For those hoping state leaders will find a way to help pare down the number of uninsured Georgians, the doctors are in.
Whether their diagnoses and cures are the right ones depends on who you listen to. Among the major proposals in front of lawmakers is a move by Gov. Sonny Perdue to embrace high-deductible health care plans and accompanying health savings accounts. Also getting attention is a pair of proposals from Lt. Gov. Casey Cagle, one that would give a financial boost to free clinics and another that would provide more information to health-care consumers. Rounding out the bunch is a proposal by Insurance and Safety Fire Commissioner John Oxendine to force health insurance companies to get his approval before they can raise premiums.
Critics question how valuable some of those free-market ideas might be and focus on efforts to expand what they see as tried-and-true government programs, such as the joint state-federal Medicaid health insurance plan for lower-income Georgians.
All of the ideas are aimed at trying to get at least some of an estimated 1.7 million uninsured Georgians onto an insurance plan, or to at least tame costs so they can afford one if they choose.
Though legislative leaders haven't necessarily rallied behind a single idea yet, some are just happy the issue is being mentioned.
"We're just elated that this is on the table to figure out how to start addressing this," said Jimmy Lewis, the CEO of HomeTown Health, an organization of small and rural hospitals.
THE CHEAPEST PRODUCT ON THE MARKET
Mr. Perdue's major initiative is an effort to promote high-deductible health-care plans. Those plans don't provide as much coverage of routine visits to the doctor or other small medical costs. Instead, patients have to pay a more sizable deductible than under other plans, one usually met only because of a long-term illness or a major accident.
In return, they pay less in monthly premiums than for more traditional and comprehensive coverage.
Supporters say the high-deductible plans often bring in many workers who would otherwise be unable to afford health insurance.
"This will be the cheapest product on the market," said Rep. Mickey Channell, R-Greensboro, a key legislative voice on health-care issues and a sponsor of the House version of Mr. Perdue's proposal.
The governor's idea, which Mr. Oxendine has recently said was largely taken from his previous proposals, would exempt premium payments for the high-deductible plans from the state's premium tax and allow Georgians to claim the payments as deductions on their state income taxes if they're not already doing so on their federal taxes.
And it would change state laws that some read as barring rewards for healthy behaviors that many high-deductible plans use to help members build up their health savings accounts.
Those accounts allow members to save the money they need to cover the small-ticket medical costs until they reach the deductible.
Critics aren't sure the plans will work.
"The problem is that they don't really address the bulk of the uninsured population," said Timothy Sweeney, a senior health-care analyst at the private Georgia Budget and Policy Institute, which advocates more funding for social programs.
Even the high-deductible programs are financially out of reach for many lower-income families trying to find health care, critics say, and some who could already pay for insurance but don't because of the current high prices.
"A certain number of people might be able to get insurance," said Alan Essig, the institute's executive director. "But then there's a question of whether they could have afforded it anyway."
Mr. Channell counters that 30 percent to 35 percent of those who sign up for the plans nationwide are uninsured when they do so.
OTHER IDEAS
Both of Mr. Cagle's ideas seem to enjoy fairly broad support among those who follow health-care issues. One proposal would give grants of up to $30,000 toward planning a free clinic and up to $150,000 for existing clinics that work with lower-income patients.
The idea is that those clinics could provide some of the less-urgent and preventative care that would keep uninsured patients out of the emergency room, where the cost of care is far higher.
Mr. Sweeney cautions against seeing the clinics as a cure.
"Free care at a clinic certainly does not replace health insurance," he said.
A separate measure by Mr. Channell would give doctors a $25-an-hour tax credit for working at one of the clinics.
Mr. Cagle would also create a Georgia Health Marketplace, which would help consumers shop around for various health-care options.
Mr. Sweeney and Mr. Essig argue that the state might already have the best solution for its uninsured residents: Medicaid. Raising the eligibility rate could bring thousands of new people into the system, with the federal government picking up 60 percent of the costs.
"That may be a more effective way of enrolling people, getting people health care, than some of the more individual ways that we're talking about now," Mr. Essig said.
Some say there are problems with that approach. Expanding Medicaid would be expensive -- even with federal help -- and would likely rankle some of the free-market conservatives in the GOP-controlled Legislature. Mr. Channell said he thinks it is unlikely to pass.
Mr. Lewis of HomeTown Health said expanding Medicaid would exacerbate another problem. Hospitals now complain that they lose 15 cents for every dollar they spend treating Medicaid patients because of low reimbursement rates.
"It would just accelerate the demise of a number of providers and force them out of business," he said.
Thursday, May 1, 2008
Tuesday, April 29, 2008
You're sick, They're quick
You're sick. They're quick.
That's the big idea behind putting small health clinics inside retail stores ranging from Wal-Mart to H-E-B.
And with more than half of walk-in clinic patients saying they will return again because of extended hours and short wait times, the battle for customers with minor ailments, such as strep throat, earaches and bladder infections, is heating up in Houston.
By year's end, the number of so-called "convenient care" clinics located inside drug stores and supermarkets is set to double in the area.
This week, CVS and Walgreen Co. announced they would each install eight in-store clinics around town by the end of 2007. RediClinic, the Houston-based outfit funded in part by AOL co-founder Steve Case, is adding three more locations inside H-E-B grocery stores by Thanksgiving.
"It's for busy people. We're not here to take the place of a primary-care physician, but sometimes people call a doctor and cannot get in for two or three days. They need fast treatment so they can get back to work," said Marcy Sawyer, manager of Houston operations for CVS's MinuteClinic concept.
The four MinuteClinics that opened in Spring, Pearland and Missouri City this week give the chain 320 locations in 24 states.
How fast is MinuteClinic multiplying? Two months ago there were only 200 locations. Within three months there will be 400 across the U.S.
MinuteClinic CEO Michael Howe can see a time when 2,500 MinuteClinics in CVS stores will blanket the nation.
No appointments
Wal-Mart CEO Lee Scott has a similar vision for his stores. Last spring he announced his intention to roll out 2,000 in-store clinics over five to seven years.
Typically, clinics of this sort don't take appointments, stay open late, offer weekend hours and are geared toward sinus infections and pink eye, not broken bones or heart failure. A menu posted in the clinic lists all services and price transparency for those paying in cash.
But it's insurance companies that are driving the expansion of in-store clinics as much as consumer demand.
Two short years ago, most store-based clinics catered to a cash-only crowd. Today, 80 percent of MinuteClinic's visits are from people with health insurance, Howe said.
A recent study by Forrester Research showed only 3 percent of people surveyed have used store-based health clinics, but that group tended to be younger, more affluent and had children.
"Moms want a place to get their kids treatment fast. They don't want to wait around in a doctor's office for something minor," said Sawyer, a nurse practitioner who used to work in private practice.
The clinics in Walgreens, CVS and H-E-B all have contracts with major insurers such as Cigna, Humana, United Healthcare and Aetna. Medicare has also signed on. While the typical walk-in visit runs around $60 out of pocket, those with insurance frequently get a discount. The clinics say they bring affordable care to the uninsured.
Oppostion lines up
But many doctors see drawbacks, even though some medical professionals view the clinics as an essential relief valve on overburdened emergency rooms that end up practicing primary care.
The American Medical Association has sounded the alarm over the cozy nature that exists between some clinics and some insurance companies.
In Minnesota and Alabama, Blue Cross/Blue Shield and other providers lowered — and in some cases waived entirely — copayments for insured workers who sought primary care from a store-based clinic instead of a regular doctor's office. The AMA is lobbying to have that practice outlawed.
The group has also questioned the clinics' underlying business model of using nurse practitioners and physician assistants to prescribe medication. Those prescriptions then get filled just a few feet away at the pharmacy counter.
The AMA calls it a conflict of interest. The industry calls it synergy.
MinuteClinic's Howe says he understands consumers' obsessions with speed and affordablity. (He used to be CEO of Arby's.) Howe also takes issue with critics who imply clinics abuse prescriptions to gin up a store's sales numbers.
"We don't get many complaints — six for every 10,000 visits — and most of those are because the nurse practitioner wouldn't write a prescription," he said, adding MinuteClinic's personnel encourage everybody to get established with a primary care physician in case more complicated health matters arise.
Traditional Urgent Care vs the Retail Clinic
Traditional Urgent or Immediate Care Centers are just as quick, and just as inexpensive, but they have a huge advantage over retail clinics for the consumer because they are staffed by board certified physicians, and have an on site lab, and X-Ray which means they can treat a wider rangle of symptoms much more effectively. remember, there is no substitute for seeing a board ceritfied physician.
That's the big idea behind putting small health clinics inside retail stores ranging from Wal-Mart to H-E-B.
And with more than half of walk-in clinic patients saying they will return again because of extended hours and short wait times, the battle for customers with minor ailments, such as strep throat, earaches and bladder infections, is heating up in Houston.
By year's end, the number of so-called "convenient care" clinics located inside drug stores and supermarkets is set to double in the area.
This week, CVS and Walgreen Co. announced they would each install eight in-store clinics around town by the end of 2007. RediClinic, the Houston-based outfit funded in part by AOL co-founder Steve Case, is adding three more locations inside H-E-B grocery stores by Thanksgiving.
"It's for busy people. We're not here to take the place of a primary-care physician, but sometimes people call a doctor and cannot get in for two or three days. They need fast treatment so they can get back to work," said Marcy Sawyer, manager of Houston operations for CVS's MinuteClinic concept.
The four MinuteClinics that opened in Spring, Pearland and Missouri City this week give the chain 320 locations in 24 states.
How fast is MinuteClinic multiplying? Two months ago there were only 200 locations. Within three months there will be 400 across the U.S.
MinuteClinic CEO Michael Howe can see a time when 2,500 MinuteClinics in CVS stores will blanket the nation.
No appointments
Wal-Mart CEO Lee Scott has a similar vision for his stores. Last spring he announced his intention to roll out 2,000 in-store clinics over five to seven years.
Typically, clinics of this sort don't take appointments, stay open late, offer weekend hours and are geared toward sinus infections and pink eye, not broken bones or heart failure. A menu posted in the clinic lists all services and price transparency for those paying in cash.
But it's insurance companies that are driving the expansion of in-store clinics as much as consumer demand.
Two short years ago, most store-based clinics catered to a cash-only crowd. Today, 80 percent of MinuteClinic's visits are from people with health insurance, Howe said.
A recent study by Forrester Research showed only 3 percent of people surveyed have used store-based health clinics, but that group tended to be younger, more affluent and had children.
"Moms want a place to get their kids treatment fast. They don't want to wait around in a doctor's office for something minor," said Sawyer, a nurse practitioner who used to work in private practice.
The clinics in Walgreens, CVS and H-E-B all have contracts with major insurers such as Cigna, Humana, United Healthcare and Aetna. Medicare has also signed on. While the typical walk-in visit runs around $60 out of pocket, those with insurance frequently get a discount. The clinics say they bring affordable care to the uninsured.
Oppostion lines up
But many doctors see drawbacks, even though some medical professionals view the clinics as an essential relief valve on overburdened emergency rooms that end up practicing primary care.
The American Medical Association has sounded the alarm over the cozy nature that exists between some clinics and some insurance companies.
In Minnesota and Alabama, Blue Cross/Blue Shield and other providers lowered — and in some cases waived entirely — copayments for insured workers who sought primary care from a store-based clinic instead of a regular doctor's office. The AMA is lobbying to have that practice outlawed.
The group has also questioned the clinics' underlying business model of using nurse practitioners and physician assistants to prescribe medication. Those prescriptions then get filled just a few feet away at the pharmacy counter.
The AMA calls it a conflict of interest. The industry calls it synergy.
MinuteClinic's Howe says he understands consumers' obsessions with speed and affordablity. (He used to be CEO of Arby's.) Howe also takes issue with critics who imply clinics abuse prescriptions to gin up a store's sales numbers.
"We don't get many complaints — six for every 10,000 visits — and most of those are because the nurse practitioner wouldn't write a prescription," he said, adding MinuteClinic's personnel encourage everybody to get established with a primary care physician in case more complicated health matters arise.
Traditional Urgent Care vs the Retail Clinic
Traditional Urgent or Immediate Care Centers are just as quick, and just as inexpensive, but they have a huge advantage over retail clinics for the consumer because they are staffed by board certified physicians, and have an on site lab, and X-Ray which means they can treat a wider rangle of symptoms much more effectively. remember, there is no substitute for seeing a board ceritfied physician.
Monday, April 28, 2008
Walk in Care Expanding to Airports
Reluctant to deal with the hassles of airport security, sales executive Michael D'Souza generally packs the syringes he needs for his daily medication in a bag that he checks when he travels.
The strategy backfired for the Toronto resident recently when he needed the medication while he was stuck during a four-hour delay at Newark Liberty. D'Souza found new needles when an airport customer service rep told him about a pharmacy that opened late last year in Terminal C.
"I don't think I've ever seen a pharmacy at an airport," he says. "But I thought: What a good idea. People are traveling sick all the time."
Last-Minute Prescriptions
Pharmacies and walk-in health clinics are opening at more airports in the U.S., hoping to capture a sizable portion of travelers and airport employees who want access to basic primary healthcare and to fill their prescriptions at the last minute.
Such facilities are common at large foreign airports, but domestic airports have mostly focused on services that cater to travelers' immediate needs. Several entrepreneurs are betting that there's pent-up demand for such services at airports in the U.S.
While similar to primary care physician offices, walk-in clinics generally focus on a limited range of medical services and medications. Nurse practitioners typically deliver the services.
Harmony Pharmacy, which launched at Newark Liberty late last year, will open another airport shop at the much-anticipated JetBlue Terminal 5 at New York's John F. Kennedy airport in September.
AeroClinic, which runs a walk-in clinic at Hartsfield-Jackson Atlanta, will open its second branch at Philadelphia International in the spring.
Solantic, which operates walk-in clinics at several Wal-Marts, will expand into the airport market by opening at Orlando International later this year. Atlanta-based AirportMD opens its first store in Miami next month, followed by another in Minneapolis in the fall.
"Airports lend themselves as an ideal market for retail-based care because [there are] a lot of people in between flights or who have downtime," says Tine Hansen-Turton, executive director of the Convenient Care Association, a trade group for retail walk-in clinics. "You also have employers who have hours not conducive to going to primary care providers."
Several factors are driving the trend:
Greater marketing emphasis. Airports are increasingly looking for non-aviation revenue to offset discounts and promotions given to airlines to court new flights. As a result, a greater array of services and retail shops that consumers normally don't associate with flying are starting to appear between gates, including health and wellness services.
Longer waiting time. Airports have always been a potentially attractive market, says Rosemary Kelly, marketing executive of AeroClinic. About 1.2 billion people traveled through the top 20 airports last year, not including the 500,000 employees who work there. "It's the largest consumer venue anywhere in the world," she says.
With more stringent security, fliers are arriving earlier, which gives them time to receive basic health services that wouldn't otherwise be feasible.
Growth of the retail clinics industry
Airports are a new market for an already fast-growing industry. According to the Convenient Care Association, there are about 950 clinics in the U.S., and more than 500 more will open by the end of this year. Many of them are at strip malls or in big-box drugstores, but transportation hubs are seen as an attractive growth market, says Hansen-Turton.
Menu Pricing
AeroClinic says its shop at Atlanta Hartsfield focuses on 30 of the most common requests among travelers. They include ear infections, stomachaches, flu shots, antibiotics, asthma inhalers and heart medication. It also offers some preventive care for people who have more time, including diabetes monitoring, cholesterol checking and drug testing.
While they take most insurance policies, including Medicare, a distinct feature of walk-in clinics is the menu pricing rare in other doctors' offices or hospitals. At Solantic, most services fall into one of three categories.
The Level 1 category -- seeing a nurse practitioner and getting a prescription -- costs US$59.
Level 2 service -- more complicated procedures, such as strep tests, EKG (electrocardiogram) or injections -- costs $109.
Level 3 procedures -- such as stitches and X-rays -- are $169.
Harmony Pharmacy has a narrower focus on pharmaceutical products, though it has some basic primary care services delivered by nurse practitioners. It specializes in filling prescriptions and selling sundries and other travel products. It has about 1,100 types of prescription drugs, says Ken Corroon, Harmony's CEO. "People go on vacation, and they forget their heart medication or Viagra. People have varying needs."
The strategy backfired for the Toronto resident recently when he needed the medication while he was stuck during a four-hour delay at Newark Liberty. D'Souza found new needles when an airport customer service rep told him about a pharmacy that opened late last year in Terminal C.
"I don't think I've ever seen a pharmacy at an airport," he says. "But I thought: What a good idea. People are traveling sick all the time."
Last-Minute Prescriptions
Pharmacies and walk-in health clinics are opening at more airports in the U.S., hoping to capture a sizable portion of travelers and airport employees who want access to basic primary healthcare and to fill their prescriptions at the last minute.
Such facilities are common at large foreign airports, but domestic airports have mostly focused on services that cater to travelers' immediate needs. Several entrepreneurs are betting that there's pent-up demand for such services at airports in the U.S.
While similar to primary care physician offices, walk-in clinics generally focus on a limited range of medical services and medications. Nurse practitioners typically deliver the services.
Harmony Pharmacy, which launched at Newark Liberty late last year, will open another airport shop at the much-anticipated JetBlue Terminal 5 at New York's John F. Kennedy airport in September.
AeroClinic, which runs a walk-in clinic at Hartsfield-Jackson Atlanta, will open its second branch at Philadelphia International in the spring.
Solantic, which operates walk-in clinics at several Wal-Marts, will expand into the airport market by opening at Orlando International later this year. Atlanta-based AirportMD opens its first store in Miami next month, followed by another in Minneapolis in the fall.
"Airports lend themselves as an ideal market for retail-based care because [there are] a lot of people in between flights or who have downtime," says Tine Hansen-Turton, executive director of the Convenient Care Association, a trade group for retail walk-in clinics. "You also have employers who have hours not conducive to going to primary care providers."
Several factors are driving the trend:
Greater marketing emphasis. Airports are increasingly looking for non-aviation revenue to offset discounts and promotions given to airlines to court new flights. As a result, a greater array of services and retail shops that consumers normally don't associate with flying are starting to appear between gates, including health and wellness services.
Longer waiting time. Airports have always been a potentially attractive market, says Rosemary Kelly, marketing executive of AeroClinic. About 1.2 billion people traveled through the top 20 airports last year, not including the 500,000 employees who work there. "It's the largest consumer venue anywhere in the world," she says.
With more stringent security, fliers are arriving earlier, which gives them time to receive basic health services that wouldn't otherwise be feasible.
Growth of the retail clinics industry
Airports are a new market for an already fast-growing industry. According to the Convenient Care Association, there are about 950 clinics in the U.S., and more than 500 more will open by the end of this year. Many of them are at strip malls or in big-box drugstores, but transportation hubs are seen as an attractive growth market, says Hansen-Turton.
Menu Pricing
AeroClinic says its shop at Atlanta Hartsfield focuses on 30 of the most common requests among travelers. They include ear infections, stomachaches, flu shots, antibiotics, asthma inhalers and heart medication. It also offers some preventive care for people who have more time, including diabetes monitoring, cholesterol checking and drug testing.
While they take most insurance policies, including Medicare, a distinct feature of walk-in clinics is the menu pricing rare in other doctors' offices or hospitals. At Solantic, most services fall into one of three categories.
The Level 1 category -- seeing a nurse practitioner and getting a prescription -- costs US$59.
Level 2 service -- more complicated procedures, such as strep tests, EKG (electrocardiogram) or injections -- costs $109.
Level 3 procedures -- such as stitches and X-rays -- are $169.
Harmony Pharmacy has a narrower focus on pharmaceutical products, though it has some basic primary care services delivered by nurse practitioners. It specializes in filling prescriptions and selling sundries and other travel products. It has about 1,100 types of prescription drugs, says Ken Corroon, Harmony's CEO. "People go on vacation, and they forget their heart medication or Viagra. People have varying needs."
Sunday, April 27, 2008
Politics and Health Care
Democratic lawmakers in Washington say they're drafting a health care reform bill that would expand coverage for low-income kids. President Bush says he'll veto any such legislation, warning that it would lead the nation "down the path to government-run health care for every American."
Like that would be a bad thing.
What's particularly galling about Bush's position is that it's coming from a man who just underwent a colonoscopy performed at the taxpayer-funded, state-of-the-art medical facility at Camp David by an elite team of doctors from the taxpayer-funded National Naval Medical Center in Bethesda, Md.
If anyone understands the benefits of government-run health care, it's the president.
But let's not get sidetracked. Bush wasn't being entirely accurate when he derided the notion of government-run health care for every American. That might make for a fine little sound bite, especially among those who fear the specter of "socialized medicine," but it's not really what's at stake.
Rather, advocates of health care reform are seeking government-run insurance for every American, leaving the health care part to those who know best - doctors and nurses.
This is a crucial distinction at a time when 47 million Americans lack medical coverage and, according to researchers at Harvard University, about a third of the $2 trillion spent annually on health care in this country is squandered on bureaucratic overhead.
"Cuba is socialized medicine," observed Dr. Kevin Grumbach, who heads the Department of Family and Community Medicine at UCSF. "The government employs all the physicians and owns all the hospitals. That's not what anyone is talking about for this country."
Rather, the focus here is on two indisputable facts: that the United States spends about twice as much per person on health care as most other industrialized democracies, and that Americans on average do not live as long as people in countries that guarantee medical coverage to their citizens.
"Why have all other countries figured out a way to do this?" Grumbach asked. "Why are we the only ones that are so uncivilized?"
The United States spent an average of $6,102 per person on health care in 2004 (the latest year for which figures are available), according to the Organization for Economic Cooperation and Development.
Canada spent $3,165 per person, France $3,159, Australia $3,120 and Britain a mere $2,508. Life expectancy in the United States was lower than in each of these other countries and infant mortality was higher.
Looking at the numbers another way, the Kaiser Family Foundation determined earlier this year that health care spending accounts for 15.2 percent of the U.S. economy.
By contrast, health care spending represents 9.9 percent of Canada's gross domestic product, 10.4 percent of France's, 9.2 percent of Australia's and just 7.8 percent of Britain's.
And again, the citizens of these countries on average live longer than we do.
In Washington, Democratic lawmakers are crafting legislation to expand the State Children's Health Insurance Program, which subsidizes insurance for low-income kids.
The Senate Finance Committee last week approved a five-year plan to increase funding for the program through a 61-cents-per-pack increase in the federal cigarette tax. This would maintain coverage for 6.6 million recipients while adding 3.2 million uninsured kids to the system.
Bush told an audience in Nashville last week that the Senate bill is "the beginning salvo of the encroachment of the federal government on the health care system." He said he'd veto any such legislation making its way to his desk.
That's a fine how-do-you-do for a guy who had five growths removed from his colon on Saturday largely at the government's expense and had them promptly examined by government experts at the government-run National Naval Medical Center.
Happily, the tests showed no sign of cancer. So Bush can rest easy for another few years, thanks to all that government health care.
No one at the White House could be reached to discuss how much the president paid out of his own pocket for the colonoscopy and subsequent testing.
Presidents typically have their own health insurance, although the first-class treatment they receive is largely defrayed by taxpayer funds. In other words, they're prime beneficiaries of government-run health care - just like in Cuba.
In a paper found on the Web site of the Defense Department's Armed Forces Institute of Pathology, former White House physician George Fuller outlines the mission of the taxpayer-funded White House Medical Unit.
He writes that a primary purpose of the group is to provide "confidential, immediate and private access to preventive, routine and urgent care for the principals." This, Fuller adds, "is a 24-hour, seven-days-a-week commitment with no exceptions."
The quality of health care is so exacting, he observes, "that the president cannot even ride an elevator in the Eisenhower Executive Office Building without a physician escort."
According to Fuller, the president enjoys the benefits of medical and dental clinics in the White House, as well as "a fully equipped and supplied outpatient clinic" at Camp David, where Bush's colon was explored.
He says the White House Medical Unit also "keeps a unique and extensive library of medical facilities throughout the world" to provide for the president's health care needs during overseas travel.
All in all, Bush is the last person with a right to complain about government-run health care for every American. We should all be so lucky.
Like that would be a bad thing.
What's particularly galling about Bush's position is that it's coming from a man who just underwent a colonoscopy performed at the taxpayer-funded, state-of-the-art medical facility at Camp David by an elite team of doctors from the taxpayer-funded National Naval Medical Center in Bethesda, Md.
If anyone understands the benefits of government-run health care, it's the president.
But let's not get sidetracked. Bush wasn't being entirely accurate when he derided the notion of government-run health care for every American. That might make for a fine little sound bite, especially among those who fear the specter of "socialized medicine," but it's not really what's at stake.
Rather, advocates of health care reform are seeking government-run insurance for every American, leaving the health care part to those who know best - doctors and nurses.
This is a crucial distinction at a time when 47 million Americans lack medical coverage and, according to researchers at Harvard University, about a third of the $2 trillion spent annually on health care in this country is squandered on bureaucratic overhead.
"Cuba is socialized medicine," observed Dr. Kevin Grumbach, who heads the Department of Family and Community Medicine at UCSF. "The government employs all the physicians and owns all the hospitals. That's not what anyone is talking about for this country."
Rather, the focus here is on two indisputable facts: that the United States spends about twice as much per person on health care as most other industrialized democracies, and that Americans on average do not live as long as people in countries that guarantee medical coverage to their citizens.
"Why have all other countries figured out a way to do this?" Grumbach asked. "Why are we the only ones that are so uncivilized?"
The United States spent an average of $6,102 per person on health care in 2004 (the latest year for which figures are available), according to the Organization for Economic Cooperation and Development.
Canada spent $3,165 per person, France $3,159, Australia $3,120 and Britain a mere $2,508. Life expectancy in the United States was lower than in each of these other countries and infant mortality was higher.
Looking at the numbers another way, the Kaiser Family Foundation determined earlier this year that health care spending accounts for 15.2 percent of the U.S. economy.
By contrast, health care spending represents 9.9 percent of Canada's gross domestic product, 10.4 percent of France's, 9.2 percent of Australia's and just 7.8 percent of Britain's.
And again, the citizens of these countries on average live longer than we do.
In Washington, Democratic lawmakers are crafting legislation to expand the State Children's Health Insurance Program, which subsidizes insurance for low-income kids.
The Senate Finance Committee last week approved a five-year plan to increase funding for the program through a 61-cents-per-pack increase in the federal cigarette tax. This would maintain coverage for 6.6 million recipients while adding 3.2 million uninsured kids to the system.
Bush told an audience in Nashville last week that the Senate bill is "the beginning salvo of the encroachment of the federal government on the health care system." He said he'd veto any such legislation making its way to his desk.
That's a fine how-do-you-do for a guy who had five growths removed from his colon on Saturday largely at the government's expense and had them promptly examined by government experts at the government-run National Naval Medical Center.
Happily, the tests showed no sign of cancer. So Bush can rest easy for another few years, thanks to all that government health care.
No one at the White House could be reached to discuss how much the president paid out of his own pocket for the colonoscopy and subsequent testing.
Presidents typically have their own health insurance, although the first-class treatment they receive is largely defrayed by taxpayer funds. In other words, they're prime beneficiaries of government-run health care - just like in Cuba.
In a paper found on the Web site of the Defense Department's Armed Forces Institute of Pathology, former White House physician George Fuller outlines the mission of the taxpayer-funded White House Medical Unit.
He writes that a primary purpose of the group is to provide "confidential, immediate and private access to preventive, routine and urgent care for the principals." This, Fuller adds, "is a 24-hour, seven-days-a-week commitment with no exceptions."
The quality of health care is so exacting, he observes, "that the president cannot even ride an elevator in the Eisenhower Executive Office Building without a physician escort."
According to Fuller, the president enjoys the benefits of medical and dental clinics in the White House, as well as "a fully equipped and supplied outpatient clinic" at Camp David, where Bush's colon was explored.
He says the White House Medical Unit also "keeps a unique and extensive library of medical facilities throughout the world" to provide for the president's health care needs during overseas travel.
All in all, Bush is the last person with a right to complain about government-run health care for every American. We should all be so lucky.
Saturday, April 26, 2008
Studying Your Urgent Care Options
You're enjoying a weekend getaway and wake up in your hotel room with a sore throat and high fever. You attend an out of town wedding and sprain your ankle on the dance floor. You're about to leave Disney and your child complains of ear pain. Where should you go for treatment?
Urgent care centers deliver ambulatory care in facilities outside of the hospital. They see people on a walk-in basis without an appointment. They are appropriate for people with an injury or illness that requires immediate care but is not necessarily serious enough to warrant an emergency room visit. Urgent care centers are not open 24 hours a day but their hours are more extended than a primary care physician and most have weekends and evenings hours.
Urgent care centers treat many problems generally covered in primary care physician's offices and also offer services that are generally not available such as X-rays. Some have minor trauma rooms to treat lacerations. They cost less than an emergency room visit and usually you can get in and out in less time.
Walk-in clinics, aka retail health clinics, provide a lower level of medical treatment but still may be effective depending on your needs. They are most often found in strip malls, drugstores and mega stores. Although not popular locally yet, Kiplinger reports they will experience brisk growth and expansion over the next few years. Both CVS and Walgreens have purchased retail clinic chains and have placed them in their stores in various parts of the country, and Wal-Mart is contracting with hospitals to open in-store clinics.
Walk-in clinics are generally open seven days a week and don't require an appointment. They are usually staffed by nurse practitioners or physician assistants. You will often find a price board for various services outside the clinic so you know the charges before you are seen. The clinics treat about 25 to 30 common ailments such as cold and flu, sinus, ear and bladder infections, pink eye, allergies, minor burns and rashes, sore throat and sprains. Some provide preventive care such as health screenings and vaccinations.
Clearly, if you are very sick you should see your doctor (if available), or go to an emergency room. Chest pain, abdominal pain, trouble breathing, high fever, deep tissue damage, acute weakness, severe burns and questionable broken bones are just some of the symptoms that probably warrant an emergency room visit. But, if it's less serious you might try an alternative.
Consider your symptoms and organize your medical plan when choosing what type of clinic to go to:
Urgent Care Centers can address more serious issues, have physicians to treat you, and most likely have X-ray facilities.
*Retail health clinics treat a limited number of common conditions.
*Check with your health insurer regarding coverage for urgent care and clinics.
*Clinics will not have your medical history so it is imperative that you can accurately articulate "the highlights" and detail any currently taken medications.
The American Academy of Pediatrics opposes the use of retail clinics as an ongoing source of medical care for children due to the inability to ensure continuity of care.
Urgent care centers deliver ambulatory care in facilities outside of the hospital. They see people on a walk-in basis without an appointment. They are appropriate for people with an injury or illness that requires immediate care but is not necessarily serious enough to warrant an emergency room visit. Urgent care centers are not open 24 hours a day but their hours are more extended than a primary care physician and most have weekends and evenings hours.
Urgent care centers treat many problems generally covered in primary care physician's offices and also offer services that are generally not available such as X-rays. Some have minor trauma rooms to treat lacerations. They cost less than an emergency room visit and usually you can get in and out in less time.
Walk-in clinics, aka retail health clinics, provide a lower level of medical treatment but still may be effective depending on your needs. They are most often found in strip malls, drugstores and mega stores. Although not popular locally yet, Kiplinger reports they will experience brisk growth and expansion over the next few years. Both CVS and Walgreens have purchased retail clinic chains and have placed them in their stores in various parts of the country, and Wal-Mart is contracting with hospitals to open in-store clinics.
Walk-in clinics are generally open seven days a week and don't require an appointment. They are usually staffed by nurse practitioners or physician assistants. You will often find a price board for various services outside the clinic so you know the charges before you are seen. The clinics treat about 25 to 30 common ailments such as cold and flu, sinus, ear and bladder infections, pink eye, allergies, minor burns and rashes, sore throat and sprains. Some provide preventive care such as health screenings and vaccinations.
Clearly, if you are very sick you should see your doctor (if available), or go to an emergency room. Chest pain, abdominal pain, trouble breathing, high fever, deep tissue damage, acute weakness, severe burns and questionable broken bones are just some of the symptoms that probably warrant an emergency room visit. But, if it's less serious you might try an alternative.
Consider your symptoms and organize your medical plan when choosing what type of clinic to go to:
Urgent Care Centers can address more serious issues, have physicians to treat you, and most likely have X-ray facilities.
*Retail health clinics treat a limited number of common conditions.
*Check with your health insurer regarding coverage for urgent care and clinics.
*Clinics will not have your medical history so it is imperative that you can accurately articulate "the highlights" and detail any currently taken medications.
The American Academy of Pediatrics opposes the use of retail clinics as an ongoing source of medical care for children due to the inability to ensure continuity of care.
Wednesday, April 23, 2008
Urgent Care Centers Popping up in the Midwest
New urgent care centers are popping up across the Midwest, mirroring a national trend and reaffirming patients' growing desire for convenience.
Healthy Trust Immediate Medical Care opened it's Wheeling, Illinois medical clinic in July or 2007. The aim of urgent care centers like healthy Trust Immediate Medical Care is to quickly treat patients who need immediate care but don't require the level of service provided at an emergency room. They're staffed by board certified physicians as well as other medical professionals. There's no need for an appointment, and most urgent care centers are open on weekends and evenings.
Patients with broken bones and earaches are prime candidates. Urgent care centers don't provide long-term management of chronic diseases, but they frequently have X-ray machines, laboratories and other features not found in most physicians' offices.
With many primary care doctors booking appointments weeks in advance and wait times of several hours at emergency rooms, the demand for urgent care centers is growing, experts said. Many insurers are helping drive the expansion by offering patients lower co-pays if they choose an urgent care center over an emergency room.
Urgent care centers like Healthy Trust, many of which were started by physicians' groups, first sprouted up in the early 1980s. Over the next 15 years, a decline occurred. Some of these centers went bankrupt, others were sold to hospitals and then closed. A resurgence began in the mid-1990s. There are between 12,000 and 20,000 of these centers nationwide, according to a 2004 report by the California Healthcare Foundation. A 2005 report in Emergency Medicine Review estimated as many as two new urgent care facilities open each week.
Dr. Boris Gurevich of Healthy Trust Immediate Medical Care points out that several of the urgent care centers locally are within a couple of miles of each other. "The question is how many of these centers will remain self supporting, how many will remain successful?"
Dr. Gurevich believes the centers that survive will provide the services of board certified physicians, and marketing which is directed toward helping the surrounding community get quality health care at an affordable price. he feels that retail clinics staffed by Nurse Practitioners without an onsite lab, and radiology have too narrow a diagnostic scope to survive long term.
Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.
Healthy Trust Immediate Medical Care opened it's Wheeling, Illinois medical clinic in July or 2007. The aim of urgent care centers like healthy Trust Immediate Medical Care is to quickly treat patients who need immediate care but don't require the level of service provided at an emergency room. They're staffed by board certified physicians as well as other medical professionals. There's no need for an appointment, and most urgent care centers are open on weekends and evenings.
Patients with broken bones and earaches are prime candidates. Urgent care centers don't provide long-term management of chronic diseases, but they frequently have X-ray machines, laboratories and other features not found in most physicians' offices.
With many primary care doctors booking appointments weeks in advance and wait times of several hours at emergency rooms, the demand for urgent care centers is growing, experts said. Many insurers are helping drive the expansion by offering patients lower co-pays if they choose an urgent care center over an emergency room.
Urgent care centers like Healthy Trust, many of which were started by physicians' groups, first sprouted up in the early 1980s. Over the next 15 years, a decline occurred. Some of these centers went bankrupt, others were sold to hospitals and then closed. A resurgence began in the mid-1990s. There are between 12,000 and 20,000 of these centers nationwide, according to a 2004 report by the California Healthcare Foundation. A 2005 report in Emergency Medicine Review estimated as many as two new urgent care facilities open each week.
Dr. Boris Gurevich of Healthy Trust Immediate Medical Care points out that several of the urgent care centers locally are within a couple of miles of each other. "The question is how many of these centers will remain self supporting, how many will remain successful?"
Dr. Gurevich believes the centers that survive will provide the services of board certified physicians, and marketing which is directed toward helping the surrounding community get quality health care at an affordable price. he feels that retail clinics staffed by Nurse Practitioners without an onsite lab, and radiology have too narrow a diagnostic scope to survive long term.
Healthy Trust Immediate Medical Care serves the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.
Monday, April 21, 2008
ER vs Urgent Care
A headache attack has brought you to the brink of seeking medical treatment. Do you visit the local emergency room (ER) or should you visit an urgent care facility (UC)? According to a recent online survey conducted by the National Headache Foundation (NHF), more sufferers visited an ER; however, headache sufferers might benefit by seeking treatment at a UC facility.
According to the NHF online survey, 68% of survey respondents have visited an emergency room for headache treatment. Forty-five percent of respondents stated that they visited the ER at least one to two times in the last year to treat their condition.
Headache sufferers were asked about the treatments they received in the ER and in the UC. The survey showed the following distinctions: With regard to wait time, 67% waited less than one hour in the UC versus 33% in the ER during that timeframe.
When asked if the medical provider was polite and respectful, 67% responded favorably about the UC compared to 54% about the ER.
Respondents were asked if the diagnosis was clearly explained to them, of which 58% answered positively for the UC and 38% for the ER. As far as whether the treatment they received was effective, 53% responded affirmatively for the UC against 36% for the ER. Fifty-five percent stated that the UC staff provided clear instructions about what to do if the headache returned, countering the 37% for the ER. The survey queried sufferers as to whether they were made to feel like a drug seeker, with 29% stating that they did not feel that way when treated in the UC, while 50% said they did feel that way in the ER. When polled about being placed in a quiet area, 76% said that was the case in the UC, while 60% answered the same for the ER.
In the case of being provided with a home care plan prior to leaving, 43% of survey participants received one from the UC, but only 17% were provided with such a plan from the ER.
When survey respondents were asked about their overall experience, 50% described their level of satisfaction in the UC as very good or good compared with 36% who visited the ER.
“While the ER is familiar to many people, headache sufferers are encouraged to consider their local urgent care facility the next time they require immediate headache treatment,” said Dr. Roger Cady, vice president of the National Headache Foundation.
In cooperation with the Urgent Care Association of America (www.ucaoa.org), a second survey was conducted of healthcare providers about their experiences treating headache patients in an urgent care setting. The results of this survey indicated that sufferers could help their own cause by following the prescribed treatment regimen.
According to this survey, 67% of headache patients have failed to properly use their home plan before seeking assistance at a UC facility, and 59% of those in need of preventive medication are not receiving them. The healthcare providers surveyed indicated that 85% of the people they see have been previously diagnosed by another physician. The most common headache with which patients present in the UC is migraine.
“This data indicates that when a primary physician is not available, an urgent care center provides effective treatment in a sensitive environment for many headache sufferers,” said David Stern, MD, board member, Urgent Care Association of America.
The National Headache Foundation, founded in 1970 is a nonprofit organization dedicated to serving headache sufferers, their families and the healthcare providers who treat them; promoting research into headache causes and treatments; and educating the public to the fact that headaches are a legitimate biological disease and that sufferers should receive understanding and continuity of care.
According to the NHF online survey, 68% of survey respondents have visited an emergency room for headache treatment. Forty-five percent of respondents stated that they visited the ER at least one to two times in the last year to treat their condition.
Headache sufferers were asked about the treatments they received in the ER and in the UC. The survey showed the following distinctions: With regard to wait time, 67% waited less than one hour in the UC versus 33% in the ER during that timeframe.
When asked if the medical provider was polite and respectful, 67% responded favorably about the UC compared to 54% about the ER.
Respondents were asked if the diagnosis was clearly explained to them, of which 58% answered positively for the UC and 38% for the ER. As far as whether the treatment they received was effective, 53% responded affirmatively for the UC against 36% for the ER. Fifty-five percent stated that the UC staff provided clear instructions about what to do if the headache returned, countering the 37% for the ER. The survey queried sufferers as to whether they were made to feel like a drug seeker, with 29% stating that they did not feel that way when treated in the UC, while 50% said they did feel that way in the ER. When polled about being placed in a quiet area, 76% said that was the case in the UC, while 60% answered the same for the ER.
In the case of being provided with a home care plan prior to leaving, 43% of survey participants received one from the UC, but only 17% were provided with such a plan from the ER.
When survey respondents were asked about their overall experience, 50% described their level of satisfaction in the UC as very good or good compared with 36% who visited the ER.
“While the ER is familiar to many people, headache sufferers are encouraged to consider their local urgent care facility the next time they require immediate headache treatment,” said Dr. Roger Cady, vice president of the National Headache Foundation.
In cooperation with the Urgent Care Association of America (www.ucaoa.org), a second survey was conducted of healthcare providers about their experiences treating headache patients in an urgent care setting. The results of this survey indicated that sufferers could help their own cause by following the prescribed treatment regimen.
According to this survey, 67% of headache patients have failed to properly use their home plan before seeking assistance at a UC facility, and 59% of those in need of preventive medication are not receiving them. The healthcare providers surveyed indicated that 85% of the people they see have been previously diagnosed by another physician. The most common headache with which patients present in the UC is migraine.
“This data indicates that when a primary physician is not available, an urgent care center provides effective treatment in a sensitive environment for many headache sufferers,” said David Stern, MD, board member, Urgent Care Association of America.
The National Headache Foundation, founded in 1970 is a nonprofit organization dedicated to serving headache sufferers, their families and the healthcare providers who treat them; promoting research into headache causes and treatments; and educating the public to the fact that headaches are a legitimate biological disease and that sufferers should receive understanding and continuity of care.
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