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 Tag: medical tourismOur newsletter features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. It is emailed in an HTML format from the galen@galen.org email address, via Constant Contact, and you may have to adjust your email settings and junk mailbox to ensure that you don’t miss an issue.NewslettersMay, 9 2008
Making ProgressI spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. HighlightsCONSUMER HEALTH WORLD: I spent the early part of this week in Las Vegas at the Consumer Health World conference at the Venetian Resort and continue to be awed by the innovative ideas and investment in solutions, technologies, and advances in health care and coverage. Sally Pipes of the Pacific Research Institute and I did a keynote address with thoughts about how the policies of a new Republican or Democratic president would impact consumers and health care. But the real news was from business and medical leaders who are leading market changes, including: Digital medical care, the globalization of medicine, medical tourism, the unstoppable demand for more personalized information from consumers, technologies to extend a medical home, sophisticated employee wellness programs, and ways to dramatically reduce health costs through efficiencies in the delivery of care. My take away from the conference: More and more companies from other industry sectors are focusing their skills, technologies, and experience on the health care space, with the potential to produce dynamic, bottom-up change. The political climate matters a lot in being receptive to these changes, but these companies have the potential to be transformative in reducing costs and increasing quality if we will let the market work. The next conference will be in Washington, Dec. 8-10, just after the presidential election, and it will be even more important then to see what these leaders see for the future. Congratulations to Skip Brickley and his team at Transmarx for another great conference. It's hard work, but hugely valuable.  The conference happened to coincide with the opening night of the new Cher concert in Las Vegas, and my dear husband figured out how to get us tickets. Cher is a world-class performer with spectacular sets and at least a dozen even more spectacular costumes. At age 61, she is the quintessential performer.  She will be rotating with other performers (Elton John, Bette Midler) for the next three years at Caesars Palace. See the show if you can. It's not to be missed. WYDEN-BENNETT BILL: The Wyden-Bennett health reform bill received a coveted "budget neutral" cost estimate from the Congressional Budget Office and the Joint Tax Committee last week, and the bi-partisan legislation is attracting even more attention as a result. But let's look at the fine print:
Budget scorings are important. Former HHS Secretary Donna Shalala said during a Senate Finance Committee hearing this week that a CBO estimate of the cost of the Clintons' proposed Health Security Act in 1994 was "devastating. It changed the momentum of the discussion." Alluding to CBO's estimate that Sen. Wyden's Healthy Americans Act would be budget neutral, Shalala said that if one starts the debate with a score of budget neutrality, "you take a giant step." But the numbers also reflect the reality of the bill. And it would be a major, major change from the current system. The details matter. AN OPEN LETTER FROM DOCTORS: Physicians are mad as hell and they're not going to take it anymore. That's the conclusion we draw from a new grassroots campaign by a group of physicians to get signatures on an open letter to Americans from physicians. Their unifying theme: "We all desire to provide the best medical care possible to patients in our respective communities. This is at the heart of everything we do." But they are "alarmed by the current trends in our healthcare system…and the challenges we face in providing quality care to our patients." The idea was proposed by Sean Khozin, MD, MPH, and gained 1,000 signatures just in the first day it was posted on the Sermo website (a very interesting, innovative, and important secure web-based discussion platform that allows doctors to consult with each other about medical cases). The doctors say that "For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources." But they say that as a result of high costs and third-party intrusion, "patients have lost their freedom of choice…As a result, it has become difficult for physicians to deliver the best possible care," and the doctor-patient relationship is being compromised. The doctors don't make any policy recommendations in the letter, but it is a way for them to give a voice to their central concern about wanting and needing to put their patients first. That's the right place to start with any policy discussion. Grace-Marie Turner Recent News Articles and Studies How Risky is Individual Health Insurance? How Risky is Individual Health Insurance? Mark V. Pauly and Robert D. Lieberthal, Wharton School at the University of Pennsylvania People in fair or poor health who have health insurance are less likely to drop or lose coverage if they have individual insurance than if they have small-group coverage, according to a study from Mark Pauly and Robert Lieberthal of Wharton. In particular, the study found that among workers in relatively worse health, those with small-group coverage who became unemployed were substantially more likely to also become uninsured than their counterparts with individual coverage. Among those with small-group coverage, 67% of workers in fair or poor health who became unemployed also became uninsured, while among those with individual coverage, only 9% of workers in fair or poor health who became unemployed also became uninsured, according to the study. The authors say this result stems largely from a unique policy feature generally included in individual health insurance policies: guaranteed renewability at class-average rates. Drug Companies Win Alzheimer's Appeal Against Watchdog Nigel Hawkes Tens of thousands of Alzheimer's sufferers and their families had their hopes raised last week as two drug companies won a landmark victory in the U.K.'s Court of Appeal, reports The Times. The National Institute for Health and Clinical Excellence (NICE), the powerful body that controls access to new drugs, was judged to have acted unfairly in making an appraisal of the Alzheimer drug Aricept. NICE had ruled that Aricept should not be prescribed on the NHS to patients with mild Alzheimer's disease because the economic model failed to show that it provided good value. But it refused to allow Eisai and Pfizer, who market the drug, full access to the model. The court ruled that NICE must give up its most precious secrets — how it measures the benefits that novel treatments bring. The ruling is the first case that NICE has lost in court and means that, in the future, it will have to be transparent in the way it reaches its decisions, revealing the inner workings of the models it uses to measure value for money, reports the Times. UnitedHealth: HSA Enrollment Exceeds Traditional Accounts Carissa Wyant UnitedHealth Group said last week that for the first time, enrollment by its members in health savings accounts (HSAs) have surpassed enrollment in more traditional health reimbursement arrangements (HRAs), reports the Minneapolis/St. Paul Business Journal. UnitedHealth said it had 2.7 million individuals enrolled in its consumer-driven health plans; 1.38 million were enrolled in HSA-qualifying insurance as of March 31, compared to 1.34 million members who were enrolled in HRAs. The figures include plans which are employer-sponsored as well as plans purchased by individuals and families. More than 22,000 employers now offer such plans through UnitedHealthcare, and it recorded an increase of 325,000 participants from December 2007 to March 2008, reports the Business Journal. A new podcast from Deloitte on "Embracing Disruption: How Consumers Are Transforming the U.S. Health Care System" describes consumer activists who are searching for quality care and are willing to go outside the traditional health care system to get it. Sally Satel, M.D., American Enterprise Institute Do various financial relationships between doctors and the pharmaceutical industry — promotional marketing, paid speaking and consulting, and research funding — compromise patient care, bias medical research, and diminish the integrity of the profession, asks AEI's Sally Satel. Unfortunately, on many medical-center campuses, the verdict is already in: physicians who engage in any financial relationship with industry are not to be trusted. Such blanket condemnation of all associations with the companies that invent and produce countless life-saving healthcare products will surely have real costs to society, writes Satel. We can live without free pens and mouse pads. The real threat to medicine and the public interest is suppression of freedom of university-based researchers to interact with their scientific colleagues in the pharmaceutical industry, writes Satel. That might make anti-industry purists feel better — at least until they look for the next breakthrough drug only to find that it doesn't exist. Scott Gottlieb, American Enterprise Institute As a presidential candidate, Sen. Barack Obama says people lack health insurance because "they can't afford it." But he is also partly responsible for why health insurance is too expensive, writes Gottlieb. During Mr. Obama's tenure in the Illinois state Senate, 18 different laws came up for a vote and passed that imposed new mandates on private health insurance. Mr. Obama voted for all of them. A long list of studies shows that mandates like the ones Mr. Obama has championed drive up the cost of insurance for the very people priced out of coverage, writes Gottlieb. One way to make insurance more affordable is to allow people to purchase health plans across state lines. People could choose which state regulations to buy into, creating a market for the insurance mandates. This would give states more incentives to fix local problems that have helped make health insurance expensive in the first place. Wal-Mart Expands Low-Price Drug Program Peggy Harris Wal-Mart Stores Inc., the world's largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women's medications at a discount, reports the Associated Press. The move marks the third phase of a company program that began in 2006 to provide a 30-day supply of generic prescription drugs for $4. With the expansion, the company began filling prescriptions Monday for up to 350 generic medications at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S, reports the AP. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer. In addition, the company will add several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone deficiency. Wal-Mart also said it would lower the prices of more than 1,000 over-the-counter drugs to $4 or less in its pharmacies. New Georgia Law Gives Best Health Insurance Options Center for Health Transformation, 05/08/08 A new Georgia law will result in Georgia families having the best health insurance options available in any state, according to the Center for Health Transformation (CHT). The law makes premiums for health savings account-eligible plans 100% deductible against state income tax for individuals. It also allows a $250 tax credit per employee for small employers who offer HSAs to their employees. By creating opportunities for Georgia insurance companies to offer new, innovative products not only will the state benefit from a robust and competitive marketplace, but also a half million uninsured Georgians will soon have access to health coverage, writes the CHT. Department for Innovation, Universities & Skills in collaboration with the Department for Business, Enterprise & Regulatory Reform, 11/07 This report, published by the UK government, summarizes the 2006 data on investment in R&D and financial performance of the 850 most active UK companies and the 1,250 most active R&D companies globally. Key highlights include:
Saving on Surgery by Going Abroad Avery Comarow Medical tourism can produce significant discounts on care, writes U.S. News & World Report as part of its "Consumer's Guide to Medical Travel." Thousands of Americans — estimates range from 5,000 to 500,000 annually, if minor procedures are counted — leave the U.S. for surgery, especially if they are paying for the procedure themselves. For example, Brad Barnum, a 53-year old building contractor, had knee and hip replacement surgery in India for $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80% less than the $125,000 or more he expected it to cost in a U.S. hospital, reports the magazine. Medical travel has captured the world’s attention and imagination, but a new McKinsey study suggests that the market isn’t as large as reported and that most medical travelers seek high quality and faster service instead of lower costs. Upcoming Events Grace-Marie Turner speaking on the Kirby Wilbur Show Racial and Ethnic Disparities: States and Feds to the Rescue? The Seniors' Entitlement Crunch: The Politics of Social Security and Medicare Reform 6th Annual Health Care Conference Health Reform and the 2008 Election: Opportunities and Pitfalls National Medicare Education Program (NMEP) Coordinating Committee Meeting Whatever Happened to Medicare Reform? Presidential Forum on Health Care Reform Social Determinants of Health & Consequences of Disparities Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at http://rs6.net/tn.jsp?t=epyitmcab.0.0.xkzt75bab.0&ts=S0339&p=http%3A%2F%2Fwww.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.
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CDHC March, 28 2008
Healthy InsightsDr. Denis Cortese, president and chief executive officer of the Mayo Clinic, offered Washington a healthy dose of insight about the crucial importance of patient-focused care during a speech at the National Press Club on Good Friday. Mayo is renowned worldwide for its expertise in medical diagnosis, and Dr. Cortese drew on these capabilities to help policymakers think differently and more strategically about health reform.Dr. Denis Cortese, president and chief executive officer of the Mayo Clinic, offered Washington a healthy dose of insight about the crucial importance of patient-focused care during a speech at the National Press Club on Good Friday.Mayo is renowned worldwide for its expertise in medical diagnosis, and Dr. Cortese drew on these capabilities to help policymakers think differently and more strategically about health reform. Here are a few key points he made:
Having 90,000 avoidable hospital deaths a year is the equivalent of a major airliner crashing every two and a half days, Dr. Cortese said. That is unacceptable, but the lack of information is driving these mistakes. People get the right medical advice only about half the time. We need to exchange information in real time to improve, and we need transparency of outcomes, safety, and costs. We need teamwork to integrate care from diagnosis through treatment. And that care must be individually focused. Physicians need to think of themselves as team leaders and coordinators of the medical team. And Dr. Cortese concluded with some guidance for the new president, offering questions he or she should ask the new administration's health policy team every day:
It is not a coincidence that Minnesota, the Mayo Clinic's home state, ranked first in the nation in overall health care quality this year, based upon a report just issued by the Agency for Healthcare Research and Quality. Mayo offers valuable lessons for all of us interested in improvements in our health sector. Two experts writing in the Los Angeles Times offer some legal advice about current proposals to require everyone in America to obtain health insurance: They're probably unconstitutional. Karl Manheim, a law professor at Loyola Law School in Los Angeles, and Jamie Court of the Santa Monica-based Consumer Watchdog explain that a government mandate requiring people to purchase private insurance is either a constitutionally forbidden "taking" (of money) or a violation of constitutionally protected due process. They say a mandate would mean that the federal government would be requiring people to buy a good (health insurance) offered by private businesses, implicitly delegating taxing power to private business. The Constitution explicitly delegates taxing authority to the Congress (Article 1, Sec. 8). Yes, states can and do require people to buy automobile insurance or install fire sprinklers in a house. "But in such cases, the 'mandate' is discretionary -- you don't have to drive a car or build a house," they write. The same is true with requiring vaccinations for children enrolling in public schools: Parents have the option of sending their children to private schools or to home school them. But a health insurance mandate would not, by definition, be optional. "A health insurance mandate is essentially a forced contract." If government were instituting new taxing powers requiring everyone to enroll in a government program, that would actually pose less of a constitutional problem, they say. But that's not politically popular. In fact, Sen. Hillary Clinton would mandate insurance but would give people the "choice" of buying highly-regulated private coverage. It actually is this choice of private coverage that could trip up her plan with the court, as Manheim and Court explain. So is Massachusetts' individual mandate unconstitutional? Probably. "These 'unfunded mandates' are unlike any form of government regulation we've seen," they write. But someone has to take it to court first, and I'm not aware of any court challenges, at least yet. So here's an interesting prospect: Do we want to spend the next 10 years battling in the courts over the constitutionality of an individual mandate for health insurance? Or do we want to actually spend that time trying to give people more options of more affordable, private coverage? And the Harvard School of Public Health has a new poll out that underscores the huge partisan divide over health reform. More than twice as many Republicans (68%) as Democrats (32%) believe that the U.S. health system is "the best in the world." Further, more than half of Democrats (56%) say they would be more likely to vote for a candidate who advocates moving toward a system more like Canada's, France's, or Great Britain's. In contrast, only a fifth (19%) of Republicans say they would be more likely to vote for a candidate that advocates moving toward such systems. Interestingly, even though many people want to import other countries' health systems, they don't know much about them: 53% of all of those responding to the survey, for example, say that they aren't sure how our system compares to France's, for example. So it shows that people do think that the grass is greener. But maybe they need to learn a bit more about what it's really like living under those systems before they throw out the one health care system that is driving innovation in new medicines, new treatments, and new medical technologies, and that many people think is the best in the world. And we're going to help with that education: We welcome Brian Lee Crowley to the Galen Institute as our newest visiting senior fellow. Brian is the president of the Atlantic Institute for Market Studies in Nova Scotia, where he will continue working while he also helps us educate the debate over market-based solutions to problems in the health sector -- including a clearer picture of the challenges of Canada's health care system. Grace-Marie Turner Recent News Articles and Studies Loose Political Lips Can Sink Our Economy Loose Political Lips Can Sink Our Economy Grace-Marie Turner, Galen Institute The Wall Street Journal, 03/28/08 It would take much more than a weak dollar and the sub-prime mortgage collapse to shake confidence in an economy as strong as the United States is. Unfortunately, other forces are at play that could lead to just such a crisis, including: 1) Continual talk by Sens. Hillary Clinton and Barack Obama about huge future tax increases, including the expiration of President Bush's income and capital gains tax cuts; 2) The anti-immigration sentiment that could severely constrain the future labor pool; and 3) The erosion of our leadership in the investment world because of the insidious impact of Sarbanes-Oxley. Investors do look to the future, and taken together, these and other bad policy decisions could indeed undermine even the strongest economy in the world. It's time for political leaders to wake up and understand the damage caused by these anti-growth policies. Checking into Bumrungrad Hospital
This photo from a BusinessWeek report on the growing trend of medical tourism tells the story about how big this industry is becoming. Last year, 65,000 Americans went to Bumrungrad Hospital in Bangkok for in-patient or outpatient treatment, up from just 10,000 in 2001. Many of the patients from the U.S. were uninsured, taking advantage of medical costs that are a fraction of those in American hospitals. Last month, Bumrungrad announced an alliance with Blue Cross & Blue Shield of South Carolina, with the American insurer agreeing to cover expenses for members who travel from the U.S. to the Thai hospital. Other hospitals, including some in Singapore and India, have also teamed up with the South Carolina insurer, which is betting that some members would be willing to travel abroad rather than pay thousands more for operations in American hospitals. Bumrungrad's revenue from foreign patients rose 14% last year, and non-Thais now account for 55% of Bumrungrad's business. Who Really Pays for Health Care? Employers like to say -- and often believe -- that they pay for health care, write Emanuel and Fuchs. And union leaders want members to think that health benefits are a bonus on top of wages. But wages and fringe benefits, such as health insurance, are simply components of overall worker compensation. This cost-wage trade-off is usually well hidden from employers and workers, but it is nonetheless a painful reality for average Americans. The increasing cost of health care has resulted in American workers receiving relatively flat wages for 30 years, they write. The reality is that individuals bear the full cost of health care through lower wages and higher taxes. 2008 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds The financial outlook for the Medicare program continues to raise serious concerns, and a "Medicare funding warning" is triggered again by the findings of this report. Total Medicare expenditures were $432 billion in 2007 and are expected to increase in future years at a faster pace than either workers' earnings or the economy overall. The HI trust fund will be exhausted by 2019. As a percentage of Gross Domestic Product, expenditures are projected to increase from 3.2% in 2007 to 10.8% by 2082. Growth of this magnitude, if realized, would substantially increase the strain on the nation's workers, Medicare beneficiaries, and the federal budget. The American Enterprise Institute hosted a briefing this week to discuss the Medicare Trustees' report and the policy challenges facing the program. The Hazards of Harassing Doctors: Regulation and Reaction in Trans-Atlantic Healthcare Beyond its impact on the quality of care and on the invisible costs of illness, government tampering with doctor autonomy and patient choice raises crucial questions related to human liberty, writes Alphonse Crespo, a Swiss physician. Doctors have yet to make their voice heard in the battle of ideas between the guardians of obsolescent socialized medicine and proponents of a free society. But this is changing as bureaucratic interference with medical practice has reached a threshold that now pushes doctors to engage in protest movements in various parts of Europe. Enlightened health-policy makers can minimize the transition costs of change by deregulation of health insurance services, gradual privatization of public healthcare infrastructures, and fiscal incentives for medical savings accounts and health banking capital. In a separate essay, American physician Marc Siegel cautions that medicine is moving further in the direction of shrinking reimbursements and insurance company-controlled strategies which put a stranglehold on a doctor's decision-making. Five Myths of Health Care Sally Pipes debunks the five most prominent health-care myths: forty-seven million Americans do not have health insurance; universal health-care coverage can be achieved through an individual mandate; expensive prescription drugs are a big reason health-care costs increase; drug importation will save patients a fortune; and the state-run health-care systems in Europe and Canada are better and cheaper than America's. In a separate op-ed, Pipes writes that Thailand's misuse of compulsory licensing to obtain patented prescription drugs allowed corrupt officials to steal millions. Sick Thai citizens have yet to see any benefits and the move has set a dangerous precedent that will stifle innovation and endanger the health of millions. The newly elected Thai government is wisely examining this issue and appears more interested in pursuing a thoughtful, long-term policy of economic development that will serve its citizens far better than quick-fix political schemes that result in Thailand becoming a hero to anti-capitalist activists, but a pariah to the world economic community. Why McCain Has the Best Health-Care Plan Sen. John McCain's health care plan is the only one of the candidate proposals that has a chance of getting medical costs under control, writes Fortune Magazine. McCain's plan would eliminate the employer exclusion for health care and allow people to buy insurance plans on their own, including across state lines. In essence, he wants to create a kind of national insurance market that puts more decision-making power into the hands of consumers. John McCain's health care plan would create a world where health care is treated as the precious resource that it is, rather than a costless entitlement, and where nationwide competition pushes down prices and consumers focus their attention and spending on what's really crucial to their health. The price of health care is never going to get under control until patients get what they deserve: the right to be customers too. McCain bemoans the high cost of pharmaceuticals and, with a heavy dose of anti-corporate rhetoric, he champions the idea of drug reimportation. But McCain would be better served by abandoning this idea and speaking out instead in favor of reforms that will help Americans pay a fair price for prescription drugs, writes the Manhattan Institute's Dr. David Gratzer. McCain should offer Americans a way forward to lower drug prices, without endangering the innovation that has sparked the pharmaceutical revolution.
Upcoming Events Taking Back Our Fiscal Future H.R. 5613, Protecting the Medicaid Safety Net Act of 2008 Can Tax Credits Be a Linchpin for Health Reform? Lessons from the Factory Floor Enhancing Quality Performance Measurement: A New Paradigm for Health Care Accountability Has Arrived Is Free Trade Good for Your Health? Can We Repair What's Wrong with our Health Care System through Christian Principles? Whose Healthcare is it Anyway? Understanding the Patient as a Consumer Cracking Down on Killer Drugs: Dora Akunyili and the Nigerian Success Story Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features a commentary by Grace-Marie Turner on the major developments and issues of the week as well as summaries of writings by participants in the Health Policy Consensus Group and other articles of interest from the health policy world, plus announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at www.galen.org. If you wish to subscribe to this free weekly newsletter, update your address, or be removed from our list, please send an e-mail message to galen@galen.org. The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors. |
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