May 14, 2011 Jeanne Rust

Health Insurers Profit While Clients Postpone Care

I read an article this morning that made my blood boil. The New York Times reports that in the last three years, health insurance companies have piled up record profits. UnitedHealth Group told analysts that so far this year, insured hospital stays actually decreased in some instances. In reporting its earnings last week, Cigna talked about the "low level" of medical use.

The author attributes this surprising development to "a lingering recessionary mind-set among Americans who are postponing or forgoing medical care." He goes on to explain that, "even with a halting economic recovery, doctors and others say many people are still extremely budget-conscious, signaling the possibility of a fundamental change in Americans' appetite for health care."

Excuse me? What part of the current state of health care coverage don't you understand? Despite the current recession, is there any industry where workers aren't squeezed between higher health insurance premiums and reduced coverage for medical expenses? But it could be worse. You could be among the 14.9 million unemployed Americans who are unemployed and may have no health insurance at all.

So obviously we're dealing with something a bit more sinister than a reduction in "Americans' appetite for health care."

Let's look at some recent trends in health insurance coverage for treatment of eating disorders. There was a fascinating presentation on this topic at the 2011 Symposium of the International Association of Eating Disorder Professionals.

Dr. Craig Johnson, Medical Director for The Eating Recovery Center, led off with statistics regarding the steady decline in the average number of days of treatment authorized by insurance companies, beginning with the HMOs in 1992. The current average is 27 days. At an average weight gain of two pounds/week, if a client weighs 75 pounds on admission, it would take 53 days to achieve 90% of ideal body weight and 89 days to achieve 100% of ideal body weight. The result has been a huge increase in the number of readmissions (currently 30% within one year of discharge).

As Dr. Craig concluded, "insurers appear to have concluded that since policy holders change insurers every two years on the average, the insurers won't have to bear the costs of the inevitable relapse."

Yet the big insurance companies continue to press for higher premiums, even their coffers are overflowing and shareholders have been rewarded with new dividends. If you're not outraged, you're not paying attention!