Florida physicians reportedly continued to decrease or eliminate important health services in 2004 in response to difficulties in finding or paying for professional liability insurance, according to a study in the October 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Despite growing concern about possible effects of instability in the professional liability insurance (PLI) market on patient access to health care, there has been little formal, systematic assessment of how physicians may be changing their services to adapt, according to background information in the article. Understanding the impact of professional liability insurance market instability on health service delivery is important to clinicians and policymakers concerned with patients' access to needed medical care, the authors suggest.
Robert G. Brooks, M.D., of Florida State University, Tallahassee, and colleagues surveyed rural and urban/suburban physicians in Florida in 2004 to determine recent changes in services offered, professional liability insurance premium changes, satisfaction with practice and future practice plans.
Overall, 727 (54.4 percent) of the 1,346 responding physicians (380/685 rural and 347/661 urban/suburban physicians) stated that they had decreased or eliminated the delivery of patient services in the previous year, the researchers report. "The most common services eliminated were nursing home coverage (42.1 percent), vaginal deliveries (29.1 percent) cesarean deliveries (26.0 percent), emergency department coverage (22.8 percent) and mental health services (21.2 percent). In addition to outright elimination, a number of physicians responded that they had decreased services in these areas as well. . Surgical specialists (70.2 percent) and general surgeons (68.5 percent) respectively, had the highest number of decreased or eliminated services. Obstetricians/gynecologists (63.6 percent) and family medicine physicians (60.2 percent) were also commonly represented in this group."
"Changes in health care services seemed to be related to changes in PLI premiums," the authors write. "Overall, physicians who had premium changes in the highest quartile (increase > 50 percent) (61.1 percent) were more likely to indicate that they had decreased or eliminated services compared with those in the lowest quartile (increase < 15 percent) (51.4 percent). . Similarly, we noted statistically significant relationships between increases in PLI premiums and decrease in or elimination of services for rural physicians (66.2 percent vs. 48.1 percent) and for actual premiums for urban/suburban physicians (64.7 percent vs. 43.0 percent.)"
The authors conclude that the findings presented in the study "strongly suggest that physicians across Florida have continued to decrease or eliminate important health care services. This trend seems to be affecting a broad array of services and types of physicians, both generalists and specialists. Given the importance of access to health care for vulnerable populations, these statewide trends suggest the need for additional attention by physician leaders and policy-makers to the ongoing effects of the PLI market."
Reportedly, Senator Dick Durbin (D. Ill.) has removed a block that has stalled legislation in the Senate intended to help fund state high risk medical insurance pools. Durbin had cited that legislation's favoring small states over large states as reason for his block. Apparently, the legislation now has been modified to treat large states equally.
Most Americans rate medical research as a high national priority and strongly support greater public and private funding, according to an article in the September 21 issue of JAMA, a theme issue on medical research. However, recent opinion surveys indicate that Americans also are increasingly dissatisfied with the nation's health care system and think the national commitment to health-related research should be higher.
Also, according to the survey, most Americans do not believe that America has the best healthcare system in the workd and growing numbers are voicing dissatisfaction with its current state.
Lead author Mary Woolley, M.A., of Research!America, Alexandria, Va., presented the findings of the article today at a JAMA media briefing on medical research.
Elected and appointed officials representing the public continuously shape policy affecting the conduct of health-related research and health care in the U.S., according to background information in the article. These officials pay close attention to issues that concern the health of the public. Medical researchers and funders of health-related research should be well informed of the public's attitudes toward research.
Mary Woolley, M.A., and Stacie M. Propst, Ph.D., of Research!America, Alexandria, Va., summarized 10 years of data gathered from national and state opinion surveys on public attitudes and perceptions about health care and health-related research. Data in the article were drawn from 70 state surveys and 18 national surveys commissioned by Research!America from 1998 through 2005. Most of the surveys had a sample size of 800 or 1,000 adults (range, 800 - 5,377). Participants were selected at random and surveyed by telephone interview.
In a 2005 poll, Americans ranked health care (28 percent), education (22 percent), and jobs (20 percent) as the most important domestic issues. That same year, the majority of interviewees (78 percent) said it was very important that the U.S. maintain global leadership in health-related research. More than half (55 percent) of Americans want more spent on research, and, most importantly, they are willing to pay for it.
The majority (67 percent) of Americans said they are willing to pay $1 more per week in taxes for additional medical research, an increase from 2004, when 46 percent said were willing to pay more for health research. When asked what type of research was more valuable-research to prevent disease or research to cure disease-nearly half (48 percent) said prevention research was more valuable.
Other Survey Results:
* Health care costs are a leading concern in terms of national priorities, with accelerating medical and health research rated as very important to 66 percent, somewhat important to 28 percent.
* 58 percent indicate that as the U.S. looks for ways to manage health care costs, the national commitment to health-related research should be higher.
* 60 percent of Americans say they do not believe the U.S. has the best health care system in the world.
* More than half (55 percent) of the public say they are currently dissatisfied with the quality of health care in this country, compared with 44 percent who reported the same in 2000.
* Many Americans (66 percent) say the U.S. is spending too little on public health research, and 64 percent say at least twice as much should be spent.
* A majority of Americans (58 percent) favor embryonic stem cell research, while 34 percent strongly favor it. Of the 29 percent of people opposed to stem cell research, 57 percent said their position was based on religious objections.
* 56 percent of Americans do not believe an abstinence-only approach to teen sex education will prevent STDs and unwanted pregnancies, while 39 percent believe it will.
"The understanding, support and engagement of the public are essential if the research enterprise is to continue to succeed. To ensure that success, stakeholders in research must commit to listening to the public and being responsive to their concerns. The concerns expressed by the public are to be expected in the conduct of research that seeks to chart the unknown. The research community should embrace every opportunity to engage the public in an effort to answer their questions and put a human face on research," the authors write. "The widespread public support for research and researchers is now, as it has long been, entirely consistent with public aspirations for better health and well-being, and for longer and more productive lives."
Citing alleged unfavorable treatment to Illinois and other states with large populations, Senator Dick Durbin, (D., Ill.) has blocked legislation that would provide states with $300 million federal aid in order to provide high risk benefit pools to people who otherwise cannot obtain medical insurance, according to the Chicago Tribute.
State governments have relied on �short-term solutions� to address the budgetary squeeze posed by increasing Medicaid and SCHIP expenses and lagging tax revenues during the recent economic turmoil, which �pushed their fiscal problems into the future,� according to a new article published June 16 on the Health Affairs Web site.
States were generally reluctant to raise taxes or reduce either benefits or program rolls, and they frequently relied on one-time actions such as depleting rainy-day funds, shifting money from surplus accounts into general funds, changing accounting rules, or delaying payments from one fiscal year into the next, according to a review of actions in eight states related to Medicaid and the State Children�s Health Insurance Programs (SCHIP) in 2003-2005.
Among the strategies was selling bonds backed by the expected revenue stream from the national tobacco settlement. California, meanwhile, got voter approval to sell $15 billion in deficit financing bonds to close budget gaps over the next several years.
�States did not fundamentally reassess the basic structure or rules related to their major budget items, and few questioned their tax structures and policies,� wrote the authors, Teresa Coughlin and Stephen Zuckerman, both principal research associates at the Urban Institute�s Health Policy Center.
�Instead, this review of eight states shows that states relied on a range of short-term solutions that, in some cases, pushed fiscal problems into the future,� the authors wrote. �By taking this approach, however, some states have created structural deficits that will profoundly influence state policy making for many years to come.�
The authors� research was supported by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute�s Assessing the New Federalism project, which is funded by a consortium of foundations that includes the Robert Wood Johnson Foundation.
The eight states reviewed were Alabama, California, Colorado, Massachusetts, Michigan, New York, Texas, and Washington.
The states had little political support for tax increases in 2003 but were more likely to increase taxes and fees or close loopholes in 2004. Only two states increased broad-based taxes: New York enacted a temporary three-year increase in personal income taxes along with sales taxes, and Michigan increased its sales tax.
States frequently borrowed from dedicated accounts, such as education, transportation, or human service funds, to help finance Medicaid. California, Colorado, and Michigan delayed paying bills to shift spending from one fiscal year to the next. Several states imposed provider taxes to raise Medicaid payment rates, which states use to increase the federal government�s contribution to state Medicaid accounts without expenditures from the state general fund. Other similar Medicaid maximization strategies also were employed.
To reduce spending, states were more likely to change administrative rules to reduce the number of Medicaid or SCHIP enrollees than they were to enact broad-based benefit cutbacks. The states also imposed copayments for some Medicaid and SCHIP beneficiaries, strengthened asset collection activities, and cut or froze provider payment rates.
While tax revenues have begun to recover, the authors write that the decisions made in their review period will need to be addressed in the near future.
�After the difficult fiscal period that states have just weathered, getting back on track will undoubtedly be a challenge,� they write. �Because of the tax cuts many states adopted in the late 1990s, states have a much lower tax base to pay their bills.
�To compound the problem, many states borrowed or pushed current obligations into the future. Although these obligations could be dealt with through new revenue sources, the reluctance to raise taxes makes that quite unlikely. However, if these structural deficits cannot persist indefinitely, states will be forced to confront the choice between cutting spending drastically and bucking the antitax sentiment.�
Big money is being spent on two competing propositions on the California ballot. Proposition 79, favored by consumer groups, would establish discounts, discourage drug companies that refuse discounts from participating in the state's Medicaid program, and allow consumers to sue drug companies for profiteering. Its rival, Proposition 78, favored by the drug companies, would allow drug companies voluntarily to participate in a discount plan.
Newsday.com details the California struggle.
The Heath Committee of the California Assembly, by 9-4 vote July 6, approved Californias single-payer legislation, according to People's Weekly World Newspaper Online.
As previously reported, the state Senate has already approved the bill.
Congresswoman Barbara Lee criticized two Republican measures considered in the House this week, saying the bills fail to lower health care costs or do anything meaningful to provide access to health insurance to the more than 45 million Americans who are uninsured.
�These bills are nothing more than window dressing, designed to hide the fact that when it comes to our nation�s healthcare crisis, Republican policies are more of a poison than a cure,� said Lee. �These bills do nothing to reduce healthcare costs or provide significant coverage to the more than 45 million Americans who live in fear of getting sick, because they have no insurance and can�t afford to go to the doctor.�
H.R.525, which the House considered on Tuesday, is designed to create Association Health plans and allow businesses to purchase health insurance policies at lower rates. According to the Congressional Budget Office, however, millions of small business would actually see their health insurance premiums increase due to cost shifting and cherry picking by AHPs.
Lee also pointed out that the measure would exempt association plans from state benefit requirements that assure coverage of women's health services such as contraceptive equity, cervical and breast cancer screening and treatment, STD screening, clinical trials, and emergency services.
�Not only does this bill fail to provide any significant coverage for the uninsured, it also puts women and girls at risk by pre-empting state laws that guarantee access to basic health services,� said Lee. �This bill overrides protections in 21 states that currently ensure access to contraceptives and treatments for sexually transmitted diseases, and there is nothing healthy about that.�
Lee also criticized H.R. 5, a measure to limit medical malpractice awards, particularly citing provisions that exempt drug makers from liability for products approved by the FDA.
�Not only does this measure limit the rights of legitimate malpractice victims, it fails to address insurance industry abuses and does nothing to lower healthcare costs,� said Lee.
Proponents claim malpractice suits increase healthcare costs, despite ample evidence to the contrary. According to the CBO, malpractice costs account for a very small fraction of total health care spending, and even a significant reduction in malpractice costs would have a relatively small effect on total health plan premiums.
Lee is a co-sponsor of three Democratic bills aimed at Expanding health care access for small business employees, Expanding health care access for low-income working parents and Expanding health care access for those aged 55 to 65 that together would reduce the number of uninsured by more than half.
Earlier this year, Lee, who has long been a leading voice in the fight to make access to healthcare universal, reintroduced H.R. 3000, the United States Universal Health Service Act. The measure, which would establish a United States Health Service (USHS) and provide health coverage for all Americans, was first introduced in 1978 by her predecessor, Rep. Ron Dellums, and has been a priority for Lee since her election in 1998.
U.S. Senators Byron Dorgan (D-ND) and Olympia J. Snowe (R-ME) Thursday won approval by the full Senate Commerce Committee for their plan to allow re-importation of lower priced prescription drugs. The lawmakers added the bill as an amendment to the legislation reauthorizing the Federal Trade Commission (FTC), according to a press release.
The amendment is similar to bipartisan prescription drug importation legislation by Dorgan and Snowe, the Pharmaceutical Market Access and Drug Safety Act (S. 334). The Commerce Committee passed the amendment by a vote of 14 to 8.
The Committee also adopted, without objection, a package of three second-degree amendments offered by Senator Vitter (R-La.) to the Dorgan-Snowe amendment. ( Vitter's 1st, 2nd, and 3rd.)
�Today�s action makes clear there is strong, bi-partisan support for this legislation in the Senate,� Senator Dorgan said after the committee�s vote. �U.S. consumers are charged the highest prices in the world for prescription drugs and it is unfair. Our goal is to put downward pressure on drug prices.�
�Today�s action by the Commerce Committee is a great step forward,� said Snowe. �I joined Senator Dorgan in introducing this amendment because people across this great nation want safe access to affordable prescription drugs. Despite broad recognition of the need - despite six years of legislative efforts - our constituents continue to wait for the federal government to act. Many Americans have lost patience leaving nearly half the states across the country with no choice but to consider implementing their own drug importation programs, including my own great state of Maine. But this is a federal issue, and that is why there has been bipartisan support in Congress to pass legislation to ensure safe access to affordable medicines.�
The Pharmaceutical Market Access and Drug Safety Act would allow individuals to directly order medications from outside the U.S. when using a Food and Drug Administration (FDA)-registered and approved Canadian pharmacy. FDA would examine, register and inspect these facilities on a frequent basis. FDA would also ensure the highest standards for such essential functions as recording medical history, verifying prescriptions, and tracking shipments. It would also allow U.S. licensed pharmacists and wholesalers to import FDA-approved medications from a number of major industrialized nations and pass along the savings to their customers.
Citing a recent report that malpractice premiums have soared while payouts have remained constant, Connecticut�s Attorney General Richard Blumenthal on July 7 called for stricter oversight of the malpractice insurance industry, according to a press release from his office.
According to the release:
Blumenthal, in a letter to the [National Association of Insurance Commissioners (NAIC) and state Insurance Commissioner Susan F. Cogswell], said the data raises serious questions about competition among malpractice insurers. He said the report requires immediate and meaningful steps to address potentially pervasive unfair and deceptive practices.
"These numbers tell a powerful story about who should bear the blame for the astounding and alarming medical malpractice insurance costs � the insurers themselves," Blumenthal said. "Insurers are reaping gratuitous surpluses while doctors are fleeing high-risk specialties or closing practices altogether.
"The numbers underscore the need for much tougher, more aggressive oversight to prevent and punish profiteering. Federal and state regulators should thoroughly scrutinize recent rate increases and take appropriate corrective action.
"Affordable medical malpractice insurance is critical to public health. Expensive insurance rates become a matter of life and death when they drive doctors out of business � as is happening in Connecticut and nationwide. Insurance company greed can be hazardous to our health."