Policy Watch
healthalerts.com.au article posted on: Monday 30th March 2009
Australia’s private health insurance model, which boasts community rating as one of its key features, represents international best practice.
Community rating facilitates affordable access to private health care for all Australians. It means that everyone pays the same premium for their health insurance and health funds are prevented from discriminating against members on the basis of health status, age or claims history.
The new United States administration is working with US health funds to overhaul the existing “risk rated” system in favour of a model which resembles the Australian example.
US health funds are working on a set of proposals to make health insurance more affordable.
Health Insurers Offer to Drop 'Risk Rating'
Boston Globe
March 25, 2009
Trying to head off a proposed government insurance plan that would compete with them, health insurers yesterday offered for the first time to curb the controversial practice of charging higher premiums to people with a history of medical problems.
The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate about overhauling the nation's healthcare system to rein in costs and cover an estimated 48 million uninsured people.
In a letter to key senators, the two insurance industry groups said their members are willing to "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage.
"The offer here is to transition away from risk rating, which is one of the things that makes life hell for real people," said health economist Len Nichols of the New America Foundation, a public policy center. "They have never in their history offered to give up risk rating."
Insurers are trying to stop the government insurance plan, proposed by many Democrats and advocacy groups, to offer consumers another choice for affordable care and to increase competition.
"This letter demonstrates that insurance companies are open to major insurance reform, and are even willing to accept broad consumer protections," said Senator Jeff Bingaman, a moderate Democrat from New Mexico. "It represents a major shift from where the industry was in the 1990s during the last major healthcare debate."
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To try to win political support, the industry has already made a number of concessions, including offering to end the practice of denying coverage to sick people and pledging support for a national goal of restraining cost increases.
The latest offer goes beyond that.
Insurance companies now charge very high premiums to people who are trying to purchase coverage as individuals and have a history of medical problems, such as diabetes or skin cancer. Even if such a person is offered coverage, that individual is often unable to afford the high premiums. About 7 percent of Americans buy their coverage as individuals, while more than 60 percent have job-based insurance.
"This changes everything," said Karen Ignagni, president of America's Health Insurance Plans, the leading trade group. "When you have everyone in the system, and you can bring [financial] assistance to working families, then you can move away from health status rating."
The companies left themselves several outs, however. The letter said they would still charge different premiums based on such factors as age, place of residence, family size, and benefits package.
"If the goal is to make healthcare affordable, this concession does not go far enough," said Richard Kirsch, campaign manager for Health Care for America Now, a group backed by unions and that is trying to build support for sweeping healthcare changes. "It still allows insurers to charge much more if you are old."
Also, the industry did not extend to small businesses their offer to stop charging the sick higher premiums. Small employers who offer coverage can see their premiums zoom up from one year to the next, even if just one worker or family member gets seriously ill.
Ignagni said the industry is working on separate proposals for that problem.
"We are in the process of talking with small business folks across the country," she said. "We are well on the way to proposing a series of strategies that could be implemented for them."
healthalerts.com.au article posted on: Wednesday 22nd August 2007
The U.S. Food and Drug Administration today announced manufacturers of certain drugs approved to treat Type 2 diabetes have agreed to add a stronger warning on the risk of heart failure, a condition that occurs when the heart does not adequately pump blood.
The information will be included in the form of a "boxed" warning—FDA's strongest form of a warning. The upgraded warning emphasizes that the drugs may cause or worsen heart failure in certain patients.
After a review of postmarketing adverse event reports, FDA determined that an updated label with a boxed warning on the risks of heart failure was needed for the entire thiazolidinedione class of antidiabetic drugs.
This class includes Avandia (rosiglitazone), Actos (pioglitazone) Avandaryl (rosiglitazone and glimepiride), Avandamet (rosiglitazone and metformin), and Duetact (pioglitazone and glimepride). These drugs are used in conjunction with diet and exercise, to improve blood sugar control in adults with type 2 (non-insulin-dependent) diabetes. FDA had asked the drug's manufacturers, GlaxoSmithKline and Takeda, to address these concerns.
"Under FDA's postmarketing surveillance program, we carefully monitor new safety information for marketed drugs and take appropriate action when necessary to inform patients and health care providers of new information," said Steven Galson, M.D., M.P.H., director of FDA's Center for Drug Evaluation and Research.
"This new boxed warning addresses FDA's concerns that despite the warnings and information already listed in the drug labels, these drugs are still being prescribed to patients without careful monitoring for signs of heart failure."
FDA's review of adverse event reports found cases of significant weight gain and edema—warning signs of heart failure. In some reports, FDA noted, continuation of therapy has been associated with poor outcomes, including death.
The strengthened warning advises health care professionals to observe patients carefully for the signs and symptoms of heart failure, including excessive, rapid weight gain, shortness of breath, and edema after starting drug therapy.
Patients with these symptoms who then develop heart failure should receive appropriate management of the heart failure and use of the drug should be reconsidered. People who have questions should contact their health care providers to discuss alternative treatments.
The warning also states that these drugs should not be used by people with serious or severe heart failure who have marked limits on their activity and who are comfortable only at rest or who are confined to bed or a chair.
FDA's review of Avandia and possible increased risk of heart attacks is ongoing. On July 30, 2007, FDA's Endocrine and Metabolic Advisory Committee and the Drug Safety and Risk Management Advisory Committee recommended that Avandia continue to be marketed, and further recommended that information be added to the labeling for risk of heart attacks (ischemic risks).
Source: United States Food and Drug Administration, 17th August 2007
healthalerts.com.au article posted on: Thursday 17th May 2007
The National Joint Replacement Registry is being expanded to include data collection on ankle, shoulder, wrist and spinal disc replacements.
About one in four hip and knee replacements fail and there is no reason not to expect that the statistics collected under the expanded registry will reflect those already available on hip and knee prostheses.
More than 70,000 Australians undergo joint replacement procedures every year.
The Australian Health Insurance Association will continue to lobby on behalf of health consumers for appropriate clinical testing for all prostheses used in Australia.
Federal Budget 2007: National Joint Replacement Registry - increased data collection (762 KB)
healthalerts.com.au article posted on: Thursday 17th May 2007
The expansion of the current Medicare item for Bone Mineral Density testing to allow people aged 70 years and over to have their bone density tested without the need for other medical indications, such as fractures, is great news for Australia’s ageing population.
This test, when combined with Fosamax therapy is an excellent preventative health measure and will reduce fracture risk in older Australians. An extension of the listing of Fosamax on the PBS was announced in the recent Federal Budget.
The AHIA advises all Australians over 70 years of age to discuss having tests done on their Bone Mineral Density with their General Practitioner.
Federal Budget 2007: Pharmaceutical Benefits Scheme - extension to the listings of Fosamax (633 KB)
healthalerts.com.au article posted on: Friday 13th October 2006
The Australian Orthopaedic Association's national conference has today heard that new types of artificial hips have a higher failure rate than previous technology.
Surgeons have been asked to consider abandoning the newer, more expensive products in favour of their cheaper and more effective predecessors.
The Australian Health Insurance Association has backed the calls, saying more rigorous clinical testing should be undertaken on the new products
FULL TRANSCRIPT
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(Source: ABC Local Radio - The World Today)
healthalerts.com.au article posted on: Friday 6th October 2006
After years of complaints that they don't offer value for money, Australia's private health insurance funds are preparing to deliver some big changes to their members.
From April next year private health funds will be allowed to offer rebates for a range of services designed to prevent disease as well as coverage for out-of care hospital costs, as Samantha Donovan reports.
The nation's health insurers are busy developing new policies, which will see them not only able to cover diet advice and exercise classes, but also more medical treatment outside hospital. More cancer patients, for example, may be able to have chemotherapy at home and dialysis and palliative care is expected to be covered by many.
Health Economist Paul Gross is an enthusiastic supporter of the changes, which he says many other Western countries introduced five to ten years ago. FULL TRANSCRIPT
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(Source: ABC Local Radio - The World Today)
healthalerts.com.au article posted on: Friday 1st September 2006
The Pan Pharmaceutical "problem" two years ago exposed weakness in the regulation of herbal and natural remedies. The massive recall of Pan products prompted the Federal Government to commission a review of the burgeoning alternative therapies industry. That review found that the sometimes dangerous side-effects of complementary medicines were being widely under-reported and the Federal Government has since agreed to overhaul its reporting system and to develop a public information campaign. More(Source: ABC 7:30 Report)