In the midst of our Olympic games we may have to think about gaming by Health Insurers.
©2012 Am Ang Zhang
I wrote a while back:
We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.
“….Ethics in medicine has of course changed because money is now involved and big money too. What was in dispute in this case was that the private health insurance that sustained Candythrough the last eighteen months had dried out. The private hospital then tried to get the NHS to continue to pay for the service on the ground that Candy’s life would otherwise be in danger. The cost was around seven hundred pounds a night….’
Let us not forget that many private hospitals can make more money from the NHS because the NHS does not exclude. The NHS pay for everything including those Private Health Insurers chose to exclude.
“……A quick calculation gave me a figure of over a quarter of a million pounds per year at the private hospital. No wonder they were not happy to have her transferred out. Before my taking up the post, there were at one time seven patients placed by the Health Authorities at the same private hospital. Not all of them for Anorexia Nervosa, but Anorexia Nervosa required the longest stay and drained the most money from any Health Authority. I have seen private hospitals springing up for the sole purpose of admitting anorectic patients and nobody else. It is a multi-million pound business. Some of these clinics even managed to get into broadsheet Sunday supplements. I think Anorexia Nervosa Hospitals are fast acquiring the status of private Rehab Centres. Until the government legislates to prevent health insurers from not funding long term psychiatric cases, Health Authorities all over the country will continue to pick up the tabs for such costly treatments……”
I did not agree to that patient staying on at the private hospital paid for by the NHS. That hospital did not like me!!!
NHS & Faults:
Our NHS is not without faults and often the faults were to do with government. Impossible targets set up by successive governments have one aim: limit access to health care.
I wrote in 2008 in The Cockroach Catcher:
The doctor’s position had over the last ten years moved nearer the bottom end with no such counter moves by politicians. Some argued that the rot started with Shipman and the move to check on doctors’ competence will soon become law. The sad truth is that incompetence was not Shipman’s problem as he was able to shield the deaths that he created with his expert medical knowledge. The incompetence was with those that regulated him. He was probably more up-to-date with medicine than most, and expert at euthanasia. Recent scandals relating to Cleveland, Bristol, Alder Hey, Kent Authority, and MMR all help to erode people’s trust in their doctors and their regulator, the GMC.
Then we have Mid-Staffordshire & Baby P amongst others that demonstrated how if you try hard to meet targets patients died and if you whistle-blow, you die professionally. Successive governments tried to pretend that the problems have nothing to do with their main aim: cutting funding to Health Care of the citizens of the land in the form of covert rationing.
So, a new sales pitch came in: Choice & Competition to improve the quality of health care plus let us involve the privateers as they are good.
Good at what!
Then we have world class cancer hospital and third world cancer survival. No it did not make any sense at all.
So the decision was to get rid of the NHS as it was but retain the name as a brand.
Many consider it too late to prevent private bodies taking over our once efficient NHS.
But!!! And a very big BUT!!!
Why not legislate to rein in Health Insurers?
- Ends discrimination against people with pre-existing conditions.
- Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
- Limits premium discrimination based on gender and age.
- Prevents insurance companies from dropping coverage when people are sick and need it most.
- Caps out-of-pocket expenses so people don’t go broke when they get sick.
- Eliminates extra charges for preventive care.
- Contribute to an ABTA style cover.
Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital.
This will eliminate problems like PIP breast implants.
It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.
To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.
Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!
In fact, to save money, government can buy insurance for the mental patients and the chronically ill.
This way their will be real choice and insurers will be competing with each other to provide the worst deal.
What Health Insurer will want the business?
Perhaps they will go back to the US and we will have our own NHS back.
“……The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it……..” These are the very same people we pay market rate or they will go elsewhere!!!