潇湘渌水 @ 2010-08-16 23:13
逐利的美国health insurance industry看来无路可逃，他们居然支持Obama，这看起来很不可思议，但却是他们的exit strategy，因为90年代至今的HMO策略已经无利可图，而对cost的控制也是无能为力。Health Insurance Industry必须面对这些。下面就是他们的一段brief history： from rise to fall --
1990s HMO executives set out to control the cost of American healthcare, and to make a spectacular profit doing it. And for a few years, they seemed successful. Healthcare inflation slowed dramatically in the late 1990s, and HMO profits soared.
But it was all an illusion.
The initial impressive profitability of New Model HMOs was due to the one-time reduction in cost you always get when you implement efficiencies of scale (made possible by merging enterprises), and by instituting the new standardization techniques favored by managed care theory. These steps reduced the cost of healthcare for a while, but the underlying rate of healthcare inflation (which is mostly caused by new medical technologies and an aging population（Pro Skinner 和 Chandra在09年两篇文章中有不同看法，当然技术仍然是个难题）, neither of which are cured by managed care) was pretty much unchanged. So by the early 2000s, when these one-time cost reductions had been fully realized, healthcare inflation was right back on the same unsustainable trajectory it had been on before.
By that time they had tried everything. Beginning in 1994, filled with confidence and enthusiasm and cheered on (initially, at least) by the public and by public officials alike, the health insurance companies had more than 15 years of more-or-less unfettered freedom to institute any efficiencies they wanted to. In the ensuing years insurance companies tried all kinds of legitimate ideas for reducing healthcare costs, such as managed care, gatekeepers, clinical pathways, disease management programs, pay for performance, wellness programs, medical homes, and even a ruthless consolidation of the industry to achieve “efficiencies of scale.”
They also tried every sneaky and underhanded idea they could think of for reducing costs, like cherry-picking the healthy patients, treating chronically ill patients like pariahs so they would go away, making access to specialty care as inconvenient as possible, forcing doctors to sign “gag clauses” to prevent them from telling their patients about certain treatment options, browbeating primary care physicians into zombie-like compliance with handed-down care directives, refusing to cover expensive-but-effective medical services, and canceling the policies of tens of thousands of patients after they get sick, based on trumped-up technicalities.
内容来自Dr Rich的blog，他的创见真恐怖，居然叫做“The Grand Unification Theory of Healthcare", 难道他真的认为物理学里的大统一理论能用到经济社会里来。仅作参考，左左们的意见在历史上一直都是受欢迎的，但一直都是在不断害人的。
source：http://covertrationingblog.com/weird-fact-about-insurance-companies/why-the-health-insurance-industry-supported-obamacare
1990s HMO executives set out to control the cost of American healthcare, and to make a spectacular profit doing it. And for a few years, they seemed successful. Healthcare inflation slowed dramatically in the late 1990s, and HMO profits soared.
But it was all an illusion.
The initial impressive profitability of New Model HMOs was due to the one-time reduction in cost you always get when you implement efficiencies of scale (made possible by merging enterprises), and by instituting the new standardization techniques favored by managed care theory. These steps reduced the cost of healthcare for a while, but the underlying rate of healthcare inflation (which is mostly caused by new medical technologies and an aging population（Pro Skinner 和 Chandra在09年两篇文章中有不同看法，当然技术仍然是个难题）, neither of which are cured by managed care) was pretty much unchanged. So by the early 2000s, when these one-time cost reductions had been fully realized, healthcare inflation was right back on the same unsustainable trajectory it had been on before.
By that time they had tried everything. Beginning in 1994, filled with confidence and enthusiasm and cheered on (initially, at least) by the public and by public officials alike, the health insurance companies had more than 15 years of more-or-less unfettered freedom to institute any efficiencies they wanted to. In the ensuing years insurance companies tried all kinds of legitimate ideas for reducing healthcare costs, such as managed care, gatekeepers, clinical pathways, disease management programs, pay for performance, wellness programs, medical homes, and even a ruthless consolidation of the industry to achieve “efficiencies of scale.”
They also tried every sneaky and underhanded idea they could think of for reducing costs, like cherry-picking the healthy patients, treating chronically ill patients like pariahs so they would go away, making access to specialty care as inconvenient as possible, forcing doctors to sign “gag clauses” to prevent them from telling their patients about certain treatment options, browbeating primary care physicians into zombie-like compliance with handed-down care directives, refusing to cover expensive-but-effective medical services, and canceling the policies of tens of thousands of patients after they get sick, based on trumped-up technicalities.
内容来自Dr Rich的blog，他的创见真恐怖，居然叫做“The Grand Unification Theory of Healthcare", 难道他真的认为物理学里的大统一理论能用到经济社会里来。仅作参考，左左们的意见在历史上一直都是受欢迎的，但一直都是在不断害人的。
source：http://covertrationingblog.com/weird-fact-about-insurance-companies/why-the-health-insurance-industry-supported-obamacare
