> They are not worried about the high upfront cost since every citizen is paying taxes for that.
Not only that, but that they can look very clearly at cost vs benefit. With a citizen, who is unlikely to move anywhere else, you can look at lifetime care costs and reduced earning ability (at least in the average case), and say outright that it is sensible to pay $100,000 to save many times that on a lifetime of ineffective care and reduced potential. You can also look at the public health impacts - treating one patient might reduce the risk of wider infection in society, which can also be placed in the cost-benefit analysis.
This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out), and more difficult for insurers (because they are subject to much greater short term pressures, and can't look at wider benefits).
From the article:
“If it is cost-effective from a societal standpoint, it is not necessarily going to be cost-effective from a health plan standpoint,” said Dan Mendelson, chief executive of Avalere Health, a health care consulting company.
In the US one way to help mitigate this problem is to start shifting some of the risk from the insurance plans on to the provider networks. As mentioned people can change insurance plans frequently so investing in their health can be difficult. While they change plans frequently, the providers they see would be slower change. There are times when a change in plans will cause in change in PCPs. But that should still be less frequent then the change in insurance.
But we would need to reward provider networks for keeping people healthy, not just treating them when sick.
> This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out)
Simple: make it federal. Scale it up until you get controlled borders.
Not only that, but that they can look very clearly at cost vs benefit. With a citizen, who is unlikely to move anywhere else, you can look at lifetime care costs and reduced earning ability (at least in the average case), and say outright that it is sensible to pay $100,000 to save many times that on a lifetime of ineffective care and reduced potential. You can also look at the public health impacts - treating one patient might reduce the risk of wider infection in society, which can also be placed in the cost-benefit analysis.
This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out), and more difficult for insurers (because they are subject to much greater short term pressures, and can't look at wider benefits).
From the article:
“If it is cost-effective from a societal standpoint, it is not necessarily going to be cost-effective from a health plan standpoint,” said Dan Mendelson, chief executive of Avalere Health, a health care consulting company.