Equal? access

Dr. Brock, President of MedExtra is live on the Tommy Shnurmacher show this morning. The title of the episode:

The government says it wants to help autistic children...I don't buy it. (click to listen)

Tommy is speaking with Dr. Brock and Stanley Schulman, a client of MedExtra's who has been frustrated with the Quebec healthcare and medicare system in the quest to address Stanley's son's medical issues which stem back to David's adoption from the FSU.

MedExtra helped the Schulman family to undergo assessment with Dr. Ronald Federici.

Dr. Federici offered insight to the child's condition, which no local hospitals were able to do, and proposed a treatment plan - again something the local hospitals were unable to achieve.

The hospitals understood their limitation, and supported the family in approaching Medicare for funding for the out of province treatment. The application for funding was denied, citing that the treatment was available locally, and further that the medical discipline Dr. Federici practices is not eligible for funding.

You would expect that the local availability of the care is a cue to a happy ending, shockingly, Medicare declined to direct the family how or where to access the care locally.

Stanley took matters into his own hands and self-financed his son's in-patient care in the US.

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Maybe the time is right for a Second Opinion

When questions about the accuracy of cancer pathology emerge & re-emerge within a span of a a short few weeks, it is enough to give rise to concern.... Was my pathology done correctly?

The current episode of the ongoing Canadian saga of questioning the accuracy of pathology tests for breast cancer began at the beginning of June when the Quebec health minister ordered breast cancer retests. The move came as Minister Yves Bolduc, reacted to the Quebec College of Physicians issued report that 30% of pathology tests were potentially questionable.

Now, it turns out that the initial group of about 2,100 reassesments will be increased by another 630. CTV reports that this might not even be the end to test called into question.

Unfortunately these tests will only be concluded by the end of 2009!

The expectation is that some 100 patients will have a new course of treatment recommended. Which means, that until the treatment is changed, they are on the wrong treatment plan. Some Quebecers could be receiving inappropriate care for 6 months before it is corrected.

The underlying problem is that the system is overburdened. While there are an increasing number of cases the resource; professional and technological, have not been invested in to accommodate the increased demand.

MedExtra has been organizing Remote Second Opinions for nearly a decade to take the guesswork out of diagnosis and treatment of our members' medical conditions. Learn more about how MedExtra's Remote Second Opinions integrate with Critical Illness Insurance.

Pharmaceutical Costs on the Rise

Canadian group plan sponsors (employers) dread the annual renewal - or quarterly updates from their agent/broker/actuary/third party administrator, since the cost of the plan - and consequently the premium trend upwards. It is no surprise that 11 major Canadian insurers* report a 15.19% increase in drug costs in 2009 - according to a Buck Consulting survey.

Typically drugs costs account for about 80% of the group plan... a little napkin math and you are looking at 12% increase in costs alone!

That is pretty substantial for a corporate balance sheet item which generates 0 revenue - particularly in the current economic condition.

There are two things which are critical for plan sponsors:

1) Understand that a large portion of the group health plan is a cash-flow tool to assist employees in paying their health costs

• The plan pays ALL employee's health costs
• The employer contributes some portion to the plan
• The plan spreads the remaining cost across ALL employees

2) Put in place measures to control the costs which are paid for by the plan.

Would you think that it is possible to control costs after they are incurred. Of course not! So then why is it that a common reaction is to go and shop the plan to another insurer for a lower rate?

Costs have to be controlled proactively which means equipping the spenders (employees) with the tools and incentive to ensure that the health dollars are spent wisely. According to the survey:

When employees share in the cost of medical
services, they tend to appreciate the actual cost and are
more judicious in their health care purchases.

Strategies include:

• Pharmacy program to address drug plan cost and optimize drug utilization
• Strategic use of generic drugs
  
• Incentivising employees to seek lower cost drug options where available.
  

These should ideally be aligned with a plan sponsor's overall Healthcare Productivity Management Strategy - the employer's plan to focus healthcare related expenses to maximize Return on Investment and Employee Satisfaction for the greatest number of participants.

What measures are YOU taking to control these spiralling costs?


*The 11 partipating insurers:
Alberta Blue Cross
Desjardins Financial Securities
Great-West Life
Green Shield
Manulife Financial
Medavie Blue Cross
Pacific Blue Cross
Saskatchewan Blue Cross
SSQ Financial
Standard Life
Sun Life Financial