Based on my personal health care experience and prior experience in financial analysis with an insurance regulatory agency, I would say the key is to encourage patients to practice preventative health care measures and establish an open communication with their primary care provider.
For instance, I have purposely chosen within my network a primary care physician who maintains her own private practice who I have used for probably over fifteen years now. I know that she does read my medical history, what medications we have tried and what the effect has been. It helps in some instances for the patient to be a
The Progressive Pule, in a recent article, provides their top 10 favorite health insurance innovations. I'll share my point of view on the subject. I read this article with an eye and a bias toward the insurance companies. Yes, I said the insurance companies. It is very easy to come out and criticize the innovations and practices of insurers, expecially when it is in vogue, someone feels personally "wronged" or the concepts are complicated to understand.
But insurance companies are skilled in predicting loss ratios (and absolutely must do that in order to provide the products at all). Most of America does not understand how the process of pooling and underwriting risks works.
The only way that someone who is sick can get a payout is if someone who is well is making payments into a benefit that they may not fully use.
And more people have to be well than sick.
If the insurance companies didn't calculate these risks with their finely segmented classes, limits on the maximum benefits, and exclusions, every company would be bankrupt rather quickly. The real answer lies in innovations that help consumers drive their own prices down by getting incentives to be "as well as they can be".A recently published book called "Bend the Healthcare Trend" by Mark Gaunya and Jennifer Borislow covers the subject. And they are two of the few who really understand these dynamics while also suggesting a path to true innovation. A world with no heath insurance seems inappropriate. However, without people understanding, accepting and taking responsibility for the way the system works, it may become a reality. The insurance companies are still obviously the lead innovators here, and with the right combination of insight, idea and communication (getting people to REALLY understand, those innovations can work in market.
Now that we have new reforms in place I'm curious to know how you percieve the communication portion of the insurance equation. How can companies to more to make sure consumers truly understand the system?
July 11, 2011 5:26 AM
The way you described it was pretty clear: More people have to be well than sick for insurance companies to stay in business.
If the consumer knew that he/she were part of a greater whole. If the consumer knew the faces and stories of other people in their risk pool who were not well, they would know who is benefiting from the insurance.
A friend and I were just having an interesting conversation. His father is deathly ill in the hospital. He said, of his father, "He did one thing right, having us." He was referring to the fact that his father had him, his sister, and mother to worry about him and to advocate for his treatment at the hospital.
"If you don't have someone to advocate for you, you're just a piece of meat. They're not going to go the extra effort to keep you alive if someone is not hovering over you, asking the doctor questions."
With millions of American adults growing older, and many being single, this writer not excluded, there is the thought of, "Who will hover over me?'
Advocacy insurance would create pools of people who are in a similar state of life. They have assurance that they are part of a pool where everyone in it is asking the same hover question. This is different from in-home health care or personal assistance because it would have more of a social service bent and provide counselors skilled in being your advocate when you are in life's final stages, to ensure you get the best care possible and do not go with at least a little bit of a fight (as well as a witness).
This could be a feature add-on to an existing plan, or the centerpiece benefit from which to build out plan participants. If a plan member should get married and bring on blood related advocates, they can reduce the depth of their plan or be transferred to a different pool that is beneficiary benefit orientated.
Advocacy insurance, not sure if I would buy it right now, but the friend who inspired this conversation said that after being with his dad in the hospital, and if he were in a similar situation, he would want to have an advocate. And he would advocate for himself now by paying advocacy insurance premium while he's well, so that a qualified and caring person can advocate for him later, when he's not well.
By being well, and paying while you're well, you are allowing others to be cared for when they're sick. If consumers felt more of a 'we're in it together' with others who are like them and in the same pool, they'd thank the insurance company for bringing them together rather than distance themselves from insurance companies because they've master-minded profit-centered innovations that make it difficult to enter into insurance when you are already not well, like pre-existing condition clauses.
Maddock Douglas
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July 14, 2011 9:33 AM
Love this...yes! That is the point exactly. Thank you for your insightful example!
July 25, 2011 5:10 PM
While I agree that advocacy is helpful at any stage in the care continuum, it strikes me as somewhat sad that you (we) think it necessary for a paid advocate to insure that a patient gets the care that they need or deserve. Our society seems recently, more accepting of the schism that we are natural adversaries of one another and that if I have something of value that the last thing you would do with it is to give it to someone else. If it is my profession to help sick people, why would I not be offering to do what I can to help you without a third-party insisting that I do? We saw this in the predatory lending practices of banks prior to 2008 when they offered (or foisted) mortgage products on unwitting (I didn't say "unwilling") consumers who could neither afford the house nor the payment that went with it. Consumers fell prey to the banks just as you suggest patients are to the insurance company, hospital or physician.
The other side of the schism is that consumers think they can read the Cliffs Notes and still pass life's exam. How often I've heard, "just give me the Cliffs Notes" or "just give me the bottom-line." Unfortunately, we are all asked to take responsibility for our actions. We are treated and expected to act as the sovereign of our domain. Government step in where we as individuals leave a void and it seems we are prone to do that more and more, e.g. the brand new Consumer Financial Protection Bureau.
Patients as consumers must protect themselves from the predatory practices of the "business" of healthcare. It would help however, if both parties to the transaction would treat the other with the respect for which America and Americans were once known.
Civility is not an innovation, although it may well be innovative to think and act that way in today's world.
July 25, 2011 8:42 PM
Ron,
All very good points, and I agree with you on many levels... It is more than somewhat sad that a patient or perspective future patient like my friend or myself would be even entertaining the possibility of having to arrange a paid advocate to navigate the nuances of a system in the event either of us ever become sick enough to require extensive use of our health insurance plan.
In terms of consumer rights, look at overdraft protection. For adults who cannot balance their books. And the new credit card charts included in your bill which show you how many years it would take to pay off your current balance based on the current interest rate- for those who don't understand that if you buy an item on super sale using a credit card that's carrying a balance, that sale item will cost many more times than it would have been at full price when it is financed out (thank you to The Oprah Winfrey Show where I initially learned this lesson back when I was a teen!)
But unlike the financial sphere, the same sort of "cut and dry" advocacy/Consumer Rights tools are not as easy to pinpoint or exercise when it comes to the true cost of health care and the decisions that doctors must make on whether or not to forge ahead with certain procedures. Health insurance literacy on the part of the well-read-non-Cliff-note-using consumer just means that a patient-consumer, or their loved one or advocate if the patient might not be coherent or conscious enough to recall their rights as a consumer, knows the ins-and-outs of the system and can help navigate it to ensure that the patient is aware of all that is available in terms of spectrum of care and services.
When civility is eclipsed by Capitalism, as you indicate, there's a problem beneath the surface which tugs deeper at our shared humanity and innate sense of responsibility to each other. And anyone who believes our current finance, and health care systems aren't about capitalism and the profiting of few at the expense of many, needs their head checked. If it's covered.
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View unverified member's comment - posted by Ron Sheaffer