Posted by on September 13, 2012 - 7:56am

This week a public meeting will be held in Chicago to determine which Essential Health Benefits (EHB) Illinois will cover in future health insurance plans. The Affordable Care Act has tasked each state with creating a set of EHB, which are a comprehensive package of health benefits.

Beginning in 2014, all health plans are required to begin offering the EHB to beneficiaries in the individual and small group markets. These state-based benchmark decisions are due by September 30, 2012, and could eventually affect nearly 70 million Americans, many of whom are women. The law mandates that 10 basic categories must be covered. These inlcude:

1. Ambulatory Patient Services

2. Emergency Services

3. Hospitalization

4. Maternity and Newborn Care

5. Mental Health and Substance Use Disorder Services

6. Prescription Drugs

7. Rehabilitive and Habilitive Services

8. Laboratory Services

9. Preventative and Wellness Services and Chronic Disease Management

10. Pediatric Services

Governor Pat Quinn will choose a benchmark plan that will then serve as the mandatory minimum for insurance plans in the state. The greatest importance of these EHB decisions will be the amount of coverage required in each category and the costs of insurance due to those new requirements. At first glance, it might seem the package of services related to maternity and new born care will have the most impact on women, however, it is likely that the mental health and substance use disorders services may be most needed given that women are far more likely to suffer from a wide range of anxiety disorders and depression. Despite enthusiasm for more even coverage and plan equality, the minimum categories will require that almost all insurance plans offer more than they do at present, certainly impacting the cost of health insurance.

Posted by on August 24, 2012 - 7:40am

The U.S. can learn from Mexico's recent efforts at health reform, especially as it relates to transferring care from specialists back to primary care physicians, researchers said.

Mexico created its national health insurance program, called the Seguro Popular in 2003, and achieved universal coverage for its 100 million citizens earlier this year, Felicia Knaul, PhD, of Harvard Medical School and colleagues wrote in the Aug. 16, 2012 edition of The Lancet.    The program now provides coverage to 52 million previously uninsured Mexicans, they noted.

Its list of essential covered services grew from 91 in 2004 to 284 in 2012 -- covering treatment for more than 95% of conditions in ambulatory units and hospitals, Knaul and colleagues wrote.  Meanwhile, Mexico also built 15 high-specialty centers, more than 200 hospitals, and almost 2,000 ambulatory clinics.

As the country slowly expanded coverage, its state-run specialty care centers became overcrowded with patients. To avoid facing a similar problem, the U.S. could learn to strengthen primary care's ability to provide follow-up treatment to patients recovering from catastrophic illnesses such as cancer, Knaul said in an interview with MedPage Today.

"That's not what primary care has been able to do well," she said.

The real challenge for the medical community will be how to train primary care doctors to handle that, Knaul said. It's not good for patients to continue to seek treatment at the specialty level, but it can be complex to link that follow-up care back to primary care doctors.

Regardless of how that's done, Mexican reform has shown it's possible to build financially responsible ways to treat chronic diseases alongside prevention, Knaul and colleagues wrote.

"Part of the global community has been convinced that middle-income and especially low-income countries should limit their activities to prevention in the case of chronic and noncommunicable diseases," the paper stated. That line of thinking is wrong and would conflict with the point of health reform, which is to provide affordable healthcare to all citizens, Knaul said.

For example, although treating a chronic illness like childhood asthma isn't expensive from month to month, Knaul pointed out that it adds up over time and can be financially burdensome.

Knaul knows of Mexican families living in the U.S. that have developed serious medical conditions, lost their jobs and their work visas as a result, and have returned to Mexico because they can be treated there. "Hopefully, this will change as a result of reform in the United States," she said.

Health reform in Mexico has spurred economic growth while improving health, Knaul noted. The infant mortality rate dropped from from 18.2 to 14.1 per 1,000 live births from 2000 to 2010. The percentage of deaths from communicable diseases also fell -- from 15.4% to 10.8% -- during the same period.

Meanwhile, the gross domestic product per capita in Mexico increased from $11,852.70 in 2000 to $12,440.90 in 2010.