4 ms·

That's denying, or more like denying the the whole purpose of insurance. Also, it's bad design of incentive. The insurance companies has an incentive to deny t

by ezoe 7y ago

That's denying, or more like denying the the whole purpose of insurance. Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. So the better incentive design is not to allow the insurance company to deny the payment. Take a look at my country(Japan) and my insurance company for example. They offer a free cancer test. Why? The treatment of later stage cancer costs so much money. Since they can't deny the payment, it's better to find the cancer as early as possible. That will reduce their cost, increase their profit. It also lead to healthier people as a bonus.

lotsofpulp 7y ago
Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid. US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect. It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will? Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society. I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.
gridlockd 7y ago
> Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time. Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.
greedo 7y ago
Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.

by ezoe 7y ago

lotsofpulp 7y ago

Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid. US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect. It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will? Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society. I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.

gridlockd 7y ago

> Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time. Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.

greedo 7y ago

Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.