State-based Medical Care: Rx or Bust

It ain't just the MVNHS©:

"Swiss drug giant Roche Holding AG has stopped delivering its drugs for cancer and other diseases to some state-funded hospitals in Greece..."

Oh, the humanity! That evil, greedy Big Pharma, putting innocent lives at risk in favor of their obscene profits?

Wait, what?

Turns out, it's not so much greed as necessity:

"...some state-funded hospitals in Greece that haven't paid their bills."

Oh.

But surely Greece is an outlier here, what with their well-publicized financial turmoil, right?

Um, not so much:

"Roche may need to adopt in Spain, as well. Some state-funded hospitals in Portugal and Italy have also fallen far behind on payments"

But I thought that state-run health care was more efficient and saved more money than our terrible private-sector system? And that folks got better care with fewer delays and hassles?

What's next?

That would be the newest form of healthcare delivery, self-serve:

"Patients at some hospitals now must take their prescriptions to a local pharmacy, and ... bring them back to the hospital to be administered"

Yikes! But surely this is an exceptional time, what with the global economy and all, right?

Guess again:

"There are hospitals "who haven't paid their bills in three or four years"

So this has been going on for over 4 years? Since before ObamneyCare© was even passed? But how could that be? That whole effort was based on the premise that our system was inferior to the European model, but now that turns out not to have been the case?

Okay, as terrible as this is, it's only one drug manufacturer, so things will start improving, right?

Oh:

"Roche isn't the first pharmaceutical company to stop supplies to some Greek buyers. Denmark's Novo Nordisk S/A last year stopped shipping certain brands of insulin"

Those poor diabetics! Why would Big Pharma leave them twisting in the wind?

Hmm, maybe a clue here:

"Greece said it would cut the prices by more than a quarter."

Arbitrarily nationalize and then artificially reduce the price of a commodity? One wonders what they might have been thinking when they made that brilliant move.

Luckily for Greece, their national health care system is far superior to our version. Or maybe not:

"(C)ritics of the health-care system say it is bogged down in waste."

Ya don't say.

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Cavalcade of Risk #140: Doom & Gloom edition

Dr Jaan Sidorov presents this week's collection of risky, often scary posts, all tied together with a big dollop of (very dry) humor.

Don't miss this one!

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The Benefits of Telemedicine

Nowadays almost every person in the UK has access to the internet either at home or at work, yet it is hard to find examples where internet enabled healthcare is applied. According to a report by the NHS Confederation, the NHS is behind the rest of the world when it comes to telemedicine; the underlying part of this problem is the assumption that patients are always in favour of remote consultation.

Telemedicine is an especially attractive proposition for those patients that live in rural areas, one example of a successful application it is the remote stroke consultation where doctors can use video to talk to their patients as well as viewing their scans from a laptop. This allows them to make swift care decisions on treatment that can be provided at the local’s patient unit. A quick delivery of drugs is essential when it comes to minimizing the effects of a stroke; according to the North Cumbria University hospitals trust, the introduction of this service will mean that 24 more patients in the area will survive a stroke each year.

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As long as we're being silly: Bruce Banner, CLU

MSN had a rather silly little post the other day, wondering if Batman needs life insurance:

"A survey asking which fictional characters need life insurance suggests most of us don't know much about coverage."

After reading the article, it's apparent that the author still doesn't.

Let's do a little fisking, shall we?

First up, the strange case of Batman. His alter ego, Bruce Wayne (who lives in stately Wayne Manor, of course), is quite well off. One might think that his vast assets would mitigate the need for life insurance, and that's just what the article says.

Trouble is: that's quite wrong.

Life insurance is not just for estate creation, but estate conservation. Given the profligate spenders in DC, Mr Wayne would most likely have a team of estate planners and attorneys scouring the books for ways to minimize estate taxes and the like. Permanent life insurance is a perfect fit for such cases.

Next, Peter Parker (aka Spiderman) gets the Investopedia treatment. The article notes that although Peter may well need coverage, his dangerously swinging lifestyle might make it difficult to come by.

Never fear, though: Peter's job as a news photographer probably grants him access to worksite insurance products (think Aflac and the like), including simplified or even guaranteed issue life insurance plans.

And although the article is about life insurance, we'd be remiss if we failed to point out that Aunt Mary ought to be considering some Long Term Care insurance for herself.

The piece has an obligatory reference to Harry Potter, as well. Here, it notes the lack of dependents who would suffer financially from his premature demise at the hands of Lord Voldemort. While that may indeed to be true now, we know that he eventually gains a spouse; what better way to protect his future insurability than with a life insurance policy bought, and priced, at a young age?

Following Spidey and Harry, we turn to Fred, Wilma and Pebbles (and don't forget Dino!). Of course, Fred most likely has at least some group coverage thanks to his employment at Slate Rock and Gravel Company. He should also have at least some life insurance that he actually owns, and which is not dependent on his continued employment.

Hot on the heels of Fred & Family we have the Queen of Big Hair, Marge Simpson. Here, I agree with the Investopedia folks:

"Marge also needs more life insurance than the aforementioned superheroes; her nonfinancial contributions provide vital services to the family."

That's because, as a stay-at-home parent, her income value to the family is non-trivial. In fact, it could be the equivalent of over $120,000 a year. That's a lot of Duff Beer.

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Haggling will reduce the cost of health care: The eternal hope of optimists

Consumer Reports Magazine, in its Oct. 2011 issue, has an article How to Haggle with your Doctor. Once again we have an article that directs the consumer, in this case a patient, to haggle with a physician over the cost of medical care. While being able to haggle with a physician seems like a great way to bring down the cost of that health service, the reality is that the physician has the least control over prices in healthcare. Now, some of you non-trusting souls will say yeah, it is all the insurances. Nope, that is also incorrect. The entity with the most control over prices in healthcare is the U. S. Government. As many readers of my past blogs already know, Medicare prohibits any provider from discounting or in any way changing a charge for any patient for any reason. That one regulation nullifies this article, but let’s look at some of the finer points of it. The article present three possible scenarios, 1) You are healthy, 2) The unexpected occurs, and 3) You are having an elective procedure.

In scenario number 1 the article states: “Physicians, nurses, and other providers have a professional obligation to take your financial resources into account when recommending and delivering care”. Actually, providers cannot take your financial resources into account. The provider must recommend the best option regardless of price. To do otherwise would appear as if the provider is only looking at your financial resources and not what is best for you medically. This is a big no-no from the federal government. The federal government wants the provider to recommend the best treatment, period. That is why physicians are the last people who truly know what procedures cost since they cannot use that information to determine their plan of treatment.

In scenario number 2, the article suggests that you review your medical bill with the doctor after the treatment to ensure that the treatment was necessary. Well, if you are alive, I would think that determines that the treatment was necessary. But let’s look at this from another business, food. How many of us would haggle with a chef after a meal at a restaurant? “The chicken did not meet my standards of preparation and thus I would like to have a 50% discount”. The next sound you hear is laughter from the chef and the request to pay or he will be forced to have you arrested for theft. Unfortunately, a provider cannot have you arrested for theft after failure to pay since a provider delivers a service, not an actual product. As to collecting after the medical treatment, I heard a great quote from a manager of a large acute care facility, “Can I have my medical treatment back?”

The article then suggests that you ask a provider for the same discount that he takes from insurance companies. A provider signs a contract with an insurance company accepting lower reimbursement because the insurance company agrees to direct its customers to him for medical treatment. As an individual you have signed a contract with the provider that you will pay all fees as charged by the provider in accordance with your insurance contract. The provider has already agreed to a reduction in payment from your insurance company and now you want him to take less from you as well. Let me know how that works for you.

Section 3 actually has sound advice, which is do your research. Find out the costs, the charges, the results.

Health care is expensive because there is a perception that all diseases and injuries should be treated and cured and mankind should not suffer death any longer. Well, the reality is that man is mortal, man does die and the cost to keep man alive is, in some cases (cancer, heart disease, genetic complications and injuries) very expensive. It is a simple mathematical equation: the willingness to spend money on healthcare is directly proportional to the value one holds over one's quality of life. I for one have never haggled over my own or my family’s healthcare, and I would hope that you, dear reader, would not haggle over yours.

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Grand Rounds is up!

Dr Ramona Bates hosts this week, with an eclectic collection of great medblog posts.

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