The United States of Affordable Care (Act)

Health Care Financing would seem to be a long way off from the patient waiting to see their physician.

In today's world the quantitiy and qualitiy of care depends very much upon the type of health insurance the patient has to use.   The care may be far different according to region, or state.

The term 'public health ' is a misnomer. The public health system is not accessible to all people for a number of reasons.  Many perceive public health as inferior to the 'private system of health care", and only would access a center if there were no other option. Many current users of public health and/or Federally Qualified Health Centers would not even know how to access ' private care'. Learn more about them here and here and  here.  I particularly like the last one. No one home --

The resource cannot be found.

If you are successful, the rules are as long as the Affordable Care Act.

A new term which may be unfamiliar to most providers and/or patients is the "Federally Qualified Health  Centers".  These centers are found more commonly in areas of low economic assets and amongst many people who fall in the range of the Federal Poverly Level (FPL).  And here are the numbers which are both unrealistic at the lower end and even more unbelievable at the top end.

• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8

We seem to be an impoverished nation in the world of developed countries.

Many of these centers predominantly serve 'medicaid' beneficiaries. They also serve ( unintentionally) to isolate medicaid and those who are receivng public assistance from the main stream of health care.  Hospitals and providers also treat these patients differently, not so much in terms of the quality of care they receive....rather the accessibility.  Many budgetary decisions by states often effect Medicaid patients first, because large portions of state budgets are allocated to Medicaid.

There is a non-admitted  'caste' system when it comes to medical care.  It largely is secondary to income and location, and in cities there is often a sharp divide between those living in upper middle class neighborhoods and lower class neighborhoods.

The situation is also becoming worse, and there is no sign the Affordable  Care Act will diminish the divide.
Although the ACA specifies preventive medical care  (for free)  Despite being "free", there will be a cost. There are 14 general categories,   22 special categories for women, and 25 categories for children.

A disturbing distinction between public health and private health financing is also more evident with the introduction of health information technology. In order to qualify for Grants for Information systems and operational financing a non-profit status is a requirement, which immediately rules out most entrepenurial systems (ie, private fee for service office and/or clinics, as well as some hospitals.

Health Benefit Exchange

Has health care improved since the ACO went into effect??  We have been told that already the ACA has saved millions and perhaps billions of dollars. How is that so?  Where are the details?

I have an open mind and I am willing to consider the facts....so just show me the numbers. How is it that the government has infused billions of dollars into health IT and providers must now support it operationally ? Given the lifetime of IT hardware and software obsolescence in five years at the most it will all have to be upgraded and/or replaced with a second generation of sofware that has real meaningful usability, not the garbage that HHS is insisting we use to accomodate the "quants" at HHS who massage the information spewing out of their machines.

Health care now supports an industry of high tech that has nothing to do with patient care. Vendors of hardware, software, consultants, IT consultants, a stream of auditors, review firms, outcome studies. What idiots think we are saving money?  The money in health care no longer is going to patient care......it is going to many parasitic organizations.  The only good thing about it is that unemployment would be much worse than it is already.

How long will  health benefit exchanges  be useful after the initial period of signing up the uninsured. Surely it will cost a great deal to fix it, and maintain it.

If the affordable care act continues to roll out the next five years will be a financial and health disaster.

For all the details on Health Benefit Exchanges and which insurance companies have signed up here is the list. It does not mean your doctor will accept these plans since the reimbursement rates in the Affordable Care Act will be very low compared to the current rates.

Stay tuned.

NIH Leader Calls for Evidence on mHealth

Only about 20 randomized clinical trials involving mHealth tools or services have been conducted in the United States since 2008 under the auspices of the National Institutes for Health. And more than half of them have failed to document clear evidence of improved outcomes.

 Francis Collins, MD, the NIH's director, delivered the message to attendess at the 2012 mHealth Summit in his closing keynote on Dec. 5. Collins pointed out that the lack of trial-based evidence is hindering acceptance of the technology by a healthcare industry that could really use these tools.

Dr. Collins also noted that controlled trials often are diffiicult to design in the real world by saying,

"The mHealth field is evolving so rapidly that oftentimes the technology used in trials is outdated by the time the trials are completed. For that reason, he said, the scientific and healthcare communities have to work together to fine-tune the process, producing viable results in a timely manner.

The alternative? Forge ahead with mHealth without evidence that mHealth is improving healthcare."

This viewpoint may be highly biased as to the cohort and demographics of such a study.  Presently there are thousands of mobile apps in development, most stimulated by public perception and enthusiasm from the HIT community. The feeding frenzy for profit is dynamic with the federal stimulus packages.

Many vendors in mHealth would argue differently. Hopefully some of them will comment here.

[See also: New bill would create FDA mHealth office.]