|The British Medical Journal this year published a comparison of Kaiser Permanente and the National Health Service, concluding that health care “costs per capita in Kaiser and the NHS are similar to within 10 percent and that Kaiser’s performance is considerably better in certain respects, particularly access to specialist diagnosis and treatment, and hospital waiting times."|
|Time to see a primary care physician||2001: average 3 days; <48 hours by 2004||Urgent: <24 hours; routine: 80% <7 days|
|Telephone help line and associated services||NHS direct help line available. By 2004, NHS Direct will provide gateway to advice, appointments, and out of hours care.||24-hour hot line available for advice and appointments. Appointments can also be made online.|
|Repeat prescription available without calling or visiting a doctor||Available nationwide by 2004||Available now|
|Time spent with primary care physician||8.8 minutes||Medical: 20 minutes; Ob/Gyn: 15 minutes; pediatrics: 10 minutes|
|Waiting time to see a specialist||2001: 36% <4 weeks, 20% >13 weeks, 4% >6 months; by 2005, average 5 weeks and maximum 3 months||2001: 80% <2 weeks|
|Waiting time for inpatient treatment or surgery||2001: 41% <13 weeks, 33% >5 months, 7% >12 months; by 2005: average 7 weeks and maximum 6 months||2001: 90% <13 weeks|
|Children who received various immunizations by 2 years old||DTP=95%, MMR=88%, Hib=94%||DTP=91%*, Polio=93%*, MMR=94%*, Hib=91%*, Hepatitis B=86%*, Chicken pox=83%*|
|Specialists per 100,000 people|
|Breast||69% of women age 50–64 had mammogram in past 3 years†||78% of women age 52–69 had ≥1 mammogram in the past 2 years*|
|Cervical||84% of women age 25–64 screened at least once in past 5 years‡||80% of women age 21–64 screened at least once in past 3 years*|
|People with diabetes who received annual retinal examination||60%||70% for <65 years;
80% for = 65 years
|Coronary revascularization procedures per 100,000|
|Transplantation per 100,000|
|*Data from Kaiser US (not California).
SOURCE: “GETTING MORE FOR THEIR DOLLAR: A COMPARISON OF THE NHS WITH CALIFORNIA’S KAISER,” BRITISH MEDICAL JOURNAL, JAN. 19, 2002
House Republicans come out with their ACA alternative. A continuous coverage surcharge replaces the individual mandate. But where’s the CBO score?
The biosimilar segment of the pharmaceutical industry is on fire. Some 700 biosimilars are at some stage of development, and more than 660 companies are involved in some way in the biosimilars land rush. Still, only a handful may get on the market in the next few years.
No one knows how much of an effect biosimilars will have on oncology expenditures. Pricing and market share are in a large, opaque “to be determined” cloud. But there’s certainly potential for a major impact that could lower oncology expenditures by millions, if not billions.
The future of biosimilars in this country is nothing if not uncertain. Most immediately, the U.S. Supreme Court is hearing a case that will determine the timing of the 180-day waiting period before a biosimilar can go on the market. But there are larger and longer-term issues at play as well.
While coupons help individual consumers, they are also having a major impact on the insurance industry and anyone responsible for paying health care bills. Insurers and pharmacy benefit managers complain that they foil formularies and other pricing strategies designed to steer consumers to less-expensive drugs.
The hard truth is that telehealth’s future—its size, its contours—will depend a lot on what payers will be willing to pay for. Currently, commercial plans cover only a limited number of services. In addition, research suggests that there may be quality and utilization problems.
Insurers should consider covering new drug-delivery devices that can improve outcomes while lowering disease-specific pharmacy and long-term overall health care costs. Managing these devices in the pharmacy benefit will consolidate volume-based purchasing and capitalize on PBM strategies for improving adherence.
Basaglar is coming on the scene during tumultuous times for insulin products. Manufacturers are under attack for price hikes. There are allegations of backroom rebate deals. And a class-action lawsuit has been brought on behalf of uninsured patients, charging insulin makers with setting artificially high prices.
Evaluating the quality of telemedicine care is about as easy as evaluating the quality of health care, period, and researchers are still ironing out the methodological kinks. That may be one reason research results are all over the place. This article involved reviewing nine such studies, and the findings are a mixed bag.
The results can be tragic. Patients with addictions are unlikely to wait the hours or days it takes health insurers to approve the medications they need. Insurers are changing their practices, but not without some outside pressure.