health costs

AL charges state employees fees for health problems

Anne Zieger — Tue, 26 Aug 2008 13:20:54 -0400

The Alabama State Employees' Insurance Board has announced that it will go forward with a plan requiring state employees who are obese or have other health problems to make progress on those issues or pay a monthly charge for health insurance. Employees will be required to undergo a health screening at no charge by January 2010 or pay a $25 monthly charge for their health insurance, which workers currently receive at no cost to them. If the screening finds blood pressure elevation, high cholesterol, high glucose, or obesity--defined as a BMI of 35 or above--employees will have one year to visit a physician at no cost, enroll in a wellness problem or take their own steps to improve their health. If follow-up screenings don't show progress, employees will begin to pay the monthly surcharge in January 2011. Plan administrators expect to spend an estimated $1.6 million next year for screening and wellness programs, but believe they'll see big savings over the long term, as individuals with a BMI of 35 to 39 cost $1,748 more in annual health costs than those with a BMI of less than 25.

To learn more about this plan:
- read this Kaiser Daily Health Policy Report item

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U of IL hospital sending back Mexican immigrant

Anne Zieger — Wed, 20 Aug 2008 12:05:22 -0400

Recently, we ran an article which stirred up some serious discussion on the subject of how to pay for the care of undocumented, medically-indigent immigrants, and how to handle things when a provider feels they can no longer foot the bill. The article detailed the practice, engaged in by some U.S. hospitals, of sending uninsured immigrants with costly, long-term medical needs back to their home countries--sometimes without the immigrant's permission.

Now, an Illinois case has come up which brings this practice into the spotlight. In this case, the University of Illinois Medical Center at Chicago is planning to return a 30-year-old Mexican man in a coma back to his home country over the objects of two of his family members. Francisco Pantaleon, who suffered a severe brain hemorrhage in mid-July, has lived in the U.S. for 11 years and has two children. After treating him for a while, UIMC plans to transfer Pantaleon to a hospital in Acapulco at its own expense. Though the facility has the consent of his immediate family to transfer the comatose man, his sister and cousin have hired lawyers to stop the transfer, saying that he won't survive the trip, or that if he does, he won't get adequate care in Mexico.

With large numbers of undocumented, uninsured immigrants doing physically dangerous jobs in this country, expect to see this issue arise more frequently. Short of a sudden switch to universal coverage or single-payer system, which presumably would make allowances for this situation, the issue's not going away anytime soon.

To learn more about this debate:
- read this Chicago Tribune piece
- read the Editor's Corner from FierceHealthFinance

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Trend: Medical prices set to jump again

Tue, 22 Apr 2008 06:59:57 -0400

While medical prices fell for the fourth consecutive year in 2007, observers say that health costs likely will shoot up again, soon. According to an article in the journal Health Affairs by author Paul Ginsburg of the Center for Studying Health System Change, there are several factors contributing to the coming jump in prices, including a hospital's need to cover the cost of their tremendous recent investments in new buildings; the growth in physician ownership of ambulatory surgery centers and specialty clinics, which Ginsburg says has historically driven up prices; and a shift in the overall U.S. economic cycle. Such price increases could drastically hike health insurance premiums. Even with health cost increases having been moderate over the last few years, health insurance premiums still have risen 78 percent since 2001.

To learn more about this trend:
- read this article from The Oregonian

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Report: Incentive program could save U.S. $368B

Thu, 20 Dec 2007 06:59:55 -0500

A new report suggests that if the U.S. created a program designed to provide the right incentives and improve decision making, payers could save $368 billion on health costs over the next 10 years. The report, which was published by The Commonwealth Fund, contends that the savings could mount up to more like $1.5 billion if this effort were to be combined with other efficiency programs. Among other things, the report proposes establishing a "Center for Medical Effectiveness and Health Care Decision-Making" which would squeeze information on relative clinical and financial effectiveness of treatments into an insurance benefit design. This same center would create incentives for key stakeholders--largely providers, payers and consumers--to use such information. The report also recommends that the healthcare industry boost healthcare IT investment, particularly to foster health data sharing.

To learn more from the report:
- read this Healthcare Finance News piece
- read the Commonwealth Fund press release

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TX hospital may stop cancer care for indigent illegals

Mon, 03 Dec 2007 06:59:54 -0500

A Texas cancer center is considering what must be a difficult move: it's thinking about ceasing to offer cancer care to indigent and undocumented immigrants. The hospital, the University of Texas Medical Branch, set aside $12 million of its $1.4 billion annual budget to care for indigent cancer patients, but with that budget under pressure, execs are trying to find ways to stretch it. Even if it does follow through with this plan, it won't stop treating those already in its care, administrators said. Meanwhile, no ne knows exactly how many undocumented, indigent cancer patients it sees, so it's not clear what the financial impact of such a policy would be anyway.

To learn more about the controversy:
- read this Associated Press piece

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Study: Less illegal immigrants use health system than thought

Tue, 27 Nov 2007 06:59:54 -0500

A new study suggests that despite popular perceptions, illegal immigrants from Latin American countries are 50 percent less likely to use hospital emergency departments than U.S.-born Latinos, a finding echoed by other studies which also find lower health system participation rates by this population. The study, published in the Archives of Internal Medicine, analyzed data from 42.044 participants in a 2003 health survey conducted by UCLA and the California Department of Public Health. The study found that ED usage was lower even when adjusted for age, health status, insurance status and poverty level. The researchers also found that illegal immigrant Latinos were 30 percent less likely than U.S.-born Latinos to have a regular source of healthcare.

To find out more about the study:
- read this piece from the Los Angeles Times

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SPOTLIGHT: Pennsylvania health reforms bogged down

Tue, 10 Jul 2007 20:01:32 -0400

Pennsylvania Gov. Ed Rendell (D) is an unabashed liberal with big hopes for reforming the state's healthcare system. When he was re-elected last year, he vowed to put forth a plan to cover the state's 900,000 uninsured residents. He soon realized, however, that unless he could help cut health costs, his proposed reforms would never work. He also realized that cutting costs would probably mean cutting income for healthcare industry stakeholders. Now officials are wondering whether he will be able to stitch together a compromise that will satisfy the various entrenched interests affected by health reform. Article (reg. req.)

TX county grapples with care for illegal immigrants

Thu, 14 Jun 2007 20:01:35 -0400

In a debate that resonates across the U.S., leaders in Tarrant County, TX are discovering what the real cost would be if they permit illegal immigrants access to the county's indigent care program. This week, a consultant hired by the JPS Health Network board of managers told executives and officials that the cost would be $41.2 million a year, or about 10 percent of the hospital's current operating budget. For that amount, the hospital could see 29,000 new patients and would probably end up admitting about 385 more people to the hospital. By 2017, the consulting firm said, the influx of immigrants would force the hospital to expand by 70 beds. However, a immigrant advocacy group contends that it would cost dramatically less, about $4.2 million a year, to provide care for this population. That's because illegal immigrants are generally young and healthy with little need for ongoing medical care, the advocates said.

To learn more about the debate:
- read this Fort Worth Star-Telegram article

Related Articles:
Payments to help hospitals pay for immigrant care. Report
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GM, Ford plan retiree healthcare cost hand-off

Tue, 23 Jan 2007 19:01:37 -0500

It could be the biggest healthcare cost hand-off in modern history, and a radical step for all concerned. General Motors and Ford have begun talks with the United Auto Workers union that would, if successful, see the union running a gigantic fund to pay for retiree healthcare costs. The deal would involve a huge one-time payment into the new UAW fund. The deal seems to be inspired by an agreement reached by tire manufacturer Goodyear, which recently passed off $1.2 billion of retiree health costs to United Steelworkers. The numbers are much bigger in this case, however; according to some estimates, GM alone may have $55 billion in future retiree health liabilities. It's not clear where the companies will get the money to fund the transfer, either.

To get more information on the negotiations:
- read this item from The Independent

Related Article:
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Universal health model emerges

Mon, 01 Jan 2007 19:01:37 -0500

At a federal and state level, policymakers are beginning to agree on some bare bones requirements for universal healthcare access. Massachusetts' plan is an early trendsetter, though there's plenty of opportunity for other states to make their marks as well.

Existing universal healthcare proposals differ in some important ways:

How much financial responsibility uninsured consumers will be required to assume
How to determine the amount employers will be forced to spend on health coverage. (Pretty much every model assumes that employers will pick up more health costs than they have in the past, but ideas vary as to how the money will be spent.)
Deciding how much states or federal government will absorb. Virtually all proposals would allow the uninsured public to buy in to public health plans like Medicare and Medicaid (an approach favored by Pennsylvania Governor Ed Rendell), or the health insurance programs offered to federal employees.

Still, the increasingly popular consensus model for universal healthcare seeming to include some element of employer buy-in, consumer buy-in (sometimes subsidized) and governments extending the health programs already in place.

Regardless, despite some important policy differences, I believe that the consensus blueprint for universal health access will emerge this year. It could take several more years before legislators agree on the finer details--and actually produce a bill that state governors will pass--but this year should see a lot of progress in this direction.