There is one change to America’s Healthcare system which is required in order to actually improve the care and reduce costs.
It’s the change that HMO’s were supposed to make, but failed.
Currently, healthcare workers and companies from insurors to orderlies are paid based upon the number of treatments.
Insurers make a percentage of the insurance premiums--so the higher the premium, the more the insurance company makes.
Hospitals and clinics are paid based upon the number and kind of treatments given. And Healthcare workers are paid either by the hour or by the year or by the treatment.
Currently, nobody in the system except the patient has any real incentive to actually keep peo[le healthy--financially it is best for them if the patients stay ill enough to require services, but not so ill that they die.
We need to design the system to give those involved a financial advantage for a healthier people.
While complicated in detail (what multi-trillion-dollar industry isn’t complex?) the concept itself is quite simple:
First, insurance premiums are only paid when you are healthy--illness/injury stops the premium payments.
This provides the insurance industry an incentive to make certain that treatments are effective AND cost-effective.
As it is considerably cheaper to keep people healthy than it is to attempt to repair them when they are sick or injured, maintaining premiums at a stable rate causes the insurance companies to make higher profits from healthy policy holders on the same premiums.
Providers could concentrate on getting, keeping and training the best possible workers if their income depended upon the cure rate rather than the treatment rate (again, there are lots of details.)
Like a well run modern manufacturing plant, you would be able to tell by looking at how busy people were treating patients to determine how well things are going--the most profitable days are those where the staff spends their time learning and teaching instead of treating.
Fewer patients would permit us to eliminate some of the least safe practices of our system: workers would no longer be over-worked and short of sleep--both of which are major contributors to the accident rate in treatment..
My original impetus for this came from wondering why insurance companies wouldn’t cover drugs and treatment to help people stop smoking--but instead seem to prefer treating lung cancer and other diseases which often result from smoking. It doesn’t take genius to realize that paying $100 to help someone quit is cheaper than spending 10’s of thousands to attempt to repair them after they have a disease!
But if cancer rates drop, the amount spent on treating it drops and everyone in the system loses money--including insurance companies who base their premiums upon actuarial statistics and compete on having the lowest premium or ‘best’ coverage.
Currently, it is far more profitable for a patient to come frequently to the provider for expensive (profitable) treatments which never actually cure them!
Without this change, no change to the system will result in improved health care at lower costs.
The healthcare industry, like defense contractors on “cost plus” contracts, have far more incentive to raise costs than to lower costs.
It’s the change that HMO’s were supposed to make, but failed.
Currently, healthcare workers and companies from insurors to orderlies are paid based upon the number of treatments.
Insurers make a percentage of the insurance premiums--so the higher the premium, the more the insurance company makes.
Hospitals and clinics are paid based upon the number and kind of treatments given. And Healthcare workers are paid either by the hour or by the year or by the treatment.
Currently, nobody in the system except the patient has any real incentive to actually keep peo[le healthy--financially it is best for them if the patients stay ill enough to require services, but not so ill that they die.
We need to design the system to give those involved a financial advantage for a healthier people.
While complicated in detail (what multi-trillion-dollar industry isn’t complex?) the concept itself is quite simple:
First, insurance premiums are only paid when you are healthy--illness/injury stops the premium payments.
This provides the insurance industry an incentive to make certain that treatments are effective AND cost-effective.
As it is considerably cheaper to keep people healthy than it is to attempt to repair them when they are sick or injured, maintaining premiums at a stable rate causes the insurance companies to make higher profits from healthy policy holders on the same premiums.
Providers could concentrate on getting, keeping and training the best possible workers if their income depended upon the cure rate rather than the treatment rate (again, there are lots of details.)
Like a well run modern manufacturing plant, you would be able to tell by looking at how busy people were treating patients to determine how well things are going--the most profitable days are those where the staff spends their time learning and teaching instead of treating.
Fewer patients would permit us to eliminate some of the least safe practices of our system: workers would no longer be over-worked and short of sleep--both of which are major contributors to the accident rate in treatment..
My original impetus for this came from wondering why insurance companies wouldn’t cover drugs and treatment to help people stop smoking--but instead seem to prefer treating lung cancer and other diseases which often result from smoking. It doesn’t take genius to realize that paying $100 to help someone quit is cheaper than spending 10’s of thousands to attempt to repair them after they have a disease!
But if cancer rates drop, the amount spent on treating it drops and everyone in the system loses money--including insurance companies who base their premiums upon actuarial statistics and compete on having the lowest premium or ‘best’ coverage.
Currently, it is far more profitable for a patient to come frequently to the provider for expensive (profitable) treatments which never actually cure them!
Without this change, no change to the system will result in improved health care at lower costs.
The healthcare industry, like defense contractors on “cost plus” contracts, have far more incentive to raise costs than to lower costs.
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