THE IMPACT ON PATIENTS OF DELAYS IN
PASSING A PATIENTS’ BILL OF
RIGHTS:
A SENATE HELP COMMITTEE MINORITY STAFF STUDY
April 7, 2000
For Immediate Release
Contact: Jim Manley
(202)
224-2633
Delays in passing legislation to curb insurance company abuse result in
injury to thousands of patients daily and millions of patients annually.
Drawing on two prior studies on the incidence of abusive health plan
practices, this report looks at the number of patients affected daily,
weekly, monthly and yearly.
The estimates are based on patient self-reports of experiences with
health plans and on physicians' reports of the frequency of various abuses
and the seriousness of injuries sustained by the patients they see in
their own practices.
Highlights:
According to patient reports, every day, as the result of actions of
their health plan:
o 59,000 patients experience added pain and suffering
o 41,000 patients experience a worsening of their condition
o 35,000 patients have needed care delayed
o 35,000 patients have a specialty referral delayed or denied
o 31,000 patients are forced to change doctors
o 18,000 patients are forced to change medications
According to physician reports, every day:
o 14,000 physicians see patients whose health has seriously declined
because an insurance plan refused to provide coverage for a prescription
drug
o 10,000 physicians see patients whose health has seriously declined
because an insurance plan did not approve a diagnostic test or procedure o
7,000 physicians see patients whose health has seriously declined because
an insurance plan did not approve referral to a medical specialist
o 6,000 physicians see patients whose health has seriously declined
because an insurance plan did not approve an overnight hospital stay
o 6,000 physicians see patients whose health has seriously declined
because an insurance plan did not approve a referral for mental health or
substance abuse treatment.
METHODOLOGY
The data presented in this report was drawn from two sources. Patients'
self-reports on difficulties with their health plans and illness and
injury caused by actions of their health plans was drawn from a random
sample survey of individuals in California with private health insurance
conducted by the Center for Health and Public Policy Studies, School of
Public Health, University of California at Berkeley. Helen Schauffler,
Ph.D., was the principal investigator. The survey was conducted during
September, 1997 for the Managed Care Improvement Task Force of the State
of California, and reported in Improving Managed Health Care in
California, Findings and Recommendations, Volume Two, January, 1998,
Tables 4 and 19.
The survey asked whether the respondent experienced specific
difficulties with a health plan. Those who experienced difficulties were
asked about the impact of the difficulty on their health. The figures
presented in this report assume that the incidence of such events is the
same among the total U.S. population of privately insured individuals as
it is among the privately insured population in California. Daily, weekly,
and monthly figures were derived by dividing annual rates by 365, 52, and
12, respectively. All figures in the tables are rounded to the nearest
1,000 patients.
Data on physicians' reports of health plan practices and serious
declines in health experienced by patients as the result of health plan
actions were drawn from the 1999 Survey of Physicians and Nurses by the
Kaiser Family Foundation and the Harvard School of Public Health. The
survey was conducted between February 11 and June 5, 1999. Physicians were
asked how frequently a set of plan practices occurred (weekly, monthly,
every six months, yearly, never, or not applicable to my practice).
Physicians who reported that the practice occurred were asked for the
impact on the health of their patients.
The figures reported in the survey were converted into daily, weekly,
monthly, and annual totals by adding the proportions seeing the specified
event during the specified time period. For example, to derive a weekly
total, the numbers of doctors reporting seeing such patients weekly was
added to one-fourth of the doctors reporting seeing such patients monthly
plus one-fifty-second of the doctors reporting seeing such patients
annually. The proportions were then multiplied by the size of the sampling
universe of 470, 364 physicians. All figures reported in the table are
rounded to the nearest 1,000 patients.
Note that the tables are not comparable, since one reports on numbers
of patients affected, while the other reports on numbers of doctors seeing
affected patients. Many doctors saw numerous affected patients. Moreover,
judgements of doctors who attribute health declines to specific plan
practices may not coincide with patients' own conclusions. Also, the
doctor survey reports on patient injuries due to specific plan practices
which are not identical with the problems identified in the patient
survey. | 