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>> which would offer the poorest half of India health insurance to apply toward private hospitals This is a terrible idea. Did they learn nothing from the fail

>> which would offer the poorest half of India health insurance to apply toward private hospitals This is a terrible idea. Did they learn nothing from the failure of Health Care in the United States? When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view. The solution is to make the consumer participate in driving costs down. In the US, one employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, but can be used any time, including after retirement). So the maximum you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize and control medical expenditure? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.

h4b4n3r0 8y ago
$4k is not a “large amount”. I buy my own insurance and cheapest plan that covers anything at all is $13k/yr for a family of 3. If that’s all this employer is contributing, the employees are getting shafted.
- nv-vn 8y ago
  The GP was probably just making up numbers or basing it on costs for a single person.
rishav_sharan 8y ago
This is not a problem in India as a lot of treatment s in govt run hospitals is free for low income people. But then, the problem is that such hospitals are hugely overused and the quality of care suffers. By enabling the poor to use private options the demand can be better distributed between private and public.
victor106 8y ago
That is one of the best ideas I have heard on healthcare so far. I wonder which company that is. One thing I would add to that plan is to provide free annual/biannual preventive health checkups. The incentive shouldn’t be so much that consumers stop going to a doctor at all.
vsr_pg 8y ago
With all due respect, the premise of this comment--that consumers reduce costs by "shopping around" and being cost conscious--is being misrepresented. The plan type I believe you are referring to is a high-deductible health plan. HDHPs have a little success at reducing costs, but mostly at the expense of compromising quality of care. They can be a part of the solution, but they are not "the" solution as you put it. “Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” says lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2664065 https://jamanetwork.com/journals/jamainternalmedicine/articl...) "Research published last year in the American Journal of Managed Care showed that switching to a consumer-directed health plan—an HDHP paired with a health savings account—did, in fact, result in lower outpatient spending. But the researchers, led by Neeraj Sood, vice dean and professor at USC’s Price School of Public Policy at the University of Southern California, found no change in spending on 26 commonly used, low-value services." (https://www.managedcaremag.com/archives/2018/6/hdhps-cost-shift-no-swing-high-value-care https://www.managedcaremag.com/archives/2018/6/hdhps-cost-sh...) "Current evidence suggests that HDHPs are associated with lower health care costs as a result of a reduction in the use of health services, including appropriate services" (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0610 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0...)
- icebraining 8y ago
  The proposal seems to be for an HDHP with an employer-funded HSA, which would remove the inventive to save that money for non-healthcare-related expenses. It's not clear to me that those studies are valid for that particular model.
cpeterso 8y ago
> the maximum you will spend out of pocket per year is $2000. Do the employees have to pay all of their medical costs up front out of pocket and are later reimbursed $4000 through the HSA? So an employee must have the available funds to pay more than $2000 up front.
thatfrenchguy 8y ago
Lol « participating for costs » is a staple of American healthcare and it’s 10x more expensive than not participating for cost literally every other country :-). And then you get the usual people not going to the doctor when they’re sick (staple of american life) and infecting everyone.
- cyborgx7 8y ago
  Exactly "participating for costs" is exactly what is destroying the American health system. And it's what sets it appart from most other developed nations where helthcare works. The idea that this is what is missing, is one of the worst conclusions I've ever seen.
  - refurb 8y ago
    My understanding is that there are several countries in the EU where you are expected to pony up money for healthcare. It's usually token amounts, but the fact they do that indicates that's not what's "destroying the American health system".
    - thatfrenchguy 8y ago
      Token amounts means you're never going to ask yourself "can I afford this 3 euros ?", compared to the "should I really do this x-ray and eat up my 500$ deductible ?"
pcrh 8y ago
There is merit in having a deductible, however there are several ways in which this system is flawed. First, employers should be out of the healthcare equation entirely, except in as far as either taxes or salaries are used to fund health costs the employee bears. After all, employers don't participate in many other common expenses people bear, from housing to educating their children. Second, individuals are generally not capable of "shopping around" for the best value healthcare; they simply don't have sufficient knowledge to properly evaluate the various options. This is why you need some form of independent assessment of treatment costs and benefits, such as the UK's National Institute for Health and Care Excellence [1]. Insurance based systems with government oversight are the norm in most of Europe. https://www.nice.org.uk/ https://www.nice.org.uk/
- blinkingled 8y ago
  > First, employers should be out of the healthcare equation entirely, This. A million times. If there's one thing that's bugged me a hell lot as an immigrant in the US it is this. It's insane to give employers control over something as personal as your healthcare. I have been lucky enough not to have major issues with this arrangement but I have heard far too many horror stories from colleagues.
vidarh 8y ago
Yet somehow this works e.g. in France, or for GPs and dentists in the UK. A lot of socialised universal healthcare systems socialise the insurance part but rely on private actors to deliver all or part of the service. They tend to keep the prices down by either regulating them, or having the socialised insurance provider negotiate a fee structure on the basis that the insurance provider can offer the lowest amount that gives sufficient capacity of the required standard. E.g. in the UK, general practitioners negotiate as a block, and individual practices can take or leave whether or not they want to provide services for the NHS or private services. The NHS needs to offer contracts attractive enough for enough practices to take NHS patients and ensure continued recruitment, but no better. It's a market, but skewed by a very large actor with a strong interest in keeping prices down. If they "just" let people shop around without regulating or negotiating prices (and leveraging the volume of business), then it would be a problem. But having the consumer participate in driving costs down is demonstrably not necessary. On the contrary I'd argue it's counter-productive, because when dealing with people with less money it creates a risk that people gamble on options that cost less in the short term at the expense of creating higher costs in the long run.
neffy 8y ago
There speaks the healthy... ... when you or your family are on death´s door because of an accident/cancer/heart attack/stroke/bug/immune disorder etc., you may find comparison shopping isn´t the first thing that comes to mind.
trumped 8y ago
Terrible idea. The $6000 should instead be a percentage of your income (above a certain point, like poverty)... i.e.: ($60,000 - $12,000) * 0.05
jogjayr 8y ago
> When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view. There's also the problem that there isn't any price transparency in the US health care system. You literally can't find out how much many procedures cost ahead of time.
dv_dt 8y ago
Most first world nations have government bodies with medical experts setting maximum costs for drugs and procedures. Their costs for healthcare are much lower than the US. The idea that "The solution is to make the consumer participate in driving costs down." has been demonstrated in none of those nations for healthcare. As a well-educated white collar worker in a non-medical field, if I broke a bone and a doctor gave me three different options and costs for setting that bone, I would really have no basis for being able to choose the right option for the best long-term cost/quality of health. This idea is like asking regular computer users to determine what software stack they should buy to use in their cloud computing provider.

h4b4n3r0 8y ago

$4k is not a “large amount”. I buy my own insurance and cheapest plan that covers anything at all is $13k/yr for a family of 3. If that’s all this employer is contributing, the employees are getting shafted.

nv-vn 8y ago
The GP was probably just making up numbers or basing it on costs for a single person.

rishav_sharan 8y ago

This is not a problem in India as a lot of treatment s in govt run hospitals is free for low income people. But then, the problem is that such hospitals are hugely overused and the quality of care suffers. By enabling the poor to use private options the demand can be better distributed between private and public.

victor106 8y ago

That is one of the best ideas I have heard on healthcare so far. I wonder which company that is. One thing I would add to that plan is to provide free annual/biannual preventive health checkups. The incentive shouldn’t be so much that consumers stop going to a doctor at all.

vsr_pg 8y ago

With all due respect, the premise of this comment--that consumers reduce costs by "shopping around" and being cost conscious--is being misrepresented. The plan type I believe you are referring to is a high-deductible health plan. HDHPs have a little success at reducing costs, but mostly at the expense of compromising quality of care. They can be a part of the solution, but they are not "the" solution as you put it. “Most Americans in HDHPs are not doing things that can help them get the care they need at the lowest possible cost, and even those who are doing so could realize more benefits,” says lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine at U-M. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2664065 https://jamanetwork.com/journals/jamainternalmedicine/articl...) "Research published last year in the American Journal of Managed Care showed that switching to a consumer-directed health plan—an HDHP paired with a health savings account—did, in fact, result in lower outpatient spending. But the researchers, led by Neeraj Sood, vice dean and professor at USC’s Price School of Public Policy at the University of Southern California, found no change in spending on 26 commonly used, low-value services." (https://www.managedcaremag.com/archives/2018/6/hdhps-cost-shift-no-swing-high-value-care https://www.managedcaremag.com/archives/2018/6/hdhps-cost-sh...) "Current evidence suggests that HDHPs are associated with lower health care costs as a result of a reduction in the use of health services, including appropriate services" (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0610 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0...)

icebraining 8y ago
The proposal seems to be for an HDHP with an employer-funded HSA, which would remove the inventive to save that money for non-healthcare-related expenses. It's not clear to me that those studies are valid for that particular model.

cpeterso 8y ago

> the maximum you will spend out of pocket per year is $2000. Do the employees have to pay all of their medical costs up front out of pocket and are later reimbursed $4000 through the HSA? So an employee must have the available funds to pay more than $2000 up front.

thatfrenchguy 8y ago

Lol « participating for costs » is a staple of American healthcare and it’s 10x more expensive than not participating for cost literally every other country :-). And then you get the usual people not going to the doctor when they’re sick (staple of american life) and infecting everyone.

cyborgx7 8y ago
Exactly "participating for costs" is exactly what is destroying the American health system. And it's what sets it appart from most other developed nations where helthcare works. The idea that this is what is missing, is one of the worst conclusions I've ever seen.
- refurb 8y ago
  My understanding is that there are several countries in the EU where you are expected to pony up money for healthcare. It's usually token amounts, but the fact they do that indicates that's not what's "destroying the American health system".
  - thatfrenchguy 8y ago
    Token amounts means you're never going to ask yourself "can I afford this 3 euros ?", compared to the "should I really do this x-ray and eat up my 500$ deductible ?"

pcrh 8y ago

There is merit in having a deductible, however there are several ways in which this system is flawed. First, employers should be out of the healthcare equation entirely, except in as far as either taxes or salaries are used to fund health costs the employee bears. After all, employers don't participate in many other common expenses people bear, from housing to educating their children. Second, individuals are generally not capable of "shopping around" for the best value healthcare; they simply don't have sufficient knowledge to properly evaluate the various options. This is why you need some form of independent assessment of treatment costs and benefits, such as the UK's National Institute for Health and Care Excellence [1]. Insurance based systems with government oversight are the norm in most of Europe. https://www.nice.org.uk/ https://www.nice.org.uk/

blinkingled 8y ago
> First, employers should be out of the healthcare equation entirely, This. A million times. If there's one thing that's bugged me a hell lot as an immigrant in the US it is this. It's insane to give employers control over something as personal as your healthcare. I have been lucky enough not to have major issues with this arrangement but I have heard far too many horror stories from colleagues.

vidarh 8y ago

Yet somehow this works e.g. in France, or for GPs and dentists in the UK. A lot of socialised universal healthcare systems socialise the insurance part but rely on private actors to deliver all or part of the service. They tend to keep the prices down by either regulating them, or having the socialised insurance provider negotiate a fee structure on the basis that the insurance provider can offer the lowest amount that gives sufficient capacity of the required standard. E.g. in the UK, general practitioners negotiate as a block, and individual practices can take or leave whether or not they want to provide services for the NHS or private services. The NHS needs to offer contracts attractive enough for enough practices to take NHS patients and ensure continued recruitment, but no better. It's a market, but skewed by a very large actor with a strong interest in keeping prices down. If they "just" let people shop around without regulating or negotiating prices (and leveraging the volume of business), then it would be a problem. But having the consumer participate in driving costs down is demonstrably not necessary. On the contrary I'd argue it's counter-productive, because when dealing with people with less money it creates a risk that people gamble on options that cost less in the short term at the expense of creating higher costs in the long run.

neffy 8y ago

There speaks the healthy... ... when you or your family are on death´s door because of an accident/cancer/heart attack/stroke/bug/immune disorder etc., you may find comparison shopping isn´t the first thing that comes to mind.

trumped 8y ago

Terrible idea. The $6000 should instead be a percentage of your income (above a certain point, like poverty)... i.e.: ($60,000 - $12,000) * 0.05

jogjayr 8y ago

> When insurance pays for everything patients stop worrying about costs, which in turn causes hospitals and drug companies to raise prices. This is what has caused Health Care to fail from a costs point of view. There's also the problem that there isn't any price transparency in the US health care system. You literally can't find out how much many procedures cost ahead of time.

dv_dt 8y ago

Most first world nations have government bodies with medical experts setting maximum costs for drugs and procedures. Their costs for healthcare are much lower than the US. The idea that "The solution is to make the consumer participate in driving costs down." has been demonstrated in none of those nations for healthcare. As a well-educated white collar worker in a non-medical field, if I broke a bone and a doctor gave me three different options and costs for setting that bone, I would really have no basis for being able to choose the right option for the best long-term cost/quality of health. This idea is like asking regular computer users to determine what software stack they should buy to use in their cloud computing provider.