Health Insurance: The dilemma of Quality

Consumer stakeholders are concerned with identified aspects of health services: Access to and affordability of quality and timely health care.

What does quality mean to the stakeholders? It is the consumer who is responsible for promoting change that improves the quality of health care. While Obama's plan points out that to promote quality and efficiency it would include a requirement that health services providers report data, including using "technology", and while Clinton's plan focuses on giving providers MORE money in the form of incentives to adopt technology to also gage outcome based results, the flailing and confusion in the health services industry is missing the point: Quality for consumers means that they get the amount of care needed to stay or get well. Like physicians throwing consumers into a frenzy of testing and pre-testing and re-testing and medication adjustment, trial, and new trial, the candidate plans are throwing around technology, preventive services, and elimination of waste in a vague, wordy attempt to reform health services that unfortunately misses the point for consumers... it is the lack of oversight of health services providers that causes negative quality impact for consumers.

While those seeking "reform" cannot shift their focus from micromanaging consumers, mandating screenings, mandating health insurance purchases, mandating lifestyle changes, mandating divulging every aspect of their lives and putting it up for review while holding their breath to see whether they make the cut, the candidates become lukewarm (we should use more technology), ridiculous (paying doctors to do their jobs)
and downright impractical (magical technology will eliminate waste and fraud) when it comes to their ideas for quality. Rather than rip apart the poorly conceived notions, it would be better to encourage the candidates to come down off their high horses and realize that their plans don't require a complex series of cost-shifts, but a refocus.

Every statistic emphasizes that the COST of health services is rising. Therefore, the starting place for health services management is cost control.

Cost control are not out of reach.

1) Using the technology available, there should be a national database of health services providers. Their information put right out there for everyone to see: Physician, specialty, amount charged, patient comments, percentage of income from Medicare, percentage of income from specific insurance plans, time spent with patients, average number of additional tests ordered per patient, number of prescriptions for additional testing written on average, number of prescriptions for medications written, on average, incentives accepted from drug companies, patients, equipment suppliers. Sounds like a tall order? Not really. This information is largely required by law to be recorded to begin with. Putting it on one site, readily available for consumer review and cross-indexed by state and specialty would simply take all the "auditing and monitoring" that we know the government has not done well from the medicare model and put it in the hands of the consumer.

2) Medical services providers should bundle preventive packages. Instead of the ever-growing business of seeing a health service provider, then going to a laboratory, then getting billed, then going back to the health services provider, all preventive services should be bundled. If you see a physician and need a referral for a preventive test, then this is bundled in your fee. One bill for preventive services. This is also not impossible. Based on very generalized profiling for age/sex/weight/habits people are being sent to the same providers for screenings. Let physician groups negotiate who they use and how much these providers charge and present the consumer with a single bill. Insurance loves preventive medicine because its costs are KNOWN, physicians love preventive medicine because it covers their butts and insurance companies okay the expenses, consumers are run around from one provider to another and the positive outcome is that they are told they are fine after incurring months of test-taking costs and waiting periods.

3) Lose the personal health record busywork for consumers. If consumers have a serious medical condition they still use the medic alert bracelets. Personal health records are already being pushed by insurance companies with the proviso that such records are only a starting point. If the personal health record does not preclude duplicating tests, information and filing, in other words if relying on information provided by consumers will not avoid duplicate testing vis a vis "verification", it is a non-starter.

4) Instead of treating consumers like adversaries: to be excluded from the process of rate setting, currently determined by insurance companies as that notorious usual and customary charge (national database registry of physician fees by area and specialty would allow consumers to see what the charges are for providers in their own areas are), instead of imposing a SICK tax (currently all information about you is used to raise your rates, exclude you from coverage, and justify waiting periods for pre-existing conditions) have insurance companies disclose what percentage of costs they will cover for various illnesses, combined with physician disclosures, consumers can do the math, instead of eroding patient privacy further, focus on the health services providers.

Read through the proposed "health" plans...they are more of the same. It is time to focus on the health services providers.