Physician Patient

Archive for the ‘Message from the President’ Category

Health Care Competition In Minnesota – Missing In Action

Sunday, August 21st, 2016

Re: http://www.startribune.com/fears-for-competition-grow-on-exchanges/390741181/

Blue Cross/Blue Shield of MN is exiting all but its HMO product on a floundering MNsure public insurance exchange causing anxious concern for many rural-dwelling Minnesotans dependent on BCBSM. And, large insurance conglomerates such as UnitedHealthcare, Humana and Aetna are dropping offerings on the ACA (Obamacare) insurance exchanges nationally.

What impact do these developments have on care and insurance options for patients and potential patients (consumers) in Minnesota? For the cost of their health care insurance in 2017? On competition between clinics and doctors for their loyalty? And, competition for dollars among Minnesota insurance companies?

It depends on your point of view. Obviously the only way to find a low cost, best value health care procedure or select an insurance policy is to compare prices and benefits. But that is neither the rule or the goal in Minnesota. There are incentives and (designed) barriers to real cost transparency for the purchasers of medical care and health care insurance coverage in Minnesota. The messages and warnings from our health plans and government authorities are mixed, and we are warned about the consequences of working for true price disclosure to Minnesota citizens.

Hospital costs are so amazingly complex, bundled, and difficult to tease out that it’s impossible for a potential patient (consumer) to know in advance or even retrospectively the answer to the simple but essential question “What does this cost?”

For outpatient procedures, which theoretically are easier to price and evaluate, we should be able to shop for imaging, outpatient surgical procedures, and professional relationships. We need a market for HSA-insurance linkages which encourage consumers to shop for value as they determine this to be. See http://www.cnn.com/2009/HEALTH/09/10/health.care.price.comparison/index.html

Shopping based on knowing the price of a medical procedure or visit becomes irrelevant if there are very few competitors who are available in business offering real options for consumers. We have seen a dramatic decline of independent, entrepreneurial private medical practices in Minnesota. In 2016 most Minnesota physicians are employees of hospital-clinic organizations which are governed by (secret) provider network contracts with insurance companies which actually determine the financial terms of engagement for patients.

Some policymakers and analysts call for more health care data and more analysis. First it is apparent that we need a hard-nosed cost-effectiveness analysis of our massive and expensive Minnesota all claims data base (ACDB). What value is the ACDB to consumers (patients and potential patients)? How is it used now by private and government purchasers of health care and insurance products? Who pays for, collects, and analyzes all this big data now? And what do we need to analyze?http://www.health.state.mn.us/healthreform/allpayer/use_of_apcd_fact_sheet.pdf

Minnesota’s health plans do not want public price disclosure for services or insurance claiming they will lose money if there is public knowledge of the finances in contracts they write with network providers (clinics) or the insurance products they offer. They are selling pre-paid medical care and the health plans claim that public knowledge of their business dealings with government and other purchasers will result in higher health care prices. This is adverse selection they claim. People will choose the richest health plan they can get paid for with someone else’s money rather than choosing the lowest cost health plan that meet their needs for specific benefits and protections.

Our current state of affairs confirms four facts: 1. Health care insurance in Minnesota does not operate in a competitive, consumer-directed marketplace. 2. Health plans which are selling pre-paid benefits must raise their prices and/or shift costs to patients and families. 3 There is little likelihood of competition for patients between health care providers or health plans until Minnesota citizens are given incentives to make prudent health care decisions (skin in the game). 4. Minnesota is spending a lot of time, money and analytic effort collecting a lot of expensive data to keep things as they are.

Placebos Work: So who should pay the doctor and for what?

Tuesday, July 19th, 2016

http://www.wsj.com/articles/why-placebos-really-work-the-latest-science-1468863413

Yes, they do. And we’ve known this (scientifically) for a while. We’re now learning that placebos work by the same biological pathways as do medications which are approved by the FDA for specified diseases.

The placebo effect is a mighty and mysterious force in clinical medicine. Its power and importance supports stepped up advocacy for (trusting) doctor-patient relationships which are governed by the doctor’s Hippocratic Ethics. We need the doctor-patient relationship controlled by the patient to be honored and enhanced in government and private health care debates.

Attempting to describe the placebo effect scientifically as “mental” (i.e. due to suggestion, authority, or shamanism) begs the question of its physiological mechanisms and the actual contingencies of reinforcement for the patient and doctor. (This question also applies to the power of prayer and measuring the consequences of charismatic leadership on our human behavior).

It’s no surprise that researchers are showing that placebos cause neurobiological effects on the brain and the body’s immune system. This is predicted by The Law of Effect (Edward Thorndike http://psychology.wikia.com/wiki/Law_of_Effect) via operant conditioning proven in nonhuman and human subjects: B = f(x) under c. Where B = behavior and x = consequences (reinforcers) under specified conditions (c).

It is also no surprise that many Minnesota parents whose children suffer from uncontrolled seizures or patients with intractable pain want access to (medical) cannabis, despite absence of studies showing marijuana’s effectiveness in mitigating seizures or pain and plenty of good evidence for its potential for addiction (Is cannabis a suitable substitute for opioids, or is it not?).

When personal testimonies prevail, who pays the doctor and for what?