An early look at ten state HIFA Medicaid waivers

In an examination of ten Health Insurance Flexibility and Accountability (HIFA) demonstrations, a major Medicaid initiative of the Bush administration, we found that states have adopted varied program designs, reflecting their particular goals and circumstances. Nationally, we estimate that 300,000 people were covered under HIFA demonstrations as of December 2005. Although this is a sizable number, coverage has fallen far short of the 820,000 expected.

Lifting the lid off of pricing. With HHS moving to post what it pays for common procedures, the debate over healthcare pricing transparency is heating up

Healthcare pricing was the focus of discussion in Washington last week, with HHS announcing agencies will be posting the prices paid for common procedures, and industry experts testifying at a hearing on the topic. The debate among lawmakers tends to mask the complexity of shifting healthcare costs, says Paul Ginsburg, left.

Covering your staff: high costs, tough choices

Like all employers, hospitals are squeezed by the skyrocketing cost of employee health coverage. Some are taking a relatively radical step: offering consumer-directed plans.

Reviving Managed Care With Health Savings Accounts

Although health savings accounts (HSAs) and managed care are often seen as antithetical, they can be integrated in fruitful ways. Moreover, combining these approaches would serve policy objectives by clarifying the payment responsibilities of patients, health plans, and premium payers, thus altering important perceptions about health care decision making. The availability in HSAs of funds that patients can use to pay for services not covered under insurance contracts should help to relegitimize the predetermination of benefits and enable the public and the legal system to take a more benign view of corporate health plans as agents of their subscribers.

Reforming America's health system through innovation and entrepreneurship

America's attempts for healthcare reform are gridlocked. Healthcare special interests are reluctant to abandon profitable activities, and American culture-distrust of centralized federal power, belief in self-improvement, desire for choice, and belief in equal access to medical technologies-is slow to change. Physician entrepreneurship and innovation, coupled with consumer-driven healthcare and public-private partnerships, may break the present gridlock.

Access to oral health care for elders: mere words or action?

For many years, the health care community has used a silo approach to oral health, with little exception, treating the oral cavity as the sole province of the dentist, with no interaction with the medical profession. However, as research shows links between periodontal disease and diabetes, stroke, heart disease, and peripheral arterial disease, it seems clear that the silo approach to oral health should be replaced with a new paradigm-that of including dental care in comprehensive medical benefits. Retirees who have limited or no access to traditional employer-based dental benefits should be among the early beneficiaries of this paradigm shift. The federal government should consider social insurance mechanisms to ensure that retirees have access to oral health care.

What do health savings accounts mean for the emergency department?

The insurance market is evolving, with increased emphasis on plans with high deductibles and a large degree of coinsurance. This article serves as an introduction to the defining characteristics of consumer-driven health care plans and their associated health savings accounts. We discuss the most recent evidence on the adoption of these plans and their effects on use and reimbursement. Compared to many specialties, the emergency department (ED) may be insulated from extensive shopping and price negotiation, because visits to the ED are often for urgent and time-sensitive conditions. However, ED utilization patterns may change if cost-conscious health savings account holders forgo other necessary medical care, or if they seek out substitutes to the ED for less urgent problems. In the long run, the ED may feel the impact of changes that stem from 2 areas: the ability of health savings accounts to control the increase in health care costs, and the potential of health savings accounts to replace or undermine more comprehensive health insurance plans. We note areas that emergency physicians should monitor as health savings accounts become more prominent.