My grandfather's idea on health care

[xiphias]

Papa Tuny is a dentist -- has practiced and taught for decades. He mentioned today that, forty or fifty years ago, he suggested a way to handle dental insurance which he felt would make it cost-effective for insurance companies to provide. They didn't go for it, obviously, and now dental insurance is very expensive because it's not very cost-effective. But I thought his idea was interesting, and might work for other areas of medicince besides dentistry.

Papa Tuny's idea was that the first year you buy dental insurance, it pays 50% of needed work, while the other 50% is out of pocket. The next year, 60%, year after that, 70%, and so forth. It might top out at 80%, it might go up to 100%, depending how the numbers worked.

But if you skipped one checkup, you dropped down to the 50% level, and had to work back up.

Because dentistry is an area of medicine where preventative medicine is MUCH cheaper than restorative. So this would give a strong incentive to the insured to maintain all the preventative stuff.

Thoughts about this? Is my grandfather's idea a good one for dentistry? Are there other areas of medicine where prevention is so much cheaper than curing -- and where "prevention" is so easily defined and tracked -- that this could be useful?

Comments

[janetmiles.livejournal.com]

My first quibble would be the necessity for tightly defining (to the patient's benefit) what "skipped a checkup" meant -- if you had to cancel your appointment because you'd developed a nasty cold, but rescheduled for a week later, would you lose your seniority? What if it was two weeks later and that crossed the one-year line?

[rmjwell.livejournal.com]

I think that defining that should be fairly easy. Let's say you schedule your next appointment for September 23rd (six months from today). You have one month from the date of your original appointment to make the date (so, we are looking at October 23rd as the cutoff) or back you go to the end of the line. Or you can make it 5 months + 1 month if dental wisdom says 6 months is better than 7.

Certainly, if someone gets hit by a bus or has extraordinary circumstances, they can get a rider. The trick is making them "extraordinary."

My question is what about dental care for kids; if you incentivize that, you really keep costs contained.

[navrins]

Sounds sort of like how auto insurance is supposed to work. SDIP ratings; get a ticket and your premium skyrockets before ratcheting back down; promotes good driving. Except it doesn't. The system is utterly black-box. I got my insurance statement today that says my rating is 3 points worse than last year. No clue why. Nothing warned me. Oh, right, I got a ticket. For going 35 on a road EVERYBODY goes 35 on 365 days a year, but that day there happened to be a cop in a bad mood or with a quota to fill stopping everybody. The guy who normally takes it at 60 and drunk - he wasn't there that day, so he's fine, but I'm a "bad driver."

If you can find some way to make the system work so that it genuinely is fair, and also feels fair, then sure, it sounds great. But the one example I can think of where it was actually tried does not bode well.

Of course, the system sucks already, so changing to a lousy system could be an improvement. Shrug.

[bikergeek.livejournal.com]

the car insurance thing is a nasty screw because traffic enforcement is so often about revenue enhancement, not about safety. if the cop stopped giving out speeding tickets and started ticketing people who tailgate, roll through stop signs and red lights, etc., then maybe they'd convince me that traffic enforcement was about safety.

so "getting a ticket" does not map to "being an unsafe driver".

Oh yeah, and the insurance companies are in cahoots with the cops. One insurance company which shall remain nameless is known to have used premium dollars to buy LIDAR guns for police departments, so the cops can write more speeding tickets, so the insurance company can raise premiums.

[alaria-lyon.livejournal.com]

This sounds a little like Tufts Health Plan's new Liberty product. Or at least one portion. It offers "rewards for healthy living." I won't go into the whole thing, you can read it here , but basically, you built up points by doing things such as preventative treatment, marathons, being tobacco free, donating blood, etc., and with those points you gain rewards. At the end of the year you start over. So for your dental insurance, you can gain points for going to the dentist twice a year. The member would be responsible for informing the insurance company that they did it and they want credit for it. And then as you gain in points your out-of-pocket could go down as a reward.

Does this sounds like what you're talking about? If it is, it's beginning in health care. Maybe it will transfer over to dental care if it proves to work.

[janetmiles.livejournal.com]

Wow. I have, um, really mixed reactions to that (admitting that I've read only your summary and not the whole information), in that it penalizes people who can't as well as people who won't.

Insurance as I see it is supposed to be about spreading out risk so everyone pays less, not about cherry-picking who pays more because they're insufficiently virtuous (or have pre-existing conditions, or are disabled, etc. and so forth).

[alaria-lyon.livejournal.com]

Well, the point is to reward the people who do. It doesn't penalize people who won't, and I'm unsure why people couldn't do preventative dental care if it is covered in full. Yes, as far as Liberty goes, part of the reason I didn't opt in was because I couldn't do some of the things they rewarded, such as give blood.

There is much more to the plan that just the rewards. It was just that the rewards was the only part that was similar to what was being proposed for dental care.

[burgundy.livejournal.com]

My big quibble is that there are a lot of people who wouldn't be able to pay that 50% for the first year. Or the 40% for the second year. And so on. So even though they might want to be proactive about their teeth, they just can't afford the extra money.

Which is a big reason why people with incomplete or no health insurance don't get adequate preventive care. Not because they don't understand "you can pay a little now or a lot later" but because when you don't have even a little to pay right now there really isn't much of a choice.

[chenoameg.livejournal.com]

That's somewhat like how my current dental insurance works. If I've gotten a checkup every six months for two years or so fillings and the like are 100% covered. Otherwise there's a larger deductible.

[unquietsoul5.livejournal.com]

Unfortunately this is not how most dental plans work... some (like the one I have) penalize you for having more regular cleanings and checkups. I get my teeth cleaned 3-4 times a year, rather than the once a year that the insurance covers, and they pay zero on the other cleanings. Same with checkups, xrays and other preventative measures...

[micheinnz.livejournal.com]

I think it's a great idea.

Socialized medicine in NZ does not cover dentistry and only the most expensive insurance plans cover it. Fortunately for me I have a reasonably-priced dentist and enough money to cover my dental expenses. A lot of people don't. I think a scheme like Papa Tuny's could help a lot of people.