"Tiered health plans cutting costs, restricting options" by Robert Weisman and Chelsea Conaboy | Globe Staff, November 28, 2011
Told he had an aggressive form of prostate cancer, Glenn McCarthy faced a decision this year.
He could make a $1,000 copayment and have surgery at Brigham and Women’s Hospital in about two weeks. Or he could wait more than a month for an opening at Faulkner Hospital, paying just $150 for the same procedure by the same surgeon.
His doctor advised against a delay.
McCarthy, 48, of Weymouth, is back at work as an insulation installer. But he is still recovering from his out-of-pocket costs, which totaled more than $4,500 after there were surgical complications.
The expenses were dictated by his “tiered network’’ health insurance, a kind of plan that ranks hospitals and doctors by cost and quality measures and assigns patients’ payments with costs in mind.
More Massachusetts employers and consumers are embracing such plans - along with other “limited network’’ plans that restrict members to certain providers and require them to pay higher rates for out-of-network care - in an effort to stem the rising cost of health insurance by directing patients to lower-cost hospitals....
That's when I left the Globe doctor's office.
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Also see:
The Massachusetts Model: Recipe For Rationing
The Massachusetts Model: Doctors' Diet
The Massachusetts Model: Office Visit
The prescription is do not.
And look who is fattening themselves up:
"Mass. health insurers post big earnings" November 16, 2011|By Robert Weisman, Globe Staff
The state’s largest commercial health insurance companies, citing seasonal improvements in their business and a decline in medical claims tied to the sluggish economy, yesterday posted robust financial results for the three months ending Sept. 30.
But two of the four health insurers saw their third-quarter net income narrow from a year ago, when all reported strong increases over the prior year.
Blue Cross Blue Shield of Massachusetts, the state’s largest health plan, led the pack in the most recent quarter, ringing up net income of $78.9 million compared with the $75.8 million it earned a year ago....
But you need to pay more for less care, patient.
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And despite the robust results and strong increases:
"Health insurers slow rise in fees; Providers accepting moderate increases" December 26, 2011|By Robert Weisman, Globe Staff
Massachusetts insurers, taking a tougher line in bargaining with health care providers under pressure from financially strained customers and government regulators, have held payment increases to the lowest level in years....
Meaning more profit for the insurance company (sigh).
The harder-line approach comes after two years of warnings by the administration of Governor Deval Patrick to rein in premiums that were crippling businesses and working families, and as state lawmakers prepare to take up a cost-control bill that would overhaul how health providers are paid.
Yes, you are getting rationed health care, Bay Stater.
Related: Memory Hole: Why the Nation Doesn't Need Massachusetts Health Care
Well, now you know why the premiums are sky-high, and you understand the disingenuous game the government, media, and insurance companies are playing. Everyone knows about the price-gouging for profit, and yet they all pretend they do not.
In addition to their tougher negotiating stances, insurers have been prodding providers, including more expensive hospitals such as Massachusetts General and Brigham and Women’s, into global payment plans that give them a budget for all of a patient’s medical services rather than pay a separate fee for each visit and procedure.
First of all, anything with the word global in it -- unless it's peace -- strikes me as a bad thing these days. That's how badly they and their promises have failed.
The second thing you notice is you better not need any medical care because that will throw your budget out of whack. So no accidents, no surgeries, no nothing except a doctor's office visit we can charge you for -- now run along, you're fine.
Insurance companies also are offering customers, including employers and government groups, new programs ranging from wellness incentives at Tufts Health Plan to a Harvard Pilgrim Health Care service that rewards members for getting tests at lower-cost providers. Most important has been the growth of limited network plans that restrict where patients can get care and tiered networks higher payments for costlier providers.
And they are going national with this.
“If you can choose a physician who is tops in quality and good on cost, it’s a good choice,’’ said James Roosevelt Jr., chief executive of Tufts Health Plan in Watertown, where every employee, including Roosevelt, will switch to a tiered plan Jan. 1.
But critics say the moves do not go far enough to ease the burden on cash-strapped small businesses and municipalities, which struggle to pay health insurance premiums that have climbed at double-digit rates for most of the past decade.
Related:
The Massachusetts Model: Municipal Health Mess
Towns to Pay Health Tax For Public Servants
Seems to me like taxpayers are taking care of everyone else while they are asked to pay more and get less -- again!!!
They also say this year’s more modest reimbursement increases were largely driven by a decline in the use of medical care, and to employers shifting some insurance costs to their workers through higher copayments and deductibles.
SEE?!?
And they STILL made good profit, remember that!
How 'bout you, Massachusetts citizen? You see your wages and pay increase every year?
“The increases are moderating,’’ conceded Bill Vernon, state director of the National Federation of Independent Business. “Do I think that’s good enough? No. Health insurance is the number one issue for small businesses. They know they have to provide it, but it’s a big expense. And it’s been going up faster than any other expense they have.’’
Last month, the Commonwealth Fund, a private health care foundation, reported that Massachusetts no longer had the nation’s most expensive health insurance premiums in 2010, falling to ninth place, behind Connecticut, New Hampshire, Rhode Island, and other states, after ranking the highest in 2008 and 2009.
But skeptics questioned whether the report, based on data from a federal survey of employers, fully reflected the extent of benefit changes under which employers have kept their premiums stable by asking employees to pay more.
And you wonder why workers grouse.
They also believe costs were held down last year partly because many employees postponed elective surgery, fearful of missing work and losing their jobs in a weak economy.
Also meaning they became unhealthier, right?
Which is odd since we are bombarded with messages telling us to go to the doctor and listen to the doctor and do what the doctor says so they can practice preventative health care. And as we have $een, the be$t way to do that is NOT GO!
“We are making substantial progress, but we have a long way to go,’’ said Andrew Dreyfus, chief executive of Boston-based Blue Cross Blue Shield of Massachusetts. “There still is an important role for government in holding us accountable and making sure the whole state is moving toward new payment models.’’
Legislators are drafting a bill, expected to be ready early next year, that would require changes like those already occurring in the commercial insurance market. It would shift health providers to a system of global payments, in which hospitals and doctors would be given a monthly per-patient budget for all care.
Rationing.
Critics say the fee-for-service system, which still dominates much of the state’s market, creates incentives to provide excessive care and lacks coordination....
Until you are the one that needs the care.
And don't worry, it won't be any of the leaders and officials deciding your fate. They are well taken care of by plans they wrote for themselves and which are funded by taxpayers.
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One thing I noticed while waiting to post is all three HEALTH articles were to be found in the BU$INE$$ section.
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