Posted in Access to healthcare, Deductibles, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relations, Doctor-Patient Relationship, Economic Issues, Health Insurance, Health Savings Accounts (HSA's), Medical Costs, Medical Practice Models, Patient Choice, Patient-centered Care, Policy Issues, Price Tansparency, Third-Party Free Practices, Uninsured

Components of Optimal Health Insurance: #1 – Insure the right things | Robert Nelson, MD | LinkedIn

A typical PPO Health insurance plan (more accurately a health maintenance plan) is economically dysfunctional when you think about how it really works. 

On one hand, the inexpensive office co-pay does not allow for any value determination or cost differentiation between a necessary trip to the doctor for hernia check and a visit to for a work excuse for forgetting an entire Monday due to a weekend hangover!  You pay the same, doctor gets reimbursed about the same. 

On the other hand, that emergency appendectomy seems to always happen when the surgeon on-call is not in your network and right at beginning of the new deductible year.  And you don’t get a rebate on your premium for the bad timing or lack of in-network surgeon. 

So why the low pain point for the small stuff and the “I didn’t see that coming” financial kick in the teeth when we really need insurance?  Short answer: We have replaced the menu with an “all-you-can-eat” pass to the buffet line if you come in through the front door at specified times.  If you’re late to dinner or don’t have a reservation, then you pay different & higher prices… you get what they serve you… AND you don’t know what the prices are until after you eat!

via Components of Optimal Health Insurance: #1 – Insure the right things | Robert Nelson, MD | LinkedIn.


A primary care physician by training, my passion is researching and writing about the importance restoring patient centered care, supporting independent private physicians, promoting free-market solutions and seeking sustainable fiscal policy in healthcare.

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