Sat 7 Mar 2009
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The potential impact on the economy from removing burdens around health care should not be underestimated as a means of stimulus. For many, fixing the system could mean enormous savings, if not just improved quality of life and perhaps care.
The solution to our health care situation goes beyond regulation; it lies in changing the focus. The intention should be about “well-being”, and all measurement and compensation for parties to system of “well being” should be driven by the success of the program. The parties include not just the doctors, but all those engaged in the health care processes: the medical insurance companies, malpractice insurers, the pharma and device companies, and extending all the way to those providing therapy and fitness services.
Differing time horizons need to be aligned. Insurers may currently find it beneficial to make decisions based on short-term exposure, regardless of potential longer-term costs that could result from those decisions. After all, it isn’t likely the patient will still be with the same insurer when the longer-term result is encountered. The relationship (or at least the impact of it) needs to be made permanent.
Medical and life insurance should be integrated so that the insurers’ interest in sustaining you is aligned with their interest in maintaining you. The medical portion of premiums should be driven in part by your relative wellness (not just relative to where you should be, but to where you’ve been) and in part by the risks you take and the choices you make about your wellness. Participation in activities that are shown to improve health and reduce risks should be rewarded, while costs should be attached to lack of participation and to risky activity.
Doctors who participate in this wellness driven system would benefit from streamlined administrative processes, not having to process and re-process while fighting for payment. For their participation, they will also have access to more reasonable malpractice coverage. Beyond the direct impact on the medical process, these changes alone should make it attractive again to pursue careers in medicine.
Compensation under this plan would be based, in part, on relative wellness achieved – the wellness performance of those under their care. This is in contrast to payment based on Relative Value Units, which is similar to the way your auto mechanic gets paid. Objectives of insurers too need to be redefined to be driven by wellness in this way too – particularly at the outset of the plan. Over time, as the balance of costs shift as a result of preventive care generating longer term savings, artificial incentives should become less economically important for proper motivation. Treatments will be driven toward solving problems rather than addressing symptoms, and away from allowing perpetual treatment and profit from such.
There are many aspects beyond these to be considered, but only through review of the full spectrum of the roles in this dynamic, with consideration as to how to achieve some of the objectives for each – and with agreement as to what problem(s) we’re trying to solve, can interests be aligned – not just on a particular purpose, but with a long view.
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