2 ms·

Canada isn't hypothetical. It is very easy to compare costs and outcomes. I live in BC, Canada, and we don't have an entire industry built around claims proces

Canada isn't hypothetical. It is very easy to compare costs and outcomes. I live in BC, Canada, and we don't have an entire industry built around claims processing, administration, etc. They still pay health care workers, but they don't have to have phone banks filled with people answering questions about claim denials. I'm not even sure if a claim denial is a thing here, or who I would call. We don't have healthcare insurance CEOs making 23mm per year. We don't have customer service reps, we don't have billing specialists in every medical practice, we don't have medical coding experts. These things kind of exist in a bare minimum way, but not anywhere at the scale that I have seen in the US. I go to the doctor, they make a medical determination about what my needs are, and we proceed from there. There is almost no fraud because the doctor has no real financial incentive to overtreat me, and since it is a single payer system, malicious patterns get picked up quickly and efficiently. Keep in mind that each province administers their own medical system, so there is no such thing as the Canadian health insurance system.

onlyrealcuzzo 2y ago
> There is almost no fraud because the doctor has no real financial incentive to overtreat me The vast majority of healthcare fraud does not come from corrupt dentists convincing you to get root canals you don't need. The largest source is billing for services not rendered. That is: some provider just makes up that you came to see them and charges the insurance company and you don't even know about it. This is a non-trivial problem to solve. Even in the NHS in the UK - where the entire system, including the providers, are public - there is STILL a large billing for services not rendered problem!
- Teever 2y ago
  It seems relatively trivial to crack down on the bulk of it by providing people open and transparent access to their digital medical records. In a situation like that many people can proactively look over their records to determine if such corruption is happening.
  - onlyrealcuzzo 2y ago
    > It seems relatively trivial to crack down on the bulk of it by providing people open and transparent access to their digital medical records. Why isn't NHS doing it then?
    - Teever 2y ago
      I'm not a citizen of the UK so I can only speculate from a poorly informed position but I would imagine that it has to do with the starve the beast tactics that are being used to weaken the NHS to make it more susceptible to privatization.
- dghlsakjg 2y ago
  Weird. This seems trivially solvable. In BC, Canada, I had an old doctor renew a prescription over the phone. This must have triggered a fraud alert because my address was now in a different health management district. They sent me an automatic notice asking me to confirm that I had been helped by that doctor at that time. I believe I can also log onto a provincial portal and see activity related to my medical care. Seems like a pretty low cost way to ensure that no fraud is happening. Set up triggers for confirmation like doctors treating people who don't live nearby, treating people who are concurrently seeing other doctors, or any number of other known fraud alerts, and follow up. Since private practice isn't really allowed here, getting removed from the provincial insurance program means a career death sentence, so I think that it just isn't that big of a problem anyway.
allturtles 2y ago
> I live in BC, Canada, and we don't have an entire industry built around claims processing, administration, etc. There certainly must be people doing all of this claims processing, maybe not an "industry" since it's part of the government: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/claim-submission-payment/teleplan/claims-processing-system https://www2.gov.bc.ca/gov/content/health/practitioner-profe... > They still pay health care workers, but they don't have to have phone banks filled with people answering questions about claim denials. I'm not even sure if a claim denial is a thing here, or who I would call. There's a long list of rejected claim codes for BC here: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/claim-submission-payment/explanatory-codes https://www2.gov.bc.ca/gov/content/health/practitioner-profe... And a support center for handling questions and disputes: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/contact-us https://www2.gov.bc.ca/gov/content/health/practitioner-profe... And an appeals process: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp/bc-residents/managing-your-msp-account/appealing-a-decision https://www2.gov.bc.ca/gov/content/health/health-drug-covera... The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow.
- Teever 2y ago
  >The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow. But it isn't just the Canadian system -- it's every other system too.[0] There is a unique form of corruption occurring in the American health system and it is absolutely tied to the insurance industry. This corruption causes the misallocation of resources in ways that are detrimental to the health of American citizens. Medical bankruptcy and the cost that it has on a person's health isn't really a thing in Canada. Having to choose between paying for medical bills or healthy food isn't really a thing in Canada. People putting off minor medical issues until they grow into major issues because they can't afford routine checkups or treatments isn't really a thing in Canada. This results in far less rationing of healthcare because people are able to make better choices that prevent the waste of medical resources. Don't get me wrong, there are issues with Canadian healthcare -- the biggest being corrupt politicians and business people trying to import American healthcare practices for their personal gain but the issues that the average Canadian face in accessing healthcare are nothing compared to those that the average American faces. [0] https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_healthcare_spending.jpg https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_heal...

onlyrealcuzzo 2y ago

> There is almost no fraud because the doctor has no real financial incentive to overtreat me The vast majority of healthcare fraud does not come from corrupt dentists convincing you to get root canals you don't need. The largest source is billing for services not rendered. That is: some provider just makes up that you came to see them and charges the insurance company and you don't even know about it. This is a non-trivial problem to solve. Even in the NHS in the UK - where the entire system, including the providers, are public - there is STILL a large billing for services not rendered problem!

Teever 2y ago
It seems relatively trivial to crack down on the bulk of it by providing people open and transparent access to their digital medical records. In a situation like that many people can proactively look over their records to determine if such corruption is happening.
- onlyrealcuzzo 2y ago
  > It seems relatively trivial to crack down on the bulk of it by providing people open and transparent access to their digital medical records. Why isn't NHS doing it then?
  - Teever 2y ago
    I'm not a citizen of the UK so I can only speculate from a poorly informed position but I would imagine that it has to do with the starve the beast tactics that are being used to weaken the NHS to make it more susceptible to privatization.
dghlsakjg 2y ago
Weird. This seems trivially solvable. In BC, Canada, I had an old doctor renew a prescription over the phone. This must have triggered a fraud alert because my address was now in a different health management district. They sent me an automatic notice asking me to confirm that I had been helped by that doctor at that time. I believe I can also log onto a provincial portal and see activity related to my medical care. Seems like a pretty low cost way to ensure that no fraud is happening. Set up triggers for confirmation like doctors treating people who don't live nearby, treating people who are concurrently seeing other doctors, or any number of other known fraud alerts, and follow up. Since private practice isn't really allowed here, getting removed from the provincial insurance program means a career death sentence, so I think that it just isn't that big of a problem anyway.

allturtles 2y ago

> I live in BC, Canada, and we don't have an entire industry built around claims processing, administration, etc. There certainly must be people doing all of this claims processing, maybe not an "industry" since it's part of the government: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/claim-submission-payment/teleplan/claims-processing-system https://www2.gov.bc.ca/gov/content/health/practitioner-profe... > They still pay health care workers, but they don't have to have phone banks filled with people answering questions about claim denials. I'm not even sure if a claim denial is a thing here, or who I would call. There's a long list of rejected claim codes for BC here: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/claim-submission-payment/explanatory-codes https://www2.gov.bc.ca/gov/content/health/practitioner-profe... And a support center for handling questions and disputes: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/contact-us https://www2.gov.bc.ca/gov/content/health/practitioner-profe... And an appeals process: https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp/bc-residents/managing-your-msp-account/appealing-a-decision https://www2.gov.bc.ca/gov/content/health/health-drug-covera... The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow.

Teever 2y ago
>The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow. But it isn't just the Canadian system -- it's every other system too.[0] There is a unique form of corruption occurring in the American health system and it is absolutely tied to the insurance industry. This corruption causes the misallocation of resources in ways that are detrimental to the health of American citizens. Medical bankruptcy and the cost that it has on a person's health isn't really a thing in Canada. Having to choose between paying for medical bills or healthy food isn't really a thing in Canada. People putting off minor medical issues until they grow into major issues because they can't afford routine checkups or treatments isn't really a thing in Canada. This results in far less rationing of healthcare because people are able to make better choices that prevent the waste of medical resources. Don't get me wrong, there are issues with Canadian healthcare -- the biggest being corrupt politicians and business people trying to import American healthcare practices for their personal gain but the issues that the average Canadian face in accessing healthcare are nothing compared to those that the average American faces. [0] https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_healthcare_spending.jpg https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_heal...