HCCD Report Rhode Island 02910

Suggested Health Care Community Discussion

Group Submission

General Questions:

How many people attended your health care community discussion?
5 licensed and soon-to-be licensed mental health counselors from RI and others
Please summarize compelling personal stories from attendees about the need for health care reform in our country and provide their contact information.

The first is a story of threat of sending a bill to collections despite the person having double insurance coverage. One of our participants had a medical procedure done inpatient in a RI hospital 4 years ago. He had Blue Cross of MA and Blue Cross of CT. The billing went through Blue Cross of RI. Most of the bills have been paid but one still lingers and while BC of MA and BC of CT fight out which of them is responsible for reimbursement, the patient continues to get threatening letters from the collection agency.

(one participant)

The second story is one of loss of healthcare coverage at 19 years old. Despite the fact that my husband will be paying exactly the same amount for family health care coverage on January 1 as he did on December 31, our son will no longer have health insurance as of Jan 1 because he turned 19 and is neither a student nor disabled. My other child, a scholar and going to college, will be covered until 25. This system values the college-ready/capable person but takes the person unready or unprepared to further his education coming out of high school and throws him to the wayside. I wonder why this is so. I am frightened to death when I think of my son without insurance.

My son has been diagnosed with ADHD and Tourette’s syndrome since elementary school. He suffers from bouts with depression; he gets stuck on ideas and beliefs and engages in thrill-seeking, high-risk behavior. He has allergies and asthma and a history of substance abuse that led him to a year in an Adolescent Residential Substance Abuse treatment facility. He left the residential part of treatment last year. In the last year he has been in Day Treatment (2 rounds) at a psychiatric hospital, spent 12 days in detox (The insurance company would not allow him to stay longer and the facility informed him in the morning that he’d have to leave that morning, which sent him into a panic. But why should the insurance company care about how their bottom-line decision will affect a covered member?), and an Intensive Outpatient program. He experienced being homeless twice and slept outside several nights. He had to be treated for scabies. He has been unable to keep a job, has not worked since he was 16, and lacks sufficient motivation and courage (related, I believe, to complications with his behavioral health issues) to put sustained energy in preparing for and searching for a job. This, of course, is complicated by a nearly 10% unemployment rate in our state.

What this means is that in a couple of days my son will no longer be able to see a doctor for prevention or illness, will have no more recommended 6-month visits to the dental hygienist (which he’s been doing since he was 2 years old) to keep his beautifully straightened teeth (a year+ of braces) in good health, he will no longer be able to afford Singulair to prevent his asthma or his inhaler to keep his lungs open (right smack in the middle of the worst season of the year for his asthma). Finally, when he realizes that he needs to address his behavioral health needs again, he will not be able to afford mental health or substance abuse counseling or other treatments. My heart aches.

(another participant)

Summary of Responses from Discussion Questions:

What does the group perceive as the biggest problem in the health system?

The biggest problem in the current health system centers around health insurance, i.e., the large number of people without insurance, poor continuity of care across health care disciplines, e.g., mental health and addictions, behavioral health and physical health, preventive and acute care intervention; insurance companies dictate treatment instead of caregivers (see example above), access to caregivers is limited due to insurance companies’ restrictions, many insurance companies are for-profit businesses that put shareholders profits ahead of health and concerns of the insured.

How do attendees choose a doctor or hospital? Where do attendees get information in making that decision? How should public policy promote quality health care providers?

We choose a hospital based on where the treating doctor has practicing rights. We choose a doctor based on provider lists from insurance companies, word of mouth, referrals from PCP and other specialists. We choose a psychiatrist based on the psychiatrist’s availability and insurance; information about psychiatrists comes from mental health counselors, PCPs, insurance companies. Referrals for behavioral healthcare come from schools, lawyers, courts, state agencies (DCYF, MHRH), attorneys, PCPs. Public policy should promote quality health care providers by promoting accountability/evaluative role, provide public access to a provider’s results on outcome measures. Consider encouraging the reimbursement of equally qualified providers fairly and equally.

Have attendees or their family members experienced difficulty paying medical bills? How can policy makers address this problem?

Yes, one person had uncovered hospital bills after surgery of a preexisting condition. As an uninsured person, hospitals and other providers charge more for same treatment than as an insured person. If everyone were always insured there would be no such thing as a preexisting condition, but for now people with preexisting conditions need to be covered and self-pay rate setting protocols ought to be set, e.g., no self-pay patient should have to pay more than Medicaid reimburses.

In addition to employer-based coverage, would the group like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?

Yes, with a sliding fee option based on family income and dependents. We had some concern that some employers would opt-out of providing healthcare as a benefit if this were the case.

Did attendees know how much they or their employer pays for health insurance? What should employer’s role be in a reformed health care system?

Yes, in most cases we were aware of how much employers pay for health insurance. Re: employers’ role in reformed health care system, we did not think we had enough information to adequately address this question. It would depend on the type of reform ultimately enacted. But whatever the role, we don’t think the healthcare system should be wholly reliant on employer-based coverage.

Were attendees familiar with the types of preventive services Americans should receive? Had attendees gotten the recommended prevention? If not, how can public policy help?

Attendees were familiar with prevention services. We had gotten the recommended prevention for the most part though were not necessarily up-to-date. We believe, as the surgeon general said in 2000 that "there is no health without mental health."And so, public policy needs to link behavioral health to physical health in order to screen for the presence of mental health conditions and/or to address the behavioral components of chronic medical conditions, i.e., heart disease, obesity, diabetes, etc.

How can public policy promote healthier lifestyles?

Public policy can promote healthier lifestyles through the development of and universal access to a continuum of care that truly integrates physical and behavioral health care.