Healthcare Management vs. Decease Management

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We have a healthcare system that focuses on managing decease (sick care) rather than prevention and wellness (true healthcare). I think this is one of the reasons why the cost of health insurance keeps going up.

We do not teach health management in our schools. People grow up without any knowledge of how to take care of themselves and how to lead a healthy life.

I have friends who make themselves sick with the way they live. And I see them going to doctors to cover up their problems instead of trying to figure out what is causing their problems.

The answers are there. I know it because I read and I learn how to lead a healthy life. People think I'm 10 years younger than I am. I suppose this has something to do with my healthy diet and exercise, in addition to a healthy lifestyle (non-smoking, etc.).

Anyone can be healthier than they presently are, but it requires two things. One is Education and the other is getting past denial.

Denial stands in the way of many successes. I see it. I once told a friend he would get cancer because he always ate carcinogens. He liked to BBQ all the time. He was in denial and continued to do this until he developed colon cancer and needed to have a portion of his colon removed.

The problem does not only lie with the patient. The system is messed up. It rewards doctors for doing procedures, not for teaching patients how to live longer. It is totally up to us to educate ourselves.

Doctors get paid for performing services, not for helping patients get healthy.

If a patient has a heart attack, a doctor can make $1500 for surgery to add a stent. But if the same doctor takes 45 minutes to discuss with the patient how to get healthy so that they can avoid future heart attacks, that doctor may get paid only $15.{1}

According to the Institute of Medicine, a 2011 study showed that 30% of healthcare spending is wasted and does not improve health. This is roughly $750 billion annually.

Inserting a stent or performing bypass surgery does not prolong life. It just solves the immediate problem. And future costs for more surgeries will most likely occur, raising the cost of insurance even further.

If a patient is not educated on the proper lifestyle to avoid heart attacks, they will most likely end up with more stents or more bypass surgeries, until they die.

The Preventive Medicine Research Institute did a survey that found heart disease is reversible.{2} Blockages in arteries that end up requiring stents actually clear up when one changes their lifestyle and eats heart-healthy foods.


Imbalance of Health Insurance Claims


If your employer is paying your health insurance premiums, you may be left in the dark about healthcare costs.

If you are self-employed and pay for your own insurance, you already know how bad it has become. My premium has gone up 268% in the past 10 years.

Health insurance, or insurance for any other purpose, is a business based on statistics. . We pay into it when we don't need it based on statistics that some of us will need it. So in return for our premium, we will be taken care of when and if we do need it.

I guess many people don't understand that fact, which is why some people wait until it's too late.

Statistically, more premiums are collected than paid out for claims. That’s how it should work anyway.

The problem is that many young people don't get insurance. Then when they get sick it's too late.

Obamacare was meant to correct that. But I don't see it working either since young people still don't get insurance. They would rather pay the small penalty.

If young healthy people would rather pay the penalty and the sick are now covered anyway, the sick will eventually never get paid for claims. So I see Obamacare failing as time goes by.

Too many people who need to collect on claims will overwhelm the statistical balance of net premium income over payments made out.

So funds will not be available for those who are sick and need it. Even though Obamacare provides insurance now for preexisting conditions, insurance companies will have a hard time paying out for claims if they don't have net income from policies that ultimately don't need to put in claims.

Insurance companies will be forced to raise premiums even more or go out of business.


Why Are Health Insurance Premiums Rising?
Why Are Health Insurance Premiums Rising? | Source

Health Insurance Abuse


Many insurance companies do not follow up on abuse in the healthcare industry. There are ways to control this by having a better communication with the patient on what is being billed and paid on their behalf.

It's obvious that the healthcare insurance industry doesn't make an effort to control costs. But we need health insurance. It can be a financial lifesaver if you suddenly have a severe heath problem.

Instead of coming up with better ways to control costs, many insurance companies would rather just keep raising their premiums. They don't include the patient in the loop when paying medical bills.

I would be pleased to have the opportunity to verify each bill from my doctors before the insurance company blindly pays them. I think that would help towards providing low cost health insurance.

One reason why medical insurance costs go up is because some doctors abuse the system and insurance companies aren't aware of it. Oh sure, they know it's happening. But they don't put enough emphasis on regulating it.

I don't see them bringing the patient into the loop. I never get a confirmation from my insurance company about all the charges the doctor is billing. They should send that to the patients as a rule so that the patient can verify the billing.


Conclusion


So what's the solution? All three of these issues need to be addressed.

  1. Teach people how to prevent decease.
  2. Better Control of Health Insurance Claims
  3. Help patients monitor Insurance Claims from their doctors.

I don't see any effort at doing anything. I hope this soon changes.



© 2013 Glenn Stok

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Comments 16 comments

GlendaGoodWitch profile image

GlendaGoodWitch 3 years ago from California

Interesting but I must correct you on the fact that you seem to be blaming doctors and they are not the problem. I have worked in this industry for almost 20 years and the insurance companies have made it near impossible for doctors to make an honest living. HMOs were one of the worst thing that has happened to this country because it is like mini government healthcare. They won't pay the doctors for many treatments and they give doctors a list of things that they can charge for. They have business men handling healthcare instead of healthcare professionals handling healthcare.

In the dental field our HMOs would use the sales tactic of showing their sign ups how cheap crowns are. Basically it was a contract with the doctor to do substandard crowns without any precious metal. The doctor does not want to do a cheezy job that will lead to other problems, but has to get paid for doing the job. This is where they will charge for something else on the list in effort to cover costs. If we did not have PPOs, HMOs and government type healthcare systems, the doctors could say, "this patient needs a crown", and could provide good healthcare without all the paperwork and creative billing.


Larry Fields profile image

Larry Fields 3 years ago from Northern California

Hi Glenn,

Everyone should know about the various frauds and abuses in our health care system. However it not possible to cover all of them in one hub of reasonable length.

For individuals, premiums are now skyrocketing, because of Obamacare. How so? Obamacare mandates that administrative costs shall not exceed 20% of the total--even when these costs are reasonable. An example of a reasonable administrative cost: paying lawyers to crack down on fraud and abuse by health care providers.

How do insurance companies get around that? By preemptive premium increases to compensate for the proportion of fraud and abuse that they're not legally able to contest anymore.

By all means, shop around for the best deal on health insurance. By all means, squawk like the dickens when you encounter blatant fraud and abuse on the part of your health care providers.

I'm not wild about the old, expensive, inefficient health care system in the USA. But in terms of the perverse incentives built into Obamacare, which is supposed to be fully phased in by 2015, you ain't seen nothin' yet!

Voted up.


Pamela99 profile image

Pamela99 3 years ago from United States

I think there is a huge amount of fraud in healthcare also. I fortunately have an insurance company that sends me paperwork on all my charges. I have doctors I can trust also, but that was not always true. This is definitely a big problem and I am glad you are shining some light on this problem with your huy.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

GlendaGoodWitch - Thank you for that enlightening alternative point of view. I admit I may be biased due to my personal experiences. And this is why posts such as yours are important in order to have a well-rounded view. My father was a physician who worked almost till the day he died. So I saw how things were from that perspective too. Thanks for reading and for your important comment.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

Larry Fields - you are absolutely right, in my opinion. I agree that Obamacare is not the answer. And things will be much worse when it fully kicks in. Each side (the doctors and the insurers) are fighting one another. There is so much more to this, and I have chosen to focus on only one aspect in this Hub. The solution to fixing the healthcare mess is not an easy thing to figure out. It has gotten way out of hand. Your comment is a very useful addition to that issue. Thank you for your thoughts and thanks for the vote up.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

Pamela - I am glad to see you are insured by a company that keeps you in the loop. That is so important. Thanks for letting us know that at least one company is doing that.


WalterPoon profile image

WalterPoon 3 years ago from Malaysia

Glenn Stok, I tend to agree with you more than GlendaGoodWitch, if we were to talk about the Malaysian experience. It is common knowledge here that doctors try to charge as high as possible, if the patient has a health insurance policy. I guess their logic is this, "Since the patient is not paying, why bother to keep prices low?" So they make you run through a battery of health tests, whether necessary or unnecessary, just to keep their host of equipment running at full capacity.

Just a note... I see that you are very generous with your line spacing... too generous in fact, LOL.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

Walter - Although every doctor handles his or her practice differently, I had a couple of doctors who did what you said... Running up the bill just because they knew the insurance would pay it, until I became aware of the issue. But fortunately, there are many honest doctors too.


RTalloni profile image

RTalloni 3 years ago from the short journey

Interesting post with comments that add to the topic. Seems like a system of checks and balances that include and empower the patient such as you mention here could definitely be helpful.

Abuse of the systems that provide medical care occur too often and on every level, from docs in private practice to hospital administrations to patients themselves, complicating sincere efforts to meet legitimate needs.

The biggest problem with government health care is that no amount of government regulation is going to solve the problems of a society whose character and moral fiber have degraded to the point of wanting what the new healthcare system is offering us.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

RTalloni - Thank you for your enlightening comment. It clearly describes problems with healthcare costs that need to be resolved. But that's not going to be easy as long as the government provides reasons to make things worse. Of course, one might assume this is happening because of lobbyists.


brakel2 profile image

brakel2 3 years ago from Oklahoma City, Oklahoma

Hi Glenn. Great article about insurance costs. Finding a good doctor and good insurance are both important. We have also encountered useless tests. Luckily insurance companies sometimes catch them. You are so right about checking your bills and being an advocate. Thanks for sharing your thoughts


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

brakel2 - Thanks for chiming in. My insurance company caught on once too. I had a doctor who put in a fraudulent claim. A doctor I never even saw. But it was done through a doctor I "did" see. He had another doctor put the bill through because he was not authorized to do the procedure. He should have been honest with me. But luckily my ins company called and asked if I ever saw that other doctor. After that, I dropped my primary doctor who sent me to him. It terrible that we have to be so careful about these things. Most people have no idea what is going on behind the scene.


MsDora profile image

MsDora 3 years ago from The Caribbean

Very relevant and very helpful! As long as the bills get paid, the doctors will keep sending them. We should really pay attention; and I agree with you that the insurance companies should ask questions. Thanks for raising this issue.


Glenn Stok profile image

Glenn Stok 3 years ago from Long Island, NY Author

MsDora - You are so right. Most people don't pay any attention. When I ask friends how much their doctor charges for various visits, they have no idea. Their silly answer is, "the insurance company pays the bills " and they don't care what it is. But then they still complain about the rising cost of insurance. I tell them, "you can't have it both ways." Thanks, MsDora, for your comment,


Sue Adams profile image

Sue Adams 2 months ago from Andalusia

Poor Americans, relying on insurance companies run by businessmen.

In Europe, we have free healthcare for all, paid for by our taxes. Mind you, the system is way over stretched. Mostly because many people don't take responsibility for their own health. Like Glenn says, education in prevention of disease would cut the cost enormously anywhere, with any system.

What bothers me most of all are the weekend bingers, alcoholics and drug addicts, and, the fatties who live on junk food.

I believe that a law should be put into place in Europe: if your illness, accident, or poor health condition is self inflicted, then you should be charged for the services the National Health Service so generously provides.

Like cigarettes, sweets, chocolate, alcohol and sugary drinks should be banned from advertising. In Britain the government has finally agreed to impose a sugar tax on drinks.

Looking after one's health should be a prime subject in all schools, all over the world.

And don't get me started on the pharmaceutical drugs cartel...


Glenn Stok profile image

Glenn Stok 2 months ago from Long Island, NY Author

Sue, I agree with absolutely everything you just said. Even here in the USA people don't take care of themselves. I once spoke with the woman who had three triple bypasses already. I mentioned that heart disease has been shown to be reversible with the right diet. She asked me what kind of diet and I told her 'a plant-based vegetarian diet'. She said 'oh no, that's too difficult, I'd rather have surgery.'

I like your idea that if an illness is self-imposed that the insurance companies should not pay full price. I also agree with you that health should be taught in school. I was always wondering why it's not. I study how to take care of myself to be healthy and live long. But I noticed most people don't care to spend the time reading and studying about these things.

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