News & Trends

April 9, 2003

Center for Studying Health System Change report on consumer's seeking health information, low wage earners have less access to health care coverage, and HMO appeals

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Jump to:Choose article section...THREE STRIKES AGAINST COVERAGE FOR LOW WAGE EARNERSWHY MOST HMO APPEALS DON'T MAKE NEWS

The buzz in health care would put consumers in the driver's seat, but a new study from the Center for Studying Health System Change says that most of them are staying off the information superhighway. Belying the image of consumers as avid net surfers, CHS reports that in 2001, nearly two-thirds of Americans did not seek health information from any source other than their doctors. Among the 38 percent — 72 million people — who turned to other sources, books, magazines, friends, and relatives were more popular than the Internet, which was used by only 16 percent of adults.

Even among those with chronic conditions, fewer than half sought extra information, according to HSC's 2000-01 Community Tracking Study Household Survey. Women, younger consumers and those with higher incomes and more formal education are most likely to broaden their search for information.

Advocates of consumer-directed health plans and patient-centered medicine would do well to heed HSC's warning: "Significant challenges lie ahead in educating consumers about trade-offs among the cost, quality and accessibility of care."

Health care costs surpassed budget expectations in 2002 for almost half of all employers surveyed in a new Watson Wyatt/WBGH survey. With costs projected to rise another 15 percent this year, expect fewer employers to absorb the increases — 32 percent sucked it up in 2002 versus 52 percent back in 2000. (COMING SOON: A B&H feature article on tactics that kept some employers under budget.)

THREE STRIKES AGAINST COVERAGE FOR LOW WAGE EARNERS

It's well known that low-income workers often have difficulty paying their share of premiums when health insurance is available, but money isn't the only barrier, according to a new report from The Commonwealth Fund. Only 65 percent of those earning less than $10 an hour work in firms that offer health insurance coverage, compared with 88 percent of those earning over $15 an hour.

Employees of small companies are particularly unlikely to have job-based coverage, but low-wage workers in firms of all sizes have less access than their higher-wage coworkers. Many are blocked by eligibility requirements that they work a certain number of hours per week or be permanent, rather than temporary or contract employees.

Consider low-wage workers in large firms: 85 percent work for companies that offer coverage, but only 69 percent are eligible. In contrast, 97 percent of higher-wage workers in larger firms are offered coverage and 96 percent are eligible. Getting back to the money issue, only 46 percent of low-wage workers in larger firms take up proffered coverage.

Employers violating worker safety and health standards face tougher enforcement from OSHA. Employers who've received "high gravity" citations can expect extra inspections, bad publicity and court actions.

WHY MOST HMO APPEALS DON'T MAKE NEWS

Fewer than 4 out of 10 disputes between patients and their HMOs actually deal with issues of medical necessity, and they usually don't involve the life-or-death dilemmas that make tabloid headlines, says a new RAND study. RAND researchers found that the majority of pre-service appeals center around the scope of coverage or a patient's right to receive care from an out-of-network provider. Patients won more than half the medical necessity appeals, many of which concerned elective procedures — including varicose vein removal and scar treatments — instead of life-saving care.

Most of these appeals were requests for coverage on speech therapy, physical therapy, dental care, alternative medicine treatments, foot orthotics, investigational therapies and infertility treatments. Considering the low percentage of appeals concerning medical necessity, the research suggests that many can be avoided with clearer advance communication to enrollees about exactly what conditions are covered.

Just two years of being uninsured can have a serious affect on the health of a middle-aged adult, according to a recent study supported by the Agency for Healthcare Research and Quality. People in their 50s who lost insurance had almost twice the risk for a major health decline as those who were covered.

 

 



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