Under the current health
insurance system, employers or individuals pay a premium to an insurance
company. The insurance company then
covers the costs of treatments based on the claims presented by the patients.
The health insurance system has many drawbacks
. Insurance companies identify health issues before enrolling a
person into a policy and exclude pre-existing diseases from the coverage. This exclusion policy however will be banned
in the US from 2014. The premium amount
depends on the health of the person. In
some cases, the insurance companies require prior authorization of tests
conducted or any treatment given. They
also sometimes refuse to pay for covered services, forcing the patients to
appeal, thus increasing the administrative burden on the patients as well as
The authors of the blog predict that the health insurance system in the
United States will be replaced by a new system consisting of accountable care
These organizations will be
made up of groups of doctors, hospitals and other health care providers, who
will take care of all the health care needs of the patients. This model will enable consumers to choose
their primary provider and his/her team.
The authors list out several
advantages of the new health-care system.
The ACOs are likely to shift the focus from treating sick patients to
keeping people healthy. They will be
paid a fixed amount on a per-patient basis rather than on a per visit or
per-hospitalization basis, with bonuses on achieving quality targets. Thus, they will earn better by ensuring that
their patients remain healthy rather than be admitted to the hospital.
The payments to the ACOs
will directly flow from the employers, Medicare or Medicaid. Insurance companies will not be required to
handle billing and claims.
The ACOs will probably be a
boon to many patients who are at the mercy of insurance companies. It remains to be seen if such changes in the
health insurance systems will be seen in India as well.