By NextBestFitHold the single payer to service standards
Publish service metrics (call wait, claim time, appeal outcomes), give an ombudsman power to order fixes, and let patients choose any provider.
Service standards and an ombudsman.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Publish service metrics
- Create an ombudsman with enforcement power
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Losing the choice of health plan and insurer competition
Publishing service measures and empowering an ombudsman to order fixes provides accountability without competing insurers, while patients retain provider choice.
- Narrow networks and out-of-network surprises
Allowing patients to choose any provider preserves provider choice within the public payer.
- Depends on other changes to work
Service measures and an ombudsman’s power to order fixes depend on political will to enforce them.
- Targets and quality metrics invite gaming
Published call-wait, claim-time, and appeal measures can be gamed rather than reflect service accurately.
Who's affected
- People with employer coverage
- Losing the choice of health plan and insurer competition: They can't keep or pick a plan they like, or switch if service is poor.
- People with ongoing or specialist care needs
- Narrow networks and out-of-network surprises: Needed specialists and therapists are often out of network.
- Hospitals, clinics, and care organizations
- Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.
- Health insurers, brokers, and their shareholders
- Narrow networks and out-of-network surprises: Narrow networks let insurers offer lower premiums.
- Hospitals and specialist groups with high private prices
- Narrow networks and out-of-network surprises: Out-of-network providers can bill high charges.
- People with ongoing or specialist care needs
- Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.
Where it has been tried
- Taiwan: High public satisfaction with NHI despite no plan choice.