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Producing a Healthy Populace on a Budget – Who in the World is Getting the Job Done? Part 3

In Part 1 of this article, I expressed the desire to take an objective view at the health care systems of different nations to see if I could find a good example of a country who was pulling off a healthy population, a high life expectancy, and a quality health care system without breaking the bank.

In Part 2, I discussed the shining example of Singapore in doing just that – Singapore has the 4th highest life expectancy in the world (people live to age 82 on average), has the 6th best health care system, and the government of Singapore spends only 3.7% of its GDP on health care!

In this final section I wished to contrast Singapore, who literally is getting the job done, to that of another part of the world. In this part of the world, government leaders decided that instead of finding a way to focus on having healthy citizens while cutting unnecessary costs, they would instead focus on making sure the entire population had health insurance. Health insurance, they surmised, was the key to the population’s health, as well as the key to keeping down the health care costs for both the government and the citizenry.

What have been the results? Did this government achieve its objective of insuring the masses? And if so, has this brought the desired curb in health care costs? Are the previously uninsured better off now that they have this insurance? Is everyone enjoying the fruits of this initiative?

I am sad to say that this experiment took place in our very own state of Massachusetts, and so far, it doesn’t look good.

According to a March 2, 2009 article in the Boston Globe, healthcare reform in Massachusetts has:

1. Failed to achieve universal coverage (200,000 are still without health insurance),
2. Failed to address the problem of health insurance being tied to ones’ employment,
3. Failed to make health insurance affordable for many citizens (including middle and low-income individuals and families),
4. Failed to shore in costs for the state (healthcare costs for the state of Massachusetts have doubled from $630 million in 2007 to an estimated $1.3 billion for 2009),
5. Failed to assure citizens’ access to healthcare.

A more recent Christian Science article from October 21, 2009 concludes that “a mandate on individuals to buy health insurance can work – just don’t expect it to reduce the cost of care.”

There may be some residents of Massachusetts who are happy with the results of the healthcare reform that have been enacted there, but the problems remain paramount.

If Massachusetts is, at best, no better off for its healthcare reform that has doubled healthcare expenses for the state, then should we not take some heed as our entire nation appears ready to plunge onto a similar course?

Should our main focus as a nation be universal health insurance? Shouldn’t we find a way follow the example of Singapore and focus on:

1. Population wellness through disease prevention,
2. Enacting policies that put more healthcare decisions into the hands of individuals, and fewer into the hands of the government?

In the meantime, I suggest each of us take actions to give us the best chances of having good health — eating a balanced diet low in processed foods and high in minimally-processed plant-based foods, drinking plenty of clean water, getting adequate exercise and sleep, and using low-cost and oftentimes effective holistic means for taking care of problems when they first arise (such as herbs, essential oils, massage, acupuncture, reflexology, etc…), thus potentially using more expensive Western modalities more sparingly as a result.

By Julie Behling

The Reform in Home Health Care

In order to understand the prospective payment system (PPS) for home health agencies (HHA), CMS has put together some easily accessible and useful information, which can be found directly on their website.

Outlier claims are inconsistent throughout the country, with some areas having suspiciously much higher percentages than others. The new 10% cap outlier policy was created to regulate the billing activities that may be in conjunction with the integrity issues that take place within the activities of certain home health agencies.

Though CMS has taken into consideration the needs of those patients who fall into the outlier category, such as those who are diabetic and are insulin dependent, those with CHF, and those who need wound care, there are still concerns as to the determination of the outlier policy’s 10% cap being based on the number of outlier payments in the urban areas compared to the suburban areas. For instance, Los Angeles County in California, one of the concerned cities targeted by CMS, consists of approximately 10 million people. Of this population, approximately 10.5% consists of individuals who are at least 65 years old and over. With such a high population, other factors must also be considered, such as the diversity in all groups, the number of patients who live alone, and various other factors. When compared to other agencies in less populated areas that have outlier dollars below 10 percent of their total payments and are assumed not to be affected by the new outlier policy, the comparison appears to be unfairly considered. More services provided as a result of highly populated areas usually mean that more outlier claims will be billed.

It is no question that fraudulent activity in all areas must be regulated. However, it is also a known fact that organizations, corporations, companies, and individuals are driven through incentives. When a home health agency has to wait 60 days to be paid for services provided, it suffers, along with those who are directly providing the services. Home health has been proven to improve and minimize Medicare costs through the decreased number of hospital visits as a result of services provided by home health professionals. With insufficient amounts of available funds to compensate home health service providers, how are agencies expected to survive?

By Lex Bishop