Post #127,668
11/26/03 8:56:49 AM
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Straight poop.
The average "administration costs" were 16% nationwide in 2000. That's the line item you want to look for, "administration costs/fees", in any reports here. Medicare back then ran around 9-10% iirc, but I distinctly remember what the "private" number was because back then I worked at an HMO and it was one of the things we measured ourselves against (we ran 13%).
Aside: Private insurers also commonly compare their "fee schedules" (money paid to medical providers) as a percentage of what medicare pays for the same procedure. The most successful ran around 115% of Medicare (we ran around 140% of Medicare). It is interesting that absolutely NO PRIVATE INSURER can ever come close to reducing the fees paid to hospitals and physicians as much as the Federal Government can.
"Administration costs" is the money that goes directly to the insurer.
BTW: NEVER, NEVER, NEVER listen to a physician talk about anything other than medical practice. Those guys/gals on any other subject are completely out of their element. (okay, not all. But 99% of physicians make all the rest look bad).
bcnu,
Mikem
Java, Junk. Both start with a "J", both have four letters. Coincidence? I think not.
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Post #127,686
11/26/03 10:49:50 AM
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Remembered where I got the 40%...
...it was from a bit on how much profit pharmaceutical companies would make on the proposed (and just passed) medicare bill.
Mike, do you have an online source for that number? I'd be much appreciative. I'm sending off a nice little letter to my rep, and would like to have some hard facts to back up my bile.
I have a red sign on my door. It says "If this sign is blue, you're going too fast."
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Post #127,844
11/27/03 11:40:32 AM
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I've been OOTL since 2k, but I'll get some for you.
bcnu,
Mikem
Java, Junk. Both start with a "J", both have four letters. Coincidence? I think not.
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Post #127,693
11/26/03 11:48:25 AM
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Question
I note that the administration costs that you are talking about are just your administration costs. You are nt counting the time and energy spent by the hospitals and doctors that you are dealing with on their administration costs as well.
The overall administration overhead in the system is going to be much higher than the figures that you cite. (No, I don't have any figures at hand for it. I do have a book somewhere from the early 90's pointing out that the difference in the cost of delivering medical care between the USA and Canada was about the difference in administrative overhead. But any figure that it quotes is going to be sadly out of date now.)
Cheers,
Ben
"good ideas and bad code build communities, the other three combinations do not"
- [link|http://archives.real-time.com/pipermail/cocoon-devel/2000-October/003023.html|Stefano Mazzocchi]
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Post #127,845
11/27/03 11:45:22 AM
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My figures were dated too.
Perhaps I misread, but I thought thane was talking about "how much HMO's" profit (i.e. what their take was). That was the basis of my response.
To be sure, Medical Secretary costs are not insignificant. But 3-4 years ago the amount of time spent by the practitioner's office processing Medicare/Medicaid/private insurance claims was roughly the same (a point the practitioner's used to beat us over the head with: we were supposed to streamline things for them, but - at least according to them - in this regard we failed). Of course, we were paying them significantly more than Medicare/Medicaid was, but that point from the perspective of the physician was immaterial. For most of them, in their minds they could never receive adequate compensation.
bcnu,
Mikem
Java, Junk. Both start with a "J", both have four letters. Coincidence? I think not.
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Post #127,846
11/27/03 12:40:55 PM
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It is unclear to me what was being talked about
Your reading is very reasonable.
My reading for a higher figure is that it is the amount of money added to the system by having to deal with all of the various kinds of insurers as opposed to something like a single payer system. In which case you need to add in not only the amount of administration on the insurer's end, but also the extra administration that everyone else has to have to be able to handle all of the variations of forms, and plough through all of the "passing the buck" that different possible insurers do.
I could easily see someone reporting the higher figure and not making it clear exactly what they meant.
Cheers,
Ben
"good ideas and bad code build communities, the other three combinations do not"
- [link|http://archives.real-time.com/pipermail/cocoon-devel/2000-October/003023.html|Stefano Mazzocchi]
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Post #127,851
11/27/03 1:07:10 PM
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there is clearing houses for insurers
Used to support a medical package that downloaded all claims to a single point of contact daily via modem. 85% of the insurers would pool to the clearing house. The other 15% had to be done manually.
thanx,
bill
"You're just like me streak. You never left the free-fire zone.You think aspirins and meetings and cold showers are going to clean out your head. What you want is God's permission to paint the trees with the bad guys. That wont happen big mon." Clete
questions, help? [link|mailto:pappas@catholic.org|email pappas at catholic.org]
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Post #128,062
11/29/03 11:26:03 AM
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Agree. (And message for Thane)
Having to be familiar with a variety of forms is an additional cost. But the forms, at least for claim submittal, were/are largely the same. And there has been ever increasing work done to standardize XML forms across the industry. One company I am familiar with ([link|http://www.realmed.com|Real Med, Inc.]) built its company on the disparity among forms and the delays in receiving payments for services provided.
I'm not taking issue at all with the superiority of "single payer" systems. In my experience there is not a single aspect of the delivery of healthcare which is not better performed by single payer systems than by private insurers.
While I'd agree with your position that once all administration fees are counted, the total is higher than 16%, I cannot believe that any healthcare practitioner spends as much as 9% of his "take" on dealing with forms.
And Thane, getting Fee Schedules is very difficult business (those are considered trade secrets and are highly protected). The NCQA sells a report (the old ones used to be free, but apparently are no longer free) called HEDIS. Check out [link|http://www.ncqa.org|http://www.ncqa.org] for more info. I guess I didn't fully appreciate how much "inside info" I was getting during my years with HMO's. Another source of information would be Insurance Brokers. They usually know more about the insurers in your area than just their fee schedules. I'm not sure which state you are in, and state laws vary considerably. But check your state's Department of Insurance for information concerning Plan performance versus Medicare. Some states require a bunch of info (like % of Medicare Fee Schedule, C-sections/1,000, Beta Blocker treatment for MI patients, etc.) and some states require almost nothing. Almost all states require all healthcare insurers to report their profit or loss yearly.
HTH.
bcnu,
Mikem
Java, Junk. Both start with a "J", both have four letters. Coincidence? I think not.
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Post #128,283
12/1/03 12:33:29 PM
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Thanks, Mike.
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