Health care is big business, but that doesn't mean it's a well-run business. In Georgia, reporters found medical services were done haphazardly. In Florida, journalists uncovered a Medicare system with severe problems. And in both cases, databases were vital to the story.
The Fort Lauderdale Sun-Sentinel examined Medicare HMOs, which are supposed to save patients' money. While these HMOs cover all medical expenses, as opposed to the standard Medicare rate of 80 percent, Medicare HMOs can still be a gamble.
The newspaper found some South Florida Medicare HMOs are half as likely as others to provide access to doctors and hospital services. Seven of these HMOs posted high rates of patients quitting their programs. In some cases, twice as many patients were leaving as were joining. More than 10,800 patients and their families complained about the care to state and federal officials - about the HMOs' not paying their medical bills.
Reporters Fred Schulte and Larry Keller requested the Beneficiary Information Tracking System from the U.S. Health Care Financing Administration, but received little cooperation.
"We asked for a tape, but they said, 'Sorry, we can't send it to you that way. We'll send you a hard copy,'" Schulte recalled. The reporters took the paper records and entered them into a dBase database by hand before analyzing the information with SPSS statistical software.
Schulte said problems with Florida's access laws often leave him building his own databases. "Even when I find a database, they won't give it to me," he said.
The work led to a series on Nov. 7-11, 1993, "The HMO Maze: How Medicare Fails Seniors."
A year after the stories, Schulte teamed with Jenni Bergal for another investigation, "Profits From Pain," on Medicaid HMOs, which ran Dec. 11-15, 1994. Again, the reporters created their own database. This time the records came from the state's HMO peer review board for all hospitals.
"They just collected the data, put it in a box and left it sitting there gathering dust," Schulte said. The reporters became the first to analyze what was in those boxes.
The results showed Medicaid HMOs had dangerously lower standards than private HMOs. At the same time, many Medicaid HMOs were spending much more on administrative and non-medical costs than private HMOs.
The series also showed that 12 of the 15 Medicaid HMOs got "poor" and "very poor" reviews when it came to caring for children and pregnant women. These HMOs covered almost all of the 25,000 patients enrolled in Florida's Medicaid system.
In addition, the journalists found nearly 200 of the 300 Medicaid HMO doctors and medical centers failed to meet standards for treatment or proper documentation.
While building the database took the reporters two to three weeks, the drudgery was worth it, Schulte said. After the series, a state investigation ensued, and Florida is considering legislation to crack down on health-care abuses.
'In Sickness And In Wealth'
In Georgia, meanwhile, The Atlanta Journal-Constitution found that health care doesn't run by the laws of supply and demand. Instead of medical need, costs are rising because of the number of doctors and hospitals beds.
The newspaper analyzed more than 600,000 health insurance claims and found a wide fluctuation in the amount of surgery and hospital care doled out from area to area. It found a seemingly haphazard delivery of medical services and published the results Sept. 30-Oct. 4, 1990.
In east Georgia, for instance, policy holders were twice as likely to undergo coronary angioplasty, where a balloon-like device is used to widen arteries. There happen to be more cardiologists in east Georgia than in the rest of the state.
The variation in treatment by itself doesn't prove that care is rationed in some places or wasted in others, the Journal-Constitution contended. But the newspaper cited experts who said the gaps represent billions of dollars in unnecessary procedures.
Hal Straus, who wrote the stories with Mike King in late 1990 as part of the series "In Sickness and In Wealth," said the idea came from earlier academic studies on prostate surgery rates in Connecticut.
"The studies showed a lot of variation, and we wanted to see if the same thing was going on in Georgia," Straus said.
To test the theory, Straus and King needed data from a handful of different sources. They obtained demographic data on Medicare enrollees, as well as data on the procedures and hospitalization days for these enrollees, from the Georgia Medical Care Foundation. The foundation reviews Medicare spending in Georgia under a contract with HCFA.
For similar data on privately insured patients, Straus and King turned to Blue Cross and Blue Shield, the state's largest insurer.
They fed nine-track tapes from both sources into the newspaper's mainframe computer and, using SAS statistical software, compared it with data on physician and hospital bed supply for various parts of the state. That data came from the U.S. Health Resources and Services Administration and the Georgia Hospital Association.
The resulting story shows gaping holes in the state's system of determining when to use medical procedures. Nevertheless, there has been little fallout from their study, Straus said. "We did the story a couple of years too early," he said. "It would have meant a lot more when there was a big push for health-care reform. But maybe people are more likely now to say to their doctor, 'I don't want this surgery unless it's absolutely necessary.'"
For more information, call Hal Straus at (404) 526-5348, or send e-mail to nal_straus@ajc.com. Fred Schulte can be reached at (305) 356-4591, or send e-mail to ferds@aol.com.
Seth Hamblin, a student at the University of Missouri, is interning this summer at The Washington Post.