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Do Private Health Insurance Practices Causes Decline In Health Care Quality?

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Science Daily reports on 09 October 2009 that "[t]he cost and quality of health care, as well as access to care and health outcomes, continue to vary widely among states, according to the Commonwealth Fund Commission " The Commonwealth Fund Commission is a private foundation working toward a high performance health system. This is it’s second rating of the various states. In their report "Aiming Higher: Results from a State Scorecard on Health System Performance, 2009".

Leading states in the 2007 report still lead, disparities are great and the gap is widening. That means the quality of your health care depends on where you live in the United States. That’s why we need national health care and a public option. I suspect that the driving factor in this is the insurance company denials of paying for quality and necessary treatment and tests. It isn’t that we have too much health care in the form of rampant defensive medicine. Its that some adjuster at a big insurance company is denying a lot of patients and their doctors necessary treatment. This rationing of medical care by private health insurance companies is making America sick. The report confirms my support for a single payer public plan for health insurance, AND reform of insurance law and strict regulation of private insurance companies.

Since the beginning of the decade, insurance coverage in most states has been eroding for adults while increasing or holding steady for children. This divergence reflects the impact of federal action to expand coverage for children through the Children’s Health Insurance Program (CHIP); rates of uninsured children in 2008 were the lowest since 1987. Nevertheless, high and rising rates of uninsured adults in many states underscore the need for comprehensive national reform to expand coverage in all states, and to further the gains made in Massachusetts, Vermont, and other states that have taken a lead in enacting reforms.

Private health insurance in the United States has failed. While the insurance industry is hugely profitable, the doctors are not being fairly reimbursed for treatments and the CFO’s of the insurance companies are directing widespread denials of treatment to patients. Who are these insurance executives anyway? They aren’t doctors so why can they make treatment decisions? It isn’t defensive medicine that is a problem, its the money hungry insurance executives that are hurting people. Maybe they could use a good dose of lawsuit abuse.

While health insurance coverage for adults declined in a majority of states, the only improvements occurred when government support was implemented such as in health coverage for children. The Children’s Health Insurance Program (CHIP).

A new bill signed into law by President Obama makes millions of children eligible to receive health insurance.

If your kids do not have health insurance, they are likely to be eligible, even if you are working and even if you have applied in the past and been turned down.

Your state (and every state) has its own program, with its own eligibility rules, but in many states, uninsured children 18 years old and younger, whose families earn up to $44,500 a year (for a family of four) are eligible for free or low-cost health insurance that pays for

Doctor visits, Dental care, Prescription medicines, Hospitalizations and much more.

Looking at overall health care in 2009, Vermont, Hawaii, Iowa, Minnesota, Maine, and New Hampshire lead the nation and these states set new standards on most indicators. Conversely, low states have declined in most areas.

"Leading states have raised the bar for better access, quality of care, and reducing disparities," said Commonwealth Fund Senior Vice President and study co-author Cathy Schoen. "Where you live in the U.S. matters in terms of your health care, and it shouldn’t. These wide and persistent gaps among states highlight the need for national reforms and federal action to support states. National leadership has been critical for children– particularly for states with historically high rates of children uninsured— so we know that strong national efforts can make a real difference even in struggling states."

The sharp variation across states spans access, quality of care, costs, and lives. For example, rates of hospital readmissions (within 30 days of a previous hospital stay) among Medicare beneficiaries ranged from a high of 23 percent of hospital admissions in Nevada to a low of 13 percent in Oregon. The percent of adult diabetics getting recommended preventive care ranged from a low of 33 percent in Mississippi to a high of 67 percent in Minnesota as of 2006-07, a new high. On these and other measures, the lowest ranked states would have to improve 40 percent to 100 percent on average to achieve the performance of top ranking states.

Here’s what would happen if the low states caught up:

    • Twenty-nine million more people would have health insurance—cutting the number of uninsured by more than half;

    • Nearly 78,000 fewer adults and children would die prematurely every year from conditions that could have been prevented with timely and effective health care;

    • Nine million more adults age 50 and older would receive recommended preventive care, and almost 800,000 more children would receive key vaccinations;

    • Five billion dollars could be saved annually by avoiding preventable hospital admissions and readmissions for vulnerable elderly and disabled residents.

It isn’t all bad news. Most states improved in treatment for heart attack, heart failure, pneumonia, and prevention of surgical complications. And the lowest states have improved in some areas to what the average was in 2007. In addition, most states improved significantly in the quality of care in nursing homes (reductions in pressure sores, pain, and use of restraints) following a national effort to make that data publicly available. Wouldn’t it be nice if the reason was that doctors and nurses made this improvement on their own? Why does it only happen when the poor quality is exposed to public view. lawsuits and news stories are the only tools that force change. That’s why tort reform has no place in health care reform.

"The differences we see among the states translate to real lives and dollars," said Commonwealth Fund President Karen Davis. "If we can enact health reforms that give all states the opportunity to do as well as the best states we will save lives, improve quality, and cut costs. And, the good news is that these aren’t pie in the sky goals—we know they are attainable because we see it happening in the states at the top of the pack."

Here are the declines in health insurance coverage from the private sector:

In 1999-2000 there were only two states with 23 percent or more of adults uninsured, by 2007-2008 there were nine. In 1999-2000, 22 states had less than 14 percent of adults uninsured; by 2007-2008 the number dropped to only 11 states. Children fared much better—due in large part to the CHIP program. The number of states with 16 percent or more of children uninsured dropped from nine to three between 1999-2000 and 2007-2008.

Gaps in coverage between states were particularly stark, with 32 percent of working-age adults uninsured in Texas compared to only 7 percent in Massachusetts as of 2007-2008. Several states stood out in terms of health insurance coverage expansions, as part of comprehensive reforms. Massachusetts, which had only begun to implement its universal health insurance program during the period covered by the State Scorecard, had the greatest increase in coverage for adults and gains in coverage for children. The reforms passed by Vermont in 2006 to cover the uninsured and establish a "blueprint for health" focused on preventing and controlling chronic disease are providing a new model for other states. And, Minnesota has achieved high rates of adult coverage and better preventive care through public–private collaboration.

The 2009 state scorecard includes 38 indicators grouped into five dimensions of performance—access, prevention/treatment quality, avoidable hospital use and costs, equity, and healthy lives. The analysis ranks states on each indicator and then averages the indicator ranks to determine the dimension rank. Dimension scores determine the overall rank. Equity measures the gaps in performance between vulnerable groups and the national average.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.

Hawaii health care is at the top of this review and is an example of how to do things right. A separate report gives details of 7 top states and why they rank at the top: "Aiming Higher for Health System Performance: A Profile of Seven States That Perform Well on The Commonwealth Fund’s 2009 State Scorecard".

Hawaii: An Early Quest for Coverage

Hawaii has one of the healthiest populations in the nation, as measured by the Commonwealth Fund’s

State Scorecard on Health System Performance, 2009 (Table 5). Compared with most states, fewer people in Hawaii smoke and are overweight or obese, and more people are engaged in regular physical activity, which is not a surprise given the state’s natural beauty and diverse geography. However, Hawaii also has its share of health-related challenges. For example, Hawaii has the highest incidence of breast cancer of all 50 states, but it also has the lowest death rates for breast cancer. How is that possible? Hawaii’s residents have excellent access to primary and preventive care, say the states health experts, and that reduces preventable mortality and enables early identification and management of chronic disease.

Hawaii also has had mandatory health insurance for all employees since 1974 and that system is singularly distinguishable across the country. If you wonder how our little states can afford this, it actually saves money because with everyone in the system the numbers make the insurance side of the system more efficient just like national health insurance reform would do in a single payer public plan.