The keystone of the American Health Care Plan is the economic plan. In order to control costs and cost inflation we must design a new method for financing Health care deliverY.
Our current method of finance is based on third party payment from the insurance carrier directly to the provider in response to claim forms sent to the insurance carrier by the provider for individual procedures. This method is associated with at least 23 cost drivers (see the section on cost drivers). The explosion of medical knowledge and technology during the latter half of the 20TH century is no longer functional in the antiquated third party payment for individual medical procedures. The result is cost inflation greater than anything else in our economy.
It makes more sense to provide the patient’s asset account with an appropriate budget that will allow the patient to pay for all anticipated expense due to their insurable event at fair market value directly and personally. This budget can be determined by proprietary software that verifies that a particular insurable event has occurred at a particular complexity level. This is automatically, electronically transmitted from the physician’s computer to the insurance carrier’s computer along with information from the patient’s electronic medical record. This patient specific information is matched by a matching algorithm at the computer of the insurance carrier to release the appropriate budget in the form of a lump sum to the patient’s asset account. This new business system of a patient specific prospective payment in a lump sum that represents an appropriate budget is the keystone of the economic plan and is designed to completely replace our current third party payment, procedure driven system.