Inequalities in stroke treatment: health insurance coverage does matter

All people are created equal. So why don’t people get equal treatment when it comes to stroke? Does it have something to do with health insurance coverage?

Ischemic stroke occurs when a blood clot blocks a blood vessel supplying blood to the train. The cutting off of the blood supply (and therefore oxygen) of the brain can lead to death of brain cells which can in turn cause permanent damage. Ischemic stroke is the most common type of stroke and is a major cause of disability.

The state of the art in the treatment of ischemic stroke is the tissue plasminogen activator (tPA). tPA is a thrombolytic or clot-busting agent and is the only drug of its kind which has been approved by the US FDA for the emergency treatment of acute ischemic stroke. It is also a time-critical type of treatment and should be given within 3 hours after the onset of stroke symptoms to be effective. Recent studies even suggest that tPA can still reverse the neurological effects of stroke and prevent death and disability when given up to 4.5 hours after the onset of stroke.

However, a recent study funded by the U.S. Centers for Disease Control and Prevention (CDC) showed that “between July 1, 2005 and June 30, 2007, the tPA treatment national average was 2.4 percent of all ischemic stroke patients in the Medicare database.” Reports of rates of tPA administration in hospitals all over the US range from 0 to 24%. The rate of 2.4% among Medicare patients is seemingly low. In addition, 64% of all hospitals in the US did not administer clot busters to Medicare stroke patients during this time period.

According to a Dr. Lee Schwamm, an associated professor of Neurology at Harvard University

“This study sheds important light on a major disparity in acute stroke care delivery…Individuals and agencies responsible for the equitable distribution of healthcare resources need to examine these and other data to identify strategies that will provide adequate acute stroke care to all their citizens.”

There are of course other factors to consider, including the size of the hospitals in question, as well as their geographical location. A previous study on emergency care of stroke victims also found that the following factors can make a difference in the kind of treatment received:

• the type of hospital (does it have a Primary Stroke Center?)
• the manner of patient arrival/delivery (walk in vs. ambulance delivery)
• gender (men get treated faster!)

The issue of health insurance coverage is a major issue in the US.  Read more about the “crisis of the uninsured” in a previous post.

               

The crisis of the uninsured: the whole community suffers

The state of the health care system of the US has always been a subject of great controversy. The recent approval of the Children´s Health Insurance Bill by President Obama which gives health care access to all American children as well as children of legal immigrants was met with mixed reactions. Its proponents were pleased and hope that this is the first step in their goal of having health coverage for everyone. Those against the bill, on the other hand, the bill too closely resembles “socialized medicine” or “government-run health care for every one” that can easily be abused and can cost taxpayers a lot of money.

A recent report by the Institute of Medicine (IOM) states that “having health insurance is essential for people’s health and well-being”. However, the report continues to provide troubling statistics about health insurance coverage in the US, namely:

• The number of people who have health insurance is decreasing.
• Employment-sponsored coverage, which is the main source of insurance coverage for Americans, is also dropping due to increasing unemployment and the current economic crisis.
• In 2007, almost 10% of American children and 20% of non-elderly adults had no health insurance.
• In a separate report by the U.S. Department of Health & Human Services (HHS) the number of children enrolled in the State Children’s Health Insurance Program (SCHIP) has increased by 4% in 2008, probably due to the current economic crisis.

The IOM report states that there is an urgent need for government intervention to prevent further decline of health insurance coverage among Americans.

The report gives evidence that the problems of the uninsured can spill over to the whole community whereas coverage for everyone benefits everyone, not only the needy. This was demonstrated by comparing the health status of people before and after enrolment in Medicare, Medicaid, and the SCHIP.

What are the consequences of lack of insurance coverage?

• Adults without coverage are much less likely to receive preventive and preemptive care that can reduce preventable diseases and premature death.
• Thise with underlying and chronic conditions delay or forgo check ups and are less likely to comply with follow-up treatments.
• Early screening and detection are less likely among the uninsured whereas diagnosis of late-stage cancers and acute conditions are more likely.
• Those hospitalized with serious conditions are also more likely to suffer poorer outcomes and premature death, and have poorer quality of life.

These problems can affect those with health insurance as well.

Based on the available evidence, the committee concluded that when a community has a high rate of uninsurance, the financial impact on health care providers may be large enough to affect the availability, quality, and cost of local services for everyone, even people who have insurance.  For example, survey data show that privately insured, working-age adults in areas with higher uninsurance rates are less likely to report having a place to go for care when sick, getting a checkup or routine preventive care, and seeing a specialist when needed.  They are also less likely to be satisfied with their choice of physicians or to trust their doctors’ decisions.

However, there is also evidence obtaining coverage lessens or reverses many of these harmful effects. As an example, insurance coverage for children can have the following benefits:

“Children are more likely to gain access to a regular source of care, immunizations and checkups, needed medications, asthma treatment, and basic dental services. Serious childhood health problems are more likely to be identified early, and those with special needs are more likely to have access to specialists. Insured children experience fewer hospitalizations and improved asthma outcomes, and they miss fewer days of school.” In the process, outbreaks of infectious diseases and disruption of school schedules are reduced.

Currently, Americans without health insurance coverage are taken care of by the so-called “safety-net services such as charity care and emergency departments.” The IOM report, however, indicates that these “safety nets” are not enough and is urging the current US administration to act urgently and solve the “crisis of the uninsured.”

               

Taking on childhood obesity

We have a common enemy and it’s called children obesity. Let us look at the latest statistics for children aged 6 to 11 years old who are overweight:

• non-Hispanic whites:16.9% of boys and 15.6% of girls
• non-Hispanic blacks: 17.2% of boys and 24.8%of girls
• Mexican Americans: 25.6% of boys and 16.6% of girls.

While the majority of the efforts fighting the obesity battle come from health advocacy groups, government agencies and not-for-profit organizations, it is great to know that corporate America also has a social conscience and has joined the battle. Two of these corporate initiatives are described below.

Obesity and advertising

The Council of Better Business Bureaus’ (BBB) Children’s Food and Beverage Advertising Initiative is fighting obesity at the consumer level. The initiative was launched by BBB way back in 2006 to advocate for more responsible advertising among food manufacturers. “The Initiative is aimed at shifting the mix of advertising messaging directed to children under 12 to encourage healthier dietary choices and healthy lifestyles.”

The terms of the initiative include

• at least 50% of ads targeting children under 13 should provide healthy messages and promote better dietary choices and lifestyles. This covers also interactive games and marketing strategies.
• no advertising of junk food and beverages in elementary schools.

The companies who have pledged (as of February 2009) to the initiative are:

• Burger King Corp.
• Cadbury Adams, USA, LLC
• Campbell Soup Company
• The Coca-Cola Company
• ConAgra Foods, Inc.
• The Dannon Company
• General Mills, Inc.
• The Hershey Company
• Kellogg Company
• Kraft Foods Inc.
• Mars, Inc.
• McDonald’s USA
• Nestlé USA
• PepsiCo, Inc.
• Unilever United States

The Initiative is based on a self-regulation program and participation is voluntary. However, once a company has publicly pledged its support for the initiative, it is subject to the standards set by the Initiative.

This is quite different from what is going on in the European Union where the EU Directive on Unfair Commercial Practices has set guidelines on advertising junk food for children, but the law is to be implemented independently in each member country.

Obesity and healthcare access

Health insurance companies are known to be mean when it comes to health benefit coverage and doctors’ reimbursements. But it seems that some insurers have a social conscience after all that prompted them to be part of the Alliance Healthcare Initiative, which is part of the Alliance for a Healthier Generation. The initiative is a joint effort of the American Heart Association and the William J. Clinton Foundation (founded by former US President Bill Clinton) and is basically an alliance among leading US insurance companies and other big corporations.

Here is what the initiative offers:

• comprehensive health benefits to children, including coverage for treatment and management of obesity
• reimbursements for doctors and dieticians for following up children with obesity problems
• educational campaigns about childhood obesity

Initially in its first year, the alliance will cover 1 million children all over the US. The coverage will be expanded to 25% of all overweight (about 6.2 million) children.

Some of the insurers who signed up for the initiative are

• Aetna
• Blue Cross
• Blue Shield of North Carolina
• Blue Cross Blue Shield of Massachusetts
• WellPoint.

The battle against obesity -especially childhood obesity - is far from over but as long as we fight this together, we will surely win.

 

Video: http://www.youtube.com/watch?v=5IulTLCWriw

               

Reconstruction After Breast Cancer - No Good Choices

An article in my local newspaper makes me wake up and take notice of a real problem for women who, after breast cancer surgeries, wish to have their breast(s) reconstructed.

Mind you — we aren’t talking about breast enhancement surgery. No discussion of “boob jobs” here.

We’re talking about women who have had their breasts removed to remove cancerous cells, and who simply want to have additional surgery to reclaim as much of their femininity as they think they need to feel “whole.”

(Men — if you have trouble with this — picture losing your most manly appendage to cancer. Would you want a reasonable facsimile to replace it?)

In the United States, by federal law, a woman has a right to ask for reconstruction, and, by law, her insurance must pay for it. Sort of. Even Medicare or Medicaid must pay for it. Sort of.

The problem is, like with any medical service or procedure, these companies tell the physicians and surgeons what they will pay them, without regard to what those physicians and surgeons charge.

Think of that this way: it would be like you telling your auto mechanic what you will pay for repairs on your car, without regard to what your auto mechanic charges. Sounds like a great idea, right?

But — the problem is that at a certain price, your auto mechanic would just refuse. If you didn’t offer enough money, and if someone else offered more, then your mechanic would do the work for the person who was going to pay him more. That’s his choice.

And that’s how plastic surgeons, the ones who do breast reconstruction, look at it, too. Depending on how much cancerous breast tissue needs to be removed, the reconstruction surgery can take 5 to 11 hours. On average across the US, plastic surgeons charge $9300 per breast. Medicare and Medicaid reimburse at only $600. Is it any wonder that plastic surgeons won’t take breast reconstruction cases?

Even private insurance only reimburses a maximum of 80 percent — meaning — if both a woman’s breasts need reconstruction, then it will cost her more $5000 or more (don’t forget — the surgeon’s fee is only part of the cost. She must still pay for the hospital stay, meds, and all the other aspects.)

And some plastic surgeons will not work with private insurers either. If a woman wants the additional surgery, she needs to pay out of her pocket first ($18,600!) — and hope to get reimbursed by her own insurance later.

Of course, this becomes a very easy way to divide the haves from the have-nots…. and it made me wonder what would happen if we had a national health plan. Would it solve the problem?

Yes and no.

I looked to Canada’s national health coverage to see what the situation is there for women who want reconstruction surgery. From what I can learn, all Canadian women who choose reconstruction post breast cancer surgery can have it. It costs them nothing beyond what they are already paying into the system through their taxes — BUT — they have to wait up to two years before they get their “turn.”

And I believe the Canadian “haves” — the women who prefer to have the surgery immediately — are coming to the US to pay to have it done. Which, of course, means that those American plastic surgeons don’t have time to reconstruct the breasts of the have-nots in the US. They are busy being paid in cash by our Canadian counterparts.

The answers? No easy ones. No good choices. We Americans need to ask ourselves… is it better to pay cash and have the surgery immediately? Or is it better to wait for awhile and have it taken care of for us?

Or do we even have choices at all? I know I couldn’t afford it. Can you?

               

Medicare Made Simple

In battling healthcare issues in general and Alzheimer’s disease specifically, it’s important to know and understand Medicare and/or your private insurance coverage. 

What is Medicare?  Medicare is a government program that provides healthcare insurance coverage for Americans who are 65 years of age and older.

Medicare, like most insurance, does not pay 100% of medical costs. 

Medicare pays about 50% of medical costs for seniors.

In general, Medicare pays for: 

• Hospitalization, doctors, some nursing care, some prescription drugs, and medical equipment and supplies.

Medicare has four main parts: A, B, C & D

• Part A includes coverage for hospitalization, some skilled nursing facility/home health care, and hospice (someone has called hospice, the best kept secret in Medicare.  I am planning a series of posts on this important coverage)
• Part B includes coverage for doctor’s services and outpatient care including: X-rays, lab work, physical and occupational therapy, some home health care and some preventive screenings.
• Part C (sometimes called Medicare Advantage) is Medicare received via an HMO (Health Maintenance Organization), which is a privately managed care system.  Coverage can also be received through a PPO (Preferred Provider Organization). 
  • The important aspect of this plan is that it includes all of the benefits of Parts A and B as well as some additional coverage from the private plan.
  • The caveat of this plan is that it limits WHERE and HOW members receive care
• Part D consists of private insurance plans that partially cover prescription drug costs.

Who is Eligible

In short, citizens or permanent residents of the United States who are 65 years of age or older qualify for basic Medicare benefits.

Eligibility for Part B coverage-All United States citizens and legal residents over 65 years old are eligible.  If, however, a person has been receiving Social Security disability for two years OR has a chronic kidney disease, they may also be eligible. 

How Do You Enroll for Medicare?

Parts A and B

If a person is receiving Social Security benefits of any kind, they will be automatically enrolled in Parts A and B. They should receive Medicare enrollment cards and information in the mail three or so months prior to their 65^th birthday.

If it doesn’t happen automatically, then you can go to the local Social Security office and sign up.

You can also go to the Medicare site and complete the online enrollment form.

Parts C and D

These are optional coverages and enrollment is handled via the specific HMO or PPO that they want to be enrolled in.

Here are a few resources to help you along the way as you deal with Medicare information gathering and enrollment.

http://www.medicare.gov/

http://www.ssa.gov/mediinfo.htm

http://www.medicare.org/

http://www.caring.com/ (click on medicare)

Information for this post was gathered from the above links and my personal experiences.

               

Future Planning for a Loved One With Alzheimer’s Disease

By J. Trevey

If you have a loved one who has recently been diagnosed with Alzheimer’s disease, you may initially be filled with questions about what the diagnosis means for your family. If you have spoken with the doctor and performed your own research about Alzheimer’s disease, you have likely realized that the diagnosis will undoubtedly bring about some changes in the lifestyle of your loved one. Your loved one will need more care and support as time goes on, not to mention the financial implications of medical visits and eventual fulltime care. Though you may be faced with a barrage of emotions at first, it is important to remember that you are in the company of millions of other people in the same situation, as made evident by the plethora of organizations, support groups and associations that exist to help people like you understand and respond to the symptoms of Alzheimer’s disease.

Besides educating yourself about Alzheimer’s disease, it may also be beneficial to begin planning for the future now, while your loved one is the most independent and able to provide input about decisions affecting his or her future. Creating a plan for your loved one’s medical and other care expenses and establishing how decisions will be made on his or her behalf in the future can help ensure that your loved one has access to proper care and prevent you from encountering a gray area that leaves your hands tied in the future.

Arranging for healthcare is an important stage of planning for your loved one’s future. Establishing a situation in which long term medical care is available and affordable can benefit anyone, but is especially important for people with a long term illness such as Alzheimer’s disease. If your loved one currently has a long term care insurance policy, carefully read over the policy as it relates to progressive or long term illnesses. Clarify with the provider any portion of the policy about which you or your loved one have questions. If your loved one is uninsured, you may consider the possibility of obtaining the best policy that is affordable, paying particular attention to the coverage of medical care for long term illness outlined by the policy.

If your loved one is over the age of 65, he or she should qualify for Medicare, a federal health insurance program that covers some hospital, medical and prescription expenses. You may want to investigate your loved one’s eligibility for Social Security and Medicaid benefits as well to ensure that he or she receives the maximum assistance for which he or she qualifies.

The progressive nature of Alzheimer’s disease results in a decreasing decision-making ability over time. For this reason, it is important to discuss financial planning with your loved one as early as possible, and establish how and by whom he or she would like financial decisions to be handled. The procedure through which future financial, medical and other decisions will be made on behalf of the patient can be officially established by a document called a power of attorney. A power of attorney, often a component of a person’s estate plan, gives an appointed person or organization the authority to make decisions on behalf of your loved one when he or she is no longer able to do so. Talk to a trusted lawyer about the type of power of attorney that is appropriate for your individual situation.

Planning for the future is an important step in caring for your loved one with Alzheimer’s disease. Taking the initiative now to plan for future financial, medical and decision making needs will provide numerous benefits to yourself and your loved one moving forward.

About the Author: John Trevey is the manager of The Breckinridge, a Kentucky assisted living home specializing in Alzheimer’s care. For more information, please visit www.thebreckinridge.com

Article Source: EzineArticles.com/?expert=J._Trevey