There is always a number being thrown around that other “civilized countries” spend HALF per capita on health care that we do… and then the discussion goes into how long a wait that people in other countries have to get services… and other reasons why our system is superior.. which it may be.
Routinely, we hear about fraud and abuse … could part of the problem be because of the assignment process that our system utilizes? Assignment, allows for the patient to agree that the provider be paid directly from the insurance company. If patients had to pay for services up front (POS) and wait for payments from the insurance company to reimburse them… would that put a dent into the fraud and abuse issue.
Right now there are stories of store front vendors who will pay people with Medicare/Medicaid cards a certain $$ for letting the store front vendor to copy their card and submit medical claims against their number. Everyone “wins”.. except the US taxpayers.
Could it be that we have such a every increasing bureaucracy whose sole focus is to make sure that there is a medical necessity for any provided medical service. Although it would seems that their primary function is to deny a claim or create a labyrinth to go thru to get a claim approved/paid.
Way “back when” I was a young RPH.. it was reported that 6% of healthcare dollars went to Rx medications… today that number is claimed to be 12%. To do some comparison from then and now… back then .. average Rx price was $4-$5 range, there were few generics, no PBM’s, no Medicare… no mail order ..patient paid cash or store charge for their Rx.
Today, we have 80%+ generics, PBM’s are involved with 90%+ of all Rxs… we have step therapy, generic substitution, therapeutic interchange , prior authorization. None of us knows how many middlemen or how many dollars change hands to oversee rebates, kickbacks, bribes between all the parties involved… nor the total dollars involved in rebates, kickbacks and bribes.
With all the other expensive advances in healthcare services… what would explain a DOUBLING of the per-cent of overall healthcare dollars that are devoted to Rx medications? Could this doubling of monies .. really have nothing to do with actual patient care or disease management.. Could a more “simpler time” actually have been a more cost efficient time? Have we passed a point of no return?
Could the rest of healthcare be so bloated with “administrative costs” that unless the system is put on a diet, the long term prognosis of the system is very poor.
Filed under: General Problems
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