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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

HIV/AIDS & Hepatitis C:
Insurance

     

Main topics can be found within the left column; sub-topics and/or research reports can be found near the bottom of this page.  Thank you

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One of the many surprises with insurance companies is that the public forgets that these companies are businesses. They survive because they make a profit. They make their profit by having more money coming into the business then going out. If an insurance company has an excessive amount of claims then it must raise the cost of coverage. Another factor with Insurance Companies, the public has become very price sensitive...the public shops around for the 'best' price not necessarily the best coverage.

Because of the competitive nature of shopping around, insurance companies can offer coverage that costs less but only if it covers less. Medicare and Medicaid (USA governmental programs for low income groups and retired people) currently offer coverage; however in many parts of the USA, these people, having governmental coverage, are unable to find physicians who will accept them as patients because of the low reimbursement rates that are offer by the government.

Two traditional forms of disease management contracts are capitation contracts and case rate contracts. Under a capitation contract, the health plan pays the disease management company a fixed amount per member per month. Under a case rate approach, the health plan pays the disease management company a fixed amount per patient treated. Some case rate contracts present the rates on a stratified basis, with higher reimbursement rates provided for patients with more advanced disease or more complications.

Goals and Objectives-the goals and objectives of the health plan and the disease management company may be different. The objectives for a health plan to negotiate a disease management risk contract may include any or all of the following:

  • To minimize financial risk associated with high-cost claims
  • To reduce aggregate healthcare costs by negotiating a capitation or case rate lower than the corresponding cost of care provided in their network
  • To simplify and reduce in size or scope the panel of physicians and other professionals, thus reducing administrative effort and the expenses associated with maintaining a physician panel
  • To improve the marketing position of the health plan or HMO by creating a strategic alliance with a regional center of excellence, whose reputation for providing high-quality treatment will enhance the reputation of the health plan by association
  • To improve its risk-based capital position by transferring risk to the disease management company

The disease management company is accepting financial responsibility for providing the specified care to patients covered by the disease management contract, and faces the risk that the cost of care will exceed its revenue. Unfavorable variation from the expected levels of utilization or cost of services can cause losses to the disease management company. The management company should take steps to reduce its financial risk, including:

  • Identifying financial, contractual and other factors affecting the level of financial risk and the volatility of the risk
  • Estimating the revenue and capital required to accept financial responsibility for the risk
  • Projecting the possible outcomes under different scenarios for factors that influence overall program costs
  • Managing the risk effectively to ensure that clinical and financial goals are achieved.

Document Name & Link to Document

Description

File Size /Type**

14 Ways to Guarantee That Your Long-Term Disability insurance Claim is Denied and you Lose in Court Reason for report-“I am sick and tired of seeing people lose their chance at getting disability benefits because they didn’t know (and the insurance company won’t tell them) the traps they can easily fall into.” 3,111 kb pdf
Adolescent Confidentiality and privacy Under HIPAA Adolescents are more likely than adults to have their state-protected right to medical confidentiality violated by providers or insurers 281 kb pdf

Assess the value of American investment

How does a venture capitalist decide where to invest his money? He compares the potential for return against the risk, and when the return appears to be significant and the risk isn't too great, he invests. As our country makes decisions about its future investment in medical research, it might apply a similar standard.

 

 

BASILE PAPPAS and THEODORA PAPPAS, H/W, v. PENNSYLVANIA HOSPITAL INSURANCE CO. (PHICO) and THE COMMONWEALTH OF PENNSYLVANIA MEDICAL PROFESSIONAL LIABILITY CATASTROPHE LOSS FUND (CAT FUND) Court dismisses HMO's claim for protection from tort cases under ERISA; technically a health insurance case but ramifications for disability insurance.  
Claims Against Insurance Companies for Fraud & Bad Faith Insurance companies nationwide have begun using claims handling practices that are aimed at cost containment and building claims profit. This means the insurance companies design practices aimed at delaying the payment of claims and underpaying the fair claim value of a given claim. This is not an ethical practice and violates all insurance industry customs and ethical principles of the insurance industry.  

COBRA Rules

COBRA is a federal law that requires employers to allow employees and dependents losing health insurance to stay on the employer’s plan.

 

Confronting the New Health Care Crisis:
Improving Health Care Quality and Lowering costs by Fixing our 
Medical Liability System provided by US Department of 
Health and Human Services
132 kb pdf

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Containing costs while maintaining Quality

Articles on how insurance companies are trying to reduce costs

 

Controversies: Should all  patients with Hepatitis C be Treated 

Healthcare costs for Hepatitis C Virus include managing patients' symptoms, managing other organ involvement, treating Hepatitis C Virus with antiviral agents, and managing end-stage liver disease as well as the cost of liver transplantation. Wong and coworkers estimated that the annual US healthcare cost for Hepatitis C Virus will exceed $1 billion by the year 2008

 

Cost of Hepatitis C in relation to insurance costs

Report on the cost of Hepatitis C Virus

 

Cost of Illness Handbook

 

 

 

APPENDIX A: INFLATION AND DISCOUNTING FACTORS

 

GLOSSARY AND ABBREVIATIONS

 

EXECUTIVE SUMMARY

 

 

 

INTRODUCTION TO THE COST OF ILLNESS HANDBOOK

 

 

INTRODUCTION TO THE COSTS OF CANCERS

 

COST OF STOMACH CANCER

 

COST OF KIDNEY CANCER 

 

COST OF LUNG CANCER

 

 

COST OF COLORECTAL CANCER

 

COST OF BLADDER CANCER

 

INTRODUCTION TO THE COSTS OF DEVELOPMENTAL ILLNESSES AND DISABILITIES

 

COST OF LOW BIRTH WEIGHT

 

 

COST OF CLEFT LIP AND PALATE

 

COST OF LIMB REDUCTIONS

   

 

COST OF CARDIAC ABNORMALITIES

 

 

COST OF SPINA BIFIDA

 

 

 

 

COST OF CEREBRAL PALSY

 

 

 

COST OF DOWN SYNDROME

 

  

 

COST OF REDUCING HIGH BLOOD LEAD LEVELS

 

INTRODUCTION TO THE COST OF RESPIRATORY

  

 

COST OF ASTHMA

 

 

COST OF ACUTE RESPIRATORY DISEASES

 

 

  

REFERENCES

 

 

SYMPTOMS

 

 

SYMPTOM GROUPS

Reliance on cost of illness information is controversial for many reasons.  COI usually includes only direct medical costs that substantially underestimate total costs (discussed in Chapter 1 of the Handbook). COI estimates can be extensively manipulated by economists to achieve desired results (e.g., OMB now requires such heavy "discounting" that some serious illnesses appear to have no costs).  More scrutiny and critique by health professionals is needed in this area, given the role economic analyses play in federal health protection policies.

This appendix provides information on the inflation of medical services and computations that can be used to calculate the present value of futurecosts. This information can be used to modify the values presented in the various Handbook chapters.

This glossary provides brief definitions of some technical terms used in the handbook. Special effort was made to include those that are used repeatedly or that may cause confusion because they have a number of different meanings (e.g., colloquial versus technical).

The societal benefits of environmental regulations and programs are typically manifested by the reduction in adverse health effects. These reductions are associated with decreased exposure to environmental agents. Ideally, valuation of these human health benefits would include all costs to society associated with the benefits, including medical costs, work-related costs, educational costs, the cost of support services required by medical conditions, and the willingness of individuals to pay to avoid the health risks. These factors can be referred to in aggregate as society’s total willingness to pay to avoid an illness.

The cost of illness is an estimate of the incremental direct medical costs associated with medical diagnosis, treatment, and follow-up care. This includes various cost elements, such as physician visits, hospitalization, and pharmaceuticals. This Handbook does not estimate the costs in lost time or wages that may be incurred by either a patient or his or her unpaid caregiver. The costs also do not include pain and suffering, which may be substantial.

This section of the handbook contains chapters that describe costs of medical treatments for a variety of cancers that have been associated with exposure to environmental agents. Cancer is one of the three leading causes of death in the United States and throughout the world (Williams and Weisburger, 1993). It is a serious illness that has been associated with environmental exposures in both human and animal studies.

Stomach cancer, also called gastric cancer, refers in most cases to adenocarcinoma, which comprises 90 to 95 percent of all gastric malignancies.

Kidney cancer is a malignancy within the kidneys and may be localized or have spread to multiple sites (Bennet and Plum 1996). It represents one to three percent of all adult cancers in the United States (Javadpour 1984, Klein et al., 1993). Kidney cancer occurs most frequently in individuals in their fifties through seventies, with two to three times as many males as females developing the disease

Lung cancer is a malignancy within the lungs and may be localized or have spread to multiple sites (Bennet and Plum 1996). All types of lung cancer likely originate from a common pluripotent stem cell. There are four types of lung cancer: squamous (epidermoid), adenocarcinoma, large cell, and small cell (oat cell).

Colorectal cancers are malignancies of the colon or rectum. They are most often adenocarcinomas that are thought to develop through genetic alterations in the cells. Colorectal cancers can be differentiated, based on the site of the tumor(s). As noted above, however, they are considered as a single cancer type for this cost analysis.

Bladder cancers are tumors that arise from the transitional cell lining of the urinary tract. These are a part of a larger group of tumors that are all related and are referred to as urothelial cell cancers. Urothelial cell cancers may occur in the kidneys, ureter, bladder, urethra, and the ducts of the prostate.

This section of the handbook focuses on developmental illnesses and disabilities that may be associated with exposure to environmental agents. Its chapters (III.2 through III.9) provide data on the direct medical costs of individual effects or groups of similar types of developmental effects. As in previous chapters, information is not included on all elements of willingness to pay (WTP) to avoid the illness.

Low birth weight is a serious medical condition that occurs in approximately seven percent of all infants born in the United States (Oski, 1993). It is associated with multiple adverse effects in numerous organ systems and carries a much higher risk of death than normal birth weight. Consequently, considerable medical resources are devoted to the treatment of LBW infants and the medical expenditures on these infants is estimated to be $5 billion per year

Cleft lip and palate occur when structures in the nose and mouth fail to close during embryonic development. These birth defects appear as openings or incomplete structures in the centerline of the face and mouth. They often occur concurrently (approximately 50 percent of the time), due to the mechanism of damage that leads to these defects

Children with limb reductions frequently have other birth defects. In 30 to 53 percent of affected children, other malformations are present, including anomalies of the heart, kidney, anus, abdominal walls, esophagus, vertebrae, and palate. Webbing between digits and spina bifida are also associated with this defect

A number of cardiac anomalies occur at birth or in early infancy, and are quite varied. These are structural defects in the development of the heart, arteries, and associated tissues. They arise when the function, movement and relationships among cardiac cells fail to progress normally. Five defects, all conotruncal heart anomalies, are discussed in this chapter. The specific anomalies include: truncus arteriosus, transposition of the great arteries, double-outlet right ventricle (DORV), single ventricle, and tetralogy of Fallot.

Spina bifida occurs when the neural tube, from which the brain and spinal cord develop (central nervous system), fails to close properly. Depending on where closure fails to occur, portions of the brain, spinal cord, and nerves connected to them will not function properly. If failure to close occurs on the lower portion of the spinal cord, then the bowel, bladder or sexual organs will be affected. Failure at mid-level may cause paralysis or malfunction of the arms and legs. Anomalies at higher levels may affect the brain. In most spina bifida cases, the normal flow of cerebrospinal fluid is also blocked (Arnold-Chiari malformation), which would result in hydrocephalus unless treated

Cerebral palsy is a motor disorder appearing in early childhood that is caused by brain damage (Waitzman et al., 1996).2 It is the most common movement disorder of childhood and affects approximately one to six children per 1,000 births. The estimate varies considerably because mild cases may not be determined in early childhood, and all cases may be obscured by other developmental disabilities, such as seizures and mental retardation. The most severe cases may result in rapid death and not be detected. When estimates of the incidence of cerebral palsy are based on evaluations in the neonatal period, the occurrence will be underestimated.

Down syndrome occurs as a result of having three, rather than two, copies of chromosome 21 (hence the name “trisomy 21”). Mental retardation and a group of physical characteristics are commonly associated with Down syndrome. In addition, a number of serious defects in critical organs (e.g., heart, digestive system) are also commonly found in people with Down syndrome. The syndrome involves clusters of external physical anomalies, learning disabilities, and organ system anomalies.

Elevated PbB levels in young children occur when children are exposed to lead via any media (i.e., air, water, food, soil). Elevated PbB in children is a considerable public health concern, due to the potential adverse effects of lead on multiple organ systems and the particular susceptibility of young children to many of these effects, including neurological damage. Lead is toxic to the kidneys and is associated with low birth weight, male sterility, cancer, and a wide array of neurological disorders.

Respiratory illnesses involve the upper or lower respiratory system, which usually includes the nose, tonsils, throat, mouth, trachea (wind pipe), and all the structures of the lungs (bronchi, alveoli, etc.). Respiratory illnesses also are usually defined to include ear infections, sinusitis, and related illnesses (Oski et al., 1994). Often the illnesses involve multiple parts of the respiratory system.

Asthma is a leading cause of morbidity among children and is the most commonly cited reason for school absenteeism, accounting for one-third of all school days lost. It is the most common cause for hospitalization of children. The median age of onset of asthma is four years; however, more than 20 percent of children who are diagnosed with asthma develop symptoms during the first year of life

Indoor air contamination in non-industrial buildings has received increased attention in recent years due to improved understanding of the potential impact of indoor air quality on the health of residents and workers. Air pollutants that are known to cause irritation, allergic responses, and infection are numerous, and vary widely in their potency and in the responses they elicit. Groups of illnesses that result from exposure to contaminants in indoor air have been categorized as “sick or tight building syndrome,” or with other designations that encompass a variety of diseases and symptoms. Some groups of illnesses have highly specific target organs.

Symptoms are of interest because in some cases they are the only information sources available that describe the adverse response effect to pollutant exposure. This situation is commonly encountered in the study of indoor air pollutants, which may elicit a number of symptoms in the absence of a definitive disease diagnosis.

Many environmental irritants and allergens, whether chemical or biological, can cause systemic toxicity and irritation of mucous membranes, leading to pain and related symptoms. The Indoor Environments Division has been evaluating impacts of various indoor air pollutants. This analysis examines the direct medical costs of addressing symptom groups, such as eye irritation, throat irritation and pain, coughing, headaches, and other nonlife-threatening medical conditions, to address the division’s specific requirements

 

All files are pdf and in some cases-increase down-load time should be expected

 

DECISION AND COST-EFFECTIVENESS ANALYSIS Decision-Tree methodology: Discounting is the method to adjust future health outcomes and costs to their value in the present. Value in the present is called “net present value”, or NPV. This technique has long been used to represent time preference for costs. Recently a consensus has been reached to discount health outcomes. Not doing so leads to some logical conundrums in CEAs. On average people exhibit time preferences for health outcomes similar to those for costs.  
Delays, Denials & Deceptions-The truth about LTD insurance Claimants who succeed in the battle for benefits tend to be savvy, articulate and persistent individuals with the resources to obtain sophisticated medical evidence and aggressive attorneys. Poorer, older, less-educated and extremely ill claimants seldom fare as well. The sickest and least privileged among us may be easily brought down by insurance company employees who find them fair game for harassment, deception and intimidation.  

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

Disease management

Insurance report on Successful Disease Management Programs

PDF  211KB

Disease Management: Findings from Leading State Programs
Disease management programs are designed to contain costs 
by improving health among the chronically ill.  More than 20 
states are now engaged in developing and implementing 
Medicaid disease management programs for their primary
 care case management and fee-for-service populations
378 kb pdf
Disparities in State Health Coverage: A Matter of Policy or Fortune? (Large Report-Increase Download Time)
This paper explores the reasons why states differ in their 
Medicaid coverage of the at-risk population, focusing in particular 
on the large disparities in Medicaid spending associated 
with these differences.
3374 k pdf
EMTALA: A general guide for the physician assistant
Advocacy groups for patients' rights are becoming more 
prominent and vocal in the United States. Some consumer groups 
have begun to publish information on the Internet about the EMTALA 
compliance of physicians and hospitals. One Web site, for example, 
lists 527 confirmed EMTALA violations at hospitals between 1997 
and 2001 and notes that one in five US hospitals has been cited for 
EMTALA violations since 1988. Some hospitals are now beginning 
to distribute patient rights brochures, which detail what each patient 
should expect when visiting the hospital. The distribution of these 
brochures appears to be a response to growing emphasis on patient 
rights and the dissemination of EMTALA information and increased 
EMTALA violation assessments.
 
EMTALA: The Basic Requirements, Recent Court Interpretations, and More HCFA Regulations to Come

 

In 1994 the Health Care Financing Administration (HCFA) issued
 interim final regulations to implement EMTALA (42 CFR 489). Yet, due
 to federal Paperwork Reduction Act "technicalities," the regulations 
were not enforced until September 1995. Over the succeeding years, 
the regulations have been amended to add additional requirements for 
hospitals and physicians.  Also, included in this report are several 
court cases and their resolutions
 
EMTALA-complete regulations from the Department of Health and Human Services

 

Medicare Program—Clarifying policies related to the responsibilities of 
Medicare-participating hospitals in treating individuals with Emergency
Medical Conditions
 
EMTALA-Implementations and Enforcement Issues—a GAO report
EMTALA requires hospitals that participate in Medicare to provide a 
medical screening examination to any person who comes to the 
emergency department, regardless of the individual’s ability to pay.  
If a hospital determines that the person has an emergency medical 
condition, it must provide treatment to stabilize the condition or provide 
for an appropriate transfer to another facility.
 
EMTALA-State Operations Manual
Interpretive guidelines, responsibilities of Medicare participating 
hospitals in emergency cases
 
ERISA Disability Litigation How To Sue Your LTD Insurance Carrier In United States Federal Court Without an Attorney This report is oriented to those persons who are disabled by Chronic Fatigue and Immune Dysfunction Syndrome (a.k.a. CFIDS, CFS, M.E.) and other so called "self-reported conditions" such as Fibromyalgia Syndrome (FMS) and Multiple Chemical Sensitivity (MCS) who must sue to recover long term disability benefits from employee benefit plan providers (insurance companies).  

Estimated future of Hepatitis C morbidity, mortality, and costs in the US

This study estimated future morbidity, mortality, and costs resulting from hepatitis C virus (Hepatitis C Virus).

PDF  133 KB

FTC Antitrust Actions in Health care Services and Products In the mid-1970’s, the FTC formed a division within the Bureau of Competition to investigate potential antitrust violations involving health care.  The Health Care Services and Products Division consists of approximately thirty-five lawyers and investigators who work exclusively on health care antitrust matters. 293 kb pdf
Health and Disability insurance and Social Security Disability Patients with chronic illnesses unfortunately must advocate for themselves, whether it be with a doctor or an insurance company. Knowing your rights will help. If you have internet access, you have access to the best research tool in the world. 487 kb pdf

Health care exposure

Report on exposure to toxin and infectious diseases in the work area

PDF  471 KB

Health care fraud

Insurance magazine (mid-way thru paper) reports on Healthcare fraud

PDF 346 KB

Health care workers with AIDS

Report from CDC on the numbers and types of positions within healthcare who have become infected with AIDS

PDF  42 KB

Health Insurer Benefits

OXFORD HEALTH PLANS reported improved first-quarter earnings yesterday and raised its profits forecast for the year, becoming the latest health insurer to benefit from a nationwide trend of moderating hospital and drug costs

 

Health Spending Growing Faster than US Economy

For the first time in almost a decade, federal health economists reported January 8, health expenditures outpaced the growth of the economy.

 

High Income Americans opt out of Health Insurance

Of the 41 million Americans currently uninsured, the largest portion is made up of the working poor, but those with high-incomes are quickly joining in, as growth in uninsured wealthy and poor rose almost equally last year.

 

HIPPA-portability

Report from insurance industry on HIPPA requirements

PDF  50 KB

HIV Exposure Report Form

Exposure form for Law Enforcement-Calif.

PDF  80 KB

Humana, Inc. v. Forsyth and Federal Claims Against Insurance Companies The application of federal law, especially RICO, to the insurance industry should provide policyholders with additional remedies to combat persistent and repetitive practices of insurance companies that damage large numbers of policyholders. The Court’s decision may also result in the application of numerous other federal civil and criminal laws, including federal consumer protection law and civil rights law, to the insurance industry and HMOs as well. Pdf 82 kb

Insurance

Report from insurance industry on capitation (limits of cost) concerning healthcare coverage

PDF  462 KB

Insurance privacy issues

Magazine article from insurance industry (mid-way thru) Article on Privacy Issues for Health Plans and HIPPA regulations

PDF  336 KB

Insurance-Actuarial aspects of Dread Disease

Actuarial aspects of Dread Disease Products and the methods in marketing with pricing formulas for determining costs

PDF  526 KB

Insurance-Hepatitis C-health, law protection

Hepatitis C Virus threatens silently-that has the potentially could lay your operation low—risk management

PDF  417 KB

Measuring Capacity Building Capacity building has become central to USAID health sector assistance strategies.  Experience suggest that achieving better health outcomes requires both an injection of resources and adequate local capacity to use those resources effectively. Pdf 135 kb
Medicare Modernization Act (MMA) and Dual Eligibles-A Transition in Crisis MMA eliminates Medicaid drug coverage for 6.4 million dual eligibles (those enrolled in both Medicare and Medicaid) and moves them into Medicare drug coverage on Jan. 1, 2006.  Because Medicaid coverage ends on the first day that Medicare coverage is effective, the transition leaves literally no margin for computer error, system failures, postal delays, or inevitable disruptions and confusion involved in moving millions of the frailest older and disabled adults out of one program and into a very different one. 140 kb pdf
New Medicare Drug Benefit Table/chart of how much will consumers pay over time 240 kb pdf

Outcomes and Costs of Care in Hepatitis C

Based on the current evidence of the cost-effectiveness and improved response rate of the combination regimen, it seems very likely that combination therapy, with duration therapy determined by genotyping alone and without pretreatment liver biopsy or Hepatitis C Virus RNA quantitation, is also likely to be a cost-effective approach.

 

Patients paying Larger Percentage of Medical Costs

Faced with "rapidly rising" prescription drug spending, which is climbing at about 15% per year, employers and insurers have increasingly shifted the costs to patients, who "may soon pay even more,"

 

Prescription For Danger "The insurance companies are pushing all of us around, they're pushing the patient, the consumer, they're pushing the physician and they're pushing the pharmacist." The drugs and dosages an insurance company prefers are called its 'formulary.' We discovered your insurance formulary often depends on secret deals your health plan makes with drug manufacturers. Depending on which drug is not selling well, manufacturers give incentives -- what some call kickbacks.  
Preventive Services: Helping Employers Expand Coverage By purchasing health insurance for their employees, employers influence access to health care for more than 168 million insured Americans…Two out of every three Americans were covered by private health insurance sponsored by employers in 2001 348 kb pdf
Preventive Services: Helping States Improve Mandates (Large file-please allow extra time for download) Mandating coverage of a range of recommended preventive services can improve health, prevent disease and disability, and potentially lower some health costs 1487 kb pdf
Pulling away the safety nets The Safety Net She Believed In Was Pulled Away When She Fell Debra Potter made a good living selling disability coverage. But like many working Americans, she learned the hard way that federal law now favors insurers.  
Quality of Care-followed by publicly provided care Power Point presentation 807 kb pdf

Re unaffordable meds

People without insurance typically pay the world’s highest prices for prescription drugs. That is because the average American prices are the highest in the world and uninsured Americans pay prices above the average

PDF  27 KB

Risk & Management for Healthcare workers-bloodborne

Exposure to blood-borne pathogens poses a serious risk to health care workers. Transmission of at least 20 different pathogens by needle stick and sharps injuries has been reported.

PDF 354 KB

Socio-Economic Aspects of Reproduction The economic approach to analyse the health care services system was used for many decades. Cost benefits (CB) studies were developed to evaluate the economic gain related to the expenditure for a specific treatment or health care method. The great challenge of those studies are how to quantify, for example, the life of a person, its health status or some morbidity condition, in order to compare the cost of a treatment to the benefit in terms of health, cure or death avoidance. How much is the cost of a woman’s life?"  
Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2008 Current Population Survey The percentage of uninsured individuals in the United States decreased in 2007 because the percentage of the population covered by government programs increased. Overall, the percentage of the nonelderly population with employment-based health benefits was unchanged between 2006 and 2007 at 62.2 percent  Employment-based health benefits are still by far the dominant source of health coverage in the United States for the population under age 65, providing coverage for over 162 million people under age 65. Pdf 907 kb

The Business of Medicine

AMA member is on a mission to educate other physicians about the changing face of the business of medicine, and its potential fallout on patients – particularly the elderly

 

The End of Health Care: Who Plays God in a System Bent on Profit? "In the spring of 1987, as a physician, I caused the death of a man," testified Dr. Linda Peeno, to Congress. "Although this was known to many people," she continued, "I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was 'rewarded' for this. It bought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the 'good' company doctor: I saved a half million dollars."

"The decision about the California patient [in need of a heart transplant] was made from the 23rd floor of a marble building in Louisville, Kentucky," added Peeno, herself a Louisville resident, a medical reviewer for Humana and medical director at Blue Cross/Blue Shield Health Plans. Peeno had no license to practice medicine in California, but to her employer, this was irrelevant. "The patient was a piece of computer paper, less than half full. The 'clinical goal' was to figure out a way to avoid payment. The 'diagnosis' was to 'DENY.' Once I stamped 'DENY' across his authorization form, his life's end was as certain as if I had pulled the plug on a ventilator."
 

The Health Insurance Cost Spiral: How It Happened 

Colorado must head-off another medical malpractice crisis by re-affirming the limitations which allow injured patients to be compensated but limit runaway verdicts.

 

The high cost of Health goes Higher

Health Research and Educational Trust finds that premiums for employer-sponsored health insurance, which covers two of three Americans, increased an average of 11 percent in 2001, the largest increase since 1992. Overall inflation during the same period was only 3.3 percent.

 

The Other Drug War-Public citizen

The lobbying side of the pharmaceutical companies and how the pressure the government

 318 KB PDF

The Right to Equal Treatment: Student Toolkit to address Racial and Ethnic Disparities in US Health Care The problem of racial and ethnic disparities in health is one of the most serious human rights issues facing Americans today.  People in racial and ethnic minority groups in this country tend to live shorter lives and suffer higher rates of diseases than do whites. 263 kb pdf

Tip of iceberg

Report by insurance industry on the risk of exposure in the work area and what they should do about it

445 KB PDF

What Happens When COBRA Ends

There are two federal laws that can be used to continue health insurance once your COBRA Continuation Coverage ends. Both provide access to health insurance without having to prove that you are "insurable."

 

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