When an Insurance Card Isn't Enough: The Need for Enabling Services

Americans are demanding, more than ever, change in our health care system.  We want meaningful reform that means that we will be able to get the care we need, so that we can be healthier and productive as individuals, families, communities, and as a nation. But when the health care reform debate is narrowed to a discussion of insurance coverage, rather than actual ability to access quality care, the discussion falsely considers health care to be a commodity, like Nintendo Wiis.

But surely we as a country value health more than our gaming consoles; indeed, we believe as a nation that health care is a right stemming from our basic human dignity and America's promise of opportunity, in the same manner as access to our interstate highway system or the protection from disaster provided by our firefighters.  True reform of health care in the United States requires a recognition of the wisdom of the adage, "If you don't have your health, you don't have anything."  Providing real access to necessary care should be the central mission for how we redesign the broken health care system in America, a system that finds over 1 in 5 Americans unable to pay the bills for necessary medical care or prescription drugs, and 1 in 4 Americans who have put off necessary care in the past year.

Real access to health care requires more than an insurance card in your wallet.  Too many working families find barriers to primary and preventative care every day, whether it be due to their local hospital closing and taking a provider network along with it, or as occurs quite often, because they don't have access to needed support or services that is essential to getting to a doctor in the first place.  "Enabling services," as they are called, include transportation to a medical provider, childcare during appointments, interpreters for those with limited English proficiency or hearing impairments, case management, health education, and training of medical professionals to provide such services in a culturally competent manner.  And they are crucial to not just the ability to access health care, but overall well-being and health outcomes.  A 2007 study by the Association of Asian Pacific Community Health Organizations (AAPCHO) found that patients using enabling services had significantly lower hemoglobin A1C (blood sugar) than those not using enabling services.  As AAPCHO reported:

“What this study begins to show us is that enabling services, which include translation services and health education, do in fact improve health outcomes for vulnerable and medically underserved Asian American, Native Hawaiian and other Pacific Islander patients,” said Jeffrey B. Caballero, executive director at AAPCHO.

Mr. Caballero further explained, ”With current health care discussions revolving around comprehensive healthcare systems and defining the “medical home”, federal agencies and lawmakers must recognize the true value of enabling services and the CHCs that provide them.”

Many health care facilities provide these sorts of services already, but they are not consistently available, encouraged, or covered by health insurance policies.  Making these essential services "reimbursable," that is, something that insurance plans will pay for just as they pay providers for flu shots and check-ups, should be a key of any health reform proposal going forward.

Read more at The Opportunity Agenda's blog.

Tags: Health, Opportunity (all tags)


1 Comment

Healthcare Hell in Massachusetts

Read this:
Massachusetts' Plan: A Failed Model for Health Care Reform

Also, Massachusetts citizens who are buying high deductible "insurance" now can't afford to go to the doctor or buy (non-covered) prescription drugs.

http://www.citizen.org/pressroom/release .cfm?ID=2828

Massachusetts Is No Model for National Health Care Reform

Public Interest Groups Urge Sen. Kennedy to Introduce Single-Payer Legislation

WASHINGTON, D.C. - The Massachusetts health care system, widely regarded as an example of how to provide universal coverage and keep costs low, is in fact faltering badly and should not be held up as a national model for reform, according to a study released today by Physicians for a National Health Program (PNHP) and Public Citizen.

The groups urged Sen. Edward Kennedy (D-Mass.) to reject his home state's approach and, instead, introduce Senate legislation crafted after the House's United States National Health Care Act, H.R. 676, which would implement single-payer financing of health care while maintaining the private delivery system. The public interest groups also released a letter to Kennedy signed by approximately 500 Massachusetts physicians and health professionals urging the senator to embrace single-payer reform.

"Massachusetts physicians have the unique opportunity to observe the effects of this reform on patients every day," said Rachel Nardin, M.D., president of the Massachusetts chapter of PNHP and lead author of the study. "The nearly 500 doctors who have signed the open letter to Sen. Kennedy see that the reform is deeply flawed."

PNHP's study of the Massachusetts model found that the state's 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.

Many low-income residents, who used to receive completely free care, now face co-payments, premiums and deductibles under the new system - financial burdens that prevent many of them from receiving necessary medical treatment. Since the state's reforms passed, premiums under the state insurance program have increased 9.4 percent. The study found that if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

Many residents remain uninsured or have inadequate insurance.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government.

"We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits -- all at the expense of American consumers," said Sidney Wolfe, M.D., director of Public Citizen's Health Research Group. "Massachusetts' failed attempt at reform is little more than a repeat of experiments that haven't worked in other states. To repeat that model on a national scale would be nothing short of Einstein's definition of insanity."

The study found that a national nonprofit single-payer system could save Massachusetts about $8 billion to $10 billion a year in reduced administrative costs. Currently, Americans spend 31 cents of every health care dollar on administrative costs, by far the highest rate in the world and much higher than the 17 cents spent in Canada, which has single-payer universal health care.  

"Big hospitals and insurers have gotten rich off reform, but a survey shows that more people directly affected by it have been harmed that helped," said Steffie Woolhandler, M.D., a PNHP co-founder and associate professor of medicine at Harvard Medical School who helped prepare the study. "We're seeing patients who now can't afford vital medications and treatments that they've been on for years because of the new co-payments and deductibles imposed by the law."

Read the report, "Massachusetts' Plan: A Failed Model for Health Care Reform."

Read the letter to Sen. Kennedy.

Read the labor letter to Pres. Barack Obama.

Read personal stories from Massachusetts patients.

by architek 2009-03-16 06:27PM | 0 recs


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