In the current system, insurance companies add negative value -- which is to say, they make healthcare worse, not better. And here's why: It is actually against their interest for insurers to compete on giving us the best care. It's not simply that they're not doing it, but given the structure of the marketplace, they shouldn't do it.
) Universality: Insurers cannot compete effectively unless everyone is in the pool.
2) An end to cherry-picking: Insurers cannot be allowed, before offering insurance, to use demographic sub-slicing to cherry-pick the market. .... Insurers should have to offer insurance to anyone who wants it for the same price. No exceptions.
3) Risk adjustment: .... So on top of the universal system and the community rating, you need risk adjustment, which means either that insurers are reimbursed more for taking on sicker patients, or (my preferred method, and the one used in Germany) insurers with particularly healthy pools pay into a central fund that redistributes to insurers with less healthy pools. At the end of the day, it has to be as profitable for an insurer to insure a sick person as a healthy one.
4) Benefit floors: There has to be a minimum level of comprehensiveness below which insurance plans cannot dip. Otherwise, they'll just sell the healthy on plans that don't cover anything and so are very cheap. That's just another way of pulling in the healthy and keeping out the sick. Creating a floor ends their ability to segment the market by offering less value.
5) Information transparency: ...And within that space, it needs to be easy for individuals to compare insurers on plan comprehensiveness, price, outcomes, etc.
I think the way to fix these issues is to expand the hours of urgent care to 0600-2200 and then put an urgent care center right next to the ER. Patients could be triaged and sent right over to urgent care and told to wait if need be for opening hours.
I don't defend irresponsible behavior but as I said being judgemental closes the door to influencing better choices. Its the old you can catch more flies with honey than vinegar approach...
The other part of this is that we need to provide culturally competent care to our patients.
Culturally competent care requires a commitment from doctors and other caregivers to understand and be responsive to the different attitudes, values, verbal cues, and body language that people look for in a doctor's office by virtue of their heritage. The concept of tailoring health care isn't a new one; we already have medical specialties based on age and gender. Cultural sensitivity is one more dimension of that kind of refinement.
Cultural competence does not require that patients be treated by using the same methods used in their country of origin. However, cultural competency does create a compelling case for understanding the different ways patients act in a clinical setting and for communicating with patients to ensure the best possible clinical outcome.
HM2VikingRN, RN
4,700 Posts
As I said.....
I don't defend irresponsible behavior but as I said being judgemental closes the door to influencing better choices. Its the old you can catch more flies with honey than vinegar approach...
The other part of this is that we need to provide culturally competent care to our patients.
http://xnet.kp.org/permanentejournal/winter00pj/competent.html
Mow to bring this back on track.....
The article speaks to the perverse incentives attached to our current system......
How are we going to make insurers compete to give us the best care?