THE ELDERLY AND PRIVATE HEALTH INSURANCE COVERAGE: (GAO) (1998)  Coverage fell from 79.5% in 1980 to 70.5% in 1995. While "most Americans under 65 continue to have private health insurance- 164 million people in 1995- nearly 21 mil. more would have had private health insurance if coverage had remained at the 1980 level." Unfortunately, this is consistent with statistics with the working population- in 1995, over 40 million Americans- 17.3% of those under 65-"lacked any health insurance coverage," compared to 11.8% in 1980. Even worse, the proportion of the population under 65 enrolled in Medicaid (the state program for the very poor) grew from "an estimated 8.2%" in 1980 to 12.5% in 1995. The report noted that decline in private coverage between 1980 and 1995 has occurred in "nearly all demographic, income and employment groups."

HEALTH COVERAGE: (HIAA 1999) "Nearly one out of every four uninsured Americans have no health coverage because of the cost of state mandates. There exist well over 1,000 coverage mandates throughout the U.S. Between 1970 and 1996, there was at least a 25-fold increase in the number of state mandates on health plans. (The study finds that state mandates raise premiums by up to 13 percent for businesses that offer health insurance to their employees.) Eighteen percent of small businesses without health coverage would buy it in the absence of state mandates. But according to the University of Alabama- "In general, proponents of mandates are special interest groups that stand to personally benefit from the laws."

HEALTH BEHAVIOR: (2000) The CDC Surveillance Summaries provide a means for CDC programs to disseminate surveillance findings, permitting detailed interpretation of trends and patterns based on those findings.

March 24, 2000 / Vol. 49 / No. SS--2

State Pharmaceutical Assistance Programs Report Chart (pdf) provides up-to-date information about the availability and characteristics of state pharmaceutical assistance programs.

Prescriptions: (2001) "Persons older than 65 now account for 12.6% of the U. S. population, with the average patient older than 65 filling approximately 20 prescriptions per year, compared with the average patient in his or her 20s filling approximately 3 prescriptions per year. In addition, the average per-member-per-year cost for a person between the ages of 66 and 70 years ($704.52) is nearly 9 times higher than for a person younger than 20 years ($81.06). These figures are included in "Prescription Drug Trends in the U.S. 2000: Utilization and Cost Implications for Pharmacy Benefit Plans," compiled and published by PCS HealthSystems"

Elderly Americans spend about 12 percent of their income on out-of-pocket health expenses on average and the poor elderly spend about 20 percent (2001) , according to a new RAND study. Previous estimates - such as those calculated by researchers at AARP and other institutions - placed the average burden for all the elderly at about 19 percent and for the poor elderly at about 35 percent. The paper, "Methodological Biases in Estimating the Burden of Out-of-Pocket Expenses," appears in the current issue of Health Services Research.

According to the paper's authors, the Medicare Current Beneficiary Survey used by AARP and others understates family income by about 20 percent and household income by 41 percent. As a result, the cost share estimates are much too high.

Escalating costs: (pdf 2001) Health care costs rose 7.2% last year, the biggest increase in medical inflation in 10 years.

Medication Errors in United States Hospitals (2001) This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors.

Health care costs going way up: (Hewitt Assoc 2001) Workers now signing up for health plans for next year are facing the largest rate increases in 10 years. Employees of many large companies are facing increases of roughly 15 percent

Per the NY Times- Fifteen years ago, managed care companies promised to control costs for employers without sacrificing the quality of care by striking hard bargains with doctors and hospitals. But in recent years, they have been unable to keep those promises. Costs have been rising faster as the insurers have yielded to customer demands for more freedom to select doctors and hospitals. Also, hospitals, strengthened by mergers, are raising prices. Finally, the average age of the American population is increasing, and that means more medical bills.

"How the Slowing U.S. Economy Threatens Employer-Based Health Insurance," documents the connection between the loss of employment and the loss of health care coverage.

*Unemployment leads to loss of health insurance: Thirty-seven percent of workers who lose their jobs also lose their health coverage. That rate is nearly three times higher than the 14% uninsurance rate for the general population. While 75% of unemployed workers are eligible for COBRA coverage -- which allows workers to retain employer-sponsored coverage by paying 102% of the premium -- only 20% purchase such coverage, "mostly due to cost."

*Low-income workers are often ineligible for COBRA: Low-income workers, who are more likely to work in small businesses, are more likely to be ineligible for COBRA coverage if they are laid off.

*The uninsured are less able to cover "basic" expenses: According to a Commonwealth Fund survey, 40% of the uninsured cannot pay for living costs such as food, rent, heating or electricity, compared to 12% of the insured population.

*The uninsured will impact state budgets: Under current Medicaid eligibility rules, a two percentage-point increase in the unemployment rate will add about 3.3 million people to Medicaid, which would cost $5 billion in one year. However, most states are currently reporting Medicaid budget shortfalls that may be $15 billion for 2002.

How things change- (Kaiser 2001) In August, 14% of respondents ranked health care as one of the two "most important issues" for the government to address, trailing only education and economy/jobs. In October, only 3% said health care was one of their two main concerns, while terrorism topped the list at 65%, followed by war/defense at 46%. While 35% of respondents said in May that costs were among the most important health care problems, only 12% said so in November -- about the same percentage that cited "health care problems resulting from terrorist attacks." Concern about insurance coverage fell from 23% to 8%, while concern about prescription drug costs declined from 15% to 6%.

Job-Based Health Insurance In 2001: Inflation Hits Double Digits, Managed Care Retreats HMO enrollment has hit its lowest level since 1993, as double-digit premiums signal the end of an era.

Prescription Drug, Managed Care Costs Forecast to Rise in 2002 Prescription drug benefits and overall health plan costs are projected to rise in the double digits next year, according to a survey by benefits consulting firm The Segal Company.

Employers May Jump to Defined Contribution Products to Cap Health Costs (2001) As employers brace for another round of anticipated double-digit healthcare benefit cost increases next year, 20% of large employers surveyed by benefits consultants Watson Wyatt Worldwide say that they will probably adopt a defined contribution approach to healthcare benefits over the next 12 months.

Health care: (The Commonwealth Fund 2001) Nearly a million people in the United States are at risk of losing their health insurance as a result of the economic downturn and the September 11 attacks. Medicaid rolls could rise by as many as 3.3 million people as those with and without health insurance through their jobs lose income.

One reason why health costs will not go down- (NFO WorldGroup 2001) Despite attempts to control healthcare maintenance, most people still firmly believe that decisions regarding course and cost of treatment should reside with themselves and their doctors and not with insurance companies and other providers. Even in cases where death may be considered close at hand, patients should receive the best possible care regardless of cost - and monetary caps should not be arbitrarily placed on patient care, believe most Americans.

Been going on for a long time: PATIENTS OFTEN PRESSURE PHYSICIANS FOR UNNEEDED ANTIBIOTICS (2001)  Overprescription and subsequent overuse of antibiotics is an increasing concern, contributing to higher drug costs and the increasing prevalence   of antibiotic-resistant bacteria.

INCREASED HEALTH COSTS TO BE PASSED ON TO EMPLOYEES   According to a 2001 Watson Wyatt survey, 56% of employers plan to deal with next year's expected health care benefit cost increases by raising employee contributions by as much as -- or more than -- the amount of their expected cost increases. The survey, which was based on responses from 200 companies covering 1.4 million employees, also revealed the following actions employers intend to take to manage their health care costs over the next 12 months.

Employee education via the Web: 75%

Reduce benefits/increase co-pays: 71%

Targeted interventions (health management): 60%

More aggressive managed care: 32%

The survey found that employers expect their health plan costs or active employees to rise 13.6% in 2002 (more than the 12.2% increase in 2001 and 8.1% increase in 2000). Other expectations for premium cost increases from 2001 to 2002 include the following.

Prescription drug benefits: 17%

Medical only: 13%

Dental: 6.7%

Health Care Costs 2002 - Watson Wyatt Worldwide Survey Results

Health Care costs: (Buck survey 2002) ``The rate at which health care costs are rising is alarming for employers, and unfortunately there's no silver bullet like managed care was in the early 1990s. Companies are actively evaluating new solutions and alternatives, while trying to contain costs through traditional methods, such as cost sharing and design changes.''

Nearly all employers (99 percent) report being ``significantly or critically'' concerned about health care costs, while 75 percent are concerned that employee dissatisfaction with health care benefits is impacting attraction, retention and engagement. Companies also report being concerned about health care quality and productivity issues (68 percent), liability and regulatory issues (61 percent), and benefits delivery and administration problems (60 percent).

Cost Control Strategies - Employers' primary methods for controlling health care costs includes increasing employee premium contributions (43 percent) and employee plan design cost sharing (37 percent). Organizations also are moderately interested in employing condition/disease management programs (47 percent), moving to different health plans (37 percent), and implementing new delivery systems and purchasing models (36 percent) to control health care costs.

Employers expect the current Patients' Bill of Rights proposals to create higher health care benefit costs (96 percent), increase employee cost sharing (95 percent), reduce the number of employees with access to health care benefits due to increased employer liability (80 percent), and shift a greater part of the responsibility to consumers for health care decisions (66 percent).

Employers reported that health plans need improvement in areas, such as health data analysis and tracking (45 percent), medical management and disease management programs (39 percent), financial efficiency and total cost management (38 percent), Internet information access (34 percent), and financial reporting and accounting (34 percent). - Organizations expect a 14 percent increase in costs for 2002 across all plan types.

Health care: (2002) A recent study by the consulting firm William M. Mercer found 13% of smaller companies and 6% of larger companies are considering ending company-sponsored health care.

A study released in September by the Kaiser Family Foundation and the Health Research and Educational Trust found 99% of employers with 200 or more employees offer health benefits but only 66% of their employees are covered by those plans; of companies with less than 200 employees, 65% offer insurance that covers just 59% of employees.

Families USA found that more than 529,000 Americans lost their health coverage from September to November, most of them because of layoffs and the subsequent loss of employer-sponsored coverage.

Cancer survival: (2002) In one 1998 study of cancer patients, where physicians indicated that patients had a low chance (10% or less) of surviving six months, 11% of those patients survived six months or longer. And, where the physicians indicated a high chance (90% or more) of surviving six months, 29% did not survive six months.

Health care: In Largest Increase in 12 Years, Health Care Spending Rose 7% in 2000

*Hospital expenditures "drove" spending growth in 2000, with hospital spending rising to $412 billion in 2000, an increase of 5.1% over the previous year.

*Medicare spending grew 5.6% in 2000, while Medicare hospital spending grew 4.5%. Medicare spending on home health care rose 0.8%.

*Spending on CHIP programs grew to $2.8 billion in 2000, up from $1.8 billion in 1999. CHIP enrollment grew by 70% in fiscal year 2000.

*Private health care spending grew 6.9% in 2000, nearly 1% more than 1999 growth.

*Health insurance premiums reached $444 billion in 2000, up 8.4% from 1999.

*The proportion of workers covered by preferred provider organizations grew from 35% in 1998 to 41% in 2000.

*Nursing home care expenditures rose 3.3% in 2000 to reach $92.2 billion.

*Prescription drug expenditures grew 17.3% last year, the sixth consecutive year of double-digit growth. While spending on prescription drugs slowed from 1999 to 2000, the report notes that pharmaceuticals were still "the fastest-growing service" for that year. Consumer spending for outpatient pharmaceuticals was the largest single component of out-of-pocket spending.

The increasing number of Americans who lack health insurance will likely become a "growing public concern" in 2002, while the "return of federal budget deficits crimps Washington's capacity to reverse the trend,"

* Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.

Redd Foxx

1/13: HEALTH CARE- (Centers for Medicare & Medicaid Services) Healthcare spending in the United States rose to $1.3 trillion in 2000, a 6.9 percent increase over the previous year, according to a new government report. The increase for 2000 compared with a 5.7 percent growth rate in 1999 and was the highest annual increase recorded since 1993, when spending rose by 7.4 percent

Health care spending averaged $4,637 per person in 2000, nearly a 6 percent rise compared to 1999.

Hospital spending rose to $412 billion in 2000, accounting for the lion's share of spending at an increase of 5.1 percent over 1999. Nursing home expenditures, which had been trending downward since 1995, rose by 3.3 percent in 2000.

'' Spending for prescription drugs jumped 17.3 percent to $121.8 billion, the largest percentage rise in health-care spending, but the pace slowed when compared with the 19.2 percent rise in 1999.

Medicare, the federal program for senior citizens and the disabled, accounted for 38 percent of public spending on health care and 17 percent of overall health spending. Spending for Medicare rose to $224 billion in 2000, an increase of 5.6 percent for the year. Increases in Medicare spending were attributed largely to changes in provider payments, including those enacted in the Balanced Budget Refinement Act of 1999, according to the report. Federal and state spending for Medicaid, a program of health care for low-income families, totaled nearly $202 billion in 2000, an increase of 8.3 percent from 1999.

Health care: In Largest Increase in 12 Years, Health Care Spending Rose 7% in 2000

*Hospital expenditures "drove" spending growth in 2000, with hospital spending rising to $412 billion in 2000, an increase of 5.1% over the previous year.

*Medicare spending grew 5.6% in 2000, while Medicare hospital spending grew 4.5%. Medicare spending on home health care rose 0.8%.

*Spending on CHIP programs grew to $2.8 billion in 2000, up from $1.8 billion in 1999. CHIP enrollment grew by 70% in fiscal year 2000.

*Private health care spending grew 6.9% in 2000, nearly 1% more than 1999 growth.

*Health insurance premiums reached $444 billion in 2000, up 8.4% from 1999.

*The proportion of workers covered by preferred provider organizations grew from 35% in 1998 to 41% in 2000.

*Nursing home care expenditures rose 3.3% in 2000 to reach $92.2 billion.

*Prescription drug expenditures grew 17.3% last year, the sixth consecutive year of double-digit growth. While spending on prescription drugs slowed from 1999 to 2000, the report notes that pharmaceuticals were still "the fastest-growing service" for that year. Consumer spending for outpatient pharmaceuticals was the largest single component of out-of-pocket spending.

The increasing number of Americans who lack health insurance will likely become a "growing public concern" in 2002, while the "return of federal budget deficits crimps Washington's capacity to reverse the trend,"

HEALTH CARE- (Centers for Medicare & Medicaid Services 2002) Healthcare spending in the United States rose to $1.3 trillion in 2000, a 6.9 percent increase over the previous year, according to a new government report. The increase for 2000 compared with a 5.7 percent growth rate in 1999 and was the highest annual increase recorded since 1993, when spending rose by 7.4 percent

Health care spending averaged $4,637 per person in 2000, nearly a 6 percent rise compared to 1999.

Hospital spending rose to $412 billion in 2000, accounting for the lion's share of spending at an increase of 5.1 percent over 1999. Nursing home expenditures, which had been trending downward since 1995, rose by 3.3 percent in 2000.

'' Spending for prescription drugs jumped 17.3 percent to $121.8 billion, the largest percentage rise in health-care spending, but the pace slowed when compared with the 19.2 percent rise in 1999.

Medicare, the federal program for senior citizens and the disabled, accounted for 38 percent of public spending on health care and 17 percent of overall health spending. Spending for Medicare rose to $224 billion in 2000, an increase of 5.6 percent for the year. Increases in Medicare spending were attributed largely to changes in provider payments, including those enacted in the Balanced Budget Refinement Act of 1999, according to the report. Federal and state spending for Medicaid, a program of health care for low-income families, totaled nearly $202 billion in 2000, an increase of 8.3 percent from 1999.

Health care; (2002) In a telephone survey of 927 insured adults conducted in December 2001, 67% of those with employer-provided plans graded their plans with an A or B, while only 8% gave their plans a D or F. In addition, 75% of those with employer-provided plans said they would "recommend their own health plans" to healthy family or friends, while 68% said they would recommend their plan to family or friends with a "serious or chronic illness." The survey found that Medicare beneficiaries were "somewhat more satisfied" with their health coverage than Medicaid beneficiaries or those with employer-sponsored coverage. Only 24% of Medicare beneficiaries graded their plans with a C, D, or F, while 31% of Medicaid beneficiaries and those with employer-sponsored coverage gave their plans similar grades. Of Medicare beneficiaries, 18% said they would not recommend their health coverage to a healthy family member or friend, compared to 31% of Medicaid beneficiaries who said the same thing.

Health Costs: (2002) Health care spending in the United States rose to $1.3 trillion in 2000, a 6.9 percent increase over the previous year, according to a report by the Centers for Medicare & Medicaid Services, and published in the Jan/Feb 2001 issue of the journal Health Affairs. The increase for 2000,compared with a 5.7 percent growth rate in 1999 and was the highest annual increase recorded since 1993, when spending rose by 7.4 percent. CMS economists said the increase primarily reflected a rise in economy-wide inflation. The growth in expenditures in 1999 and 2000 slightly outpaced growth in gross domestic product. The share of GDP spent on health care increased from 13.1 percent in 1999 to 13.2 in 2000. Spending for prescription drugs once again led in the pace of growth in 2000, although at a slower rate than recent years. Drug spending increased by 17.3 percent to a total of $121.8 billion in 2000,compared to 19.2 percent increase to a total of $103.9 billion in 1999.

Going up: ("2000 National Health Care Expenditures)" Health care spending in the United States rose to $1.3 trillion in 2000, a 6.9 percent increase over the previous year, according to a report by the Centers for Medicare & Medicaid Services, and published in the Jan/Feb 2001 issue of the journal Health Affairs.

Life and Health (BEST 2002) life/health industry is expected to report 5% growth in net premium and 15% decline in pretax statutory operating earnings in 2001, as compared to 11% and 10% respectively in 2000. Extreme volatility in the equity markets and low interest rates create significant challenges in managing insurers' balance sheets as customers shift from variable to fixed products.

In or near default bonds will reach their highest levels since the early 1990's and asset sales and writedowns will push realized capital losses to $1.7 billion in 2001.

The need to define limits on terrorism coverage going forward is critical. While a more immediate issue for property/casualty insurers, the implications of bioterrorism and other threats make it a concern for life/health insurers as well.

The federal government's potential involvement in providing a terrorism backstop for insurers could hasten an already well established movement toward federal regulation of insurance as part of a dual federal-state regulatory system.

There are some indications that more people are seeking out life insurance, turning the old ``life insurance is sold not bought'' adage on its head.

The shift from variable to fixed products offering guarantees gained considerable momentum in 2001 as policyholders seek refuge from extreme stock market volatility.

Health Insurance:  (2002) During 2001, an estimated two million Americans lost their health insurance, the largest one-year increase in the number of uninsured in nearly a decade, according to new data released today by Covering the Uninsured.

According to the most recent information from the Census Bureau, nearly 39 million Americans did not have health care coverage in 2000. Since that time, a slow economy, higher unemployment and rising health care costs likely mean that more Americans became uninsured. New data released today by Covering the Uninsured that were compiled by Families USA, show an estimated two million Americans became uninsured due to job loss in 2001. More than a quarter of the increase occurred during the month of October.According to the most recent information from the Census Bureau, nearly 39 million Americans did not have health care coverage in 2000. Since that time, a slow economy, higher unemployment and rising health care costs likely mean that more Americans became uninsured. New data released today by Covering the Uninsured that were compiled by Families USA, show an estimated two million Americans became uninsured due to job loss in 2001. More than a quarter of the increase occurred during the month of October.

Healthcare: (USA Today 2002) Hispanics, Asians and blacks are more likely than whites to have difficulty communicating with doctors and accessing health care, a study says. Hispanics were more than twice as likely as whites — 33% vs. 16% — to cite communication problems

Health Care Costs (CMS Office of the Actuary 2002) National health care expenditures will more than double between now and 2011 to $2.8 trillion a year, accounting for 17% of gross domestic product, according to projections by the The Chicago Tribune reports that the annual study, published in Health Affairs, found that health spending reached 14% of GDP for the first time last year. Then read the comment about obesity again.

The report found that health costs are expected to grow at a rate of 7.3% per year between now and 2011. By then, Americans will spend an estimated $9,216 per person on health care, up from $4,637 in 2000

*Overall Public-Sector Spending: While expenditures are expected to have accelerated more rapidly in 2001 than had previously been projected, largely as a result of "giveback" legislation that increased Medicare reimbursement rates to doctors and hospitals, public health care spending growth is expected to "moderate greatly" for 2002 and the following years, in part because funding provisions of that legislation will expire. From 2001 to 2011, public health spending is projected to grow an average of 7.3% a year -- a rate slower than the 9% seen in the period from 1990 to 1997 but faster than the 4.5% seen from 1998 to 1999.

*Medicare and Medicaid: Medicare expenses grew at a projected 9.5% rate last year, although that rate is expected to fall to 4% by 2003 based on the expiration of the "giveback" law (Heffler et al., Health Affairs, March/April 2002). However, providers are seeking an increase in Medicare reimbursements, which could push Medicare costs higher (Chicago Tribune, 3/12). Medicaid spending, meanwhile, is projected to grow by 11.5% in 2001, up from an 8.6% rise in 2000, although that rate is also expected to slow in future years.

*Government Public Health Programs: The report projects that public health spending will have increased by 11.8% in 2001 and will rise 16% in 2002, up from an 8.3% increase in 2000. The increase is attributable mainly to increases in bioterrorism preparedness spending.

*Overall Private-Sector Spending: Spending in the private sector is expected to have grown 8.9% in 2001 and to grow 9.4% in 2002, up from a 6.9% increase in 2000. This rise is attributed to the "lagged effect of recent rising household incomes, a shift to less restrictive forms of managed care, rising price inflation resulting from the weaker influence of selective contracting and provider consolidation." However, predicting more restrictive managed care and a rise in the number of uninsured, the report projects that private-sector spending growth will decline to 5.9% by 2011.

*Premiums: Private health premiums grew 8.4% in 2000, the highest rate of increase since 1993. The report projects that premium growth hit 9.6% in 2001 and will reach 10.4% in 2002 before leveling off at around 6% by the end of the decade. And while consumers' out-of-pocket costs are "expected to accelerate sharply as well ... the rate of increase is expected to remain below that for private insurance premiums," the report found.

*Hospitals: The report projects a 8.3% increase in hospital spending for 2001, up from a 5.1% rise in 2000 and 3.4% in 1999. The acceleration reflects projected increases in Medicare and private spending through 2002. By 2011, the hospital spending growth rate is projected to fall to 5.1%.

*Prescription Drugs: The report projects a deceleration in the rate of spending growth on prescription drugs from 17.3% in 2000 to 10.1% 2011, down from 19.2% in 1999. The study authors attribute the decline in part to greater cost-sharing among consumers and the less frequent introduction of "blockbuster" medications. The report predicts that between 2001 and 2011, drug spending growth will exceed total health spending growth by almost 5% on average. By 2011, prescription drugs will account for 14.7% of total health expenditures.

*Nursing Homes: Total nursing home spending growth is projected to average 5.5% annually from 2001-2011 and accelerate over that period, "mostly as a result of acceleration in private-sector spending."

Because of the economic recession and greater Medicare and Medicaid spending in the short term, health care expenditures now account for a greater portion of GDP than previously estimated, the study authors note. Nevertheless, the rate of medical inflation is expected to decline from 2003 to 2011. The report concludes that "during this period real health spending growth is expected to outpace real economic growth, resulting in a continually growing share of the nation's resources being allocated to health care" (Health Affairs, March/April 2002).

Insurance: During 2001, an estimated two million Americans lost their health insurance, the largest one-year increase in the number of uninsured in nearly a decade. According to the Census Bureau, nearly 39 million Americans did not have health care coverage in 2000.

Eight out of 10 uninsured Americans are in working families. '' Medical studies demonstrate that uninsured Americans live sicker and die younger because they are forced to go without the medical care they need. Medical bills are a leading cause of bankruptcy.

Health coverage (American Journal of Public Health 2002)  1.36 million health care workers who have jobs but no health insurance, a number that has increased 83% since 1998.

Compared with the mid-1980s, "Insurance coverage was diminished for virtually every health occupation in every type of institution, suggesting a widespread deterioration in the quality of health care jobs.

5.4% of doctors reported they are uninsured.

About 39 million people in the USA go without health coverage for some period each year. 

Surgical Intervention for Disability: (2002) Medical Cost Containment Practices Odds With The Financial Interests Of Employers (Met Life) The study - completed in late 2001 - examined musculoskeletal claims from a 29-month period (January 1999 - May 2001), comparing claimants who received surgical intervention with those who did not. The results show that surgical intervention boosts productivity by reducing an eight-week disability claim by an average of three weeks. "Extended employee absences are a major concern of employers, as it puts a drain on workplace productivity," notes Dr. Ron Leopold, National Medical Director for MetLife Disability and the study's author. "It's important for employers and employees alike to understand how surgical procedures often benefit all parties involved." Among some of the most notable comparisons: -- Surgical patients with a rotator cuff tear lost 5.3 weeks of work, compared with 12.2 weeks for non-surgical patients - a savings of almost 7 weeks. -- Patients with lower-back stenosis who underwent surgery averaged 10.3 weeks of recovery versus 15.9 weeks for non-surgical patients - a savings of 5.6 weeks -- Patients with a meniscus tear of the knee who had arthroscopic repair lost 5.2 lost work weeks, compared with 9.7 weeks for non-surgical patients - a savings of 4.5 weeks. The study also suggests that employers and workers could benefit from better coordination of group health and group disability benefits. "Often, medical cost containment efforts are directly at odds with an employer's goal of getting employees back-to-work in a timely manner. The productivity benefits from a more aggressive medical and surgical approach to musculoskeletal injuries can outweigh the increased medical costs.

Health Care Coverage: (Reuters Health 2002) - Most physicians believe health insurance coverage--more than race, income or other factors--determines the type of care a patient receives, a new Kaiser Family Foundation survey reveals. Seventy-two percent of doctors surveyed agreed that the US healthcare system treats people unfairly "very often" or "somewhat often"

HMO's: (AM Best 2002) Five of the 10 most densely populated states have the highest penetration of health maintenance organizations: Health maintenance organization penetration in the United States averages 23% based on statutory filings received by A.M. Best. California, Tennessee and Massachusetts are among the highest HMO-penetrated states. Among the most densely populated states, Massachusetts, Connecticut and Maryland top the list with more than 35% HMO-penetration rates.

Hospitals Performing Large Number of Surgeries Have Fewer Complications, Deaths 2002

Hospitalized Patients Increasingly Hire Own Private Nurses Because of Shortage

Health costs (Kaiser 2002) Many small business employees will likely have to cover a larger share of the cost of their employee-sponsored health plans next year and may receive fewer benefits "if health insurance costs continue to escalate.

Driven by Increased Use and Advertising, Drug Spending Rose 17% in 2001, Kaiser Study Finds.

Health Insurance 67% of small business executives report "they are very or somewhat dissatisfied" with the cost of health care and health insurance. In addition, 35% of small businesses that offer health coverage may require employees to cover more of the cost in the next year. The study found that about 60% of small businesses provided health insurance for employees in 2001, although 71% offered employees only one health plan. The study also found that 28% of small businesses that provided health insurance for employees in 2001 had switched health plans in the past two years, with cost cited as the "most important reason." In addition, 72% of small businesses that did not offer health insurance for employees cited cost as a "very important reason." According to the study, a 10% increase in health insurance costs would likely prompt 36% of small businesses to reduce health benefits for employees and 17% to drop coverage, while a 25% increase in costs would likely prompt 48% to reduce health benefits and 27% to drop coverage

SENIORS GET MORE PERSONALIZED CARE IN TRADITIONAL MEDICARE (2002) While there's a significant financial advantage to joining a Medicare HMO, seniors who remain in traditional Medicare are happier with the quality of care they receive from their doctors than are HMO members

Here's some facts on why health costs go up: (PricewaterhouseCoopers 2002) Prescription drugs, medical devices and other advances in health care were the biggest contributors to a 13.7% rise in US health care costs last year. Costs for drugs, medical technology and advances in diagnostics and treatment rose 3% overall. While costs due to prescription drugs, medical devices and other advancements rose the most, those same improvements may produce savings in the future by reducing hospitalizations and related health care services.

A 2.5% rise in expenses at hospitals, which are negotiating higher payments from health plans, was the second biggest factor driving up health insurance premiums, after advances in care. General consumer inflation was next, also up 2.5%; followed by expenses from government mandates and regulation, up 2%; costs due to increased consumer demand for services, up 2%; litigation expenses, up 1%; and the cost of fraud, up 0.7%. The aging of the population, greater media coverage of new treatments, increased attention to prevention and diagnostics, and the move away from less-expensive managed care is generating greater consumer demand for medical services, the report said. At the same time, expenses for class action lawsuits, malpractice premiums and other legal costs as well as government-mandated benefits are on the rise.

Hundreds of Thousands are being affected- more to come: (NY Times 2002) Surging inflation in medical costs is draining hundreds of millions of dollars from corporate profits, and many large employers are responding by cutting back on health care benefits for retirees or requiring them to pay more for coverage.

current health care costs for retirees are soaring 18 percent a year, on average, according to the United States Chamber of Commerce. And large companies' liabilities for future health care costs for retirees are rising as much as 34 percent.

Almost two-thirds of companies with 5,000 or more employees still provide some health benefits for retirees, according to the latest Kaiser Foundation-Commonwealth Fund study. But only 3 percent of small companies with fewer than 200 workers do so. Retirees now pay all or part of the costs in 8 out of 10 company health plans, according to a national survey of costs in 2001 by Mercer Human Resource Consulting.

Costs too much: 25% of Small Businesses Say Rising Health Premiums 'Threaten' Their Viability (2002)

Interesting: Doctors Who Have Studied Managed Care Less Likely To Enroll in HMO Themselves,

Increasing Number of Doctors Leaving Managed Care, Moving Toward Cash-Only Practices

Many Large Employers Cutting Back Health Benefits for Retirees

Health Care (Harvard School of Public Health and the Commonwealth Fund report 2002) Americans are much more likely than residents of four other industrialized nations to report problems securing access to healthcare due to cost, according to survey results released Tuesday. At least one in five US adults in the study reported having a problem paying medical bills or difficulty affording prescriptions, medical care or doctor-recommended tests and follow-up treatment

"For countries with universal systems, the results suggest the need to focus on the problems of people who are less well-educated and have lower incomes," he said. The US, which has the highest percentage (21%) of people reporting having a problem paying medical bills, ranks below other nations on most measures of patient perceptions and experiences. While lower-income citizens in all five countries reported difficulty getting access to dental care because of cost, for example, the gap was greatest in the US. Just over half (51%) of lower-income Americans reported.

LACK OF INSURANCE COVERAGE IS DAMAGING HEALTH: IOM REPORT The widespread lack of medical insurance in the US is directly contributing to poorer health and higher rates of early death among adults, according to a report released on Tuesday by the Institute of Medicine.

How much are your body parts worth  Your amount depends on which body part you've lost and the method of compensation — whether it's a payout from your state's workers compensation fund, an accidental death and dismemberment (AD&D) policy, or a lawsuit.

USP SAYS HOSPITALS KEEP MAKING THE SAME MEDICATION MISTAKES

While hospitals and health systems are doing a better job of reporting medication mistakes, they continue to make the same errors over and over, according to findings released by the US Pharmacopeia (USP), a national standards-setting organization.

COSTS OF GROUP HEALTH RISING - (The Council of Insurance Agents + Brokers 2002)Group health plans are becoming so expensive that employers are actively seeking ways to cut back on the coverage and are engaging in significant cost-shifting to employees . Small and medium accounts, those representing up to 500 employees, are feeling the brunt of the cost increases. According to the brokers and agents who placed the coverage, 72% of the small accounts (representing 50 or fewer employees) and 77% of the medium accounts (with 51 to 500 employees) experienced premium hikes of 10% to 30% for their group medical renewals.

FOR-PROFIT HOSPITALS HAVE HIGHER MORTALITY RATES For-profit hospitals in the US are associated with higher mortality rates than non-profit hospitals, according to a report published in the May 28th issue of the Canadian Medical Association Journal.

PATIENT ADVOCATES ARE HELPING PHYSICIANS TO RESOLVE CLAIM DISPUTES Professional patient advocacy, spawned by the complexities of managed care, is turning out to be a godsend to docs.

Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic Costs --- United States, 1995--1999

Cigarette smoking is the leading cause of preventable death in the United States and produces substantial health-related economic costs to society (1,2). This report presents the annual estimates of the disease impact of smoking in the United States during 1995--1999. CDC calculated national estimates of annual smoking-attributable mortality (SAM), years of potential life lost (YPLL), smoking-attributable medical expenditures (SAEs) for adults and infants, and productivity costs for adults. Results show that during 1995--1999, smoking caused approximately 440,000 premature deaths in the United States annually and approximately $157 billion in annual health-related economic losses. Implementation of comprehensive tobacco-control programs as recommended by CDC (3) could effectively reduce the prevalence, disease impact, and economic costs of smoking.

Drugs: The Kaiser Family Foundation  released a state-by-state analysis of prescription drug costs and spending. The data show that while total spending for prescription drugs grew 17.3% nationally in 2001, there is wide variation in spending by state -- ranging from a low of 12.0% growth in Maine to a high of 25.2% in Alaska. Data for every state, as well as national and regional comparisons, are available through the Foundation's online state data resource, "State Health Facts Online" (19 Jun 2002)

Annual U.S. Health Care Costs Per AIDS Patient Averages $34,000 (2002)

HMOs: (DSS Research 2002) Consumers in a national survey gave health maintenance organizations marks similar to those given for other types of health plans with regard to overall satisfaction and value. While HMOs did rank lower in terms of overall satisfaction, problem resolution and overall quality of care, the differences were slight, indicating that HMOs may be closing a perceived satisfaction gap with consumers.

55 percent of HMO consumers gave their plans top ratings on the satisfaction scale, only five percent less than the number of PPO and Indemnity consumers who indicated the highest levels of satisfaction with their plans. -- 74 percent of HMO consumers ranked the performance of their doctors and nurses excellent or very good, with 81 percent of PPO consumers giving their doctors the highest ratings. -- Older consumers (age 55 and up) appear to be the most satisfied with their plans, with more than 70 percent of this subgroup ranking their plan at the top of the satisfaction scale and a significantly higher percentage (67 percent) indicating that their plan is a good overall value.

"Health Care Spending During 1991-1998: A Fifty-State Review," the national average for health care spending per person was $3,759 in 1998, the latest year for which data are available.

Consumer Confidence in U.S. Health System Slightly Increased Between 1997 and 2002,

High Cost of Insurance Leading Some Healthy People To Opt Out of Employer-Sponsored Coverage

More Medicare HMO's are dropping out due to low reimbursements. (2002) Overall enrollment has dropped from 6.3 million in 1999 to 5 million currently, which represents more than 12% of all Medicare patients. Last year, 536,000 patients had to switch insurers or go back to traditional Medicare as plans withdrew from the program.

Health care: (Census bureau 2002) 1.4 million more people went without medical coverage last year, bringing the total uninsured to 41.2 million

Other findings:

Of households earning less than $25,000 annually, 23% lacked health insurance.

Adults ages 18 to 24 were least likely of any age group to have coverage, with 28% lacking coverage.

Hispanics were less likely than non-Hispanic whites to be covered by health insurance, with 66.8% having insurance, compared with 90% of whites. Among blacks, the coverage rate of 81% was the same as that for Asians.

Families with incomes above $75,000 made up nearly 58% of the increase in the uninsured, although they make up only 30% of the population. Experts said that income group is most likely to have coverage and, therefore, in times of recession or job cutbacks, most likely to lose it.

Health plan (Kaiser 2002) Although fewer small employers seem to be offering health care coverage than in the past, less than 1% of firms say they are very likely to stop offering the benefits in the future.

The percentage of businesses with three to 199 employees has decreased from 67% in 2000 to 61% this year, most likely due to the softened economy and escalating health insurance premiums, which surged an average of 12.7% last year, the largest increase since 1990.

Premiums for individual coverage in group plans cost an average of $3,060 this year, while family coverage averages $7,954, according to the survey of 750 employers. Employee costs for single coverage average $454 per year. The employee share of premiums for family coverage averages $2,084. Deductibles for in-network providers in PPO plans rose 37% to $276, up from $201 in 2001.

The PPO still is the most common type of plan, with a little more than half of all employees enrolling in it. HMO enrollment, with about 26% of employees, seems to have stabilized after falling for the last few years. But most small firms – about 93% of all small companies that offer coverage – only offer one health plan, compared to 40% of larger companies.

Health costs: (2002) A survey by the Employee Benefits Research Institute (EBRI) reveals that 38% of employees are not happy with the cost of their health insurance, and 44% are not satisfied with their out-of-pocket cost...up about 20% since 1998. The percentage of respondents identifying healthcare as a critical issue for the nation also increased from 14% in 1998 to 19% and ranks second only to terrorism and national security as a national concern.

HMO increases: (Milliman 2002) HMOs will increase renewal rates by approximately 17% in 2003. Responding HMOs also reported that 2002 premium rates were 16% to 22% higher than 2001 premium rates. Rising health care expenses continue to drive up premiums. This is the fifth year in a row that premiums have increased after four years of little or no increase.

HMO executives say they expect employers to increase workers' share of health care costs, while stepping up efforts to educate employees about making wise health care decisions.

The prescription drug cost increase in 2002 was 12.5%. Hospital inpatient costs also rose at a rate lower than the overall average premium increase. The hospital inpatient cost increase in 2002 averaged 7.1%.

HMO's: (2002) A.M. Best Co. has released financial strength ratings on 40 California health maintenance organizations (HMOs). These ratings include 19 secure and 21 vulnerable, with 11 downgrades, two upgrades, 10 initial ratings and 17 affirmations. The rating assignments reflect the strong market positions HMOs have in California and their consistent operating performance. This is partially offset by declining investment income and increasing provider instability. California HMOs continue to expand their membership by reporting 12% growth in 2001 to more than 25.7 million members, while national HMO enrollment has remained flat. The only line of business in California to experience enrollment declines was Medicare+Choice, which was largely attributable to lower reimbursement levels from the Federal government. A.M. Best continues to view California as a stable marketplace. However, HMOs will continue to be challenged to maintain their historical level of profitability due to health-care expenditures.

Understanding Your Health Plan's Rules

Understanding Your Insurance Coverage American Academy of Family Physicians (2003)

Health Care (2003) Over 33% of large employers that offered health care retirement benefits have either terminated such benefits for retirement or expect to do so in the next three years. This will make Medicare- already strapped for funds- even more debatable as a viable health care alternative.

All but 5% of the companies said they would continue benefits for the already retired but 85% said they would pass on greater costs to these retirees.

Health Insurance: (NY Times 2003) According to recently released Census Bureau figures, 1.4 million Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and resulting rise in unemployment. The largest group of the newly uninsured — some 800,000 people — had incomes in excess of $75,000. They either lost their jobs, or were priced out of the health care market by rapidly rising insurance premiums.

The numbers of uninsured during the last recession from 1990-92 jumped to 35.4 million from 32.9 million. But the number continued to rise even in the boom years of the mid- to late 1990's, reaching 40.7 million in 1998 before dipping slightly in 1999 and 2000.

Percent of Persons of All Ages Without Health Insurance Coverage: United States, 1997 - 2002, National Center for Health Statistics

Health Care Spending Rose 8.7% in 2001, the Fastest Rate in 10 Years (2003)

It's not going to stop:  (NY Times 2003) Americans' health care spending soared 8.7% in 2001 and accounted for 14.1 percent of the total economy. Spending averaged $5,035 for each person in the United States.

"There was some increase in prices, but it was not as large as the increase in quantity. The increase in quantity took many forms: more days spent in hospitals, more outpatient services, more diagnostic tests, more prescriptions and greater use of new technology, which has the potential to extend life and improve its quality."

Medicare spending, for the elderly and disabled, rose 7.8 percent in 2001, while spending under Medicaid, the federal-state program for low-income people, soared 10.8 percent. The growth of Medicaid was driven by an increase in enrollment, resulting from the recession and from state efforts to expand coverage.

prescription drugs as the fastest-growing category of health spending. The nation spent $140.6 billion on such medicines in 2001, up 15.7 percent from the prior year.

The growth in drug spending eased in 2001, after increases of 16.4 percent in 2000 and 19.7 percent in 1999, as fewer new drugs entered the market and employers raised co-payments in a successful effort to encourage greater use of generic drugs.

Pharmaceutical companies say prescription drugs still account for a relatively modest share of total health spending, 9.9 percent in 2001, compared with hospitals and doctors, which together account for more than half.

Spending on hospitals rose at the fastest clip since 1991, reaching $451.2 billion in 2001, up 8.3 percent from the prior year.

In 2001, spending for doctors and clinical services rose 8.6 percent, to $313.6 billion, the government reported.

Budget Deficits in 40 States Impacting Health Care Programs 2003

Elderly health: (Journal Psychosomatics 2003) How much an elderly person complains about pain, gastric symptoms and other body problems may be tied more to overall well-being and life satisfaction than to actual physical health, says new research published in the . A German team of psychosomatic and gerontology researchers assessed 251 general hospital inpatients' body complaints and how those complaints related to demographic factors (such as age and marital status), age-related changes, life satisfaction and doctors' ratings of problems. Body complaints studied included exhaustion, gastric symptoms, pain, cardiovascular complaints and other symptoms. The patients' average age was 75 years, and more than two-thirds (68.1 percent) of the patients were women.

The researchers found that only three factors were significantly associated with the elderly persons' body complaints: self-assessment of life satisfaction; self-assessment of age-related changes related to activities, cognitive performance and state of health; and doctors' ratings of somatization -- that is, patients' physical complaints that cannot be explained by a bodily cause. Age, gender, marital status, living arrangements and objective health-related variables were not associated with the level of subjects' body complaints. "Complaints of psychosomatic symptoms in elderly patients have been receiving increased attention," Dr. Schneider and colleagues write. "Our results confirm those of other studies that have shown a correlation between subjective body complaints, subjective well-being, depressive mood and psychiatric disorders."

Kaiser also reports the steepest health premium rise in a decade...13.9% this year.

This will not get better: (USA Today) States cut Medicaid benefits and increased copayments in 2003 to slow spending growth in the low-income health insurance program for the first time in seven years.

Average Medicaid spending growth in the 50 states and the District of Columbia was 9.3%, down from 12.8% a year ago. Enrollment in the program over the same period increased 7.8%.

STATE MEDICAID CHANGES

In fiscal 2003:

50 reduced or froze payments to providers, such as physicians and hospitals.

46 controlled prescription drugs costs.

25 restricted eligibility.

18 reduced or eliminated dental or vision coverage, or limited physician visits.

17 increased copayments.

Planned for fiscal 2004:

49 will reduce or freeze provider payments.

44 will control prescription drug costs.

21 will increase copayments.

20 will reduce benefits.

18 will reduce or restrict eligibility.

The problem promises to get worse in 2005 when states exhaust a $10 billion federal windfall that temporarily increased the federal Medicaid matching rate. The survey found states do not expect their fiscal woes to be over when the federal aid runs out.

Health costs 2004 (CFO)
Medical
HMO 14.7%
POS 14.5
PPO 14.4
Indemnity 16.4
Dental
PPO 7.6
Indemnity 7.6
PHARMACY 17.7
VISION 3.8

TAX BENEFITS OF HSAs - (2005) HSAs offer many tax advantages over traditional health insurance arrangements. 1) Reduce your federal income taxes. 2) Reduce your adjusted gross income, helping you to qualify for other lucrative tax breaks tied to overall income. 3) Reduce your state income taxes. 4) Tax-deferred growth. 5) Pay for dental expenses with pre-tax dollars. 6) Pay for vision care with pre-tax dollars. 7) Pay for alternative care with pre-tax dollars. 8) Pay for aspirin, bandages, cold medicine, and other household medical expenses with pre-tax dollars. 9) Pay Medicare expenses with pre-tax dollars, including Medicare premiums, deductibles, copays, and coinsurance. 10) Pay for long-term care insurance with pre-tax dollars.

Health Care:  (2005) a significant number of working Americans in every state do not have health care coverage, with more than 20 million working adults not having coverage. In eight states, at least one in five working adults is uninsured. In 39 other states, at least one working adult in every 10 does not have health care coverage. The report further reveals that in all 50 states and the District of Columbia, between one-fourth and one-half of all uninsured adults were unable to see a doctor when needed in the past year because of cost.

Additional findings, of surveyed adults ages 18-64, include:

The problem is pervasive among workers in every state. States with the highest rates of uninsured residents among employed adults include Texas (27 percent), New Mexico (23 percent), Louisiana (23 percent), Florida (22 percent), Montana (21 percent), Oklahoma (21 percent), Nevada (20 percent), and Arkansas (20 percent). States with the lowest uninsured rates among employed adults include Minnesota (7 percent), Hawaii (9 percent), Delaware (9 percent), and the District of Columbia (9 percent).

Uninsured adults are unable to see a doctor when needed. Nationally, 41 percent of uninsured adults report being unable to see a doctor when needed in the past 12 months, due to cost, compared to just nine percent of adults who have health care coverage.

Uninsured adults are less likely to have a personal doctor or health care provider. Nationally, 56 percent of adults without health care coverage say they do not have a personal doctor or health care provider, compared with just 16 percent of people with health care coverage.

Adults who are uninsured are much more likely to report being in poor or fair health than are adults who are insured. Nationally, one in five uninsured adults (20 percent) say their health is fair or poor, compared with nearly one in nine adults with health coverage (12 percent).

Better care?: (WSJ 2007) Several new studies suggest that there is no relationship between the amount spent on treating a patient and the quality and outcome of the care.

Consider chronically ill elderly patients in the last two years of their lives. According to a comparison of hospitals across the country done by researchers at Dartmouth, if the patients die in a hospital in New York State, the average cost of those two years would be $38,369. In Florida, by contrast, it would be $29,604, while in Iowa it would be only $23,746.

Medicare spending on hospital care for heart attack victims surged two-thirds from 1986 to 1996, after accounting for inflation. But the percentage of victims who were alive a year after their attacks also increased, though by just 10 percentage points, to roughly 68 percent.

The relationship — rising costs bringing increased benefits — has broken down recently. From 1996 to 2002, Medicare spending on treatments for heart attack victims increased about 14 percent, after inflation. But there was virtually no improvement in survival rates.

And this was interesting- “The biggest failure of the American health care system is not that we overuse stuff but that we underuse stuff,” said David Cutler, an economist at Harvard. Consider aspirin. It helps prevent formation of blood clots, and its widespread use has probably been the cheapest breakthrough in the history of heart disease treatment.

A study five years ago by Dr. Mark McClellan and Dr. Paul A. Heidenreich, estimated that growing aspirin use explained more than a third of the decrease in the death rates of heart attack victims from 1975 to 1995.

Still, a Duke University study of about 32,000 patients with coronary artery disease who were treated from 1995 to 2002 found that only 83 percent took aspirin. And only 71 percent did so consistently.