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Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
Healthcare Finance Systems and Reforms
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Healthcare Finance Systems and Reforms

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  • 1. Healthcare Systems
  • 2. Investors decide to start company
    Investors
  • 3. And invest funds
    Investors
  • 4. To set up insurance company
    Investors
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Service Provider
  • 5. Patient buys insurance
    Investors
    Executives
    Advertising
    Process Applications
    Process Claims
    Investigate Pre-Existing Conditions Exclusions
    Premiums
    Insured
    Patient
    Service Provider
  • 6. Patients need medical care
    Investors
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Premiums
    Payments
    Insured
    Patient
    Service Provider
    Medical Service
    Co-pay & Deductibles
  • 7. Investors receive dividends (profits)
    Investors
    Dividends
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Premiums
    Payments
    Insured
    Patient
    Service Provider
    Medical Service
    Co-pay & Deductibles
  • 8. Most service providers also gain profits
    Investors
    Dividends
    Executives
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Premiums
    Payments
    Profits
    Insured
    Patient
    Service Provider
    Medical Service
    Co-pay & Deductibles
  • 9. Non-Profit Insurance / Public Optionor Single Payer (Public Financed)
    Government / Private Charity
    Administrators
    Applications
    Claims
    Premiums
    Payments
    Profits
    Insured
    Patient
    Service Provider
    Medical Service
    Co-pay & Deductibles
  • 10. Medicare / Medicaid
    Government
    Administrators
    Applications
    Claims
    Taxes
    Payments
    Tax Payer
    Profits
    Service Provider
    Medical Service
    Elderly
    Poor
    Co-pay & Deductibles
  • 11. How can we improve on the problem of high spending and poor outcomes?
    Option 1
    Universal access will reduce costs of healthcare and improve adult productivity, childhood development and student performance by emphasizing preventative care and regular treatment of chronic conditions. Many of he following would help achieve universal access.
    Investors
    Dividends
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Payments
    Premiums
    Profits
    Service Provider
    Insured
    Patient
    Medical Service
    Co-pay & Deductibles
  • 12. How can we improve on the problem of high spending and poor outcomes?
    Option 2
    Remove profit from medical financing with public financing (Canada, Medicare) or non-profit insurance (Germany, Japan.) Focus spending on patient care.
    Option 3
    Remove profit motive from medical services with Government Health Service. Focus spending on patient care. (Britain, Veteran’s Administration)
    Investors
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Dividends
    Payments
    Premiums
    Profits
    Service Provider
    Insured
    Patient
    Medical Service
    Co-pay & Deductibles
  • 13. How can we improve on the problem of high spending and poor outcomes?
    Option 6
    Simplify claims process by eliminating pre-existing conditions exclusions.
    Option 7
    Prevent dropping patients or changing terms and pricing when they become ill.
    Option 4
    Eliminate or limit differentiated pricing based on age, gender or health condition to ensure that the elderly and sick can get health insurance.
    Option 5
    Eliminate advertising costs and exorbitant salaries and bonus for insurance executives.
    Investors
    Dividends
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Payments
    Premiums
    Profits
    Service Provider
    Insured
    Patient
    Medical Service
    Co-pay & Deductibles
  • 14. How can we improve on the problem of high spending and poor outcomes?
    Option 8
    Improve treatment and reduce avoidable complications with improved collaboration, record keeping, oversight.
    Option 9
    Change payment structure to reward good outcomes rather more procedures and visits.
    Investors
    Dividends
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Payments
    Premiums
    Profits
    Service Provider
    Insured
    Patient
    Medical Service
    Co-pay & Deductibles
  • 15. How can we improve on the problem of high spending and poor outcomes?
    Option 10
    Limit malpractice law suits and penalize frivolous law suits to reduce defensive medicine and the overhead costs of malpractice insurance.
    Option 11
    Reduce poverty and relative poverty.
    Option 12
    Improve general health through diet and exercise and reducing smoking.
    Investors
    Dividends
    Executives
    Advertising
    Applications
    Claims
    Investigate Pre-Existing Conditions Exclusions
    Payments
    Premiums
    Profits
    Service Provider
    Insured
    Patient
    Medical Service
    Co-pay & Deductibles

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