A NEW MODEL FOR HEALTHCARE
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.
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.