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Reply #89: No, I am not the one who is responding to something other than what was said [View All]

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stevenleser Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Jun-28-09 10:06 PM
Response to Reply #54
89. No, I am not the one who is responding to something other than what was said
I am simply stating that if we have an insurance market with multiple plans, there needs to be benchmarks so people and governmental bodies have a meaningful way to evaluate their effectiveness. That has nothing to do with rationing or pooled risk or anything else either of the two responders said.

If you have any experience with benchmarking business processes you will get what I am talking about. If not, you won't, and any response will be as useless as the two I got previously.

Health care plans are benchmarked and rated all the time. This is how we know France's health care system is rated #1. Someone or some group spent the time to look at pieces of the plans of various countries and compared them and came up with a rating system.
That is a kind of benchmarking called performance benchmarking. That rating did not include costs but there isnt any reason why it couldn't in the future.

The reason this is needed even more acutely with a public option being in the mix with private insurers is to counter false arguments that it is providing care less efficiently and effectively or if the argument is made and it is not false, someone can then step in and try to fix it. It is also critical with a public option for the very reason someone else stated regarding the risk that the sickest and poorest may flock to the public option.

If the systems are properly benchmarked then it doesnt matter if the sickest and poorest tend to go to one plan. As long as we see that:

Private Plan A saw 10000 patients with an acute case of Y disease and spent an average of $5000 per patient and 10% of patients died

Private Plan B saw 8000 patients with an acute case of Y disease and spent an average of $4500 per patient and 12% of patients died.

The Public plan saw 2,000,000 patients with an acute case of Y disease and spent an average of $5000 per patient and 8% of patients died.

or Public plan saw 2,000,000 patients with an acute case of Y disease and spent an average of $8000 per patient and 2% of patients died.

Those are the kinds of benchmarks I am talking about and I have even simplified them a bit. Age and prior healthcare and other factors could be added. The point is that the overall costs of the plans (and thus things like the concept of pooled risk) are irrelevant because we are looking at average costs and average success rates of people who present similarly. We need to know which plans are effectively and efficiently handling health issues. Obviously if in the above case we had the Public plan seeing 2,000,000 patients with an acute case of Y disease and they were spending $15,000 per patient and 20% were dying, we would know there is a high likelihood that we have a problem and someone needs to check it out.

This is the answer to Diane Feinstine's question about cost of a public plan. You put into place a strong system of benchmarks to see what you are getting.
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