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Have you received that hefty packet detailing your health benefits from the human-resources department yet? If not, you’ll likely get one soon, as fall is the time many companies ask their employees to rethink their insurance coverage. And while 80 percent of us will simply check off what we had last year, benefits experts say that can be an expensive mistake. As insurance costs for companies rise, you can bet some of that burden will shift to employees. But by choosing the smartest insurance plan and taking advantage of other ways your employer or insurer can pick up more of the tab, you can still save hundreds of dollars next year.

The catch? You need to invest some time and effort: Read that benefits packet carefully, and visit your insurance company’s Web site or call their customer-service representative. Here, four of the best ways to shave costs.

Choosing the health-insurance plan that will ultimately cost you the least while providing the care you want is no simple task. Most people look at just one number when deciding between insurance options: the monthly contribution their employer charges for coverage, says Richard Ostuw, a consultant with benefits firm Towers Perrin in New York City. But also knowing what you’re likely to spend out-of-pocket in the coming year is crucial.

First off, ask your insurance company’s customer-service department for a tally of fees you paid yourself in 2004, then break them down into co-payments for doctor’s visits, co-pays for prescription drugs, and the like. Remember to factor in what the co-pay would be for an emergency-room visit or hospital stay in case of injury, especially if you participate in active sports.

Two more numbers to pay attention to are your deductible, or the amount you have to pay before your benefits kick in, and your co-insurance, or the percentage of physician’s fees you’re responsible for. Many managed-care plans don’t have a deductible and pay 100 percent of physician’s fees, but you’re restricted on which doctors you can see, so you need to consider how much you’re willing to compromise in your choice of physicians.

Two separate studies released Aug. 3 show that the steadily escalating cost of health care benefits clearly has reduced the number of workers who receive health care coverage through employers.

“As health insurance costs continue to escalate, it is likely the level of coverage will continue to decline. The increasing cost burden is making it progressively more difficult for employers to compete,” said Ed Potter, president of the Employment Policy Foundation (EPF), a Washington, D.C.-based research group.

One of the studies released by the EPF revealed that, during the past year, the cost of employee health insurance has edged out paid leave as the most expensive benefit for employers. The foundation’s analysis of data from the U.S. Bureau of Labor Statistics found that health insurance benefits accounted for 23 percent of non-wage employee compensation in the first quarter of 2004.

According to the EPF researchers, this marks the first time health care has surpassed paid leave as the most expensive employer-provided benefit. Leave benefits, including paid vacations and sick time, were the second most expensive benefit, accounting for 22.6 percent of non-wage employee compensation.

Potter said that at some point the cost increases will hit a breaking point where employers cannot afford to spend any more on providing health benefits. There are some indications that level is approaching. Another report, released by the Center for Studying Health System Change (HSC), a nonpartisan research organization in Washington, D.C., found that a growing number of employers are opting to reduce or even eliminate health care benefits.

The study concludes that last year 63 percent of employees in the U.S. workforce received their health insurance through employers, down from 67 percent of the workforce in 2001. The proportion of the U.S. population under the age of 65 and in a family with at least one worker dropped from 84.2 percent in 2001 to 81.4 percent in 2003. Approximately 9 million fewer people now receive health care coverage through employer-provided benefits.

“While the economic downturn reduced employment and accounted for much of the decline in employer coverage, the rapidly rising cost of health insurance, which increased about 28 percent between 2001 and 2003, likely contributed to the decline as well,” said Bradley C. Strunk, a health care researcher and co-author of the HSC’s 2003 Community Tracking Study Household Survey.

According to the Centers for Disease Control and Prevention, 23.7 percent of United States adults age 20 years and older were obese in 2003–an increase of over 4 percent since 1997. As obesity levels continue to rise, the health implications associated with being obese, such as increased risk of high blood pressure and cholesterol, stroke, coronary heart disease, congestive heart failure, diabetes and an array of psychological disorders such as depression, eating disorders, distorted body image and low self-esteem, will exact an even greater toll on society.

The cost of obesity to United States businesses for health care, sick leave as well as life and disability insurance is estimated at $12.7 billion, according to a recent study in the American Journal of Health Promotion. Another study in Health Affairs estimated that cost could eventually top $30 billion. As a result, company health insurance premiums jumped an average of 13 percent last year, according to the nonprofit Kaiser Family Foundation.

Based on the financial implications of increased health-insurance costs, employee absenteeism and decreased employee productivity, many corporations now entirely fund or partially subsidize incentives for employees to achieve better health. Funding or ensuring discounted fitness club memberships for their employees is becoming increasingly common. In fact, The Society for Human Resource Management’s annual survey of employee-benefit managers found that 31 percent subsidize or reimburse gym membership fees–a 35 percent jump from 1999 to 2003.

A great example of businesses turning to preventive health care can be found in Florida’s Tampa Bay area, where large and small companies are providing their employees health and wellness education as well as access to fitness facilities. Tampa Bay-based company, Lifestyle Family Fitness, is an active provider of preventive health care to local businesses. Its Corporate Wellness Program saw a 38 percent increase in its corporate client base during the first quarter of 2004. The increased interest in fitness is a welcome trend for Lifestyle Family Fitness.

Healthcare magazine’s Health Care Hall of Fame during the American College of Healthcare Executives Congress in March. The Hall of Fame honors those who have made lifelong contributions to the healthcare industry.Sister Gerald was an active participant in the early years of HFMA, serving as the elected president in 1954 and 1955. At that time, she was general treasurer, Sisters of the Holy Cross, Notre Dame, Indiana. She later served as administrator at Holy Cross Hospital, San Fernando, California, and at Holy Cross Hospital, Salt Lake City, Utah. She also has taught Asian and African sisters at Mater Ecclesiae Center in Tiberias, Israel; served as field consultant for financial management at the Catholic Health Association of the United States, St. Louis, Missouri; and consulted for bishops in dioceses throughout the world.

Sister Gerald served on the HFMA committee that wrote and scored the first HFMA Fellowship examination. She herself became a Fellow of HFMA in 1958. She received the Frederick C. Morgan Individual Achievement Award in 1962 and was awarded HFMA life membership in 1953. A league was named for her in the former Graham L. Davis program, and currently one of the chapter awards of excellence is named for her. Sister Gerald attended ANI in 1996 to accept the Board of Directors Award on behalf of all past elected HFMA presidents and chairmen during HFMA’s 50th anniversary.

HFMA President and CEO Richard L. Clarke, FHFMA, commented about Sister Gerald’s Hall of Fame induction, “This acknowledgement by the healthcare community is a fitting recognition of Sister Gerald’s achievements. For more than seven decades, Sister Gerald has been a financial expert, manager, teacher, healer, and mentor to thousands of colleagues and community members throughout the world. Her work with a variety of organizations, including HFMA, has made a significant difference in health care and in the lives of the people she has touched.”

The Hall of Fame has had only 61 inductees since its establishment in 1988. Sister Gerald joins Graham L. Davis and Harold Hinderer as Hall of Fame members who had significant HFMA involvement.

Insisting that health care is a moral issue, religious liberals are demanding that Capitol Hill make it a priority when Congress takes up the president’s budget proposal this month.

A letter to Congress signed by more than 75 nationally known religious leaders and scholars says they will evaluate the government budget to make sure it provides health care, education and housing for the neediest Americans.

“The federal budget is a moral document,” Episcopal Church Presiding Bishop Frank Griswold said January 25 in New York City during a panel discussion sponsored by a left-leaning think tank, the Center for American Progress. “I notice how glibly we use phrases–’One nation under God,’ and then I find myself saying, ‘So what does God think?’”

The panel, which included Griswold, Center for American Progress President John Podesta, Northwestern University ethics professor Laurie Zoloth and Georgetown researcher Ann Neale, faced audience questions about the absence of liberal religious leadership for the Clinton health plan proposed in the early 1990s. Panel members also addressed religious liberals’ failure to mobilize the way religious conservatives have.

The “progressive” religious voice, which Podesta credits for the civil rights and labor movements, has been silenced, he said, as “people began to equate being religious with being conservative.”

That can change, panel members said. Health care can become a moral rallying cry the same way abortion and gay marriage issues have mobilized Republicans, said Zoloth, an Orthodox Jew and self-described “optimistic Democrat.”

“There is a link between the economy and a moral life,” she said. “Our problem in this budget is how to make the future fair for all Americans. There are ways for health care to move to the front of the agenda.”

About 45 million Americans, or 15 percent of the population, don’t have health insurance, according to the Washington-based Kaiser Family Foundation. A budget that neglects their needs and those of Medicare dependents “is more than wrong,” Podesta said. “It’s immoral.”

Use of personal digital assistants (PDAs) for healthcare applications is growing rapidly Even healthcare organizations that do not intend to use them should become familiar with their capabilities and risks because physicians and medical students already may own one.

One reason for the growing popularity of PDAs is the expanded memory and new software products that are becoming available. Software applications that are particularly useful to physicians and hospitals include patient tracking, laboratory order entry and results checking, access to reference materials, medical calculation, prescription writing, and charge capture.

Patient tracking. Patient-tracking programs allow notes on patient care to be uploaded or downloaded, giving physicians the ability to view or add chart information from any location. Such software provides improved access to the patient’s medical record and scheduling, billing, and contact information. In addition, patient-tracking software may coordinate with charge-capture, laboratory management, and medication lists.

Laboratory order entry and results checking. Physicians using laboratory test-ordering systems can check test results and order new tests. These programs also may include features that offer reminders or negate orders found to be inconsistent with input data.

Access to reference materials. Reference programs provide access to a large variety of medical information and medical specialty reference books as well as vast amounts of drug information, One of these systems, ePocrates, can be downloaded at no charge. (a) It allows drugs to be searched by generic name, trade name, or class and provides access to information on cost, adult and pediatric dosing, drug interactions, and adverse reactions. A function labeled “other info” provides information such as DEA status, pregnancy and lactation cautions, route of excretion, and mechanism of degradation/excretion. A multicheck function alerts physicians to possible drug interactions among multiple prescriptions involving up to 30 drugs at a time.

Medical calculation. These programs help physicians perform calculations using a variety of medical measures. They may either contain preset calculations or permit users to customize their own.

A non-binding fiscal year 2003 budget blueprint under consideration in Congress would nearly double President Bush’s requested funding increase for veterans health care and rejects a proposed $1,500 deductible for certain veterans treated by the VA.

The congressional budget resolution adopted by the House of Representatives includes $56.9 billion for the Department of Veterans Affairs, an 11.7% increase over the current level. For so-called discretionary spending, it calls for $26.8 billion in new budget authority, $2.8 billion more than in fiscal year 2002. That includes a $2.6 billion increase for veterans health care, nearly double what the Bush Administration had proposed.

The Administration has proposed only $1.4 billion in increased funding for VA medical care, an amount that barely covers anticipated employee salary and benefits and routine inflationary costs.

“In all, the Administration’s budget request also falls $744 million short in discretionary funding for other veterans programs,” said National Legislative Director Joseph A. Violante.

As laid out in The Independent Budget, the DAV and other veterans service organizations have called for funding veterans health care at $24.5 billion, a $3.1 billion increase over the fiscal year 2002 appropriation. “This recommendation addressees current chronic underfunding that has placed extreme stress on the VA health care system, rationing of care for thousands of veterans, and unprecedented waiting times for treatment,” said Mr. Violante. “Our recommendation provides full funding to meet the needs of all enrolled veterans in the coming fiscal year, including funding for mandated long-term care and homeless veteran programs.” (See the March/April DAV Magazine.)

The budget resolution being crafted by Congress merely sets priorities for spending in various areas, details and actual funding levels will be determined by other legislation.

Under a Senate Budget Committee draft plan, veterans benefits and services would be funded at $56.2 billion, including $26.7 billion in discretionary spending. (The full Senate had not yet acted on its version of the budget resolution as DAV Magazine went to press.)

For military retirees with VA service-connected disability ratings of 60% or higher, the 2003 federal spending plan approved by the House includes $6.1 billion over five years to begin phasing in concurrent receipt of full retired and disability pay. (Battle Continues for Concurrent Receipt.)

Investigative reporters and the only journalists in history to be awarded two Pulitzer Prizes and two National Magazine Awards, Donald L. Barlett and James B. Steele have presented a riveting expose of the critical state of the health system in the United States with their book Critical Condition: How Health Care In America Became Big Business-And Bad Medicine.

Beginning with the assertion that American health care has been transposed from one of compassion to a system motivated by profit–the authors present a distressing analysis as to what went wrong. Where forty-four million citizens do not have health insurance, and tens of millions more are underinsured. And yet there seems to be this enduring myth propagated by many that the USA has a “world-class health system.”

As mentioned by the authors, the USA spends more on health care than any other nation, when you compare it to Germany, France, Japan, Italy, and Canada. However, in these countries citizens do not think twice about seeking care if they are ill. They do not worry who will foot the bills.

In the USA, it has become a lottery. If you are fortunate to be employed by a large company providing generous health benefits, you win. On the other hand, if you are self-employed or work for a small enterprise providing little or no coverage, you lose. You may even go bankrupt and lose your home in order to pay your medical bills.

Relying on interviews, studies from various organizations as the World Health Organization, the US department of Health and Human Services, legal suits, brokerage reports, congressional hearings, newspaper articles, magazine stories, SEC filings, professional journals, and a resevoir of many other sources (all of which are mentioned in the Notes section at the back of the book), the authors deliver legitimate arguments illustrating how an assortment of factors have crawled into the system with calamitous effects.

Upbeat news: In 2005, health care providers will bask in a spate of salubrious financial weather.

Downbeat news: Salubrious is a relative term. The sunshine is spotty. Slippery patches of ice lurk in the shadows and ominous clouds billow on the horizon.

Start with the positives.

Sunny spots

Medicare, which accounts for about $4 of every $10 in revenue collected by 4,800 U.S. hospitals and 875,000 physician practices, will augment total reimbursements to doctors by 4 percent this year.

That means an additional $2.2 billion to divvy up. Hospitals will share an extra 6.6 percent for outpatient care, or some $1.5 billion.

The increase for physician services works out to a 1.5 percent payment boost across the board. The Balanced Budget Act (BBA) of 1997 had called for a 3.3-percent cut, but Congress intervened. Hospitals meanwhile will get a 3.3 percent inflation update for outpatient services.

Inpatient care at urban hospitals is slated for reimbursement at a 4.7 percent higher rate in fiscal 2005; rural hospitals will see an average increase of 6 percent. Total Medicare payments to approximately 3,900 acute care facilities are projected to be $105 billion, up from a projected $100 billion in fiscal 2004.

Doctors and hospitals will also have a new source of Medicare revenue: “Welcome to Medicare” physical examinations for incoming beneficiaries. Hospitals can collect $78 for each outpatient exam from the government and, along with doctors, can bill for a more extensive visit and follow-up treatments if indicated.

A new emphasis on preventive care for Medicare patients will cover blood glucose and cholesterol tests for those at risk of diabetes or heart disease. The Center for Medicare and Medicaid Services (CMS) will also reimburse physicians 106 percent of the price they pay for drugs they administer in their offices.

Non-profit hospitals and health systems in general are as flush as they’ve been in years. Those with the highest credit ratings, from AA+ to A-, averaged almost 4 percent profitability, according to Standard & Poor’s managing director Martin Arrick. That’s the best performance since 1997.

A different kind of health care debate is emerging in the states. Instead of fostering the familiar rounds of government and business butting heads over how much health care employers must provide–and pay for–some legislatures are trying to shift the burden to the employee.

In a trend that mirrors proposals from the Bush administration at the national level, many states are considering applying the “ownership society” concept to health care. They are weighing laws that would require workers to obtain health care coverage, just like drivers must have auto insurance.

While none of these proposals has a lock on passage this year, they do represent an attempt to change the increasingly tense political atmosphere.

State legislatures have passed more and more mandates dictating what services and practices must be paid for by providers, raising costs for providers, for employers and–say many employer organizations–for employees as well through higher premiums. Employer and business groups have fought back.

Case in point: the 2004 California referendum on SB 2, the state law that would have forced most employers to provide health coverage to every worker. After a bitter campaign in which employer and business groups claimed that many companies would be forced to leave the state or go out of business, state voters narrowly overturned the law in November, handing a stinging defeat to organizations and legislators who had backed SB 2.

A variety of proposals have surfaced in California and other states, which are not satisfied to wait for the federal government to take the lead in solving the health care funding crisis. Under one California proposal, individuals would be responsible for obtaining coverage from their employers or other sources, with the state government subsidizing coverage for those who cannot afford to purchase it.

A different–and more radical–California bill would create a single-payer program in which the state government would take over the entire health care system. Assuming health care providers would be willing to hand over their business to a bureaucracy, the system would have a funding edge through streamlined operations, backers say.