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It’s not only profit. They also cause a lot of administrative overhead. For example if doctors had to deal only with one insurer or at least one coding system t
by Ididntdothis 7y ago
It’s not only profit. They also cause a lot of administrative overhead. For example if doctors had to deal only with one insurer or at least one coding system they wouldn’t need four billing assistants as I have seen. In essence insurance companies do a lot of unnecessary stuff. Their profit is only a small part of that cost.
- pg_bot 7y agoThere are two coding systems (ICD - for diseases, and CPT for procedures) that are mandated to use by medicare/medicaid and all the insurance companies use them as well. Most of them even accept the same forms. They need those billing assistants for other reasons.
- Ididntdothis 7y ago”They need those billing assistants for other reasons.” Whatever it is they do exactly it deals with insurance companies. Germany also has private doctors but they have much smaller staff and dealings with insurance are very straightforward. American insurance companies cause a lot of friction. I don’t know exactly why but they do.
- pg_bot 7y agoInsurance companies are mainly trying to combat fraud. They kick back claims if they are formatted wrong (why did you code an operation on the left knee when the right knee was the problem), or they deem that the work done was improper, unnecessary or does not fit the standard of care. Billing staff also handle accounts receivable and collections. The biggest problem IMO is how we structure payment for health services in the USA. The fee for service model is highly inefficient and disincentivizes preventative care. All of the current proposals for universal healthcare do not address this fundamental problem, and so long as this remains in place we will continue to have the highest costs in the world. (disclosure, I am working to try and solve this problem) If you were to pick countries to emulate, I would pick Singapore, Japan, the Netherlands, and Switzerland instead of Canada and the U.K.
- lotsofpulp 7y agoMuch of the administrative stuff insurers do to prevent healthcare providers from doing unnecessary stuff. In a taxpayer funded system, there would still have to be an entity to double check healthcare providers’ billing.
- ceejayoz 7y agoSuch an entity already exists. They're substantially more efficient at it. https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/ https://www.healthaffairs.org/do/10.1377/hblog20110920.01339... > According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
- Ididntdothis 7y agoThat’s government. We all know that private companies are always more efficient. Right?
- lotsofpulp 7y agoYes, I agree. I don’t see why Medicare should only apply to those 65+. But until it applies to everyone, insurance companies have to serve that purpose. I worded it confusingly, but I meant to imply that insurance companies’ work is not all waste, since they’re doing a task that someone has to do, even if all healthcare was taxpayer funded.
- lrem 7y agoOn the other hand: since automation is eating the useful jobs and we're not getting UBI any time soon, maybe that's for the better?
- seanmcdirmid 7y agoAnd the ACA only puts a lid on insurer administrative overhead, not hospital admin overhead....