News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Healthcare Reform in the United States May Actually Increase Medical Tourism

More medical tourists may also contribute to further globalization of lab testing

Medical tourism continues to be a force with the potential to exert significant influence on healthcare in the United States. For that reason, experts have weighed in recently on how efforts to reform healthcare may either inhibit or encourage growth in the number of Americans opting to become medical tourists.

Just as medical tourism has the potential to be transformative to certain aspects of healthcare here in this country, Dark Daily believes that medical tourism may also encourage greater globalization of pathology services and clinical laboratory testing. For both reasons, pathologists and clinical laboratory managers will find recent commentary to be enlightening. (more…)

Good News/Bad News with Massachusetts’ Universal Coverage Health Reform

Now in its second year, the closely-watched mandate for universal health coverage in Massachusetts is a mix of good news/bad news. Because this is a potential model for national healthcare reform, the Massachusetts universal health insurance program is also viewed as an opportunity to work out the bugs in finance and care delivery before rolling out a national program. First, the good news. From a public policy standpoint, the universal healthcare mandate is successful. Roughly half the state’s estimated uninsured residents, or 440,000 people, are now enrolled in either a state, an employer-sponsored, or a private insurance plan.

Second, the bad news. The financial costs of the program exceed the original budget estimates upon which caused Massachusetts Democrats and Republicans to come together and pass this unprecedented legislation. For year two, the Massachusetts’ program mandates that all adults enroll in a health plan or pay a state income tax penalty. For 2008, that penalty was increased to $912, a jump of 416% from the $219 penalty that was assessed in 2007.

Additionally, businesses with more than 10 full-time employees must either provide their employees with health insurance, or pay the state $295 per employee per year. Critics claim this per-employee payment falls far short of covering the true costs of the mandate. Employer contributions only generated $6 million last year, even as the “play or pay” mandate expanded employer-sponsored health coverage to 85,000 workers.

Cost overruns plague the universal healthcare program. For 2007, the cost exceeded the budget by $100 million, due, in part, to a failure to enroll young, healthy members who can pay their own way. It is also now clear that lawmakers originally underestimated the program’s actual costs. Costs estimates were based on a low estimate of uninsured residents who require premium subsidies and did not figure on double-digit increases in the price of health insurance.

Over the last three years, the state-sponsored plans created by the universal coverage mandate offered enrollees an exclusive network of four insurers. These insurers raised premiums at near double-digit rates during the first two years. Rates increased by 9% in 2008, according to Jon Kingsdale, executive director of the state’s health insurance Connector Authority, who notes that while the increase was well above the 2% cap the Connector staff had proposed, costs should not exceed this year’s budget of $869 million.

In a report, Striving for Universal, Affordable Health Care: Lessons From Massachusetts,  State Attorney General Martha Coakley, who oversees the Connector Authority, notes that rising healthcare costs must be addressed to achieve universal health coverage. In an effort to cut costs, stabilize premiums and pay carriers fair rates, the Massachusetts Healthcare Connector will open the state health insurance program to competitive bidding for the next budget year, which begins in July 2009. However, new rules will apply to the upcoming bidding process: carriers will be limited to offering plans with a maximum monthly premium of $404, which represents a 2% percent increase over this fiscal year and includes $35 for administrative fees.

Because the Massachusetts’ mandate for universal coverage is only now completing its second year, it is too early to determine whether clinical laboratory services in the Commonwealth have been negatively affected. However, pathologists and laboratory administrators will want to keep an eye on unfolding events in the Bay State. Universal health coverage may be one of the first priorities for the new President and Congress, and the Massachusetts experience may be used as a guide in crafting federal legislation to tackle this issue.

Related Information:
Massachusetts Reform Has the Blues

Striving for Universal, Affordable Health Care: Lessons From Massachusetts

City of San Francisco Launches Universal Healthcare

It’s now the one-year anniversary for the nation’s first attempt by a city to institute universal healthcare. The Healthy San Francisco program was created by the City of San Francisco to give its 73,000 uninsured city residents access to affordable health care. Technically, the program is not health insurance because beneficiaries can only access benefits within the city limits of San Francisco.

The program is funded by businesses with 50 or more employees that don’t provide health benefits. These businesses began paying between $1.17 and $1.76 per hour per employee in January. In April, businesses with between 29 and 49 uninsured employees also paid $1.17 per hour per employee, or pledged to offer minimum benefits to workers.

Restaurants in San Francisco are particularly negative about the Health San Francisco initiative, claiming that it will create economic hardship for them and force them to close or relocate. Some restaurants have gotten around the problem by passing the cost directly on to consumers. One restaurant added a service charge of $1.25 per dinner “in support of Healthy San Francisco” with an Internet address of the healthcare program.

Time magazine calls San Francisco’s program, operated by the San Francisco Department of Public Health (DPH) and conceived by Mayor Gavin Newsom in his 2005 State of the City pledge, “universal healthcare.” The Healthy San Francisco Web site says “Healthy San Francisco is not insurance, but a reinvention of the San Francisco health care safety net, that will enable and encourage residents to access primary and preventive care. It provides a Medical Home and primary physician to each program participant, allowing a greater focus on preventive care, as well as specialty care, urgent and emergency care, laboratory, inpatient hospitalization, radiology, and pharmaceuticals.”

Currently, the program is enrolling about 600 individuals per week, and enrollees now total 24,000. At least 27 clinics in the city are participating in the program and the City of San Francisco estimates it will cost $200 million per year to provide care to all 73,000 uninsured people within the city limits.

The program in San Francisco is being hailed as groundbreaking and a model for other cities in the US to follow. In an era where most cities and states simply continue to complain about the state of health care, San Francisco has actually chosen to try something. These innovations and experiments in the delivery of healthcare services should be welcomed, because they are “real world learning laboratories.” As such, they quickly demonstrate whether such innovations actually deliver value and contribute to improving the delivery of healthcare.

Related Articles: