Clip files / Local news from the states
Clip files / Local news from the states
This column features selected short items about state health care policy digested from publications from around the country.
New Jersey insurers cover non-drug costs for cancer trials
TRENTON—An agreement among New Jersey’s largest health insurers has opened access to clinical trials for as many as 20,000 state residents with cancer who now can’t afford such care.
The voluntary agreement, the first of its kind in the nation, calls for the health insurers to provide care to cancer patients in Phase III clinical trials, those that compare experimental drugs with standard treatments, said William Hait, MD, PhD, director of the Cancer Institute of New Jersey in New Brunswick.
About 400 to 1,000 cancer patients in New Jersey currently are involved in such trials, Mr. Hait said. Normally, the cost of the medicine used in the trial is paid for by the pharmaceutical company developing the drug. But the costs of routine care, including hospitalization, lab tests, outpatient visits, and treatment of other illnesses associated with the clinical trial, often are not covered by insurance.
—The Star-Ledger, Feb. 25
Pennsylvania Medicaid HMOs limit optional benefits
PHILADELPHIA—Two of four Medicaid HMOs in southeastern Pennsylvania are dropping popular but discretionary benefits in their adult vision and dental plans.
Then cutbacks went into effect Jan. 1 at Keystone Mercy Health Plan, whose 225,000 members make it the largest Pennsylvania Medicaid managed care plan. Similar changes are being implemented at 71,000-member Healthcare Management Alternatives (HMA) Medicaid plan.
The only nonprofit plan among Pennsylvania’s Medicaid managed care roster, 104,000-member Health Partners, will continue to cover eyeglasses and dental care, spokeswoman Deborah Tortu said. The fourth plan, HRM Health Plans (formerly Oxford), also plans no cutbacks, though it does not cover glasses or contacts for adult members except for those who have particular conditions.
—The Inquirer, Feb. 18. For more information on problems among Pennsylvania Medicaid managed care plans, see State Health Watch, October 1998, p. 7.
State commission cuts Maryland hospital rates by 1%
BALTIMORE—Despite warnings that the move could lead to program cuts and a loss of 3,000 jobs, officials in Maryland have cut hospital reimbursement rates by 1%.
The Health Services Cost Review Commission, concerned that Maryland’s hospital costs were outstripping those in other states, initially proposed a 2% rate rollback. The commission’s move essentially splits the difference between the industry and state positions.
Hospital costs in Maryland were 25% above the national average when the commission began setting rates in 1976. By 1992, costs had dropped to 13% below average. Since then, however, Maryland costs have grown faster than the national rate for six straight years, and the cost of an average hospital stay in Maryland now is once again above the national average.
—The Sun, March 4. See story in State Health Watch, March 1999, p. 7.
San Francisco officials face deficit, bursting ER conditions
SAN FRANCISCO—Health officials want to limit ambulance admissions at San Francisco General Hospital as a way to cope with an overcrowded emergency room and a $24 million deficit.
The hospital’s 36-bed emergency room is using gurneys in the hallways to juggle as many as 54 patients at a time.
A recommendation to scale back emergency room admissions is under consideration by the Health Commission and must ultimately be approved by the Board of Supervisors, which has final say over hospital policy.
The new policy would suspend rules allowing private hospitals to divert ambulances headed toward San Francisco General. Instead, patients suffering from broken bones, illness, and heart attacks would have to be treated by the nearest hospital. Only severe trauma cases, such as gunshot wounds, car accidents, and burn victims, would be guaranteed a ride to the county emergency room.
Administrators say an increased number of poor patients and inadequate government compensation are generating a record amount of red ink. Even with added money, the county hospital does not have the space to handle the current level of patients in need of emergency care, officials say.
—San Francisco Chronicle, March 2.
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