Envisioning “no-frills” healthcare – or not

Last updated on: June 24, 2015 at 9:52 pm by Jane the Actuary

Envisioning “no-frills” healthcare – or not 2015-06-24T21:52:06-06:00 Jane the Actuary

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So, remember how my son broke his arm last week? And remember my brief run-down of healthcare systems outside the U.S.?

I was thinking about our experience, and the differences between healthcare here and abroad. One common way, after all, of providing healthcare is with something that you might call “Medicaid for all” — that is, a lousy base level of healthcare that’s free (no or minimal out-of-pocket costs) and the opportunity to upgrade by buying private insurance. In the case of the NHS in the UK, it’s a “duplicate” system, in which the insurance pays the full cost of the hospital stay (though private insurance costs are moderate because individuals still use the NHS for routine treatment, and the structure of the insurance is set up to provide incentives for doing so). In other countries, it’s a “supplemental” system, where the State reimbursement covers part, but not all, of care at a private clinic or various doctors who don’t accept the State reimbursement as payment in full.

Hence, “Medicaid for all” — with the opportunity to upgrade.

But then you think about it a bit more:

What elements of my son’s treatment would I have given up, or identify as suitable for “upgrade”, as a “frill” that could be discarded for the masses?

We arrived at the hospital, and they brought him back to a room immediately. I am not exaggerating. OK, it took a minute for them to write down his name and date of birth and print out a wristband, and another minute to assign him to a room and summon the nurse. Then they took him for X-rays almost as quickly. Pain meds took a little longer because they had to determine whether he’d need surgery first.

I can’t imagine being in a nightmare-hospital where you’re waiting much longer. Now would I want to be in a situation where I have to drive past this hospital, to another one further away, potentially much further away, not because of being in a rural area, but solely because the closest hospital isn’t in the network.

And that’s of course a fairly simple hospital visit. What about more complex cases? The UK is quite rigorous about determining whether particular treatments are even covered at all, and might well have sent my friend home away without any treatment at all, considering the cost of his current treatment regimen.

What would you label as a part of a “basic” benefit plan vs. a “frill”?

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