高免赔额和从薪水到薪水的生活:一种基于贷款的初级保健覆盖模式
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摘要
迄今为止，医疗保健资助模式仅限于保险、储蓄计划和未报销的护理，其中保险是主要模式。然而，许多现代保险包括免赔额，这与许多美国人靠薪水过日子的现实根本不相容。在信息技术无处不在的现代社会背景下，通过重新审视如何为医疗保健提供资金的旧假设，新模式可以在保留最近政策进展的同时，减轻选民的一个共同沮丧来源。本文概述了一项建议，该建议可以使用基于贷款的方法，弥合高免赔额造成的覆盖差距，这在ACA交换计划和许多雇主提供的计划中都很常见。通过简化大多数交易，这种方法似乎大大降低了医疗保健中相当可观的交易成本，并为普通交易提供了一种更以患者为中心的方法，达到免赔额限制。提出了如何使用现有系统实现这样一个建议的具体建议，并提出了支付方案。在提供方，广泛用于处理健康储蓄账户(HSA)付款的借记卡处理系统可以与类似联邦学生贷款计划的东西相结合，用于偿还贷款。联邦学生贷款计划提供大量资金，还款条件高度灵活，目前对纳税人来说略有盈利。将这两个现有系统结合起来，可以以一种更加以患者为中心、降低成本、扩大覆盖范围并以纳税人最低成本的方式为患者提供急需的救济。此外，我们还展示了当前的健康储蓄账户框架如何促进我们修改后的ifrs规定:1)允许账户持有负余额，2)将与医疗保健相关的利息费用作为可允许的费用。本文章由计算机程序翻译，如有差异，请以英文原文为准。
High Deductibles and Living Paycheck-to-Paycheck: A Loan-Based Model for Primary Care Coverage
To date, healthcare funding models have been limited to insurance, savings programs,
and unreimbursed care, with insurance being the dominant model. However, many modern
insurance panels include deductibles which are fundamentally incompatible with the reality that
many Americans live paycheck-to-paycheck. By reexamining old assumptions of how healthcare
should be funded, in the context of a modern society with ubiquitous information technology, a
new model could alleviate a common source of frustration for voters while preserving recent policy
advancements. This paper outlines a proposal which could bridge the coverage gap created by
high deductible levels, which are common in both ACA exchange plans and many employer
provided plans today, using a loan-based approach. Such an approach would seem to greatly
reduce the rather substantial transaction costs in healthcare by simplifying most transactions
and provide a more patient-centered approach for common transactions up to a deductible
limit. A specific proposal of how to implement such a proposal, using existing systems,
is presented and payment scenarios are also presented. On the provider-side, debit card
processing systems, which are widely used to process health savings account (HSA)
payments, could be combined with something like the federal student loan program for loan
repayment. The federal student loan program provides substantial funding with highly
flexible repayment terms in a manner which is currently slightly profitable to taxpayers.
Combining these two existing systems could provide much needed relief to patients in a way
which is more patient-centered, reduces cost, expands coverage, and at minimal cost to taxpayers.
Additionally, we show how the current health savings account framework could facilitate this if
IRS regulations we modified to: 1) allow accounts to carry negative balances and 2) make interest
expense related to medical care an allowable expense.
and unreimbursed care, with insurance being the dominant model. However, many modern
insurance panels include deductibles which are fundamentally incompatible with the reality that
many Americans live paycheck-to-paycheck. By reexamining old assumptions of how healthcare
should be funded, in the context of a modern society with ubiquitous information technology, a
new model could alleviate a common source of frustration for voters while preserving recent policy
advancements. This paper outlines a proposal which could bridge the coverage gap created by
high deductible levels, which are common in both ACA exchange plans and many employer
provided plans today, using a loan-based approach. Such an approach would seem to greatly
reduce the rather substantial transaction costs in healthcare by simplifying most transactions
and provide a more patient-centered approach for common transactions up to a deductible
limit. A specific proposal of how to implement such a proposal, using existing systems,
is presented and payment scenarios are also presented. On the provider-side, debit card
processing systems, which are widely used to process health savings account (HSA)
payments, could be combined with something like the federal student loan program for loan
repayment. The federal student loan program provides substantial funding with highly
flexible repayment terms in a manner which is currently slightly profitable to taxpayers.
Combining these two existing systems could provide much needed relief to patients in a way
which is more patient-centered, reduces cost, expands coverage, and at minimal cost to taxpayers.
Additionally, we show how the current health savings account framework could facilitate this if
IRS regulations we modified to: 1) allow accounts to carry negative balances and 2) make interest
expense related to medical care an allowable expense.
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