On November 7, with a number of amendments from its original form, the health care reform bill was passed with a slim margin of victory. While it is an important step, a number of steps remain before the bill is signed into law. The amended form of the health care bill includes concessions to pro-life democratic congressmen, who would only pledge their signatures after the bill was amended to include no support for abortions under the government-run public option. The passed version of the bill only garnered one vote from a Republican.

The bill now faces an equally rough ride in the Senate. Republicans in the Senate can come up with a number of amendments for the bill and keep it tied up for weeks, a threat that severely impairs the end-of-year deadline set by President Obama. House Republicans have said that the bill would be “dead on arrival” to the Senate floor.

The Senate Majority Leader, Harry Reid, is waiting to receive a cost estimate from the nonpartisan Congressional Budget Office for the Senate version of the legislation before unveiling it. Once that estimate is in, Reid could use a procedural technique known as reconciliation to avoid a Republican filibuster and get the bill passed before the end-of-year deadline. To do so, however, may be politically explosive as it would signal an end to the bipartisan negotiations that President Obama has tried to foster throughout the health care reform debate.

You can read more on the most current developments at CBS News.

Americans understand that insurance doesn’t actually pay for everything, according to a study by the Sacramento Center for Health Care Decisions. This shows that Americans are quite able to set priorities for health care on their own without leaders trying to tell them what to do. The study put health care issues into three categories; what matters most, what matters a little, and what matters least. As healthcare organizations, we can use this information to do a bit of triage on what patients deem important in their own care.

What Matters Most:

• Problems that will lead to serious medical consequences or death if left untreated
• Problems that interfere with daily life
• Problems that result in higher societal costs if left untreated

What Matters A Little:

• Problems that bring personal distress
• Problems that result in physical discomfort
• Nonmedical services that prevent disease through getting healthy and fit

What Matters Least:

• Problems that are unsightly but not harmful (i.e. varicose veins)
• Problems that delay or prevent recreation
• Treatments that are required by patients to feel reassured
• Problems that resolve without treatment
   

There are a few takeaways from this list. One of the more interesting items is that prevention, which many would have thought mattered the least, actually matters a little to most Californians who took the survey. Since California has a reputation as a healthier state than most, it would be interesting to see the same study done on a national scale to see if this still held true. Perhaps it is better to have it done at the state level in order to more accurately gauge the wishes of people in each individual state.

One of the most interesting aspects of the study is that people tended to put the welfare of their family and friends ahead of their own, and even the welfare of society. You certainly wouldn’t have expected to see “problems that have a higher societal cost” at the top of the list if you were to guess the results in advance.

All in all, a very interesting study and one that bears repeating as we forge ahead with health care reform.  More at recordnet.com.

For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

Ron Paul, excerpted from Examiner Article

Upon reading this, we thought we should explore both “the old days” of healthcare referred to by Paul and also how other countries handle their health care. We start part one of this series with exploring how other countries handle their health care.

Many second and third world countries operate on a cash basis for any doctor and healthcare related visits. In Venezula, a vacationing family had to have emergency health care for their son after he had a seizure that was caused by an ear infection. After two hospital visits and ambulance rides, with multiple tests at both facilities, the bill came out to only $685.00. While this obviously isn’t comparable to prices in the US due to the lower cost of everything in a second world country, it is interesting to explore their system. Costs are kept down because doctors are required to donate three days a week of their time, something that would be unenforceable in the States but the idea is worth exploring. What if everyone in the medical industry donated an hour a week? How much money could we all save then?

In Canada, instead of paying private health insurance, Canadians pay more taxes to the government than we do. Income tax in Canada ranges from 24% to 46%, depending on your tax bracket. Most Canadians fall into the 24%-32% tax rates. The government, in turn, pays for all health care except for prescriptions and dental. Emergency dental procedures are covered, as are drugs given on an emergency hospital visit. Canadian doctors do not donate any time to the government, although they are less well-paid than their colleagues in the US and as a result there is a marked “brain drain” of doctors from Canada to the US. In contrast, in the US in 2008 companies paid an average of $12,700 per worker for health care premiums. Employees are often asked to kick in for premiums as well, and not all costs are usually covered in all plans. This means that running a company in the US is much more expensive than doing business in Canada or any other country. There have been a number of claims in the US media lately that Canadian healthcare is deplorable, but the only real down side is a wait time of 4 weeks for a specialist and longer for non-emergency surgeries. Most Canadians are happy to wait since the price is right.

In Sweden, the state pays 95% of medical costs, with the patient paying a nominal cost for examination on each visit. In addition, if a patient is declared ill, the patient is paid a percentage of their daily wage from the second day for the first 14 days by the employer, and after that by the state until they are declared fit.

In Nepal, the state subsidizes health care so that each resident pays about 70% of health care costs in cash on each visit.

Japan has an interesting system. Since 1973, all seniors have been covered for their health care. Everyone else is governed through a universal health care insurance system with fees set by a government committee. You must be enrolled in an insurance company if you are a resident of Japan. This is very similar to the two-tier insurance system that President Obama is putting forward, minus of course the free health care for seniors. 

There are lessons to be learned here from all countries. In the case of Nepal, partial subsidy keeps costs down significantly. In Venezuela, payment is still solicited, but doctors donate a good portion of their time to ensure that the system works. Japan has managed to provide free health care for its seniors and runs a state-sponsored health insurance program, all for the low cost of 6% of their GDP, much lower than Canada’s 10% of their GDP for providing free health care for everyone.

It could be argued that the most sensible avenue to health care reform is to examine what works and what doesn’t in each country in order to put together a system that works well for everyone. For companies, health care organizations, and of course patients.

Quality ratings for hospitals come in two flavors – professional and public. As can be expected, the professional quality ratings are the ones that can be trusted, but they are not as easy to access as the public rating systems. Public rating systems can be skewed towards a positive outcome by advertising, or skewed towards a negative outcome due to one complaint. Professional rating systems are often fairly done through industry reports and surveys, and thus can be more trusted. Patients should be discouraged from using internet healthcare rating systems, even if they are favorable towards your organization. What then are the professional quality ratings that you can trust, and how do they work?

The first thing to note is that even hospital quality rankings that are considered top in the industry can be considered flawed when placed under a microscope, such as the rankings of the US News and World Report, a frequent go-to guide for hospital rankings. These reports are generally meant to be overall rankings and may not take into account representative samples or all statistics that are available. In the end, there is no one way to denote “the best” hospital for a certain surgical procedure. Most hospitals and medical professionals are created equal and while some surgeons and physicians may be considered subject matter experts, there is no guarantee that this expertise will translate into better patient care.

The US News and World Report uses the four following criteria to rank hospitals:

1. Having intensive care units staffed by specially trained doctors

2. Having computerized order-entry systems for medications and other orders with error-prevention measures

3. Performing procedures such as cardiac catheterization and caring for certain high-risk neonatal conditions4. Having practices such as those designed to control hospital-related infections and cut down on medication and treatment errors.

While these are lofty goals, what about overall patient satisfaction surveys, or other criteria that medical professionals and patients alike can start rattling off? The reason is simple – these four are really the only universally measurable criteria for most organizations. Until there is a better source of information, such as the new EHR’s that the Obama administration wants to see in place, the US News and World Report is the best source for quality ratings of health care organizations.

The American Academy of Family Physicians (AAFP) is encouraging its members to sign up for a new health care online system, the Health Care Notification Network (HCNN).  If 5% of AAFP members sign up from the link on this page , AAFP will receive a nominal fee.  This system is more efficient than paper-based patient safety alerts and will give you an instant notification when one is issued.  The service is free, does not include advertising and it only takes a couple of minutes to sign up.

The system replaces the “Dear Doctor” letters mandated by the FDA that traditionally appear by postal mail for recalls and alerts.  “Online alerts from the HCNN are delivered immediately to a physician’s (e-mail) inbox,” said Henry DePhillips, M.D., HCNN’s chief medical officer.  If the doctor doesn’t read the alert within 72 hours, they are mailed a paper copy of the alert, ensuring that it reaches them.  This system not only saves the environment by cutting down on paper, it saves the government money and improves the overall operational efficiency of the system. 

Imagine – no more massive piles of paper for you and your staff to deal with.  HCNN currently reaches more than 250,000 physicians and 70,000 physician assistants.  You can choose to add staff members to your alerts, which minimizes the chances that an alert will be missed.  More on the new system on the AAFP website.