Tuesday, July 28, 2009

Healthcare Advocates

The Medical Savings and Loan helps restore direct negotiations between doctors and patients. Because patients are spending their own money, the system greatly reduces the role of the insurance claims adjuster.

Unfortunately, a MS&L cannot completely eliminate the role of an adjuster. The system will need people to review and approve claims to prevent fraud. For example, the system would have to prevent a person from using a medical loan to buy a car.

Considering that there needs to be an adjuster role in a medical savings and loan, I began to think about the direction I would to take this role. In this thought experiment, I came to a startling realization.

I realized that the form of the financial system directs the flow of care.

In pooled insurance (this applies to both employer based and government based care), payments come from a pooled resource.

Since the payments come from the pool, the primary goal of the claims adjuster is to protect the pool.

In theory, protecting the pool protects the interests of the people in the pool. Ask people whose claims have been denied. They will often tell you that they don't feel protected.

In a medical savings and loan, payments for health care will come from the patient.

Changing the form of health funding from a pool-based to an individual-based creates a shift in the actual delivery of health care.

I imagine that in the Medical Savings and Loan, the claims would transform from a bureaucrat charged with protecting community resources to becoming an advocate of the patient who helps the patient spend resources wisely.

The structure of the financial mechanism determines the flow of care. When payments come from a pool, the system must protect the pool. When payments come from the individual, the system will morph into a design that helps protect the patient's interests.

My interest in the Medical Savings and Loan goes beyond the simple government v. private industry conflict. I realized that a system based on personal accounts would effectively create a more patient centric health paradigm.

Readers of this blog have probably noticed that I have a strange fascination with doulas. A doula might be described as a lay position that works with doctors, midwives and nurses in the birthing process. I called the doula a lay position as the training is intense, but less intense than a professional degree like an RN.

I keep bringing up doulas because I actually see them as a model for the health care advocate.

Healthcare Whisperer

Anyway, my reason for staying up late is that I discovered a fun site called Healthcare Whisperer. This site was established by a nurse practitioner who is creating a team of healthcare advocates.

Judging from the HealthCare Whisperer's blog, the owner of the site was really hoping that Obama's healthcare reform would open room for her type of services.

Having worked in government run healthcare, I fear that she misunderstands the structure of the system. Pooled insurance requires strict regulation and standardization for the uniform delivery of care.

The HealthcareWhisperer has a truly beautiful vision of a patient advocacy program that helps navigate the waters of the medical system. There are some many wonderful options for care these days.

We cannot realize this vision as long as the paradigm is based on pooled insurance.

The Medical Savings and Loan is the one structure that truly allows people to design the right health care regime to fit their life.

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