June 7, 2009

Cover me with kisses baby, cover me with love- but first cover me in Hospital

Posted in Health Insurance, Health System Reform, Public Private Partnership tagged , , at 10:03 am by healthyacrossthenations

There seems to be a lot of anxiety in many areas.

There are those that are concerned about poor service, rationing, and a lowere standard of technical prowess in the Bio-medical field if the US were to go down the Single Payer route.

There are those who are concerned that the Employers would have to foot the entire bill- and who worry about the management of the System.

There are those who are concerned that a mandated System will be a problem because of overcrowding or because it might seem that we were all being forced to be doomed to a single payer system….whoa.

Firstly, There are so many different ways that a single payer system can look- publicly financed- privately provided (like Canada) or perhaps Publicly Financed, semi-privately managed- and privately provided (like in France and Israel). If we worked with existing Managed Care Organisations (Health Funds)- financing them through a combination of a payroll tax- a sliding scale fee per family  income- and fees for  supplemental services that the Health Funds will offer- among other things.

The Health funds might be financed according to a capitation formula that takes into account the number of customers they have, their ages, and the numbers of whch have certain health conditions. The Heath funds would then have no reason to pick and choose their customers- all would be applicable.  I am pretty sure rationing may have been more severe when there was more uncertainty. Though some rationing is inevitable- it also might be a healthy alternative to the wasteful useage of decades past.

If there are people concerned about the quality of technical Health Science development- there is no reason why there need not be a public/private fund where Innovative companies are awarded research grants.

Moreover- Israel only Passed their Mandated Health Insurance law in 1995- however prior to that 95% of the population was covered anyway.  I think that if there is a good financing system, and the Health Funds can continue to be the care managers- continue to compete with another to provide uality care (Internal markets)- and adjust to a more efficient system- I think that many people would sign on without being mandated- and perhaps n a few years- Being mandated will no longer seem scary….

Of course- I think it will be important to have the availability of supplental services from the Health Funds. For example,  basic coverage could entitle someone to choose from among 2-3 Doctors while perhaps if one pays a bit more- one gets to choose frm more choices. Some Doctors might have ‘lists’ of patients  that come open throughout the year- but that mght get full- except perhaps for 2 spots which remain open for members of the Health Clinic- so that if I choose to become a dues paying member ($4-$8 per month) I might be able to get the Doctor who’s list was otherwise full- and after a year I could keep that Doc even if I did not renew my Membership perhaps…..

Again- using existing infrastructure to coordinate such a system.

Health IT will be a crucial element- as will setting up a good department/unit that can act as the financers of the new Health are System. In Israel there has been some regret over the trasury being in charge as opposed to the Ministry of Health as they are tighter wit hthe purse and sometimes less knowledgeable.

I would propose a team of people from the treasury and the Health department as the keepers of the purse.

over the last 10-15 years there has already been rationing from the Managed Care Organisations- reasonable rationing.


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