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> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care,

> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. We have this already to an extent with managed care. The old system of fee for service incentivizes healthcare providers to treat the symptom and not the root cause. As of 2016 over 80% of Medicaid and Medicare patients patients are on a form of managed care plan instead of a fee for service. And Medicaid and Medicare are responsible for about 40% of Americans. Additionally there are systems like Kaiser that have similar incentives in the private market.

Frost1x 7y ago
There are still plenty of abuses in managed care plans that I've seen (I'm closely related to several healthcare professionals working in home healthcare and in/outpatient service providers). For example, often times, healthcare professionals are encouraged/pressured to report improvements during the managed care plan at ambiguous levels (lie) to continue regimes to the allowable extent before they're discharged. Those patients are frequently then readmitted for the same or other health problems after new hospital visits. Healthcare providers are often pressured to not report their judgement tells them a specific treatment program won't help a patient much in their professional opinion. Ultimately, the incentive for continued treatment to maximize profit is still there, the approaches just change/adapt to fit within new rule systems. It's really down to individual healthcare professionals to resist continual unethical business pressures concerned with profit over patient outcome which can put their employment/livelihood at risk if they don't have their own practice. This happens in large and small healthcare providers from my sample pool of 3 huge national providers, 3 local/regional hospitals, and several in home healthcare from varied business size. The only leverage healthcare professionals have is that they're in such high demand and under supplied that they can often resist these pressures. If that changes, their hours are often reduced or they're replaced by people with more ethical flexibility. So we (our society) still don't care about patient outcomes. We can pretend we do and often the healthcare professional working directly with you probably does care about your outcomes (most people aren't sociopaths) but they may have to frequently weight milking you and your insurance provider against their livelihoods which shouldn't be the case (healthcare will always have continual demand, pretty much guaranteed business).
- gnopgnip 7y ago
  Most of the managed healthcare plans base the patient outcomes on a number of factors, and the doctors report is either not a factor at all or a small factor. If the patients are being readmitted multiple times that will outweigh what is misreported. But more generally I agree that there will always be financial pressure weighing against ethical issues or patient outcomes. But a managed care plan is strictly better than fee for service in aligning patient outcomes and incentives for healthcare providers. And there is market pressure going the other way, patients can switch healthcare plans or switch providers if they have a better alternative with better outcomes.

Frost1x 7y ago

There are still plenty of abuses in managed care plans that I've seen (I'm closely related to several healthcare professionals working in home healthcare and in/outpatient service providers). For example, often times, healthcare professionals are encouraged/pressured to report improvements during the managed care plan at ambiguous levels (lie) to continue regimes to the allowable extent before they're discharged. Those patients are frequently then readmitted for the same or other health problems after new hospital visits. Healthcare providers are often pressured to not report their judgement tells them a specific treatment program won't help a patient much in their professional opinion. Ultimately, the incentive for continued treatment to maximize profit is still there, the approaches just change/adapt to fit within new rule systems. It's really down to individual healthcare professionals to resist continual unethical business pressures concerned with profit over patient outcome which can put their employment/livelihood at risk if they don't have their own practice. This happens in large and small healthcare providers from my sample pool of 3 huge national providers, 3 local/regional hospitals, and several in home healthcare from varied business size. The only leverage healthcare professionals have is that they're in such high demand and under supplied that they can often resist these pressures. If that changes, their hours are often reduced or they're replaced by people with more ethical flexibility. So we (our society) still don't care about patient outcomes. We can pretend we do and often the healthcare professional working directly with you probably does care about your outcomes (most people aren't sociopaths) but they may have to frequently weight milking you and your insurance provider against their livelihoods which shouldn't be the case (healthcare will always have continual demand, pretty much guaranteed business).

gnopgnip 7y ago
Most of the managed healthcare plans base the patient outcomes on a number of factors, and the doctors report is either not a factor at all or a small factor. If the patients are being readmitted multiple times that will outweigh what is misreported. But more generally I agree that there will always be financial pressure weighing against ethical issues or patient outcomes. But a managed care plan is strictly better than fee for service in aligning patient outcomes and incentives for healthcare providers. And there is market pressure going the other way, patients can switch healthcare plans or switch providers if they have a better alternative with better outcomes.