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Previously on Oy, Canada:

"Patients also experience significant waiting times for various diagnostic technologies."

And that's just to be seen and treated. But what happens next? Often, the provider prescribes a med (or meds) to help treat the issue.

That's the easy part:
I'm Canadian. I have universal healthcare. My oncologist prescribed Xeloda, an oral chemotherapy, to try to extend my life. In Ontario, oral chemotherapy isn't covered.

My insurance has been dragging their heels and just today declined coverage. #ThisDoesntSeemUniversal
— Katie Davidson (@LovlyKatieLumps) July 19, 2018
That's right: in at least one province CanuckCare© doesn't cover oral cancer treatment.

And if one follows the comments, one is reminded of this dirty little CanuckCare© secret:

"[P]rivate insurance is responsible for oral chemo (different from province to province"

That's right, our Neighbors to the North© recognize the devastating limitations of "free" health care, and have developed (and market) supplements, much like our own government-run health care system (Medicare).
The more you know....
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Specifically, enforced medical tourism.

For example, just a week or so ago we leaned of a teeneager with a heart condition that the Brits' "free" health care was unable to treat, thus forcing his parents to seek help from the much-maligned American health care system:

"'Teen 'not sick enough' for NHS heart transplant has urgent op in US'"

And, of course, the Much Vaunted National Health Service© is (in)famous for its gleeful slaughter the most vulnerable:

"UK Supreme Court declines appeal from parents of ill toddler"

But sometimes, the bureauweenies lose, and the patient wins:
After U.K. Doctors Said His Heart Couldn’t Be Fixed, U.S. Saves Baby Oliver https://t.co/zM8camyCoy pic.twitter.com/JA64ZPpYpK
— The Daily Signal (@DailySignal) July 19, 2018
Turns out, little Baby Oliver was born with a rare heart problem that the "free" British health "care" system was unable to treat. So, of course, the compassionate and warm-hearted government-run service denied care doomed the baby to death. The parents, understandably, demurred, and successfully sought treatment in the United States.

Specifically, the Boston Children's Hospital, which, unlike its counterparts in the UK, boasts a 100% success rate.

Okay, that's not fair, allow me to explicate:

Boston's Children's Hospital, unlike the MVNHS©, boasts a 100% survival rate.,
Ah, that's better.
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Well, it's that time of year again, when the temps soar, folks head to the beach and the pool, and insurance companies announce when they'll be cutting checks to comply with ObamaCare's Medical Loss Ration (MLR):

"Final Medical Loss Ratio (MLR) rebate reports for UnitedHealthcare customers will be available on the broker portal the week of Sept. 15, and customers will receive their rebate payments in the mail at the end of September."

In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds.

By the way, that MLR check's no bargain for insureds. As co-blogger Patrick pointed out a few years ago:

"MLR was designed to leverage insurance company profits and administrative expenses. Reality is all we have seen from MLR is an increase in profits and expenses."
True then, true now.
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Over the years, we've reported on a number of health insurance claims that hit (and/or exceeded) the magic $1 million mark. These have always been rare, partly because, even in today's inflated medical expense environment, it takes a lot of medical care to reach that summit:

"Olive-McCoy, 44, has hereditary angioedema (HAE), a life-threatening disease so rare that many doctors have only read about it ... the price of just one of Olive-McCoy’s drugs will be about $600,000 this year ... she has received hospital bills for more than $1 million"

But this is apparently changing:

"The number of million-dollar medical claims has nearly doubled, with cancer care remaining the most costly health condition"

Cancers of various types accounted for almost $800 million in health insurance reimbursements fro 2014 through last year. And the total number of million dollar patients nearly doubled: from 104 in 2014 to almost 200 in 2017.

What's also interesting  to me  is that cancer was the #1 culprit: I would have guessed that the opioid crisis would have been to blame, but that doesn't seem to even register on the radar. Granted, these are from a study of self-funded plans from one carrier, but still; it's not as if employees and their dependents are immune.

What wasn't a surprise is the low percentage of folks who experienced these claims:

"Patients with claims of more than $1 million represented only 2% of the total number of stop-loss claims from 2014 to 2017."

But that low number comprised almost one-fifth of the total dollar paid out.

So, 2% ate up 20%. Interesting.
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India faces an interesting challenge: how to provide health care to it most vulnerable (ie poorest) citizens. Currently, health care financing and delivery models are left up to the individual states (not necessarily a terrible idea, but that's for another post). The country's federal government has been tasked with rolling out private health insurance to some 500,000 of its citizens, which is proving - mas one might imagine - quote a challenge:

"Almost five months after announcing the ambitious program, the government is still working to lock in hospitals and insurance companies in time for its planned August launch."

One challenge is infrastructure: "Although ... the IT infrastructure has been put in place, the involvement of hospitals — public and private — and insurance companies was still to be finalized." Sounds familiar.

The other problem is something we also face: how to provide care to an ever-expanding population with a shrinking supply of providers?

"It will not be possible for health care providers to respond to such a huge expansion of coverage without substantial investment in medical facilities and manpower,” said Owen O’Donnell, associate professor at the Rotterdam-based Erasmus School of Economics. “Without that, the extension of coverage risks being nominal rather than real.”

I bet. And again, similar to what we see here with, specifically, expansion of Medicaid "coverage" with narrower and narrower networks from which to obtain actual care. Wonder if our Indian friends will be more successful.

At least they're trying a privatized alternative, even as we plunge headlong toward single payer. What do they know that we don't?

[Hat Tip: FoIB Allison Bell]
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■ Case Study #1, The Much Vaunted National Health Service©:

Nurses quit NHS to work in Lidl because pay, hours and benefits better via @LondonEconomic https://t.co/1WbEc4BR91 pic.twitter.com/j80uwwAmCk
— Sally Pipes (@sallypipes) July 6, 2018

As we've previously noted, MVNHS© docs aren't doing much better:

"A "talented" junior doctor who had spoken about the pressures of working in an A&E department has been found dead at her home."

So, low pay, horrendous workload, "free" health care. What's not to love?

■ Case Study #2, Direct Primary Care Fees:

So who gets to decide the single price and unit measure? If I sell my services as a doctor to a patient who is happy with the price and service, why do you get to choose what I price my service at? #FreeMarket #DPC
— Jackson Hole DPC, Jonathan Figg MD (@JacksonHoleDPC) July 9, 2018

As regular readers know, we've been longtime fans of the DPC model, while acknowledging its (substantial) limitations. But this is something that's been under our radar, and bears consideration. That is, DPC practices are, by definition, independent, and free to set their own fee schedules and rates. But this also means that it's currently kind of a "wild west" in terms of defining what is - and is not - a true DPC office. For better or worse, there doesn't seem to be a nationally recognized "DPC Association" that offers some kind of consistency across various practices. Now, I kinda like that, but it also means major 'caveat emptor' warning should apply.

■ Case Study #3, Medicaid as Flawed Model

'Dozens of Studies Demonstrate Failure of Medicaid' via @RealClearHealth. Why do people want to expand Medicaid, again? https://t.co/oa2DNtPORa pic.twitter.com/XYcbqsvAJi
— Sally Pipes (@sallypipes) July 12, 2018

This one stands pretty much on its own, I'll add only that a better question might be "Why would people want Medicaid-For-All, again?"
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Last month, we reported on the strange case of the child versus the glass sculpture:

"[T]he young lad, attending a wedding reception replete with expensive (and apparently fragile) art work, who (apparently accidentally) knocked over a priceless glass statue."

Well, maybe not "priceless:"

"A Kansas mother says an insurance company wants her family to pay $132,000"

Now, if you're wondering about how that seemingly-arbitrary value was assigned, well, it appears to have been the sales price of said sculpture [ed: notwithstanding that "asking price" isn't necessarily "what someone ultimately pays"]. In the event, there was some dispute about whether or not the child actually touched, let alone knocked over, the piece.

The good news is that this is now settled:

Surveillance video shows the child wrapping his arms around it and then struggling to hold it up as it fell https://t.co/ITQnKZKSat
— New York Post (@nypost) July 10, 2018
 
So, that's that, and we appreciate the tip from FoIB NARNfan who also asks (one presumes rhetorically) "How much would you get if you stole it and fenced it?"

The world may never know.
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[Hat Tip: SoIB Gail S]
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If you're fortunate enough to (still) have a PPO-type health insurance plan (coverage for both in- and out-of-network expenses), then you probably know the frustration of actually filing those OON claims. What if there was a simple, inexpensive way to get them paid with little or no hassle?

Well, as you might have guessed, there's an app for that:

"Reimbursify’s smart dashboard manages your claims, helping you to make new claims, and keep track of pending reimbursements."

There's even a feature that helps if your claim is denied.

There's also a "Provider Pro" version for doc offices; this waives the $2 per-claim filing fee. And the folks behind the app promise to keep your personal health info as safe as possible.

The app itself is free, and available for both Apple and Android devices.

Oh, and it may be especially useful for folks who choose both insurance and Direct Primary Care (since DPC folks are by definition out-of-network).

Cool.

[Hat Tip: Vatsal G. Thakkar MD]
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