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insurance costs: let's talk about it

Posted by elliott on 8/15/02 at 15:23 (092584)

OK, so most people on this board understandably just want to find out about ESWT or are waiting until it is covered by insurance. No one ever seems to address insurance premium costs resulting from incorporating expensive new technology such as ESWT. I was wondering if we could take a moment's break from our pains and miseries to have a somewhat loftier discussion than usual, in this case of the problem of health care costs in the U.S., and perhaps how ESWT should fit into the picture.

For some background, please read the recent N.Y.T. article in the link below (5 pages worth), which just happened to be sent to me by email today. The article's not perfect--political spins, way too anecdotal, written in almost a feverish pitch, etc., but it does offer some perspective on rising costs, insurance, decisions, and differing viewpoints, so it's a good starting point. Love to hear what you have to say.

http://www.nytimes.com/2002/08/11/health/11HEAL.html

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Re: To Elliott insurance costs: let's talk about it

Pauline on 8/15/02 at 18:29 (092608)

Elliott,
I read the article and agree with your analysis of its content. It smells of politics and borders on hysteria. I think its worth discussing, but
opposing view points wouldn't be politically correct nor welcome in this arena.

Re: To Elliott insurance costs: let's talk about it

Dr. Zuckerman on 8/15/02 at 20:52 (092623)

Hi

Can I join in? It sounds like a good topic. I will go read it. I really like the discussions that come up between the three of us. I will always respect your opinions and not try to joke. I am being serious . Some of the most interestng topics have come from both Elliott and Pauline. I learn alot from these . We may have to ask Scott to have a separate sections called Hot topics of disussion or something similiar. I am serious. We do have alot of pateints on this board that don't want to be involved or even listen to our sometimes heated discussion . I for one enjoy them but respect other patients right to talk only about solutions and not debates.

Re: To Elliott insurance costs: let's talk about it

Pauline on 8/15/02 at 21:39 (092628)

Problem is only one of us is free to speak their mind. The others must guard their tongue.

Re: why not yell?

Scott R on 8/15/02 at 21:56 (092630)

If people want to yell at each other, they should take it to the social/support board. Lord knows fighting is what many people enjoy most, and entertainment is what it's all about.

Re: insurance costs: let's talk about it

Ed Davis, DPM on 8/16/02 at 21:20 (092701)

Sorry, but I did not get through the sign up screen for the NY Times. Perhaps later.

One concern about new technologies is the cost of those technologies but insurance companies always seem to view such costs as 'add on' costs. That is not always the case since new technologies may provide means to substitute one cost for another. Plantar fascial release surgery is a cost (or set of costs including the surgeons fee, surgicenter fee, anesthesiologist and costs associated with time loss) which will potentially be substituted by ESWT. Now we certainly would expect ESWT to be performed at a higher frequency than surgery due to potentially less pain and complications.

Utilization patterns would need to be scrutinized carefully. ESWT is presumably for 'intractable' PF. But what is truly intractable PF? This message board is filled with posts which read...' I have tried everything...' with posters listing a few treatments that did not work.
ESWT has little downside risk (outside of cost) so the potential for overutilization is high. Reading into Dr. Z's posts a bit, he seems to feel that perhaps ESWT is something that should be done sooner than later in the disease process.

I think that treatment costs will come down rapidly as availability expands. Insurers often have near monopsony power in many markets an thus
will be able to 'set' the fees for this modality as they have for many other treatments.
Ed

Re: Room for multiple types of discourse as long as courtesy rules

Ed Davis, DPM on 8/16/02 at 21:25 (092702)

Readers and posters can pick and chose what to read. Some like debate and politics (heck there has been a lot of it when it comes to healthcare), others would just like to see positive solutions. There is something for everyone.
Ed

Re: good points

elliott on 8/18/02 at 00:18 (092804)

ESWT in America may well take an evolutionary course similar to that of other new medical technology: It starts with a few expensive machines and the procedure not being covered by insurance (it would be too expensive at this stage). Then, due to results being observed both in Europe and among those paying out of pocket in America, as well as new studies in America, there is increased pressure to cover the procedure, especially give the number of sufferers. Blue Crossy-type plans are usually the first to cover it, often due to their quasi-gov't stature and sometimes gov't funding and an ability to charge higher premiums. Other insurers belatedly jump in, especially after newer cheaper machines come out from competing companies, lowering the price of the machine and the cost to the insurer. The cost in premiums likely still goes up, but perhaps acceptably so.

It might eventually be that every pod's office, not to mention hospital, will have a portable ESWT machine tucked into the corner of a room, and patient pays a minor co-pay for treatment. It's just unfortunate for those needing treatment now to have to wait until technology and market forces develop to that point.

Of course, it doesn't always happen this way, e.g. sometimes a disease is rare and treatment remains very expensive. While TTS is not quite that rare, if there ever is a zapping machine invented for it, even if the technology were similar to ESWT, it might be far more expensive, given there are only 1/10 of 1% as many TTS cases as PF cases (so says a pod I once saw). Unless, of course, the zapping machine also works for carpal tunnel. Then look for your premiums to rise yet again, but perhaps acceptably so.

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Re: To Elliott insurance costs: let's talk about it

Pauline on 8/15/02 at 18:29 (092608)

Elliott,
I read the article and agree with your analysis of its content. It smells of politics and borders on hysteria. I think its worth discussing, but
opposing view points wouldn't be politically correct nor welcome in this arena.

Re: To Elliott insurance costs: let's talk about it

Dr. Zuckerman on 8/15/02 at 20:52 (092623)

Hi

Can I join in? It sounds like a good topic. I will go read it. I really like the discussions that come up between the three of us. I will always respect your opinions and not try to joke. I am being serious . Some of the most interestng topics have come from both Elliott and Pauline. I learn alot from these . We may have to ask Scott to have a separate sections called Hot topics of disussion or something similiar. I am serious. We do have alot of pateints on this board that don't want to be involved or even listen to our sometimes heated discussion . I for one enjoy them but respect other patients right to talk only about solutions and not debates.

Re: To Elliott insurance costs: let's talk about it

Pauline on 8/15/02 at 21:39 (092628)

Problem is only one of us is free to speak their mind. The others must guard their tongue.

Re: why not yell?

Scott R on 8/15/02 at 21:56 (092630)

If people want to yell at each other, they should take it to the social/support board. Lord knows fighting is what many people enjoy most, and entertainment is what it's all about.

Re: insurance costs: let's talk about it

Ed Davis, DPM on 8/16/02 at 21:20 (092701)

Sorry, but I did not get through the sign up screen for the NY Times. Perhaps later.

One concern about new technologies is the cost of those technologies but insurance companies always seem to view such costs as 'add on' costs. That is not always the case since new technologies may provide means to substitute one cost for another. Plantar fascial release surgery is a cost (or set of costs including the surgeons fee, surgicenter fee, anesthesiologist and costs associated with time loss) which will potentially be substituted by ESWT. Now we certainly would expect ESWT to be performed at a higher frequency than surgery due to potentially less pain and complications.

Utilization patterns would need to be scrutinized carefully. ESWT is presumably for 'intractable' PF. But what is truly intractable PF? This message board is filled with posts which read...' I have tried everything...' with posters listing a few treatments that did not work.
ESWT has little downside risk (outside of cost) so the potential for overutilization is high. Reading into Dr. Z's posts a bit, he seems to feel that perhaps ESWT is something that should be done sooner than later in the disease process.

I think that treatment costs will come down rapidly as availability expands. Insurers often have near monopsony power in many markets an thus
will be able to 'set' the fees for this modality as they have for many other treatments.
Ed

Re: Room for multiple types of discourse as long as courtesy rules

Ed Davis, DPM on 8/16/02 at 21:25 (092702)

Readers and posters can pick and chose what to read. Some like debate and politics (heck there has been a lot of it when it comes to healthcare), others would just like to see positive solutions. There is something for everyone.
Ed

Re: good points

elliott on 8/18/02 at 00:18 (092804)

ESWT in America may well take an evolutionary course similar to that of other new medical technology: It starts with a few expensive machines and the procedure not being covered by insurance (it would be too expensive at this stage). Then, due to results being observed both in Europe and among those paying out of pocket in America, as well as new studies in America, there is increased pressure to cover the procedure, especially give the number of sufferers. Blue Crossy-type plans are usually the first to cover it, often due to their quasi-gov't stature and sometimes gov't funding and an ability to charge higher premiums. Other insurers belatedly jump in, especially after newer cheaper machines come out from competing companies, lowering the price of the machine and the cost to the insurer. The cost in premiums likely still goes up, but perhaps acceptably so.

It might eventually be that every pod's office, not to mention hospital, will have a portable ESWT machine tucked into the corner of a room, and patient pays a minor co-pay for treatment. It's just unfortunate for those needing treatment now to have to wait until technology and market forces develop to that point.

Of course, it doesn't always happen this way, e.g. sometimes a disease is rare and treatment remains very expensive. While TTS is not quite that rare, if there ever is a zapping machine invented for it, even if the technology were similar to ESWT, it might be far more expensive, given there are only 1/10 of 1% as many TTS cases as PF cases (so says a pod I once saw). Unless, of course, the zapping machine also works for carpal tunnel. Then look for your premiums to rise yet again, but perhaps acceptably so.

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