NPR: Why picking a doctor is harder than ever.

Michelle Andrews from NPR has written the following article about why it's difficult to find a doctor in today's world.  The article discusses several reasons and it's important to address these issues to improve the continuity of care as well as pursue the mission of accessible care for everybody.

In just a few weeks many people who get health insurance on the job will have to pick a health plan. Often the decision boils down to which one has your favorite doctors within the network.

Your choices might be even more limited this year than in previous ones, if your employer is looking, as most are, to slow the rise in health costs, So if you're in the market for a new doctor, how do you decide? It's not easy.

While U.S. News & World Report has "best hospital" rankings, they don’t necessarily always reflect where to go if you need a procedure. But they are, at least, compiled from hard data as well as broad surveys of specialists in the fields. But with few exceptions, there's not a lot of quality information out there on doctors.

You probably put more research into buying a new television than into picking a doctor. When consumers do shop for a physician, who they trust for advice varies a lot on the type of doctor they're looking for.

If it’s a primary care physician someone's after, about half of people turn to friends and relatives; and more than a quarter of those people look no further than people they know, according to a study by the Center for Studying Health System Change.

But when a specialist is needed, nearly 70 percent of people rely on a referral from their primary care doctor, and only 20 percent turn to friends and relatives.

Of course, most people with insurance already have a primary care physician or have visited one, so it’s easy to weigh in with suggestions. But when it comes to medical problems you need a specialist for, even if you’re willing to share private details with friends, it may be tough to find people who can make a personal recommendation for a doctor who does hip replacements or treats overactive bladders, for example.

In addition, “I think there’s still quite a lot of patient trust in their physician,” says Ha Tu, a senior health researcher at the Center for Studying Health System Change and the lead author of the study. “When they need a specialist or procedure, it’s hard for secondary data sources to replace that relationship.”

That’s unfortunate news for the health plans that are under pressure by state and federal government officials to keep costs down. They're nudging members to use physicians they rate highly for providing the best care for the least cost. People consult health plans for information less frequently than they do either friends or other doctors, according to the study.

Health insurance plans tend to evaluate doctors more on cost than on quality. Right now, most consumers still don't have much incentive to pay attention to costs, because they’re not paying much out of pocket for their care.

In fact, cost remains one of the least important factors consumers consider when choosing a physician, whether primary care or specialist, according to the study. Just under 30 percent of primary care physician shoppers considered cost; for specialists, the figure was even lower: a tad more than 12 percent.

Congress: Health Care Provisions for Young Adults

Dear Friends,

Each spring marks a time of new opportunities for our recent college and high school graduates entering the workforce. Earning your degree is no small feat, and those who have been given their diplomas this year deserve all of the praise and accolades which have come their way. However, this is not the end of the journey. In fact, it is really just the beginning. These young future leaders of our nation will be facing much uncertainty as they embark on their careers. Thankfully, for over 13 million of them, having health care will not be one of those challenges.

As families and small businesses continue the slow and steady climb out of the recession which reached its apex in December 2008, far too many people were forced into situations where they lost coverage, were denied care or forced to pay exorbitantly high premiums. In many cases, young adults without employer-based coverage were forced off their parents' plan until they were able to find a job that actually offered health coverage. Thanks to the new health insurance reform bill, young adults will now be able to retain health coverage while they work towards standing on their own two feet.

According to a report issued by the Commonwealth Fund, the Affordable Care Act will enable the vast majority of uninsured young adults - up to 13.7 million of them - to gain coverage. Young adults, the most uninsured age group, will be able to take care of their most important asset, their health. As a parent, I believe that knowing my children could be cared for when they are sick is a huge relief, and I am proud to have supported this legislation for this reason and many others.

The law's provision requiring health insurers to extend dependent coverage up to age 26 for young adults on their parents' plans will go into effect this September. This means that millions of our children can go to the doctor when sick, and not hold back because they fear the cost. Many insurers have elected to implement this provision early, filling in the coverage gap for many new college graduates. In the cases of those young adults with serious conditions, this could be life saving.

The newly-created insurance exchanges and lower premiums for lower- and moderate-income families - which begins in 2014 - will provide coverage for six million more uninsured young adults. In addition, new insurance regulations, an essential benefits package, and limits on cost-sharing will ensure young adults have comprehensive health insurance to protect them from high out-of-pocket costs. Expanding Medicaid eligibility will also provide coverage to millions more young adults. The Affordable Care Act eliminates lifetime limits on coverage - another provision to take effect in 2010 - which will protect young adults from devastating medical debt.

A lot of attention has been paid on many other groups in relation to the health care debate, but its our young adults who have the most to gain from this law. As a father, I have always tried to provide for my children and, of course, that does not end once they stand on stage in their cap and gown. Clearly, I am not alone in this thinking and I am extremely proud to have cast my vote for this law so that my children and yours will have a healthier future.

Sincerely,

Eliot L. Engel
MEMBER OF CONGRESS

CNN: Why do Latinas avoid the doctor?

Here's an interesting article off of the CNN website about Latina women and their fear of going to the doctor. One must question, though, if this is only about Latina women. This could be a trend in immigrant populations across the board. But it raises an interesting question about cultural sensitivity.

By: Sabriya Rice
CNN Medical Producer

Social and cultural factors may play just as big a role as economics in the poor health care outcomes of Latinas, a new study finds.

The small study, published in the journal Ethnicity and Disease, looked at Latinas in upstate New York found that 70 percent of the women reported delaying doctor appointments, even though nearly all had insurance and over half had diagnoses of chronic medical conditions including diabetes, heart disease and cancer.

"Diagnosis should typically motivate you to seek further attention," says Janie Jurkowski, an assistant professor at the University at Albany's School of Public Health and lead author of the study. "It's really quite scary and striking to see that even with a chronic disease people are delaying care.”

Among the reasons the women listed for avoiding their doctor appointments included opting for alternative therapies, previous experience with discrimination in a clinical setting and a preference for doctors of their own race who "speak their language." Jurkowski says the cultural competence of the provider is very relevant in today's society and efforts to diversify the work force, provide interpretation services and encourage cultural sensitivity benefits everyone in the long run.

"The longer the these patients delay, the worse the outcome and the more rigorous and costly the treatment,” Jurkowski notes. “Getting people in sooner would be better for the healthcare system as whole, especially in the era of rising costs. "

Most of the participants in this study were of Dominican and Puerto Rican heritage, however the trend has been viewed in other Hispanic groups in the U.S., and the number of Hispanic Americans continues to rise. According to census reports, the Hispanic population is increasing at more than three times the growth rate of the total U.S. population, and by the year 2020 Hispanics will represent nearly 18 percent of the U.S. population.

"There are lot of places in this country that are seeing fast growing Latino populations, and the health care system is not ready culture-wise to respond to the growth," Jurkowski says.

Asthma Awareness Month 2010

Dear Friends,

As spring continues, and allergy season takes center stage, it is important to remember those suffering from asthma. This season can be a difficult time for the 20 million Americans who suffer from this lifelong disease. I know first hand, as several members of my family have to cope with the affects of asthma. Because of their plight, and that of the millions upon millions of others, the Environmental Protection Agency (EPA) has named May, Asthma Awareness Month. However, that awareness needs to be carried over into the rest of the year as well.

Asthma is a serious respiratory disease which has steadily increased for the past thirty years. Although there is no cure for asthma, it can be controlled through medical treatment and management of environmental triggers. It is important to take the time this month to educate both ourselves and others about the different catalysts that affect millions of Americans with this disease each year.

I led the charge in passing the Asthmatic Schoolchildren’s Treatment & Health Management Act in 2004. This bill gives preference to states that require schools to allow students to self-administer medication to treat asthma. All 50 states now have laws protecting students’ rights to carry and administer their lifesaving medication at school. Asthma is the most common chronic condition among children, affecting one in every 20 children. Each year, the costs of asthma totals $20 billion, while every day 40,000 people miss school or work, 30,000 have an attack, 5,000 visit emergency rooms, and 1,000 are admitted to the hospital due to asthma. The costs to our nation in dollars, time and lives is far too high, as 4,000 people die annually from asthma-related causes, and another 7,000 die from causes where asthma is a contributing factor.

The EPA conducts ongoing research into how the environment can affect asthma patients and how to manage environmental asthma trigger. However, environmental health studies have led to a growing consensus that chemicals are playing a role in the incidence and prevalence of asthma in our country.

It is for this reason I am supporting the Toxic Chemicals Safety Act of 2010. This act will lead to the revision of the outdated Toxic Substances Control Act of 1976. The revised bill will give greater powers to the EPA, and includes a requirement for all chemical industries to submit any data needed to help bring the agency up-to-date with the chemicals on the market today. This will be used to ensure that the information the public is receiving is correct. The bill also includes a program to further the understanding of the vulnerability of children to chemicals and addresses the public exposure of toxic chemicals in certain “hot spot” locations.

Asthma remains a major problem in New York State with significant public health and financial consequences. In 2008, an estimated 1.3 million adults and 475,000 children had asthma. Current asthma prevalence among adults increased from 6.3% in 1999, to 8.7% in 2008. Asthma prevalence in New York has been higher than the national average since 2002. Between 2005-2007, an average of 255 asthma related deaths were recorded per year. With only 30% of New Yorkers suffering from asthma on a self-management plan to help control their asthma, the time has come for a change in how we deal with this problem.

It is for these reasons that we should make the effort to learn about asthma and its sufferers. I have watched my loved ones deal with asthma, and those experiences have helped me to understand just how dangerous this disease can be, and just how important it is to fight it. Simply put, asthma kills if not treated, and only through raised consciousness and improved research will we come to a day where this disease has become a thing of the past.

Sincerely,

Eliot L. Engel
MEMBER OF CONGRESS

Asthma: Focus on the Bronx

Here's a NYC Department of Health report that illustrates asthma rates across the 5 boroughs (if you prefer Google Docs, click here). If you haven't noticed, this report was released back in 2003.

The NYC.gov website has a separate site dedicated towards an asthma initiative, however the only recent activity on this matter is a report on rates of hospitalizations and mortality in the city from 2000-2007.

The goals for the Asthma Initiative have been laid out below:

• Working to strengthen the ability of families, schools, communities, health care institutions and city government to control and prevent asthma;
  
• Building on existing research, educational and clinical efforts, resulting in a coordinated and comprehensive effort to understand, treat and prevent asthma in New York City;
• Developing linkages among health facilities, schools, communities and government agencies; and
• Reduce hospitalizations due to asthma throughout the city, with special attention to high risk populations.

One thing that is bothersome is that community involvement in reversing this trend in asthma rates requires voluntary participation by members of the community. Also, you have to wonder how many schools have been approached by the department of health in terms of establishing linkages between schools, health facilities, and government agencies in regards to asthma.

The flaw in the approach by the Department of Health is that if the corrective action is less aggressive than the progression of the disease, then you're not doing an adequate job fixing the problem. You can pay for all the research to point to the problem and publish a paper with colorful graphs and charts that illustrate the problem, but now you have to do something about it.

If you look at the trends in their hospitalization data, you'll notice inconsistent trends of positive and negative percent increases. So one can only hope that the Asthma Initiative relies on more than voluntary community involvement.

Here are some staggering stats from this report about asthma and the Bronx:

• The highest asthma prevalence rates in New York City schools (ages 4-5) are in the Bronx.
• The Bronx has the highest asthma hospitalization rates across the city.
• The hospitalization rates in New York City compared to the national average is double for children ages 0-14 years.
• The Latino population had the highest prevalence of asthma in adults 18 and older.
• Asthma prevalence is doubled in low income areas when compared to high income areas.
• The Bronx has the highest mortality rates out of the 5 boroughs as a result of asthma.
  

Dept. of Health and Human Services

This afternoon, U.S. Department of Health and Human Services Secretary Kathleen Sebelius will deliver a speech entitled, “Health Reform and You: How the New Law Will Increase Your Health Security” at the National Press Club. Secretary Sebelius' remarks as prepared for delivery are below.

In her remarks, Sebelius notes that some scam artists have attempted to capitalize on the new law by setting up 1-800 numbers and going door to door trying to sell fraudulent insurance policies. Today, Sebelius sent letters today to State Insurance Commissioners and Attorney Generals asking them to investigate and prosecute these scams. Copies of these letters are attached.

• Attorneys General Fraud Letter (PDF)
• Insurance Commissioners Fraud Letter (PDF)

When the conversation about reforming our health insurance system began nearly a year ago, there were some pundits who thought the days of America solving big problems were over. They wondered whether transformative legislation like Social Security and Medicare was part of a bygone era like soda fountains and five cent matinees. Last month, those pundits got a definitive answer. After decades of asking, “When are we going to fix our broken health insurance system?” – we finally have an answer: “starting now.”

The law that President Obama signed will give Americans more control of their health care. The mom who worries she’ll have to skip her next round of chemotherapy because her insurance policy puts a lifetime cap on her benefits, can stop worrying: this law makes those caps and other unfair insurance practices illegal.

The factory worker who puts off retirement because he knows his diabetes will make it impossible to get health care coverage on the individual market can retire in peace: this law will end insurance discrimination based on preexisting conditions.

The entrepreneur who’s frustrated because she wants to buy insurance but can’t find an affordable policy will finally get some relief: this law will create a new, consumer-friendly health care market where she can band together with other consumers to negotiate lower rates, just like Fortune 500 companies do.

And the parents like me who believe we need to reduce our long-term debt so that our children can have the same opportunities we had can feel confident, knowing this law doesn’t just pay for itself – it actually reduces the deficit by more than $100 billion over ten years and $1 trillion over the next ten.

Now, I want to be clear: the Affordable Care Act is not a magic pill that will cure all the problems in our health care system. It will take time for all the benefits to kick in. And if you look at the history of major social legislation, you see that there are always revisions and adjustments along the way.

But this law is the biggest expansion in health care coverage since Medicare; the biggest middle class tax cut for health care in American history; the most aggressive health care cost-cutting law we’ve ever had; and the most ambitious health care innovation legislation I’ve ever seen, all rolled into one.

The more Americans learn about this legislation, the more they’ll like it.

But our work didn’t end when President Obama put down his pen. In some ways, it’s just begun.

We have a great law. Now, we have to carry it out effectively.

To do that, we’ll need to communicate clearly with the American people. Many of our friends and neighbors still have questions about this law. That’s understandable. Given the complexity of our health care system, which makes up one sixth of our economy, it would be surprising if they didn’t. And it didn’t help that they were bombarded by nearly two hundred million dollars in ads over the last year, many of which were intentionally misleading.

For these Americans, our department will serve as a nationwide health insurance reform Help Desk. If you have questions, we’ll have answers. If you aren’t sure what to believe, we’ll have the facts.

We know that the only way this law will achieve its full potential is if Americans understand and take advantage of all the new benefits and choices that will be available to them.

So here are the facts: if you like your doctor, you can keep your doctor. If you like your health plan, you can keep your health plan.

This law builds on the health insurance system we have, and makes three key changes. First, it makes sure that every American who has an insurance policy gets real security by creating common sense rules of the road that require insurance companies to treat you fairly.

Second, it makes insurance affordable for millions of Americans by creating a new insurance marketplace and providing tax credits for those who need additional help.

Third, it starts to bring down costs for families, businesses, and governments with the broadest health care cost-cutting package ever – one that includes every serious idea for health savings that was proposed over the last year.

That’s the basic outline.

Now, one way to carry out this law would be to make all these changes immediately. But that might overwhelm our health care system. And it wouldn’t give us enough time, for example, to work with states to design the new health marketplace.

Since our goal is to strengthen the health insurance system for all Americans without disrupting it for any, we took a different approach. We’ll implement these reforms quickly, but not all at once. Instead, they’ll fit together like puzzle pieces, each one leading logically to the next.

Still, we knew we had to give some immediate relief to the millions of Americans struggling with our health care system. For many of them, there will be help right away.

For example, starting on June 15th, seniors who have hit the prescription drug donut hole will get a $250 rebate check to help them afford their medicines this year. And there is a new tax credit – available right now – to help small business owners like the man who wrote me and said: “As a small business owner, I am near the breaking point. With guaranteed annual increases at 10-15 times inflation, eventually we will go out of business or be forced to cancel insurance.”

At the same time, we’re adding new protections that will make insurance stronger for Americans who have it. That new rule ending lifetime caps on benefits takes effect this year. So does a rule preventing insurance companies from canceling your coverage when you get sick.

And the new health reform law will also make it easier for Americans to get insurance. Right now, it’s totally legal for insurance companies to refuse to cover kids who have a preexisting condition In other words, we have a health insurance system that often excludes the people – sick kids – who need it most.

Starting this fall, this practice will be outlawed. We’ll also create a temporary high risk insurance pool program that will be available to all Americans who are shut out of insurance because of their preexisting conditions. And young adults who need coverage will be able to stay on their parents’ insurance until they’re 26.

During these early years of implementation, we’ll also be working with doctors across the country to turn Medicare into a quality-driven, high-value health care purchaser. When seniors walk into a hospital or doctor’s office, they should get the best care possible each and every time. And as the world’s largest insurance program, Medicare has a lot of clout when it leads by example. History has shown that if Medicare can find smarter ways to pay for care, other insurers will copy them, and we’ll all get better results.

Under the new law, Americans will start getting more control over their health care this year. By this fall, it will be easier for seniors to get medicines, easier for families and young adults to get coverage, easier for small businesses to cover their workers, and every American who has health insurance will have more security. If you have any questions or want to see the whole list of first-year benefits, I encourage you to visit our website – healthreform.gov.

What’s going to make these 2010 reforms even more effective is that they’ll build on the significant improvements we made to health care in 2009. This is a story that a lot of people overlooked. But for example, one of the first bills President Obama signed was the CHIP Reauthorization Act. And by the end of last year, we had enrolled 2.6 million previously uninsured kids in CHIP and Medicaid.

Then we passed the Recovery Act, which was a job creation bill first, but was also one of the biggest health innovation bills in American history. Under the Recovery Act, we funded proven, local health and wellness strategies to help give families more healthy choices in their neighborhoods. We expanded Community Health Centers, which now provide high-quality primary care to 19 million Americans a year. We invested in the National Health Service Corps to strengthen our primary care workforce, especially in underserved areas. And we made a historic investment in health information technology, which helps patients fill out fewer forms and doctors deliver better care.

I’ll give you one example of the kind of impact this technology can have: yesterday, I visited Cincinnati Children’s Hospital where they’ve now gone over 1,000 days without a serious safety incident in their Neonatal Intensive Care Unit. And they say a big part of the reason why is electronic health records.

Our goal is to spread these outcomes across the entire country. And today, I’m happy to announce the latest round of these Health IT grants, which will help create 60 Health IT regional extension centers around the country. These centers are going to be like Apple Geniuses for Health IT. If your doctor wants to switch to electronic records, all they have to do is come to one of these centers and they’ll get the expert advice and technical assistance they need to get that system up and running.

When all the progress we made in 2009 is added to this law’s new reforms for 2010, you get a health care system where it’s easier to get coverage, easier to afford care, easier to find a doctor, easier to make healthy choices, and easier to access your own health information. That means a health care system where Americans are going to get a lot more health for their investment.

These changes also create a foundation for 2014 when the biggest elements of this new law kick in. That’s when the health insurance exchanges become operational and tax credits become available for individuals and families to buy insurance. This will be a huge breakthrough for health care consumers. For the first time, the question so many people write to me – “where can I find affordable insurance?” – will have an easy answer for every person in America. Instead of having to visit a dozen different websites and poring through the fine print, there will be a one-stop shop where the benefits for different plans will be clearly listed and easy to compare.

This is the new law. And as America’s Help Desk we want make sure every American knows about the benefits and choices that come out of it. So over the next few months, we’ll be reaching out directly to Americans across the country to make sure they know how to take advantage of it. For example, we’ve already begun to educate seniors about prescription drug assistance. Last week we put out a series of fact sheets that explain step-by-step how small business owners can collect their health care tax credits. And soon, we’ll put out a similar fact sheet for employers who want to take advantage of a new reinsurance program that will help them provide coverage for early retirees.

Every American should bookmark our website healthreform.gov. You can go there to read more fact sheets, get your questions answered, and watch weekly web chats where we take questions live from around the country. We’ll also be working with lots of stakeholder groups to broadcast information about the bill even more widely.

For years, Americans have struggled with a health insurance system that was opaque, unnecessarily confusing, and often overwhelming to navigate. Our goal as we implement this law is to be the opposite of that – to be as clear and transparent as possible. As soon as we know something, we’re going to tell you.

But ultimately, we recognize that actions speak louder than words. No matter how good a job we do educating Americans about the benefits for them in the bill, it won’t be much use unless we also implement those policies responsibly and effectively. As the President has said many times, we need to get this right. And as the letters I get every day make clear, we have no time to waste.

So in the week since President Obama signed this law, we’re already acting. We’ve restructured the Centers for Medicare and Medicaid Services so that it’s better prepared to take on its new responsibilities under health insurance reform. Last Friday, we began working with states to create a new high risk pool program that will help uninsured Americans with pre-existing conditions get coverage. Today, we will send new guidance to Medicare Advantage plans, which includes stronger cost sharing protections for seniors. And later this week, we’ll open new Medicaid options to cover low-income adults.

Unfortunately, scam artists have been moving just as quickly. We’ve already heard reports crooks trying to capitalize on this new law by setting up 1-800 numbers and going door to door trying to sell fraudulent insurance policies. This kind of criminal activity which preys on the Americans who are most vulnerable in our health care system is outrageous. That’s why I sent letters today to State Insurance Commissioners and Attorney Generals asking them to investigate and prosecute these scams.

This kind of communication and collaboration will be the key to making this law work for Americans. Over the next few years, we’ll be working with providers and employers, consumers and seniors to get this law right.

Many of the key reforms will be carried out by the states. As a former Insurance Commissioner, I know how tough and effective state regulators can be. That’s why states will have the option to oversee the development of the insurance exchanges, regulations, and consumer protections. The law provides resources and assistance to states, but when it comes to the specifics, we assume that the people on the ground know best.

As a former Governor, I also understand the budget challenges that states face. And what I’ve said over and over again is that this is actually a very state friendly bill.

It’s true that part of the law makes health care coverage a partnership between the states and the federal government. That expansion starts in 2014. For the following three years, the federal government picks up the entire bill. After that, the states start paying up a share, which rises to ten percent by 2020. So there will be some new costs.

But those costs are balanced by new benefits, including less spending on uncompensated care, savings from reduced insurance paperwork, more resources to cover children, and more money to crack down on fraud and abuse. And that doesn’t even count all the people who will get better care, live healthier lives, and be more productive workers. As a Governor, I can say unequivocally that if you had offered my state this deal, I would have taken it in a heartbeat.

At HHS, we’ll work closely with the states as the lead federal department for implementing this law. So in closing today, I want to share a few of my operating principles for making sure the full benefits of this law reach the American people.

First, as I said earlier, we will be transparent. That doesn’t just mean sharing what we know. It also means making it as convenient as possible for the American people to access that information. For example, today, we’re announcing the release of what we call our Medicare dashboard. This is an online tool that will make it much easier for Americans to search and sort aggregate Medicare data with full protections on patient privacy. Today, we’re making available Medicare’s inpatient hospital spending data, which you’ll be able to sort by state, condition, and hospital. But this is just the first step of many we’ll be taking to give consumers, purchasers and providers the health information they need to make smarter choices.

Second, we’ll make every dollar count. Eliminating waste in our health care system is a key part of this law. It’s also a principle we’re going to apply to every step of implementation. One of the ways we’ll save money is by depending heavily on people and systems that are already in place. Our department already has great talent, resources, and knowledge of the health care system. As we move forward, we’re going to rely on these resources as much as possible as we fulfill our new responsibilities under this law.

Third and most important, we will never lose sight of why we pursued this legislation in the first place, fought so hard for it, and are celebrating it as such a historic accomplishment. Over the last year, I’ve read letter after letter from families and small business owners who feel powerless in the health insurance system we have.

Their premiums go up by 30 or 40 or 50 percent every year and they don’t understand why. They’d argue with their insurance company, but they’re afraid their coverage will get cancelled. They’d switch to another plan, but many of them have a preexisting condition and know they couldn’t get another policy. Even Americans who get good insurance through their job worry. They see more and more of their paycheck being eaten up by rising premiums every year, and they know how quickly the partial security they do have could disappear if they switched jobs or retired.

Our goal is to put these Americans back in charge of their health care. We will provide information and education if it’s needed; set basic guidelines that will help foster a competitive insurance market; serve as an umpire to make sure insurance companies treat Americans fairly; and provide targeted resources to help empower consumers. But ultimately, this isn’t about us. It’s about you. It’s about giving Americans more choices, more security, and more control.

There will be bumps along the way. There will be twists and turns. It will not be easy.

But after decades of standing still, we are finally moving forward.

Source: Original Press Release on the US Dept. of Health and Human Services Website.