Monday, February 23, 2009

Best Healthcare Plan I've seen

This is the plan, as created by Ezekiel Emanuel and Victor Fuchs.

It's called the Guaranteed Healthcare Access Plan, and it is single payor, but to my knowledge is vastly different than other plans in existence.

It will guarantee coverage to EVERY american citizen. Here's a snippet from Emanuel's book.

Benefits and Coverage

1. Guaranteed Coverage
Each American household will receive a healthcare certificate for coverage through a qualified health plan or insurance company. The certificate will NOT be a "cash card" to buy healthcare services; rather, it is an insurance voucher entitling the individual or family to enrollment in a healthplan of their choice.

2. Standard Benefits
Standard Benefits will be generous, modeled on services currently recieved by members of Congress. Benefits include office and home visits, hospitalization, preventive screening tests, prescription drugs, some dental care, inpatient and outpatient mental-health care, and physical and occupational therapy. Patients can choose their own physicians and hospitals.

3. Freedom of Choice
With the healthcare certificate, Americans will be able to choose from among several health plans. Plans will be required to accept any enrollee without exclusions for preexisting conditions and with guaranteed renewability each year.

4. Freedome to Purchase Additional Services
Americans can use their money to buy additional services and amenities, including a wider selection of physicians, additional mental-health benefits, coverage of complementary medicines, and "concierge medicine." Such purchases will be made with after tax dollars.

5. Elimination of Employer-Based Insurance
The current 200 billion dollar tax exemption for employer-based health insurance will be eliminated. Employers will stop offering health insurance, and worker's wages will rise accordingly.

6. Phasing Out of Medicare, Medicaid, and SCHIP
No one recieving benefits from Medicare, Medicaid, SCHIP, or other government programs will be forced out, but there will be no new enrollees. Current enrollees will have the option of joining the Guaranteed Healthcare Access Plan. Over a period of about fifteen years, these programs will be phased out.

7. Independent Oversight
Modeled on the Federal Reserve System, a National Health Board and twelve Regional Health Boards will be created to oversee the healthcare system. Supported by dedicated funding, the Boards will be independent of annual congressional appropriations, and insulated from political and special interest lobbying.

8. Patient Safety and Dispute Resolution
Each of the twelve Regional Health Boards will create a Center for Patient Safety and Dispute Resolution to receive and evaluate claims of injury by patients, compensate patients injured by medical error, and discipline or disqualify from practice those physicians found to be repeatedly injuring patients. Funded by a dedicated revenue, these regional Centers will develop, and finance the implementation of interventions proven to enhance patient safety.

9. Cost and Quality Control
Funded through a dedicated tax, an Institute for Technology and Outcomes Assessment will assess the effectiveness and cost of new drugs, medical devices, diagnostic tests, and other interventions. It will also assess and publish the clinical outcomes of patients in different health plans.

10. Dedicated Funding
Initially, the healthcare certificates will be funded by a dedicated VAT of 10% on purchases of goods and services. Revenue from the tax can not be diverted to other uses such as the military or Social Security. No other tax revenue will be used to pay for the Guaranteed Healthcare Access Plan. Congress has the power to increase the VAT rate."


Comparison of Out of Pocket health care costs.

This is interesting data. I was under the impression that the United States would be leading this category, but we are not. Switzerland is way up there.

Household Out-of-pocket payments as a percent of total country expenditures on health in 2006 varied widely; for example, Luxembourg was 6.5% and Switzerland was 30.3%; France was 6.7%, Germany was 13.2%, and the U.S. was 12.8%. Note that these are not the percent of income that individuals or households pay, but the aggregrate percent of country-wide expenditures paid by out-of-pocket household spending.

Interesting, any thoughts?

Monday, February 9, 2009

DNP title...

OKEY DOKEY. I like NP's, I consider them colleagues, but I think that they have gone off the deep end with this one. First, mandating that all NP education is awarded a doctorate by 2015 is foolish. This will decrease enrollment of many potential RN's, and especially those that might be likely to practice in rural and underserved areas, where we have the greatest need. The added expenses of completing a doctoral degree will ensure that DNP graduates will seek out better paying opportunities in more attractive locales in order to pay down student loan debt.

My other concern is the use of the title, "Doctor". It is true that pharmacists, PT's, and others have moved to a doctoral degree. BUT, none of those professions outside of a psychologist, use the title "Doctor" when treating patients.....why you might ask?

Simple, it is confusing to the layperson, and downright fraudulent, especially when you consider how closely a PA/NP's duties are to a physicians. I am a firm believer that the title "Doctor" should be reserved for MD's, DO's, DPM's, DDS's, and PhD psychologists. I have several PA colleagues who have PhD degrees, which despite some beliefs, is certainly more difficult than completing a DNP degree from what I have gathered. Not a single one of them will use the title "doctor" in the clinical setting. It is simply not worth the potential confusion. I get called "Doctor" all day long as it is, and I politely remind the patients that I am a PA, not an MD. They usually reply, "Okay, thanks doctor".....but to DELIBERATELY call yourself a doctor is potentially misleading. Trust me, when I complete my doctorate in about 3 years, the title doctor, will not be used in the clinical setting.

A recent article I read in Advance for NP's suggested that 47% of current NP's or NP students PLAN ON USING THE TERM DOCTOR UPON completion of their degree. This is a potential legal minefield, and I would urge the NP community to tread lightly with this. Everything will be fine as long as no bad outcomes occur.......unfortunately, BAD OUTCOMES do occur, and they will happen to everyone that practices medicine at some time. It is a simple statistical reality. When that happens, I can already see a case of fraud, or misidentity being brought easily.

Here's a snippet and link from an article on ADVANCE for NP's...

Using the Title 'Doctor'
One of the greatest hurdles NPs with DNPs will face is opposition to use of the title "doctor" in professional practice. Historically, the term "doctor" has been an academic title.

In the past century, physicians have used the title "doctor" to identify themselves as medical practitioners. However, many professions, including pharmacy, physical therapy, clinical psychiatry and naturopathy, have already or soon will transition to a doctorate degree for entry to practice. In 2008, the AMA passed resolutions to restrict professional use of the title to physicians, osteopaths and podiatrists. These resolutions do not have the force of law.

In response, seven national nurse practitioner groups convened to craft a position statement. In the document, the American Academy of Nurse Practitioners, the American College of Nurse Practitioners, the Association of Faculties of Pediatric Nurse Practitioners, the National Association of Nurse Practitioners in Women's Health, the National Association of Pediatric Nurse Practitioners, the National Conference of Gerontological Nurse Practitioners (now the Gerontological Advanced Practice Nurses Association) and NONPF addressed three important issues: the DNP, NP certification and use of the title "doctor."

"The DNP degree more accurately reflects current clinical competencies and includes preparation for the changing health care system," the groups wrote. The document also stated that the NP groups do not support a National Board of Medical Examiners (NBME) certification for DNPs, and that the title "doctor" is earned by many and should not be reserved for physicians alone.

"Physicians have nothing to fear in the long run and would probably do well to embrace the possibilities of partnering with these advanced practice nurses as it would be of benefit to all involved - especially the patient," O'Dell notes.

Laura K. Melaro, NP, has been an NP for 20 years. Sheearned a DNP from the University of Tennessee in Memphis in 2008.

Melaro has already had to address the use of her new title. "I have found myself minimizing my accomplishments by going out of my way to assure that people are aware that my degree is in nursing, not medicine. I have always proudly identified myself as a nurse." She sees the AMA's actions as excessive, "considering that all health care providers are required to display their licenses, degrees and credentials in their practice settings."

"Most of my peers and patients have been very positive, and they often comment that they are proud that I am being recognized for the level of work that I do," Melaro says. "I am often chastised for not using my title. I have only recently started using my credentials professionally and allowing people to call me 'doctor.'"

No matter what degree they earn, NPs must follow their state laws as to how they may identify themselves in practice. Seven states prohibit NPs from using the title "doctor" in professional settings.4

Why Get a DNP Degree?
Many NPs with master's degrees wonder what the DNP will add to their everyday practice. Nurse practitioners who have earned the DNP say that it's hard to grasp what is to be gained from the degree "until you've already earned one."

O'Dell says the DNP is a symbol of having earned the highest level of practice ability in the nursing discipline. "If an NP is going to grow professionally and contribute as the professional that I believe us to be, then a terminal degree is the next logical step in demonstrating skills in our discipline."

Sunday, February 8, 2009

Insurance Coverage.

This is incredibly sad, and very illustrative of the current problem with the american health system. While we have a great many problems, and need to completely overhaul a system that was put together piecemeal, the people that need medical care the most are falling through the cracks. As unemployment rises, and people continue to lose their jobs, this will become increasingly prevalent. Unfortunately, many of these people will not seek care at all, and others will utilize the ED for provision of care for their chronic problems. I'd like to make a joke, or say something witty, but this is simply too sad.