The National Health Insurance (NHI) is not a radical shift to dismantle a functioning system, but an opportunity to review two poorly functioning ones.
The public sector sees very high volumes of patients but gives them bad service and produces very poor outcomes. The private sector is modelled on low volume, high cost care – it uses its huge quantities of resources badly, to service very few people.
As the Health Market Inquiry (HMI) report makes clear, the large commercial medical schemes are resisting needed reforms that with better productivity would lead to the convergence of the two systems. In particular, they persist with an outdated tariff system that pays for services not outcomes and doesn’t support team-based delivery models. This is probably because it threatens their claim payment and ‘managed care’ role that justifies a very high income. This strategy is counterproductive for their members.
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