Lat­est re­ports add more ev­i­dence about our cost, qual­ity chal­lenges

New re­ports add em­pha­sis to the cost and qual­ity chal­lenges in health­care

Modern Healthcare - - MODERN HEALTHCARE -

As if we need any re­minders, it’s painfully clear that the U.S. health­care sys­tem con­tin­ues to grap­ple with some se­ri­ous health is­sues. Yet an­other batch of re­cent re­ports reaf­firms the fact that Amer­i­cans are pay­ing far too much for their care and health cov­er­age and get­ting too lit­tle qual­ity in re­turn—trends that have been at work for decades.

Last week brought a high-pro­file re­port from the Kaiser Fam­ily Foun­da­tion and the Health Re­search & Ed­u­ca­tional Trust bear­ing bad news on health in­sur­ance pre­mi­ums. It showed that costs this year re­sumed their his­toric trend line, with in­creases near­ing dou­ble-digit ter­ri­tory, af­ter some pre­vi­ous moder­a­tion.

Ac­cord­ing to the re­port, the av­er­age an­nual premium for in­di­vid­ual cov­er­age was about $5,400, or 8% higher than last year, while the premium for fam­ily cov­er­age topped $15,000, or 9% higher. The rise in the cost of fam­ily cov­er­age in 2010 was only 3%. This year’s in­creases out­paced gen­eral in­fla­tion and ran far ahead of typ­i­cal pay raises.

Mean­while, ac­cord­ing to a study sup­ported by the Com­mon­wealth Fund and pub­lished online last month in the jour­nal Health Pol­icy, the U.S. ranked last in a study of deaths that could po­ten­tially have been pre­vented by timely med­i­cal care.

The anal­y­sis in­volved 16 high-in­come in­dus­trial na­tions, look­ing at deaths from 1997-98 to 2006-07 that oc­curred be­fore age 75 from causes such as treat­able can­cer, di­a­betes, child­hood in­fec­tions/res­pi­ra­tory dis­eases and com­pli­ca­tions from surgery. While all na­tions in the study saw a de­crease in the rates of pre­ventable deaths, coun­tries other than the U.S. saw an over­all drop of 31%; the de­crease in the U.S. was 20%.

Also last week, an an­nual sur­vey by Consumer Re­ports showed that more Amer­i­cans are go­ing against the ad­vice of their physi­cians and are skip­ping med­i­ca­tions or other treat­ments be­cause of af­ford­abil­ity is­sues.

Of the 2,038 re­spon­dents, nearly half (48%) said they had taken cost­cut­ting mea­sures in­volv­ing their health­care, such as skimp­ing on drugs, for­go­ing doc­tor vis­its or de­lay­ing med­i­cal pro­ce­dures. This year’s num­ber re­flects a 9 per­cent­age-point in­crease com­pared with 2010.

Ac­cord­ing to a sep­a­rate on­go­ing sur­vey by Consumer Re­ports, lack of money to pay for med­i­cal bills and pre­scrip­tion drugs is con­sis­tently among the top fi­nan­cial con­cerns for Amer­i­cans polled.

All of these find­ings cer­tainly don’t of­fer the com­plete pic­ture of Amer­i­can health­care, but they do show ma­jor stress frac­tures for pa­tients and providers.

As such re­ports con­tinue to make head­lines, it’s in­evitable that the Pa­tient Pro­tec­tion and Af­ford­able Care Act will be tar­geted for more scorn. Crit­ics will ask why the ACA isn’t im­prov­ing qual­ity and pa­tient safety. They’ll also say the re­form law bears most of the blame for the surg­ing in­sur­ance pre­mi­ums.

And they would be wrong. Shar­ing in this opinion is the CEO of the Kaiser Fam­ily Foun­da­tion. Ac­cord­ing to Drew Alt­man, who wrote an es­say ac­com­pa­ny­ing the re­port on in­sur­ance pre­mi­ums, the is­sue is far more com­pli­cated than that.

“Crit­ics of the national health re­form law passed in 2010 like to blame every­thing but the weather on ‘Oba­macare,’ ” Alt­man wrote. “But re­gard­less of how you feel about the Af­ford­able Care Act, its ef­fect on pre­mi­ums this year is modest. Most of the law’s pro­vi­sions don’t go into ef­fect un­til 2014.”

Alt­man said two pop­u­lar pro­vi­sions of the re­form law—al­low­ing young adults to stay on their par­ents’ in­sur­ance poli­cies un­til age 26 and re­quir­ing health plans to of­fer some pre­ven­tive ser­vice for free—to­gether ac­counted for about 2 per­cent­age points of the premium hikes.

No, the re­form law isn’t the cure for the health­care cost cri­sis, but it’s still po­tent medicine.

DAVID MAY As­sis­tant Man­ag­ing Editor/fea­tures

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