>>OFF TOPIC<<
Hi Duncan,
>>For economic forces to work, the copayment would have to be hefty,<<
The egalitarians among us (I'm in the middle) could argue that the copayment could be tied to income. For example, say for discussion purposes that your basic cost for a day in the hospital is $500 (it's probably more). A lower income person (not the indigent, who would pay nothing) would pay, say, 5% or $25 daily out of pocket. An upper income person might have to pay 15% or $75 per day -- put in whatever numbers you like. This would produce a self-regulating mechanism on hospital stay. I wouldn't be getting those ridiculous calls from insurance companies: "Why is Mr. Jones still in the hospital?" Answer: "Well, if you weren't on the opposite coast in your office, you could come over here and see that he is in intensive care with tubes in every natural orfice and several man made ones, is on a ventilator and receiving most of the free worlds' antibiotics and wonder drugs. Why don't you come over and discharge him?" That is not an exaggeration. Of course there would have to be a cutoff point, either in dollars or in days for the copayment to cease, as any major medical policy would do.
What we have now is a "sky's the limit" approach. Take Medicare for example. Once you pay the deductible, all the hospital costs are paid for.
The best way to contain cost is to have the patient become a partner in the decision making process. You come to the Emergency room with a headache. In my area, you'll almost surely get a CT (CAT) scan of the head. Your cost? About $800. This is a lot more that "take two aspirin and call me in the morning". Medicare or insurance pays for it. There is no incentive for the patient not to get it; it costs him nothing. The ER doc knows that if you are the one in several thousand people who's headache is due to a ruptured brain aneurysm or a brain tumor, and he has not ordered the scan, that he will be hung out to dry by the lawyers. Furthermore, it doesn't cost the ER doc anything either. It's all free, and nobody can say you didn't omit something for which you may be legally liable. But if the patient had to pay, say even 50 or 100 bucks as a copayment, then he and the ER doc could discuss what the chances were of anything's being found, what the risks of not doing it would be, what the alternatives are (watch and check again in the morning). An intelligent decision could be made about whether to spend a lot of the insurance company's money and a little bit of the patient's. That little bit on the patient's part is what puts the system on a sensible basis.
Jack |
