Friday, June 10, 2005
has had an interesting discussion about universal health care vouchers
. Today, Paul Glastris follows up with a question about how the Veterans Hospital Administration
is able to provide excellent care at lower costs:
First, Phil demonstrated pretty convincingly that the VHA owes its success to the fact that it has clients it knows will (almost certainly) not leave for another health care provider. Thus, it knows that its upfront investment in quality control and case-management-based information technology and preventive care and so forth will pay off economically for the VHA in the long run. That's something most health insurers and providers can't count on. They know the opposite: that their patients will flit about from provider to provider, insurer to insurer based on which insurer their employer chooses. Under Zeke's plan, it seems to me, that flitting about will continue, even accelerate, as families change insurers to get better deals or to fit their changing life stage circumstances. Doesn't that mean there will be no incentive for these insurers to invest in the technology and systems we know are crucial to controlling costs and improving quality?
Although I've had the same job and the same primary care physician for 5 years, I've had three different insurance plans. I've had the same auto and home insurance carriers for 10 years, but nearly every year at my annual physical I've got to change my insurance provider information.
Glastris's point is that it's economically inefficient for the insurers to invest funds in preventative care for short-term customers. Let me add this to that: it's inefficient for my local clinic, as well, because they are constantly updating insurance information for each member of the family Hammer. Also, my prescription drug formulary changes each time my insurance company changes -- if not more often. On several occasions my family and, I assume, my insurer paid more for medication because my doctor didn't have a current version of my formulary.
It just doesn't make sense to have a system where there's no incentive to help me stay healthy.