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The alternative is medicare for all bundled with something that looks like per capita allocations to take care of a patient population. Patients pay nothing at
by SapphireSun 9y ago
The alternative is medicare for all bundled with something that looks like per capita allocations to take care of a patient population. Patients pay nothing at the point of service. Hospitals must drive down costs to make a profit. If they start cutting corners, they lose their bonuses. If they really aren't making enough money to do their job and can prove it to an independent board, their allocations can be increased. You can imagine some kind of bonus system based on YOY improvement or maintenance of patient outcomes.
- nradov 9y agoThat doesn't work for a single hospital in isolation since hospitals mostly only treat patients that present with serious problems. If you're going to use a capitation payment model then it has to cover a complete integrated delivery network including acute care, ambulatory care, laboratories, imaging, physical therapy, etc.
- SapphireSun 9y agoThat's what I was thinking of but didn't articulate correctly. Can you elaborate? What interactions fail if the model isn't comprehensive?
- nradov 9y agoThere's just no practical way to do it. If a payer wanted to do capitation payments to a single isolated acute care hospital how would they even figure out what to pay and what incentive would the hospital have to take that deal? In order for something like an accountable care organisation (ACO) to work they have to control all aspects of patient care so that they have a chance to address problems early, long before the patient is admitted to the hospital.
- SapphireSun 9y agoI think this is similar to the idea of Health Justice that I've heard Tim Faust talk about. The reason the hospital will take the deal is simple, it's the only deal by law and the private insurance payers will be eliminated.
- nradov 9y agoWe don't live in a dictatorship and there's no way politically to force them to take that deal. Major changes won't be made to the healthcare system without at least rough consensus from the wealthiest and most powerful stakeholders, including major hospital chains. Even under single payer systems, hospitals are funded at least partially based on the actual amount of care delivered.
- SapphireSun 9y agoAs you can see with the tax plan being rammed through, the minority of the wealthiest can ram through whatever they damn well please. We can do the same to them. We outnumber them. Any yes, we can rationally allocate resources to ensure care is adequately delivered.