Cash for office care and insurance for hospital and surgicareby delmeyer on 12/09/2020 1:26 AM
Health care has suffered the ignominy of being so expensive that almost all individuals would not be able to afford it without insurance. When hospital care was becoming unaffordable, Blue Cross came to the rescue with Health insurance for hospital care. Surgical care was likewise becoming unaffordable and Blue Shield came to the rescue and offered surgical care.
In the absence of outpatient coverage, Blue Cross stipulated that the annual exams would be covered if done in the hospital. This created a massive infusion into hospitals and hospitals obliged physicians and hired medical students to do history and physical exams in the evenings. This was financially rewarding for the medical students to pick up three or four exams at $25 each in the evenings a couple of times a week while healthcare costs continued to soar.
Blue Cross then accommodated outpatient coverage to eliminate the expensive early admission requirement to obtain the history and physical prior to medical or surgical procedures. Then Blue Cross further expanded coverage to most of the outpatient medical care. This was “open sesame” for health care cost rising through the roof. Deductibles were only on the office call but the laboratory and x-rays were essentially without deductible—without a ceiling—a free for all.
The strategic innovation we propose in outpatient health care cost is to move forward to a place that we have been before. The massive takeover of health care by the health care insurance field has hidden our past experience. Outpatient healthcare costs are relatively inexpensive. The very idea of paying cash, however, makes many people very nervous—even creates indigestion for fear of the unknown. Let us review what the real cost of outpatient health care is. We will base this on the records from Kaiser Permanente Medical Group, the Cleveland Clinic, the Mayo Clinic as well as web-based information in what is considered basic high-quality outpatient health care.
In addition to a physician visit for a basic physical exam every year or so in our 20s and 30s, you will need to run a few medical tests each year because many diseases like hypertension, diabetes, and hyperlipidemia do not show any signs and symptoms initially.
A list of tests may be run on your sample of blood or other body fluids either as a part of the screening or
as a way to confirm a diagnosis and to assess health status by serial medical tests.
Another reason for doing medical tests or screening tests is because some diseases show subtle signs and symptoms. The gravity of their effect on our body can be assessed by medical tests. Some insurance companies are now offering coverage without copayment. This will again be “open sesame” which will cause over utilization without regulatory powers by the insurance companies. A copay for every test is its own internal regulatory control. There are now laboratories that allow you to order your own test which will automatically be authorized by their own medical director.
The lists in the next section will help you understand some basic medical tests that are generally recommended during annual exams for both males and females. Since you will prepay for these tests, this is its own internal utilization control.
Read more in Section 8 . . .
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The majority of alleged innovations do NOT improve healthcare.
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