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domain
Member


Reged: 07/17/03
Posts: 131
Loc: Midwest
Re: Should the uninsured lay down and die?! [Re: dsmmcm]
      #188906 - 09/27/04 01:22 PM

After having read all the replies on this thread I have to jump in with some observations.

Having served for a 12 year term on the local county hospital board and just recently left the same board here are some of the trends we have seen.

Insurance:

There are a growing number of people who had insurance but dropped it due to the outrageous costs.

The insurance companies all have reimbursement schedules with every provider and hospital in the country. On average they pay 40-60% of charges.

Medicaid / Medicare:

Medicare pays very low rates but it does cover costs. The reimbursement rates are of course set by the Feds and vary by geographic location.

Medicaid is terrible! It does not even come close to covering costs and sometimes takes months and months to transmit payments back to the provider. You will see more and more providers opting out of accepting medicaid patients as time goes on.

Provider costs:

Doctors, like hospitals, are seeing costs rise monthly. Now you need to have an office manager that undertstands how to submit bills to insurance, medicare & medicaid. You have to spend untold $$$$ on software programs to code everything. The HIPPA privacy act has added a few more thousand dollars on to software expense for everyone. When your bill is rejected by the government or insurance companies for a coding error it cost a minimum of $300 per record to correct it and resubmit. And speaking of coding, the DRG manual of codes changes every time you turn around so you need a software update that costs $$$.

People complain about the cost of a provider visit, on average $65-$70. If you take away the increased costs to the provider of software, business coding specilists, insurance submition requirements you would see that same office visit drop to $30-$40.

Other influences:
While doctors have control over this hospitals do not. Illegal workers using valuable medical resources. Hospitals can not treat illegals unless it is an emergency situation. Rountine clinic treatment is off limits to them. There are countless programs for illegal workers to receive healthcare thru special community clinics. The costs of these clinics are in the miilions of dollars to taxpayers. Now illegal workers being here is another story for a different day, I'd like to point out that they pay no taxes and do not contribute to the healthcare system.

Medicaid / Medicare abuse:

It is a very, very small number of doctors that abuse the government programs and I can not remember the last time I heard of a hospital doing it.
Is there abuse by the patients? Yes there is, and like anything elese it's a rather small, but growing number. The number of retired persons on Medicare abusing the system is growing. Grandma likes to doctor shop and see's a new provider every month. We've run into this more often in the past year.
Medicaid abuse by patients? It's growing at a larger rate every month. It's not abuse as in money but rather healthcare. Medicaid user brings little Mary in for a cold and runs up a $150.00 bill to find out that there's nothing that can be done, it's a cold and it will pass. Some Medicaid users think the program is unlimited use of healthcare and will not even listen to the concept of "wellness." Now mind you, this is less than 5% of Medicaid users that do this but that's up 40% from last year.

Is there an easy answer? I don't know and I saw it first hand for years. Is there a solution? I think there is but it's going to take alot of work, change and attitude adjustment. Let's start by not running to the doctor for every ache and pain. Use common sense, if you have the flu it will pass, if you have a cold it will pass. Take some responsibility for your own well being.

As for the cost of drugs, that's another discussion entirely.

Thanks Everyone


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dsmmcm
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Reged: 11/08/03
Posts: 615
Loc: southwest US
Re: Should the uninsured lay down and die?! [Re: dsmmcm]
      #188967 - 09/27/04 07:00 PM

Quote:

Quote:

And you think we really fund our own research? That would be ILLEGAL. Read a real clinical trial and look into how they are actually run, and how the physicians who monitor the trials are chosen. The physicians in charge of the clinical trials are unbiased and not paid by pharmaceutical companies. Those would be major violations of the FDA. The people who publish the study are not paid by the pharmaceutical companies...once again that would be ILLEGAL.





So who funds these trials?




Sorry to quote my quote, but there are over 800 industrial sponsored clinical trials in progress right now. They are not illegal.
D.


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sassyg
Member


Reged: 08/12/02
Posts: 171
Loc: Coloraddy
Re: Should the uninsured lay down and die?! [Re: dsmmcm]
      #189015 - 09/27/04 10:01 PM

TO ANSWER THE ORIGINAL QUESTION: I don't know whether or not I should lay down and die, just that I WANT to, with the never-ending toothache I have. Since I lost my job last February (hence my health insurance), and the filling fell out of my tooth, and the tooth broke, I've been in a SUPER-TERRIFIC amount of pain! Yippee!!! And there's NO WAY I can afford to see a dentist!!! I'm sure there are plenty of Americans who go through pain TEN TIMES WORSE than mine, because they have no health insurance, hence NO HEALTH CARE!!! Shucks, y'all, it almost makes me ashamed to be an American!

--------------------
Sassy!


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purppoptart
Journeyman


Reged: 04/28/04
Posts: 84
Re: Should the uninsured lay down and die?! [Re: dsmmcm]
      #189069 - 09/28/04 04:29 AM

One time when I was waiting in my husband's shrinks office, a pharmacutical rep came in with home-baked COOKIES!!!! They are on a first name basis with the receptionist and his office and waiting area is filled with drug-rep stuff. I'm sure this is just the tip of the iceberg.

--------------------
......and his hair was.....PERFECT!!


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purppoptart
Journeyman


Reged: 04/28/04
Posts: 84
Re: Should the uninsured lay down and die?! [Re: sassyg]
      #189070 - 09/28/04 04:31 AM

sassy...I'm so sorry to hear you've been in pain for that long. There is nothing worse than tooth pain! Can't you find a teaching school somewhere to get that tooth looked at? You certainly can't stay that way much longer.

--------------------
......and his hair was.....PERFECT!!


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domain
Member


Reged: 07/17/03
Posts: 131
Loc: Midwest
Re: Should the uninsured lay down and die?! [Re: purppoptart]
      #189115 - 09/28/04 10:36 AM

Sassy, if there is a local public safety net hospital in your area go to it. The ER's in hospitals see people with dental problems all the time and if it's a public hospital that offers low cost or free care you will be taken care of. I know the feel of tooth pain, been there several times, and it can turn into a serious health problem beyond the dental part if not treated. The hospital ER will normally give you a pain killer and antibiotic. If it's a public hospital they normally have an oral surgeon on the staff that will take care of you. The ER would rather see you now instead of later when the tooth is breaking down and dumping bacteria into your system and creating a potential for a life threatening situation. I waited too long one time and the side of my face swelled up and I had to spend 24 hours in the hospital on IV antibiotics. If this scares you then you should do something right now and not wait any longer.

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cody
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Reged: 07/12/02
Posts: 18
Re: Should the uninsured lay down and die?! [Re: dsmmcm]
      #189903 - 09/30/04 08:58 PM

Okay, so I said it was illegal that pharmaceutical companies fund their own clinical trials. What I meant was that it is illegal for the pharmaceutical companies to "pay" the physicians and people involved in the trials above and beyond a small unrestricted educational grant. This grant covers the cost of the medication, the cost to pay the patients involved in the trial, and a small reimbursement to the physicians running the clinical trial. Many times special interest groups that represent diseases will put in a lot of funds into the trials in hopes of speeding up a disease curing medication. These physicians do not run the clinical trials for the cash, as they don't pay much. So why do they do it then? They do it for the reputation, they gain a reputation as being an honest medical thoughtleader throughout the worldwide medical commmunity. Also, the patients do not know if they have been given the real medication or a placebo so it does them no good to falsify their subjective remarks and you cannot argue objective lab results.

Have you ever questioned why the pharmaceutical companies are made to look so bad, why the media portrays it as the American people vs. the American pharmaceutical companies. Dig a little deeper. Yes, we all know the pharmaceutical companies could easily jump ship and run their entire company overseas, thus taxes, stock gains, and taxed stock gains go overseas and political support go overseas too. That's partly the reason why the gov supports the pharm industry so much. The other reason for the us vs. them mindset that has successfully happened....the old strategy...divide and conquer.


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dsmmcm
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Reged: 11/08/03
Posts: 615
Loc: southwest US
Re: Should the uninsured lay down and die?! [Re: cody]
      #189946 - 09/30/04 11:16 PM

Quote:

Okay, so I said it was illegal that pharmaceutical companies fund their own clinical trials. What I meant was that it is illegal for the pharmaceutical companies to "pay" the physicians and people involved in the trials above and beyond a small unrestricted educational grant. This grant covers the cost of the medication, the cost to pay the patients involved in the trial, and a small reimbursement to the physicians running the clinical trial. Many times special interest groups that represent diseases will put in a lot of funds into the trials in hopes of speeding up a disease curing medication. These physicians do not run the clinical trials for the cash, as they don't pay much. So why do they do it then? They do it for the reputation, they gain a reputation as being an honest medical thoughtleader throughout the worldwide medical commmunity. Also, the patients do not know if they have been given the real medication or a placebo so it does them no good to falsify their subjective remarks and you cannot argue objective lab results.

Have you ever questioned why the pharmaceutical companies are made to look so bad, why the media portrays it as the American people vs. the American pharmaceutical companies. Dig a little deeper. Yes, we all know the pharmaceutical companies could easily jump ship and run their entire company overseas, thus taxes, stock gains, and taxed stock gains go overseas and political support go overseas too. That's partly the reason why the gov supports the pharm industry so much. The other reason for the us vs. them mind set that has successfully happened....the old strategy...divide and conquer.



I really don't think you understand the mind set of researcher, medical or otherwise. They (and I am one of them, although not medical) will go to great lengths to get exactly what you describe: funding of the research expenses, small fees, etc. And of course any good study is "double blind". But the ultimate interpretation of the data is inevitably influenced by the source of the funding. It is just human nature. If all clinical drug trials were funded by NIH or NSF, things would be different: what would matter is the truth, not whether or not you published that company X's last drug was good or bad.
D.


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