Illness, medical bills linked to nearly two-thirds of bankruptcies

Medical bankruptcy in the United States, 2007: Results of a national study,” David U. Himmelstein, M.D; Deborah Thorne, Ph.D.; Elizabeth Warren, J.D.; Steffie Woolhandler, M.D., M.P.H. American Journal of Medicine, June 4, 2009 (online). [Full text] [Fact Sheet] [Q&A]

Medical problems contributed to nearly two-thirds (62.1 percent) of all bankruptcies in 2007, according to a study in the August issue of the American Journal of Medicine that will be published online Thursday. The data were collected prior to the current economic downturn and hence likely understate the current burden of financial suffering. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The authors’ previous 2001 findings have been widely cited by policy leaders, including President Obama.

Surprisingly, most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness, including 60.3 percent who had private coverage. Most of the medically bankrupt were solidly middle class before financial disaster hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance. More…

Full text of the study is on-line or through the American Journal of Medicine, ajmmedia@elsevier.com , (212) 633-3944.

Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 – The Commonwealth Fund

Sharon K. Long, Ph.D., and Paul B. Masi, Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008, Health Affairs Web Exclusive, May 28, 2009, w578–w587. Full text.

More than two years after implementation of its landmark health insurance reforms, Massachusetts had achieved historically high levels of coverage and widespread improvements in access to care, according to this study—the latest in a series of updates, funded by the Blue Cross Blue Shield of Massachusetts Foundation, The Commonwealth Fund, and the Robert Wood Johnson Foundation, on implementation of the state’s reforms. The authors find, however, that constraints on provider capacity and rising health care costs—trends that predate reform—have eroded some of the gains. Massachusetts is now seeking ways to contain costs and expand provider capacity, including a proposal to shift from fee-for-service provider payments to global fees that emphasize care coordination and collaboration. More at: Access and Affordability: An Update on Health Reform in Massachusetts, Fall 2008 – The Commonwealth Fund.

JAMA | Regulating the Safety of Pharmaceuticals: The FDA, Preemption, and the Public’s Health, May 20, 2009, Gostin 301 (19): 2036

Lawrence O. Gostin, JD. Regulating the Safety of Pharmaceuticals:  The FDA, Preemption, and the Public’s Health. JAMA. 2009;301(19):2036-2037.

In 2008, the US Supreme Court held that the Medical Device Amendments (MDA) bar common law claims challenging the safety or effectiveness of a medical device approved by the US Food and Drug Administration (FDA).1 Riegel v Medtronic Inc2 had broad implications for patient safety because it removed all means of judicial recourse for most consumers injured by defective medical devices. At that time, the Supreme Court agreed to hear Wyeth v Levine,3 which consumer safety advocates feared would similarly preempt pharmaceutical lawsuits with far-reaching effects. There are 11 000 FDA-regulated drugs, with nearly 100 more approved each year,4 and patients would have no safety net in the event the FDA fails to detect and correct safety hazards. In a recent 6-3 decision, the Supreme Court ruled that the FDA’s approval of a drug label does not preempt a state law product liability claim charging the . . . [Full Text].  Source: JAMA — Regulating the Safety of Pharmaceuticals: The FDA, Preemption, and the Public’s Health, May 20, 2009, Gostin 301 (19): 2036.

Health Affairs Web | What Does It Cost Physician Practices To Interact With Health Insurance Plans?

Julie Ann Sakowski, Jeffrey M. Newman, James G. Kahn, Richard G. Kronick, and Harold S. Luft. Peering Into The Black Box: Billing And Insurance Activities In A Medical Group. Health Affairs Web Exclusive, May 14, 2009. [Abstract] [PDF] [Full Text]

Billing and insurance-related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician. In addition, clinicians spent more than thirty-five minutes per day performing these tasks. The cost to medical groups, including clinicians’ time, was at least $85,276 per FTE physician (10 percent of revenue).

Health Affairs Web | Peering Into The Black Box: Billing And Insurance Activities In A Medical Group

Lawrence P. Casalino, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, Theodore Karrison, and Wendy Levinson. What Does It Cost Physician Practices To Interact With Health Insurance Plans? Health Affairs Web Exclusive, May 14, 2009. [Abstract] [PDF] [Full Text][Supplemental Exhibits & Appendix]

Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year.

Health Affairs | Mental Health Is Focus Of Newest Issue

Many more people are using mental health services and U.S. mental health spending rose 65 percent in the past decade, but there is still a disturbingly large gap between access to care and quality of mental health care received. These are some of the findings discussed in the May/June issue of Health Affairs — Mental Health Care: Better, Not Best – released on Tuesday, May 5.

The issue explores key aspects of U.S. mental health care including the latest mental health care trends, comparative effectiveness research in mental health treatment, barriers facing veterans in need of mental health services, and supported employment as a means of helping Social Security disability program recipients with psychiatric disabilities earn incomes. Source:  Health Affairs Blog by Chris Fleming.