On Jan 1st, Medicaid expanded its coverage eligibility across 25 states and DC. The expansion has reformed the program from a last-resort healthcare option towards providing broad based access to a new and more diverse set of individuals. However, the expansion will bring with it multiple obstacles for healthcare professionals throughout the near future.
It was announced in January by the World Health Organization, in conjunction with theWorld Palliative Care Association, that a resolution to expand Palliative Care access throughout the world will be confirmed at theWorld Health Assembly in May.
The proposal would do more than just expand access to such treatments; it could also be critical in lowering spending & costs across global healthcare systems. By determining patient preferences in their treatments and coordinating care effectively, many healthcare systems could reduce the number of unnecessary readmissions, treatments, and diagnoses.
How? Because Palliative Care offers more than just pain relief. It is patient-centered and can often address physical, psychosocial and emotional suffering for many patients and their families fighting serious illnesses. The problem is, palliative care is only readily-available in wealthier countries and is normally administered to the elderly.
Barriers Restricting Access to Palliative Care
Currently, there are an estimated 40 million people worldwide requiring palliative care treatments. 50% of those individuals are elderly patients seeking end-of-life care, while 6% are children. The more alarming fact, however, is that 6.5 million of these patients will die without ever receiving the palliative care treatments they require.
The resolution proposed by the WPCA is seen as a way to drastically reduce these numbers, specifically by expanding access to lower- and middle-class individuals worldwide. A WPCA Spokesman stated, “Our efforts to expand palliative care need to focus on bringing relief of suffering and the benefits of palliative care to those with the least resources.”
Today, only 20 countries offer sufficient palliative care access through their healthcare systems – Australia, Austria, Belgium, Canada, France, Germany, Hong Kong, Iceland, Ireland, Italy, Japan, Norway, Poland, Romania, Singapore, Sweden, Switzerland, Uganda, United Kingdom, United States of America.
Furthermore, a 2011 study by the WPCA found that 74% of countries have no palliative care services or their services reach only a small percentage of the population, while only 3 Million people actually received the care they required.
This is a result of multiple barriers restricting the delivery of palliative care services and treatments. Some of these include:
- Lack of clearly defined regulations and policies promoting access to palliative care for various age groups and patient types.
- Lack of palliative care education amongst healthcare professionals and the public.
- Lack of access to resources for palliative care providers and national healthcare systems.
- The misconception of associating palliative care with elderly patients and hospice care.
Implementing a Resolution
The WPCA hopes to break these barriers by urging those countries with poor palliative care services to expand access to pain medicines and treatments for life-threatening illnesses. The pain associated with such illnesses can be treated with relatively inexpensive medicines.
Additionally, an increase in technical assistance and training of healthcare workers, under the supervision of the WHO & WPCA could dramatically decrease the amount of unnecessary treatments issued to patients that are not only seeking pain relief.
The proposed resolution is built around effective integration of palliative care amongst national health systems, and could also encourage more patient-centered care while avoiding aggressive or costly treatments.
It has been drafted under the leadership of Panama and co-sponsored by Albania, Australia, Brazil, Chile, Colombia, Ecuador, Ghana, Japan, Lebanon, Libya, Kazakhstan, Malaysia, the Maldives, Mexico, Nigeria, Panama, South Africa, Spain, Switzerland, Turkey, Ukraine, Uruguay, and the US.
As for now, we must wait until May to see where the next step lies ahead for Palliative Care services across the globe.
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Medical tourism is a hot topic these days. Providers and payers worldwide both see multiple benefits in offering or arranging medical treatments across borders - however it’s the patient’s demand for better quality at lower costs that continue to drive medical tourism’s growing popularity. As a result, many domestic medical providers have begun to lose patients and ultimately revenue and market share.
Corporate-Sponsored Medical Tourism VS International Medical Tourism
Recently, a team of UK-based researchers looked further into the feasibility behind “International Medical Tourism” and just how cost-effective it really is. There research revealed three underlying myths associated with the idea of medical tourism:
- The number of patients who seek treatment through medical tourism is rapidly rising;
- National governments play a large role in stimulating medical tourism through high-tech investments; and
- Opportunities for growth into the medical tourism sector are restricted to international services only.
Furthermore, most of the data surrounding medical tourism has been captured and encouraged by already-interested parties.
On the flip-side, for healthcare parties that may lose revenue and market share to international medical tourism, an alternate offering exists – Corporate-Sponsored Medical Tourism.
What is Corporate-Sponsored Medical Tourism?
Corporate-Sponsored Medical Tourism works very similar to a hospital-system that is utilized only by a contracted employer and its employees. A group of participating providers will partner together in conjunction with the employer to form an Employer Center of Excellence Network and agree to a fixed fee or bundled payment for the entire episode of care.
For the patient, or employee, they no longer have to worry about out-of-pocket costs, transportation to and from facilities, and an accompanying caregiver. Patients and employees living in rural areas can gain access to quality medical facilities that may traditionally be viewed as out-of-network or out-of-area.
For the employer, immediate savings may come in the form of cheaper treatments, but they’ll see greater savings in the long-run through the reduction of hospital-incurred infections or complications; unnecessary revisions and diagnosis; and employees getting back to work quicker than anticipated.
While the benefits for employers and their employees can be easily measured, corporate-sponsored medical tourism is touted to have an even bigger effect on achieving the overall goal of healthcare reform – transparency & price.
The idea behind this corporate-sponsored form of medical tourism and essentially payment reform is to better mold the current healthcare landscape to the needs of small, medium and large employers. Corporate-sponsored medical tourism could generate new forms of competition allowing regional providers to compete with the larger health systems that have begun to emerge.
The system seeks to further its impact by aligning itself with medical centers that offer specialty treatments. Through such a system, employers or groups of multiple employers can manage the relationships amongst their own hand-picked, contracted network of providers, monitor cost and behavior drivers, and ultimately create a transparent healthcare system.
Corporate-sponsored medical tourism is becoming a very popular alternative to traditional PPOs and is saving large national companies, such as Lowes and Walmart, money that would originally have been spent on out-of-network costs or even sending its employees across borders to seek care.
To learn more about how corporate-sponsored medical tourism can help your business, or if you’d like to hear about PayerFusion’s alternatives to traditional PPOs, subscribe to our monthly Health Insights newsletter here.
Emergency room visits and treatment account for approximately 2% of all US Healthcare spending. In an age where cost means everything and subsidized healthcare has become the nation’s crutch, this becomes an alarming figure. While ER visits have risen between 1995 and present day by almost 30%, more concern should be shifted towards the fact that a large amount of these visits are preventable. Preventable ER visits total approximately $14 billion USD a year.
As of Jan. 1, 2014, the key provisions of the new health law, the Patient Protection & Affordable Care Act went into effect.
The law has already altered the current healthcare landscape and established a number of new benefits available to Americans. Under the health law, specific ramifications for consumers, state officials, employers and healthcare providers will act towards addressing the affordability, quality and accessibility of healthcare nationwide. The current process for attaining care, coverage and paying for it has also been modified – but has received criticism from insurance companies and certain sectors of the federal government.
Below are a series of FAQs for individual consumers concerned with how the new health law will affect them as of Jan 1. 2014.
Will I have to buy health insurance? What happens if I don’t?
Under the health law’s Individual Mandate, all individuals are required to enroll in a health insurance plan by March 31. Those who fail to do so are subject to a tax penalty. For individual plans, that penalty begins at $95 or up to 1% of household income, and will rise to $695 or 2.5% of household income by 2016. For family plans, the penalty begins at $285 or 1% of household income and will grow to $2,085 or 2.5% of household income in 2016.
However, those individuals and families whose current plans were cancelled due to failing to meet PPACA requirements will be exempt from the penalty under an expanded Hardship Exemption. The health laws Hardship Exemption originally only allowed those who could not afford healthcare coverage to purchase “catastrophic” coverage with lower premiums and higher deductibles.
Where and how can I purchase my health insurance?
Accompanying the Health Law is the introduction of the Individual and Group Marketplaces. These are accessible via phone or online at HealthCare.gov. Consumers can shop insurance options and purchase coverage via State run or Federally run Health Insurance Exchanges. Coverage can also be purchased via paper applications, over the phone, through brokers or insurance companies directly.
Consumers can learn more about their coverage options, which plan may best suit them and other questions they have by contacting the newly introduced Healthcare Navigators program. Navigators will be positioned in communities nationwide to assist individuals with any issues they may have in signing up for coverage. There are also a variety of sites that offer educational information regarding signing up for healthcare.
If I currently get my health coverage at work, can I keep my current plan? How will the health law affect my current plan?
Individuals can keep their employee-sponsored insurance plans. However, the health law has altered a number of the regulations surrounding such plans such as adjusting the age for children covered on an employees plan to 26 and banning lifetime limits.
What are the key provisions that will take effect this year?
The new health law put a number of key provisions into place as of Jan. 1. These include:
Individual Mandate – All US individuals are required to have healthcare coverage either through Medicare & Medicaid, the Individual Health Insurance Marketplace, or through employer-sponsored plans. Failure to do so will result in penalties. Individuals who cannot afford the plans offered on the marketplace and do not qualify for Medicare or Medicaid are eligible for a Hardship Exemption and can purchase “catastrophic” coverage.
Denial of Coverage – Insurers are no longer to deny an individual or their dependents coverage based on a pre-existing medical condition.
Annual Limits – Insurers are banned from placing annual limits on medical coverage of a pre-determined set of essential health benefits, including prescription drugs and hospitalization.
Essential Health Benefits, Preventative Services & Mental Health Parity – Under the new health law, insurers are required to offer a set of 10 benefits to consumers in across all of their available plans. They must also offer preventative services such as breast cancer screenings and cholesterol tests with no out-of-pocket costs. Furthermore, the addition of the Mental Health Parity to the law requires plans to cover mental health services amongst the Essential Health Benefits.
Rescission – Insurers are also restricted from canceling your coverage prior to falling sick – unless there are legal or fraudulent issues present at the time of application.
Insurer Rebates – Insurers are required to issue rebates to consumers who have used less than 80%-85% of their premium dollars on medical care.
Grandfathered Plans – Coverage under existing plans prior to the health laws introduction are exempt from certain parts of the law, only if the plan has not significantly changed.
Will my Health Insurance be more or less expensive under the health law?
The price of Health Insurance on the state and federal exchanges will vary according to the individual. Most premium prices will be determined by age, household income, and the plans available on the exchange.
It is expected that younger people will see more expensive premiums to balance the risk pool and counter the healthcare expenses of the older and sicker individuals.
What should I do if I can’t afford health insurance?
For individuals whom can’t afford health insurance, many will be eligible to receive coverage through Medicaid. The health law expanded the eligibility requirements for Medicaid to anyone with an income at lower than 138% of the federal poverty line. However, individual states are not required to make the expansion. 25 states including DC have chosen to expand Medicaid.
What if I do not qualify for Medicaid but still can’t afford health insurance?
Individuals who are ineligible for Medicaid can still qualify for government subsidies towards private insurance offered through the Health Insurance Exchanges. For individuals who fail in the threshold of not qualifying for Medicaid or federal subsidies they will be exempt from the individual mandate.
For further information on the changes to healthcare under the new health law, the PPACA, that may affect you as an individual, please feel free to subscribe to our monthly Health Insights newsletter here. Or you can find more articles, white papers and infographics regarding the new health law by reading our blog here.