Russia is a sad state.
"Corruption Pervades Russia's Health System
Drastic Reform Is Crucial As Country's Population Continues To Decline
MOSCOW, June 28, 2007.
(AP) When Karen Papiyants lost his leg in a road accident last year, his medical nightmare was only beginning.
Although like any Russian he was entitled to free treatment, he says the doctors strongly suggested he pay $4,500 into their St. Petersburg hospital's bank account or be deprived proper care — and perhaps not even survive.
Faced with that choice, the 37-year-old truck driver's relatives scrambled to scrape together the money. But Papiyants said that didn't stop the nursing staff from leaving him unattended for most of the night and giving him painkillers only after he screamed in agony.
"It's nothing but blackmail and extortion on the part of doctors," Papiyants said.
In theory Russians are supposed to receive free basic medical care. But patients and experts say doctors, nurses and surgeons routinely demand payments; even bribes; from those they treat. And critics say the practice persists despite Russia's booming economy and its decision to spend billions to improve the health care system.
Medical care in Russia is among the worst in the industrialized world. A 2000 World Health Organization report ranked Russia's health system 130th out of 191 countries, on a par with nations such as Peru and Honduras.
This is one of the few nations in the world where life expectancy has declined sharply in the past 15 years. The average Russian can expect to live only to age 66; at least a decade less than in most Western democracies, according to a 2005 World Bank report. For men, the figure is closer to 59; meaning many Russian men don't live long enough to start collecting their pension at age 60.
Compounded by alcoholism, heart disease claims proportionately more lives than in most of the rest of the world. Death rates from homicide, suicide, auto accidents and cancer are also especially high.
Russia's population has dropped precipitously in the past 15 years, to below 143 million in what President Vladimir Putin calls "the most acute problem of contemporary Russia."
In 2004, according to the Organization for Economic Cooperation and Development, Russia spent $441 per capita on health care, about a fifth of what the Europeans spend. Over the past two years the government has more than doubled health care spending to some $7 billion, but that still works out to only about 3.4 percent of all government spending, and the World Health Organization recommends at least 5 percent.
Experts here say new spending does little if it fails to tackle corruption.
The state covers all Russians under a standardized medical insurance package, while well-heeled citizens can buy extra insurance and be treated privately.
In the Soviet era, patients occasionally rewarded doctors with money or gifts, but were largely guaranteed free treatment. The Soviet Union's public health system was, for a time at least, considered among the world's best.
But the system failed to keep up with Western medicine, and after the Soviet collapse, went into decline. Today, many who can't afford to pay or bribe; especially those in remote provinces; may never receive proper care.
Some experts say this has helped drive up death rates.
"Corruption in health care is a threat to Russia's national security in the broadest sense of the word," said Yelena Panfilova, head the Russian branch of Transparency International, a global corruption watchdog.
According to a summer 2006 study commissioned by the group, 13 percent of 1,502 respondents who had sought medical help during the previous year had to pay an average of $90 under the table, out of wages averaging $480 a month. The poll had a margin of error of 2.6 percentage points.
Panfilova also said medical and pharmaceutical companies routinely bribe health officials so that hospitals buy their equipment and medicines, even though their quality is often not the best.
Kirill Danishevsky, a health researcher with the Russian Academy of Sciences' Open Health Institute, has estimated that up to 35 percent of money spent on health care consists of under-the-table payments.
At the Dzhanelidze Emergencies Institute where Papiyants was treated, spokesman Vadim Stozharov denied that doctors refused to provide free care. But he conceded the hospital has received so many similar complaints it set up a hot line to deal with them.
The Health Ministry declined to comment on the bribery allegations. But Galina Lavrishcheva, the top health official in Stupino, an industrial town in the Moscow region, acknowledged that health care workers sometimes demand payoffs.
"Yes, it is true, I am not going to hide it; extortion takes place," Lavrishcheva said.
The Stupino regional hospital is at the forefront of government reform efforts. Officials have fought overcrowding by cutting the number of beds from 800 to 625, have set up an outpatient clinic and have installed new equipment, including ultrasound and electrocardiogram machines.
Overspecialization, a legacy of the Soviet era, is a big problem because patients are shuttled from one narrowly focused specialist to another. Meanwhile, no physician generally takes responsibility for their state of health.
Dozens of Stupino's specialists have been retrained as general practitioners and their salaries raised to reduce the lure of bribes and create incentives for more doctors to become GPs.
Yelena Filippova, a freshly retrained GP, now treats some 2,000 patients and earns $700 a month, more than double her previous salary. Filippova, 27, says the system is more efficient. Her patients like it as well.
"It's professional, it's high quality, it's quick and convenient; you don't have to stand in lines," said Viktor Lenok, a 60-year-old retiree, whom Filippova treats for asthma.
But critics say these changes are no substitute for radical change; just a high-profile way of spending the country's oil-driven wealth in an election year. They insist the reform does not address bribe-taking by emergency health care providers and medical specialists.
"A huge heap of money is being pumped into the same health care system; but why invest into something that doesn't work?" said health researcher Danishevsky. "The very system needs to be reformed."
http://www.cbsnews.com/stories/2007/06/28/world/main2992334.shtml
The Russian Health Care Reform - What Led to the Institutional Trap During the 1990s, and are Recent Changes in Health Policy Likely to Help?
BENOIT MATHIVET
University College London - School of Slavonic and East European Studies
--------------------------------------------------------------------------------
June 2007
Abstract:
This article analyses why, fifteen years after the introduction of reformed financing mechanisms, the Russian health care system is unable to cope with public health issues brought by the economic transition as well as inherited from the Soviet era.
This reform was dual and consisted first in the decentralization of the former budgetary financed system to the regional and local authorities. The second aspect of the reform was to introduce the Mandatory Health Insurance System. This new system was relying on a different source of financing (payroll) and new pooling and purchasing arrangements, introducing market based regulation through the establishment of private mandatory health insurance companies as key actors. This system was supposed to quickly supply a significant share of resources. Self interest of those private companies was also supposed to bring, through the purchasing process, very profound changes in health care provision leading to quality improvements as well as better cost-control.
The confrontation of the mechanisms introduced by the Russian Law with initial conditions (main characteristics of the former system, and socio-economic conditions at the date of introduction of the new system) is analyzed, in order to show that it inevitably led to a perverse situation. Effects of the presumably desired coexistence of both financing systems are also investigated. Main result of the reform seems to have been a lack of incentives for actors to behave accordingly to the original plans which inevitably led to poor effects on the resources available and few sanitary improvements. Moreover, there are presently very important regional disparities in the application of the reformed health care financing and provision mechanisms. Depending on regions, population does not benefit equal quality of care, and this first inequality is reinforced by the all pervasive development of informal payments within the system. The large variety of arrangements between actors of the system at individual, local and regional levels, weather they are informal payments for treatment or bargaining concerning the divestiture of social assets of firms for example, generated a relative stability within the perverse functioning of the system, thus creating the institutional trap.
Recent measures taken at federal level, such as the Federal Priority Project - Health, a massive federal intervention for years 2006-2007, might paradoxically bring weak results as they tend to repeat mistakes of the past.
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=994827
Not sure what you'll be told about the US system, but it's important to note that we do NOT have a free market, with a few exceptions:
Read:
http://www.azcentral.com/community/gilbert/articles/0217er17.html
A doctor owned and run hospital that sees everyone gets care, no matter what happens to the bottom line.
http://www.simplecare.com/ a doctor-driven group where reasonable rates are charged.
Note you can go to a walk-in clinic at Wal-Mart or CVS or the like in many cities and get many of the most typical reasons for seeing a doc addressed for under $100.
The price of LASIK has DROPPED dramatically over a decade. Plastic surgery is CHEAP. Compare a major procedure like a tummy tuck with the bill an uninsured patient will get for a medically necessary appendectomy WITHOUT complications.
Medicare is help up by the uninformed as the model to use. The FACTS don't support that:
In the US, Medicare is going bankrupt. In 1998, Medicare premiums were $43.80 and in 2008 will be $96.40--up 120%. "Medigap" insurance is common because of the 20% co-pay required for service. Medicare HMOs are common because they reduce that burden without an extra charge in many cases. HOWEVER, many procedures which used to have no or a low co-pay NOW cost the full 20% for the HMO Medicare patient. ALSO the prescription coverage they tended to offer has been REDUCED in many cases to conform to the insane "donut hole" coverage of the feds. Doctors are leaving Medicare because of the low and slow pay AND because the crazy government wants to "balance" their Ponzi scheme on the backs of doctors.
"That dark cloud lurking over the shoulder of every Massachusetts physician is Medicare. If Congress does not act, doctors' payments from Medicare will be cut by about 5 percent annually, beginning next year through 2012, creating a financial hailstorm that would wreak havoc with already strained practices.
Cumulatively, the proposed cuts represent a 31 percent reduction in Medicare reimbursement. If the cuts are adjusted for practice-cost inflation, the American Medical Association says Medicare payment rates to physicians in 2013 would be less than half of what they were in 1991."
http://www.massmed.org/AM/Template.cfm?Section=vs_mar05_top&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=11037
MEDICAID is worse--it's obviously rationed as is ALL UHC care throughout the world (UHC is Universal Health Care):
Oregon's at least honest about the FACT that ALL government health care IS RATIONED care:
"But the real-life story of 18-year-old Brandy Stroeder may come to embody a harsher truth: namely, that even as we perfect more and more advanced medical procedures, not everyone is going to have access to them. And, as Americans struggle to come up with an equitable health care system, that even the best-intentioned system can seem heartless when forced to balance the good of thousands against an individual's suffering.
The story began last fall when doctors told Brandy, who lives with her single mother in a weather-beaten farmhouse about an hour south of Portland, Ore., that she was likely to die within a year unless she got a simultaneous lung-liver transplant, an operation that has been performed fewer than a dozen times in the United States.
Under Oregon's unique Medicaid system, which openly rations healthcare in order to provide basic care to as broad a population as possible, Brandy was eligible for a liver transplant or a lung transplant, but not both. In January, and again after a review in May, the state-run health plan said no. There wasn't enough data to show the $250,000 procedure was worthwhile, the health plan's administrators said, and the plan didn't cover experiments.
But Brandy wouldn't take no for an answer. A tough, determined young woman who had managed to work part-time at a photo studio, baby-sit her boss's children, coach the high school football team and maintain a 3.2 grade point average between numerous and prolonged bouts in the hospital, Brandy wasn't about to give up her life without a fight. She sued the state of Oregon, charging that it was making a flawed moral choice in refusing to save her life. Since then her caustic, articulate criticisms of the Oregon system have given a vivid sense of the obstacles any universal healthcare plan for the nation would face.
"They'll pay for an alcoholic to get a liver transplant because they've been drinking all their life," she says, sitting with her mother at a rickety picnic table under a cherry tree by her front door. "They'll pay for a heroin addict to get cured, to help someone kick the cigarette habit. Those are things people do to themselves. If you put it to a vote the people would say pay for some girl's operation instead of some alcoholic's liver transplant or some crack head's needles. I just think it isn't very fair.'"
http://archive.salon.com/health/feature/2000/07/07/brandy/
Texas has also been the boldest in supporting the growing-in-popularity "futile care theory":
"Texas, however, has become ground zero for futile-care theory thanks to a draconian state law passed in 1999 — of dubious constitutionality, some believe — that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient's decision to receive treatment, he or she can take it to the hospital ethics committee. A committee hearing is then scheduled, all interested parties explain their positions, and the members deliberate in private.
If the committee decides to refuse treatment, the patient and family receive a written notice. At that point, the patient/family has a mere ten days to find another hospital willing to provide the care, after which, according to the statute, "the physician and health care facility are not obligated to provide life-sustaining treatment."
Since the patients threatened with death by ethics committee are often the most expensive to care for, it will often be difficult for families to find other institutions willing to accept a transfer. But the futility deck may be especially stacked against Houston patients. Many city hospitals participate in the "Houston City-Wide Guidelines on Medical Futility," raising the suspicion that participating hospitals will not contradict each other's futility decrees.
If so, this would mean that patients seeking refuge from forced treatment termination will have to be transported to distant cities, as has already occurred in a few futile-care cases, perhaps even out of state. Illustrating the level of hardball some hospitals play against patients and families, the Clarke family's lawyer Jerri Ward told me that St. Luke's agreed to pay the $14,806 transportation costs to transfer Clarke to a hospital in Illinois — more than 1,000 miles away — if the decision to transfer is made on Thursday (4/27). If the family doesn't decide until Friday, the hospital will pay only one-half of the cost of transportation. Thereafter, it would pay nothing."
http://www.nationalreview.com/smithw/smith200604271406.asp
Before you're depressed, the US could fix its problems, but the CEOs of the handful of insurance companies won't like it and the pols would lose some bargaining chips.
I want QUALITY, ACCESSIBLE, AFFORDABLE health care for all.
That means preventative care (physical with follow up). Real medication (no Medicare "donut holes" the really ill are screwed again.) No bogus ridiculously low "caps" on needed medical procedures. No abuse of the ER. No paying for the silly with the sniffles to go to the doc for free. No more bankruptcies over medical bills. I want THIS plan that ends abuse of the taxpayer, takes the burden off employers, provides price transparency, and ends the rip-off of the US taxpayer at the hands of greedy insurance CEOs (which has been repeatedly documented).
http://www.booklocker.com/books/3068.html
Read the PDF, not the blurb, for the bulk of the plan. Book is searchable on Amazon.com
Cassandra Nathan's Save America, Save the World
And some of what I mean about the insurers:
"the vast majority of health insurance policies are through for-profit stock companies. They are in the process of “shedding lives” as some term it when “undesirable” customers are lost through various means, including raising premiums and co-pays and decreasing benefits (Britt, “Health insurers getting bigger cut of medical dollars,” 15 October 2004, investors.com). That same Investors Business Daily article from 2004 noted the example of Anthem, another insurance company. They said the top five executives (not just the CEO) received an average of an 817 percent increase in compensation between 2000 and 2003. The CEO, for example, had his compensation go from $2.5 million to $25 million during that time period. About $21 million of that was in stock payouts, the article noted.
A 2006 article, “U.S. Health Insurance: More Market Domination, More CEO Compensation”
(hcrenewal.blogspot.com) notes that in 56 percent of 294 metropolitan areas one insurer “controls more than half the business in health maintenance organization and preferred provider networks underwriting." In addition to having the most enrollees, they also are the biggest purchasers of health care and set the price and coverage terms. “’The results is double-digit premium increases from 2001 and 2004—peaking with a 13.9 percent jump in 2003—soaring well above inflation and wages increases.’" Where is all that money going? The article quotes a Wall Street Journal article looking at the compensation of the CEO of UnitedHealth Group. His salary and bonus is $8 million annually. He has benefits such as the use of a private jet. He has stock-option fortunes worth $1.6 billion."
--Save America, Save the World by Cassandra Nathan pp. 127-128
Just PART of an article:
"While growing into a colossus, UnitedHealth has repeatedly failed to perform its basic job of paying medical bills. UnitedHealth, which covers 70 million Americans, has been sanctioned in nine states for paying claims slowly; shortchanging doctors, hospitals, or patients; or poorly handling complaints and appeals.
One Nebraska woman complained to state regulators that UnitedHealth's computers had incorrectly rejected claims related to her son's surgery six times.
At one point, UnitedHealth owed Dr. George Schroedinger, an orthopedic surgeon, $600,000. He and his clinic sued UnitedHealth of the Midwest in 2004.
Deciding for the clinic, U.S. District Judge Stephen Limbaugh of Missouri declared that the company's claims processing systems were "flawed in many ways, denying, reducing, and improperly processing claims on a regular basis. And despite innumerable requests, United was unwilling to remedy the underlying errors in its systems" (Star-Tribune Dec. 12, 2007).
Payment troubles continued after the verdict, and Dr. Schroedinger filed a second lawsuit. "These people can never get it right, which says to me that they just plain lie," he said in an interview.
Failure to pay isn't the only complaint. The insurer also gives incorrect information on which physicians are in its network, creating enormous problems for physicians' staff.
The AMA said that no other insurer has prompted as many complaints as UnitedHealth about abusive and unfair payment practices. AMA officials have met with UnitedHealth executives 16 times since 2000, with little to show for it.
"They have always got a new plan to fix it," said Dr. William G. Plested III, past president of the AMA. But "nothing ever happens."
It seems to us that this case is just the tip of the insurance iceberg. More and more stories are appearing daily in the news media about how insurance company are instructing employees their jobs are to deny claims and/or delay payments.
With such a high percentage of medical premiums and other costs going to the legal profession, to maintain compliance with endless government rules/regulations and being hoarded by the insurance companies and executives — is it any wonder medical costs are increasing so dramatically?
It's time to take a closer look at the medical insurance companies.
UnitedHealth Group is not the first medical insurance company to rob patients, hospitals and clinics to pay obscene salaries to their executives.
It's a modern day robbing patients to pay pimps.
Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in economics and citizenship at the International Trade Education Foundation of the Washington International Trade Council.
Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
http://www.newsmax.com/medicine_men/medical_insurance/2008/01/03/61543.html
Linda Peeno, MD testified that SHE had often denied treatment JUST to save the insurance company money (http://www.thenationalcoalition.org/DrPeenotestimony.html)
Shows that United isn't alone in its corruption.