What is this thing called free markets in health care? Depending on who you ask, it can mean more competing health insurance companies and allowing individuals to select from both trimmed down and robust health plans or it can also mean patients acting like consumers, including buying health care services directly without the aid of insurance except for catastrophic expenses (to be defined). As one advocate recently put it on a discussion blog, “I want the best health care I can afford.” Yikes!
Is that how most patients feel? [Not me, I want the best health care possible… if I knew what that was🤓]
I don’t think so, especially when it comes to a serious illness or the illness of a child. So, here are the names of three surgeons who perform this operation. One of them has the most experience and highest success rate and the other two are good and they charge less so perhaps you can better afford one of them. Okaaaaay
If I’m going to shop for a new TV, I may be limited to a 42″ because that’s what I can afford. Or I may stay at a Days Inn when I would really like the Four Seasons, neither of those decisions are comparable to obtaining health care.
Certainly patients should have some stake in the cost of care behind premiums. They need a stake at the point of service, but not one that inhibits care or creates a financial hardship. The growth of high deductible plans; often much higher than required by the IRC for qualified high deductible plans/HSAs, creates hardship for many families and may also prevent obtaining necessary care.
A better approach would be a modest annual deductible equal to three or four office visits and then use ongoing co-insurance scaled to the service, say 30% for office visits, 25% for higher cost exams, scans, MRIs etc. Hospital inpatient care would have a separate modest deductible and a modest say 10% coinsurance up to a limit scaled to income brackets.
Personal responsibility and having a reasonable stake in spending are both essential, but access to the best care possible should not be based entirely on what individuals can afford to pay.
I would also eliminate all provider networks and negotiated fee reimbursements. Instead, provider groups and insurers would mutually determine a regional fee schedule which would be published and available to patients. This would include bundled payments for inpatient care.
This places competition with the health care system where it belongs. Competition would be based on quality, price (a function of efficiency) and customer (patient) satisfaction. The substantial cost of developing and maintaining networks would be eliminated thus also lowering premiums. Patients would be free to seek any provider in the Country knowing in advance their out-of-pocket cost.
There would be no variables in covered services, all plans would be the same. Insurance companies would compete largely on customer service and the administrative efficiencies they create. A portion of customer service may reflect the level of health care management (questioning appropriateness of care provided) a policyholder wants to tolerate, but this is also reflected in premiums because the more care provided, the higher claims will be.
Are patients ready for competition in health care. Is health care ready for competition?