/100000 is shocking, in fact.
>>
>>> Taking expenditure into account: you got me there. The amount of waste
>>> in our system is way up there. e.g.: Pre-eclamptic labs ( alll you need
>>> to R/O HELLP syndrome is a platelet count and you are going to get one
>>> anyway so that anesthesia will consent to putting in an epidural What do
>>> most folks get? Complete liver panel that's what.) Waste Waste
>>
>>There you go
>>
>>> Access to Health Care: If you don't care about going bankrupt, you can
>>> get health care.
>>
>>Actually that's true but irrelevant.
>>
>>> Disposable income by OB-GYN's: I don't know about anyone else, but I am
>>> comfortable and happy. Far from being rich, but comfortable.
>>
>>Yes, sure, but why did you wrote the other day you left to become a CMT?
>>:-)-O
>>
>>greetings, el
>>
>>--
>>Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>PO Box 8421 \ / Please do NOT email to this address
>>Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
>>
>--
>JFields, RN, BSN
>
--
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Medical Director, Loch Haven Ob/Gyn Group
Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
Orlando, Florida
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