[Congressional Record Volume 146, Number 42 (Thursday, April 6, 2000)]
[Senate]
[Pages S2339-S2340]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HONORING THE GOOD WORKS OF THE SOCIETY FOR MATERNAL-FETAL MEDICINE
Mr. THURMOND. Mr. President, I rise to recognize the vital work
performed by a group of tireless and dedicated professionals: The
members of the Society for Maternal-Fetal Medicine (SMFM). I
congratulate the Society for its outstanding achievements, and note
this year they celebrated their 20th annual meeting.
It is often said that the United States is home to the finest pool of
health care professionals in the world. I could not agree more. Each
and every day, these professionals provide cutting edge care for
millions across the country. Treatments that did not exist just ten
years ago are now saving lives on a routine basis. I am hopeful that we
never take this high level of care for granted.
The Society for Maternal-Fetal Medicine is one group that
demonstrates the tremendous talent we have in our country. For many of
us, ``maternal-fetal medicine'' may not be an everyday term. However,
we all acknowledge that mothers experiencing complicated pregnancies
require and deserve the best care possible. Maternal-fetal specialists
provide care or consultation during complicated pregnancies. In
addition, they provide education and research concerning the most
recent approaches to the diagnosis and treatment of obstetrical
problems. As a result, these specialists promote awareness of the
diagnostic and therapeutic techniques for optimal management of these
complicated pregnancies. In addition, it should be noted that maternal-
fetal medicine specialists are complementary to obstetricians in
providing consultations, co-management or direct care before and during
pregnancy.
Mr. President, I urge my colleagues to join me in congratulating the
members of the Society of Maternal-Fetal Medicine for their outstanding
work. I also want to acknowledge the fine work of Dr. Peter Van
Dorsten, President of the SMFM, who resides in my home state of South
Carolina. There is no doubt that Americans across the country join me
in thanking these unique individuals.
Mr. KENNEDY. Mr. President, seven months have elapsed since the House
of Representatives passed the bi-partisan Norwood-Dingell bill to end
insurance company and HMO abuses, and more than six months have passed
since House and Senate conferees were appointed to prepare the final
version of this important measure.
Today, I am releasing a new study by the Minority Staff of the
Health, Education, Labor and Pensions Committee that documents how
devastating this long delay has been for millions of Americans and
their families, and how urgent it is for the House-Senate conference to
complete its work as soon as possible.
Drawing on data gathered by the University of California School of
Public Health and the Harvard School of Public Health, the report
documents unacceptably high numbers of patients who are denied needed
care, who suffer increased pain, or whose health has seriously declined
because too many HMOs and insurance companies put profits ahead of
patients.
According to the study, 59,000 patients each day--22 million patients
a year--report added pain and suffering as the result of the actions of
their health plans. Large numbers of patients have specialty referrals
delayed or denied. Others are forced to change doctors. Still others
are forced to take prescription drugs that are different from the drugs
their doctor prescribed.
In addition to patients' reports of significant problems as the
result of actions of their health plans, thousands of physicians report
seeing patients every day whose health has seriously declined as the
result of abuses
[[Page S2340]]
such as the failure to cover recommended prescription drugs, denial of
needed diagnostic tests and procedures, and unwillingness to allow
referrals for specialty care.
This study provides powerful new evidence of the need for Congress to
move promptly to pass a strong Patient's Bill of Rights. Millions of
families are suffering because of the failure of Congress to act.
Families across America deserve protection, and it is time for Congress
to fulfill its responsibility and see that they get it.
I ask unanimous consent the study be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The Impact on Patients of Delays in Passing a Patients' Bill of Rights:
A Senate Health, Education, Labor and Pensions Committee Minority Staff
Study
Delays in passing legislation to curb insurance company
abuse result in injury to thousands of patients daily and
millions of patients annually. Drawing on two prior studies
on the incidence of abusive health plan practices, this
report looks at the number of patients affected daily,
weekly, monthly and yearly.
The estimates are based on patient self-reports of
experiences with health plans and on physicians' reports of
the frequency of various abuses and the seriousness of
injuries sustained by the patients they see in their own
practices.
Highlights
According to patient reports, every day, as the result of
actions of their health plan: 59,000 patients experience
added pain and suffering; 41,000 patients experience a
worsening of their condition; 35,000 patients have needed
care delayed; 35,000 patients have a specialty referral
delayed or denied; 31,000 patients are forced to change
doctors; and 18,000 patients are forced to change
medications.
According to physician reports, every day: 14,000
physicians see patients whose health has seriously declined
because an insurance plan refused to provide coverage for a
prescription drug; 10,000 physicians see patients whose
health has seriously declined because an insurance plan did
not approve a diagnostic test or procedure; 7,000 physicians
see patients whose health has seriously declined because
an insurance plan did not approve referral to a medical
specialist; 6,000 physicians see patients whose health has
seriously declined because an insurance plan did not
approve an overnight hospital stay; and 6,000 physicians
see patients whose health has seriously declined because
an insurance plan did not approve a referral for mental
health or substance abuse treatment.
Table 1 shows the incidence of plan restrictions on care
and patient injuries resulting from plan actions by day,
week, month, and annually, as reported in the survey of
patients. Table 2 shows the number of physicians seeing plan
abuses that result in serious declines in patient health each
day, month, week, and year.
TABLE 1.--PATIENT SURVEY
----------------------------------------------------------------------------------------------------------------
Number of Number of Number of Number of
patients patients patients patients
Health plan abuse affected per affected per affected per affected per
year month week day
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Delay in Needed Care........................ 12,880,000 1,073,000 247,000 35,000
Delay or Deny Specialty Referral............ 12,880,000 1,073,000 247,000 35,000
Forced to Change Doctors.................... 11,270,000 939,000 216,000 31,000
Forced to Change Medications................ 6,440,000 537,000 124,000 18,000
Results of Health Plan Abuse:
Added Pain and Suffering................ 21,638,000 1,803,000 415,000 59,000
Worsening of Condition.................. 14,876,000 1,240,000 285,000 41,000
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Source: Committee Analysis Based on Helen H. Schauffler's ``California Managed Health Care Improvement Task
Force Survey of Public Perceptions and Experiences with Health Insurance Coverage.'' U.C. Berkeley School of
Public Health and Field Research Corporation, September, 1997, reported in Improving Managed Health Care in
California, Findings and Recommendations, Volume Two, January 1998, tables 4 and 19, projected to the national
level.
TABLE 2.--PHYSICIAN SURVEY
----------------------------------------------------------------------------------------------------------------
Number of Number of Number of Number of
doctors each doctors each doctors each doctors each
year seeing month seeing week seeing day seeing
Health plan abuse patients with patients with patients with patients with
serious decline serious decline serious decline serious decline
in health plan in health from in health from in health from
abuse plan abuse plan abuse plan abuse
----------------------------------------------------------------------------------------------------------------
Denied coverage of recommended prescription 137,000 111,000 71,000 14,000
drug.......................................
Denied coverage of needed diagnostic test... 149,000 100,000 51,000 10,000
Denied referral for needed specialty care... 122,000 76,000 37,000 7,000
Denied overnight hospital stay.............. 110,000 65,000 29,000 6,000
Denied referral for mental health or 116,000 63,000 30,000 6,000
substance abuse treatment..................
----------------------------------------------------------------------------------------------------------------
Source: Committee Analysis Based on Kaiser Family Foundation and Harvard School of Public Health, ``Survey of
Physicians and Nurses,'' July, 1999.
methodology
The data presented in this report was drawn from two
sources. Patients' self-reports on difficulties with their
health plans and illness and injury caused by actions of
their health plans was drawn from a random sample survey of
individuals in California with private health insurance
conducted by the Center for Health and Public Policy Studies,
School of Public Health, University of California at
Berkeley. Helen Schauffler, Ph.D., was the principal
investigator. The survey was conducted during September, 1997
for the Managed Care Improvement Task Force of the State of
California, and reported in Improving Managed Health Care in
California, Findings and Recommendations, Volume Two,
January, 1998, Tables 4 and 19.
The survey asked whether the respondent experienced
specific difficulties with a health plan. Those who
experienced difficulties were asked about the impact of the
difficulty on their health. The figures presented in this
report assume that the incidence of such events is the same
among the total U.S. population of privately insured
individuals as it is among the privately insured population
in California. Daily, weekly, and monthly figures were
derived by dividing annual rates by 365, 52, and 12,
respectively. All figures in the tables are rounded to the
nearest 1,000 patients.
Data on physicians' reports of health plan practices and
serious declines in health experienced by patients as the
result of health plan actions were drawn from the 1999 Survey
of Physicians and Nurses by the Kaiser Family Foundation and
the Harvard School of Public Health. The survey was conducted
between February 11 and June 5, 1999. Physicians were asked
how frequently a set of plan practices occurred (weekly,
monthly, every six months, yearly, never, or not applicable
to my practice). Physicians who reported that the practice
occurred were asked for the impact on the health of their
patients.
The figures reported in the survey were converted into
daily, weekly, monthly, and annual totals by adding the
proportions seeing the specified event during the specified
time period. For example, to derive a weekly total, the
numbers of doctors reporting seeing such patients weekly was
added to one-fourth of the doctors reporting seeing such
patients monthly plus one-fifty-second of the doctors
reporting seeing such patients annually. The proportion was
then multiplied by the size of the sampling universe of
470,364 physicians. All figures reported in the table are
rounded to the nearest 1,000 patients.
Note that the tables are not comparable, since one reports
on numbers of patients affected, while the other reports on
numbers of doctors seeing affected patients. Many doctors saw
numerous affected patients. Moreover, judgments of doctors
who attribute health declines to specific plan practices may
not coincide with patients' own conclusions. Also, the doctor
survey reports on patient injuries due to specific plan
practices which are not identical with the problems
identified in the patient survey.
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