By Roger Feldman

May still Medicare pay for sufferer expenditures the best way vehicle insurers pay for car_repair debts? Medicare's present approach to paying physicians units charges for greater than 8,000 separate approaches and companies, totaling over $60 billion each year. With Medicare's formulation underpaying for a few prone and overpaying for others, this complicated approach is an inefficient use of assets that daunts using basic care in prefer of costlier distinctiveness prone. supplied with almost limitless scientific companies at low or free of charge, sufferers this day have little incentive to settle on their care properly. In tips on how to repair Medicare: Let's Pay sufferers, now not Physicians, health and wellbeing economist Roger Feldman argues radical shift in Medicare coverage is not just attainable yet critical. less than Feldman's 'medical indemnity' idea, Medicare may pay each one sufferer a hard and fast amount of cash, booking greater subsidies for sicker humans. sufferers, in flip, would choose their very own clinical providers from services who may set their very own aggressive premiums. A scientific indemnity process may put off the distortion in sufferers' incentives wrought by way of traditional Medicare assurance. Given a set amount of cash to spend on treatment, sufferers could have robust incentives to buy the combo of prone, services, and costs that almost all heavily meet their wishes.

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Additional resources for How to Fix Medicare: Let's Pay Patients, Not Physicians (Aie Studies on Medicare Reform)

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While interesting, this proposal has several weaknesses. ” The auto repair shop has a good idea how much it will cost to fix and repaint a bumper—there is not much risk in accepting this job. But physicians may not know how much it will cost to treat a case of cervical cancer—the risk of accepting this job is substantial. Simply transferring that risk from patients to physicians does not eliminate it, although physicians might be able to pool the risk if they treat many REAL REFORM—MEDICARE INDEMNITIES 47 patients with the same indemnified diagnosis.

The top fifty diagnoses accounted for 54 percent of the $81 billion of Medicare-allowed charges by physicians and suppliers in 2002. In comparison, the top fifty “HCPCS” codes, representing the types of services performed, accounted for 47 percent of allowed charges (Centers for Medicare and Medicaid Services 2006, table 64). Thus, the types of illness represented in the Medicare population appear to be somewhat more concentrated than the types of services provided. This should make it easier to focus on setting the indemnity payments—in contrast to the difficulty of trying to determine the cost of each service provided.

Any costs associated with the use of indemnity insurance “may exceed efficiency benefits for the individual, even though the benefits to all individuals exceed costs” (Pauly 1971, 56). 1 This leaves individuals exposed to the risk that they will not receive adequate compensation after developing a severe case of the condition. In contrast, traditional “cost coverage” insurance does provide protection against severity risk. Pauly proposed an alternative approach to a “pure” indemnity, combining a set payment with partial coverage of the risk that charges will exceed the indemnity level.

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