4 ms·

> It has been around for decade. Assume that's a typo and you mean decades. Kaiser dates back to the interwar period and the modern version of it to the 70s/80

> It has been around for decade. Assume that's a typo and you mean decades. Kaiser dates back to the interwar period and the modern version of it to the 70s/80s. > For the majority it seems like it's a cheap but very rigid option (especially compared to PPOs). I don't think it's cheaper on the monthly premium level, at least for me it's always listed as the more expensive option to choose from. If you end up using significant healthcare services it's probably cheaper than most PPO plans. > People either hate it or love it because it is quite rigid in how it works (and you have to go specifically to their facilities). I've noticed that too in my friend group. I've heard good things and the rare case that gets sent in to my academic hospital comes with a chart that suggests Kaiser is providing high quality care (in the Bay Area at least). The rigidity is very annoying though, for example I wouldn't be able to get care at the hospital I work at if I went with Kaiser. Conceptually I like the idea of HMOs, seems less wasteful while still good quality.

jmspring 3y ago
Yes, typo. S key acting up.
massysett 3y ago
I’ve been in a Kaiser plan most of my life and the “rigidity” doesn’t bother me, maybe I’m just used to it. I know exactly where I get care. Nearly everything is under one roof: doctor, lab, pharmacy, x-ray, specialists, etc. I almost always know exactly what it will cost. In recent years, I can now book all appointments online and view my medical record online. I guess I understand the appeal of being able to pick any random doctor that takes Blue Cross Blue Shield, but this doesn’t appeal to me. I don’t know squat about picking doctors and might as well throw darts at a board. Most PPO plans I look at have vague pricing: “you pay 15 percent of the plan allowance.” Well, what exactly is “the plan allowance”? Kaiser quotes me an exact copay, like $30. And then I read horror stories about people being unable to get an appointment with a primary care doctor for months, if they can find one at all. Many just go to urgent care or ER for everything. Not a problem with Kaiser. I can look through their primary care doctors and pick one. If I don’t pick, they assign me one. I can get an appointment with my doctor in a few days or a few weeks sometimes. If I need an appointment right away, I can get one with another Kaiser doctor, perhaps at a clinic I never go to. I tried a non-Kaiser HMO for a year or two and hated it, right down to the doctor who answered his cell phone during my appointment. I look at PPOs and the opaque pricing kills it for me. Kaiser has been great.
- haldujai 3y ago
  > I’ve been in a Kaiser plan most of my life and the “rigidity” doesn’t bother me, maybe I’m just used to it. I should have said it can be* very annoying, the rigidity isn't an issue for everyone and it really depends on your situation/healthcare needs and what your alternatives are. The rigidity is mostly annoying when you want to see a specialist without having to go through a PCP (although this may not be a bad thing from a health systems perspective) or need advanced care (like cancer) that may be better outside of Kaiser (although again noting that they're still very good from what I've seen) and you want to choose where you get treatment. Or if, like in my situation, you know exactly where you want to get your care and it's not part of Kaiser.
hedora 3y ago
The rigidity and cost savings come from the fact that they don’t have to spend money negotiating with themselves about whether to pay a bill. On average, 33 cents of every insurance dollar in the US goes to paperwork and paid negotiators on the doctor or insurance company side. If hospitals and insurance companies established a standardized (regional) fixed price list for all procedures, auto-approved everything and asked patients to occasionally spot check bills for care they received (for anti-fraud), then all that could be automated, and the balance could go to increasing quality of care without increasing prices. That would make them cost-competitive and roughly as convenient as Kaiser, but also less rigid than Kaiser.
- haldujai 3y ago
  > On average, 33 cents of every insurance dollar in the US goes to paperwork and paid negotiators on the doctor or insurance company side. That's misleading, this is the percentage quoted for overall non-clinical costs. The better number you should be mentioning is billing and insurance related (BIR) expenditures which ranges from 3-15% depending on the setting you're talking about. Note that a fixed fee schedule does not eliminate BIR expenditures, Medicare which works like what you're proposing is ~3.5% for BIR. Canadian provinces are in the 5-10% range. > If hospitals and insurance companies established a standardized (regional) fixed price list for all procedures Should procedures cost the same wherever you go? The quality of care is certainly not the same although everyone meets the minimum standard. e.g. cancer care at Stanford is higher quality than at a neighboring community hospital, should they not be allowed to charge more for it? In any case that's the point of PPOs, the hospital/provider has pre-negotiated/accepted the insurer's fee schedule for the year. It's not negotiated on every visit. > auto-approved everything Does anywhere do this? How do you control for unnecessary/wasteful use of resources? Neither HMOs nor the public Canadian health system auto-approve everything. HMOs like Kaiser appear to "auto-approve" but they control the referral and keep a check on their PCP resource utilization and referral rates. You can't just walk in and demand a spine MRI because you've had back pain for 2 days, if the PCP imaging rates deviate from what is expected they will be audited and/or disciplined by Kaiser.

jmspring 3y ago

Yes, typo. S key acting up.

massysett 3y ago

I’ve been in a Kaiser plan most of my life and the “rigidity” doesn’t bother me, maybe I’m just used to it. I know exactly where I get care. Nearly everything is under one roof: doctor, lab, pharmacy, x-ray, specialists, etc. I almost always know exactly what it will cost. In recent years, I can now book all appointments online and view my medical record online. I guess I understand the appeal of being able to pick any random doctor that takes Blue Cross Blue Shield, but this doesn’t appeal to me. I don’t know squat about picking doctors and might as well throw darts at a board. Most PPO plans I look at have vague pricing: “you pay 15 percent of the plan allowance.” Well, what exactly is “the plan allowance”? Kaiser quotes me an exact copay, like $30. And then I read horror stories about people being unable to get an appointment with a primary care doctor for months, if they can find one at all. Many just go to urgent care or ER for everything. Not a problem with Kaiser. I can look through their primary care doctors and pick one. If I don’t pick, they assign me one. I can get an appointment with my doctor in a few days or a few weeks sometimes. If I need an appointment right away, I can get one with another Kaiser doctor, perhaps at a clinic I never go to. I tried a non-Kaiser HMO for a year or two and hated it, right down to the doctor who answered his cell phone during my appointment. I look at PPOs and the opaque pricing kills it for me. Kaiser has been great.

haldujai 3y ago
> I’ve been in a Kaiser plan most of my life and the “rigidity” doesn’t bother me, maybe I’m just used to it. I should have said it can be* very annoying, the rigidity isn't an issue for everyone and it really depends on your situation/healthcare needs and what your alternatives are. The rigidity is mostly annoying when you want to see a specialist without having to go through a PCP (although this may not be a bad thing from a health systems perspective) or need advanced care (like cancer) that may be better outside of Kaiser (although again noting that they're still very good from what I've seen) and you want to choose where you get treatment. Or if, like in my situation, you know exactly where you want to get your care and it's not part of Kaiser.

hedora 3y ago

The rigidity and cost savings come from the fact that they don’t have to spend money negotiating with themselves about whether to pay a bill. On average, 33 cents of every insurance dollar in the US goes to paperwork and paid negotiators on the doctor or insurance company side. If hospitals and insurance companies established a standardized (regional) fixed price list for all procedures, auto-approved everything and asked patients to occasionally spot check bills for care they received (for anti-fraud), then all that could be automated, and the balance could go to increasing quality of care without increasing prices. That would make them cost-competitive and roughly as convenient as Kaiser, but also less rigid than Kaiser.

haldujai 3y ago
> On average, 33 cents of every insurance dollar in the US goes to paperwork and paid negotiators on the doctor or insurance company side. That's misleading, this is the percentage quoted for overall non-clinical costs. The better number you should be mentioning is billing and insurance related (BIR) expenditures which ranges from 3-15% depending on the setting you're talking about. Note that a fixed fee schedule does not eliminate BIR expenditures, Medicare which works like what you're proposing is ~3.5% for BIR. Canadian provinces are in the 5-10% range. > If hospitals and insurance companies established a standardized (regional) fixed price list for all procedures Should procedures cost the same wherever you go? The quality of care is certainly not the same although everyone meets the minimum standard. e.g. cancer care at Stanford is higher quality than at a neighboring community hospital, should they not be allowed to charge more for it? In any case that's the point of PPOs, the hospital/provider has pre-negotiated/accepted the insurer's fee schedule for the year. It's not negotiated on every visit. > auto-approved everything Does anywhere do this? How do you control for unnecessary/wasteful use of resources? Neither HMOs nor the public Canadian health system auto-approve everything. HMOs like Kaiser appear to "auto-approve" but they control the referral and keep a check on their PCP resource utilization and referral rates. You can't just walk in and demand a spine MRI because you've had back pain for 2 days, if the PCP imaging rates deviate from what is expected they will be audited and/or disciplined by Kaiser.