Posts Tagged ‘Health Policy’

Interstate health insurance shopping

February 24, 2010

John Goodman doesn’t seem like someone I’d normally agree with. I’m not talking about the former Roseanne star; I’m talking about the founder of the National Center for Policy Analysis. The site calls him the “Father of Health Savings Accounts” and  lists one of his major accomplishments as “playing the pivotal role in the defeat of the Clinton Administration’s plan to overhaul the U.S. health care system.”

That being said, I really enjoyed a posting he recently submitted to the HealthAffairs Blog on allowing consumers to purchase health insurance across state lines. He makes some great points about the benefits, including the ability to choose among 50 different insurance regulatory schemes. This means that if your state mandates in vitro fertilization coverage but not the chiropractic coverage you want, you could shop around for insurance from a state that does require chiropractic coverage to ensure you always have that coverage.

He notes that allowing interstate shopping could be bad for people with preexisting or chronic conditions. Healthy people from their state that might have normally subsidized their care through “guaranteed-issue and community rating in the individual market” might flock to states with cheaper insurance rates. This could leave people with preexisting or chronic conditions (which insurance companies do not like to insure) in ever smaller insurance pools and accordingly, higher premium costs. He mentions that the 6 states that currently require this could be exempt from interstate insurance shopping unless they want to opt in, but an even better solution would be “for states to find more rational ways of subsidizing the care of high-cost patients.” That’s the part that made me smile the most, because I fully agree that it’s important to help people with preexisting and chronic conditions receive affordable health insurance!!

Read the full posting here. If interstate health insurance shopping were allowed, what do you think states could do to subsidize the care of high-cost patients?

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People FREAKING About Mammograms!

December 15, 2009

I like the way this New York Times article explains that there is such a thing as too much screening. A nugget:

Much of our discomfort with the panel’s findings stems from a basic intuition: since earlier and more frequent screening increases the likelihood of detecting a possibly fatal cancer, it is always desirable. But is this really so? Consider the technique mathematicians call a reductio ad absurdum, taking a statement to an extreme in order to refute it. Applying it to the contention that more screening is always better leads us to note that if screening catches the breast cancers of some asymptomatic women in their 40s, then it would also catch those of some asymptomatic women in their 30s. But why stop there? Why not monthly mammograms beginning at age 15?

Stick with him through the math, because he makes a good point. Basically, false positives can have a big effect on whether or not a screening program really works. I also like how he talks about survival measurements:

Another concern is measurement. Since we calculate the length of survival from the time of diagnosis, ever more sensitive screening starts the clock ticking sooner. As a result, survival times can appear to be longer even if the earlier diagnosis has no real effect on survival.

So… we need to consider some pretty nerdtastic factors when we’re talking about screening, including probabilities, sensitivity, specificity, and measurement. I GD love epidemiology!

Confused by health reform? You have options!

October 16, 2009

Confused by all the health reform talk out there? Not sure what is in which bill? Ha, you are definitely not alone. Two great options are available to you so you can know what is what and what the heck is going on.

First, the Kaiser Health Foundation has a side by side comparison on their website of the major reform proposals. It is a pretty nifty tool because it allows you to pick and choose which plans you want to see or just specific topics (e.g. individual mandate, long-term care, prevention). It also currently reflects recent amendments to some of the plans.

Then for those of you who get tired of staring at your computer there is Hear the Bill. Instead of having to read the bills, you can listen to them. Handy.