eLetters

Health Affairs encourages readers to engage in debate via electronic letters to the editor.

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Electronic Letters to:

Troyen Brennan and Lonny Reisman Value-Based Insurance Design And The Next Generation Of Consumer-Driven Health Care Health Affairs, March/April 2007; 26(2): w204-w207. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Electronic letters published:

The Ultimate Value-Based Paradigm

Ralph Schmeltz, M.D.   ( 1 February 2007 )

Values in Health Care Utilization

Patrick Cimino   ( 1 February 2007 )

It's All About . . . Economics And Marketing

Raymond Bihis   ( 5 February 2007 )

The Ultimate Value-Based Paradigm 1 February 2007
Ralph Schmeltz, M.D., Med Director, Diabetes Managment and Education Washington Hospital Send letter to journal: Re: The Ultimate Value-Based Paradigm rschmelt{at}pitt.edu Ralph Schmeltz, M.D.	How about "contingency fee" as the ultimate value-based reimbursement? Perhaps keyed to salary...10% of your weekly salary to cure your cold, no fee if you expire with a heart attack, but 10% of your yearly salary if you survive. Now all I need to do is find the right three patients.
Values in Health Care Utilization 1 February 2007
Patrick Cimino, Medical Director HealthPoint Medical Group Send letter to journal: Re: Values in Health Care Utilization patrick.cimino{at}baycare.org Patrick Cimino	While I agree with the authors that there is a great need to infuse values into health care utilization, there are several insurmountable flaws in the logic that consumer-driven health care will resolve this. (1) With the current employer-based system there is too much transience for commitment to occur between the payers and insured. (2) Our society believes that even the slightest margin of benefit, regardless of cost, should be pursued. The last decade has shown that payers cannot control this effectively and maintain public image. Perhaps it should not be a role left up to the payers. If faced with not providing the newest cancer treatment, regardless of efficacy, versus cutting back on proven but high-utilization and costly prevention, prevention loses. And no one will appear to die because of it, unlike the cancer patient. (3) Perverse universal access -- the governments (state, federal, and local) pay for 40-plus percent of all health care. The ultimate universal access in our society is through hospitals. There is a convoluted system of shifting dollars to cover the "uninsured" and poorly reimbursing. The payers pay dearly for this. Consumer-driven health care does little to nothing to address this access. While we revile bureaucracy, our convoluted health care financing is just that. We need to make sense of our paradox, spending the most money per capita in the world with only marginal outcomes.
It's All About . . . Economics And Marketing 5 February 2007
Raymond Bihis, HCS Manager UHA Send letter to journal: Re: It's All About . . . Economics And Marketing rbihis{at}uhahealth.com Raymond Bihis	This evolution is on the right track as far as I am concerned as an industry revolutionary looking at innovative and effective ways of incentivizing. As Steven Leavitt explains in Freakonomics, incentives are the cornerstone of modern life. Understanding them -- or often, ferreting them out -- is the key to solving just about any riddle, including health benefits. Now I want to expand on it more by adding the marketing portion. There is a way of communicating the solution with such clarity that it moves the audience to act towards the desired direction. This sometimes is lacking that we in this industry of health care may not have the skills necessary to execute and propagandize the evolution into a rapid transormation for the greater good.