Leppäkoski Paperworks

Paperwork, Insurance Tricks, and Tools for Health Disparity

The administrative burden of healthcare is something that everyone experiences, but it hits people with social and economic disadvantages especially hard. Thus, paperwork and insurance tricks become tools for promoting health disparity that often escape notice.

The Administrative Burden of American Healthcare

A recent research brief from Health Affairs tells us that as much as 30 percent of healthcare spending pays for an excessive administrative burden. At least half of these costs are wasteful and the cost is far from trivial:

“Even at the lower end of estimates, US spending on administrative costs annually accounts for twice the spending on care for cardiovascular disease and three times the spending for cancer care.”

A Disparate Effect

This burden falls unevenly on people who do not have the resources to deal with it. A new report from the Inspector General of the U.S. Department of Health and Human Services finds troubling rates of denials in Medicaid managed care programs. In short, private, for-profit insurance companies that oversee health benefits for Medicaid patients issue prior authorization denials at roughly twice the rate for these patients compared to patients in Medicare Advantage plans. Plus folks in those Medicare programs get automatic, independent medical reviews for any denials they encounter.

So the Inspector General’s report concludes:

“These differences in oversight and access to external medical reviews between the two programs raise concerns about health equity and access to care for Medicaid managed care enrollees.”

A Real Human Cost

Chavi Karkowsky, a maternal-fetal medicine physician in New York, describes the effects of this disparate burden placed on her patients. The case of one of her patients provides a distressingly vivid picture. This patient required intensive care for a kidney infection that put both her and her baby at risk in the late stages of her pregnancy. It could have been prevented if her pharmacy had not turned her away because of problems with a prior authorization:

“She had noticed symptoms of a urinary tract infection about four days ago; she had gone to her doctor the next day and had gotten an antibiotics prescription. But the pharmacy wouldn’t fill it – something about her insurance, or a mistake with her record. She tried calling her doctor’s office, but it was the weekend, and she couldn’t get through.”

This is how problems with paperwork create disparity in health outcomes.

Adding to Disparities in Obesity Care

These disparities are apparent in obesity care – both access to care and clinical outcomes. Obesity medicine physician Fatima Cody Stanford tells us she sees administrative burdens, which have no clinical merit, magnify this problem:

“Medicaid will deny coverage of metabolic surgery unless a patient has clinic visits for several months in a row – even if they’ve completed a full preparation program for surgery. One missed appointment sets them back to restart their preparation.”

This is but one of many stupid insurance tricks that put a disparate burden on persons with limited social and economic resources. They serve only to widen health disparities.

Click here and here and for more on the dismaying effects of administrative burdens in healthcare. For more on the barriers that insurance creates for access to obesity care, click here.

Leppäkoski Paperworks, photograph from Museovirasto / Wikimedia Commons

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July 22, 2023