Prescription Drugs, Quality of Care, Malpractice Insurance, HMO Finances
Though Congress' ardor for a Medicare prescription drug benefit appears to have cooled, HHS is looking for ways to improve access to drug therapy and comprehensive pharmacy services for uninsured and underserved Americans.
Community health centers and other "safety net" organizations currently are able to purchase most drugs at discounts of 25 to 40 percent, under the Public Health Service Act. But their patients often can't afford to travel to distant pharmacies. Now HHS, through demonstration projects, seeks ways for individual centers to purchase more drugs without increasing total expenditures.
To increase the number of sites where patients can obtain medications, for example, entities participating in the new initiative can contract with multiple pharmacy service providers.
Although medical professionals and hospital administrators don't give rave reviews to America's health care system, most rate it "very good/excellent" (42 percent) or "good" (38 percent), according to a survey funded by the Robert Wood Johnson Foundation.
However, nearly all respondents report witnessing major medical errors or poor-quality care. And while four out of five believe that it will take more than minor fixes to improve the system, fewer than half think that individual physicians should be held accountable for developing and managing quality-improvement efforts. Most say that responsibility lies with health plans, hospitals, and physician groups.
In releasing the survey findings, the foundation also announced it will spend nearly $21 million to fund an initiative on improving health care.
When The St. Paul Companies decided not to renew medical malpractice coverage for 1,262 policyholders in Georgia, state insurance commissioner John W. Oxendine stepped in. He ordered St. Paul to renew the affected policiesor face a three-year suspension of its license and one-year probation.
St. Paul plans "to vigorously pursue all legal remedies" to block the directive. The company claims that it's paying out $1.79 for every dollar it receives in premiums. Its decision (to place some or all of these policyholders with a surplus insurer) was an attempt to maintain a market that meets the doctors' needs while producing a profit, the company said.
The commissioner's order affects five St. Paul companies that together write 15 percent of the total dollar volume of malpractice insurance in the state.
Lavish compensation remains the order of the day for the highest-level jobs within the largest health plans, according to figures taken from SEC filings and released by Families USA, the health care advocacy group. Last year's pay packages for top executives of the 10 biggest for-profit, publicly traded insurance and managed care companies totaled more than $117 million, and unexercised stock options amounted to almost $495 million.
*Includes salaries, bonuses, benefits packages, travel allowances, long-term incentive payouts, performance awards, and stock options cashed in 2000. N.R.: not reported in SEC filing.
Joan Rose. Practice Beat. Medical Economics 2001;15:17.