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Many people might find it awkward to bring up money with their doctor, but a new study finds that physicians and patients are talking about health care costs in about one-third of office visits, and that nearly half of those conversations focus on ways patients could save money.
"With surprising frequency, doctors and patients are talking about health care costs during clinical encounters," says Dr. Peter Ubel, a Duke University professor and one of the authors of the study, published last month in the journal Medical Decision Making.
Though doctors were not traditionally taught to consider the cost of care, the study finds that they initiated about 58 percent of the cost conversations.
"I think the doctors are bringing it up because they see a lot of patients suffering," Ubel says. "They've had enough patients complain about costs. They're more aware of it; their antennas are up for the problem."
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A bill introduced in the California legislature this week seeks to force health insurers to notify consumers about coverage premiums that state regulators have deemed "unreasonable." The legislation would also require insurance companies to give those consumers time to shop for a new plan.
Under existing law, the California Department of Managed Health Care and the California Department of Insurance review rate hikes proposed by the insurers and health plans each regulates.
But when the agencies conclude that an increase is unjustified, there's not much they can do. The regulators can ask the insurer to rescind the increase, but the company is not legally obligated to comply. The two departments' only recourse is to post the information on their websites.
"Frankly most consumers aren’t looking over a Department of Managed Health Care or Department of Insurance website," says Anthony Wright, executive director of Health Access California, which sponsored the bill. "And even if they did, it would be hard for them to figure out whether the plan they're in has the unreasonable rate."
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This week, the U.S. Preventive Services Task Force for the first time specifically included pregnant women and new mothers in its recommendation that all adults get screened for depression. The guidelines, published Tuesday in JAMA, say screening should be accompanied with effective treatment or referral to someone who can provide care.
Dr. Emily Dossett, an associate clinical professor in the psychiatry and obstetrics and gynecology departments at Los Angeles County-USC Medical Center, described the move as "wonderful."
"We're hoping [the recommendation] will encourage primary care doctors, pediatricians working with postpartum moms, and OB-GYN's working with pregnant women, to really take these recommendations to heart and start implementing them in their practices," says Dossett, who also runs a program at County-USC that offers prenatal care and psychiatric treatment to low-income women.
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The concept behind high-deductible health plans is that if people are on the hook for a larger share of their medical bills, they'll be more likely to consider cost when making health care choices. But a new report finds that people enrolled in high-deductible plans are no more likely than those in traditional plans to shop for affordable care.
Researchers at Harvard and USC conducted a national survey of about 2,000 people; about 1,100 of them had deductibles greater than $1,250 for individuals or above $2,500 for a family. Despite being concerned about costs and aware of cost differences, just 4 percent of people in these high-deductible plans said they compared costs the last time they used medical care. Three percent of those in plans with low deductibles said they had done any cost shopping.
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A northern California Catholic hospital is fighting a lawsuit seeking to force it to perform a tubal ligation, arguing that its ethics code generally prohibits it from performing sterilizations. Some reproductive health experts say that code has created another problem at Catholic hospitals that use it: Limited treatment options for women experiencing pregnancy-related complications.
The organization that lobbies on behalf of the state's Catholic hospitals acknowledges that they follow different protocols in cases of pregnancy complications, including sometimes transferring patients to non-Catholic hospitals. But the group insists that these women ultimately receive the treatment they need.
In the northern California case, the American Civil Liberties Union has sued Mercy Medical Center in Redding on behalf of Rebecca Chamorro, a woman planning to give birth at the facility. Chamorro decided with her doctor that she would have a tubal ligation following her planned Cesarean section in late January. Experts say this sterilization method is common, routine and effective.