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I'm curious how it would work at the hospital level, or even at the hospital network level. Pay the network a monthly fee, and then when you get sick, all of yo

I'm curious how it would work at the hospital level, or even at the hospital network level. Pay the network a monthly fee, and then when you get sick, all of your care is already paid for. I suppose this is the idea behind HMOs, but the execution hasn't been there.

ceejayoz 10y ago
All the little hospitals and clinics in our area have been bought up by one of the two healthcare networks in the five-county region, and I'm fairly shocked they haven't done this. Maybe it's illegal for a hospital system to offer insurance in NY? I don't know. You'd think they'd be happy to cut out all the fuss around handling insurance approvals/rejections and pocket the 20% middleman cut.
- whafro 10y ago
  I don't have a ton of first-hand knowledge, but I know that being licensed to provide health insurance in NY specifically is no joke. Todd Park (former US CTO, AthenaHealth founder) once told me that he didn't pay much attention to Oscar early on until he found out they had gained an NY license, at which point he dove into it. More broadly, many hospitals and hospital are getting involved in the ACO (accountable care org), which gets at some of these goals, but it's not 100% clear that an ACO model can be successful (financially or for patients), and it doesn't cut out all the relevant middle-men.
- chimeracoder 10y ago
  > Maybe it's illegal for a hospital system to offer insurance in NY? Definitely not. A lot of hospitals are part of networks which are doing exactly this. And many of the ones that aren't are entering long-term capitated agreements with insurers, which basically means they're acting as if they were insurers but without technically being one.
- Spooky23 10y ago
  The consolidation is happening because there's a huge surplus of hospital beds and specialists in NY.
coredog64 10y ago
It's more like capitation, which was tried very early on with PPOs. Unfortunately, people don't like being told "no", so a lot of the discipline required to make it work was removed.
- chimeracoder 10y ago
  > It's more like capitation, which was tried very early on with PPOs. Unfortunately, people don't like being told "no", so a lot of the discipline required to make it work was removed. Capitation is still very much alive, and in fact more common than ever. It's just structured now so that it's hidden from the patient. You may already be receiving care under capitated agreements yourself and simply not know it.

ceejayoz 10y ago

All the little hospitals and clinics in our area have been bought up by one of the two healthcare networks in the five-county region, and I'm fairly shocked they haven't done this. Maybe it's illegal for a hospital system to offer insurance in NY? I don't know. You'd think they'd be happy to cut out all the fuss around handling insurance approvals/rejections and pocket the 20% middleman cut.

whafro 10y ago
I don't have a ton of first-hand knowledge, but I know that being licensed to provide health insurance in NY specifically is no joke. Todd Park (former US CTO, AthenaHealth founder) once told me that he didn't pay much attention to Oscar early on until he found out they had gained an NY license, at which point he dove into it. More broadly, many hospitals and hospital are getting involved in the ACO (accountable care org), which gets at some of these goals, but it's not 100% clear that an ACO model can be successful (financially or for patients), and it doesn't cut out all the relevant middle-men.
chimeracoder 10y ago
> Maybe it's illegal for a hospital system to offer insurance in NY? Definitely not. A lot of hospitals are part of networks which are doing exactly this. And many of the ones that aren't are entering long-term capitated agreements with insurers, which basically means they're acting as if they were insurers but without technically being one.
Spooky23 10y ago
The consolidation is happening because there's a huge surplus of hospital beds and specialists in NY.

coredog64 10y ago

It's more like capitation, which was tried very early on with PPOs. Unfortunately, people don't like being told "no", so a lot of the discipline required to make it work was removed.

chimeracoder 10y ago
> It's more like capitation, which was tried very early on with PPOs. Unfortunately, people don't like being told "no", so a lot of the discipline required to make it work was removed. Capitation is still very much alive, and in fact more common than ever. It's just structured now so that it's hidden from the patient. You may already be receiving care under capitated agreements yourself and simply not know it.