On Wed, Feb 11, 2009 at 4:25 PM, Charles Bennett <[email protected]> wrote:
> Sooner or later some petty official will decide that *you* simply need > to accept *their* decision about you living or dying on their schedule. Actually, if you can get your head round the idea, the above is actually not a bad set-up. The point is, that if you agree that some kind, any kind of insurance-basis is the right set-up for healthcare, then the people at the helm making the decisions about what gets paid and what does not are the employees of the insurance company. And guess what, if these employees are provided with the right kind of information, then they are, in point of fact, all things considered, the right people to make that decision. (*You* surely don't want the government to control this and *I* sure as hell don't want the decision (about reimbursement) left to individual doctors.) And guess what else, if you have a largely centralized system of health *information*, then the quality of the information that the insurance company employee has at his disposal to make these decisions is far better than when you don't have a centralized system of health information. It is recognized more, or less worldwide that the two cornerstones of such a system are "evidence-based medicine" and a treatment catalog. The current system in Germany and other European countries is, I believe, based on a system that was developed in Australia. The system is based on DRGs (diagnosis related groups) and a system of coding procedures and treatments within these groups (in Germany these codes are known by the acronym OPS (operationsschluessel). The idea is that you categorize the patient in a DRG and within that DRG everything that you provide in the form of treatment should be entered in a computer in the form of OPS codes. The DRG has a multiplier that operates on the basic reimbursement for a patient based on basic parameters including length of stay. Some, but not all, of the OPS codes that are then entered for a patient in a DRG may also influence the ultimate reimbursement. When combined with "evidence-based medicine" this becomes something that embodies quality *and* progress *and* control. In fact it sounds very much like what the new US admin is trying to establish. This is a good goal, because it controls reimbursement (spending) according to established successful practise (you get paid for treatments that work and not (at least not out of the social pot) for those that either don't, or for which there is insufficient evidence to decide)). You also get transparency in spending and the possibility to modulate the DRG multipliers according to changes in "evidence-based medicine". What more could you hope for ? Perhaps a system where you can "bid" for the time of a private quack largely beyond control who takes backhanders from industry so that he can spend 80% of his time on the golf course ? Doesn't matter if he fucks everything up, because you, or your survivors can always sue him ! mark. _______________________________________________ OSX-Nutters mailing list | [email protected] http://lists.tit-wank.com/mailman/listinfo/osx-nutters List hosted at http://cat5.org/
