CT Health Notes Items for Consumers

21. New study and consumer guide to Medicaid/CHIP for grandparents raising grandchildren

The Children's Defense Fund has released "Healthy Ties: Ensuring Health Coverage for Children Raised by Grandparents and Other Relatives", a study across states, and a very useful guide for relative caregivers - both to ensure that children obtain and retain coverage and, incredibly important, how caregivers can "spread the word" in their communities. The study highlights barriers to Medicaid/CHIP coverage for children in relative care - some barriers are common to all eligible children, but some are specific or more acute for relative caregiver families. The report makes policy recommendations to improve access to coverage. The Connecticut Health Policy Project, UConn Health Center's Child and Family Studies, and DSS participated in the study. To view the report, go to http://www.childrensdefense.org/cwmh/ss_healthyties.htm  (CT Health Notes, 10/27/01)

22. New report predicts the number of uninsured likely to rise, dispels myths about who is uninsured

Coverage Matters: Insurance and Health Care, a thoughtful new report by the Institute of Medicine, describes America's uninsured population in detail, dispelling many myths. The report is a great resource, detailed but very readable. For example, there is a common perception that people without health insurance are young, healthy adults who decline employer-sponsored coverage because they feel they don't need it. In fact, only 4% of all workers ages 18-44 are uninsured because they declined an employer offer of coverage. The authors predict that the slowing economy, increasing unemployment, and accelerating health insurance costs will boost the number of uninsured Americans. The report is the first in a series from the IOM's Committee on the Consequences of Uninsurance. Future reports will address health outcomes of uninsurance, family impacts of lacking coverage, community-wide effects of uninsured populations, economic costs, and strategies and models for providing coverage. A summary is available on-line and the entire book can be ordered at http://www.iom.edu/uninsured. (CT Health Notes, 10/12/01)

23. Consumer mistakes are not responsible for most health insurance problems

A recent study found that 71% of health insurance problems are due to errors by health plan administrators (54%) or providers (17%). Consumer mistakes accounted for only 29% of errors. The researchers were surprised by the results, expecting that consumers were unsophisticated in navigating complex health systems. The vast majority of problems involved claims (86%); 12% involved access to care. 8% of problems were "critical" requiring resolution within 24 to 48 hours; the other 92% were labeled non-critical, usually arising after care has been delivered. Employers can expect that approximately 2 to 4% of enrollees will have a problem each year that needs assistance to be resolved. These problems can be extremely time consuming and frustrating for employees leading to "decreased productivity, morale as well as overall dissatisfaction with benefits." The study by Hewitt Associates included 2500 health plan problems. ( http://was.hewitt.com/hewitt/resource/newsroom/pressrel/2001/09-05-01.htm) (CT Health Notes, 9/28/01)

24. Consumer guide to buying short term health insurance/major medical

For consumers in need of short-term health insurance, insure.com has published a guide to what is available, what is usually covered, how to find it, and how to check on insurers. Often called major medical, short term insurance can fill gaps in coverage due to unemployment, graduating from college or otherwise losing parents' coverage, or other reasons. Short term insurance policies are indemnity plans, without gatekeepers or HMOs. Coverage usually includes surgery, hospital care, emergency services, prescription drugs, and follow up office visits. Preventive services, maternity care, and pre-existing conditions are typically not covered. Most policies last from one to six months and are not renewable. While premiums are usually very low ($30 per month for a healthy single male in his early 20's), the plans generally include very high deductibles ($2500 is not uncommon) and co-pays above that amount (typically 20%). For some policies, the deductible is per injury or illness, not over the life of the policy. Some policies have maximum benefit caps (usually $1 or $2 million). It pays to investigate all options and costs fully before buying short-term coverage. (http://www.insure.com/health/shortterm.html) (CT Health Notes, 8/31/01)

25. Federal court rules CMS must disclose complaint investigation results to Medicare consumers

A federal judge in the District of Columbia has ruled that consumers are entitled to information about the substantive disposition of a Medicare complaint. Current CMS (formerly HCFA) regulations and its Peer Review Organization Manual prohibit disclosure to beneficiaries of the final disposition of a complaint if the investigation identifies a practitioner who does not consent to disclosure. In Public Citizen, Inc. v. Dept. of Health and Human Services, the court found that Medicare law requires disclosure to beneficiaries with or without the consent of the physician. (American Health Lawyers Assoc., 7/23/01) (CT Health Notes, 8/4/01)

26. Networks provide bulk-purchasing clout for uninsured

Several Florida companies are creating provider networks for the benefit of uninsured consumers, with negotiated service prices similar to those enjoyed by managed care organizations. For example, a $200 mammogram costs only $50. The companies charge a fee -- $1000 annual membership or $5 to $15 per visit - and manage patients' appointments. Consumers pay for services up front, in some cases with an advance balance like a pre-paid phone card. Providers are willing to accept lower rates because they are assured timely payment, in some cases within 48 hours. One company, HealthAccess, has a network of 18 South Florida hospitals, nearly 2,000 physicians and almost 50,000 members. HealthAccess believes this business model has great potential; as the company president points out, Aetna, the largest US insurer has 11 million members, but there are 40 million uninsured. (Kaiser Daily Health Policy Report, 7/19/01) (CT Health Notes, 8/4/01)

27. Managed care fact sheets for consumers

The National Health Law Project has drafted five fact sheets about managed care for a general audience. They are available in both English and Spanish and in various on-line formats. The five are - How can this information help me?, Understanding quality measures, Figuring out which health plan meets your needs, Report cards, and Consumer surveys. (http://www.healthlaw.org/pubs/FS/managedcarefactsheets.shtml) (CT Health Notes, 8/4/01)

28. On-line resource on childhood asthma for families

The mother of a child with asthma has created a website with useful, understandable information on childhood asthma for families. The site includes clinical information, current studies, up-to-date research articles, presentations, and on-line discussion forums. The site includes information on triggers, successful asthma management strategies, what works and what is a waste of money, and asthma-related legislation, relying on information from recognized, trusted sources. The site is also remarkable for a lack of condescension and "dumbing-down" too common in "consumer-friendly" sites. (http://www.asthmamoms.com) (CT Health Notes, 8/4/01)

29. New issue guide to medical research from Public Agenda Online

Medical research is changing the nature of health and health care with increasing speed. While most Americans believe that research is vital to improving our quality of life, there are many misconceptions and concerns. Public Agenda Online's new guide provides an objective, user-friendly analysis of confusing and scary medical research issues. Topics include stem cell research, potential benefits and dangers to mapping the human genome, drug research & development, the role of private and corporate funding in research and how much funding for medical research is enough. The guide includes not only straightforward information, but also includes public opinion polling and viewpoints. (http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=medical_research) (CT Health Notes, 7/20/01)

30. Less than half of Americans get the most effective preventive health care services

A study in the July issue of the American Journal of Preventive Medicine surveyed Americans' access to the 30 most important preventive health services recommended for average-risk patients based on health benefits and cost effectiveness. Some of the most effective services are not offered to most patients. Tobacco cessation counseling for adults, vision screening for older adults, colorectal screening for those over age 50, chlamydia screening, screening and counseling for problem drinking and flu vaccinations for older adults each reached fewer than half of Americans. If only 10 of 10,000 teenagers received anti-tobacco and anti-alcohol counseling, and followed their doctors' advice, there would be significant health benefits and net savings. Expanding each of these services would have significant influences on health status. The study is the first to integrate the cost and impact of a disease or injury with the cost and effectiveness of preventive measures. ( http://www.elsevier.com/locate/ajpmonline, http://www.cdc.gov) (CT Health Notes, 7/7/01)

31. Tuskegee syphilis study suspicions still limit blacks' participation in medical research

Underepresentation of minorities in medical research studies led the National Institutes of Medicine to mandate their inclusion in all studies they fund. However, a new survey demonstrates that suspicions and distrust remain from the US government-sponsored Tuskegee study of the natural history of syphilis among black men. The Tuskegee study began in 1932 but researchers continued the study of the disease in untreated men for years after the discovery that the disease could be treated effectively with penicillin. The recent survey found that 81% of blacks and 28% of whites knew about the Tuskegee study. Half of blacks said that said that the study played a role in their reluctance to participate in clinical trials due to lack of trust. Among whites who knew about the study, only 17% said that it reduced their trust in medical researchers. The authors call for medical researchers to acknowledge past abuses, their commitment to ethical research practices and safeguards to protect current participants with potential subjects. (AHRQ Research Activities, May 2001) (CT Health Notes, 6/23/01)

32. Consumers with choices between health plans are more likely to purchase coverage; Educated consumers make better choices

Researchers found that employees with a choice between health plans are more likely to purchase coverage and are more likely satisfied that their families' health needs are being met. Researchers also found the likelihood of a usual source of care was higher for employees with a choice of health plans and they were more likely to be enrolled in an HMO. (AHRQ Research Activities, April 2001, http://www.ahrq.gov).

In another study, researchers found that providing consumers with out-of-pocket cost information during open enrollment periods helps them make choices that fit their needs. Consumers choosing between health plans have little information about quality and even less about expected health plan costs. Two groups of consumers were provided with supplemental decision support materials comparing likely out-of-pocket costs across plans; the control group received conventional plan information. Consumers in the two experimental groups selected cheaper, less comprehensive plans. Researchers discussed the study's implications in encouraging a truly competitive marketplace for health insurance based on educated consumers and the potential to restrain overall health care spending. (Schoenbaum, et. al., Inquiry 38:35-48, Spring 2001) (CT Health Notes, 5/25/01)

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