Category: Health Care Access

Health Status Related to Income Not Insurance

Women joggingAn extremely thorough analysis of changes in incomes and mortality in the United States, 2001 through 2014 presents some sobering conclusions for those who think fixing our health system will make us healthier. The research, let by Raj Chetty of Stanford University, ran data on incomes and mortality through a battery of statistical tools.

It is well understood that people in high-income households are healthier than those in low-income households. The latest research demonstrates how important incomes are to health status. Forty-year old men in households in the highest quartile of income (mean = $256,000 annually) had an average life expectancy just under 85 years in 2001. This increased by 0.20 years (a little over ten weeks) by 2014. For those in the lowest quartile ($17,000), life expectancy was about 76 years in 2001, and it only increased 0.08 years (a little over four weeks) by 2014.

Obamacare is likely to accelerate this gap, because it significantly reduces incentives for people in low-income households to increase their incomes.

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Apr 29, 2016 | 12 comments | by

A ‘Free Health Clinic’ for Montana State Employees

Before he left office, then-Montana Gov. Brian Schweitzer decided Montana’s 11,000 state workers, retirees and their dependents needed an employee health clinic. Before leaving office he had one created without consulting the legislature. For those of you who have not heard of the concept, it’s sort of like the school nurse, except there are doctors and real medical equipment involved. At most employee health clinics, physician visits are either free or involve no cost-sharing. Montana employees aren’t required to use the clinic; they can continue to see their own doctors with the normal cost-sharing.

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Mar 29, 2016 | 12 comments | by

When You Need Care Now But aren’t Likely to Die, Urgent Care is the Answer

According to a Wall Street Journal article, urgent care centers are becoming Americans medical home away from home – mainly evenings and weekends when their primary care providers are not available.  About two-thirds of patients at urgent care centers have a family physician.

There are an estimated 10,000 urgent care centers in the United States and another 1,400 are expected by 2020. Increasingly, traditional providers are getting in on the act. Hospitals are building, acquiring or partnering with urgent care providers. Walk-in patients are welcome, although many allow patients to make an appointment. Wait times are 30 minutes or less whereas a wait in the emergency room can run eight times that length. The average cost at an urgent care center is about $150, compared to $1,354 for an emergency room visit. Centers are usually open evenings and weekends when doctors’ offices are closed.

When a retail clinic won’t do, this sounds like a much better solution that non-emergent ER visits or waiting a week for a physician visit.  It would be even better if these facilities were integrated so you could choose the level of provider (and price level) you need. As one of the commenters said in the WSJ article, why doesn’t every hospital have one of these next to the emergency room?  I’d go even farther; why doesn’t every hospital have one of these with a retail clinic inside next to the ER?

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Mar 23, 2016 | 14 comments | by

Retail Clinics Raise Medical Spending??? So What!

Many health policy wonks had hoped that retail clinics would reduce medical spending. Yet, an article in the health policy journal, Health Affairs, claims that retail clinics, like CVS Minute Clinics, don’t save money.   Although, the article did confirm that retail clinics are less expensive than a traditional physician visit, it found retail clinics are associated with an increase in medical spending of $14 per year by those who use them.

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Mar 11, 2016 | 2 comments | by

Dr. Pharmacist Will See You Now

A recent article in the International Business Times outlines how pharmacists are pushing for a bigger role in health care. According to the article, Washington recently became the first state to recognize pharmacists as health care providers, and require that insurers reimburse them for consultations. Beginning next year pharmacists in Washington can bill insurers for appointments just like doctors and nurse practitioners.

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Jul 30, 2015 | 2 comments | by

Hooray! Cheap Lab Tests Coming to a Walgreens Near You! No Physician Required!

A recent Huffington Post article explains how a 31-year old college dropout wants to alter your relationship with your doctor — but in a good way. Elizabeth Holmes, a self-made billionaire, is in the process of shaking up the stodgy laboratory testing industry. The first of her tests have received clearance from the U.S. Food and Drug Administration, with others to follow.

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Jul 15, 2015 | Leave a Comment | by

Direct-To-Consumer Lab Test Works Fine!

Fellow Forbes contributor and health care entrepreneur Dan Munro has taken advantage of Arizona’s new law allowing patients to buy lab tests directly without a physician’s order. It was a positive experience:

The Theranos process really has removed much of the friction I associate with blood tests I have taken in the past. Access is through a familiar retail facility with pharmacy hours. Billing is a typical retail transaction with credit, debit and HSA cards (or cash/check). The lowest price blood test is $2.70 (Glucose) and Theranos advertises that their pricing is at least 50% below Medicare reimbursement rates for all tests.

The highest price test on the Theranos order form was $59.95 ‒ a comprehensive test for Sexual Health. For comparison purposes, RequestATest (which appears to be an online, front-end for using LabCorp locations around the country), charges $199 for a comprehensive STD test and AnyLabTest Now (with 3 locations in the Phoenix metro) charges $229 for a comprehensive STD test.

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Jul 14, 2015 | Leave a Comment | by

One Year After Veterans Waiting List Scandal, Doctors Only 2,000 of 23,000 New VHA Hires

I hate to bring this up right after Independence Day, but the Veterans Health Administration appears to have devolved from an expensive and failing bureaucracy to an even more expensive and failing bureaucracy.

We have  already discussed that waiting lists have grown one year after the scandal broke. Now, see what they’ve done with the billions of dollars Congress handed them in the wake of the scandal:

o Bonuses at the most troubled VA facilities ran virtually unabated.
o Out of 23,000 new employees added to the employment counts during the scandal, fewer than 2,000 were doctors. Less than 1 in 12 new hires were doctors.
o At the troubled Hines VA in Cook County, IL bonuses leapt to three year highs, but the number of doctors actually decreased.
o Across the system, the VA cut the number of accountability positions: inspector general, auditors, and quality assurance officers.
o There are only 23,768 doctors in the system, but over 338,297 total employees. It’s still an employment farm, not a medical system.
o Yet, the VA increased the Public Relations Directors total salaries by $3,000,000. Painters, Interior Decorators, and Gardeners also increased in headcount and salaries.

(Open the Books, July 4, 2015)

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Jul 06, 2015 | Leave a Comment | by

Veterans’ Waiting Lists Up 50 Percent One Year After Scandal Exposed

Affordable-Care-ActUnfortunately, our predictive abilities at NCPA’s Health Policy Blog appear to be holding up pretty well. Last July, I wrote that giving billions of dollars to the Veterans Health Administration to “fix” the problems of long waiting lists for treatment would be viewed by the VHA bureaucrats as a “reward,” and they would react accordingly.

That is exactly what has happened:

One year after an explosive Veterans Affairs scandal sparked national outrage, the number of veterans on wait lists to be treated for everything from Hepatitis C to post-traumatic stress is 50 percent higher

Ahead of the House Committee on Veterans Affairs budget hearing scheduled for Thursday, VA leaders also warned that they are facing a $2.6 billion budget shortfall. They said they may have to start a hiring freeze or furloughs unless funding is reallocated for the federal government’s second-largest department. (Emily Wax-Thibodeaux, “One year after VA scandal, the number of veterans waiting for care is up 50 percent,” Washington Post, June 23, 2015)

At what point does a government bureaucracy that fails so badly get put out of business? Not very often, and not soon enough.

NCPA’s CEO, Allen B. West, has also written about this scandal.

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Jun 23, 2015 | 3 comments | by

Drug Shortages Getting Worse

Robin Miller, a 62-year-old oncologist in Atlanta with bladder cancer, was scheduled to receive a potentially lifesaving drug in December. But her doctor’s office called shortly before the appointment to say: “Sorry, we don’t have any. We can’t give it to you,” according to Dr. Miller.

The disruption was due to a global shortage of the drug, BCG, which arose after manufacturing problems at two of the few global suppliers. Without the drug, Dr. Miller feared her cancer would come back and she would have to have her bladder removed, a step she called “barbaric.”

The crisis illustrates the potentially grave consequences of a persistent problem in health care: drug shortages. The number of drugs in short supply in the U.S. has risen 74% from five years ago, to about 265, according to the University of Utah’s Drug Information Service, which tracks supplies. They range from antibiotics and cancer treatments to commodity items such as saline. (Peter Loftus, “U.S. drug shortages frustrate doctors, patients,” Wall Street Journal, May 31, 2015)

The U.S. government’s measures to mitigate this problem have failed because it has ignored NCPA’s conclusion that shortages result from too much, not too little control over the market for these drugs.

The government keeps tightening the screws on manufacturers, and the shortages keep growing.

See Devon Herrick’s testimony to the U.S. Senate in 2011 and my own study published in 2012.

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Jun 02, 2015 | 2 comments | by
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