Medical Device Daily Washington Editor
WASHINGTON — On the heels of the President George Bush's recent push to rally support for medical liability reform legislation (Medical Device Daily, Jan. 10, 2005), a new study shows that the public favors reducing jury awards in malpractice lawsuits but puts it relatively low on a list of 12 healthcare priorities for the president and Congress this year.
According to a post-election survey conducted by the Kaiser Family Foundation (Menlo Park, California) and the Harvard School of Public Health (Boston), roughly a quarter of those polled (26%) cite reducing malpractice awards as top priority for the government. Overall, it ranks 11th on the list, just ahead of increasing federal funding for stem cell research (21%).
At the top of the list, almost two-thirds (63%) of U.S. adults cite lowering the costs of healthcare and health insurance as the top priority for the president and Congress, followed by making Medicare more fiscally sound for the future (58%) and increasing the number of Americans with health insurance (57%). Just under a third (31%) cited allowing drugs to be imported from Canada as a top priority, ranking it eighth on the list.
Overall, according to the Kaiser study, U.S. adults rank healthcare issues third when asked to name the single most important priority for lawmakers to address. Fewer Americans cite healthcare issues (10%) than the war in Iraq (27%) or economic issues (17%). Terrorism/national security (10%) tied with healthcare as the third-most cited issue.
The survey, conducted from Nov. 4-28, is based on a national representative sample of 1,396 adults.
“The public isn't pushing hard for malpractice reform, but will be happy to have it if the lawyers, doctors, the administration and Congress can agree to a plan,“ said Drew Altman, PhD, president of the Kaiser Family Foundation.
According to Altman, the public sees malpractice lawsuits as a significant factor in rising healthcare costs and generally sees the number of lawsuits as a bigger problem than the size of resultant jury awards.
Almost a third (32%) said that the most important factor in causing rising malpractice insurance rates is too many lawyers filing unwarranted lawsuits, while 15% say it is the high profits of malpractice insurers; 14% said it is too many patients making unwarranted claims against doctors; and 11% said it is too many doctors making mistakes. While most of the policy debate has focused on putting caps on jury awards, 9% cited “too many juries making excessive awards“ as the main reason why malpractice costs are rising.
More than seven in 10 (72%) said they favor legislation to prohibit people from filing medical malpractice lawsuits unless an independent medical specialist reviewed the claim and thought it reasonable. More than six in 10 (63%) said they favor legislation that would limit the amount of money that can be awarded as damages for pain and suffering.
Among the 63% who supported a cap on damages for pain and suffering, most favor a relatively high cap: 30% of this group favored a cap of $1 million or higher, 23% favored a $500,000 cap, 16% favored a $250,000 cap, and 15% favored a cap of less than $250,000. The remaining 17% said they either don't know or wouldn't say.
The Bush plan would put a limit of $250,000 on non-economic damages — which also means the pain and suffering portions of malpractice awards — and there would be no imposed limits on economic losses suffered as the result of what the president calls “legitimate medical error.“
Most surveyed also said that both damage caps and requiring independent medical review would have at least some impact on the overall cost of healthcare in the U.S.
There also was a clear division along party lines on the issue. Republicans (37%) were more likely than Democrats (17%) to say that reducing jury awards in malpractice lawsuits should be a top priority, and they were also more likely to favor various malpractice reforms as impacting the overall cost of healthcare.
U.S. healthcare spending slows, CMS says
The pace of health spending growth slowed in 2003, marking the first deceleration in these national costs in seven years, according to a report by the Centers for Medicare & Medicaid Services (CMS; Baltimore).
“This is good news for the public and our healthcare system, and is the result of changes designed to slow down the growth in spending,“ said Tommy Thompson, secretary of Health and Human Services. “But we have more to do before we can declare victory over rising healthcare costs.“
According to CMS figures, U.S. health expenditures grew 7.7% in 2003 to $1.7 trillion, down from a 9.3% growth rate in 2002; average per-capita health spending increased by $353 to $5,670. Health spending accounted for 15.3% of the gross domestic product in 2003, outpacing growth in the overall economy by nearly 3%.
Private payers (primarily private health insurance and payments by individuals for co-pays, deductibles and services not covered by insurance) funded more than half of national health expenditures in 2003, or $913.2 billion. The public sector funded $766 billion, with the Medicaid program funding 16% of aggregate health spending, or $267 billion, nearly equaling the 17%, or $283 billion, spent by Medicare.
CMS said that changes in public funding for healthcare greatly influenced overall 2003 health spending. Total public spending growth slowed from 9.7% in 2002 to 6.6% in 2003. This reduction was driven by a slowdown in Medicaid spending, from 12.6% in 2002 to 6.9% in 2003 and the expiration of certain supplemental funding provisions, the agency said.
Private-sector spending growth decelerated only slightly as compared to public spending, growing 8.6% in 2003 and 9.0% in 2002, CMS said. Private health insurance premium growth decelerated for the first time since 1996, growing 9.3% in 2003, just over a percentage-point slowdown from the previous year.
Hospital spending, nearly one-third of total national health expenditures, also saw a slowdown in growth, increasing by 6.5%, down from 8.5% growth in 2002. Because hospital care comprises the largest single share of health spending, the impact of its slowed growth drove the deceleration in overall health spending, according to CMS.
Coverage expansion for cochlear implants
CMS also recently reported that it would propose an expansion of coverage for cochlear implant devices by lowering the threshold for Medicare coverage of the implants. Currently, Medicare covers cochlear implants for beneficiaries with severe sensorineural hearing loss, determined by a sentence recognition test administered in the patient's best listening condition. Under current policy, the patient must demonstrate a test score of 30% or less on the sentence recognition, based in part on previous FDA-approved labeling, which has been updated recently.
Under the proposed new policy, Medicare would cover cochlear implants in beneficiaries who have test scores of 40% or less correct in the ear to be implanted on tape-recorded tests of open set sentence recognition. In addition, Medicare would cover cochlear implants in beneficiaries who have test scores over 40%, up to and including 60% if they are participating in a Medicare-approved clinical trial of cochlear implantation.
“This is a welcome change for many beneficiaries who did not previously qualify for Medicare coverage of a cochlear implant,“ said CMS Administrator Mark McClellan, MD, PhD.
An estimated 25 million Americans have hearing loss, including one out of four older than 65.
A draft national coverage decision is posted on the CMS web site.