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View Diary: I feel sorry for health insurance companies. Yes, I said that. Why? This Time report must be read. (228 comments)

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  •  Global payment versus fee-for-service (5+ / 0-)

    Part of the issue is that we in America view healthcare through the same lens that we view purchasing other services or goods even though it is totally different. As someone pointed out if you walk into an ER, even if you aren't insured, you get some health care (even if it isn't the best or even sufficient), but if you go into a grocery store without money you get nothing.

    Hospitals, and other health care organizations, for years operated on a "fee-for-service" basis. You give me a drug or procedure, I pay you money for that. In part because of new regulations, some areas are moving towards a "global payment" system. The concept here is that you are paid a flat fee to take care of healthcare for a certain population regardless of what that means. In theory this means a greater focus on preventative health (as it is cheaper to convince someone not to smoke than to treat them for lung cancer).

    Basically what is happening in 'fee-for-service' situations today is that they are trying to artificially capture the totality of the costs of the health care it provides. So while, yes, the acetaminophen tablets appear to cost too much they are actually just standing in proxy for not just the cost of the drug, but also some of the doctor's time, and nurse's, and pharmacist's, and security, and HR, and utility bills, and uninsured, and marketing, and insurance, and underpayments, and all the other hundreds of little things that go into running a company (hospital or otherwise).

    Take it easy, but take it.

    by ltsply2 on Thu Feb 21, 2013 at 09:31:28 AM PST

    •  Fall out from global payment system... (3+ / 0-)
      Recommended by:
      ltsply2, SilentBrook, ladybug53

      An interesting side effect of this system is that it will also be more expensive to address certain issues. If a physician knows that the patient will be complex or that they will have to send them out, they will be losing money. In this case there are incentives to actually not perform treatments.

      Actually, hearing from physicians, there is now more rollout of 'firing' patients cause they won't be profitable to treat. Those people while getting some care, will be transferred to the least level of service possible.

      My wife as a provider has a high probability of closing her practice as it will likely no longer be profitable to continue. In the future, providers will most likely much less skilled (MS / BS level).

      "I know the meaning of life. It doesn't help me a bit."

      by dss on Thu Feb 21, 2013 at 10:09:55 AM PST

      [ Parent ]

      •  Absolutely (2+ / 0-)
        Recommended by:
        SilentBrook, ladybug53

        There is definitely a HUGE difference between how global payment works in theory versus in practice. As long as you can "fire" patients, it still doesn't solve the problem. Another reason why single payer works better. Global payment is a half measure towards real health reform that doesn't necessarily solve the real problems (like the ACA generally). I do, however, think it is useful in getting people to conceptualize health care differently.

        Take it easy, but take it.

        by ltsply2 on Thu Feb 21, 2013 at 10:20:05 AM PST

        [ Parent ]

      •  To be honest... (0+ / 0-)

        A lot of problems don't require an outright MD for treatment.  A smarter system would be to employ PAs and NPs to handle easy problems and only escalate to doctors when necessary.  That is probably a smart way to reduce costs.

        However, it still doesn't explain why right now we're paying twice as much for inferior care than other countries.  We start out with severe inefficiencies that even smart practices are insufficient to solve.  

    •  Grocery store actually does provide food to people (1+ / 0-)
      Recommended by:

       Have you heard of the phenomonon of dumpster diving at the back of the store to find things to eat?  
        Also our grocery store takes donations of cash from paying customers, and uses it to buy food at cost for the local food banks, and also  donates a lot of food to the free pantries.    They are very active in feeding the hungry.

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