Healthcare Systems<br />
Investors decide to start company<br />Investors<br />
And invest funds<br />Investors<br />
To set up insurance company<br />Investors<br />Executives<br />Advertising<br />Applications<br />Claims<br />Investigate...
Patient buys insurance<br />Investors<br />Executives<br />Advertising<br />Process Applications<br />Process Claims<br />...
Patients need medical care<br />Investors<br />Executives<br />Advertising<br />Applications<br />Claims<br />Investigate ...
Investors receive dividends (profits)<br />Investors<br />Dividends<br />Executives<br />Advertising<br />Applications<br ...
Most service providers also gain profits<br />Investors<br />Dividends<br />Executives<br />Applications<br />Claims<br />...
Non-Profit Insurance / Public Optionor Single Payer (Public Financed)<br />Government / Private Charity<br />Administrator...
Medicare / Medicaid<br />Government<br />Administrators<br />Applications<br />Claims<br />Taxes<br />Payments<br />Tax Pa...
How can we improve on the problem of high spending and poor outcomes?<br />Option 1<br />Universal access will reduce cost...
How can we improve on the problem of high spending and poor outcomes?<br />Option 2<br />Remove profit from medical financ...
How can we improve on the problem of high spending and poor outcomes?<br />Option 6<br />Simplify claims process by elimin...
How can we improve on the problem of high spending and poor outcomes?<br />Option 8<br />Improve treatment and reduce avoi...
How can we improve on the problem of high spending and poor outcomes?<br />Option 10<br />Limit malpractice law suits and ...
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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Healthcare Finance Systems and Reforms

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

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