another idea (to get rid of the middle man)

[USCguy]

I have another idea to get the middle man out of the process of healthcare delivery/reimbursement...

Some hospital systems offer all the necessary services that you could resonably expect to ever need. They have the hospital with ER, ORs, L&D, etc; nursing homes; primary care centers spread out all over the coverage area; urgent care centers; physical therapy and other medical centers with your jumble of different specialties. So...why not allow citizens to choose to pay into the hospital system for "insurance" if every medical service they receive will come from that hospital system. Seems like a reasonable way to cut down on middle man dipping his hand in the pot.

I know some people will say that this will lead to a monopoly, but if you live in a town where there is only one hospital, there already is a monopoly (especially with laws concerning "certificate of need"). Most decent sized cities have multiple hospital systems so competition will be there. I can see how this might be detrimental for someone in solo practice.

thoughts?

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[southerndoc]

It becomes a problem if a user works outside the area for his/her hospital system or if they travel on vacation.

 

[USCguy]

It becomes a problem if a user works outside the area for his/her hospital system or if they travel on vacation.

could be solved by a process similar to current practices when someone with PPO has an emergency "out of network." You are still covered (with the hospital system reimbursing the OON hospital for your care) for the emergency with the expectation that you will receive all your follow-up care at your "in-network" providers.

This system would function much like the current insurance companies, except all profits at the non-profit hospitals would be reinvested in the system instead of going to shareholders.

 

[docB]

What you describe is roughly the Kaiser system in CA. The insurer also owns the hospitals. It works reasonably well but it is obviously not leaps and bounds better than anything else to the point that it is expanding and gobbling up other health care entities in the area.

Advantages of this set up are centralized and accessible records, easy referrals (all referrals are in system), little push back from consultants because everyone is insured (sort of). Disadvantages are that if you are a member and Kaiser says "no" on something you're screwed, their EDs are still bound by EMTALA so the uninsured/non-members suck up resources and if you have to go out of network for something you're gonna pay a lot.

 

[Miami_med]

Jackson Memorial Hospital has a similar system down here with the JMH healthplan, though they weren't able to generate as much interest until they started to offer some out of network access.