THE IMPACT ON PATIENTS OF DELAYS IN
PASSING A PATIENTSí 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.

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