Insurance Shopping: Did you ask about your insurer's UTILIZATION rate?

Savvy consumers check out charities before they give money...including numbers of how much of donated dollars actually go to the client charity. Yet with health insurance, we hear surprisingly little about consumers checking out the utilization rate for our insurance premium dollars...how much is actually used to pay for medical services. Consumers need to start asking this question: How much of each premium dollar is used for utilization over the past year or two years?

The information is currently difficult to locate which is really strange. The health industry's own group AHIP has conducted such studies, mostly out of a self-righteous attempt to justify health insurance premium increase. Below is such a report cite:

http://www.ahipbelieves.com/press-releases/health-insurance-premium-growth-slows.html

While the insurance company report boasts that up to $.86 of every dollar goes to paying for medical services, the report discloses that the vaguely described "costs of medical liability and defensive medicine" are "EMBEDDED" in that $.86. So the amount of OUR premium dollars actually spent on what we think we're buying which is puffed up to $.86 cents on the dollar, is actually LESS. It's like giving a dollar to a charity and finding out that less than $.86 cents of your dollar actually goes to the charity.

As consumers explore their own options, the utilization rate should be a point of inquiry and such a rate should NOT be puffed up by including vaguely defined amounts for medical liability and defensive medicine that protect doctors not consumers.

This information should be public information for consumers, much like the secretary of state is responsible for keeping track of how much of charity dollars actually go to "charities."

Politicians, Health Services Providers, Insurers, don't forget the consumer

http://www.pnhp.org/ is the website for Physicians for a National Health Plan. While the website promotes a single-payer form of medical insurance coverage, the site shows the similarities that this organization has with the AMA: Their concern is physician payment. As stakeholders in our health services industry, consumers (want needed medical care in a timely fashion at an affordable price), politicians (look at gross numbers of who is insured without addressing quality), health services providers (want to get paid at the highest amount they can) and insurance companies (want to maximize profit by covering less for more money in premiums, deductions or copays), consumers are the only ones whose number one priority is health. Therefore, for the other stakeholders whose PRIMARY concern is profit, consumers must figure out a way to speak to the other stakeholders' bottom line while purusing our goal of health services.

For the physicians promoting a single payer (government) national health plan, the obvious failing is the same as the other promotions by health care services: They do not address controlling costs of health services. No solution to our current health care crisis will succeed until clear boundaries are assigned for profit meaning that health services costs must be promoted by informing providers that their volume of business depends on such a compromise. Similarly, politicians must stop ignoring the QUALITY of the health insurance they are trying to have everyone covered under by understanding that people need insurance to pay for needed medical services and therefore, the solution must include legislative mandates of what insurance companies must cover. Such mandates already exist on the state level and of course, insurance companies don't want them..too bad. Insurers must be insurers and cover risk. By trying to weed out those likeliest to use their health insurance, insurers have replaced their role of insuring with a strong-arm way of promoting policy (quit smoking, quit being overweight, quit aging) so as to reduce their risk to near zero. If insurers are unwilling to modify this new-style insurance then new financial vehicles for paying for medical services should be sought such as the medical discount card.

The health services crisis is multi faceted, but all the profit-motivated segments are dependent on the consumer, meaning that our goals for affordable accessible health care are paramount. While the other stakeholders try to protect themselves and their concern for profit by finger-pointing at the other stakeholders, the consumer is the one that must clarify that however they want to work out those goals is less our concern than the fact that our goals be met.

So what of the physicians arguing for national health plans? They've got some good ideas but controlling the cost of the services consumers need must be part of the program. Stakeholder Adam Smithisms (free market economy) when it comes to their own profit is absurd. Governmental financing, support, legislation and enabling of the profit motive for stakeholders other than the consumer means that consumers also must have governmental support in achieving their goals.