- Who comes up with the fraud prevention standards for the claims clearinghouse?
- Why centrally negotiate ambulance and emergency department prices instead of having the former be set by local bidding and the latter via negotiation/networks with insurers?
Revisions
- Replace diagnosis based risk adjustment with reinsurance
- Maintain demographic-based risk adjustment (if you want to keep community rating)
- Both financed by a fee on all Medicare plans
- I’d do a higher out of pocket maximum also
Possible Additions
- Default to longer-term insurance contracts
- Publish risk-adjusted mortality scores for each plan at point of purchase (could replace star system)
- Bundle life insurance
- End site-based billing (favors large hospitals at the expense of all other types of facilities)
- Shift FDA to just a safety standard (instead of safety and efficacy)
1. The government, and specifically CMS, presumably.
2. Because it appears the market is absolutely awful at setting prices that way. Prices both in the US and in the Netherlands set that way vary wildly without justification or convergence. Furthermore, the lack of elasticity of demand for emergency services and unstoppability creates a bargaining framework that is especially prone to rent-seeking on behalf of providers. Central negotiation would lead to more rational and lower prices.
Responses to Revisions
Still don't fully understand 1-2
Responses to Additions
1 Makes sense, what length?
2 Hmm are there any other variables you think should be published to?
A side issue not directly related to healthcare itself has been having an effect on healthcare administration. Hospitals and other institutions related to medicine seem to be hit disproportionately by ransomware and other cyber attacks. Is there something about such institutions which makes them more prone to such attacks? Such incidents can drive up costs and undermine confidence in the system.
My preliminary thoughts:
Questions
- Who comes up with the fraud prevention standards for the claims clearinghouse?
- Why centrally negotiate ambulance and emergency department prices instead of having the former be set by local bidding and the latter via negotiation/networks with insurers?
Revisions
- Replace diagnosis based risk adjustment with reinsurance
- Maintain demographic-based risk adjustment (if you want to keep community rating)
- Both financed by a fee on all Medicare plans
- I’d do a higher out of pocket maximum also
Possible Additions
- Default to longer-term insurance contracts
- Publish risk-adjusted mortality scores for each plan at point of purchase (could replace star system)
- Bundle life insurance
- End site-based billing (favors large hospitals at the expense of all other types of facilities)
- Shift FDA to just a safety standard (instead of safety and efficacy)
Answers
1. The government, and specifically CMS, presumably.
2. Because it appears the market is absolutely awful at setting prices that way. Prices both in the US and in the Netherlands set that way vary wildly without justification or convergence. Furthermore, the lack of elasticity of demand for emergency services and unstoppability creates a bargaining framework that is especially prone to rent-seeking on behalf of providers. Central negotiation would lead to more rational and lower prices.
Responses to Revisions
Still don't fully understand 1-2
Responses to Additions
1 Makes sense, what length?
2 Hmm are there any other variables you think should be published to?
3 Interesting, why?
4 What is the alternative?
5 Based
A thoughtful and reality based post.
A side issue not directly related to healthcare itself has been having an effect on healthcare administration. Hospitals and other institutions related to medicine seem to be hit disproportionately by ransomware and other cyber attacks. Is there something about such institutions which makes them more prone to such attacks? Such incidents can drive up costs and undermine confidence in the system.
Interesting question! Let me know if you find anything and i’ll add it to my notes ;)