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发表于 2014-10-26 21:59:45
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Part II: Speed
Walmart’s Affordable Care Act By Alison Griswold | Oct. 22, 2014
[Time 2]
Earlier this month, Walmart made a pair of unfortunately timed announcements. First, on Oct. 6, Walmart said it would begin working with DirectHealth.com, an online health insurance agency, to help shoppers compare coverage options and sign up for Medicare or plans on the Affordable Care Act exchanges. The very next day, Walmart stated it would cut health insurance for 30,000 part-time workers and raise premiums for its full-time employees, effective Jan. 1.
Walmart is among several retailers racing to make a name for itself in the nearly $3 trillion U.S. health care market. And, in many ways, it’s already proven to be a leader. In 2006, Walmart introduced its $4 prescription program, which cut the cost of roughly 300 generic drugs to $4 for a 30-day supply. It has dozens of simple-service clinics that test for common ailments and provide vaccinations, and this year has focused on rolling out a handful of primary care facilities that charge $40 per visit in Texas, South Carolina, and Georgia. The partnership with DirectHealth.com is a logical next step in Walmart’s push into wellness—a perk that might help draw consumers into Walmart’s stores and build their trust in its brand for not just cheap groceries, but also cheap health services.
At the same time, Walmart’s interest in building faith in its health offerings does not extend to its own employees. It made that much clear when it slashed benefits and raised premiums the day after publicizing its DirectHealth.com initiative. People are already sensitive when it comes to health services. Should they trust a giant corporation to handle them, especially one that appears to be so callous about the health care of its own employees?
[281 words]
[Time 3]
The simple answer, health policy experts say, is yes. “Consumers are going to benefit from new entrants who think more like retailers than health care providers,” says Zack Cooper, professor of health policy and management at the Yale School of Public Health. “If I had one word to describe Walmart coming in, it would be cool.” The influx of retailers like Walmart into health care means that consumers are suddenly getting more information about and access to crucial services. While many doctor’s offices are used to operating from 9 to 5, Cooper says that retailers are starting to extend those hours. Walmart’s new primary care clinics are open from 8 a.m. to 8 p.m. during the week and for slightly shorter hours on Saturday and Sunday; CVS’s Minute Clinics run on similar schedules.
The DirecHealth.com partnership should also be a useful tool for people struggling to navigate the exchanges and healthcare.gov. “When people choose insurance plans, they have a hard time because the information is so complex,” says Ateev Mehrotra, professor of health care policy and medicine at Harvard Medical School. “A lot of times patients are not choosing the best plan for them.” The DirectHealth.com agents stationed in Walmart’s stores will make the same commission on all policies they sell, a Walmart spokesperson said, meaning there are no incentives to steer customers toward more expensive options. “For consumers, more information from a trusted source is better,” Cooper says.
[239 words]
[Time 4]
In April, PricewaterhouseCoopers wrote in a report on the health industry that consumers “are ready to abandon traditional care models for ones that echo experiences in banking, retail, and entertainment.” Nearly 50 percent of people surveyed told PwC they would be likely to have a wound treated at a clinic in a retail store or pharmacy, or have stitches removed there, if it cost less than the traditional option of a hospital or physician’s office. Fifty-nine percent said they would be interested in using an at-home strep test.
Then again, health policy is rarely simple. It’s hard to know if the advance of Walmart and other retailers like CVS (which rebranded as CVS Health in September), Target, and Walgreens will actually decrease health care spending. “The more you make health care accessible and the easier it is for people to touch the health care system, the more that they’re probably going to consume,” Cooper explains. The economic term for this is induced demand: Make it cheaper and easier for patients to seek treatment, and they’re more likely to do so. At the same time, Walmart and its peers are offering a potentially valuable addition to the U.S. primary care system—bridging a gap between problems that can’t or shouldn’t wait for a visit to the doctor’s office and issues that require a trip to the emergency room. “You see a lot of innovation historically in healthcare at the high [cost] end,” Cooper says. “Those are the big-ticket items; that’s where pharma is focused.”
As for Walmart’s treatment of its own employees, it’s far from the first retailer to cut benefits from part-timers. Target ended health coverage for part-time workers earlier this year, and Home Depot did the same in 2013. But it’s the timing of the Walmart announcement that makes it feel gross and manipulative, in the same way that it feels gross when Walmart profits off the food-stamp spending of its poorly paid employees. Walmart’s strides in healthcare might indeed be good for the market, and if they are, people should take advantage of that. But that can’t shake the thought that Walmart, by cutting off 30,000 employees from health care benefits, has also conveniently supplied DirectHealth.com with 30,000 new customers.
[372 words]
Source: Slate
http://www.slate.com/articles/business/moneybox/2014/10/walmart_and_health_care_partnership_with_directhealth_com.html
For Africa, health care that works
by Mandy Moore | Oct. 22, 2014
[Time 5]
(CNN) -- I've just returned from a visit to Tanzania with the global health and development organization Population Services International to better understand the challenges facing health workers in the developing world. The outbreak of Ebola only underscores the dire need for trained health workers -- a global shortage of nearly 7.2 million health workers, according to the World Health Organization.
About half of the spending on health care in Africa goes to private providers and care can be unregulated and quality inconsistent. During my week on the ground, however, I met PSI community health workers, nurses, doctors and business owners who deliver controlled and quality health care across Tanzania.
PSI has ensured quality care by applying proven commercial franchising strategies -- think McDonalds or Subway -- to health care. PSI operates a franchise network that spans 31 countries and serves 10 million people every year. In Tanzania, the franchise is called Familia.
Lucy, a Familia community health worker, goes out into the community every day and educates women about family planning and other health issues. Lucy then refers these women back to the neighborhood Familia clinic located right in the village she serves.
I joined Lucy for a session she organized at a modest apartment building with a few rooms separated by concrete walls and colorful fabric curtains. When I climbed the stairs to the front porch, about a dozen women with babies who were seated on straw mats greeted me. Lucy began to talk with them about their contraception options, and they had lots of questions for her. The most vocal was a gregarious woman named Sophia.
Sophia had used condoms and pills to space her births, but when Familia began offering longer-term methods like implants, she switched. The implant prevents pregnancy for up to three years, and she shared with us how it was a great weight off her shoulders. She told the group that she wanted to be able to plan her family size, so she and her husband could save for the future. Lucy reiterated that for women like Sophia, access to family planning is a key to health and economic stability.
[356 words]
[Time 6]
According to a report by the United Nations Population Fund and Guttmacher Institute, returns on investment in contraception can be recouped four times or more by reducing the need for public spending on social services. This is something Lucy knows well -- before she ended the session, she gave out vouchers to our new friends for a consultation at their local Familia clinic.
After the session, we walked back to the clinic together and Lucy introduced me to Dr. John -- the clinic owner and care provider. He's the kind of doctor anyone would want: one with a gentle bedside manner who cares deeply for the community he serves. We talked about the clinic, his needs and the number of clients he sees -- up to 200 per day.
Dr. John said what he most needed was better business management skills. He was most appreciative about that component of PSI's franchise model -- the ongoing training he and his staff receive. This helps him retain employees -- a major problem in developing countries underscored by this most recent epidemic -- and maintain a standard of care his clients can trust.
The Familia franchise incorporates 260 private health facilities across 16 regions in Tanzania. PSI establishes the quality standards that clinics in the network, like Dr. John's, must meet. And prices for products and services are set based on people's ability and willingness to pay. With this structure, the health facilities can reach the very poor with free services and those who can afford to pay something with reduced fees.
It's working and clients are happy with the services they receive. According to PSI's study of the Familia Network, the client retention rate is 81%. From 2009 to 2011, Familia health workers provided 45,000 IUDs and 14,000 implants to women who wanted a long-lasting method of contraception -- which equals 143,000 years of protection from unintended pregnanc y for Tanzanian couples.
This innovative model takes an unregulated sector with varying degrees of quality and standardizes the level of care. It provides the vital infrastructure necessary for a woman like Sophia to take care of herself and her family, and a doctor and business owner like John to earn a decent living.
As we left, I asked Dr. John if his future plans included opening a few more clinics. He smiled, and simply said, "That's my dream."
[395 words]
Source: CNN opinions
http://edition.cnn.com/2014/10/22/opinion/moore-tanzania-health-care-africa/index.html?iref=allsearch
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