Government and Insurance companies - establishing the BPS model

Found this on an old USB stick:

​

From googling I found it quoted here. It amazes me how fast Google can search the web.

 

I knew it was bad, but ...

 

from Byron Hydes Little red book

 

"6. Treatment is difficult, extraordinary sensitivity is necessary."

This from Wessely, you must be joking.........the way he and his colleagues have repeatedly, publicly vilified us over all these decades.......their treatment of us has been extraordinarily insensitive, unscientific, unethical and abusive.

"6. Great flexibility is essential in treating these patients, each case is different."

That's not what he's been preaching and prescribing for the past decades, it's CBT/GET and that's it, whether a patient says it is making them worse or not it doesn't matter, no flexibility what so ever.

 

blog by David F. Marks posted elsewhere but relevent here:

https://davidfmarks.com/2021/03/25/dog-whistle-medicine-and-disability-denial/

 

Just coming back to this again:

• What evidence did SW ever have for this I wonder?
• Did any evidence obtained target physical illnesses that medical practitioners disbelieved in, given that would significantly contribute to mental distress.

 

I have to admit that I have yet to read Faulkner's In the Expectation of Recovery.

Faulkner, George (2016), In the Expectation of Recovery, Centre for Welfare Reform, https://www.centreforwelfarereform.org/uploads/attachment/492/in-the-expectation-of-recovery.pdf

Also, I don't have the time (and mostly not the health) ATM to investigate and understand the concept and agenda of the Centre for Welfare Reform.

What do others think of it (both the publication and the Centre)?

Edit: Above all: Does Faulkner cover the PACE trial investigators' links to the insurance companies?

 

I am not familiar with the work of the Centre beyond Faulkner's writings, which include probably the best account of the historical problems of PACE we have. This publication served me as a primer for PACE analysis some years back and it is always worth referring back to. It mentions the insurance industry 19 times. I don't think anyone needs to worry about the depth of understanding Faulkner has in this area - it is clearly comprehensive.

 

https://twitter.com/user/status/1399795582965850126

 

Thanks. Just to clarify: I didn't worry abouth Faulkner's understanding.

Just curious about his work on ME research / politics.

Also, wondered whether @Hilda Bastian is aware of the links and even positions of some trial investigators within insurance companies, and that Peter White and others even owned a private company to promote the BPS model etc. -- and was about to look up the best references for that.

If Hilda chose the author of an publication dealing with all that and the references are OK then she will be aware and there's no need to give her references to what I said in the Cochrane review/ IAG thread (about the 'network of people who have the power to influence decisions that directly -- and badly -- impact PWME's lives', and that said network shaped a certan image of PWME).

In another post @cassava7 added more references in one succinct paragraph which I think warrants to be saved elsewhere --- not about links to insurance companies but relevant as it hints to the scope and agenda of people in that network. Hope it's OK to park it here until I or someone else finds a better place:

 

Thanks for that, Jonathan. George is awesome. It's a privilege to know and work with him.

 

Yes. I quoted George's publication in the first post I wrote about ME/CFS. And this is what I wrote to that point:

There was another powerful camp that was attracted to the idea that cheap short interventions could get rid of ME/CFS, if only the person was willing to make an effort: insurance and welfare stakeholders. It was in their interests to reduce treatment expenditure and income dependency for this fairly common condition. The close associations disclosed by ME/CFS researchers in the biopsychosocial camp with these policy communities have the potential to be conflicts of interest – and they are certainly seen that way by many.

Though I realize what I said may seem too circumspect for many, it certainly led to .... let's call it "lively" .... correspondence.

 

I only read his article on PACE and it was excellent. He also wasn't afraid of making the connection to the health insurance industry.

He wrote

 

i think it is worth juxtaposing this post with a copy of this 2001 document of the Insurance Bureau of Canada
IBC TO LAUNCH NEW HEALTH CARE GUIDE FOR CLAIMS PROFESSIONALS - Insurance-Canada.ca - Where Insurance & Technology Meet

IBC TO LAUNCH NEW HEALTH CARE GUIDE FOR CLAIMS PROFESSIONALS

Oct 30, 2001 | Posted by Insurance-Canada.ca


Share

TORONTO, Tuesday, October 30, 2001 — Insurance Bureau of Canada
is about to launch a new reference guide for insurance claims professionals. Managing
Injury Claims and Health Care Issues was released to the industry in an introductory
session Wednesday, November 28, 2001.

“Managing health care issues has become increasingly
complex and costly,” said Paul Kovacs, IBC Senior Vice President, Policy. “A
need was identified for a manual that would provide the necessary tools to work with, and
answer questions related to, health care claims.”

The result was months of work by a team of industry experts
to develop a package of information tools.

“Putting all of the information in one place will be a
tremendous help to those sorting through the details of government health insurance plans,
best treatment options, and access to community-based care, for instance,” Mr. Kovacs explained.

The reference guide has a national focus and will regularly
be supplemented with new general and province-specific materials. It is designed to
promote increased knowledge and understanding of:

• principles and legislation underlying health care policy in Canada;
• the interaction of provincial health care and automobile
  insurance legislation and implications for claims handling;
• health care issues faced by injury claims staff and ways to
  effectively deal with them;
• evidence-based practices for common and controversial
  injuries/conditions and how these may be applied to promote cost-effective claims management; and,
• trends in, and strategies for, the management of both health
  care and health care costs.

The Ontario version of the guide was released at the
November 28 session. Similar programs will be held in Alberta and the Atlantic provinces in 2002.

Panelists introducing the manual will include: Carol
Jardine, Vice President Claims, Royal & SunAlliance; George Lytwyn,
Rehabilitation Co-ordinator, Axa Insurance; Viivi Riis, President, Dynamic
Rehabilitation and Chair of Continuing Professional Development Committee, Dept. of
Physical Therapy, Faculty of Medicine, University of Toronto; Dr. Arthur Cott,
Associate Professor, Faculty of Health Sciences and Director of Behavioural Medicine
Centre, McMaster University and President, Prisma Health; Randy Bundus, Vice
President, General Counsel and Secretary, IBC; and Deborah Camirand, Manager,
Health Care Project, IBC.

NOTE: This manual came about at the request of IBC’s member
companies. It is available only to IBC member companies and their employees. Only those
people from member companies, who are interested in obtaining a copy, should contact
Yvonne Cuellar, 416-362-2031, extension 356

I have copied it in full lest it disappear. The nature of the Canadian Prisma Health collaboration with the insurance industry can be seen. This raises a number of questions which I will raise in a further post.

 

The precise relationship between PRISMA and Prisma Health is unknown but this work for the Insurance Bureau of Canada seems to be entirely in line with the stated intentions of PRISMA and it would be surprising if there were no connection.

We would always have suspected that Swiss Re, UNUM and probably Allied Dunbar would have been involved with PRISMA, but this potentially provides two further names- Royal and Sun Alliance and AXA Insurance.

This document may indicate the ways in which organisations and doctors associated with PRISMA operated to devise policy in relative secrecy.

It seems strange that the information is not to be made generally available. This is guidance for commercial companies offering insurance policies to the public. Insurance policies are supposed to require "utmost good faith" as to disclosure on the part of both parties. However it appears that the insured are to be deprived of information as to the assessment and treatment of conditions potentially covered by the policy. This seems highly dubious. Contract law requires certainty of terms and conditions. This seems to specifically avoid that requirement.

2001 is along time ago. One wonders to what extent Canadian patients were aware of the McMaster Behavioural Medicine Centre and Prisma Health role in setting general policy regarding assessment and treatment.

 

my post from thread about TC MUS webcast.

Interesting bit on Aviva
"
The insurance companies known to be involved in ME/CFS claims include UNUM, Swiss Life,
Canada Life, Norwich Union (now Aviva), Allied Dunbar, Sun Alliance, Skandia, Zurich Life and
Permanent Insurance, and as re-insurers, the massive Swiss Re (not the same as Swiss Life).
These insurance companies all seem to be involved in re-insurance; for example, Norwich
Union (now Aviva) uses Swiss Re. "

http://margaretwilliams.me/2013/pace-for-new-lawyers.pdf

 

I wonder whether we have been following an "Irrlicht" with SW and PRISMA. ( I do like that word, especially as we are all on a "Winterreise" of or own.) We need to go back to basics and look for substantive corroborative evidence for the existence of PRISMA and its dealings. The matter always seemed complex, it may be more complex than imagined.

One clue provided by Margaret Williams was in Sharpe's contribution to the 2002 UNUM CEO report of Maxwell Head Unum CMO Report 2002 by maxwell head - issuu

There is a major need for effective rehabilitation of treatable patients. Existing pain and rehabilitation services would provide a useful basis. However their capacity and skills are currently far too limited. Funding of rehabilitation by commercial bodies has begun in the UK (with organisations such as PRISMA) and is likely to continue. As long as the economy remains strong and skilled workers are sought after, it will be in employers' interests to rehabilitate sick but valued employees.

I hesitate to say this, but it is hard to quibble with Sharpe's overall, somewhat idealised, message. But, (I know I shouldn't start a sentence with a conjunction, but do so anyway) as always, the devil is in the detail. What is "effective rehabilitation" or , at least, how, in this context, are the words "effective" and "rehabilitation" being used? What is a "treatable patient"? How do you decide that a patient is "untreatable", and what is to become of them then? What evidence, in a particular case or generally, would falsify the claim that a treatment was effective?

It appears, then, that PRISMA was merely a particular provider of rehabilitative services purchased by insurance companies or government. It may not even have been that. It might have been an umbrella organisations with various "francisees" for want of a better term. In Canada Prisma Health seem to have used the Cott model, which seems to have been an overarching approach; in the UK SW may have advised on a particular part of the service, with particular reference to MUS or CFS. Whether the same model was used throughout the "franchise", remains to be established.

In any event, over and above this were the purchasers - insurance companies or government. There is nothing wrong in principle with this. The difficulties arise if there are secret, possibly collusive, agreements between purchasers and providers which leave end-users (otherwise known as patients) unaware of the nature of the arrangements to which they are subjected. The problem is compounded when multi-national insurance companies carry a particular model from one location to another leaving patients completely in the dark as to the reasons for the availability of a particular treatment.

This seems to have been the intent with the Canadian agreement with its express provision that the report was only to be available to IBC members.

It might be interesting to consider the extent to which these insurance company practices could be considered anti-competitive. Could this be a reason for appearing to develop ideas outside the US? If more than one company are agreeing terms, on behalf of all members of a national insurance burea,u with one major service provider to establish common procedures it all seems rather dubious. All there is left to compete on is price, and as no-one is allowed to know what is to be provided it is not clear how that can occur.

The possibility has to be considered that other providers might be entering into agreements with the same or other insurance companies either along the same lines as the Caanadian agreement, or possibly with a particular local provider. The similarity of the provision in various places may come about either because of agreement between a particulsr group of doctors, or of purchasers, or general agreement between both.

One now needs to look at, for example, the relationship of Per Fink and Trygheddsgruppen as indicated in this post https://www.s4me.info/threads/gener...disorders-in-denmark.13820/page-3#post-355507
by @Kalliope . If AXA were coming to particular nin Canada were their associates or partners coming to similar arrangements in Demark and elsewhere. AXA is a French company. Royal and Sun Alliance, as it then was was British> UNUM was American, and still is.

And who knew of this:
Axa Health[edit]
Further information: AXA_Health
AXA Health sells private medical insurance in the UK. It was previously the London Association for Hospital Services, set up in 1938 as a private healthcare scheme for people of middle income in London.[26][27] It was incorporated in 1940 with assistance from the British Medical Association, the King's Fund, and the medical royal colleges.[28]

Guardian Royal Exchange Assurance bought it in 1998 for £435 million; a year later it was bought by Sun Life & Provincial Holdings, an Axa subsidiary.[29]

Axa - Wikipedia

or this

The Fund has also awarded eleven endowments for several million euros supporting research institutions of excellence (HEC Paris, National University of Singapore, University of Bristol, London School of Economics, Met Office, INSERM, IHES). These research and education chairs intend to attract the best scientists. For example, the Axa Polytechnique Chair in Cellular Cardiovascular Engineering,[54] held by Abdul Barakat, aims to promote research on cardiovascular diseases, but also to train and develop young researchers through extended educational programs.

 

I haven't read this yet.

Summary: Structural dimensions of the biopsychosocial model

https://www.healthcarehubris.com/post/summary-structural-dimensions-of-the-biopsychosocial-model

 

ME, the insurance industry and psychiatry
22. april 2021 · by melivet

About psychiatry and the insurance industry’s impact on financial support systems for ME patients, in Denmark and Norway.

https://melivet.com/2021/04/22/me-the-insurance-industry-and-psychiatry/

 

This was already discussed here

https://www.s4me.info/threads/gener...disorders-in-denmark.13820/page-3#post-355546

where the links to AXA insurance were noted, along with reference to a protocol involving Canadian insurers and Arthur Cott of PrismaHealth.