Why copays?
Retail clinics: The competition heats up
By Ken Terry
Medical Economics
June 16, 2006
“Retail” walk-in clinics, located in supermarkets and stores like CVS and Target, are already competing with physicians in many communities. Now Blue Cross and Blue Shield of Minnesota has added a new twist: It’s waiving copayments for patients who go to these in-store clinics.
Copayments for office visits are on the rise everywhere. So if there were no copays in retail clinics, an increasing number of patients would have an incentive to go there. Blue Cross sees this as a matter of saving money for its customers and for itself.
FP Michael J. Morris of Willmar, MN, thinks the insurer’s approach to this issue works against its efforts (and those of other plans) to encourage primary care doctors to manage patients’ overall health.
FP David D. Luehr, president of the Minnesota Medical Association, agrees.
“It’s important for physicians to see patients in their offices, where they have their medical records,” he says. “This type of approach starts to disrupt that continuity.”
Rick Kellerman, president-elect of the AAFP, says the Blue Cross initiative is “a bit shortsighted. If they’re going to waive copays on visits to retail clinics, why don’t they waive them for a similar service in a physician’s office? They should try to encourage people to have a personal medical home, where cost can be better controlled and quality better assured.”
So why not give patients the same incentive to visit primary care physicians for minor problems that the plan gives them to go to retail clinics? It’s mainly a matter of price, replies (internist David W. Plocher, senior vice president and medical director of Blue Cross and Blue Shield of Michigan).
If a nurse practitioner can provide the same service at half the cost, Blue Cross wants patients to use the NP.
http://www.memag.com/memag/article/articleDetail.jsp?id=333253
And…
CalPERS to Weigh Cutting Health Benefits The proposed changes, including some higher co-pays, are designed to give patients incentives to choose cheaper medical care.
By Daniel Yi
Los Angeles Times
June 19, 2006
The California Public Employees’ Retirement System, once a benchmark of generous employer-sponsored health plans, is proposing to trim benefits for hundreds of thousands of its members in a bid to rein in runaway healthcare costs.
CalPERS’ plans include raising co-pays for more expensive treatments and lowering premiums for those willing to use a smaller network of doctors.
Health plans and large employers have been dropping more-expensive doctors and hospitals from their provider networks to save money, but such measures are reaching their limits. Increasing patients’ financial stakes may be unpopular but does drive down costs.
CalPERS currently offers two Blue Cross of California PPO plans. Among the measures being considered Tuesday is the creation of a third PPO that would have about half the number of doctors in the network compared with the other two plans, but premiums would be 7.5% cheaper.
“My problem with these proposals is that they don’t address the underlying problem of lack of affordable healthcare,” said Yvonne Walker, a bargaining official with Service Employees International Union Local 1000, which represents 90,000 state employees. “You have gas going up, the overall cost of living going up, and you want to put people in a position where they have to make financial decisions about their healthcare. I don’t think that is the direction we want to go.”
But that is the direction most are already headed, said Peter Lee, chief executive of the Pacific Business Group on Health, a coalition of employers.
If the system is not made more efficient, rising healthcare costs will drive more employers to drop benefits, leaving workers unprotected, Lee said.
“Costs will be shared one way or the other,” he said, either through co-pays or “taxes going up to treat more uninsured people.”
http://www.latimes.com/business/la-fi-calpers19jun19,1,5491259.story?coll=la-headlines-business
Comment:
By Don McCanne, M.D.
Copayments have continued to grow in popularity because they have been proven to reduce health care utilization, and, therefore, health care spending. The problem with copays is that they are a very blunt instrument.
They reduce utilization of beneficial health care services and result in impaired health outcomes. Clearly we should be looking for policies that contain costs while improving health care quality.
It has been well established that improving the primary care infrastructure, establishing a medical home for everyone, improves quality while reducing spending. It seems that the private insurers would want to establish policies that would promote primary care. But what are they doing?
BC/BS of Minnesota is now adopting a policy of discouraging use of primary care by requiring copays, but waiving them when the patient fragments their own care by using discount, walk-in, retail clinics. When insurers adopt policies to discourage efficient, higher-quality care in exchange for a cheaper, instant fix, it’s clearly not about encouraging better health consumer shopping; it’s purely “a matter of price.”
CalPERS’ new Blue Cross PPO raises similar flags. In order to reduce premiums, they are slashing the list of contracted providers. Insurers should be adopting policies that improve access to primary care providers, rather than disrupting the medical home of those whose primary care providers are deleted from the approved lists.
Blue Cross already uses coinsurance to limit patients’ choices of a medical home. Coinsurance is a percentage of the fee that the patient must pay. Like copays, coinsurance is a disincentive to obtaining care, but even more so since the out-of-pocket payments are often much higher than with copays.
Coinsurance can also be very disruptive when it heavily penalizes the patient for staying with his or her non-contracted primary care provider.
Affordability of health care concerns everyone today, but policies designed to reduce use of beneficial services are the wrong way to go.
Peter Lee says that we will share costs either through copays or taxes.
Clearly our current copay policies are detrimental to health care. What about taxes? Not only are they much more equitable, but the public stewards of a single payer system would ensure that each and every one of us has affordable access to a medical home.