The New York Times article noted “Restricting consumers to a fixed network of doctors and hospitals, called in-network coverage, helps keep costs down, and for the first year, none of the 16 insurance companies in New York’s exchange deviated from that model.”
“Advocates for consumers had lobbied hard for out-of-network coverage, saying that some patients needed more choices, particularly since the networks are being kept small to further reduce costs. Under the current in-network system, someone who lives part of the year out of state, or a student at a college out of state, are not covered while they are away, except for emergency care.”
“Though the views were spectacular, the cardiac arrest team could not get there as quickly as it could to the regular wards.”
The New York Times article asked the questions “What is going on here? Is This a Hospital or a Hotel?”
“The Henry Ford health system in Michigan caused a stir after it hired a hotel industry executive, Gerard van Grinsven of the Ritz-Carlton Group, in 2006 to run its new hospital, Henry Ford West Bloomfield. There are some medical arguments for the trend — private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing.”
“Every year between 210,000 and 440,000 Americans die as a result of medical errors and other preventable harm at hospitals, according to researchers.”
These numbers are equivalent to a jumbo jet crashing every day with no survivors. Based on these figures, medical errors could be considered the third-leading cause of death in America, behind heart disease (more than 590,000 a year) and cancer (more than 570,000 a year).
New models of clinical practice are being used in the “doctor’s office.”
A Wall Street Journal article noted: “An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases.”
So why are you delaying your colonoscopy again? Colonoscopy! Ugh! But…
The Wall Street Journal article reported “The incidence of colon cancer, declining since the mid-1980s, plunged a further 30% last decade among Americans 50 and older as more people had colonoscopies…”
The New York Post reported “An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more”
“Doctors and administrators say they’re concerned. So are some state insurance regulators. In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their state exchange”.
The New York Daily News article was a first person story of experience with the health care system.
“My plunge into the world of ambulances, emergency rooms and minor surgery came without warning, like a trapdoor opening beneath my feet. One second, I was skiing along happily in upstate New York’s Adirondack Mountains with my son and a group of friends. The next, I was writhing on the slope in pain — having wrenched my right leg in an awkward, slow-speed fall. In the blink of an eye, I went from a healthy and independent 52-year-old to a trauma victim in need of a lot of expert help from a lot of people.”
Here’s a great cartoon story about the implementation and benefits of Obamacare by Jen Sorensen, as featured in Kaiser Health News.