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Somebody will be paying, and will want adequate and auditable documentation about what they are paying for. The potential for fraud is too great. Medicare and s

Somebody will be paying, and will want adequate and auditable documentation about what they are paying for. The potential for fraud is too great. Medicare and states all have to watch for fraud in their claim payments.

bdamm 8y ago
Right, but it’s probably done by auditing resources to treatment records. The actual patient needn’t be involved. And in countries like Canada you may end up with multiple operating agencies that are competing for efficiency, such as Coastal Health vs Providence, even though ultimately it’s the government footing the bill.
- Scoundreller 8y ago
  Providence is under Vancouver Coastal health. The authorities aren’t competing with each other (well, not really) as they have their own geographic catchments.
  - bdamm 8y ago
    Right, but they're able to be audited against each other, even though they have separate geographic catchments. Significant discrepancies can be then analyzed. Folks who view single-payer as a system without checks need to know how those checks do in fact occur.
analog31 8y ago
That's true. But I think the system could be simpler if there were fewer, and possibly just one, entities. I work in a factory, so we live by SAP. And it's complex, typical "enterprise" software, but I don't think it's even within an order of magnitude as complex as Epic. We want an audit trail, but most of the transactions are made within a single business entity, e.g., from the stockroom to an assembly area. We've had process improvement projects that reduced the number of SAP transactions required to make something. So maybe the key isn't so much having a government run system, but simply reducing the number of entities. For instance a hospital doesn't have to make a claim to Medicare, if the hospital is Medicare. Also, the game of figuring out how much to bill the patient goes away. We don't even know how many entities there are in the medical system, or how much money is going to each one. Were I inclined towards cynicism, I'd suspect that this is by design.
xenadu02 8y ago
If we had a national healthcare system the documentation would consist of proof of citizenship or permanent residency (or guardian's proof of same in the case of minors). That allows spot-checks to validate that fake or deceased people aren't being "treated" to generate fake charges. Right now even Medicare/Medicaid need lots of process to verify you are eligible and/or enrolled. That wouldn't be a problem if everyone were covered automatically.
SolarNet 8y ago
Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price. And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abuse (by either seekers or medical personnel). With free access to proper care those drug abuse problems will sharply decrease, killing the market (the cause of the other half of drug abuse). The only reason there is medicare fraud to worry about right now is because not everyone is supposed to be on it, the "fraud" is attempting to get free health care. Which wouldn't exist if everyone had it.
- chii 8y ago
  > And also, what abuse? a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.
  - emilfihlman 8y ago
    Solved by not allowing money to enter the circle. Results in you needing to sell the drugs/things you overcount on, which is rather easy to track and find out.
    - jdminhbg 8y ago
      > Solved by not allowing money to enter the circle. This is not possible without socializing the entire economy. At some point, you have to pay doctors, nurses, staff, equipment manufacturers, etc.
      - chobeat 8y ago
        If they are public employees, they have sort of a standardized salary coming straight from the healthcare ministry/department/whatever where the specific hospital just administer the HR part. You still think in a for profit manner, where healthcare in most countries is not a for-profit endeavour. As long as it works, it's fine, even if it's a net negative. You try to limit the money you waste and inefficiencies, but not by pulling levers on the staff salaries.
Escolte 8y ago
From my Spanish Perspective. What fraud? Going to the doctor is literally useless unless you're ill. They will literally send you away home if they find you to be fine. The doctors and nurses and personnel and what have you will also get mad at you for wasting their time unjustifiably (and I've done this myself and oh boy they left an impression on me). If you mean Government fraud, from the ones planning the system yes, indeed, all documentation about how much a healthcare center "costs", how their location and capacity is decided, and etc... should be open and easily accessible to the public. Medication is partially subsidized and never given for free at a medical center or hospital unless it's an emergency, older than 65+, disabled, etc... Recently, the government ordered to make like 1200 common meds cheaper (link in Spanish) https://cadenaser.com/ser/2018/12/29/sociedad/1546084258_187663.html https://cadenaser.com/ser/2018/12/29/sociedad/1546084258_187...
- dtech 8y ago
  You're right that "patient"-doctor fraud is unlikely, but receiving unnecessary medication (addictive/fun/valuable drugs) or medical people overcharging or charging for unperformed or unnecessary procedures is a possibility for fraud.
  - endless1234 8y ago
    But the personnel are salaried, not paid per procedure.
    - lostlogin 8y ago
      Most hospitals have on-call work, overtime, outsourced work, consumables that can be billed for etc. Pay cheques vary a huge amount depending on work done, and as a radiographer in a regional hospital my yearly wage was more than half made up by penal rates and overtime.
criddell 8y ago
There's a balance though. A huge bureaucracy to stop all fraud is expensive and cumbersome. There's going to be an acceptable level of fraud in order to keep the administration costs of the system in check. Other countries have figured this out. The US could use the experience of our allies that already have systems that are working to design a system for us.

bdamm 8y ago

Right, but it’s probably done by auditing resources to treatment records. The actual patient needn’t be involved. And in countries like Canada you may end up with multiple operating agencies that are competing for efficiency, such as Coastal Health vs Providence, even though ultimately it’s the government footing the bill.

Scoundreller 8y ago
Providence is under Vancouver Coastal health. The authorities aren’t competing with each other (well, not really) as they have their own geographic catchments.
- bdamm 8y ago
  Right, but they're able to be audited against each other, even though they have separate geographic catchments. Significant discrepancies can be then analyzed. Folks who view single-payer as a system without checks need to know how those checks do in fact occur.

analog31 8y ago

That's true. But I think the system could be simpler if there were fewer, and possibly just one, entities. I work in a factory, so we live by SAP. And it's complex, typical "enterprise" software, but I don't think it's even within an order of magnitude as complex as Epic. We want an audit trail, but most of the transactions are made within a single business entity, e.g., from the stockroom to an assembly area. We've had process improvement projects that reduced the number of SAP transactions required to make something. So maybe the key isn't so much having a government run system, but simply reducing the number of entities. For instance a hospital doesn't have to make a claim to Medicare, if the hospital is Medicare. Also, the game of figuring out how much to bill the patient goes away. We don't even know how many entities there are in the medical system, or how much money is going to each one. Were I inclined towards cynicism, I'd suspect that this is by design.

xenadu02 8y ago

If we had a national healthcare system the documentation would consist of proof of citizenship or permanent residency (or guardian's proof of same in the case of minors). That allows spot-checks to validate that fake or deceased people aren't being "treated" to generate fake charges. Right now even Medicare/Medicaid need lots of process to verify you are eligible and/or enrolled. That wouldn't be a problem if everyone were covered automatically.

SolarNet 8y ago

Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price. And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abuse (by either seekers or medical personnel). With free access to proper care those drug abuse problems will sharply decrease, killing the market (the cause of the other half of drug abuse). The only reason there is medicare fraud to worry about right now is because not everyone is supposed to be on it, the "fraud" is attempting to get free health care. Which wouldn't exist if everyone had it.

chii 8y ago
> And also, what abuse? a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.
- emilfihlman 8y ago
  Solved by not allowing money to enter the circle. Results in you needing to sell the drugs/things you overcount on, which is rather easy to track and find out.
  - jdminhbg 8y ago
    > Solved by not allowing money to enter the circle. This is not possible without socializing the entire economy. At some point, you have to pay doctors, nurses, staff, equipment manufacturers, etc.
    - chobeat 8y ago
      If they are public employees, they have sort of a standardized salary coming straight from the healthcare ministry/department/whatever where the specific hospital just administer the HR part. You still think in a for profit manner, where healthcare in most countries is not a for-profit endeavour. As long as it works, it's fine, even if it's a net negative. You try to limit the money you waste and inefficiencies, but not by pulling levers on the staff salaries.

Escolte 8y ago

From my Spanish Perspective. What fraud? Going to the doctor is literally useless unless you're ill. They will literally send you away home if they find you to be fine. The doctors and nurses and personnel and what have you will also get mad at you for wasting their time unjustifiably (and I've done this myself and oh boy they left an impression on me). If you mean Government fraud, from the ones planning the system yes, indeed, all documentation about how much a healthcare center "costs", how their location and capacity is decided, and etc... should be open and easily accessible to the public. Medication is partially subsidized and never given for free at a medical center or hospital unless it's an emergency, older than 65+, disabled, etc... Recently, the government ordered to make like 1200 common meds cheaper (link in Spanish) https://cadenaser.com/ser/2018/12/29/sociedad/1546084258_187663.html https://cadenaser.com/ser/2018/12/29/sociedad/1546084258_187...

dtech 8y ago
You're right that "patient"-doctor fraud is unlikely, but receiving unnecessary medication (addictive/fun/valuable drugs) or medical people overcharging or charging for unperformed or unnecessary procedures is a possibility for fraud.
- endless1234 8y ago
  But the personnel are salaried, not paid per procedure.
  - lostlogin 8y ago
    Most hospitals have on-call work, overtime, outsourced work, consumables that can be billed for etc. Pay cheques vary a huge amount depending on work done, and as a radiographer in a regional hospital my yearly wage was more than half made up by penal rates and overtime.

criddell 8y ago

There's a balance though. A huge bureaucracy to stop all fraud is expensive and cumbersome. There's going to be an acceptable level of fraud in order to keep the administration costs of the system in check. Other countries have figured this out. The US could use the experience of our allies that already have systems that are working to design a system for us.