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How medical insurance works
(lemmy.world)
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this post was submitted on 07 Oct 2024
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You do need some checks and balances because what's to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can.
I suppose we could have the government run the hospitals too. But noooooo, that's never going to work out because communism or something.
Maybe we should try effective altruism and accelerationism instead? Let's just hand over all our money to a few tech bros and then we can go beg them to pay for the scans. And if they don't pay for it, surely someone will come up with a cheaper technology to do the same. Yes, that'll definitely work.
You could just get rid of the for-profit medical industry entirely and then there would be no incentive to over treat patients.
Yes. Hence the rest of my comment. I should've probably put a "/s" at the end. :)
Yes, it's clear why it's legal and necessary to some extent. In a for-profit system, a doctor's office or hospital, every procedure or test the doctor can order (and have the patient pay for) will generate profit. Doctors have an incentive to order as many tests as possible. I assume that most doctors are somewhat honorable and won't abuse this too much, but they'll probably still err on the side of ordering as many tests as possible not necessarily because of profits, but because more tests gives them more information.
Meanwhile, in a for-profit system, an insurance company will generate the most profit by agreeing to as few tests and procedures as possible. So, they will have an adversarial relationship with doctors and will try to arrange as few tests and procedures as possible. My guess is that the average insurance company is less ethical than the average doctor, so they're probably more likely to refuse to allow tests that are actually medically necessary.
In a sane system, there would be a neutral referee, the government, who would resolve disputes and severely punish any actor in the system that was behaving badly. But, AFAIK that only rarely happens in the US, where the idea is that the "invisible hand of the free market" will magically make it all work.
Doctors do not directly profit from ordering tests. They get paid whether they order a test or not.
You want to know who profits from over testing? Quest Diagnostics.
https://bergermontague.com/quest-diagnostics-pay-1-79-million-settle-false-claims
These guys literally defrauded the government, but everyone points their fingers at poor people, doctors, liberals, ethnic minorities, lgtbq people, ect. The problem is corrupt businesses and their CEO's hoovering up as much money as they can so they can shove it up their ass.
This would conceivably be true for car repair as well. A mechanic is incentivized to order as many repairs as possible for a car.
So why don’t they?
The answer is many-faceted, but the main ones are (a) professional ethics, (b) reputation, and (c) second opinions which kinda feed into b.
Any provider whether doctor/mechanic/wedding photographer/whatever is also incentivized to serve their customers well by selling them only things that truly benefit them.
We don’t need insurance companies in all those other industries to prevent providers from using an infinite-billing hack to generate infinite money.
They do. Car mechanics have a notorious reputation for doing repairs that aren't necessary, or for breaking something so that the owner has to come in again soon.
Yeah, there's a natural counterbalance that means they don't want to be seen as dishonest. Similarly, an insurance company is counterbalanced against trying to prevent every test or procedure by also wanting to be seen as honest.
You're aware that car insurance is a thing right? Any industry where the charges are going to be extremely high is going to involve insurance. Cars are fairly expensive devices, and so there's car insurance, and if you're in a big accident your car insurance will pay for the repairs. But, the car insurance will keep an eye on you to make sure you're not committing insurance fraud, and also limit how much the car repair shops are allowed to spend to repair your car.
Great example, mechanics are notorious for ripping people off.
If a hospital is found to push doctors to prescribe unneeded medicine or tests, the entire top staff should be questioned and jailed for fraud where applicable.
If an individual doctor does this, same treatment
We're not just talking money here were talking human lives. If you risk health for money, off yo jail you go
The patient saying no. Also a system where the patient isn’t forced to use insurance.
We could have markets run the hospitals but heaven forbid people would consent to their economic interactions.
"Hello! My mother is clutching her chest. She may be having a heart attack. Could you please email me an estimate for the treatment? I'm talking to two other car dealers, and I've read all the posts about the 4 square method online, I'm on to your tricks."