Delusions About Cost & Benefits of Health "Reform" Persist
An amazing story in the usually reliable Boston Globe by Steve LeBlanc made me gulp: might I have to recant my position on the ineffective and expensive Massachusetts health reform? Luckily, no: a report by the Massachusetts Hospital Association on the reform's "success" manages to fudge the numbers just enough to convince the casual reader that the "reform" is achieving its primary objective: reducing hospitals' so-called "uncompensated" care (actually quite well compensated by taxpayers), by enrolling uninsured residents into mandatory health insurance.
Through some kind of magic understandable to politicians, this insurance would transform these folks into responsible patients who would consult with doctors as soon as they felt poorly, instead of waiting until their illnesses turned critical and they crashed the emergency room, only to check out without paying the bill. Sadly,the MHA's exquisite recipe for fudge did rope in Mr. LeBlanc:
It was a key premise of the state's landmark health care law -- the more uninsured people who were enrolled in subsidized health care plans, the fewer uninsured people would show up at hospital emergency rooms for routine care. Now a new study says that's exactly what's happening. The report by the Massachusetts Hospital Association finds that the number of so-called "free care" visits to hospitals have declined by 28 percent over the past three years. That mirrors a 28 percent increase in enrollment in subsidized health care programs, MassHealth and the new Commonwealth Care program, which was created by the law.
It's hard to know where to begin dissecting this outrageous claim. Obviously, the exact mirror-image of savings versus cost increase, 28%, should make any reader suspect that the numbers are being cooked. Here's a list of the ingredients for the fudge recipe:
The 28% decrease in hospital free care visits is from October 2004 to September 2007, versus the same combined increase in MassHealth and Commonwealth Connector enrolment. But MassHealth is just the state's Medicaid program. The "reform" is the Commonwealth Connector, which did not start enrolling people until January 2007. So, the time period, while conveniently resulting in a balanced ledger, is quite irrelevent to the effect of the "reform".
Neither of the 28% figures are dollar costs: they are both head-counts: enrolment in MassHealth and Commonwealth Connector plans, and uncompensated care patient accounts in hospitals. Obviously, comparing the two is meaningless.
A graph on page 3 of the report shows the dollar decline in hospital uncompensated care costs: from just under $700 million (FY2004) to $613.5 million (FY 2007): about 12%, in current dollars. (In order to stretch this figure, the report also notes constant dollars, for which it claims a reduction of 23%, but what difference does this make, as it does not report dollars spent on MassHealth and Commonwealth Care, only heads counted?)
So, what really happened to hospitals' uncompensated care costs during the relevent period? We can't quite tell, but the report does state actual savings from July 1, 2006 to June 30, 2007 of a (sarcasm alert) whopping $10.1 million! Because the Commonwealth Connector launched in January 2007, only the last six months of the fiscal year are relevent. So, let's be generous and guesstimate that savings will have increased to $15 million for the first operating year of the Commonwealth Connector.
Ho, hum.....Is this all that Bay Staters get for a reform for which Governor Patrick is requesting $400 million this year? Uncompensated care savings that barely stretch into the double digits? We have already busted the Commonwealth Connector's boss for cooking up a rotten story about the program's originally budgeted costs. Now, the main beneficiary of the plan's handouts contributes its sugary recipe for fudge to the menu.
Well, if you can't stand the heat, get out of the kitchen - or the state, I suppose. At least that's what many small businesses will do if this "reform" keeps boiling over with new taxes to fund ineffective change - or no real change at all.
Source
Australia: Ambulances wait three hours to hand over patients
No reserve capacity at hospital for surges in demand
This scene outside Cairns Base Hospital's emergency department yesterday is another stark reminder why the region needs a new hospital, now. Ten ambulances were queued outside the choked department by early afternoon, forcing frustrated paramedics to wait for up to three hours before unloading patients.
Officers said they had been putting up with the "bad old days" of no emergency beds for at least a week but yesterday's jam-up had gone from bad to worse as the day went on. "It's beyond a joke," one told The Cairns Post. "Something's got to change." Queensland Ambulance Service area director Warren Martin, who oversees a fleet of 12 vehicles across Cairns, Smithfield and Edmonton, said up to 10 ambulances were effectively out of action for hours. The situation peaked about 2pm when several patients arrived around the same time, causing 10 or 11 ambulances to back up, Mr Martin said.
But he stressed that while the ambulance gridlock outside the emergency department, also known as "ramping", was still happening, new systems to fast-track patients were helping. "It means that when we do ramp, it's not lasting as long," Mr Martin said. "Today was just one of those days." All the patients forced to wait in ambulances yesterday were being closely monitored by emergency doctors, and were in the mid-urgency rather than high-urgency categories, he said. "It's a bit of a cross-section, everything from gastro upset tummies to someone with abdominal pain . I think the hot weather back with a vengeance today has been knocking older people around a bit," Mr Martin said.
Mr Martin said he was "really looking forward" to next year's expected completion of a major expansion to the emergency department, which would double its size and add 12 more beds. A Queensland Health spokesman attributed the delays to a rush of patients at once, with 30 arriving during the most intense period of 12.30pm to 3pm, or about 12 an hour. On a normal day, the department averages five patients per hour. The spokesman said his information was that the maximum number of ambulances waiting at one time had been eight.
Source
Australia: Butcher doctor. Your regulators will protect you (NOT)
THEY call him the Butcher of Bega - a NSW doctor who has committed such monstrous acts that hundreds of terrified victims have remained silent for more than five years. Dr Graeme Stephen Reeves is alleged to have routinely mutilated or sexually abused as many as 500 female patients while he was working as a gynaecologist and obstetrician at various hospitals across Sydney and the NSW south coast.
Despite the NSW Medical Board ruling he had psychiatric problems which "detrimentally affect his mental capacity to practice medicine" more than a decade ago, he managed to continue treating women without detection in a devastating trail of botched operations and negligence.
Hundreds of former patients have come forward with harrowing and graphic evidence about Dr Reeves, who was struck off in 2004 for breaching practice restrictions. As many as 500 emails from women were received by the private watchdog, Medical Error Action Group, last week telling of their humiliation and pain after parts of their genitals were removed or sewn up without their consent.
The outpouring came after a former patient of Dr Reeves, Carolyn Dewaegeneire, broke her five-year silence with two other women to give a public account of her ordeal on Channel 9's Sunday program last weekend.
Despite the shocking revelations on the program, Dr Reeves is still not being investigated by the police, the NSW Medical Board or the Health Care Complaints Commission, over the latest allegations. He is also free to re-apply to return to medical work at any time after serving a three-year ban. Dr Reeves has refused to comment on the allegations. The hospitals where Dr Reeves has practised include Hornsby Ku-ring-gai, Sydney Adventist at Wahroonga, The Hills Private at Baulkham Hills, Royal Hospital for Women and the Bega and Pambula hospitals.
Source. More here and here
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