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CHERRY PICKING/H2>
"Cherry picking" is profitable to insurers because 1% of the population accounts for over 20% of health spending, while the sickest 10% account for over 60% of health spending. In contrast, the half of the population with the least health spending accounts for only three percent of spending [EINO: It will always be the case that the bulk of health care spending will go towards care of those most seriously ill or injured, but we don't know when we might suddenly find ourselves or our loved ones in that category. Also, its this uneven use of health care that leads to general acceptance of being underinsured, since few of us test our health care coverage with critical needs].
from -Trends in Health Care Costs and Spending, Kaiser Family Foundation, September 2007
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DECODING HEALTH INSURANCE
The New York Times of May 22, 2005 by Robin Cook (MD author of the novel "Marker.")
In this dawning era of genomic medicine, the result may be that the
concept of private health insurance, which is based on actuarially pooling
risk within specified, fragmented groups, will become obsolete since risk
cannot be pooled if it can be determined for individual policyholders.
Genetically determined predilection for disease will become the modern
equivalent of the "pre-existing condition" that private insurers have
stringently avoided.
With the end of pooling risk within defined groups, there is only one
solution to the problem of paying for health care in the USA: to
pool risk for the entire nation. (Under the rubric of health care I mean a
comprehensive package that includes preventive care, acute care and
catastrophic care.) Although I never thought I'd advocate a
government-sponsored, obviously non-profit, tax-supported, universal
access, single-payer plan, I've changed my mind: the sooner we move to
such a system, the better off we will be. Only with UHC; only then will there be no motivation for anyone or any
organization to ferret out an individual's confidential, genetic makeup.
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Assessment by medical school deans of how their schools have fared under managed care. In many areas these teaching hospitals are the backbone of the public system.
From NEJM 340:928
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During the Era of Increasing
Domination by Managed Care Institutions There has been Steady Erosion of People
Enrolled in Not-for-Profit HMO's
References
BACK TO nature of managed care
FAQ
TOP OF THIS PAGE
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WHO JOINS AND WHO LEAVES THE MEDICARE HMO’S?
Inpatient Costs Compared to Fee for Service (regular) Medicare
The healthy are attracted in, the sick are forced out.
A good way to make money insuring the healthy only -that's our system.
NEJM 1997 337:169
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HMO OVERHEAD (FIRST QUARTER OF 2003)
Compared to 3 to 4 % for medicare. Estimates range
2 to 7 fold what medicare needs to administer health care.
From Managed Care Magazine July 2003
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