Insurance Payment Status Seems to Dictate Better Physician Care
Hospitals will have some explaining to do if they allow physicians to practice what seems to be a disturbing trend of preferential care to patients with higher-paying insurance companies.
According to a new study of more than 4,000 heart patients at the Yale University-New Haven Hospital that looked at physician payments and level of care, patients whose insurance coverage paid the highest fees to doctors were more likely to be given stress tests or undergo angioplasty than patients whose insurance paid lower doctor fees.
The study, headed by Dr. Harlan M. Krumholz, a cardiologist at Yale Medical School, drew correlations between physician payments and previous research that found women, non-whites and elderly were less likely to receive extensive care for heart difficulties.
Private insurance carriers generally paid doctors at least $2,500 for angioplasty and at least $80 for analyzing a stress test. But doctors whose patients were either uninsured or covered by Medicaid or Medicare were likely to be paid far less for the same services. Consequently, the study found that men, younger patients and whites, who were more likely to have high-paying private health insurance, received the more involved care.
As opposed to women and non-whites, who disproportionately tended to receive Medicare, Medicaid or were uninsured and therefore received less sophisticated care for heart ailments. (Yale University-New Haven Hospital, 203/785-4242)
When Choosing a Healthcare Plan, 'Show Me The Savings'
Healthcare reformers take heed: Americans who purchase their own healthcare stress affordability - not access or quality - as most important issue to them, according to March survey conducted by the Alliance for Affordable Health Care, a national non-profit that addresses quality of life concerns based in Washington, D.C.
The survey, which gauged the opinions of 510 Americans, found that 56 percent chose "making health insurance more affordable" as a No. 1 priority in making national healthcare reforms. Another 31 percent cited "making sure everyone has health insurance" as a top concern. And, 11 percent expressed wanting to "maintain the quality of healthcare in the United States." (AAHC, 202/347-4229)
Patients Lack Important Post-Discharge Guidance
Hospital internal communicators need to stress the importance of more thorough physician guidance when a patient is discharged, according to a recent study conducted by the American Medical Association, Many physicians overestimate how much their patients understand about treatment following a hospital stay.
After surveying 99 patients who were treated in Boston's Beth Israel Hospital for either pneumonia or heart attacks, Dr. David R. Calkins of the University of Kansas School of Medicine and colleagues found discrepancies between doctors and patients on the amount of time spent discussing post treatment.
In fact, patients and physicians agreed only 32%of the time, a significant contrast with the 43% of the time patients thought less time had been spent than the physician's recollection.
There was also serious disagreement on the patients' understanding of their medication's side effects. Fully 89% of physicians believed that patients understood the potential side effects of post-discharge medication, compared to 57% of patients who reported that they understood.
The researchers offer these tips for improved doctor-patient communication:
- More extended and targeted discussions between patients and physicians.
- Counseling by a pharmacist, or written instructions about medication.
- Comprehensive discharge planning by nurse specialists.
- Telephone follow-up and written reminders. (AMA, 312/464-5374)
Groundbreaking Study Reveals: Managed Care is Riskier For Older Women
Managed care marketers beware: women over 40 are running into more healthcare barriers than any other group, according to groundbreaking report, "Opportunities for Mid-Life and Older Women."
The study was released earlier this month by OWL, the national Washington, D.C.-based organization that assesses healthcare issues confronted by mature women. The aging of the nation's babyboomers makes the report particularly salient to millions of Americans.
Since women, on average, live seven years longer than men and have a higher rate of chronic illness, they tend to require more care.
And managed care, the rapid method of healthcare delivery, often makes it difficult for women to have their health needs adequately satisfied, according to the University of Utah School of Medicine report that surveyed about 13,000 patients in six different managed care companies.
The study also revealed that many older women are particularly victimized by the practice of using generic drugs to treat diseases like depression, arthritis and hypertension-chronic illnesses that disproportionately affect this group.
Other key findings of the report include:
- Managed care contains financial incentives that encourage providers to deny services and cut corners resulting in fewer referrals to specialists and incorrect diagnoses for patients with depressive disorder. Specialists are crucial to treating chronic diseases of older women.
- Requiring older women to see a primary care physician poses special risks for older women. Many primary providers are not trained to deal with the special needs of women over 40.
- Chronically ill Medicare beneficiaries suffer worse outcomes among elderly patients enrolled in HMOs.
(OWL, 202/833-9771)