In my previous blog I talked about the three obvious and prominent components of our FOR-PROFIT HEALTHCARE INSURANCE MODEL.
And no, it is not a free ride for the healthcare consumer. We have OUT-OF-POCKET COST. We have the privileged of paying premiums, deductibles, co-pays, coinsurance or other fees out of pocket in order to play on one of the six teams. That process, in reality, looks something like this.
In essence these six teams funnel their payment process through an INSURANCE COMPANY. They “pay” for the services, but they don’t pay those listed provider charges. They “negotiate” for lower prices with each hospital and doctor on every plan. There negotiated prices even can vary within an insurance company depending on which plan a patient (that is another word for healthcare consumer) has.
There is a FOURTH PARTY involved behind the scenes
They may look vaguely like politicians and such but in reality, they are a mixed group. These are the DECISION MAKERS. They are not necessarily Physicians even though they may be part of the Provider or Payor community. How they “decide” impacts how disenfranchised the Consumer and Provider of Health Care will become. And their main function is to navigate our model and produce the profit.
Our model is broken
WHY IS IT BROKEN? No Return on Investment. What does that mean? We pay more than any other modern country in the world for our healthcare but get very little bang for our buck.
BANG FOR OUR BUCK MEASURED:
- Access to health care
- Quality of health care
- Improvement in the Non-Medical Drivers of health care
- Improved Health of the Population
What are the non-medical drivers of health care?
They are the SOCIAL DETERMINANTS OF HEALTH. A picture says a thousand words: