Health consumers who think they're digging deeper into their pockets to subsidize employer-sponsored health plan costs are absolutely right, according to a report released today in the journal, Health Affairs.
"If you are sick and earn a modest income, then you are probably underinsured, even if you have employer-based health coverage," the authors wrote.
In 2007, employees on average contributed $729, or 34% more than the $545 they paid in 2004 in premiums, deductibles, and out-of-pocket costs, according to the survey from the National Opinion Research Center. The study extrapolated survey data on medical claims filed for 10 million American workers covered by health plans. The authors applied those findings to 161 million Americans covered by an employer's health plan.
"The years from 2004 through 2007 were a period of economic expansion, yet rising health care costs still eroded the value of employer sponsored coverage," said lead author Jon Gabel, a NORC senior fellow. Since then, employees "have been asked to shoulder even more of the cost-sharing burden during difficult economic times such as the United States is now experiencing."
He concluded that health reform must include constraints on health spending, "or else health insurance will become unaffordable for low-and middle-income Americans, and reform itself will be unsustainable."
The paper was co-authored by researchers at the Watson Wyatt Worldwide and was paid for by The Commonwealth Fund.
As expected, the increase in worker contributions for their healthcare was most pronounced among those who had the most healthcare expenses. For the highest-cost 1% and 10% of adults, out-of-pocket spending rose 42% and 39% respectively, to $8,703 and $3,364. This may be attributable to employees first exceeding their deductible, and then their out-of-pocket maximum cap. For the lowest 50%, spending rose 23% to $85, the authors said.
The trend is hardest on those earning less. For example, the authors reported, of those workers earning 200% of the federal poverty level in 2004, 13% spent more than 10% of their income on premiums and out-of-pocket expenses. But by 2007, that figure rose to 18%.
For people earning 400% of the federal poverty level in 2004, 2% spent more than 10% of their income on premiums and out-of-pocket medical expenses. But by 2007, that percentage doubled.
Healthcare providers plan to help cut up to $1.7 trillion of costs over the next decade by improving care for chronic diseases, streamlining administrative tasks, and reducing unnecessary care, major industry groups announced. Their proposals offer the first detailed glimpse into how hospitals, doctors, pharmaceutical companies, health insurers, medical-device makers, and a big labor union aim to make good on the cost-cutting promise they made to President Barack Obama. Under the groups' proposals, certain types of care could see cutbacks, potentially sparking concerns among consumers.
Leaders of the country's largest and most influential liberal groups said they are poised to spend $82 million to help push through sweeping healthcare legislation this year. Gathering at a conference to discuss how to promote President Obama's agenda, the leaders said Americans voted for major change last November, and that liberals would fight to help the Obama administration keep its promises on providing universal access to affordable healthcare.
Louisiana State University System officials must craft a more detailed business plan for the proposed state medical complex slated to be built in New Orleans as a replacement of the old Charity Hospital, Gov. Bobby Jindal said. The governor said he remains a supporter of the proposal for a 424-bed academic medical complex in New Orleans. His comments come in the context of a legislative session that includes debates over the hospital's governance and a bill that could slow the state's acquisition of land for the facility.
Though the number of doctors who perform wrist angioplasty remains small in the United States—just 1.3% of the one million angioplasties performed yearly in the United States, according to one study—the number is growing as practitioners tout its benefits: less pain, less bleeding, and shorter hospital stays. But surgeons who prefer to stick with the groin call the wrist procedure a ''gimmick'' that takes more time and can't be used in many critical heart procedures.
Ingenix, the UnitedHealth Group subsidiary that faced scrutiny over its databases used by insurers to set reimbursement rates for out-of-network care, said it has acquired a Franklin, TN-based healthcare information technology company. The acquisition of AIM Healthcare Services Inc., which helps payors and hospitals to manage claims, expands Ingenix's business of ensuring accuracy of payments at a time when eliminating unnecessary paperwork is seen as a key part of any reform of the nation's healthcare system, according to The Tennessean.
Nearly three years into a Medicaid privatization program former Gov. Jeb Bush said could be a national model, Florida officials say they do not have crucial data to measure the program's effectiveness, including how many patients' treatments and prescriptions have been approved or denied. Patients and healthcare advocates have complained they can't get doctors appointments and medications under the program. An Associated Press study found nearly 25% of doctors in Broward and Duval counties have dropped out because of red tape and an inability to treat patients as they see fit.
Florida International University's new medical school has received a major donation expected to be matched by the state for a total of $10 million. The $10 million will be used to establish the Green Family Medicine & Society Program Endowment to support a groundbreaking four-year curriculum at the College of Medicine. The curriculum includes NeighborhoodHELP, a program through which medical students will work with colleagues in other disciplines to help families in some of South Florida's under-served neighborhoods.
Doctors are encountering more patients struggling to pay for care, and some doctors have responded by selectively cutting their fees or devising novel payment arrangements; others have taken a harder line on billing and are sending more overdue accounts to bill collectors.
Many doctors say they feel a responsibility to help strapped patients, particularly those with whom they have long-standing relationships. Some say assisting patients pays dividends in the form of loyalty, which will benefit them once the economy recovers. For others, such efforts may stem an exodus of consumers at a time when elective procedures and visits to doctors' offices are down.
Ingenix Inc., UnitedHealth Group's beleaguered IT consulting arm, today purchased Franklin, TN-based medical bills auditor AIM Healthcare Services Inc., and its Netwerkes and Ingram & Associates affiliate, the companies said in a joint announcement.
"AIM is the premier company for improving payment accuracy between healthcare payers and providers," Andy Slavitt, CEO of Eden Prairie, MN-based Ingenix, said in a media release. "Everyone–including most importantly, the patient-consumer–wins. Together, Ingenix and AIM will focus on making administrative and payment processes simple, standard and intelligent for the entire health care system."
The terms of the all cash sale were not disclosed. However, the subscription Web site Nashvillepost.com, citing unnamed sources, placed the value of the deal at about $430 million.
In January, as part of a settlement with the New York Attorney General's Office in a class-action lawsuit alleging conflict of interest and too-low reimbursements, UHG agreed to close Ingenix's database, which prosecutors said at that time was the largest provider of healthcare billing information in the nation. UHG also agreed to pay $50 million to a "qualified nonprofit organization" to establish an independent data base "to help determine fair out-of-network reimbursement rates for consumers throughout the United States," New York Attorney General Andrew Cuomo said at the time.
After a year-long investigation, Cuomo's office had determined that many of the nation's large health insurers unfairly saddle consumers with too much of the cost of out-of-network healthcare, and relied on Ingenix's database to determine their "usual and customary" rates. Cuomo's investigation focused on allegations that—for more than 10 years—Ingenix's database intentionally skewed "usual and customary" rates downward through faulty data collection, poor pooling procedures, and the lack of audits. Ingenix and UHG admitted to no wrongdoing in the settlement.
On Monday, there was no mention of the class-action settlement. Instead, Ingenix and AIM officials said the new company will offer a single source for payment accuracy for health plans and hospitals that will more easily identify and reconcile payment inaccuracies, and will no longer need to engage with multiple parties to achieve payment integrity.
In announcing the purchase, the two companies cited a recent study by The Lewin Group which determined that claims inefficiencies cost the U.S. healthcare system more than $150 billion per year.
