It also includes the first article in this series.
The ABC's of Reform: Part II
D
Decision trees: Software applications now exist to help patients and doctors make better decisions by raising questions that need to be asked depending on the patient's age, stage of illness, and family health history.
Deductibles: Deductibles will continue to be used and will be one of the decision factors for employers and individuals to use when choosing a health care plan.
Delivery System: The organization of medical and health care services and providers, including financial incentives for providers will be re-structured to reward prevention and decrease the incentive for over treatment in the fee for service payment approach.
The current fee for service, pay for procedure delivery system model does not reward doctors for preventive care or early diagnosis. The current financial incentive is to fix a problem after it arises and to conduct procedures on patients rather than preventing the problem in the first place. Without changing the financial incentives in the current system, the "fix it" procedures approach rather than preventive/wellness focus will continue to be rewarded.
Diversity: Research on clinical outcomes will also examine outcomes by ethnic origins, because disease patterns often differ in different ethnic groups, such as earlier and more aggressive breast cancer in women of color.
E
Ease of Administration: A standard benefit package and electronic medical records will make health care options easier for employers and individuals to understand, select and manage.
Efficacy: Research on clinical outcomes will increase the body of knowledge on the best and most appropriate treatments given the patient's age, gender, illness and health history.
Efficiency: A basic benefit for everyone and an electronic medical record will increase efficiency, thus freeing up money for patient care.
Current estimates are that only 50 cents of every health care dollar actually goes to patient care.
Electronic Medical Records: Standard electronic medical records will improve the quality of care, reduce errors and improve medical decisions when coupled with clinical outcomes research. (See Leo van der Reis article below).
Employers: Will continue to play a major role in offering health care benefits. Having a standard benefit and research on clinical outcomes will make it easier for employers to offer benefits that have known effectiveness and will enable the large employers who operate under
ERISA (see ERISA) to add more benefits and services for their employees, thus allowing businesses to continue their practice of using health care benefits to attract and retain employees.
Entitlement programs: These programs cover the costs for those who cannot provide for themselves, such as Medicaid for low income women and children; the blind and disabled; some families below the federal poverty level and for long-term care. Medicare is for people over 65 and the severely disabled. If these programs are not continued in their current structure and financing, the entitlement services will be continued in another form.
Equity: Greater equity will exist because everyone will be playing by the same rules. Currently, individuals and employers have different benefits and different regulations, not only for private insurance, even in public programs such as Medicaid which has different services and eligibility in every state (See Taxes).
ERISA (Employee Retirement Income Security Act): Will be continued so large employers retain the flexibility they need to operate across state lines and to attract and retain employees.
F
Financing: Three major approaches are proposed to pay for health care:
Single payer: tax based, government managed health care. It eliminates employers and insurance companies as participants.
Health Savings Accounts/Vouchers: insurance payments migrate from the employer to the individual who purchases benefits from insurance companies. Keeps private insurance companies, but eliminates employers over time. Health savings accounts and voucher proposals differ. Health Savings Accounts work like a 401(k) plan. The employee keeps the funds in the account and the contributions accumulate over time. Those savings may be inherited by family members when the beneficiary dies. Vouchers, as currently proposed, are used to purchase benefits, but do not work like a 401(k) plan.
Shared Responsibility: Continues to use employers, individuals and the government (federal, state and local) to finance the health care system.
Flexibility: Having a basic benefit plan enables employers to have greater flexibility in managing their health care benefits, choosing plans that fit their needs and adding benefits tailored to their employees.
To be continued week of March 30th.
Kathleen O'Connor, Founder and CEO
