Health insurance says ‘no’ to mistakes

November 10, 2008

We take out insurance to protect ourselves against what might happen in the case of house, home, or health insurance and against what will happen in the case of life insurance. Now there is a new twist that is hitting hard in the USA, and as we seem to follow their lead in most things I thought I would give you a heads-up on this one. Medicare is the federally-funded medical plan for Americans age 65 and over that covers medical expenses such as doctor’s visits, hospital stays, drugs and other treatment – similar to the NHS, but here comes a major difference. They have just announced that they will no longer pay to correct medical errors. So, for instance if during your operation the surgeon amputates the wrong toe then the hospital itself will have to pay for corrective treatment, not Medicare. And quite right too, you might think, but in the UK this would mean that it was coming out of your hospital’s budget from the NHS which would mean less money for initial treatments. Now, we don’t want to reward bad work, but if the US trend is followed here – and the private insurers have quickly followed suit there – then the next part of Medicare’s announcement will impact us as consumers as well.

Medicare will not provide any insurance cover for what they are calling “reasonably preventable” conditions. They have listed 10 of these, including post-operative infections from select procedures,bed sores, injuries resulting from falls, and incompatible blood transfusions. In other words ‘mistakes’ that happen in hospitals every day. It is making hospitals performance oriented, which as we have seen with patient and operation targets does not always work in the way it was intended. Medicare’s Payment Advisory Commission also recently recommended that hospitals with high readmission rates had their payments reduced. So if you live in a chronically unhealthy area, or one with a high number of elderly people they are being asked to treat the same number of people for less money – and how will that impact patient care?


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