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Healthcare — Could we Eliminate the Word Insurance and Stop Using the Word Affordable

Posted Jun 10 2009 4:54pm

I can certainly agree here with all the posts I write on healthcare.  If we didn’t have to worry about money and being denied services, healthcare would be miles ahead.   If members of Congress could take time, do a field trip to a local hospital, spend a day in accounts receivable, one day with an insurance billing clerk, another day with a nurse on duty, and last but not least make round with the doctor for a day, perhaps this could lead to a better understanding of all the documentation and red tape that goes on behind the scenes.  Perhaps even spend the day with a family practice doctor at his office, observe what happens with staff and all the phone calls, faxing, etc. that goes along with processing to get the care the patient needs.  image Certainly there is a lot that technology can do to improve and save money but you almost have to see it for what it is and how it functions today to make sense to create improvements. 

Perhaps visit an independent physician’s association and see how they manage the lump sums provided by the payers to manage over a group of patients.  Some of these organizations go out of business if they are small with a few patients running up a huge tab let’s say with cancer treatment for example.  The patient may be a senior and the doctors are giving him the care and treatment he/she needs, and then later the IPA is gone.  The doctors did what they fell was necessary for treatment, but the expense was not able to be spread out over a large enough group to absorb.  In my travels I have heard this a few times along with what follows, frustration of others over the fact that large amounts of money were spent on patients who bankrupted the association.  Do you blame the patient that had cancer and needed treatment?   I have heard that along with doctors judging other doctors after the fact for their decisions, like a Monday morning quarterback as the foundation and funds for taking care of the group are now gone or very limited. 

When the funds are less than adequate, the inquisitions begin, as to why was so much spent on one or a few individuals and why were the funds not managed better, sad but this is what happens in the administration of managed care.  Algorithms are created and ran to determine a projected amount a group of patients will require for their care, and when those amounts are exceeded, we start seeing denial of service and care.  This is a ongoing procedure that goes on every day with doctors fighting for care for their patients, making the case on why they feel the money is needed for you.  As a patient, you may never see this side until it’s you that needs a large dollar amount for your care, so again I would think seeing this first hand by some members of Congress could stand to enlighten and educate.  Even with the best of technology there’s still no 100% fool proof way to project the health of a group of patients, there’s a lot that can be done to prevent and lessen the cost of certain illnesses though, that is a given. 

It became so heated in recent Senate hearings that doctors and patients had to be escorted from the building as emotions and frustration were at peak levels.  You can watch the videos at the link above and see a frustrated doctor being escorted outside.  In January testimonies were held in front of the Senate and you can watch the video as well, and see the questions posed over health records, limited, even though institutions like Kaiser have over 3 million members having access to their health information, thus my suggestions for perhaps an informative field trip?  Technology and affordability are on a crash course with healthcare and I can’t help to believe that seeing the entire picture from those at the top, would stand to help with the fix that we desperately need today.  You need to see the “big picture” and not just dollars and cents. 

A friend of mine who works for their family business and I recently had a conversation and he is responsible for negotiating the health insurance contracts for the company.  A long time employee of over 20 years became ill and needed some pretty extensive care and I listened to my friend, who liked the employee who has done a good job for over 20 years.  I now heard talk about how the employee now needed to go as their insurance rates went up over the cost on the one individual who just got sick.   Long story short, we talked and he had not even realized the thought processes and later admitted to being over whelmed by the pressure of cost and how to keep their healthcare budgets as an employer in check and felt remiss about the personal comments about the employee.  He wished they could get out of the circle and not provide “health insurance” so incidents and thoughts like this would not have to happen and is still pondering how to keep health insurance for the employees and not go out of business.  Battles and opinions are created that maybe should not be there over just needing healthcare and getting sick.

Nobody made a field trip to Wall Street and we all know what happened there, so maybe could we do things differently this time?  I think Dr. Crounse does a pretty good job in summing up the frustration and fragmentation levels of what we have today and why progress is in essence stifled and so much comes right back to education.  BD

“Politicians like to couple the adjectives “accessible” and “affordable” with the word “healthcare” when describing the goals of healthcare reform.  They say that with reform, all Americans will have health “insurance” and that it will be “affordable”.  I’d like to suggest that we eliminate the term “insurance” when talking about healthcare.

Am I missing something here?  I don’t claim to be an economist.  I’m just a doctor who gets really confused when people throw around terms that don’t “add up”.

HealthBlog : Affordable Healthcare Insurance—Say What?

Related Reading:

How Similar is Wall Street to the Health Insurance Business

Wall Street and Healthcare – Was it the Mob or have the rest of us been operating like a PC with no anti-virus protection?
U.S. Congress has an inadequate understanding Value of Health IT – HIMMS Opening Session
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