Medicare fraud and over-utilization

The Register recently criticized our fee-for-service health care payment system for causing over-utilization and for driving up health care costs.  (2/12/2015 – “Florida, home of medical scans — and scams” – see link below)  They gave examples of doctors ordering unnecessary test because they get paid more for every additional service that they provide.  They advocated paying physicians a salary like Mayo Clinic does, so that doctors, “…have no personal, financial incentive to provide unneeded care.”  They urged the Obama administration to, “…continue to work toward reimbursing providers based on quality instead of quantity while fairly reimbursing them.”  I agree with the Register that, “Ultimately, reducing the overuse and misuse of health care falls to patients.”  They urge patients to not rush to the doctor for every ache, ask questions when doctors order tests, resist clinic staff who want to schedule tests and procedures.

One thing the Register failed to mention is the importance of patients being required to pay out-of-pocket for some portion of their health care costs.   To the extent that patients are not required to pay for some portion of their costs, they will not question the recommendations of doctors and other providers and they will tend to over-utilize health care.  Requiring patients to make some out-of-pocket payment will also help reduce fraud, since patients won’t want to pay part of any fraudulent charges that billed to their insurance.  Many insurance policies under Obamacare do seem to have significant deductibles and co-payments.  That will go a long way to help keep down health care costs.

Link to Register article: http://www.desmoinesregister.com/story/opinion/2015/02/12/florida-home-medical-scans-scams/23278965/

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