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InvisibleBlack -> RE: Health Care: A Better Idea (8/13/2009 8:46:00 PM)
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quote:
ORIGINAL: SpinnerofTales
Every now and then I like to stop tearing things down and try to build them up, just for the change. Now the topic is health care. And the big question seems to be "Do we go with Obama's plan or leave things as they are?" Let's change that question: How would you (anyone, please) alter the current health care system in order to decrease costs, increase accessibility and generally stop the medical care finances from being controlled by HMO's who make more money denying care than providing it?
Can we come up with some GOOD ideas?
I'll take a stab at this. I rarely comment on healthcare because it's extremely difficult to have any sort of rational conversation about it.
A little background - I worked for several years running the data operations department of a not-for profit HMO in New York. The company was dedicated to providing free or subsidized healthcare to people who were ineligible for Medicaid but were unable to afford insurance, or adequate insurance.
The sad fact of the matter is - the healthcare industry is extremely inefficient. The insurance companies are inefficient, the hospitals are inefficient, the doctors are inefficient ... it's amazing. I also spent some time working for a defense contractor and I can tell you, in my experience, the defense industry is more efficient and has less waste than the healthcare industry. You cannot believe the waste, the excess, the money that is just plain squandered until you've seen it.
As I recall, last year one of the big think tanks did an analysis of waste in the healthcare industry. I'd post a link but I don't remember where the report was located. The United States spent something like 2.2 trillion dollars on health care in 2008. The two highest sources of waste, both of which came to something like ten percent of the cost, were doctors performing unnecessary tests and inefficiencies in the claims system (valid claims being denied and having to be redone, often repeatedly - processing of invalid or fraudulent claims, etc.). So, looking at that, approximately 220 billion dollars a year is spent on unnecessary tests and another 220 billion dollars a year is spent processing unnecessary claims.
A number of the things that people clamor about - such as uninsured people using the emergency room as a 'free' doctor account for something like one-half of one percent of the total cost. While that's still 11 billion dollars, that's a drop in the bucket compared to the more serious areas.
In all honesty, before doing anything else - I would knock down the top 2 areas. I haven't put much thought into how to prevent doctors from assigning unnecessary tests (the two drivers for this are a) it's a way to make more money & b) fear of litigation). Unnecessary claims, however - I *have* done work on since I ran the group that was assigned to trying to improve the workflow for the claims department.
The vast majority of claims are rejected because they are improperly filled out. Most of the claims processing is done electronically, meaning that no human being is involved - so if a required field is empty, the claim will automatically be rejected. Quite often, doctor's offices will simply take all their rejected claims and re-submit them without changing anything - meaning something may get rejected two or three times before it's actually revised for errors. The fact that every insurance company has its own unique claim form doesn't help. New York State was attempting to standardize the claim form but what I would suggest is, if the Federal government wants to get involved - a simple, easy to use, single claim form which is required throughout the United States would serve to eliminate a huge number of errors. Beyond that, an incentive needs to be created to properly fill out a claim. The company I worked offered to send someone to any member doctor's office to help train their staff in how to properly fill out a claim so it would not be rejected due to a processing error and fewer than 1% of the doctors were willing to allow their staff to be trained. Having some sort of sliding scale of fees or compensation based on the percentage of claims rejected for being invalid would also go a long way to helping this.
I mean, think about this, we're talking 220 billion dollars a year in unnecessary claims processing.
Beyond that, though, and to be really extreme ... the problem isn't about insurance at all. That's the box that the industry has most people trapped in. Originally, the only purpose to having insurance was to cover a person if some catastrophic problem arose that would wipe out their life's savings or be so expensive they would be unable to pay. Things like prescription medication or doctor's visits or whatever were not covered by insurance and were paid out of pocket.
The problem is not that so many people cannot afford or do not have health insurance, the real problem is that too many people cannot afford the cost of medical care. If the average family made enough money that they could cover the basic cost of medical care, then the issue of "being able to afford insurance" wouldn't really be an issue. The cost of "classic" health insurance - the kind that only covers you if your medical costs are extremely high, in the thousands of dollars, is not very much since such instances are uncommon.
Medical care has become unaffordable to the average person. If something is rising in price, it's pretty much supply and demand. Either there is insufficient supply or too much demand. So you either need more doctors, nurses and hospitals or you need people to need medical care less - or both.
A simple example would be allowing someone to be certified to perform basic procedures without going the entire process to be a nurse or a physician. What typically is done during an annual check-up (blood pressure, temperature, checking for basic signs like swollen lymph nodes, etc.) does not require an M.D. to perform. EMT's perform much more complicated (and often critical) medical procedures with much less training. T come up with some moderate or intermediate levels of medical certification and a sort of 'tiered' or 'gated' method of getting access to more experienced healthcare practitioners would likely both increase the supply of medical personnel and reduce the demand on the more highly trained ones.
Likewise, one of the reasons that the United States fares less well than other nations in these "life-span" or "health care" comparisons is due to the fact that, on average, Americans live less healthy than many other people do. Even given completely equal medical care, Americans would still have lower lifespans, etc. simply due to the greater propensity for obesity, lack of adequate exercise, etc. If people were more concerned about their health, the demand for healthcare would go down.
I'm going to stop now since this is becoming quite an essay. [;)]
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