June 15, 2009

We can shoot the sherriff, but we need not shoot the deputy

Posted in Health Coperative, Health Insurance, Health System Reform, Incentives for good Health, Public Private Partnership, Uncategorized tagged , , , , at 3:37 pm by healthyacrossthenations

For those of you who might think that any of the above blog is indicative that I support a Government run Health System, you would  be  mistaken.

I have lived in the UK- and while I think it is wonderful that there is some sort of basic coverage available for all citizens in the UK- I also think that there are other- possibly more productive ways to craft similar outcomes for the United States.

I will discuss my opinions briefly here, and more later on.

I do believe that the government should be more involved in the coordination of the financing for health care. This should be done with non-governmental organisations (NGOs) managing and providing health care coverage and coordinating services, and not being taxed as they provide a public service that tries to keep members of society healthy and as a result, productive. The government should set the rates at which employers and employees contribute to help finance the health system- decided upon in conference with many players and ordinary citizens.  The unemployed would receive a basic package of coverage (the basic preventive services- which are the cheapest investment in health care- and emergency coverage, with discounts on additional services if necessary) that the government would reimburse the health funds for.

However, below I would like to review the pros and cons of a national system of health care- much like the NHS in the UK.

Again, after living in the US where now about 50 million people are uninsured at any given time- I am most impressed when a heath system can provide basic preventive and curative care for those that need it. Moreover, General Practitioners in the UK have (in the past- I do not know if this policy has been changed) been able to keep finances ( called GP fundholding) to use towards services given in their local community- and they were given incentives to receive more of these funds (such as improved outcomes of care from their clients and improved health knowledge etc). This allowed GPs to be able to make decisions to hire more staff or to offer health education programs they felt could help their community (in one Health Clinic I visited in the UK there were special Women’s Clinic hours twice a week in the early morning and later evening hours to increase access for working women and Students. These wrere staffed with Nurses who specialized in Sexual and Reproductive Health as well as Gynecological Obstetric nurses- there were also information sessions held at these times to prevent STDs. The incentives to  keep these funds were also geared towards cost savings- by way of encouraging Primary Health General Practitioners to try to catch health issues before they became bigger problems that needed secondary or tertiary care. This was a good idea as well, though it too could have its down side (see below). The UK was and still is very creative in their tweaking of their national Health System. Moreover, there is a quality Health Information system that can help Doctors and other Medical personnel better treat patients across the UK- and at the same time prevent health crises from progressing into epidemics.


The NHS is an overburdened system that does pose challenges. Shortages of Medical personnel, particulalry in rural areas, short time allotments for each Patient in Primary Care (this is also a problem in most managed Health Systems including with HMOs in the US), long waiting times for ELECTIVE procedures (Elective procedures are those procedures which aim to correct problems which are not deemed life threatening), there is very little control over the Health Care System by the consumers (there is a very small private Health industry in the UK- though it is growing. The problem is that it has been mainly growing at the expense of the Public Health Care System- ie NHS Doctors are lowering their NHS hours in lieu of private practice hours), and there is a lot of tension about the high cost of the system- that people may feel the system is not performing what it should for the cost.

A lot of the Challenges seem to be the flip side of the Benefits.

If we are given an option in the US to Reform an under-performing health system, we should try to take the opportunity to try to enhance the Benefits of a more inclusive health system while minimizing the Challenges.

I do believe that The provision of Health Care, while not necessarily a right,   is a vital public service which improves both the social and economic productivity of the community, state, and Nation. This is why I do feel that Health Insurers or Funds or Schemes should be given both Non Tax Status (Non Governmental Organisation) and also the  necessary allotment of funds (based on the number of people each Fund is covering, their ages, and certain Health Conditions that tend to be more expensive).

There has been a movement- internationally as well as nationally- over the last few decades towards the use of Health Cooperatives. Depending on how these are crafted- and for whom these are crafted- these can be a wonderful tool to bridge the gap between the high quality of health service provision that a number of people in the US have become accustomed to- and the ability to improve access to care for millions of people n the US.

Health Cooperatives can be formulated and/or crafted in such a way that they can be so similar to the Personal Provider and Managed Care Plans that have already existed in the US for a number of years. These Health Funds could offer consumers a range of premiums as well as co-insurance payments, and office visit co-payments and even deductibles for non-preventive Health Services. The differences can be that these Funds would be NGOs with non tax status, and in my opinion, should be given some necessary amount of government collected funds based on a progressive and CAPPED income and employer tax system (These should be Capped so as not to become so over-burdensome to those with very high incomes who might be otherwise discouraged. Moreover, Value Added Tax and Sales Tax on everyday products would not be an efficient way to raise health care revenue as they are regressive taxes and adversely eat into any income lower income people would be able to contribute towards their own health care).  Sin taxes (Taxes on products that have been proved to be damaging to health) may be helpful in terms of discouraging poor health Behaviors, though according to research it seems that people at the lower end of the socio-economic spectrum in most countries are the ones that suffer the most from these sin taxes. This is because Health Promotion and Prevention education and interventions are more widely accessible to people in higher socio-economic strata due to higher education and other well funded community activity.  My advice would be to first find ways to open access to health promotion and prevention education activities for all- particularly those that find themselves on the lower end of the socio-economic strata.  Only after this might sin taxes be a positive way to give incentives to discourage people from partaking in the poor health behavior.  For example, people should be given access to support groups for quitting smoking and to substitutes that can help them quit such as nicotine gum or the patch- particularly if these items are cheaper than the cigarettes.

A nice theoretical example of the kind of Health Cooperative as mentioned above  is the Group Health Cooperative of Seattle Washington. They offer a very wide array of plans with wide variations of premiums- and some with no premium (Health Savings Account) to suit different people with different needs. They are also an NGO. They also are providers for a Medicare scheme- showing that if done well, there can be a partnership that provides care efficiently and privately- while using government funds. See below for more information about this theoretical idea.


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