Tuesday, August 18, 2009
Monday, July 20, 2009
Solving America's Healthcare Problem
Any solution for solving America's healthcare problems should include:
1) Delivery of healthcare to all residents (citizen or guest, wealthy or poor)
2) A way to manage the federal budget devoted to healthcare
3) A way to contain the cost of medical malpractice suits
4) Give control of healthcare decisions to the individual
5) A common framework for defining healthcare and healthcare insurance coverages
6) An efficient healthcare marketplace for allocating resources
7) Education to individuals for managing healthcare choices throughout life.
This healthcare framework contains two delivery systems. One based on predetermined funding by taxpayers to provide rationed healthcare to those who can't pay for it, and another market based system for those who have the resources to manage their own healthcare.
1) The federal government determines how much it will spend on providing healthcare for persons who can't afford their own care and funds the development and management of free clinics to provide that care on a rationed, triage, basis. The healthcare model used in Cleveland Ohio would be a good model for how to manage this network. New doctors and nurses would be required to serve a minimum of 2 years in this network upon graduation.
2) Individuals who can afford healthcare establish a Healthcare Account tied to social security number. The federal government defines minimum coverage requirements for nationwide insurance, states can add additional requirements within their states, and healthcare companies can add any additional coverages they wish to offer. Any government entitlements or subsidies, employer contributions, and individual savings for healthcare are deposited in the healthcare account. The individual decides how best to spend the money on their healthcare.
With this basic structure I think you will find the healthcare delivery system becomes highly competitive and very efficient in allocating healthcare resources among those willing and able to pay, yet provides a predetermined level of resources determined to be morally responsible and economically doable for those in need. The education system would support the individual in managing decisions related to healthcare by developing curriculum that teaches prevention and financial management of health resources.
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NATIONAL HEALTHCARE MODEL
This model is a framework for providing private healthcare nationwide. It accounts for different levels of government participation and control over most aspects of healthcare but relies entirely on a free market to deliver competitive products and services. A National Healthcare Registry will be maintained that defines all available medical procedures, medical tests, medical product types, and legal drugs.
Four types of healthcare are defined in terms of items from the national registry: 1) Minimum - free, rationed, healthcare with coverage defined by the National Health Board and funded by a fixed dedicated payroll tax, 2) Federal Basic - nationally defined coverage, premium quoted by Healthcare Management Companies 3) State Basic (optional) - coverage defined by State government, premium quoted by healthcare management companies. 4) Premium - Coverage defined and quoted by Healthcare Management Companies.
Minimum coverage will cover four types of care: 1) general care, 2) emergency care, 3) prescriptions and 4) hospice. A National Health Board (NHB) will set a fixed monthly rate of reimbursement and a quantity of authorized clinics by type of care (a clinic may provide any or all classes). Caregivers that want to participate must apply and be accepted by the NHB. Once accepted they must provide the approved types of care to all patients that request it on a triage basis. The minimum coverage will be funded by a payroll tax set by congress that can only be used for minimum care (estimated to be between .05% and .2%). Free clinics will have a standardized way for patients to rate the services of the clinics they use and it will be made available to the public on an ongoing basis.
COMMENTARY - This approach provides a minimum level of healthcare to people who have no other means to acquire it. The amount of resources made available for the minimum level of healthcare is determined by a fixed percentage of the wages dedicated for this purpose. The amount and quality of healthcare provided will depend on how efficiently the available resources are used and the demand by persons with no other options. Service will degrade if unemployment and illegal immigration continue to outpace growth in our economy.
Federal Basic coverage will be defined by the NHB in terms of items from the national registry that must be covered. Health insurance for this coverage can be offered by any insurance provider.
State Basic coverage may be defined by a state health board in terms of items from the national registry that must be covered. It must include all items contained in the federal basic plan. States may require this coverage in lieu of the Federal Basic plan for all state residents. Health insurance for this coverage can be offered statewide by any insurance provider.
Premium coverage is defined and priced by the Healthcare Management Companies. To be available in a State it must include all items that the States basic coverage includes. It may also include any additional items from the national registry.
The insurance providers set the premiums for their plans and specify a standard cost for each item covered. All healthcare items are available in a free market within the private sector. Individuals manage their own healthcare with financial assistance as appropriate from government, employers, charities, friends and family.
Disability insurance with coverage requirements defined at the federal and/or state level may be substituted for the patients "right to sue" for malpractice.
A Healthcare Account is created for all persons who currently have or receive a social security number. Any benefits earned from Federal, State or Employer healthcare programs are monetized and placed in the individuals account. Employer paid monthly contributions for health insurance will be paid to the individuals account. Individuals select a Healthcare Management Policy paid with monthly withdrawals from their Healthcare Account.
Comment - Individuals manage their own healthcare account with children taught in the school system how to do this responsibly. Individuals contribute to their account through life and may receive additional contributions from other sources like employers, family, charities, etc. Upon death, the balance is paid out to the estate of the individual or passed through inheritance, tax free.
Medical Savings will accrue to the individual when they use healthcare items for less than the standard cost specified in their policy and will be credited to their healthcare account. Items in excess of the standard cost will be debited to their account.
Example: A primary physician approves a colonoscopy for their patient. The standard cost in their insurance policy for a colonoscopy is $4,500. They go to the healthcare marketplace and find a suitable source for a colonoscopy and have it done for $3,500. The savings of $1,000 is placed in their Healthcare Account.
Commentary - The government could have a major impact on the current economy right now by spending $40 Billion to acquire and convert distressed properties into free clinics to provide the minimal healthcare. 40,000 clinics could be built at $1,000,000 each, removing homes and commercial properties from the market and create 200,000 "hammer ready" short term jobs. A payroll tax increase of less than .2% could fund the ongoing operations of these clinics (annual budget of $500,000) and create another 200,000 permanent jobs.
HEALTHCARE MARKETPLACE CONSORTIUM
A consortium of network companies would be contracted to develop a healthcare marketplace. Specialized versions of existing websites like Facebook, Twitter, Ebay (and/or others) could be implemented to provide a highly integrated system that emphasizes efficient communications between patient and care givers and that facilitates cost management.
Doctors would create and maintain a page on the Facebook like system that gives, as a minimum, their biography, the items they offer from the medical database, and their cost for providing those items.
Each individual would create a page on the Twitter like system and as a minimum it would include required personal information, medical history, insurance provider, policy level, and primary physician. The individual would log of any medical information they feel is pertinent to their health, such as weight, blood pressure, symptoms, blood sugar, health concerns, etc. An interface for health monitoring devices would be included.
The medical ebay like system would interface with the Facebook like system to pull all items from the medical database offered by physicians (with pricing). Suppliers of medial products, drugs and services that aren't physicians would enter their items directly to the medical Ebay system. This would become the "market" for all items covered by all levels of health insurance. Additional items not covered by insurance that relate to healthcare could also be included. The system would provide search and feedback components similar to Ebay.
The system would accommodate purchasing, setting appointments, requesting additional information from the provider, electronic prescriptions, and maintaining a purchase history for each individual. Purchases covered by insurance would be tracked and billed to the insurance provider. Covered items that cost more the "standard cost" stated in the medical database would have the "excess" billed directly to the individual. Items that cost less would have the difference added to the individuals lifetime maximum as an incentive to use less costly items.
Insurance companies would be sent a detailed bill monthly for each individual showing the covered items , standard costs, amounts due, and current lifetime balance.
Tuesday, July 14, 2009
A NEW MODEL FOR HEALTHCARE
OVERVIEW
This model puts all decisions for insurance, healthcare, and cost management with the individual. It is based on free market principles yet allows government to fund entitlements for any or all groups within a full range up to complete funding of the individuals healthcare needs. It provides a common framework based on standard definitions and management processes, and utilizes the latest internet technologies.
At the heart of this model is the establishment of a healthcare account for each citizen tied to social security number. Governments contribute to these accounts based on what they believe is morally justified and within budgetary constraints. Government may make annual contributions, a single lifetime contribution, or a combination such as a one time contribution indexed to inflation.
During an individuals lifetime, healthcare insurance, medical procedures, products, and services are paid for from the acount. The balance may be increased by using more cost effective health services, making personal contributions, or by receiving contributions from others such as employers, charities, friends or family.
Insurance policies are standardized in coverages at three levels and are offered nationwide. All policies contain a disability insurance component that replaces the patients right to sue for malpractice.
In addition to the basic entitlement, the government will fund a network of "free clinics" that is operated by private companies to provide limited healthcare to persons without funds or a healthcare account. The clinics will provide a limited subset of items covered by the basic level of insurance and is offered on a "triage" basis.
Internet based systems are developed that assist the collection, dissemination, and exchange of medical information. A healthcare marketplace component handles all transactions including purchases, sales, prescriptions, payments, reimbursements, appointments, and history.
COMPONENTS:
1) Standardized definitions of all healthcare products and services.
This includes medical procedures, tests, products and drugs. Medical products would include any items that might be covered by any level of health insurance from wheelchairs to artificial hearts. The definitions would be maintained by a National Health Board (NHB)
A good list of medical procedures and tests can be found at http://www.medicinenet.com and a list of all FDA approved drugs can be found at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm
2) Three levels of insurance: 1) basic, 2) extended, and 3) premium.
Each level is defined by a list of covered products and services using the standardized definitions.
A disability policy is included with each level. This eliminates the right to sue for malpractice. Criminal charges for negligence are still allowed.
3) A central database that contains the information of all insurance providers including company information, policy prices, covered items and standard costs.
Each provider lists the premium for each level of service. Within each level of service, the provider lists a "standard cost" for each item that is included from the standardized definitions. This is the highest price the insurer will reimburse for the item.
Individuals sign up for a policy they desire and the monthly premiums are deducted from their health account.
Individuals decide the source of all healthcare items. If the cost is greater than the standard cost, the additional amount is deducted from their account. It the cost is less, a credit is applied that increases the balance of their account.
A list of recommended care providers can be included for each insurer.
4) A knowledge base of known diseases and symptoms. This is a repository for information about the causes and symptoms of known diseases that is available to assist healthcare providers and patients. A good database of these can be found at http://webmd.com
5) Use of the internet to manage the healthcare system.
Specialized versions of existing websites like Facebook, Twitter, Ebay (and/or others) would be implemented to provide a highly integrated system that emphasizes efficient communications between patient and care givers and that facilitates cost management.
Doctors would create and maintain a page on the Facebook like system that gives, as a minimum, their biography, the items they offer from the medical database, and their cost for providing those items.
Each individual would create a page on the Twitter like system and as a minimum it would include required personal information, medical history, insurance provider, policy level, and primary physician. The individual would log of any medical information they feel is pertinent to their health, such as weight, blood pressure, symptoms, blood sugar, health concerns, etc. An interface for health monitoring devices would be included.
The medical ebay like system would interface with the Facebook like system to pull all items from the medical database offered by physicians (with pricing). Suppliers of medial products, drugs and services that aren't physicians would enter their items directly to the medical Ebay system. This would become the "market" for all items covered by all levels of health insurance. Additional items not covered by insurance that relate to healthcare could also be included. The system would provide search and feedback components similar to Ebay.
The system would accommodate purchasing, setting appointments, requesting additional information from the provider, electronic prescriptions, and maintaining a purchase history for each individual. Purchases covered by insurance would be tracked and billed to the insurance provider. Covered items that cost more the "standard cost" stated in the medical database would have the "excess" billed directly to the individuals healthcare account. Items that cost less would have the difference added to the individuals account as an incentive to use less costly items.
Insurance companies would be sent a detailed bill monthly for each individual showing the covered items , standard costs, amounts due, and current lifetime balance.
6) A way to manage entitlements by federal and/or state governments.
EXAMPLE: The government sets a lifetime healthcare credit balance in an account for each citizen. This account can be used to make monthly insurance payments and/or pay for medical services, products, or drugs directly. Government can offer incentives to increase the balance in the account for actions that "promote the general healthcare" such as registering as an organ donor.
7) A transition plan for existing healthcare systems.
Existing insurance policies would be rewritten within the existing framework and a nationwide enrollment undertaken. Individuals with employee provided healthcare would be given a credit for an amount equal to the current benefit paid by their employer. This amount would be applied to the individuals account each month as long as the individual remains employed by the company.
During the transition, the initial amount put in the account for each individual would be set by the Health Board according to age. Modifications to this amount may be made for groups being changed over from existing government plans (VA, Medicare, Medicaid).
This transition could also be implemented on a voluntary basis by individual.
8) The ability to support patients, providers, and governments worldwide.
