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POLICY/INTERNATIONAL: High co-payments prevent needed care, and not in the US this time

So charging at the point of care, another Zombie of health care policy, isn’t just a problem for the poor here—although it’s going to get a whole lot worse. It’s also a big issue in that place that the US loony right thinks will be where they ascend to heaven (or at least I think that’s what they think about it…who can tell with that bunch of nuts?).

Read up about the problems of paying for care in Israel.

Meanwhile if you want to know more about health care Zombies, read this great speech from Morris Barer

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Tarun KripalaniTerry NugentRon GreinerSteve Beller, Ph.D.Trapier K. Michael Recent comment authors
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Tarun Kripalani
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Tarun Kripalani
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Terry Nugent
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Terry Nugent

It’s interesting to me that people like people like Morrris Barer, who presumably view themselves as saintly in their tolerance and compassion, use such perjorative terms as “zombie” to describe ideas that diverge from theirs. It seems to me that the real zombies are the post Cold War adherents of socialist notions like single payer. To those with open minds, I submit the following, which I sent to Marilyn Clement of Healthcare-NOW, who is calling on the masses to rise up against George Bush’s State of the Union proposal that the market might solve the healthcare problem as it has… Read more »

John C.
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John C.

Well Mat, actually if you read Revelations you would know…
Got ya!
I love throwing that out to liberals. Its funny seeing their eyes light up.
Look discussions on policy of any kind seeks to affect people’s (or an organization’s) behavior. So whether it’s political or religous ideology, the outcome is to modify behavior. Religion is just an easy target for many to pick on.
It’s amazing how religion has this polarizing affect on common sense people. While I like to consider myself as having common sense, my wife would take issue with me on that one.

Ron Greiner
Guest

Tell us how much you charge to come and talk to a group of people Matthew. There are 2 guys here in Tampa that have started an HSA health insurance company. It will be the 1st new insurer in Florida in 5 years. They started with $900,000 of their own money and raised $6 million to start with. So that’s not much. I wish I owned the insurance company. Maybe I’ll go down and apply to be their National Sales Mangager. Having the guy who enrolled the first MSA in 1996 might come in handy for them. They are rookies… Read more »

Steve Beller, Ph.D.
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I’m left wondering if there would be no need for sizable co-payments if everyone received the most cost-effective treatments and preventative care. Eliminating excessive and ineffective interventions, dramatically reducing medical errors and omissions, using less-costly alternatives with comparable efficacy, improving diagnostic accuracy and tying it evidence-based guidelines that promote effectiveness and efficiency, enabling providers to spend the time and use the tools to understand their patients’ problems and needs better, enabling better collaboration between practitioners and researchers, and doing a better job informing patients how to care for themselves … are some examples of what our country has to focus… Read more »

Matthew Holt
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Matthew Holt

Trapier — I totally agree with you that care levels do not directly effect outcomes. Sadly the RAND experiment BOTH confirms that co-payments affect the poor’s use of health services more than the wealthy (as do numerous real world studies and common sense) and more importantly, that they were as equally likely to forog needed care as “unneeded” care. My point was that the behavior of the poor changes more with POS co-payments, as you’d expect it would, and that it has little impact on overall costs. Because of course those overall costs are to do with the people who… Read more »

Matthew Holt
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Matthew Holt

John C — I’m quite happy to bash Evangelical Fundamentalists until they go back to minding their own business and not trying to impose their views on the rest of us while we’re minding our own business. Something that’s increasingly unlikely with the new justice in the Supreme Court as of today. It’s not their religious views that I have trouble with, it’s the fact that they want to control the behavior of the rest of us. When they go back to leaving religion in the Church, then I’ll shut up. If you want to have an argument over economics,… Read more »

Trapier K. Michael
Guest

Re: “Rubbish. Payment at the point of service uniformly (in Rand study and in real life) massively impacts the behavior of the poor, and does nothing to affect overall health care spending, however much Eric thinks it ought to.” With respect, Matthew, that isn’t an accurate interpreation of the RAND study. The RAND HIS found that those in the co-payment group used 2/3 of the care used by those with more comprehensive coverage and that the health outcomes of the two groups were almost equivocal [1]. So, yes, co-payments do reduce health care spending; and, no, the affects aren’t always… Read more »

John C.
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John C.

Matthew, c’mon are you degrading into just seeking out “stuff” that only supports your political, personal ,and now religious views? Look, I know its your blog and you can say whatever you want (and I’m sure you will continue to do so which is great), but using it to bash people’s religious beliefs is kind of juvenile. Poor people in this country have access to Medicaid and they DON’T have copays! What is the problem here? Are you upset that someone with a household income of $60-80k has to pay for $15 dollars for prescriptions? On that train of thought,… Read more »

Matthew Holt
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Matthew Holt

Rubbish. Payment at the point of service uniformly (in Rand study and in real life) massively impacts the behavior of the poor, and does nothing to affect overall health care spending, however much Eric thinks it ought to.
It’s a Zombie. Pure and simple

Eric Novack
Guest

Let me propose a new prerequisite to the presenting of study and survey results (and this ought to hold true for any serious medical journal): complete disclosure of any possible bias of the researchers. The major journals have moved to disclosing any financial conflicts of interest for study researchers (ie. Dr. Jones is a paid consultant for company X or own shares in company Y), but it is a footnote, not a headline. Clear ideological leanings ought to be disclosed as well (ie. when Dr’s Himmelstein and Woolhandler publish health policy studies in health affairs or NEJM) (they are major… Read more »

Tom Leith
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Tom Leith

I understand the human problem here, but sometimes wonder what “can’t afford” means. Does this mean a choice between a copay and DirecTV? In this case, and I am sure Drs. Novack & Newberry will help me out here, it seems to me a double problem: inactivity leading to poor health, and simultaneously draining our wills and pocketbooks of the resources to cope. Other examples abound. If patriarchy is bad and choice is good, we will do nothing about it. People will overutilize DirecTV and underutilize medical services, and their health will suffer for it. If paternalism is good and… Read more »