Wednesday, August 15, 2012

The benefits of transparency in health insurance industry

Did you know that the healthcare services in other countries publish detailed performance statistics about their hospitals and clinics. For example, the average length of time it takes to get an appointment with a consultant in each specialism is routinely posted online. This openness even extends to the publication of some statistics showing how many people die when going through a number of surgical procedures. The governments in other countries believe their citizens have a right to know how well or badly the health services are delivering care. Equally important, once alerted to poor performance, the local citizens then bring political pressure to bear on the management teams responsible for the delivery of the given services. This naming and shaming is shown to produce real improvements in performance.
The situation we have can be caught in two phrases: "dropping quality" and "runaway costs". No matter which independent research organization you go to, they will all tell you about 40% of us fail to get the care we need and, even if we do get the best possible care, it's often delivered in a wasteful way. We have appallingly high levels of preventable diseases, with hospitalizations and readmissions too frequent, often based on a catalog of redundant and needlessly expensive tests. What we need is a way of improving quality while controlling costs. The one group with the best information about this situation is the insurance companies. They get thousands of claims every day that contain very detailed information about the treatments and their outcomes. What we should see is a detailed analysis of all this information. It can be stripped of anything that might identify individual patients. But with the resulting openness and transparency, we would have the same amount of information as, say, one of you playing a fantasy role in managing a baseball team. Who do you pick for your medical team if your own health or the health of your family is at risk?
Although the Affordable Care Act is supposed to introduce better measurement of performance with publication of the results, there seems little will to implement it. Doctors, of course, oppose it because they fear their incompetence would be exposed and their profits would be hit if all the unnecessary tests and treatments were eliminated. The Department of Health and Human Services also sits on a big pile of information that comes through the Medicare and Madicaid claims. HHS is hiking its charges for access to its data. Curiously, it seems to be siding with the doctors and trying to deter anyone from analyzing the data to discover which hospitals and clinics represent good value for money and are reasonably safe. A lot needs to change to push through these barriers and get access to the information that would let us all judge the performance of our doctors and hospitals. The tragedy is the performance of the health insurance companies. They seem not to care, simply increasing the premium rates to cover costs without representing their policyholders' interests. There's nothing to prevent health insurance companies from refusing to pay excessive bills from doctors or challenging the effectiveness of treatments. We are consumers. We deserve protection from a medical profession acting in secrecy.

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