High Voltage Shareware/high1.zip/high1/DIR23/HREPORT.ZIP/CHAPTER5.TXT

Text File | 1993-10-26 | 6KB | 131 lines

Chapter 5 -- SIMPLICITY



     "Each of our medical insurance policies requires separate
and different applications for reimbursement, each of which have
to be mailed to different addresses.  This mountain of paperwork
places an undue burden on older Americans . . ."

J.H.
Venice, Florida
________________________



     In order to simplify American health care, we must move
forward on two fronts.  First, we must reduce paperwork by
adopting standard insurance forms and clarifying administrative
rules.  Second, we must strip away the unnecessary layers of
regulation and oversight as we  hold health plans and providers
accountable for results.  Streamlining administrative burdens
will make our system less daunting and frustrating for consumers
and more supportive and flexible for the doctors, nurses, and
hospitals on the front lines.


REDUCING PAPERWORK

     Guaranteeing all Americans health coverage and establishing
a uniform, comprehensive set of benefits represent the first,
vital steps toward simplifying health care.  If all Americans
have guaranteed coverage for comprehensive health benefits, then
doctors, hospitals and clinics have less paperwork to do when a
patient walks in the door. Doctors, nurses and other health
professionals will no longer have to worry which patients are
covered for what services.  Patients no longer will have to deal
with confusing sets of insurance requirements, and will no longer
be stuck with huge medical bills because they didn't read the
fine print.

     The Health Security Card that every citizen and legal
resident receives will guarantee that health coverage travels
with you as circumstances change, whether you switch jobs or move
to another state. Like the cards that activate bank-teller
machines, a magnetic strip will provide basic registration
information, including identifying the health plan in which you
are enrolled.  A personal identification number will authorize
access to insurance information, reducing the process of
registering and billing, but maintaining your privacy.

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Sidebar - Pg 48


Protection of Privacy
_____________________________________________________

     The Health Security Act establishes the first national
privacy protection laws specifically aimed at protecting the
medical records of patients.

     Under reform, new security standards will protect computer
information, ensuring that medical records will be available only
to health professionals who have a legitimate need to see them.
For example, the bill clerk in the hospital's financial
department won't have access to medical information.  This is an
assurance that few insurers, or hospitals, can offer consumers
now.

_____________________________________________________

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     The Health Security Card will not be a "smart card" -- which
carries information in a computer chip -- a national
identification card, or a credit card.  It does not hold
sensitive information such as medical records. It's simply a way
to streamline the billing process, reduce paperwork for doctors
and patients, and assure people that they have a comprehensive
set of benefits that can never be taken away.

     All health plans will adopt a standard form that providers
file for services.  Replacing the hundreds of different claim and
billing forms and codes insurance companies use today will allow
health professionals to collect and send the same information to
all health plans and alliances. Uniform claim forms will reduce
the work that doctors, nurses, and hospitals must do and save an
estimated 75 cents for each claim.  In the long run we will save
billions of dollars and free health professionals to spend more
time caring for patients.

     Today, different types of insurance often overlap, causing
confusion, duplication, and waste. Under the Health Security Act,
the health care portion of both workers compensation and auto
insurance will be covered through regular health insurance.  The
need to coordinate benefits will decline and small businesses
will be rewarded with less confusion and lower administrative
costs.

CUTTING RED TAPE

     Simplifying health care also requires aggressive steps to
reduce unnecessary regulation.  The Health Security Act frees
hospitals and other health care institutions from excessive
regulations.  The federal government will develop national
standards for quality which will use them as the basis for
licensing hospitals and other health care institutions.

     Today, dozens of public and private agencies, inspectors and
outside groups inspect hospitals every year to make sure they
meet quality standards. Although they all check the same things,
they make their visits separately, and hospitals must spend time
and money preparing for each visit. Under the Health Security
Act, these groups will coordinate their visits, reducing
preparation and follow-up time.  Rather than routinely examining
every hospital each year, inspections will concentrate on
institutions with poor histories, following up on complaints and
responding to problems.

     To reduce frustration and delay, all health plans will have
to make clear to participating consumers and doctors precisely
how they perform "utilization review" -- how the plan determines
whether appropriate and effective care was given.   Health
professionals and industry groups will establish new performance
standards, eventually reducing reliance on obtrusive methods of
control.