Bad Medicine: Is Your Insurance Company Hazardous to Your Health?
Infuriated by a deteriorating economy and blatant abuse of American taxpayers, the public is taking a strong stand to prevent banking executives from getting away with fiscal robbery. What many have failed to realize is that another industry — the health insurance industry — is getting away with murder, perhaps literally, by putting their bottom lines above your welfare, and this time it could be hazardous to your health.
Across the health care community from doctors to pharmaceutical companies to hospital organizations, steps have been taken to implement ethical standards. Codes of conduct are hardly a new idea. Most are self-imposed by professional organizations or trade groups on their members, often in an effort to voluntarily level up their members’ general behavior, especially in the wake of legal or political scrutiny. For example, the pharmaceutical industry substantially revised its code governing interactions with health care professionals after public and professional criticism. Managed care organizations, however, are the only remaining hold-outs that have not adopted a Code of Conduct, leaving them highly unsupervised. Sadly, the very companies Americans often think help pay their bills are undercutting the quality of American health care in their pursuit of a fatter bottom line.
The game works like this: Health insurers’ profits increase as outlays for patient costs decrease. One such way to keep patient costs down is by prescribing generic drugs over name-brand drugs. In a practice known as drug switching, patients are switched from more expensive, name-brand drugs to generics, even if the name-brand drug was working and the patient experienced no negative side effects.
Managed care companies go to great lengths to make sure the switch appears innocent — a doctor is trying to help a patient reduce his or her medical expenses, and therefore recommends the generic. However, behind the closed doors of invite-only dinners and receptions hosted by managed care organizations, many doctors are lured into drug switching programs that offer attractive fiscal incentives, and there is no mechanism in place to regulate these practices.
Doctors are paying the price as well. In a survey done by the Toledo Blade last year among Ohio doctors, ninety-five percent of respondents said insurers interfered with decisions about prescriptions, 91 percent with testing, 74 percent with referrals, and 69 percent with hospitalization decisions. Eighty-six percent said interference compromised patient care, 76 percent said it adversely affected their patients, and 65 percent said they were unable to successfully protest denials. Most shockingly, 14 percent believed interference from an insurer had contributed to the death or serious injury of a patient.
This prompted a response from our now President:
“I am deeply troubled by The Blade’s report of how insurance companies, not doctors and nurses, are making decisions about patient care,” said Senator Barack Obama in a statement to The Blade. “Medical decisions should be made based on what’s good for your health, not what’s good for an insurance company’s bottom line.”
As managed care organizations seek to maximize profits and survive the economic downturn, the public can likely expect increasing use of cost-driven practices. These aggressive tactics must stop, and a comprehensive Health Insurer Code of Conduct must be implemented by which managed care organizations agree to abide by ethical standards such as transparency, clinical autonomy and, most importantly, patient safety and welfare.
The best Rx for every American is access to quality health care and medicine. It’s time to ensure the health insurance industry puts your safety before profits.
For more information about the National Health Insurer Code of Conduct go to: www.insurepatientaccess.org.
Fox News Health Tips:
- Know your medicines. Talk to your doctor about your prescriptions. Are they generics or brand names? What are they supposed to do? Are there less-expensive options? What are the risks and benefits of taking the drug?
- Be on guard. If anyone wants to switch your prescription, ask why. Will the new drug interact with existing medications?
- Appeal. With your doctor’s help, use your health plan’s appeals process to seek coverage for your desired medication.
Tags: Americans, benefits, costs, doctors, drug companies, economy, fiscal incentives, generics, health care, health plan, hospital organizations, insurance companies, managed care, medicine, National Health Insurer Code of Conduct, patients, pharmaceutical companies, politics, President Barack Obama, report, taxpayers, Toledo Blade, transparency
Share
The HMO’s not only control drugs but cut the type of test given. This decision is made by a “Medical Spec” who might be a RN at best, or a account Mgr who has the title of Med Assistant. The HMO’s also show the cost of the test and drug BEFORE the Hosp does the Discount or the assignment to a Auth Drug store. I’am sure that there are other cut they make without notifing anyone.
As part of any reform, I think prescription Part D coverage needs to be revamped. The so called donut hole needs to be closed. It is not very practical.
What do you do when it doesn’t matter if they give you generic or original? What do you do when the insurance refuses to pay for the medication period? Due to “cut backs”!! My husband has Gran mal seizures and is on SSD. About three months ago they decided they were no longer going to pay for his medicine. Claiming it was too expensive and refused. We’ve tried using the online sites that say they can get your meds for free or cheap!! PPBBTTSSS!!! Fooie! They still go by your credit and your income. Sorry to inform you but ours sux really bad.
I could go on venting but I won’t. It’s frustrating! Thanx for allowing my venting!
I know first hand what insurance company interference can do, their interference almost crippled me. I had to have two spine surgeries, and two more was recommended due to a insurance nurse who would only allow the doctor to fix one disc at a time instead of allowing him to fix them all while he was in there.
Joan
India is a good example of regulation of prices for Pharma products…But still some of them do get away
As managed care organizations seek to maximize profits and survive the economic downturn, the public can likely expect increasing use of cost-driven practices. These aggressive tactics must stop, and a comprehensive Health Insurer Code of Conduct must be implemented by which managed care organizations agree to abide by ethical standards such as transparency, clinical autonomy and, most importantly, patient safety and welfare.
The world may need to look into India for a good example for regulating Pharma Companies!!! Its a tight system for prices regualtion for Pharma essentials
I also think that we cannot over regulate to the point that we hurt innovation. Pharma companies spend millions to bring advanced therapies to market and if you don’t reward that with potential profits, then why would anyone develop anything with financial risk?
As a practicing physician, I have been very frustrated with managed are and HMOs, which are not nearly as popular today as they were years ago. Sure, they were aggressive to control costs. However, something has to be done to eliminate unnecessary and wasteful medical care in this country. I do not argue this primarily as a cost control effort, but as a strategy to improve medical quality. Excessive care leads to more care and interventions, which can cause medical complications. In addition, may unnecessary tests find trivial ‘abnormalties’, which then starts a medical roller coaster ride that tortures patients and their families. Much more on this at http://www.MDWhistleblower.blogspot.com
I agree with the last comment (by practicing physician). As a Risk and Quality Management Director I would like to point out, that the primary drivers behind the ballooning costs of health care are our litigious culture (which translates to cover your ass test for/treat everything with a drug medicine) and the fact that insurance does not pay for preventive medicine as well as it does for reactive medicine.
Proven screening and disease prevention strategies are not cost effective for physicians in this country to order or provide. They are time consuming and seeing ten people in one afternoon nets more revenue than seeing four. Reimbursement for a 1 hour office visit for “routine care” is the same as that for a 10 minute visit for the same. We could do a lot to reduce the costs of health care if we reduced the need/demand for aspects of it that are the most expensive; those that result from the undetected progression of preventable/manageable illnesses before they become critical or need expensive intervention.
The need for people to pay more out of pocket for preventive care means that it is not economically accessible to all not even to many who are fortunate to be able to afford to be insured.
and remember this … to follow….
Every hour in the US 11 people will die in hospital because of a preventable medical error. Every hour 5 people will die as a result of a car accident. It is more than twice as dangerous to be a patient requiring acute care in this country than it is to share the highways with drunk drivers, speeders those who make deliberate choices to neglect car maintenance, drive tired or drive distracted. (source CDC statistics extrapolated from 1999 IOM report to err is human)
As a healthcare provider with 30 year experience, the last decade dealing with risk and quality in acute care I can tell you without hesitation, that very few medical errors are a result of the kind of deliberately reckless or negligent choices that cause the majority of car accidents that occur.
@ 1.5 of every 100 acute care hospital admissions are a result of an adverse medication effect most often due to inadequate patient education, and then next due to over prescribing of unnecessary medicines. As many as 17 % of these unfortunate people will die as a result. Considering the millions of people who require an acute care admission every year, the nearly 100,000’s of thousands of people who are affected is staggering.
For every $1.00 spent on medicines, $1.33 is spent rescuing people from recognized adverse effects of drugs and drug interactions. Fewer than 10% of adverse medications are recognized for what they are.