The Center for Study of Health System Change published a brief report today suggesting that the lack of progress on lowering health care inflation combined with greater availability of both subsidized and nonsubsidized individual insurance has lessened employer commitment to continuing to offer health insurance, especially to low wage workers. This is in contrast to information published last week in Health Affairs, where a survey by the National Opinion Research Center (NORC) showed that there was little "crowd out" of employer health insurance by the new state program.
If employer-based health insurance declines, it will be hard to tell whether this is due to the state Connector program or due to the severe decline of financial fortunes in many Massachusetts industries, especially the financial services industry.
For readers in HPM 235, we'll be talking about health care reform on Wednesday, November 5 (and slides are posted at the end of class 2)
Cost Saving vs. Cost Effective
In Wednesday's class, we talked about cost effectiveness compared to cost saving. For instance, it is cost EFFECTIVE to do mammography to prevent premature deaths from breast cancer -- in that it costs less than $40,000 per quality adjusted life year saved. (This depends a bit on context -- how old the woman is, pretest probability, and previous mammogram). The good news about doing more mammograms is that fewer women will die prematurely of breast cancer. However, there are no savings available - we're just spending our resources to buy something of real value.
There are very few things we do in the "medical industrial complex" that are cost SAVING. I mentioned that from my perspective it was hard to name anything beyond childhood immunization and antiretrovirals for patients with full-blown AIDS. Class member Ben Geisler has pointed me to the Tufts cost effectiveness registry.
Ben has found a number of other medical approaches that do seem to be cost saving:
- Hip pads to prevent fractures in high risk nursing home residents
-TB testing and treatment for chinese immigrants to US in year 2000
- Gemfibrozole (cholesterol agent) for men with known cardiac disease
-Antiosteoporosis treatment for older women at VERY high risk
- Alpha interferon for hep C in 45 year old man (I am dubious on this one myself)
- Acyclovir therapy for herpes zoster and chickenpox in limited populations(I'm dubious here too)
-Leg angioplasty for a very specific population to relieve rest pain in legs
Note that in all instances these are VERY limited populations!
Remember you always have to ask "cost saving compared to what?" For instance, it might be cost effective to use Viagra instead of a penile implant -- but Viagra can never be cost saving within the health care system compared to no therapy at all!
Women Pay More for Insurance Than Men
Abby Ruettgers of our class points out that the NYTimes published data today showing that women are charged more than men for health insurance in the individual insurance market. This is especially prominent for young adults.
This isn't a real surprise. In fact, I think this represents childbirth as opposed to gender discrimination.
This is one more example of the problems of the individual market. While many will say that the individual market eliminates "moral hazard" and makes people pay for their own poor health decisions -- it's not clear we want to penalize women of childbearing age for the chance they might decide to have a child!
