Among all the horror stories coming out of the Gulf Coast cities, I was most shocked by what the TV audience didn't see: inadequate or failed emergency systems that left hospitals in the dark; bodies stacked up in the hallways because the morgues were flooded; doctors and nurses pumping air into the lungs of patients whose respirators were without power; and bedridden nursing-home patients left behind to die.
The U.S. health-care system failed its most important test. Even as the emergency workers and field hospitals arrived, it was too little too late.
America's health-benefit system didn't perform much better. In the days after Katrina, America's Health Insurance Plans in Washington, the industry trade group, announced the response of its membership: some financial contributions to relief agencies, expedited prescription drug service and suspension of managed care restrictions for health-plan participants in affected areas.
Survivors of the nation's worst natural disaster in modern times received the benefit of not having to call a toll-free telephone number to precertify their hospital admission or worry about whether or not the doctor treating their septic wound was in their PPO network. They wouldn't have to get approval from their primary-care physician (assuming they could have even found them) in order to be treated by a specialist.
In short, the health insurance industry's way to improve the delivery of care to those in need was to eliminate all of the bureaucracy that supposedly makes the delivery of care more efficient--an unintentional admission that managed care isn't working.
And not just after a disaster, either.
According to the National Committee for Quality Assurance's 2004 State of Health Care Quality, managed care, in general, is failing. The report, released in July, indicated that the health-care system "is plagued by enormous quality gaps."
Most horrifying is the conclusion that in thousands of cases, physicians are unintentionally rewarded for their mistakes by the complexity of reporting and multiple reimbursement systems.
To be fair, the study also reported marginal improvements over previous years, even as the system, overall, was bombing.
How will the survivors fare in the post-Katrina health-care system, when the chains of managed care are restored? Probably about as well as emergency medical patients who haven't been through a hurricane.
A study published in the Sept. 14 issue of the Journal of the American Medical Association tested postemergency-room patient access to follow-up care in nine large American cities. The study revealed that many emergency patients are not getting timely follow-up care critical to their recovery.
Fewer than half of the researchers posing as postemergency-room patients were able to get appointments within one week, while only about one-third who posed as Medicaid patients and about one-fourth of those claiming to be poor and uninsured were able to get prompt follow-up appointments.
Researchers who said they had private insurance did better, but fewer than two-thirds of them actually got appointments.
It's not just the Gulf Coast that needs to rebuild from the ground up.
a professor and benefits expert, is the benefits columnist for Risk & Insurance®.
November 1, 2005
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