Controlling healthcare costs


As I've blogged before, would-be reformers need to realize that we should not isolate people from the cost of healthcare, otherwise prices tend to spiral out of control. That is true whether you are relying on tax or insurance to fund your healthcare. Both systems rely on third-party payment, and both therefore cause the same problem.

Imagine a typical third-party payment scenario. You go to the doctors, feeling unwell. You've already paid your taxes or your insurance premium, so you'll want to feel like you're getting your money's worth. In other words, you'll want to maximise the amount of care you receive, regardless of the cost. Now look at it from the doctor's perspective: it is also in his interest to provide as many and as expensive services as possible. The more he does, the more money he earns from the insurance company or the government.

Put simply, in a third-party payment context, both parties to the healthcare transaction have an incentive to maximise costs, while neither has an incentive to contain them. And that feeds back into higher taxes, or higher insurance premiums – neither of which are remotely desirable.

Clearly, third-party payment is good for big-ticket health expenditure. Very few people could cover the cost of a serious illness out-of-pocket, so pooling risk and resources makes perfect sense. On the other hand, it's not sensible at all for dealing with lesser ailments, where its bureaucratic cost can often outweigh the cost of the services provided.

How do you translate this into policy? In the US, the best way would be to stop subsidizing employer-provided insurance, and encourage individual/family insurance instead (perhaps through a tax-credit). You would also want to encourage people to combine high-deductible insurance plans with health savings accounts, so that third-party payment is kept to a minimum. Studies have shown that health plans like this produce 3-year savings of $1m per 1000 participants.

In government-dominated systems like the UK's, it is a little more difficult. Assuming outright privatization is not on the cards (and it should be, at the very least in primary care) then the introduction of user charges and co-payments are the way to go. And really, that is not nearly such a radical suggestion as British politicians seem to think: pretty much every other European country has them.