Wednesday, March 24, 2010

Obama Health & The NHS: Patients Trading

President Obama signed major health care legislation into law on Tuesday.
Doug Mills/The New York Times

It would be interesting to see how universal health insurance will pan out in the Obama health care reform.

It made sense that insurers should not be allowed to “cherry pick”. The Cockroach Catcher just realised that perhaps there now will be a new commodity: patients.

The financial world has been about risks and derivatives were designed to minimise risks. All very laudable until some smart ones realise that much money could be made from such instruments.

Health Insurers are a special group of such financial institutions and no doubt they will want to minimise the risks. In the past, it is very simple: exclude risky patients. 


“Insurance companies have long engaged in the practice of ‘rescission,’ whereby they investigate policyholders shortly after they've been diagnosed with life-threatening illnesses.”

It would not have been possible to run the Obama reform without tackling the “cherry picking”. Well by 2014 in any case:

"One of the central reforms of the bill won't start until 2014, when the exchanges open. From then on, insurers will not be able to turn away people with medical problems or charge them more."         The Associated Press

The problem is that you may not be allowed to exclude, but you can certainly devise ways to encourage high risk patients to go to other insurers.


Simple! Money!

As with my parenteral feed patient: pay them to go elsewhere. One insurer paying the patient to go to another one!

It is suddenly very interesting as having a chronic illness or a novel one may become an asset rather than a burden: in other words, it is a new commodity.

At a financial level, re-insurance may become the norm. A sort of “subprime” for Health and of course we all know what happened to the other “subprime”.

At a medical level, it might encourage insurers to offer the best treatments as anything else might prove more expensive.

Of course the unthinkable might happen: patients being paid to go elsewhere.

In England, if Health Insurers cannot “cherry pick”, there is nothing to stop the PCTs (Primary Care Trusts: public bodies that are responsible for funding public patients) insuring NHS patients to limit the cost. 

Who would still want to run Private Health Care then, I wonder! Especially if PCTs insure all their long term medical and psychiatric conditions.

We may get back our NHS!!!

Grand Rounds: See First

Obama & Health: Would you like to move?

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