Nylander Healthcare Reform Planning

[Sal]

In the context of Nyland, what was the evolution of Nylandic healthcare? It is facing similar high-prices as in the US of A? Is the healthcare lobby as big? Whats the average cost of healthcare per capita? How could single-payer impact a regular doctor, as in visit times, patient overload? Why am I asking these questions? Will medical research be brought down due to single-payer, or could the Feds make up for the large of market level capitalism towards it?

A note on the bold part.

Regarding cost of healthcare per capita, it will most likely be driven down overall. I don't know what the starting point is, but if the government is the single payer, it has the right (like an insurance company does) to decide what procedures it will and won't pay for, which keeps costs down. That's basically its entire mechanism to keep things cheap. Like Flo mentioned, emergency services are generally going to remain easy to access and covered under the government, but "optional" procedures probably won't be (keep in mind that an "optional" procedure is not always aesthetic like a nose job; the quality of life can be greatly improved by a certain procedure and it still may not be covered - think knee replacements, excess skin reduction surgery after losing lots of weight, LASIK, fertility treatments... Also keep in mind that the longer you wait with certain things, the worse that non-life threatening condition may become, and the more expensive the treatment will be when a patient ultimately gets seen.) It's these sorts of optional procedures that you're going to see the longest wait times for (although excessive wait times are the result of many factors, including the poor coordination of various sectors of the healthcare industry - acute/emergent care vs. specialized practices vs. long term care and hospice, etc.)


I'm thinking one of the big issues you'll have with this system is the "free rider" conundrum. With the Bismarck model, what Nyland currently has, you get a voucher only if you've paid your taxes. That doesn't mean that you can't go to the doctor if you haven't paid your taxes, because hospitals and clinics are privately operated, but you'll be paying the total amount out of pocket. With the NHI model that's being proposed, doctors are paid out of a pool of tax money, meaning nothing's tied to the individual. Illegal immigrants, the destitute, medical tourists, etc. can tap from this pool for services (think Americans border-hopping to Canada for cheap organ replacements or something) which, philanthropically speaking, is great, but the more this occurs, the more often you have money coming out but not going back in, and the more covered services may/will eventually be limited (or tax hikes, whatever).


To put the change in the simplest terms, you need to keep in mind the three parties involved in the system Nyland is moving from and the one it's moving to: Patients, Doctors, and Government.

Currently: Patients pay their taxes; Government gives taxpaying Patients vouchers/set amount of money; Patients give vouchers to Doctors for whatever they want (or use it to buy supplemental insurance from private companies, or to put in a health savings account, etc.)

Proposed: Patients pay their taxes; Government uses tax money to pay Doctors directly whenever Patients visit, taxpayer or not.

We're not moving from America to UK with this proposal; we'd be moving from Japan to Canada.


Personally, I don't know that this proposed change is going to dramatically impact the cost of healthcare if that's your overall aim. In my opinion (take it with a grain of salt as healthcare economics wasn't my concentration with my MPH), price caps is the way you need to go if the main issue is doctors making their costs really steep/different from hospital to hospital. Through a combination of real-world codes that we have that can basically identify every single aspect of a patient, a hospital, a drug, a procedure, etc. - for reference, look up LOINC, SNOMED, and ICD-10 codes - you can put a price on literally anything done in any medical institution. Use these to create a menu of prices that remains constant throughout the country, possibly adjusting for cost of living by region or something, and set the prices, and I'd see more impacts happening to costs.


It's good to keep in mind that all systems have pros and cons, and it all probably balances out somewhere along the way (except whatever the US is doing, because we have the most exorbitant healthcare spending with worse outcomes than several other modernized nations).