July 6, 2009

Necessary Parts

Posted in Health Insurance, Health System Reform, Incentives for good Health, Medical Savings Accounts, Public Private Partnership tagged , , , at 11:11 pm by healthyacrossthenations

Below you will see a lot of posts that address Health Reform in the US- of which I believe there are many components:

– I do not believe that a national plan option competing with the current private status quo will be effective in what it aims to do. Only those who feel they cannot access the private care market will opt for this plan- that is, those who cannot afford the costs of private plans, and those who have been excluded due to pre-existing medical conditions. Expecting all taxpayers to pay for this group of people, who as a result of lower income and pre-existing conditions will likely need the service more- ON TOP of their own private Health coverage that they will want to keep is simply nonsensical. It will not work.

– Leaving the system as is will not work either. Costs are rising ever higher- mostly due to the fact that Doctor’s are paid per service rather than a salary- they have an incentive to over test and over treat. The private sector is also becoming more and more exclusionary in adversely selecting healthy patients to cover, leaving a high number of people unable to afford the higher quote premium- or completely uncovered. Dostors themselves are also investing in Specialty Medical centers and referring patients to have testing at these centers. Moreover- for all this higher spending, quality of care is not good compared to other countries- not commensurate with the costs.

– Offering only a system of tax breaks for health care will not work, because this is a complex system. Those that would benefit most are those who are in the lower socio-economic brackets who often have lower levels of education. It is difficult for anyone- much less those less educated- to navigate the maze of tax breaks and research has shown that offering tax breaks in a number of states in the US to go toward health care has led to many people paying a tax preparer to help them navigate this maze- and all or most of the tax savings they may have made would go toward paying the tax preparer (part of my MSc thesis).

– Medical Savings Accounts are a brilliant idea- but not alone. They are particularly helpful when somehow attached to their health fund plan, tax free, when people can go to one place to compare and make financial decisions related to their health- it is most effective.

– Health Insurance Funds should be Non Governmental and thus not taxed. Providing Health Coverage is a service to society. Helping people stay healthy is helping people remain productive members of society.

– State Health Insurers should link up with one of five or six national health funds that will be government financed at the basic level based on a capitation formula that includes the numbers of people covered, their ages, and certain illnesses that have a costlier treatment character. These monies should come from minimal employer and patient salaries and/or incomes on a graduated sliding scale progressive basis that is capped. Monies can also come from Sin taxes (taxes on items which can cause adverse health events physical or Mental, such as cigarettes, alcohol or gambling). People who wish to supplement their coverage to get more private cover should be able to pay fees to the Health Fund to get higher levels of service. Each Health Fund can tailor make its own private Higher level service structure. This way the basic coverage that everyone pays goes towards everyones health coverage- and those who can afford additional coverage and wish to pay for it can.

– Perhaps at the start, this plan might not be mandated. If one chose not to enroll, then one would have to pay the  premium directly to a National Health Fund, or to a small private coverage group (with higher costs al around) directly- choosing basic or basic plus supplemental coverage. The down side would be that the rates might seem hgh since they would not be the rates arrived at in negotiations with the government. Since it would be virtually the same coverage in both situations- people would be encouraged to join the Public/Private Insurance plan and rather use their money to get better supplemental coverage under one of the public/private national FHealth Funds within the program (direct acccess to specialists without referrals, Semi-private Hospital rooms, and more).

– Each Health Fund should have a center- similar to Kaiser Permanente centers- in each town where patients can go for much of the lab work (although some family clinics can and should offer some general blood work). These centralised offices should also have Doctors offices to give a choice to people who want the one stp shop. There should also be local Health Clinics that the Health Funds contract with (as is done now) in order to keep choice available.  Private specialty testing or imaging centers should be discouraged, in other words their existence is acceptable but allowing the numbers of those tyes of clinics to rise may not be useful.  Medical Professionals should be discouraged form conflict of interests with their careers, their service provison and their finances. Medical Professionals should be encouraged to grow in their field- to provide quality care to patients and to become experts at managing care. They should be given financial and other incentives when their patients are healthier and when their clinic is proving to be giving quality care and reducing health events and risks.

– Preventive Health Education and Services should become a part of the Basic level of care for all. There should be incentives for Clinics to provide these activities. Preventive health reduces costs and is much cheaper than corrective treatment.

– Health Clinics should be given financial incentives to provide quality of care. In other words if evidence shows a program they ran improved health for their patients, then they might get additional funding for their staff and/or further program development.

– The US should develop an Evidence Based Medical database to help Medical Professionals keep up to date with the best methods of care, knowledge management, and as a good review tool in general. The UK and a few other countries have already developed such systems and found them to be useful to both patients and Medical Professionals.

-The US should try to develop an electronic medical record system for patients nation wide- either on a national medical tiered level of access basis.  This will help the Doctor to more quickly be able to review the patients records when they visit or call, and will help them better treat the patient when seeing the history of past treatment so easily and frequently. Moreover, this will help make Medical visits and treatment easier for the patient if they have to see another Doctor at their clinic (if his is sick or n vacation- or moves) or if the patient moves to another city or state.  Finally, Electronic records will be most helpful for public health purposes, as in the case of epidemic flus and the like- it will be helpful for medical personnel, Hospitals, and the Center for Disease Control.

– Perhaps Doctors should be paid by their clinics a salary- so as to take away the incentive to over treat or over test (being paid per service does this) and would engender more of a secure professional environment among professionals.

– There should be a public/private fund dedicated to the high standard of research and development in the life sciences that the US has grown accustomed to. Pharmaceutical, Medical Technology, and other Life Science companies spend a lot of money on quality research and development. They often point to this fact in their need to find a way to reimburse themselves for this cost- often adding to the cost of their products to recoup their losses. If there were a public/private fund where all interested parties (all the above companies could contribute as well as other companies or benefactors that feel they benefit from life science- including the health funds)  could contribute along with the government (perhaps from sin taxes and other tax items), then perhaps this would help lower the singular burden and thus the coss of products to the consumer. This could then enable their to be better negotiations with pharmaceutical, medcal technology, other Life Science companies and the health funds for quality products at reasonable rates.

– Poor chronic health behaviors should be discouraged through financial and other incentives. Those who go to a gym regularly should get discounts to continue going to the gym. Those that sign pledges annually attesting to not regularly partaking in activities like smoking, drinking more than 2 light drinks a day, or eating fast food more than twice a week should be able to get benefits such as free training sessions or a software program for exercise, dscounts on travel and the like (see one of the posts below- ‘change your evil ways’). Moreover, perhaps those that do not sign the pledge should be charged an additional fee to continue their basic coverage.  Every year they can opt to take the annual physical and have an opportunity to sgn the pledge(s) again.  Those that do sign and are somehow caught partaking in a poor health behavior that evidence shows has  led to a health event that needed treatment, prhaps they should be fined and/or suspended from the basic coverage for one year (meaning they wold have to pay for that year privately and not have the benefit of the lower rate the rest of the public has).

All in all, health reform is neeeded on many levels. We need to carefully select incentives to encourage a cost efficient, effective and consumer friendly Health System. We need to be mindful that we need to approach this from a number of angles in order to get the most benefit for all parties. We are all in this together- and there is no bad guy. Cooperation and collaboration will help all the interested parties much more than throwing blame around. There is a lot of work to be done- and we must start soon.


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