Reduction in Medical Costs Idea
I want to present an idea, using our U. S. history of private enterprise, to reduce health care costs, while providing better care using better equipment, more effective medicines, better procedures, and effective use of human resources. This idea is as follows:
In most larger cities that three or four major medical hospitals and corporations today vie for patients in order to pay for their vast overheads, state of the art equipment, and keeping doctors compensated for sending them patients. Each major health care facility normally has several satellite hospitals, doctor's offices, and what I call 'Doc in a box' (Dib) facilities located in drug stores, food markets, or as stand-alone emergency facilities.
This mix of facilities provide good care for their local patients. Occasionally, a “Doc-in-box” will have a patient walk in that requires more extensive treatment than their facility can do, so they refer the patient to a regional hospital. If the person's needs exceed the staff or equipment at their facility, the person will be transferred to a major facility located in a central hub where care is available. The various transfers are accomplished by ambulance or helicopter.
One major cost not associated with health care is the unbelievable amount of paper forms required and flowing between facilities, doctors’ offices, insurance companies, governmental agencies and patients is the huge amount of paperwork required by the government payers as well as private payers that must be filled out and input to database and completed by the Health Care providers staff. The information on each piece of paper must be clerically read, and entered into computer files, faxed, mailed, Emailed, etc. Most of the paper does not pertain to healing a person's body and mind, but to assuage the requirements of government participation and payments in the health care marketplace.
I know when I visit a doctor, I must complete 8 or more pages of medical and private history and financial information which must be entered into a computer database, open to God only knows whom.
Consequently, I believe the health care system should operate as follows:
1. The Federal Government would be removed from the US Health Care System with exception of the Center for Disease Control and Prevention. I do not find Health Care in our Constitution or Bill of Rights, so it is not a US Federal Government mandate.
2. Each major health care facility in a region in the US would be licensed to offer annual individual and family health care insurance policies good only for their specific hospitals, satellite hospitals, satellite doctors’ offices, and 'Do-in-the-box' facilities. The present insurance commissioners in States would certify the viability of an issuer of medical insurance the same is done today for major insurance companies issuing policies in a State.
3. These policies could be crafted similar to auto insurance policies ranging from basic health care to concierge care which might include private hospital room, same day doctor appointment, gym passes, periodic health checkups, etc.
4. The cost of a policy could vary depending on the policy holder’s attention to taking good care of their own physical well-being. This would include exercise programs, eating programs, weight control programs, etc. If sponsored by an employer, the group policy could take into consideration the same areas for payment.
5. As a State has many Health Care policy issuers authorized by the State, a State would create a pool of low-income people similar to today’s Medicaid participants. The various Health Care policy insurers would be given an overview of the health care requirements of those in the State pool. The HC Providers would then bid on providing the amount of care or service for which the State would contract. Of course, the policy would be issued by a provider operating in the same neighborhood as the potential patient. The Social Service Agency in a state could assist in funding the contract to bring the low-income policy up to the normal policy standards.
Note: Why would a HC Provider bid on a State Contract? The Provider must obtain enough “Sales” dollars to cover the facilities, equipment, utilities, personnel, etc. If these costs are not covered periodically facilities must be shut down or personnel laid-off. This is the last thing a CEO would want is to lose good trained staff, or good facilities, or forego new and better equipment. Consequently, there would be an ongoing push for a Provider to have lower costs, better care, heal people faster, and get the patients well and out the door. In addition, they would desire to provide well care, so their policy holder would not need to come into the facility as a patient.
5. Also, a Health Care Provider is judged on the Internet where a patient/policy holder could negatively or positively report on their care and treatment. This would alert their fellow potential policy holders to change policies at the next anniversary or to 'jump-on-board'.
6. A person could change policy facilities issuers annually as now done in the Medicare/Drug open window policy change period.
7. In addition, State Health Care Inspectors would continue to operate as they do today.
8. In each area there will be individuals that require an excessive amount of health resources. The premium for those requiring ongoing excessive amount of treatment such as paraplegic care, stroke, major heart problems, transplants, etc. would be much higher. It would be necessary to include in general policies an excess charge to cover this care.
9. Rather than have costly duplicated care within a region, the local healthcare insurance providers would be encouraged to contract with specialist healthcare institutions to provide care such as knee replacement or cancer treatment.
10. There would be NO free Emergency Care. A policy holder must go to their Policy Issuers Emergency Care facility. Going out of town would require a separate policy to cover the difference the same as traveling overseas does today. (Available today at AMEX)
11. Each citizen of a region must have a policy to visit a Doctor or Health Care Facility. This is no difference then having a mandated auto policy to legally operate a vehicle in a State.
12. Each policy can be geared to the amount of care to be provided. This is the same as an auto policy. If you do not need a huge limit, do not buy it. Premiums would have copay or not reflected in the insurance premium cost. Premier Coverage for same day appointments? Sure, just pay a bit extra.
13. Purchasing of a catastrophic health care insurance would become available. This plan would be used if a plan member suddenly became very ill and would cover thing not covered under the original policy with a health care provider. This is like Plan F under Medicare today.
14. Nursing Homes would be able to contract with health care providers for their residents. Their contract could include weekly visits by a Doctor or Nurse Practitioner.
15. Specialists could contract with multiple Health Care Providers as one Provider would probably not be able to afford and keep busy a particular specialist.
16. Within a family, some members could contract with a provider for their children and others contract with a standard provider. School districts could contract with a provider as well as businesses and government agencies that could use their purchasing power to reduce medical costs.
17. The Health Care providers could contract with other companies to provide administration and marketing for that provider.
Why would this work:
1. Health Care providers would be under the gun to heal a person and get them out of the facilities as quick as possible along with understanding that they will be rated by the patient on the internet services and State Inspectors, and lose money if they do not perform.
2. The Health Care providers and associates would be under the gun to reduce paperwork and still track the necessary care given.
3. Providers would make use of Telemedicine and databases of their treatment protocols to facilitate treatment.
4. New equipment and drugs that have demonstrated healing more rapidly would be used.
5. There would be an initial scramble to reduce overhead costs such as adding unused facilities, betting on the come, etc. (There is one huge hospital in Houston Medical Center that has never opened since construction was completed several years ago.)
6. Doctors would want to align their careers with state-of-the-art Health Care providers.
7. With the battle for policy holders would come cost reductions in Health Care.
8. Healthcare providers would contract with drug companies to obtain meds as well as pharmacies.
9. This idea is almost in practice today by Kelsey Seybold Clinic™ and Scott and White Hospital™ in Texas.
This idea is presented by George Koeninger.
I, George Koeninger , have no investment in any Health Care Company or Insurance Company. These ideas are my own caused by my interface with Health Care Agencies or Medical Practice Offices. I find government intrusion into the Health Care Industry like finding Poison Ivy in your yard. It is easy to grow, hard to kill, and causes a bad rash when you try to remove it.
2119 River Falls
Kingwood, Texas 77339