To date, healthcare funding models have been limited to insurance, savings programs, and unreimbursed care, with insurance being the dominant model. However, many modern insurance panels include deductibles which are fundamentally incompatible with the reality that many Americans live paycheck-to-paycheck. By reexamining old assumptions of how healthcare should be funded, in the context of a modern society with ubiquitous information technology, a new model could alleviate a common source of frustration for voters while preserving recent policy advancements. This paper outlines a proposal which could bridge the coverage gap created by high deductible levels, which are common in both ACA exchange plans and many employer provided plans today, using a loan-based approach. Such an approach would seem to greatly reduce the rather substantial transaction costs in healthcare by simplifying most transactions and provide a more patient-centered approach for common transactions up to a deductible limit. A specific proposal of how to implement such a proposal, using existing systems, is presented and payment scenarios are also presented. On the provider-side, debit card processing systems, which are widely used to process health savings account (HSA) payments, could be combined with something like the federal student loan program for loan repayment. The federal student loan program provides substantial funding with highly flexible repayment terms in a manner which is currently slightly profitable to taxpayers. Combining these two existing systems could provide much needed relief to patients in a way which is more patient-centered, reduces cost, expands coverage, and at minimal cost to taxpayers. Additionally, we show how the current health savings account framework could facilitate this if IRS regulations we modified to: 1) allow accounts to carry negative balances and 2) make interest expense related to medical care an allowable expense.
{"title":"High Deductibles and Living Paycheck-to-Paycheck: A Loan-Based Model for Primary Care Coverage","authors":"Matt Wimble","doi":"10.2139/ssrn.3166860","DOIUrl":"https://doi.org/10.2139/ssrn.3166860","url":null,"abstract":"To date, healthcare funding models have been limited to insurance, savings programs,<br>and unreimbursed care, with insurance being the dominant model. However, many modern<br>insurance panels include deductibles which are fundamentally incompatible with the reality that<br>many Americans live paycheck-to-paycheck. By reexamining old assumptions of how healthcare<br>should be funded, in the context of a modern society with ubiquitous information technology, a<br>new model could alleviate a common source of frustration for voters while preserving recent policy<br>advancements. This paper outlines a proposal which could bridge the coverage gap created by<br>high deductible levels, which are common in both ACA exchange plans and many employer<br>provided plans today, using a loan-based approach. Such an approach would seem to greatly<br>reduce the rather substantial transaction costs in healthcare by simplifying most transactions<br>and provide a more patient-centered approach for common transactions up to a deductible<br>limit. A specific proposal of how to implement such a proposal, using existing systems,<br>is presented and payment scenarios are also presented. On the provider-side, debit card<br>processing systems, which are widely used to process health savings account (HSA)<br>payments, could be combined with something like the federal student loan program for loan<br>repayment. The federal student loan program provides substantial funding with highly<br>flexible repayment terms in a manner which is currently slightly profitable to taxpayers.<br>Combining these two existing systems could provide much needed relief to patients in a way<br>which is more patient-centered, reduces cost, expands coverage, and at minimal cost to taxpayers.<br>Additionally, we show how the current health savings account framework could facilitate this if<br>IRS regulations we modified to: 1) allow accounts to carry negative balances and 2) make interest<br>expense related to medical care an allowable expense.","PeriodicalId":313883,"journal":{"name":"HEN: Information (Topic)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128347787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After identifying the economic benefits that increased medical tourism from Canada to the United States may confer on the U.S. healthcare market and local economies, this essay analyzes applicable U.S. legal impediments that certain medical tourism arrangements — to wit, those involving a third-party medical tourist "broker" — may implicate. While the authors demonstrate that such arrangements will not run afoul of the U.S. federal Stark Law and federal Anti-kickback Statute, certain state-level anti-kickback and fee-splitting prohibitions impose the most substantial of the potential legal impediments on such arrangements. Given these state restrictions, the article suggests ways to structure these transactions in a manner designed to minimize this risk, and ultimately show that making a Canadian medical practice the medical tourism broker — serving as both the clearinghouse for identifying patients and as the broker for negotiating the arrangements — is critical for legal compliance purposes. Replacing the for-profit lay-owned entity with a medical practice that does not seek to profit from the arrangement serves critically to minimize inappropriate referrals and lowers the risk to the American providers under applicable legal barriers. Finally, the authors propose changes to the applicable laws to further eliminate risk from Inbound Medical Tourism ventures, without compromising the patient protection goals of existing laws.
{"title":"Canadian Medical Tourism: Expanding Opportunities and Reducing Legal Risks for American Healthcare Providers","authors":"R. Gregory Cochran, Alicia Corbett","doi":"10.2139/ssrn.2888680","DOIUrl":"https://doi.org/10.2139/ssrn.2888680","url":null,"abstract":"After identifying the economic benefits that increased medical tourism from Canada to the United States may confer on the U.S. healthcare market and local economies, this essay analyzes applicable U.S. legal impediments that certain medical tourism arrangements — to wit, those involving a third-party medical tourist \"broker\" — may implicate. While the authors demonstrate that such arrangements will not run afoul of the U.S. federal Stark Law and federal Anti-kickback Statute, certain state-level anti-kickback and fee-splitting prohibitions impose the most substantial of the potential legal impediments on such arrangements. Given these state restrictions, the article suggests ways to structure these transactions in a manner designed to minimize this risk, and ultimately show that making a Canadian medical practice the medical tourism broker — serving as both the clearinghouse for identifying patients and as the broker for negotiating the arrangements — is critical for legal compliance purposes. Replacing the for-profit lay-owned entity with a medical practice that does not seek to profit from the arrangement serves critically to minimize inappropriate referrals and lowers the risk to the American providers under applicable legal barriers. Finally, the authors propose changes to the applicable laws to further eliminate risk from Inbound Medical Tourism ventures, without compromising the patient protection goals of existing laws.","PeriodicalId":313883,"journal":{"name":"HEN: Information (Topic)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122537502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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