Tuesday, December 30, 2008

Healthcare Reform

Today, I responded to a request for information on healthcare issues. So, I decided that I would cheat and use some of them for my blog post of the day.

Briefly, from your own experience, what do you perceive is the biggest problem in the health system?
This question is too general. Most of the issues are symptoms of a larger problem. I think the biggest problem is that the consumer, the patient, feels like he is entitled to health care in a way that is very different than housing, electricity, water, and other basic necessities. The health savings accounts where the patient is responsible for paying out of pocket up to a certain amount (as long as that amount isn't too high) but gains access to preventive services at no cost and has a maximum out of pocket for ALL medical serivices including medications puts some of the responsibility back on the patient. Providers feel that they need to order too many tests to cover their liability, and the patient doesn't care a lot of the time if they have extra tests because they aren't usually paying for each individual item. Also, there is no penalty to the patient for causing some of the issues by lack of proper preventive care and for lack of nutrition and exercise. All of this together causes costs to skyrocket from every angle. On top of this, ancient processes and systems are used in healthcare to generate and maintain paper records where electronic records will dramatically increase efficiency, improve patient care, and reduce cost.

How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers?
I chose my primary care doctor because of his schedule (open 8 - 8 Monday through Friday and 8 - 6 on Saturday and 8 - 3 on Sunday. I chose my urologist (kidney stones) based on a recommendation of a friend and then stayed because I liked him and the way he treated me. I think patient satisfaction ratings in combination with measuring quality measures for chronic disease conditions and penalties to those who do not achieve (lower rates of pay or fines for sloppy quality) are the best ways public policy can help. As an employee, I must meet certain performance objectives to get salary increases, to keep a job, and to have a potential for bonuses. Not meeting those requirements cost me increases, bonuses, and possibly my job. Why should medicine be different?

Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem? Yes, we have. With kidney stones, I have to have a lot of CT scans and then lithotripsy or uteroscopy to get them out. The medical bills have been staggering at times - even after insurance. Additionally, MANY medical bills are denied or partially paid, and it takes a HUGE amount of work to stay on top of those issues, to talk to the insurnace company about them, and to make sure the corrections are made. Policy makers should make the charges and payments part of healthcare MUCH simpler and easier to follow from a provider, patient, and payor view. It is much too complicated and has way too many risks.

In addition to employer-based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?
I think people should have access to plans regardless of their employer. I think employers can contribute to this as a benefit, but the plans should be available to the patient. Part of the problems in health care are the solutions available to smaller companies and available to certain jobs are much more expensive to get coverage AND to get care when the patient goes to get care.

Do you know how much you or your employer pays for health insurance? What should an employer’s role
be in a reformed health care system? See above question

Below are examples of the types of preventive services Americans should receive. Have you gotten the prevention you should have? If not, how can public policy help? Yes, I have gotten the prevention I should. I think discounts on coverage/care or a deduction on taxes would help patients be more active in prevention. Also, you might have to pay a higher cost when you get a disease you didn't have preventive care to receive.

Just thinking about this and thinking about the big picture is pretty outrageous. Hopefully, some meaningful reform will happen sometime soon.

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