Key Issues In Health Insurance – The Healthcare Professionals View

In preparation for the upcoming Health 2.0 conference a colleague at Creation Healthcare suggested this question: “How do healthcare professional (HCP) opinions on health reform differ between the United Kingdom and the United States; each a nation facing complex reorganization of their public health care service?

Through a series of articles, we have so far been looking at the link between health and politics and some of the opposing drivers in health reform. Here, we will continue by investigating the key issues of health insurance in health reform.

Health Insurance Issues In Health Reform

One of the key benefits to a reformed healthcare system is the premise that more people will have access to affordable care. Yet the reality is that health insurers and the insured have to negotiate and agree on a number of issues that can be particular to each individual, or to the population as a whole.

Lets start with some of the key health insurance issues as mentioned by healthcare professionals (HCPs). Over time, we can see various peeks and troughs relating to issues such as premiums, eligibility, treatment, screening and testing, pre-existing conditions, transparency, or the cost of drugs and treatments (See Figure 1).

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Figure 1 – Over time, events shape the emphasis of conversation around health insurance issues (Source: Creation Pinpoint® study into health reform in the UK and USA, 1st September 2013 – present )

Examining each of these topics in more detail can give a sense of the HCP perspective on health insurance issues in health reform:

Premiums

There is a great polarity in HCP opinion about whether the Patient Protection and Affordable Care Act in the United States is reducing premiums or causing them to go up. In Figure 2 we see a daughter enthusiastic about the savings for her mother, which was re-tweeted by a medical internist among many other HCPs and the general public. We also see a nutritionist concerned that higher premiums are likely for the population in general.

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Figure 2 – One patient received premium reductions through the PPACA programme while a nutritionist believes that higher premiums are due for many
(Sources: https://twitter.com/lawd_haleylujah/status/447935115264401409, https://twitter.com/daynutrition/statuses/497368046651322368)

Eligibility

Who is eligible for health care? In the United Kingdom the National Health Service has always aimed to provide healthcare to all, which in most cases has no direct fee at the point of care, however the sheer tax burden of running such a service is forcing a review of policies. One proposed idea, charging a fee to visitors, has caused alarm among physicians who believe it will not save a great deal of money, but will increase pressure on General Practitioners.

In an article from GPOnline.com, RCGP chairwoman Professor Clare Gerada said: ‘My first duty is to my patient – I don’t ask where they’re from or whether they’ve got a credit card or whether they can pay.’

Continuing with further healthcare professional opinion, the chairman of the GPC – Dr Laurence Buckman – said: ‘Doctors should spend their time treating patients and not acting as the arbitrators of whether patients are eligible to receive NHS care.’

Treatment Options

In the United Kingdom, the topic of ‘treatment’ had more share of voice relative to any other health insurance issue than in the United States where ‘premiums’ was the majority topic.

Gabriel Scally is concerned (See Figure 3) about the performance of the NHS and the waiting lists affecting timely treatment. Influential celebrity Deepak Chopra referring to the US health system seems to advocate non-medical treatment as a solution to the health care crisis.

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Figure 3 – In the UK, concerns are raised about waiting times for treatment, while in the US there is a discussion about non-medical treatment
(Sources: https://twitter.com/GabrielScally/statuses/471373777356722177, https://twitter.com/DeepakChopra/statuses/385432639995269120)

 Screening and Testing

Can improved screening prevent the overall cost of health care? This is a question for debate among HCPs as they review the respective government reform discussions.

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Figure 4 – One HCP in the United States is concerned about screening guidelines, while in the UK a review of screening is both positively and negatively perceived (Sources:https://twitter.com/kksheld/statuses/379282102144868352,https://twitter.com/CommonsSTC/status/486767048958435328, https://twitter.com/bendean1979/statuses/377495197464420352)

Rationing

In one relevant mention of rationing during the study period, we see how this is a topic that overlaps between both the United States and the United Kingdom. For two US healthcare professionals, they believe Obamacare to be based on a UK rationing system.

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Figure 5 – Rationing is a topic with common overlap between the UK and US
(Source: https://twitter.com/janehughesmd/statuses/476138393315713024)

Pre-existing Conditions

Here lies one fundamental issue for patients, and their physicians. Dr Kenneth Fisher, points to two articles using the hashtag #hcr2014.

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Figure 6 – Kenneth Fisher uses the hashtag #hcr2014 for relevance and to reach an interested community (Source: https://twitter.com/kennethafisher/statuses/477114734978662400)

In one of the articles titled ‘My Obamacare Agony’, we hear a first-hand experience of a patient trying to navigate a reformed health system with a pre-existing condition: “Only one brand-name drug can keep my pain at bay. Under Obamacare, I couldn’t simply refill my regular prescription, though. Instead the drug had to be pre-authorized, and ultimately my exchange plan insurer denied coverage for the drug, which costs $400 per month without insurance or discounts.”

Dr Fisher and Dr Gross publish their own opinion piece to make the case that “When compared to the government-centered approach, patient-focused solutions win every time.”

Transparency

In the past year ‘transparency’ has been discussed in the context of data, privacy, Government plans and more. In this way it is something of a ‘label’ which HCPs tend to use in the context of other thoughts, usually by adding a hashtag #transparency at the end of a tweet.

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Figure 7 – Healthcare professionals are keen to see transparency of data and issue affecting health reform programmes (Sources: https://twitter.com/Adenovir/statuses/387905464497078273, https://twitter.com/annelizhannan/statuses/388779047377195008)

The Cost of Drugs and Treatments

The cost of care is a key driver for health reform, as discussed in our previous article in the series. In the same way, the price of drugs and treatments is often a point of discussion in the context of other health insurance issues – such as rationing, or preventative care. We see in Figure 8 several examples of the HCP perception on drug prices and the pharmaceutical industry.

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Figure 8 – Several HCPs express opinions about the impact of drug and treatment prices
(Source: https://twitter.com/DamianFog/statuses/405090574337720320, https://twitter.com/archangelolill/statuses/482950342599249920, https://twitter.com/LANURSE1/statuses/471700490615803906)

Health Insurance Issues

Health insurance issues in health reform include premiums, eligibility, treatment, screening and testing, pre-existing conditions, transparency, or the cost of drugs and treatments. Healthcare professionals are keenly interested in the impact of government policies and approaches to these aspects of health provision.

In the next article from this series, we will look at the specific locations of healthcare professionals discussing health reform in the US and the UK. Will there be differences in conversation by locality?

If you have a keen interest in HCP views on health reform, you will have access to the full study by attending the Health 2.0 conference. For now, why not subscribe to the Health 2.0 blog and receive weekly updates as we unpick the differences between health reform in the UK and the USA.

If you are not already attending the conference, it is not too late to register.

About the author: Paul Grant (@paulgrant) is Chief Innovation Officer with Creation Healthcare. At the Health 2.0 fall conference, he will present research conducted using Creation Pinpoint, a service for analyzing healthcare professional opinion expressed through public social media.

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