FIxing the Healthcare financing mess isn't all the hard. FYI, this is presented from the perspective of insurance coverage for dental care, but it would also apply to medical coverage.
It should start (and pretty much end) with Congress repealing the carrier's antitrust exemption -- carriers have generally shown an inability to be trusted not to mess up the normal function of the marketplace for their own profit (whether they are for profit or non-profit entities), while also reducing the quality of care provided...
IMHO, a normal functioning health care market should allow clinics to have one and only one fee schedule, just like any other store or vendor. A carrier could offer to pay $XXX for any procedure, and the rest would be up to the patient to pay... Let patients search around for a price they feel is good for them, if cost is more important than other issues...
Without an antitrust exemption that lets carriers to set clinic fees, Carriers could base their reimbursement schedules upon some portion of the percentile fee of the spectrum of fees that clinics in an area charge. That's what they pay for a procedure, regardless of what any clinic charges.
For example, say the 60th percentile (slightly above average) charge for a crown is $1000, and the carrier wants to pay half, then they'd pay $500 for a crown, regardless of what the clinic charges. If Clinic A charges $800, then the patient portion would be $300 at Clinic A, if the Clinic B charges $1500, then the patient portion would be $1000 at Clinic B.
Such a reimbursement system would not require an industry anti-trust exemption, plans could easily cross state lines, clinics wouldn't have to sign up as providers, they'd just bill the carrier, perhaps after filing a fee schedule with the carrier to aid in their percentile fee tracking...
Carriers might also offer the patient financing for the patient's copay... Yes, it's long past time for carriers to think out of their bozo box... They don't have to do that with their precious anti-trust exemption...
Mostly, what would happen is instead of dulling the marketplace with increasing low end care options pushed by carriers, this sort of (non-anti-trust exemption) carrier reimbursement system could enhance competition for service, price and quality of care provided. And the change in improvement of care and financing options to pay for care, would likely be very swift.
It should start (and pretty much end) with Congress repealing the carrier's antitrust exemption -- carriers have generally shown an inability to be trusted not to mess up the normal function of the marketplace for their own profit (whether they are for profit or non-profit entities), while also reducing the quality of care provided...
IMHO, a normal functioning health care market should allow clinics to have one and only one fee schedule, just like any other store or vendor. A carrier could offer to pay $XXX for any procedure, and the rest would be up to the patient to pay... Let patients search around for a price they feel is good for them, if cost is more important than other issues...
Without an antitrust exemption that lets carriers to set clinic fees, Carriers could base their reimbursement schedules upon some portion of the percentile fee of the spectrum of fees that clinics in an area charge. That's what they pay for a procedure, regardless of what any clinic charges.
For example, say the 60th percentile (slightly above average) charge for a crown is $1000, and the carrier wants to pay half, then they'd pay $500 for a crown, regardless of what the clinic charges. If Clinic A charges $800, then the patient portion would be $300 at Clinic A, if the Clinic B charges $1500, then the patient portion would be $1000 at Clinic B.
Such a reimbursement system would not require an industry anti-trust exemption, plans could easily cross state lines, clinics wouldn't have to sign up as providers, they'd just bill the carrier, perhaps after filing a fee schedule with the carrier to aid in their percentile fee tracking...
Carriers might also offer the patient financing for the patient's copay... Yes, it's long past time for carriers to think out of their bozo box... They don't have to do that with their precious anti-trust exemption...
Mostly, what would happen is instead of dulling the marketplace with increasing low end care options pushed by carriers, this sort of (non-anti-trust exemption) carrier reimbursement system could enhance competition for service, price and quality of care provided. And the change in improvement of care and financing options to pay for care, would likely be very swift.
