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Is it a good idea to fix upper limit of $100000 per year of healthcare cost per insured patient?
Life support systems should not be used to prolong life of terminal patients at any cost and health insurance can refuse to pay for treatment of patients which cost too much and take resources from other patients?
One year life = 100,000 SFr
The Swiss Federal court in a judgment has agreed with a health insurance company and ruled that a year treatment for chronic or acute disease should cost no more than 100000 SFr per year. The private health insurance company had refused to pay 500,000 SFr annual cost of treatment for a patient over 60 year old with Pompe disease and on wheelchair. Pompe disease can be treated with Genzyme drugs Myozyme® (alglucosidase alfa) or Lumizyme® (alglucosidase alfa).
The judgment can be used by the private health insurance companies to refuse payments over 100000 per year for cancer, coma and patients requiring critical care. It is like a death sentence for chronic patients on life support systems. Another patient with Pomp disease with annual cost of 300000 SFr was provided free medicine by the pharmaceutical company after refusal by his insurance company to pick up the tab. Of course the free drug supply is not assured for rest of life.
The tribunal ruling has raised a firestorm in Swiss media, parliament and patient advocacy groups. It opens the door to rationing of healthcare and arbitrary glass ceiling on life. Cost cutting efforts should focus on health care system and not touch the patient. For rare and orphan diseases, creation of a special fund to cover costs of treatment is under review.
What is your opinion, do you think this will spread to other countries trying to curb increase in health care cost?
One year life = 100,000 SFr
The Swiss Federal court in a judgment has agreed with a health insurance company and ruled that a year treatment for chronic or acute disease should cost no more than 100000 SFr per year. The private health insurance company had refused to pay 500,000 SFr annual cost of treatment for a patient over 60 year old with Pompe disease and on wheelchair. Pompe disease can be treated with Genzyme drugs Myozyme® (alglucosidase alfa) or Lumizyme® (alglucosidase alfa).
The judgment can be used by the private health insurance companies to refuse payments over 100000 per year for cancer, coma and patients requiring critical care. It is like a death sentence for chronic patients on life support systems. Another patient with Pomp disease with annual cost of 300000 SFr was provided free medicine by the pharmaceutical company after refusal by his insurance company to pick up the tab. Of course the free drug supply is not assured for rest of life.
The tribunal ruling has raised a firestorm in Swiss media, parliament and patient advocacy groups. It opens the door to rationing of healthcare and arbitrary glass ceiling on life. Cost cutting efforts should focus on health care system and not touch the patient. For rare and orphan diseases, creation of a special fund to cover costs of treatment is under review.
What is your opinion, do you think this will spread to other countries trying to curb increase in health care cost?
asked Apr 16, 2011 at 10:44AM in General Medicine
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1Votes
answered Apr 17, 2011 at 07:41AMThis is very interesting. This is approaching healthcare from the perspective of an accountant. The problem is, the accountant should be involved way before the development of chronic disease. The massive waste in our systems can be ameliorated. Persons who contract a very serious disease should not bear the burden of excesses in other parts of the system. I understand the frustration of rising costs, but things like excessive pharmaceutical profits and medical device profits in areas of medicine that may be fun and interesting but don't contribute substantially to the overall health of the population need to be addressed first. -
1Votesanswered Apr 17, 2011 at 07:42AMMy perspective is that addressing health habits, food production and toxins in our environment would yield a much higher level of health in a much cheaper way. This is more of a public health approach to disease but I feel strongly it can be used to decrease costs and improve life for the largest part of our society.
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0Votesanswered Apr 17, 2011 at 09:27AMKelly,
Thanks for your comments. If the Swiss Supreme court logic is applied, patients in need of transplants, long term coma, ICU, terminal cancer, rare, orphan and genetic diseases, neurosurgery and cardiac surgery will be allowed to die because the cost of such treatment exceeds an arbitrary limit? Next step may to to exclude patients and deny treatment on the basis of race, color, sex, religion, legal status and insurance cover? -
1Votes
answered Apr 17, 2011 at 09:27AMWhile seemingly unconscionable, this is probably done more than not, even in single payer health care systems, like Canada or European countries. I think HMOs try to do it all the time in the US system, which is a patchwork of "for profit" health insurance coverage as well. There are ways to end payment of health care costs, even if it is not so blatant as in the Swiss case. One can even argue that medical assisted suicide laws are a way to "kill two birds with one stone", that is, relieve pain and suffering of hopeless medical cases, as well as save the system money. There are so many issues in this question, a couple more being, endless monetary expenditures on untreatable and aggressive medical conditions denies the inevitable (death) as a cultural value of death denying societies, and that value is put more on some lives than others, including monetary value. Europe has a lot of historical "baggage" in this area as well, what with the World War II experience, so I can imagine there are a million debates going on right now.
This is an excellent question, Krishan, and I look forward to hearing how it develops or ends in Switzerland. -
1Votes
answered Apr 17, 2011 at 10:04AMI think the answer to this dilemma regarding life vs limiting costs should not be directed toward the patient but toward the pharmaceutical companies and healthcare providers. The question which should be asked is how many dollars is more than enough for these companies and providers to receive to continue care of a single patient. If $100,000 is considered sufficient then further care and sustaining the life of the patient should continue without further costs. Think of all the money these entities continue to receive from all the patients who have not reached the $100,000 limit.
Any arguments to this rational proposal? ..Maurice. -
0Votesanswered Apr 18, 2011 at 10:05AMKim,
Thanks I agree that many private insurance companies routinely refuse costly tests, surgeries and therapy to cut costs and increase profits. They tend to prefer younger age groups than the elderly and it is always the bottom line. For insurance companies a survivor costs more.
Kelly and Maurice have both mentioned pharmaceutical industry although drug prices only contribute 15% of the total healthcare cost. However the patient co-payment for drug costs means it remains a key subject for price control and cost cutting. HMOs, private hospitals for profits, expensive diagnostic tests (like the $ 4500 BRCA test for breast cancer), imaging (MRI, CT scan) and costly devices (drug coated stents $ 3000), surgery plus hospitalization charges all are contributors to high costs.
Maurice idea of not charging patients beyond 100,000 per annum limit is good. -
0Votesanswered Apr 21, 2011 at 10:21AMIn Europe national health insurance, price negotiations and cost benefit assessment by NICE is likely to result in refusal to cover the cost of Provenge (sipuleucel T, Dandreon) for treatment of prostate cancer if approved by the EMA. The cost of 3 infusions of Provenge is $ 93000 in the US and it extends the life expectancy or overall survival by 4.1 months on average. Medicare and third party insurance in the US cover the cost of Provenge treatment. In Europe paying 93000 dollars to gain 4 months is going to be problematic and raise lot of ethical, medical and legal challenges.
A few years back an anticancer drug which increased Overall survival by only 11 days was a market failure in Europe. I do not comment on politics and religion! -
0Votesanswered Apr 22, 2011 at 09:40PMBill,
There is a breast cancer confidential profiler tool available from the American Cancer Society ACS which allows BC patients/survivors to check their treatment options. Post surgical radiation is given to almost all BC patients, so it is part of a standard treatment. Radiation treatment is mentioned in the ACS and NCI guidelines for BC, a patient can sue the insurance and win.
https://www.cancer.nexcura.com/Secure/InterfaceSecure.asp?CB=266
http://www.cancer.gov/cancertopics/types/breast -
0Votesanswered Apr 23, 2011 at 10:21PMBill,
The guidelines by the NCI (US), EORTC (European Organization for Research and Treatment of Cancer) and CRC ( UK Cancer Research Campaign) are widely followed in all OECD countries. There are several cases in the UK (common English law) where BC patients won the right to costly treatment with Herceptin in court cases and gained media sympathy. Your friend can go back to her surgeon, oncologist and radiologist to check the standard treatment protocol followed in Australia. One can check the Australian Cancer Society or equivalent body guidelines. Radiation is part of standard BC treatment to prevent relapse as about 90% of the second tumor occur in the surrounding tissue of the first tumor. -
0Votes
answered Apr 29, 2011 at 04:30PMYou have to keep in mind, why the costs are so high. It has NOTHING to do with capitalism.
Everything to do with greed and opportunism. There is a money change, and a money change... and plenty of quid pro quo to cover those responsible (sorry, but, I know one ran for president)
The costs are high, because the DNC will not have tort reform. The will not have Tort reform since lawyers, their second biggest contributors, don't want it. The guy that ran for president won his case based on bad science, bad law, and won a $900,000,000.00 settlement (which he got most of).
Cost to doctors have gotten to such an extreme, and fear of malpractice suits to the point, that Doctors spend much time doing needless things, to just cover all bases, and where we a paying lawyers millions, to not get health care... and death panels are run by the ones the lawyers are paying off.
These people will not fix the system... they will empower death panels (note: IPAB is now in place, and, we have no say until the elections, maybe.)
You want the same lawyers and politicians making the decisions?...
Keep in mind Obama did not want babies, that survived abortions, in the hospital run by his church, (Rev. Wright was on the Board), to receive any care, even if just comforting by people.... they preferred they were dumped in laundry carts until they died. Think what THEY would have done for your friend.
They have now put in place the death panels that they said they would not have, AND, when they were told, by the courts, that the law they were acting on was Unconstitutional... They didn't care.
The health insurance industry you want to blame? They are going out of business now...
Excepting AARP who had nice chunks of TARP money paid to the directors to support the bill and sell the elderly (over 50 you know) down to the abattoir... but they got ours (money that is).
Either way, the Health Insurance Industry is dying. Kill by an Unconstitutional law, being enforced by ... A man that believes in Al-Tekkeyya more than the Golden Rule.
For those that think this is ranting, sorry. This IS the topic.
The healthcare system you want, has all but bankrupted England, like it did bankrupt Argentina in the early 1900s.
I neglected to read in the Hippocratic Oath, the part that says 'OOPS... $100,000, may they rest in peace' -
1Votesanswered Apr 29, 2011 at 05:49PMHere is an alternative to discuss here: Get rid of malpractice suits and the associated burden on physicians and the large amount of money distributed in those suits. This would lead to a change in behavior of doctors regarding ordering of unnecessary tests and procedures simply because of malpractice fears. There simply should be an insurance fund run like automobile insurance but available to all which would pay appropriate but realistic amounts to patients for valid injuries in medical practice. Negligence by physicians would be evaluated by medical boards subjected to appropriate punishment or revoking of licence to practice. ..Maurice.
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Getting 'rid' of Malpractice is also a problem. I still say tort reform. Your profession has a percentage of doctors that are not the best. It is up to the doctors to clean that problem. Most of the rest are victims of those doctors, and all the lawyers.
Outlandish awards MUST be stopped. The lawyers must be curbed. Real tort reform must be done, Health costs would plummet, and services would increase. But, they in Washington are catering to the lawyers.Vincent R Villa commented Apr 30, 2011 at 01:09AM
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0Votesanswered Apr 30, 2011 at 04:40AMBy the turn of the last century (1996-2003), discredited vaccine-autism link, class action lawsuits and product injury lawsuits drove vaccine manufactures out of the US and industry bail out of R&D resulting in shortage of several critical vaccines during outbreaks. The US government declared vaccines an area of strategic and national security interests, poured billions to stimulate R&D into new vaccines. A special court was set up to deal with vaccine related injury and compensate persons harmed by vaccines financed by a 50 cent tax on vaccines sold in the US. Efforts to extend this coverage to all FDA approved drugs, devices, diagnostic procedures can go a long way in resolving these issues but has not been done so far.
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0Votesanswered Apr 30, 2011 at 05:35PMInadvertent results of a procedure that are NOT the result of negligence, and 'inadvertent' results that ARE the result of negligence are both definitions of the word "iatrogenesis."
The same word means two different things?
Inadvertent, not deliberate, non-negligent, and not plain stupidity would result in the omission of 90% of the doctors in malpractice cases. This is the object of Tort Reform...
This would reduce costs for malpractice to qualified physicians, dramatically raising them for those deserving such. The reduction in settlements of gross disproportion (the kind lawyers love because they keep the money for themselves) would pay for better facilities, equipment, and further reductions in costs. The insurance companies (hopefully there might be some left here) would have better rates and returns, no longer being bled by lawyers and judges of the same political persuasion.
The other 10% of doctors, would be the ones feeding the lawyer pool, instead (more than likely would deservedly leave the profession) They could not afford 'their' malpractice insurance.
Failure do so, would quite literally result in more 'good doctors' going to India, Costa Rica and other "medical havens".. and a greater percentile of the "10%" would be running the hospitals, as in England.
BTW: India beginning to have better overall health services than England, at lower costs, in better facilities... Wonder why?
England is trying to dump 'your' idea...
Canadians (and I note are more plentiful here) cross the boarder to get urgent health care (for now), so often, I think I saw that Canada might try to make such trips illegal. You die on their watch when they tell you???
I could be wrong. trying to keep up with information in so many countries when there are only journalists spreading.... stuff.... instead, is not easy.
In Canada, the wait for Urgent procedures is often 6-10 months or more...
As a ersatz lexicographic dilettante, I often know not what to say...
I have been doing this argument for a few years, and the reasons 'for' government care, never changes... only the lowering of services does.
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The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
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I never think it is correct to have 'lliberal' bureaucrats make decisions at any time, let alone over life and death.
Barak Obama, has shown callus disregard for life. The 'Church' he never heard a word said at for 20 years, was involved in putting babies in laundry bins, and lettng them die, with No medical attention or comfort. The bill that he introduce he voted present on.
This is who you want making life and death decisions?