Coping with Costs

Coping with Costs, Insurance, and Health Care Systems

    A-Fib.com is trying to develop a section to help you deal with the costs of A-Fib treatment, how to deal with insurance companies, how to work the health system in your area of the world. Unfortunately this is an area the author knows very little about. He welcomes and needs help and input. (Feedback---E-mail address afibfriend(at)verizon.net [When typing the email address, substitute an "@" for the "(at)"---this substitution is necessary to prevent automatic search engines from sending spam to this email address].)
    The goal is to eventually list the costs, insurance, and overview of the health systems in the US and worldwide.
    Here is an article from 2005 about reimbursements for an ablation:

Reimbursement for catheter ablation of AF
    For the Center for Medicare and Medicaid Services (CMS), the ablation of atrial fibrillation is billed under the Current Procedural Terminology (CPT) code 93651. In addition to the ablation CPT code, physicians are also reimbursed for intracardiac mapping and electrophysiology studies as required.
    Physicians performing ablations of AF are reimbursed payment for the service paid under the physician fee schedule from Medicare. The fee schedule is the product of three factors: a nationally uniform relative value for the service; a geographic adjustment factor for each physician-fee-schedule area; and a nationally uniform conversion factor for the service. The conversion factor converts the relative values into payment amounts.
    Based on adjustment and conversion factors, a cardiologist working in Manhattan billing Medicare for the catheter ablation of AF is reimbursed $1044.62 while a cardiologist working in Los Angeles is reimbursed $967.52. There are also minor discrepancies in the fee-payment schedule for intracardiac mapping. For example, a cardiologist in Manhattan is reimbursed $451.68, a Los Angeles-based cardiologist is reimbursed $415.21, and an EP working in Kentucky is reimbursed $370.74 for EP mapping.
    Almost all private insurers reimburse clinicians for the ablation of atrial fibrillation.
http://www.theheart.org/article/546039.do

Ira Levin has volunteered the first article comparing and contrasting the US and Italian health systems.

     I have lived in a European country (Italy) for just short of 40 years and can supply a lot of information about the system, its strong points and its weak points. I have lived them. I was hospitalized in Italy 11 times over the course of the 8 years, 2001-2008 in 6 different Italian hospitals. It cost me not a red cent. I had good care and my problems were dealt with promptly, including an atrial ablation. Yes, I had to wait 5 months for it, because I wanted a particular doctor in a particular hospital to perform the ablation. This public hospital followed up, calling me every 6 months for 2 years after the ablation to see if the A-Fib had returned, which it typically does in 50% of the cases. I found that impressive. That said, I had occasion to be in 3 American hospitals under Medicare last year and so I have a basis of comparison. The care I received was excellent and I can say the level of nursing in the U.S. is superior to anything I received in Italy. Nursing is one of the weak points of the Italian system. and one of the strongest points of the American. There are other defects in Italy, as in all systems. Nursing may be much stronger in other European countries, like France or the UK. I don’t know, because I have not had firsthand experience with them.

    I pay Italian taxes and have done so from the time I began working in Italy, and I contributed to the pension and health care systems as required by Italian law. All European health systems are quite similar and differ in minor ways and some are better than others, but none is deficient in any major respect. No one is neglected by the system, and the concept of “death panels” deciding who will die and who won’t would be laughable but for the sheer nastiness of this untruth and the fact that so many people in the States seem to be ready to believe it. With such a wide distribution of computers and internet access in the U.S., I can’t understand why more people do not Google or Bing European health systems to find out the what they are truly like. I think the best of the European systems, if I am not mistaken, are probably the French and Swedish, but all work well, including the UK’s National Health System.
    In Europe private insurance policies exist side-by-side with the national health services, and they offer quicker service than the public service. They cost, but not nearly as much as private American plans do. There is much more flexibility in the European systems than the American.

    As an American residing in Europe, I am appalled at the ruckus going on in the States about healthcare August, 2009). It is clear that much of the discussion is driven by sheer ideology and unconscionable scare tactics rather than a pragmatic attempt at solving a problem. And a problem in health care the U.S. has big time.
    The U.S. has a higher infant mortality rate than any of the European health care systems that have been roundly vilified by some folks in the States. Longevity is higher in the UK and in other European countries than in the U.S. So, babies and old folk, the two most vulnerable parts of the population, are doing more poorly in the U.S. than in Europe. The same is true of other parameters. The U.S. is spending a higher percentage of its gross domestic product on health care and is getting less value back than any European system. And 47 million Americans have no coverage at all.
    Americans fear changing or losing jobs because their health care disappears with it. People should be free to readily change jobs without having to worry about losing health care. The fact that loss of health care is a barrier to changing jobs is not good for the economy, which needs flexibility of employment.
    Americans should look more closely at European health care before deciding what they want and what they don’t want and they should not be terrified by the term “socialized medicine,” which is nothing more than the government providing health care, just as it does security, defense and other services. One doesn’t accuse the U.S. of “socialized security”, because the FBI is a federal agency.
    Costs in the US are high because those without coverage wait until a problem reaches crisis stage and then they go to the emergency room, where treatment is much more costly than if they had been able to go to a GP while the ailment was at its early incipient stage.
    Because Americans are the most litigious of western peoples, doctors feel it necessary to prescribe tests, many quite expensive, not for medical reasons, but as a hedge against malpractice suits where the dollar amount of damages decided by juries are way out of proportion to the injury sustained by the individual suing.
    There are other causes of the high cost of health care in the States, and high cost must be addressed along with the extension of coverage in reforming the present system.

   I would be happy to answer any questions about the Italian system, and through it about European systems in general. I can also supply information about the workings of the UK’s NHS, as my ex-wife, with whom I am in regular contact, has lived in London for the last 12-13 years and my daughter lived in London for 10 years prior to moving recently to Dubai. Both had intimate dealings with the NHS. So, through them I can supply a true picture of the NHS as well as the Italian.
    What is important is that the American people, working through their government, need to refashion their health care so it is one of the better systems in the world; rather than one of the more deficient ones, as it is now. It will be a process (and perhaps a long one given the controversy swirling around it), and the first law will have holes in it. But tinkering with it over time could produce a very fine system which serves all Americans in a way that keeps them healthy, so they can enjoy a productive work and family life.

    See also the New York Times article: http://www.nytimes.com/2009/09/03/opinion/03kristof.html?th&emc=th

Ira David Levin
Email: illit(at)icnet.it (When typing the email address, substitute an "@" for the "(at)"---this substitution is necessary to prevent automatic search engines from sending spam to this email address).

Disclaimer: the authors of this Web site are not medical doctors and are not affiliated with any medical school or organization. The information on this site is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health professional prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this service is intended to be for medical diagnosis or treatment.

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(This page last updated 1/03/11)