Editor’s note: the story goes on (if you go to the link) to talk about the impact health care costs are having in keeping people in the workforce longer.
According to findings from the 2009 EBRI/MGA Consumer Engagement in Health Care Survey, the labor-force participation rate is increasing for those age 55 and older. The percentage of civilian non-institutionalized Americans age 55 or older who were in the labor force declined from 34.6 percent 1975 to 29.4 percent in 1993. However, since 1993, the labor-force participation rate has steadily increased, reaching 39.4 percent in 2008—the highest level over the 1975–2008 period. For those ages 55–64 (the near elderly), this is being driven almost exclusively by the increase of women in the work force; the male participation rate is flat to declining. However, among those age 65 and older (the elderly), labor-force participation is increasing for both males and females. Education is a strong factor in an individual’s participation in the labor force at older ages: Individuals with higher levels of education are significantly more likely to be in the labor force than those with lower levels of education.
With Washington placing insurers in their cross-hairs and proclaiming that there isn’t enough competition among insurers, I wonder if the public has thought about what more competition among health insurers might mean.
First, a few facts. The portion of the premium that is devoted to care (otherwise known as MLR or Medical Loss Ratio) runs between 78 and 82% of premium. You can find these numbers in the quarterly financial reports of the public insurers. These claims payments are a result of contracted reimbursement rates between the insurer and providers (doctors, hospitals, labs, etc.)
Back to the original question. Will more competition drive premium costs downward. If market power in terms of volume allows you to negotiate a better rate then on at least 78% of the bill the costs may go up instead of down with new entrants into the market. The insurers will not be able to negotiate the same favorable terms with providers as they are now. Unless you think they are keeping reimbursements artificially high … I doubt you could find a physician or a hospital that would agree with that.
Therefore the government must be counting on the reduction of the remaining 18-22% to not only be reduced, but to overcome any loss of market power on the contracting with providers. Since the insurers will be smaller, they will have less market power with all of their other providers of products and services as well — from phones, to facilities, and on an on.
Perhaps in this context competition isn’t such a good idea if your goal is to reduce costs.
Then again, perhaps what they are talking about at the Federal level is all of the costly mandates that the states put on insurance providers. Requirements for coverage types, lengths of stay and so on. So maybe the issue isn’t with private enterprise, but rather with government regulation.
What do you think a couple of thousand page health care bill is going to do to the volume of regulation?
Editor’s note: It is critically important that we move the reimbursement system from fee for services to fee for care. A movement in that direction is bundled services, but it has to be more than that. Payment has to involve information about efficient process, quality, and outcomes. Otherwise in the words of Demming, “If you only focus on the ends, you may get it in ways you never intended.”
Expert: U.S. is on path toward health care payment reform
More than a dozen health care payment reform efforts are under way around the U.S., according to Karen Davis, president of the Commonwealth Fund. She told a conference that the country is on a path away from fee-for-service and heading toward bundled payments that go beyond pay-for-performance models. Healthcare Finance News (3/12)
- Upstate New York insurer will cover telehealth
BlueCross BlueShield in New York will cover a new telehealth service provided by the American Well Online Care platform that links patients to medical assistance via the telephone or Internet starting soon with western New York. Plans are in the works to expand the service to the northeastern part of the state later in the year, the insurer said. InformationWeek (3/10)
Editor’s note: a terrific piece by John Goodman with comments by some of the greatest minds in health care policy – debating some of the most salient points.
Writing in Health Affairs, Ken Thorpe and his colleagues offer a description of the current phase of the problem:
Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs.
So how are we dealing with this challenge? Poorly.
Now read more and the various rebuttals…at:
AHIP: Insurance is just a small part of health care costs
AHIP launched a TV ad campaign Tuesday showing that health insurance only accounts for 4% of health care spending, while physicians, hospitals, diagnostics and drugs are larger cost factors. The ad said Washington needs to “look at the whole health care pie” if it wants to curb health spending. The Hartford Courant (Conn.) (3/10)
Editor’s note: How do you deal with the issues of self insurance? The Health Benefits Network may be able to help. http://www.hbn1.com.
While we all start to sit down, our broker tries to put us at ease by cracking a few jokes. No matter how funny the humor, it doesn’t overshadow reinsurance renewal time for our self-insured plan.
The process starts with an overview of how many self-insured claimants hit specific level, came close, or how near we were to our aggregate attachment point.
Hospital Discharge Survey: Hip and Knee Joint Replacement Procedures
- From 1996 to 2006, the hospital discharge rate for total hip replacement increased by one-third, and the discharge rate for knee replacement increased by 70%.
- In 2006, total hip replacement rates were similar among men (18.1 discharges per 10,000 population) and women (20.5) . Discharges for partial hip procedures were about twice as common among women
(23.9 per 10,000 for age 45 years and over) as men (13.0 per 10,000). Partial hip procedures, which are often used to treat fractures, were also more common among older persons.
- In 2006, knee replacement discharges were more common among women 45 years of age and over (54.0 per 10,000) than men (34.9). As with hip replacement procedures, knee replacement discharges were more than three times as high for those 65 years of age and over (84.1), compared with those 45–64 years of age (25.7).
Source: CDC/NCHS, National Hospital Discharge Survey.
Publication: Health, United States, 2009. http://www.cdc.gov/nchs/data/hus/hus09.pdf#specialfeature
Editor’s note: If you are interested in learning more about those ‘average’ premium increases and what it is all about read this article.
In 2007, the average temperature in the U.S. in was 54.2 degrees. The average household spent $1,300 for energy. The average increase for health insurance premiums between 2007 and 2008 was 5%, according to the 2009 Employer Health Benefits Survey from Kaiser and the Health Research & Educational Trust.
What do these numbers have in common? Well, for one thing, they’re averages, which means they represent lots of numbers that can be significantly different from the average.
Further, the separate numbers that are averaged together each can have very different factors that contribute to their individual values – such as the weather in Alaska vs. Texas, electricity costs in San Francisco vs. Des Moines, or health care cost increases for a unionized manufacturing company in Baton Rouge vs. a software company in Cleveland.
Averages create a blur, a number that in many cases is overly general and not well-defined. Even when some facts are known about a statistical average, it often has little real-world value. For example, it’s highly doubtful that residents of southern Florida would make clothing choices based on the average U.S. annual temperature.
Now, keep reading, it is about to get very interesting.