Tuesday, May 12, 2009

Health Care and Consumers in Charge

Americans have a take charge mentality. This is especially true when health care is at stake. No one wants to be told that they must go to a certain doctor or be limited to a particular medical provider. That is one reason that HMOs have not been as popular as other types of health plans. People really love the power of choice for their health issues. According to HSA For America, more people than ever are signing up for HSA-qualified health insurance plans - because you have lower premiums, you get a pre-tax treatment on funds to pay your medical expenses, and you are able to set up an additional retirement account that grows tax-free.

Also, according to "Taking Charge of Your Health," a comprehensive new website that offers free advice, healthcare tips, and resources for consumers, is now live and helping people "take charge" of their health and well-being. Created by national integrated health leader the Center for Spirituality and Healing at the University of Minnesota in collaboration with the nonprofit Life Science Foundation, the site invites visitors to better manage - and expand - their healthcare options by providing information and tools for individuals to: (1) create a healthy lifestyle; (2) navigate the healthcare system; and (3) explore integrative therapies and healing practices.

1.) CREATE A HEALTHY LIFESTYLE: (www.takingcharge.csh.umn.edu/lifestyle). This section offers self-assessments and an interactive goal-setting process that focuses on eight aspects of health:
-- Diet-- Physical Activity-- Emotions & Attitudes-- Life Purpose-- Relationships-- Stress Mastery-- Self-Care-- The Environment.
2.) NAVIGATE THE HEALTHCARE SYSTEM: (www.takingcharge.csh.umn.edu/navigate-healthcare-system). This section helps people plan how best to use the healthcare system, including how to:
-- Find A Provider-- Evaluate Information on the Web-- Prepare for an Appointment-- Make Treatment Decisions-- Evaluate Insurance Options-- Increase the Likelihood of a Healthy Hospitalization .
3.) EXPLORE ALTERNATIVE HEALING PRACTICES:(www.takingcharge.csh.umn.edu/explore-healing-practices). This section provides in-depth information about the most commonly used integrative therapies, including information on over 40 integrative therapies and healing practices such as:
-- Reiki -- Acupuncture -- Mind-Body Approaches-- Music Therapy -- Chiropractic-- Healing Touch -- Botanical Medicine.

Complaints about America’s health-care system are legion and familiar to employees and employers alike, according to Strategy-Business.com. After many rocky years, more and more people — employers, physicians, patients, politicians — are showing their frustration with the managed care system. Medical costs and insurance premiums keep rising. The doctor-patient relationship seems to have become as impersonal as an ATM transaction. And no one seems to have solutions. Despite its slow pace, change in the healthcare and insurance services system has been building for several years. The paradigm shift is especially evident in a Consumerism kind of health plan, which seeks to address rising costs and service quality shortcomings by giving consumers better information to make decisions and giving them greater control over how they spend their health-care dollars. The plan has different names, known variously as consumer-directed, self-directed, or consumer-driven but it’s a singular idea — power to the consumer — whose time has arrived.

According to Washington Policy Center, for too many years Americans have been divorced from the consequences of their health care decisions. Third-party payment has enabled us to see a doctor, purchase medications, and receive surgery, without a thought about cost. In some minds this is a wonderful thing - get all the health care services you need without agonizing over affordability. But being unconcerned about affordability carries a price. If consumers are not worried about cost, individuals spend more than they would otherwise. That puts pressure on the people who actually pay the bills. If some consumers are not worried about cost, others certainly are. There is ultimately no blank check, with unlimited access to services, one way or another. Regardless of the kind of third-party involved, whether an insurer, an employer, or the government, they will decide what is worth paying for and what is not. That is the cost consumers pay for "free" care provided by a third-party. Ultimately, there is only one way to put consumers back in the driver's seat. Give them control over the resources, so they can make their own value judgments and trade-offs about their own health care priorities.

Here are some of the ideas that are putting consumers in charge, according to the Washington Policy Center:
1.) Flexible Spending Accounts (FSAs) enable workers to place part of their salary into an employer-sponsored account to pay directly for health care expenses. A provision of FSAs requires unspent funds to be forfeited to the employer at the end of the year.
2.) Health Savings Accounts (HSAs) are actually owned by the employee in conjunction with a high deductible insurance plan. Any unused funds stay in the accounts and build interest over time, similar to a 401(k) account.
3.) Indemnity insurance, unlike a third-party payment system, is a "two-party" contract in which an insured person pays a premium for future protection, and the insurer pays money to the insured person when a loss occurs. The consumer is paid the benefit directly, and is then responsible for paying the health provider. There is no expectation that the insurer have anything to do with the provider of care.
4.) Defined Contribution is a system in which the employer provides a fixed payment dedicated to employee health insurance benefits, and workers then use that contribution as core funding for a variety of benefit plans or benefit structures, often supplemented with their own funds.
5.) Opt-Out Provisions allow workers to take their employer's regular health care contribution in cash and use it to supplement a spouse's coverage, or for both earners to pool their funds to purchase coverage for the whole family.
6.) Independent Physicians represent a growing movement in the physician community to opt-out of insurance plans and the Medicare program. Many doctors are switching to a cash-based system, either independently or as part of a network of similarly inclined physicians. These physicians are finding substantial savings in overhead costs, which enable them to charge their patients less for services.
7.) New Information Systems (health info technology-HIT) allow doctors and patients to benefit from the transactional power of the Internet. Services now available on-line include doctor quality and price information, making appointments and getting follow-up care, on-line billing, information on treatments and finding disease-specific support groups.

According to Regina Herzlinger, businesses spend billions on health insurance. And what do they get for their money? A lot of unhappy employees. Workers fret about the quality of the care they receive, the burden of their out-of-pocket expenses, and the gaps in their coverage. For businesses, health care has become a lose-lose proposition: They pay way too much, and they get way too little. The problem is that the health care industry has been shielded from consumer pressure--by employers, insurers, and the government. As a result, costs have exploded even as choices have narrowed. But if companies embrace a consumerism model of health coverage--one that places control over both costs and care directly into the hands of employees--the competitive forces that spur productivity and innovation in consumer markets can be loosed upon the inefficient, tradition-bound health care system. Moving to consumer-driven health care requires that companies revamp their health benefits in six ways: Give employees incentives to shop intelligently; offer a real choice of insurance plans; charge employees prices that accurately reflect the company's costs; let providers set their own prices; adjust payments for each enrollee based on need; and provide relevant information. Putting consumers in charge of health care may seem like a radical approach. But individuals are highly motivated to educate themselves about their health, their insurance, and their care, and they want to seek the most value for their money. Promoting that economic dynamic--the same that fuels consumer markets everywhere--is the best way to enhance the health care industry's productivity and quality.

Today, according to the Washington Policy Center, there is a burst of innovation and energy going into creating a new approach for health care financing. The Consumerism era will put patients back where they belong - in the driver's seat of the health care system. After all, health care is not primarily about doctors, hospitals, insurers, and it is certainly not about employers and the government. Health care is about people. The best way for people to express their needs, values, and desires is through a market-based system that gives them the power to spend resources in a way that reflects those values.

Until next time. Let me know what you think.

1 comment:

brian7 said...

This article hit home. When I needed help with detox rehab I didn’t know where to get help.