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Incentives for Health Reform November 3, 2009

Posted by Admin in Health Insurance, Healthonymous.
Tags: , , , , , , ,

Just caught a TV program where Bill Gates, Jr. was answering questions from students. Being Bill, he was asked many questions, one of which was on health care. He spoke to the question of what behavior the system currently promotes. The example he used was the difference between preventing an asthma attack vs. having an expensive episode treated in the hospital. The latter is rewarded with money, i.e. the procedures are “covered” by insurance. The former is not always “incentivized”.

Another example was the original inclusion of discussing on a voluntary basis end-of-life care with your physician earlier this summer in one of the bills proposed by Congress. This conversation would have received insurance coverage, but due to misrepresentation and outright lies, the provision was dropped by Congress. Some types of conversations with one’s physician simply have no incentives in the current health care and insurance systems, so they don’t occur.

When you or I see a health care provider, there is usually coverage for an office visit, but tests and procedures are rewarded too.

What incentives should be built into our system?

Currently there might be an attempt to have full coverage for an annual physical. But what is included in that physical? Should mammograms and colonoscopies be included in physicals for people of certain ages? How can we design a system that would reward a doctor making a house call to an elderly patient or someone else who was housebound instead of writing a prescription? Could we design a system to treat people with flu at home, rather than forcing them to visit an office, clinic or an emergency room? Can we reward wellness, instead of disease? (Monetarily, I mean…)

I for one, would love to see:

  • a system of care which covered all people (therefore no incentive for people not to participate),
  • some level of prevention was covered annually (physicals, tests required for people of a certain age, vaccinations),
  • health care not tied to our employers or marital status
  • a health care plan that emphasizes the value of mutual obligation in our society
  • health care which emphasized patient information on both risk and benefits
  • a plan which would not result in denial of coverage for pre-existing conditions (domestic violence, being female, diabetes and other chronic conditions, acne, rape, birth by Caesarean section, hangnails)

Bill G. also recommended a book that I just put on my “things to read page” by George C. Halvorson. Big topic. All for now.



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