Pre-existing conditions covered by new high-risk insurance pools
By
Beginning today, individuals with pre-existing health conditions are eligible to enroll in a temporary high-risk insurance pool, courtesy of the health care reform law. The new Pre-Existing Condition Insurance Plan is a provision of the Patient-Protection and Affordable Care Act.
The new plan — administered by either a state or the Department of Health and Human Services — will provide health coverage options for individuals who have been uninsured for at least 6 months, have been denied coverage due to a pre-existing condition and are a U.S. citizen or legal resident. The program will be in effect until 2014 when insurers will no longer be able to deny coverage based on pre-existing medical conditions.
As of today, HHS will run the Pre-Existing Condition Insurance Plan in 21 states. The remaining 29 states and the District of Columbia will begin enrolling residents in their own insurance pools by the end of the summer, according to a press release from HHS.
From July 1, 2010, through Jan. 1, 2014, the law will provide $5 billion to fund the new plan in each state. Money will be allocated based on the population and costs of each state.
The plan, which is not based on income, will likely be an option for individuals with money to spend on insurance, but who have been denied coverage in the past due to a pre-existing medical condition such as cancer or diabetes. Although some states already have high-risk pools, by law, the new pools cannot charge higher premiums than the standard premiums in an individual’s given state.
Modeled after the Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan allows for flexibility by state as long as basic requirements are met. State programs may vary on cost, benefits and determination of pre-existing conditions. In addition, any unspent funding will be reallocated by the states. Unlike CHIP, however, there is no state matching requirement and the entire cost of the new plan will be covered by the federal government.
For more information on the federal high-risk pools, visit [Ссылки доступны только зарегистрированным пользователям ].
__________________________________________________ ____
Adherence to SCIP measures showed little improvement on infection probability
By
There was no significant improvement on infection probability when physicians adhered to the Surgical Care Improvement Project, despite the project’s aim to lower surgical care infectious complication rates, study findings suggested.
The retrospective cohort study consisted of 405,720 patients from 398 hospitals in the United States that had their Surgical Care Improvement Project (SCIP) performance recorded and submitted for public report on the Hospital Compare website. The Cleveland-based researchers joined three original infection-prevention measures and all six infection-prevention measures into two separate all-or-none composite scores.
There were 3,996 reported postoperative infections. The six infection-prevention measures’ composite process-of-care measure predicted a decrease in postoperative infection rates from 14.2 to 6.8 per 1,000 discharges (adjusted OR=0.85; 95% CI, 0.76-0.95). The three original infection-prevention measures’ composite process-of-care measure also correlated with a decrease in postoperative infection rates from 11.5 to 5.3 per 1,000 discharges (adjusted OR=0.86; 95% CI, 0.74-1.01), which researchers determined was not a statistically significantly lower probability of infection.
“Our study demonstrated that although publicly reported adherence rates to SCIP process-of-care measures were associated with improved patient outcomes in our aggregated measures, the individual item relationships are weak and lack clinical significance,” the researchers concluded. “Improved individual process-of-care measures and use of aggregation techniques in addition to improved data collection methods may be necessary to truly drive improvements in patient outcomes.”
Stulberg J. JAMA. 2010; 303:2479-2485.
|