Re: [Winona] FW: qotd: Medical-loss ratios of largest for-profitinsurers

[Craig Brooks]

[Winona Online Democracy]

We clearly need universal coverage and a single payer.  Think "Medicare for all" without hundreds of HMOs involved like the Part D mess.  We must take the middle man out from between the doctor and the patient.  We must simplify the reimbusment process.  We must remove the administrative waste. 

 

Craig Brooks

check http://muhcc.org/

and  http://www.pnhp.org/

Duane Peterson <[EMAIL PROTECTED]> wrote:

[Winona Online Democracy]

Over the years I have heard insurance company statistics that attribute 15
to 25% of the premium dollars to the cost of underwriting and issuing the
policy. The cost of claim processing has to be added to that.

Health insurance has traditionally cos t less than casualty insurance
probably because of group coverage and less complicated claim procedures.
----- Original Message -----
From: "Davis, William MD" <[EMAIL PROTECTED]>
To:
Sent: Monday, March 20, 2006 2:28 PM
Subject: [Winona] FW: qotd: Medical-loss ratios of largest
for-profitinsurers


[Winona Online Democracy]

This is related to our discussion of medical fees and the impact of
insurance. While it looks pretty good that they are spending 76 to 83%
of premium dollars on health care, they are including the cost of
processing claims and selling insurance as though it was being spent on
patients. If you add in the cost of processing the insurance in
hospitals and doctor's offices, the burden for patients is even higher.
What is also unknown is whether companies include the cost of processing
claims and selling insurance in the amount they spend on patient care.
Bill

W illiam Davis MD
[EMAIL PROTECTED]
507.454.5050 ext 623
825 Mankato Ave
Winona MN 55987

American Medical News
March 6, 2006
Health plans make more, spend less in 2005
By Jonathan G. Bethely

If physicians needed any more indication of tightening reimbursement,
how
about this - not only did profits for the biggest health plans go up
last
year, but those plans also continued to cut the percentage of revenue
they
spend on care.

The medical-cost ratio - also called the medical-loss ratio or
medical-care
ratio - is the key number for health plans in terms of their level of
profitability. That ratio, simply, is the percentage of dollars the
companies spend on health care.

Whereas 10 years ago many plans had medical-cost ratios in the high 80s
or
90s, now the highest percentage among large, publicly traded health
insurers
is Health Net, at 83.9%. Aetna, which had a medical-cost ratio wel l into
the
90s when CEO John Rowe, MD, took over in 2000, recorded a ratio of 76.9%
in
2005, Dr. Rowe's final full year before his retirement. That was the
lowest
medical-cost ratio for the nation's largest publicly traded plans.

Medical-loss ratios for 2005 (Source: Company 10-K, year-end filings
with
the Securities and Exchange Commission):

76.9% - Aetna
82.3% - Cigna
83.9% - Health Net
83.2% - Humana
78.6% - UnitedHealth Group
80.6% - WellPoint

http://www.ama-assn.org/amednews/2006/03/06/bisd0306.htm


Comment: Clearly, one-fifth of health insurance premium dollars are not

being spent on health care, but are consumed by the insurers. What does
not
show up in these numbers is the cost of the administrative burden that
these
insurers place on the health care delivery system. The billing and
insurance
related functions for physicians and hospitals burn up another 12
percent or
s o of the premium dollar (Kahn et al, Health Affairs, Nov/Dec 2005). Add

these together, and that is about one-third of the premium dollar.

We are very concerned about the continued escalation of health care
costs.
New technology and pharmaceuticals are adding to the spending on
physicians,
hospitals, laboratories and other health care services. We fret about
these
expenditures within the two-thirds of the insurance premium that
actually
makes it down to the health care system, yet we are ignoring the
one-third
that is wasted on administrative services that provide no health benefit
for
the patient.

We are enriching this industry for providing coverage for the healthy
workforce and their young, healthy families, and for covering the
healthy
sub-sector of the individual insurance market. We taxpayers are footing
the
bill for the population subgroups with greater health care needs.

We certainly are not receiv ing much value from the insurers - letting
them
have the easy stuff at a very high cost. Wouldn't it be more logical to
target their waste, rather than slowing spending growth by making health

care unaffordable for those who do have needs?

Why do we keep hearing that eliminating this industry isn't feasible?
You
would think that anyone with a modicum of business sense would believe
that
keeping them in charge is no longer feasible.


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 http://www.winonaonlinedemocracy.org