Page last reviewed: December 2, 2010Page last updated: December 2, 2010Content source: Global Health
Showing posts with label Patients. Show all posts
Showing posts with label Patients. Show all posts
Friday, July 26, 2013
Friday, June 14, 2013
Patients find plenty of health information on line, but not all of it is reliable
The Internet has no equal as an information storehouse. The trick is to know how to get right to a source of useful information and not waste time on Web sites that are biased, trying to sell you something or just plain wrong.
Marvin M. Lipman, Consumers Union's chief medical adviser, recalls having a patient who made a Google search and somehow settled on an abdominal aortic aneurysm (a worrisome bulge in the body's main blood vessel) as the logical explanation for his midback pain. No reassuring on Lipman's part eased the patient's apprehension. It took a sonogram to convince him he wasn't at death's door.
Lipman had another patient who was referred to him after her primary-care physician told her she had Graves' disease (an overactive thyroid). She arrived for her appointment armed with computer printouts of useful, accurate information and fully prepared to discuss the pros and cons of treatment options for her problem.
Lipman says that nothing has changed the doctor-patient relationship as radically during his career as the Internet. As recently as 1995, about one in 10 American adults had online access; today, about three of four adults and just shy of 100 percent of teenagers use the Internet to get information and communicate with others, according to the Pew Research Center. The one-way flow of health information from doctor to patient is now a dialogue, or even, at times, a debate.
Caveatemptor.com
Google and Yahoo are among the most-used search engines. But almost anyone can pay these Web sites to display advertisements, or "sponsored links." And anyone with something to sell can set up a Web site with few if any checks and balances on what it says.
While information sites such as AOL sometimes post paid links, many links are nothing more than ads for individual products. By searching Google for "flu symptoms," for example, ads may pop up for Kleenex, Tylenol and the homeopathic preparation called Oscillococcinum.
The top "natural" (i.e., unpaid) search results might also include some sites marketing a specific product. For instance, a recent Google search on "enlarged prostate" yielded information from the Mayo Clinic and the National Institutes of Health but also the Web site for an unproven herbal product.
The other dots
You can also find health information on the generally commercial-free government Web sites (with addresses that end in ".gov") and academic ones (".edu").
Some not-for-profit organizations run Web sites (".org") that are ad-free, including ConsumerReportsHealth.org, which charges for some of its information, and some take advertising. Others are littered with advertising, and some are fronts for industries or manufacturers with a commercial agenda.
Consumers visiting an unfamiliar site should always check the "About Us" section for clues about who is funding the content.
Figuring out the pecking order among Web sites requires narrowing the choices to those that provide up-to-date, reliable and understandable information. Many qualify. No doubt your doctors can recommend personal favorites. This is Lipman's current Top 5 list:
www.cancer.gov for information about cancer.
www.cdc.gov for information about infectious diseases, travel medicine and epidemiology.
www.fda.gov for information about drugs.
www.medlineplus.gov for information about diseases.
www.usp.org for information about medicine and nutritional supplements.
(c) Copyright 2011. Consumers Union of United States Inc.
Health insurers offer patients the option of paying extra for higher-priced care
When consumers and employers pick health plans, some increasingly are being offered a trade-off these days: They can get a hefty break on their premiums if they agree to pay more out-of-pocket when they use certain high-cost providers in their network or if they cut those providers out of their network altogether.
Blue Cross Blue Shield of Massachusetts this year introduced a "Hospital Choice Cost-Share" option. It tacks on extra charges when patients get certain services at 15 hospitals that the insurer says have higher costs than other providers. Patients pay an extra $1,000 for inpatient care or outpatient surgery at one of these hospitals, for example, and an extra $450 for high-tech imaging services.
Among the hospitals on the high-cost list are Harvard teaching hospitals Massachusetts General and Brigham and Women's in Boston as well as UMass Memorial Medical Center in Worcester.
Small businesses and individual policyholders who choose the new option can expect their premium increases to be reduced by half, to about 5 percent, says Jay McQuaide, a senior vice president at the insurer. "We believe our members can get the same quality of care in the lower-cost, high-value category," he says.
A report last year by Massachusetts Attorney General Martha Coakley found that although the prices negotiated between hospitals and insurers for services varied considerably, there was no correlation between higher prices and better quality of care.
Insurers say that businesses and individuals are increasingly interested in so-called "narrow" or "select" or "preferred" network plans. Like the BCBS of Massachusetts option, insurers generally first evaluate providers based on quality benchmarks. Those that meet standards are then segmented based on cost. Depending on the plan, pricier providers either don't make it into the network or are placed in tiers with higher out-of-pocket charges for consumers who use them.
Thomas Lee, a physician and the network president for Partners HealthCare, an integrated health-care system founded by Massachusetts General and Brigham and Women's hospitals, doesn't argue that people have to pay higher rates to get good care. Products such as Blue Cross's hospital choice option push providers to become more efficient, he says. "I don't think that's a bad thing."
The potential downside, he says, is that more-expensive hospitals often use the higher payments to subsidize less lucrative services, including burn units and pediatric mental health. When the market puts pressure on those higher payments, "what inevitably happens is that institutions look at what they're subsidizing and ask whether they can keep this going," he says.
That's a valid argument, but only up to a point, says Ha Tu, a senior health researcher at the Center for Studying Health System Change. "The difference in rates is not nearly explained by the subsidization of less profitable services or the teaching mission," she says.
For patients, the potential downside is that they may lose access to their doctors if they or their employers choose a plan with a narrower network. A doctor who only has admitting privileges at one of the higher-cost hospitals might not be a good choice for someone with the new Blue Cross plan, for example.
"The biggest thing is to educate consumers so they know what they're getting into," says Suzanne Curry, policy coordinator at Health Care for All, a Massachusetts-based consumer advocacy group.
In Minnesota, some people insured through HealthPartners have been getting an education in the new trade-offs. Last year the insurer introduced a network called Perform, which had only one difference from its other products: It excluded the Mayo Health System and its vaunted Mayo Clinic in Rochester. If any of the 34,000 customers in the Perform network want to include Mayo, their premiums could increase by up to 20 percent, says Andrea Walsh, executive vice president at HealthPartners.
Is it worth it? It depends on the situation. Barbara Gurstelle's older sister, Sally, died several years ago at age 50 after struggling for years with von Hippel-Lindau syndrome, a rare genetic disorder that causes abnormal blood vessel growth. Mayo Clinic doctors were the ones who finally were able to diagnose her illness. Over the years she received treatment elsewhere, but she returned to Mayo every so often for a workup. "It really contributed to her understanding of the disease," says Gurstelle, who lives near Minneapolis.
On the other hand, as a principal at a mid-size IT consulting firm who has taken part in trying to find affordable health insurance for the company, Gurstelle says she might be willing to accept Mayo as an out-of-network provider if the cost differential was big enough.
Her employees might agree. "Over time, employees faced with high out-of-pocket costs have become more willing to trade off some choice of providers for cost savings," says Tu.
Besides, networks aren't everything. "Most people want the option to go to Mayo, but if [a disease is] that bad a thing, you're going to find the money to go there anyway," Gurstelle says.
This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail questions@kaiserhealthnews.org.
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