Healthcare reform is a big political issue both here and in the USA. I don’t usually get political here, or talk about healthcare in general. But I’m currently studying a compulsory paper for my Certificate in Health Science called The Socio-Political Context of Health Care. It’s about like it sounds, but there are thought-provoking aspects to it. Here are some provoked thoughts.
If I were Minister of Health (which God forbid), this is what I’d do.
Following indirectly in the footsteps of Singapore, where individuals have their own healthcare account out of which they pay for treatment, I would establish a kind of voucher system of Health Points. Each person would get a certain number of Health Points each year, enough to pay for an average amount of care. They would accumulate if unused – so older people would tend to have more than younger people, after a while. Employee and employer contributions and general taxes would fund the yearly allocation of Health Points.
There would be specified top-up circumstances. If you belonged to some kind of high-risk group, such as the poor, the elderly or children, or particular ethnic groups which have poor health status as compared to the general population, you would get a “targeted top-up”. This would address the issue that people who have least resources are often in most need of health care (and vice versa). Likewise, there would be top-ups if you were diagnosed with diseases which are expensive to treat, or had a disability.
If you had private medical insurance, that would translate into “self-funded top-ups” – which, note, would carry forward into the future as well, so if you lost your insurance for some reason after years of paying in, you wouldn’t end up with nothing as is currently the case.
You could spend your Health Points in a number of ways. Certainly hospitals – public and private – would accept them in payment for treatment. Private hospitals would probably charge more Health Points, making the system market-driven to a certain extent. Doctors, pharmacists, testing clinics, therapists like physiotherapists and massage therapists – anyone who could demonstrate to a panel that there was provable benefit from their therapy and that they were qualified to offer it would be able to register to accept Health Points. Since Health Points taken in from patients or clients would translate into money when you turned them in to the Government, health dollars would go where the consumers wanted them to go. This, of course, would make consumer education quite important and kick off huge marketing battles and arguments about effectiveness. I didn’t say it was a perfect system.
Progressively, you could make Health Points exchangeable for anything that was demonstrated to enhance health. Gyms and sports clubs could accept them. Fruit shops and supermarkets could accept them in partial payment for particular foods.
Of course, you’d need to put careful fraud-prevention provisions in place – I’m thinking some kind of smart card with the end user’s photo, and verification that the end user was actually present for the treatment, etc.
The other end of the system would be the introduction of tax breaks for people who maintained their health. This would involve workplace programs of health testing (coupled with workplace programs of health promotion for employer tax breaks). Self-employed people could visit designated clinics for the health tests – paid for out of their Health Points, of course, since they wouldn’t be using them for healthcare.
This isn’t too unlike voucher systems proposed for education. It introduces a greater degree of market forces than those which operate at the moment in health care, where a few funders (or a single funder, the government) decide where the money goes and consumers have little input. For example, the headlines at the moment in New Zealand are all about the new lab testing company which has been contracted by the Auckland District Health Board to replace their old, long-established provider because the new one promised cost savings. So far, they’re not producing savings but they are producing poor communication, errors, shorter hours and fewer locations. In a system where Health Points went where consumers chose, the second provider could just have started up locations in competition with the incumbent – and would only have won business if it was actually better in the experience of the people who used it, instead of able to convince a committee that it would be better on paper.
On the other hand, this isn’t a pure market-driven scenario either, because I don’t believe health care should be driven solely by economic considerations, or more available to those with more resources when they are usually the ones with least need of it. This isn’t a rationing system, either – it’s a distribution system. It introduces a feedback mechanism so that it becomes more responsive to the people it is set up to serve, rather than to the policies of the government of the day, which are only indirectly a reflection of citizens’ priorities.
I’m sure it’s just as full of holes, and just as open to abuse and ineptitude, as any other way of arranging health care. And of course I have no influence to get it even looked at, let alone adopted. But there it is, for what it’s worth.
Technorati Tags: healthcare reform, vouchers, consumer choice
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