Trotsky

May 16 2014, 12:32 PM

Oh, there will be caterwauling as the administration tries to keep costs down and the insurance companies cut benefits to compensate. They will try to keep it all under wraps but patients will be hit with some nasty surprises.
Insurance companies simply will not tolerate a decrease in their profits and, believe me, Barack Obama is no match for them...he has shown that quite clearly.

Wait 'til some people get hit the reality of the huge deductibles they must meet before they get a dime in reimbursement. This year Obama will face a chorus of scorched cats.

The only thing writ in stone is that the insurance companies WILL get their 25% off the top of the entire amount spent on health care in the United States. Perhaps someone should tell Mr. Obama this. (Just joking because he knew this LONG ago when he told Congress and the Supreme Court "the public option is OFF the table," in essence ceding complete control to the insurance companies.)

Phillip

May 16 2014, 11:50 AM

In the consumer issues section because it could affect consumers. Not in American politics because this is about health care. Comparing what might be the direction the law of the land, that had to be read to be understood is taking. That and other news that might be of interest to those affected by the ACA.

I guess people just need to keep reading what is in the ACA as it unfolds. Mainstream media in America is a source but sometimes looking outside of America has the advantage of comparing.

The Obama administration has given the go-ahead for insurers and employers to use a new cost-control strategy that puts a hard dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.

Not to bad as an example, but later on in the article.

Nonetheless, the departments of Labor and Health and Human Services said the practice — known as reference pricing — could continue. Plans must use a "reasonable method" to ensure "adequate access to quality providers." Regulators asked for public comment, saying they may publish additional guidance in the future.

http://www.dailymail.co.uk/wires/ap/article-2629506/New-health-cost-controls-ahead-feds.html

With knee and hip as examples what does the potential for additional guidance in the future mean? Who are the regulators and and are they similar to the NHS clinical commissioning groups in the UK?

The pratice known as referance pricing sounds a lot like the rationing that is not to popular in the UK.
**************************************
Patients are facing growing rationing of treatments such as counselling, cataract removal and IVF since the coalition restructured the NHS last year, GPs say.

In a survey of 315 family doctors, GP magazine found that 71% believed that restrictions on access to treatment in their area had increased since April 2013, when the controversial shake-up of the NHS in England began.

http://www.theguardian.com/society/2014/jan/31/nhs-patients-face-more-treatment-rationing-coalition-restructuring

Having something to compare to is for those that may be affected to watch for in the comming years, especially those older sicker Americans.

Quote:

 

Although it is in the early stages, the strategy is gaining in popularity and there is some evidence that it has persuaded expensive hospitals to lower their prices.

In California, a large plan for public employees has been especially aggressive in using the tactic, and the results are being watched closely by employers and hospital systems elsewhere.

Under the program, some employees are being given the choice of going to one of 54 hospitals, including well-known medical centers like Cedars-Sinai and Stanford University Hospital, that have agreed to charge no more than $30,000 for a hip or knee replacement. Prices for the operation normally vary widely in the state, with hospitals billing from $15,000 to $110,000 for the same operation, a spread that is typical for much of the nation.

“It’s a symptom of the completely irrational pricing structure hospitals have,” said Ann Boynton, a benefits executive for the California Public Employees’ Retirement System, known as Calpers, which worked with the insurer Anthem Blue Cross, a unit of WellPoint, to introduce the program.

Overall costs for operations under the program fell 19 percent in 2011, the program’s first year, with the average amount it paid hospitals for a joint replacement falling to $28,695, from $35,408, according to an analysis by WellPoint’s researchers that was released Sunday at a health policy conference.

The study found no impact on quality of care.

Snip

One of the goals is to determine when the price of a medical service bears no resemblance to the quality care. Paying more money without getting better care in return has been a longstanding source of frustration for employers.

Snip

At the least, the California experiment may suggest that the irrationality of pricing may be coming to an end. “Price is the leading driver of health care cost growth,” said Suzanne Delbanco, the executive director for Catalyst for Payment Reform, a group that aims to encourage employers and health plans to change the way they pay for care.

The California plan has made it clear to the hospitals that it was both aware of the unexplained variation in prices and that it would no longer simply pay whatever a hospital charged the insurer, she said. “That’s a very powerful signal,” she said.