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Biotech / Medical : HRC HEALTHSOUTH -- Ignore unavailable to you. Want to Upgrade?

To: Tunica Albuginea who wrote (69)	1/2/2000 1:12:00 AM
From: Night Writer	Read Replies (1) \| Respond to of 181

TA, Most large employers are self insured for employee medical care. They might buy insurance for catastrophic medical care. The HMO, MCO, or health insurance company acts as a Third Party Administrator (TPA) for a fee. The employer determines what is covered and what isn't covered. They hide behind the TPA and let them take the heat. The lawyers are getting smart. Smaller employers do buy insurance. Price is a big issue for small businesses. They often can't afford the first class coverage they would like to buy. Health Care expense is a big problem. I hope some one comes up with a real solution. NW

To: Tunica Albuginea who wrote (69)	1/29/2000 12:27:00 AM
From: Tunica Albuginea	Respond to of 181

Canadian Medicineÿ Isn't Cheap or Effectiveÿ interactive.wsj.com ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Memo to Al Gore: ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Canadian Medicine ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Isn't Cheap or Effective ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ By William McArthur, M.D., former chief coroner for British ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Columbia. He is a palliative care physician and senior ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ fellow in health policy studies at the Fraser Institute. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ It is obvious by now that Bill Clinton and Al Gore ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ intend to make health care a big issue in this year's ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ presidential race. My country, Canada, has been cited ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ often as a health-care model for the U.S. by virtue of the ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ availability of "free" care and low-cost pharmaceuticals. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Yet it would be a costly and tragic error for American ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ seniors to conclude that they would be better served by ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Canadian-style health care or for American legislators to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ assume that they can selectively opt for price controls on ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pharmaceuticals without damage to health-care quality. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The Organization for Economic Cooperation and ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Development (OECD), which does comparative ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ economic research for its 29 member countries, recently ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ noted that disability-free life expectancy for female ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Canadians had fallen to 63.8 years in 1991 from 66.1 ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ years in 1978. Could this reflect the fact that Canadians ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ are increasingly denied health care by long waiting lists ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ for most medical and surgical procedures? ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ At a median level, Canadians wait six weeks to see a ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ specialist after their family doctors ask for the ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ consultation. Having seen the specialist they will wait a ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ further seven weeks before treatment is provided. In ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ between, they will wait for tests, most of which rely on ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ technology that is limited in supply. The median wait for ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ magnetic resonance imaging is 11 weeks; five weeks for ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ a CAT scan. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ It used to be claimed that waiting times did not impair ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ patients' health. Now, Toronto-area hospitals, reflecting ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ legal concerns about lawsuits, ask patients to sign a legal ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ release accepting that while delays in their access to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ treatment may have jeopardized their health they ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ nevertheless hold the hospital blameless. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Meanwhile, a survey of technology availability by the ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ OECD and the Fraser Institute shows that Canada ranks ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 21st in availability of CT scanners, 19th in availability ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of MRIs, sixth in availability of cancer radiation ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ machines, while ranking fifth in terms of overall ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ spending on health care. A survey of teaching hospitals ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in British Columbia, Washington state and Oregon ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ revealed that at least 18 surgical and diagnostic ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ procedures readily available in the U.S. are unavailable ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in Canada. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Canadians over the age of 65 use health care at four ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ times the rate of those under 65 and thus are more ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ exposed to the deficiencies. Moreover, the treatments ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ elders need most often are the ones where the worst ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ shortages exist. According to the Fraser Institute's annual ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ survey of hospital waiting lists, the median patient waits ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 70% longer than is medically reasonable, in the view of ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ their physicians. Waits for cardiac surgery are 145% ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ longer than medically reasonable, 90% longer for ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ orthopedics (hips and knees) and 75% longer for ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ophthalmologic (cataracts and lens replacement) surgery. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ American politicians often claim that the Canadian ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care system controls costs. It controls some costs ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ but certainly not wage costs. The average Canadian ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospital spends about 80% of its budget on labor ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ compared to 55% in a typical U.S. hospital. That's what ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ happens when you have a single, politicized purchaser of ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ labor services. A recent comparison of wages for ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ unionized hospital employees and for unionized workers ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ at private hotels found that hospital grounds keepers ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ were paid 40% more, hospital painters 63.3% more and ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospital cooks 28.9% more. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Where costs are minimized, it is often at the expense of ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ patient access and comfort. As part of this model, all ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ provinces subsidize pharmaceuticals for seniors. As is ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ typical in such cases, the provinces have sought to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ contain budget outlays by applying vigorous cost ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ containment to pharmaceutical suppliers. Savings have ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ been claimed, but at the expense of the elderly. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Because of these price controls, Naderite organizations ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in the U.S. have been backing bus trips to Quebec to buy ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ drugs for seniors in New York and New England. But ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ few Americans know how they would be treated if they ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ were residents of Quebec. A National Post article in ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ 1998 claimed that a government study--not made ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ public--had catalogued deaths in Quebec resulting from ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the lack of availability of lifesaving drugs. Efforts to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ reduce spending on pharmaceuticals doesn't take account ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of the fact that drugs are often the cheapest, most ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ cost-effective way of treating many ailments. Nor do ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ they acknowledge that government spending on drugs is ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ less than 5% of the total health-care budget. Efforts to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ control drug costs also mean that many drugs available ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in the U.S. and Europe are delayed entry to the Canadian ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ market. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ All provinces require that when chemically identical and ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ cheaper generic drugs are available that they be ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ substituted for more expensive brand-name products. No ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ one quarrels with this unless, as in British Columbia, ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ newer and more effective drugs are replaced with older, ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ chemically different agents that produce changed effects. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ A 64-year-old male patient of mine had serious peptic ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ulcers controlled for more than five years with a drug ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ called omeprazole. The government required that he be ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ switched to an older, less effective drug. Within three ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ days he required hospitalization and a lifesaving blood ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ transfusion. It took 10 days and several transfusions to ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ stabilize his condition and he was, after huge needless ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ expense, discharged on omeprazole, the drug that he had ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ been on in the first place. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The extent to which my patient's experience is ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ generalized is not yet known but is currently the object of ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ careful study at the Fraser Institute. Similar "cost ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ control" experiences have produced great increases in ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ the costs of U.S. HMOs. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The experience that Canada has had with government ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ oversight of its health-care system suggests that a ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ narrow-minded focus on the cost of particular aspects of ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health care produces unanticipated consequences that ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ directly affect the health status of populations. The fact ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ that some drugs can, for the short term, be secured more ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ cheaply in Canada does not mean that the American ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pharmaceutical policy should be shaped in our image. ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ That some changes are necessary cannot be denied, but ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ they should be made slowly, carefully and in the context ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of a primary concern for patients' health, not some ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ short-term price discounts. As too many Canadians have ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ discovered, you get what you pay for--or somewhat less.