cicerone imposter wrote:Please provide the specific circumstances and/or events in which doctors have done this?
By the way, why is it you only ask me to prove thing and not miller?
Why not? You're the one who claimed to be an expert in health care issues.
cicerone imposter wrote:Why not? You're the one who claimed to be an expert in health care issues.
I never claimed to be an expert. I only claimed to know more about the workings than you do. That's not untrue.
Since you know more than I do, what's the problem?
Here's a story about how the insurance industry is fighting against being held accountable for not paying out legitimate claims.
Quote:
Insurance companies fight law on punitive payouts
By Drew Griffin and Kathleen Johnston
CNN
SEATTLE, Washington (CNN) -- Across the country, insurance companies, trial lawyers and legislators are closely watching a November referendum in the state of Washington that could change how insurers are required to treat their customers.
Insurance giants like Allstate, State Farm, Safeco and Farmers have poured more than $8 million into the referendum battle. Their goal is to convince voters to reject a law passed earlier this year that could force insurers to pay up to triple damages and lawyer fees if they fail to pay a legitimate claim and then lose in court. A "yes" vote on the referendum allows the law to go into effect while a "no" vote strikes the law down.
Supporters of the law say it forces insurance companies to pay legitimate claims in a timely and fair fashion and frees the courts from relatively minor cases that clog the system for months and even years. One supporter, the Washington Trial Lawyers Association, has raised almost $900,000 to fight the insurance industry over the referendum.
"Insurance companies have figured out that they can make more money if they don't pay your claim,'' said Washington state Rep. Steve Kirby.
Kirby and his fellow Washington state lawmakers heard so many complaints from policy holders who believed insurers weren't treating them fairly that earlier this year they passed a law called "The Fair Conduct Act." Hearings were held, the bill was revised -- even watered down, according to Kirby -- and both the House and Senate passed it. The governor readily signed it.
But the very next day a coalition, funded primarily by insurance companies, moved in to stop the law from going into effect by filing petitions for a voter referendum on the law.
Representatives of the insurance industry say the law will raise premiums and that the system is working fine as it is. The law, they said, will only make things worse, and they want voters to have the final say.
"The insurance companies stepped in and said, 'Consumers, you get to decide if you want to do this,' '' said Dana Childers, executive director of the Liability Reform Coalition, which is leading the insurance company charge to defeat the new law.
Childers said the state's own insurance commissioner sees no need for the law.
"His own information that he provided to the legislature and the public says that this law simply isn't necessary,'' Childers said.
But that's not what Insurance Commissioner Mike Kreidler told CNN in a recent interview in Seattle. Kreidler said he strongly supports the new law and that if insurance companies act responsibly they have nothing to fear.
"If companies act in good faith, [they are] not going to have a problem," Kreidler said. "It's not going to cost any more money. There's not going to be any legal action. There's going to be no treble damages, because if companies deal with their customers in good faith there's no penalty."
The campaign to woo voters has already begun. The insurance industry-backed group is already running television commercials depicting greedy lawyers planning to sue and warning consumers that the law will lead to frivolous lawsuits and higher rates.
It's not a new tactic by the insurance companies. Earlier this year, CNN exposed a controversial insurance industry strategy that began in the mid-1990s.
Former insiders say insurance companies began limiting or denying legitimate claims in minor injury cases and reaped billions in profits as a result. The strategy has tied up courts across the country -- over minor claims, judges told CNN -- for months and even years. How did they do it?
"It really came down to basically three elements: a position of delay, a position of denying a claim and ultimately defending that claim that you're denied," said Jim Mathis, a former insurance industry insider.
But Robert Hartwig, with the industry-backed Insurance Institute, said the strategy was not intended to deny valid claims but to attack fraud, which, he claimed earlier this year, was rampant in minor accident cases.
"What insurers are doing is trying to monitor costs. And every insurance company is under the same pressure to do it," Hartwig said.
Washington state resident Michelle Tribble plans to vote for the law because she says she has experienced the strategy first-hand. She says her two accidents convinced her insurance companies don't want to play fair.
Tribble was working for an insurance company when she got rear-ended on the freeway. Ten weeks later she got hit again, this time by an uninsured motorist. The two accidents, she said, resulted in back injuries that required medical treatment. The first company agreed to pay but her own insurer, Allstate, refused to pay even though she had coverage.
"I just wanted my medical bills paid because I didn't want my credit being hurt,'' Tribble said, adding that the total came to about $18,000.
She said Allstate dug into her medical past.
"They bought out stacks of medical records, you know, to see if I was at all deceptive."
An arbitrator sided with Tribble, but Allstate refused to pay. The case went to court, where a jury, too, ruled for Tribble. But Allstate appealed again. Finally, four years after the accident, the company paid her claim.
Allstate said it could not comment on individual claims but said cases like Tribble's prove "that the current judicial system is working."
All AboutSeattle
Find this article at:
http://www.cnn.com/2007/US/law/09/28/insurance.vote/index.html
Some of you posters here just don't understand that not paying legitimate claims is how insurance companies make profit. They profit billions of dollars by denying legitimate claims, knowing that it will cost you far more money to take them to court then you could ever hope to receive. It not only screws people paying for the insurance over, it clogs the court systems and slows the whole system for all of us, costing you and I money.
Cycloptichorn
http://www.cbc.ca/health/story/2007/09/27/dca-trial.html
Not sure if this has been posted yet, but there are a few things I find interesting.
1) How is it possible that such a drug could be developed in Canada, where socialized medicine has basically ruined their healthcare?
2) How is it possible that such a drug could be developed without a Pharma company being involved in funding?
Now, obviously this drug may not work, but if it does......
It's because all the fears expressed by the people against universal health care hasn't really proved their point about "ruining" our health care. They make a lot of assumptions, but little or no proof.
The evidence in support of universal health care is over-whelming; everybody gets health care, and nobody goes broke because a family member needs expensive treatments. What I like about it the most is that all children will have health care irregardless of income.
Some interesting info on universal health care in Japan.
INTRODUCTION
Japan's health care system is characterized by universal coverage, free choice of health care providers by patients, a multi-payer, employment-based system of financing, and a predominant role for private hospitals and fee-for-service practice. Virtually all residents of Japan are covered without regard to any medical problems they may have (so-called predisposing conditions) or to their actuarial risk of succumbing to illness. Premiums are based on income and ability to pay. Although there is strong government regulation of health care financing and the operation of health insurance, control of the delivery of care is left largely to medical professionals and there appears to be no public concern about health care rationing.
Like the Australian, Canadian and many European health care systems, Japan's national health insurance program is compulsory. But Japan surpasses all 24 member countries of the Organization for Economic Cooperation and Development (OECD) in life expectancy at birth and also has the lowest infant mortality rate (Appendix 1, Table 1).1 It achieves these successes at a cost of only 6.6 percent of gross domestic product, $1,267 per capita - half that of the United States (Table 1) .
Japanese-style national health insurance raises a fascinating question: how has Japan reduced financial barriers of access to medical care and achieved a No. 1 ranking on health status at a cost that is among the lowest of wealthy industrialized nations?2 In addressing this question, we begin with a comparative analysis of health care resources and the use of medical care in Japan, the United States and other OECD countries. Next, we review the financing and organization of medical care in Japan, evaluate some strengths and weaknesses of the health care system, and explore possible lessons for health care reform in the United States.
In adopting this comparative approach to health care reform in the United States, we have relied on an extensive review of the English-language literature on Japan's health care system and on information presented at the Japan Society's April 30 conference, "Making Universal Health Care Affordable: How Japan Does It."3 We do not presume to have analyzed Japan's health care system in depth. For example, we remain intrigued by Japan's exemplary health status and by such societal values and traditions as egalitarianism and consensus- building upon which the health system is built. We have aimed, in earnest, to raise more questions than we are able to answer. We hope that these questions may lend a sense of perspective to the on-going public debate on health care reform in the United States.
NOTES:
1For comparisons between Japan and the other OECD countries, see the Tables in Appendix 1.
2This is a reference to Vogel's (1979) classic book, Japan as Number One: Lessons for America. (Cambridge: Harvard University Press).
3We also refer the reader to a previous monograph on health and medicine in Japan and America based on a conference organized by the Japan Society in 1978 (Reich and Kao, 1978).
HEALTH CARE RESOURCES AND UTILIZATION
Japan has 15.8 inpatient hospital beds per 1,000 persons, the highest number among OECD countries and more than three times the American ratio (Table 1). By contrast, with 1.6 physicians per 1,000 population, Japan has the fifth lowest physician-per-person ratio, 43 percent less than the American rate of 2.3 per 1,000 (Table 1). Japan also has one-half to one-third the American number of intensive care beds per capita (Table 1). And Japan is tied with Austria for the lowest hospital staffing ratio (that is, the number of employees per bed) among OECD countries (Appendix 1, Table 3).
As for the use of these resources, at 8.3 percent, Japan admits a smaller proportion of its population to hospitals every year than any other OECD country except Turkey, a rate barely over one-half that of the United States (Table 1). On the other hand, of all OECD countries, at 50.5 days, Japan has the longest average length of stay for inpatient hospital services, more than five times that of the United States (Table 1).
Although Japan has one of the lowest physician-to-population ratios among OECD countries (Appendix 1, Table 3), at 12.9, Japanese doctors have the highest number of physician contacts per capita, more than twice the American rate . It must be noted, (Table 1) however, that the average length of a physician visit in Japan is only 6.9 minutes, compared to over 20 minutes in the United States.1
To the extent that OECD data are available on hospital admission rates for selected procedures, with the exception of appendectomies, Japan's rates are lower than those in the United States (Table 2).2 Comparative survey data indicate that surgeons in Japan perform fewer than one-fourth the number of operations per capita that their colleagues in the United States do (Table 1).3 This pattern is supported by findings on cesarean section rates, which are half as frequent in Japan as in the United States.4 The United States is known abroad for its unusually high cesarean section rate.
It would be wrong to conclude from these data that Japan rations high-tech medical care. On the contrary, among OECD countries, Japan has the highest number of computerized axial tomography (CT) scanners per capita, the highest number of extra-corporal shock wave lithotriptors per capita, and the highest number of patients per million treated for end-stage renal disease failure.5 In addition, Japanese spend more than any other nation on drugs as a percent of total health expenditures, more than twice the American rate.6
Japanese doctors' clear preference for non-invasive procedures is demonstrated by the kinds of medical technologies imported and exported. Equipment requiring invasive operations (e.g., pacemakers and artfficial heart valves) is almost all imported, whereas diagnostic equipment (e.g., CT scanners) is produced in Japan and exported in large quantities.7
In contrast to the United States, Japan's low rate of hospital admissions (Table 1) reflects its tendency to emphasize ambulatory over inpatient hospital care.8 But once hospitalization occurs, as we have seen, Japan holds the OECD record for long lengths of stay and low hospital staffing ratios (Appendix 1, Tables 3 and 4). This is encouraged by a reimbursement system that pays hospitals on a per diem basis and a style of medical practice that emphasizes bed rest and complete recovery while a patient is still in the hospital.
Beyond these more measurable differences in resource availability and use of medical care in Japan and United States, there are a host of political-institutional and cultural factors that reinforce each health care system's distinctiveness. The United States is a federal system whose 50 states have significant autonomy on matters of health insurance and public health policies. Although the federal government exercises a dominant role over the Medicare program and regulatory aspects of health policy, Americans are multiethnic, suspicious of excessive governmental authority and inclined to solve social problems at the local level. Japan is a centralized, unitary state with a highly homogeneous population and a tradition of powerful state intervention in the economy, including its many health insurance plans.
**********************************
Medical research in Japan.
Original articles
Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases
Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy, May, 2004.
Hironori Yamamotoa, Corresponding Author Contact Information, E-mail The Corresponding Author, Hiroto Kitaa, Keijiro Sunadaa, Yoshikazu Hayashia, Hiroyuki Satoa, Tomonori Yanoa, Michiko Iwamotoa, Yutaka Sekinea, Tomohiko Miyataa, Akiko Kunoa, Hironari Ajibea, Kenichi Idoa and Kentaro Suganoa
aDepartment of Internal Medicine, Division of Gastroenterology, Jichi Medical School, Tochigi, Japan
Available online 18 November 2004.
Background & Aims: A specialized system for a new method for enteroscopy, the double-balloon method, was developed. The aim of this study was to evaluate the usefulness of this endoscopic system for small-intestinal disorders. Methods: The double-balloon endoscopy system was used to perform 178 enteroscopies (89 by the anterograde approach and 89 by the retrograde approach) in 123 patients. The system was assessed on the basis of the rates of success in jejunal and ileal insertion and the entire examination of the small intestine, diagnostic yields, ability to perform treatment, and complications. Results: Insertion of the endoscope beyond the ligament of Treitz or ileocecal valve was possible in all 178 procedures. It was possible to observe approximately one half to two thirds of the entire small intestine by each approach, and observation of the entire small intestine was possible in 24 (86%) of 28 trials. The source of bleeding was identified in 50 (76%) of 66 patients with GI bleeding, scrutiny of strictures was possible in 23 patients, and a tumor was examined endoscopically in 17 patients. Two complications (1.1%) occurred. Endoscopic therapies in the small intestine including hemostasis (12 cases), polypectomy (1 case), endoscopic mucosal resection (1 case), balloon dilation (6 cases), and stent placement (2 cases) were performed successfully. Conclusions: Double-balloon endoscopy permits the exploration of the small intestine with a high success rate of total enteroscopy. The procedure is safe and useful, and it provides high diagnostic yields and therapeutic capabilities.
From today's The Guardian's report:
UK falls further down European health league despite rise in funding
Quote:Britain and Germany represent the two fundamental systems of public healthcare in Europe, with the British "Beveridge" system unifying funding and provision, while the German "Bismarck" system is based around a plethora of competing insurance organisations independent of health service suppliers. The survey found that the German model is delivering better results.
"It is very hard to avoid noticing that the top five countries all have dedicated Bismarckian healthcare systems," the report said. "While not at all arguing that the Bismarck-type healthcare systems are in every way superior, it seems that for total customer value, the Bismarck model runs rings around Beveridge."
I like the German/Canadian system best; a mix of government and private programs. It maintains a competitive market that'll demand that quality remain high while ensuring all of its citizens with some form of health care.
Some, especially George, pointed previously to the disadvantages and deterioration of performances in our healthcare system.
We just learnt about that personally, well, actually Mrs Walter did:
she was advised by our family doctor in August to undergo a gall bladder operation. Due to various circumstances in our private life, she wanted to go to hospital somwhen in late September.
But three weeks ago, she suddenly had awfull pain in her left side, couldn't move her arm ...
I had to call the ambulance and the emergency doctor. Because it could be - after some high-tech check-ups in our home, either something heart related or a pulmonary embolism as well as 'just' omethimng orthopedic, she was driven to the hospital.
It was a blockageof some muscles, which was 'solved' immediately at the ER - and perhaps an embolism.
She only stayed there three days, since after that the blood etc was okay again.
The disadvantae here was that she could stay any longer for her gall bladder operation: that is done a) at the surgical ward and needs b) a (new) hospitalisation by the family doctor.
Which happend last week.
However, much is done now as an outpatient: on Friday, she got the general surgical examination. Today, some more tests were done and she had a talk with the anaesthetist.
On Thursday (tomorrow is our national public holiday) she'll get at first a gastroscopy, some time later the gall bladder operatuion (though same day).
Formerly, you stayed for all that in hospital.
And after such an operation, you had to stay about two weeks there.
Now it's between four to seven days.
And she doesn't get four weeks rehabilitation in a spa village but under our universal healthcare system you get nowadays three weeks (with posibly one week additionally, insetad two weeks before).
At least my insurance company - Mrs. Walter is insured there for free as my spouse - offers some quite nice places all over Germany (so she doesn't have to stay here in out village or nearby).
Yes, years ago it was better, I admit.
But our health insurence companies thus made a plus of $435,000,000 in the first half year 2007 (that's by all 300 companies - some of which most certainly made a minus). That's only the fourth year consecutively that they are making a rather big plus.
Sounds like very generous benefits. I doubt that even the best insurance policy here would provide three weeks of rest home/spa village care post operation unless there was an unusual and particular medical need for it.
$435 million profit in six months sounds like quite a lot, even for all the insurance companies in the country. That works out to over $5 million per German. Where does all this money come from?
georgeob1 wrote:Sounds like very generous benefits. I doubt that even the best insurance policy here would provide three weeks of rest home/spa village care post operation unless there was an unusual and particular medical need for it.
$435 million profit in six months sounds like quite a lot, even for all the insurance companies in the country. That works out to over $5 million per German. Where does all this money come from?
It's not only post-operation but also because of her fibromyalgia. And its not very generous: before we had the reforms, anyone could go get such any three years - just paying a bit for the accomodation himself/gerself.
The money exclusively comes from the fees the members pay - and the money, the insurances companies didn't spend:
75.7 billion income vs 75.4 billion expenses.
(I just looked it up: you pay between about $ 165 and the maximum of $ 800 per month for health insurance for a single or a family, depending on your status. (The sums vary between the various 298 insurances companies.)
georgeob1 wrote:Sounds like very generous benefits. I doubt that even the best insurance policy here would provide three weeks of rest home/spa village care post operation unless there was an unusual and particular medical need for it.
$435 million profit in six months sounds like quite a lot, even for all the insurance companies in the country. That works out to over $5 million per German. Where does all this money come from?
Surely there are more then 87 or so Germans....
Cycloptichorn
Cycloptichorn wrote:Surely there are more then 87 or so Germans....
It doesn't come from Germans only but - since health insurance is mandatory - from anyone earning some money here, from pensions to part time jobs.
(Not from civil servants and those who have a private insurance.)
Cycloptichorn wrote:georgeob1 wrote:Sounds like very generous benefits. I doubt that even the best insurance policy here would provide three weeks of rest home/spa village care post operation unless there was an unusual and particular medical need for it.
$435 million profit in six months sounds like quite a lot, even for all the insurance companies in the country. That works out to over $5 million per German. Where does all this money come from?
Surely there are more then 87 or so Germans....
Cycloptichorn
The CIA World Factbook gives the 2007 estimate for the population of Germany as 82.4 millions.
Well, I've never been good in mathematics but ...
georgeob1 wrote:Cycloptichorn wrote:georgeob1 wrote:Sounds like very generous benefits. I doubt that even the best insurance policy here would provide three weeks of rest home/spa village care post operation unless there was an unusual and particular medical need for it.
$435 million profit in six months sounds like quite a lot, even for all the insurance companies in the country. That works out to over $5 million per German. Where does all this money come from?
Surely there are more then 87 or so Germans....
Cycloptichorn
The CIA World Factbook gives the 2007 estimate for the population of Germany as 82.4 millions.
And $435 million divided by 82.4 million is.....?
Actually, only 70.2 millions (=85% of the population) are members in the one of the 238* insurance companies of the mandatory universal health care system.
* that is the now corrected number as of September 2007 - I'm pretty sure, on October 1 a couple more got united with others.
