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Some doctors argue that a more effective strategy to prevent malpractice lawsuits is to involve patients in their health care decisions.
Most of us are familiar with the concept of defensive driving: We're taught to lower our risk of car accidents by anticipating dangerous situations that could be caused by poor road conditions or other people's mistakes.
But are you familiar with defensive medicine?
Defensive medicine is when doctors attempt to lower their chances of being sued for malpractice by ordering extra tests, imaging and procedures, even if they're not clinically justified.
This practice appears to be widespread: A survey of 824 Pennsylvania physicians in six specialties found that 93 percent reported practicing defensive medicine, according to a 2005 study published in the Journal of the American Medical Association. It found that over-ordering of diagnostic tests, unnecessary referrals, and avoidance of high-risk patients were the most common forms of defensive medicine.
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Like lots of companies, Southern California Public Radio is in the midst of open enrollment season. My colleagues were not thrilled to learn recently that our health insurance premiums are increasing 11.5 percent in 2016.
I turned my co-workers' frustration into a mission for Impatient: Find out why our premiums are rising, and how this increase compares with what's going on at other companies.
Is your premium changing?
Here's what I learned about our premiums: Our company has a self-funded insurance plan, meaning it pays for every claim that's submitted. Claims submitted during 2015 were higher than expected, according to SCPR's HR department.
The company was left with a decision: It could increase premiums, deductibles or other out-of-pocket costs, or change its plan designs. For next year, it chose to increase premiums across the board.
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Vanessa Villegas, 31, of Los Angeles, and her husband would like to start a family soon. She says she's interested in having the baby at a birthing center or at home with the help of a midwife. She asks Impatient: What type of health insurance plan would provide the best coverage for an out-of-hospital birth?
Villegas currently has a high-deductible health plan. Now that Covered California has begun its new open enrollment period, she wonders whether it would be wiser to keep this type of plan and use her Health Savings Account to pay for any birthing expenses not covered by insurance, or whether she should switch to a plan with a higher premium and lower deductible.
Before I answer her question, let's review a few facts:
- Under the Affordable Care Act, a lot of women's prenatal care should be fully covered by insurance. Preventive tests – like those for Hepatitis C or gestational diabetes – should be covered at no additional cost, but services for diagnosis or treatment may not be.
- Labor and delivery should also be covered by insurance. But as I reported during our #PriceCheck investigation into the cost of childbirth in Southern California, deductibles, co-pays and coinsurance could apply.
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It's open enrollment season!
For folks who buy private health insurance or have employer-sponsored coverage, this is the time of year that they decide whether to stick with their current health plan or select a new one.
As KPCC Health Correspondent Stephanie O'Neill reported last year, there’s a lot to consider during this period, like:
- Do you want an HMO or a PPO?
- Do you want a Health Savings Account or Flexible Savings Account?
- Do you want a plan with a higher premium or a higher deductible?
If your blood pressure rises just thinking about all of these options and wonky terms, then take a deep breath and read on: O'Neill has written this updated guide to surviving open enrollment. And I'm here to help answer your personal questions about choosing a health insurance plan.
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Want to protect yourself and loved ones against the flu?
The best thing you can do is get your annual flu shot, the Centers for Disease Control and Prevention says. The Affordable Care Act tries to make it easy for people to follow that advice: Under the federal health law, the seasonal flu shot is considered preventive care, so it's covered at no extra cost to you.
But as with most things in health care, the devil's in the details.
When is your flu shot free?
Generally, if you have an HMO plan, you'll need to visit a doctor or facility in your insurance network to get your free shot.
Kaiser Permanente members, for example, can get the vaccine at no extra cost at Kaiser facilities.
"We believe this is important to enable us to maintain records of when our members received this preventive care, especially for our must vulnerable populations - small children, the aged, and those with respiratory issues," Kaiser spokeswoman Amy Thoma says in an e-mail.