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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Thursday, March 15, 2007

    Insurance Isn't Enough: Having insurance doesn't necessarily improve health:

    A political debate in Washington, and increasingly in state legislatures, focuses on what to do about 47 million Americans without medical coverage. The new research shows that having insurance doesn't guarantee someone can afford the care.
    "We often talk about health insurance as a yes-or-no thing," said Harlan M. Krumholz, who conducted a study on follow-up care for heart attack patients, at a new conference today in Washington. "But just to get health insurance without looking at the type of coverage it entails is not enough."

    Krumholz reviewed 2,498 patients recovering from heart attacks. One in five said they could not afford follow-up care, and one in eight didn't buy medicines because of the cost. More than two-thirds of those worried about costs had health insurance.
    Patients who said that these "financial barriers" kept them from following doctors' orders on care after a heart attack were 30 percent more likely to end up in the hospital again, the study showed. Those who said they couldn't afford necessary medications were 50 percent more likely to require additional hospitalization.

    "Is it OK for us to be living in a country where your financial circumstances are going to dictate your recovery?" said Krumholz, a professor of medicine, epidemiology, and public health at Yale University's medical school. "Or will we say this is repugnant?"

    It's probably easier to say "repugnant" if one has never had to sit across from a person explaining that they aren't taking their heart medicine because the $20 a month copay is just more than he can afford while at the same time admitting he smokes a $5 pack of cigarettes every day. That patient has made a choice - he feels his money is better spent on cigarettes than medication.

    That's not true of everyone, of course. Some people have insurance coverage that doesn't cover medication. But then, too often doctors prescribe their favorite brand name medications after hospital discharge without thought of cost to the patient. In our hospital, for example, the preferred ACE inhibitor among the cardiologists is Altace - a drug that's about $50 a month. Another ACE inhibitor, the generic lisinopril, is available at Wal-Mart for $4 a month.

    Here's a better idea for a study, although it would take a lot more effort than the study mentioned above- compare the outcomes for patients who are given generic medication on discharge to those given expensive brand names. Of course, that would be admitting that we're part of the problem.

    posted by Sydney on 3/15/2007 08:50:00 AM 1 comments


    "compare the outcomes"


    For some weird reason, your remark reminds me of a line from the first Muppet Movie in which Kermit becomes a star advertising exec by inventing a miraculous slogan for soap - "It gets you clean".

    What could be more reasonable than to compare outcomes for patient care rather than mainly inputs? Yeah, it's very complicated to measure outcomes. But shouldn't that be the goal?

    John Fembup

    By Anonymous Anonymous, at 5:11 PM  

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