Health Care Should Be Personal And Portable
I believe the next big issue in health care is going to be portability. My recent article in Health Affairs explains:
- What is meant by portability;
- What the legal obstacles are;
- Whether private insurance survive without it;
- What models can be used to implement it
- What are the expected gains and losses.
Read the full article.
A couple of points jump out after a first read through.
First the cost of a three year rate guarantee is not something that insurance companies will likely be falling over themselves to adopt. Their risk for “trend” is too great and therefore would likely price such a policy very conservatively. It didn’t mention if the individual opting for such a plan has any rights to withdraw prior to the three year time line (loses job,takes another job which has a different set up, can’t afford due to some other life contingency etc). It also doesn’t address very well the transition of starting with the employers “group plan” which may be individual product and then transitioning to a different product at the three year mark. This seems ripe for selection and again will create unintended consequences for both insureds and insurers.
The private market is doomed to fail as long as there is a public bail out. Since any public bail out is ultimately tax payer funded it can be analogized to paying property taxes for public schools then also paying tuition for private school without any tax credit. Works for a few but not the majority.
A few days ago, we reported on a study by the American College of Physician Executives, which concluded that many physicians are depressed, stressed and tired–in short, on the verge of burnout. We asked readers what physicians and others can do to make things easier. Here are some of the interesting suggestions we got:
Ann,
As an insurance broker I have seen and spoken to many a doctor about this topic. It is so very true!
One leading physician practice group explained to me this way. During a board meeting from his practice group, Dr Leadbetter a leading sports medicine from the Orthopedic Center at Shady grove hospital in Rockville MD told me this. Due to the rise in manage care plans such as HMO’s and many so called PPO plans that are HMO plans in disguise, that in order to maintain the same income levels from 15 and 20 years ago doctors now have to see four times the amount of patients to make what they used to make before in a given hour. Long ago, a doctor would tend to his patients in the morning and then make his hospital rounds in the afternoon.
A typical day would run about six to eight hours with time for golf and weekends off. Now, it is pressure to keep patients to a rigid time line of 10 mins per average with some less than that. No time to discuss the patient concerns in detail. The patent is in effect left to the doctor to make all the choices for them. This adds to mistakes, over billing and insurance fraud to try to make up what the insurance companies have taken away in fees.
Many of the good doctors who have been around have taken early retirements or left medicine to get into hospital administration. Others have just said they have stopped taking manage care plans all together in hope that the loyal patients will continue to pay out of pocket. Others have gone as far as saying they will no longer bill your insurance. They ask that you must pay them out of pocket and hope you will get on average .46 cents on each billable dollar back from the insurance company. This leads me to a solution:
We need education to consumers as well as to providers about consumer driven health plans. In these plans a patient could be told by the doctors that he no longer discounts his service as he is in demand. The patient would now have a choice to pay the provider either his retail charges for his services or the provider could elect to discount to some of his loyal patients with a 15 to 20% discount. The patient can pay the provider with pre tax dollars from his H.S.A fund to keep his doctor happy.
In this example the provider would now Net .80 cent on the dollar and have more time for his patient.
From the patient’s side the Net cost for this same service would cost about 57% using after tax dollars. The additional cost to the patient is more than realized in the annual savings of the major medical portion of the patients insurance. Both doctors and patients both need to understand the mechanics of these types of plans as they are not right for everyone. But to those who are financially able this is a market direction that is slowly coming to be.
Trouble is most insurance agents don’t understand this concept and so it falls short of getting any attention. There are many consumer directed agency’s you can learn more about these types of plans. Many are non commercial non profit orgs that it propose is to educate the market place.
For more information visit the following helpful sites:
http://cdhc.ncpathinktank.org/
http://www.kaiseredu.org/topics_im.asp?id=358&imID=1&parentID=61
http://actuary.org/pdf/health/cdhp_jan04.pdf
http://www.cmwf.org/publications/publications_show.htm?doc_id=226960
http://www.opm.gov/insure/05/guides/70-01/hdcd.asp
Kenneth Richter
Agency Principal
Key Benefit Services
http://www.keybenefits.us
All this means that HIPPA lulls one into thinking that true portability exists when it doesn't. There are no easy answers but if we are to devise a truly workable system, we need to start with a premise, develop a model, and make sure ALL parties approve. It has to be a collaborative effort without winners and losers.
The government should organize easy access to Medline and Health topics, medical dictionaries, directories and publications. WBR LeoP