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Residency, salary, and primary care doctors – ctd. I wrote before that residency is already terrible, and reducing the pay to zero isn’t a good idea. I’m not arguing, however, that the primary care shortage isn’t a problem worth addressing. We don’t have enough primary care docs. We need more. I don’t think, however, that focusing on educational costs will change that I think that many physicians use educational costs as a defense to explain away their decision to choose specialty care over primary care. The blue bars are the median educational debt at graduation for various degrees and career paths.

A better question is why specialists make so much more, even in relationship to their debt. Does anyone think that there’s still not a huge monetary incentive for physicians to become specialists? I also think people trivialize the choice between primary care and specialty care. So if you want more primary care docs and less specialists, I think it’s a mistake to focus on educational costs. Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives. Pay-for-performance (P4P) initiatives have been discussed since the early 1990s, but support for the concept has grown recently, fueled by experience with quality of care measures, endorsements by key players and research that underlines the need for quality improvements and reform to the physician payment system.

This synthesis examines the evidence on P4P. Key findings include: About one-third of U.S. physicians already face quality-based incentives under their managed care contracts. These measures most often relate to clinical targets, efficiency, patient satisfaction and use of information technology, but apply to a limited set of specific diseases and preventive care services. While 80 percent of plans pay for meeting benchmarks, 20 percent pay for improvements in performance. Overall, incentive payments are small, averaging at most 5 percent of total payments. Medicare Part D’s Effect on Drug Use, Other Medical Services, and Health. Building the Case for Medicaid Reform - The Agenda. For those who haven’t had their fill of the Medicaid reform discussion, the full results of the UVa surgical outcomes study have been published in the online edition of Annals of Surgery.

(I ask everyone who has had their fill for forgiveness.) There are a couple of points that keep coming up in the comments and in responses from other bloggers, so I want to spend at least one post addressing them. Austin Frakt writes that, contrary to my expressions of concern, he is quite open-minded to the possibility that outcomes with Medicaid are poorer than those of the uninsured (and especially those with private insurance). He remains reasonably skeptical that studies like the Virginia one adequately control for the poor social and health status of the Medicaid population: There are undoubtedly studies that consider Medicaid vs. uninsured outcomes using the random variations provided by the natural experiment that is Medicaid.

The evidence of Medicaid’s problems is, in my view, overwhelming. Children's Health Insurance, Scarce and Expensive. The next shoe to drop in Obamacare involves providing health insurance for children from birth to age 18. As we have indicated in prior posts, some Georgia health insurance companies are no longer offering "child only" health insurance and at least one will no longer accept child only applications after 8/15/2010.

Now word comes that Blue Cross plans in two different states are taking a different approach. The Blues in Texas and Illinois have announced filing for approval of a new child only health insurance policy. No details on rates or benefits but the announcement to insurance agents in those states includes this comment. Blue Cross and Blue Shield of Illinois (BCBSIL) is committed to offering the broadest possible range of products for our members, as well as to maintaining its strong financial position. Translation, the premium rates for this plan will start high and get even higher the longer the plan is on the market. The Health Care Blog. The Impact of an Individual Health Insurance Mandate On Hospital and Preventive Care: Evidence from Massachusetts.

NBER Working Paper No. 16012Issued in May 2010NBER Program(s): AG HC In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health insurance coverage. A key provision of this legislation, and of the national legislation passed in March 2010, is an individual mandate to obtain health insurance. Although previous researchers have studied the impact of expansions in health insurance coverage among the indigent, children, and the elderly, the Massachusetts reform gives us a novel opportunity to examine the impact of expansion to near-universal health insurance coverage among the entire state population.

In this paper, we are the first to use hospital data to examine the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts. A non-technical summary of this paper is available in the November 2010 NBER digest. You can sign up to receive the NBER Digest by email. Acknowledgments. Actuaries: Folk Heroes or Evil Incarnate? « Business Risk Management. I’d like to take a moment on this late Friday afternoon to tell you a story. It’s about an actuary. Now, most people outside of the insurance industry probably don’t know what an actuary is or what an actuary does. An actuary is a professional statistician. Unlike the statisticians who work for Major League Baseball, actuaries are more concerned about the financial impact of risk and uncertainty. These are the guys that work for the insurance companies and calculate what your health insurance premiums are going to be based on your group’s demographics, health history (claims), plan design and the insurance company’s expectation of profit (<<<sorry, couldn’t resist a little joke).

So based on the above information, you’re probably thinking that these guys were put on earth to make your life miserable. This raised a couple of questions in my mind. Ironically, Anthem’s mistake was probably the reason that health care reform was able to succeed. Like this: Like Loading... Essay-on-health-care-reform.pdf (application/pdf Object) Pre-Existing Conditions, Children, And Health Care Reform. So what’s the deal with children and pre-existing conditions and the new health care reform law? There’s a lot of confusion out there, and even after several hours of reading on the topic, I’ll admit to still being a bit confused. The best explanation I’ve found so far is in this Associated Press article. Basically, it looks like health insurance companies will no longer be able to place pre-existing condition exclusions on new policies issued for children, starting this year. But there is apparently no requirement that the policies be issued in the first place if the child has a pre-existing condition.

That requirement wouldn’t happen until 2014, when it will apply to everyone, regardless of age. When we first started working in the health insurance industry, pre-existing condition exclusions were a pretty common underwriting action, used by most of the major carriers in Colorado. -Louise. Health Insurance Reform and the Tensions of Federalism. The enactment of the Patient Protection and Affordable Care Act (ACA) marks the beginning of a new chapter in the centuries-long debate about the appropriate balance between the states and the federal government in the development, administration, and enforcement of domestic policy in the United States.

As health care reform is implemented, a new set of federalism-related tensions will arise regarding the best ways to ensure health care coverage for all Americans, secure access to care, promote prevention and wellness, and modernize delivery systems in an effort to achieve better outcomes at lower cost. Today, government incentives for and oversight of health care coverage for nonelderly Americans are responsibilities divided between the federal and state levels — an approach that highlights the best and worst in our health care system. The challenge of hybrid federal–state approaches is that the chain can only be as strong as each individual link. Effective October 1, 2010: Implementing Health Reform: Pre-Existing Condition Coverage. Editor’s Note: Earlier posts by Timothy Jost provide analyses of regulations implementing provisions of the new health reform legislation governing appeals of coverage denials, coverage for preventive services, a patient bill of rights, grandfathered plans, tax exempt hospitals, the small employer tax credit, the Web portal, reinsurance for early retirees, and young adult coverage.

As of January 1, 2014, every American will have access to health insurance without regard to health status or pre-existing conditions. Those whose household incomes fall below 400 percent of the federal poverty level will receive tax credits to help cover their premiums and subsidies to reduce their cost sharing. Those with household incomes below 133 percent of poverty will qualify for Medicaid. But 2014 is still far away for many Americans who are unable to find or to afford health insurance because pre-existing conditions make them uninsurable or insurable at only very high rates.

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