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21st Century Medicines Hard Realities Make The Case For CI Insurance

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A friend from abroad said to me a few years ago that critical illness insurance would not be much of a seller in the U.S. market. Baloney.

CI insurance has an irresistible impact in America, in some ways because of how it compensates for medical care concerns highly prevalent in this country.

In the last few years, there has been an accelerating incidence of papers in the medical literature that make disconcerting distinctions between outcomes of therapies–most notably the more risky surgical procedures–in hospitals which do high volumes of the procedures as compared to hospitals where that intervention is performed markedly less often.

These reports are eye-opening.

They also have profound implications for the informed consumer’s decision to purchase CI insurance.

Most Americans with private health insurance have access to their coverage by virtue of their employment. In many, if not most cases, the plans have limitations governing choice of doctor and/or hospital. By inference, these restrictions frequently would preclude participants from choosing the highest volume hospital–for that procedure–in their community, etc.

Therefore, to obtain the best level of care with lowest probability of complications or death, one might well need disposable funds at hand to provide for that care out of pocket.

Recent studies fill out the dimension of the problem. They detail how coronary bypass patients in low-volume hospitals face substantially greater risk of dying during hospitalization than those having the procedure at high-volume surgical facilities; how new breast cancer patients have much greater likelihood of undertreatment in low-volume institutions due to inadequate lymph node assessments; and, how high hospital volume correlates with lower risk of dying for various procedures.

Likewise with physician experience. One report from Canada shows fewer in-hospital deaths when the attending physician is a high-volume, rather than low-volume, doctor.

Does the quality of therapy also differ on the basis of hospital volume? You bet. There is research showing how much better patients fare when seen at high-volume medical centers–it is at those facilities that people are more apt to get the best-choice medications compared, once again, to low-volume centers.

The take-home message should be loud and clear: To enjoy the flexibility of maximizing chances of critical illness survival, make sure you are treated at a high-volume hospital. And you probably cannot do that unless you have CI coverage.

A related issue underscores the importance of acquiring CI coverage from a quality of care perspective.

Most of the latest and most effective drugs that are becoming available to treat–and sometimes cure–malignancies as well as other catastrophic conditions covered under typical CI policies are exquisitely expensive. Example: Monoclonal antibody drugs often cost 10 to 50 times more than conventional and less effective prescriptions used for the same condition.

Ongoing research assures that the incidence of this phenomenon will only accelerate with time.

Moreover, many heart attack or stroke patients will be motivated to pursue taking various classes of cardiovascular drugs. They will do this even if their situation does not satisfy their insurer’s criteria for availing themselves of such medications in the context of their health plan. You see, they will often want these drugs to lessen marginally their risk of further events, even where that risk is judged to be no worse than average in the context of their history.

Are already-strapped health carriers going to support the extravagant costs of such additive therapies?

If not, will the CI benefit paid out for the heart attack or stroke be the salvation of the middle-income policy owner who would be greatly encumbered if he had to fund this own optimal secondary prevention?

These are the hard realities of 21st century medicine. They are also provocative arguments for securing CI coverage as a key part of one’s insurance portfolio.

Hank George, FALU, CLU, FLMI, is president of Hank George, Inc., Greendale, Wis. His e-mail address is [email protected].

The take-home message is clear: Make sure you are treated at a high-volume hospital and that you have CI coverage


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